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Old 28th August 2003, 10:43 PM
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Anna Bryant
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In response to Chris' post on the Characteristic Symptoms topic, I put together some ideas.
The main question appears to be:
"To what extent, if any, is the CONSTITUTION of a person relevant to the homoeopathic prescription?"
Much experience of both provings and practice would be required in order to discover if and in what way constitution is relevant to the prescription. I do not have enough experience to form an opinion about the relevance of constitution so, I turned to Hahnemann's experience and understanding as a guide.
Constitution is not well-defined, but has a general association with colouring of skin and hair, build [fat or thin], muscles [rigid or lax fibre], energetic or lethargic, good or poor stamina. [Gross mentions some of these in his Comparative Materia Medica.] In some of these areas it overlaps with what might be symptoms, and so can be difficult to distinguish from symptoms, such as in cases in which the muscle tone or stamina or build appear pathological.
In some areas the constitution is clearly not something that one would or could seek to cure, such as colouring or height or bone structure.
In Organon par 5 Hahnemann states that the homoeopath should take account of the bodily constitution, particularly in cases of protracted disease. He distinguishes the bodiliy constitution from the "mental and emotional character." This suggests that he does not have in mind the classical models [sanguine, melancholic, phlegmatic, choleric] since those are all-in-one mental and physical types.
Hahnemann does not state what the homoeopath should do with this information about the bodily constitution. By default, it can be inferred that the constitution forms a measure against which to set the deviation from health experienced by the individual presenting for treatment. In this way the homoeopath's objective becomes relative in the context of each patient [relative to the optimal health facilitated by that person's constitution.] To infer any more is not supported by the vast majority of Hahnemann's published work.
This use of the "constitutional information" of par 5 is supported by the fact that it is of particular use in cases of protracted disease. In cases of acute disease, it is usually evident what is the deviation from the normal health of the patient, and this would not require a definition of the patient's baseline health in the same way as a long-term case.
The other information the homoeopath must gather - in accordance with par 5 - Occupation, Lifestyle and habits, Civic and Domestic Relationships, Age, Sexual Function are all clearly NOT constitutional factors, but nevertheless are important for the homoeopath, indeed any healer, to know, because factors in them could affect the prognosis.
I asked the question, in reference to chronic miasmatic cases:
"Would you take the base constitutional state as that of the patient a long time ago, when well, or at the previous state to the current - and how could that previous state be identified?"
My own perception is that the latter approach would lead to something like sequential therapy in which artificial moments of alterations in health are defined and thus the case is worked backwards - theoretically [contravening Organon par 1 footnote] and as far as the patient can recall the history.
If to define the patient's constitution as that of a long time ago, before the patient became ill, I would question the relevance of that 'constitution' to the current presenting symptoms. I would not rule out the possibility that there is a relevance, but it is not proven, and there are no sound practical rules for ruling out any remedies because they do not fit the original constitution. If there were, homoeopathy would be much simpler, as all the [originally] fair haired tall slim people [for example] could have their cases limited to a certain group of remedies. And so on for each constitutional group.
I conjecture that Boenninghausen and Hahnemann gathered information about the hair colour, diatheses, etc of their patients in order to ascertain whether there was any usefulness in such information for the prescriber. Their lack of interest in the topic, as shown by their later writings suggests that no great practical application could be made of the information. For example, the fact that some people with fair hair will need Nitric Acid, means that we can never use the constitutional sign to exclude the remedy, so it is not much use to know that it is more often people with dark hair who are disposed to produce characteristic symptoms that call for Nitric Acid. It is just as likely to hamper as to help the prescriber who would deploy such vague data in the selection of a remedy. I would not be confident in a prescription made even partly on the basis of a person's hair colour.

Chris cited Chronic Diseases, p.17 in which Hahnemann refers to Junker's observations about the way in which suppression of primary psora affects people with different diatheses in different ways. This accords with Organon par 81 in acknowledging that the way in which secondary psora manifests depends on the constitution of the patient. Also, Organon par 102; not only the manifestation of psora depends on the individual constitution - in order to asses the genus epidemicus of an acute miasm, it is necessary to observe the effects of the miasm on "several patients of different bodily constitution."
What is to say that the Sanguine person with pthisis might not need the same remedy as the Melancholic with insanity? Even though their constitutions dispose them to react to the suppression of psora in different ways, the characteristics they express in these diseases might demand the same remedy or remedies. Hahnemann makes no case for the association of certain diatheses or constitutions with certain remedies, just because certain diatheses or constitutions tend to react to psora in certain pathologies. It could be that the constitution merely defines the pathological tendencies of the organism. The characteristics by which the vital force will express itself and calls for a remedy are largely independent of pathology and could also be independent of constitution.
Handley's book states that Hahnemann's Paris casebooks sometimes referred to the diatheses of the patients. I do not have access to these books in English, so I can only accept uncritically Handley's analysis:
"However Hahnemann does not appear to have used such diagnoses as an aid to prescribing. The concept of the 'constitutional remedy' incorporating healthy characteristics, which has played such an important part in the development of modern homoeopathic prescribing, had not yet emerged, and he certainly did not normally take constitutional symptoms compatible with health into account when choosing his remedy. He prescribed largely on the basis of pathological symptoms, and the patient's physical pathology was fully taken into account and not regarded as subsidiary. In his own studies of the remedies he had, in fact, only just touched upon a notion which has since become the cornerstone of a certain school of homoeopathic prescribing - the idea that people may fall into personality 'types' which conform to the 'picture' of a remedy."
[In Search of the Later Hahnemann p.71]
As far as I can see, it was a step backward, an unscientific step, to reintroduce prescribing on the basis of the diatheses in which Hahnemann had been "schooled."
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Old 30th August 2003, 05:50 AM
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It is interesting to see the direction that Rajan Sankaran's work is now taking. His current method of casetaking accesses the inner disturbance through the pathology. He explores the sensation and the modalities in great detail, and uses this to discover the link between the mind and the body - to discover how the disease is affecting all levels of the person. There are times when he rarely moves from discussing the pathology at all, as he says that much of the necessary information for prescription can be found there. He follows the patient's own feelings about his disease, merely asking him to expand on what he means.

The idea of constitutional prescribing has departed greatly from the original idea of homoeopathy, and has, I think, lead many prescribers astray. Prescribers may not be able to tell the difference between what is to be cured and what is healthy in the patient.
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Old 2nd September 2003, 06:09 AM
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Hello Anna,

What an extraordinary twist of logic and inconsistency.

You do seem determined to hold fast to your conjectures in spite of being given many clear examples that present another reality.
I’m pleased at least we have finally moved beyond the “there is no constitution in homeopathy” line, albeit to one in which you suggest the 4 classic temperaments and innate constitutions, and their relevance to the homoeopathic prescription, are more or less a worthless throwback to Hahnemann’s “school” days.

Although somewhat disappointed, I still consider this in itself a groundbreaking shift!

Chris

PS. An acquired temperament can be overlayed on to the natural disposition as a result of emotional trauma, long standing poor dietary habits, environmental stresses, acquired miasmatic infections etc.
The time of onset of acquired constitutional imbalances and temperaments can be accessed, for example, when parents make references such as..."He was a happy child until....happened." The Never Well Since syndrome in casetaking is fundamental to establishing deviations from health. People adapt to life stresses in the best way they can, but unfortunately not always to their best advantage. The physiological response to long term stresses can be studied in Hans Seyles' work called the General Adaptation Syndrome. In this work, Seyle confessed that his approach (groundbreaking by modern standards) was not as complete as the Hippocratic healers of old!

In this way, you see people who have developed a "livery" irritable and morose disposition, those who have become "galled", dry and critical, those who have developed a watery weight gain and become slow, bloated, sluggish and tearful, those who become nervous, sullen and depressed, full of imaginary fears and respiratory complaints etc. Hahnemann did not, as you suggest, polarize the temperaments from the bodily constitution into two distinct camps. He continued to use the 4 classical temperaments and their 12 mixes, in his casetaking right into his final years.

Aphorism 5 sets out the 7 general constitutional rubrics to determine the cause and origin of illness in the Hippocratic tradition.
The bodily constitution contains the objective signs of disease, and disease propensities of the patient. These objective signs are confirmed by the subjective symptoms revealed by the patient through the remaining rubrics in the Aphorism.
Hahnemann knew the cause and origin of disease could be due to one or many different causes, hereditary, miasms, diet, environment, emotional and/or physical trauma, idiopathic means etc.

Aphorism 6 defines the disease symptoms as subjectively perceived by the patient and objectively by those around him, including the physician.

Aphorism 7 determines the totality of symptoms from the relevant information, bringing all the co-ordinates together to find the most appropriate remedy.
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Old 2nd September 2003, 09:48 AM
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In the provings, people of certain constitutions were more apt to develope symptoms to various substances. The constitution can therefore be used to assess how strongly someone is apt to respond to the remedy and can help assess posology. It's also useful in differentiating when several remedies are each strongly indicated.
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Old 2nd September 2003, 10:16 AM
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Anna Bryant
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good morning chris and thanks for your reply.
what is the "inconsistency" or "twist of logic" in my statement above?
what/where are the "many clear examples that present another reality"?

regarding your "p.s.":
chris:"An acquired temperament can be overlayed on to the natural disposition as a result of emotional trauma, long standing poor dietary habits, environmental stresses, acquired miasmatic infections etc."
- i agree, and when this alteration of mood happens due to alteration of the vitality, it becomes a symptom according to par 211 Organon. if ongoing external factors are causative, such as poor living conditions, then it is unwise to prescribe on such an alteration. i think we agree about this 100%

regarding the framework of the greek diatheses. it has some value, yet it appears to have no application to homoeopathic prescribing per se. i have two reasons for this conclusion:
1. historical - relating to hahnemann's practice.
2. logical.

HISTORICAL - with all his years of practice, and his education in greek medicine, H never came to the conclusion "here is the group of remedies that can be applied to x temperament, another [not necessarily exclusive group] to y temperament etc etc. - this could have been done for the 12 temperaments.

the argument that hahnemann only had one lifetime is not relevant because this sorting into groups would have been at the same time:

i. a relatively easy and brief task of statistical analysis, compared to the other work H did.
ii. a hugely simplifying tool for homoeopathic practice, HAD IT WORKED.

LOGICAL - the key point i made above which seems to have been overlooked, is that while the greek models seem to predict [somewhat] pathogical trends in constitutional types, they do not predict the characteristics upon which homoeopathic remedies are selected. characteristics span the breadth of pathology, and this i suspect, is the key to why the greek constitutions do not guide us, eliminatively, to remedy groups, at the optimal level of prescribing [on characteristics.]

chris wrote:
"Hahnemann did not, as you suggest, polarize the temperaments from the bodily constitution into two distinct camps. He continued to use the 4 classical temperaments and their 12 mixes, in his casetaking right into his final years."

my point about that was that in Organon par 5, the body constitution[1] is a separate point from the mental and emotional character[2].

according to handley [which is my only access to the casebooks] hahnemann continued to NOTE the greek diatheses in some cases, but did not USE them in selecting the remedy.

further, Handley [In Search] p.25:

"Notably absent from his casenotes are details in some of the areas a modern homoeopath is careful to investigate - family history and constitution for example..."

so it appears that often hahnemann didn't note the constitution at all by the time of the Parisien practice, and even when he did, as already quoted, he didn't use it symptomatically.

it is merely a semantic point to suggest that the seven parts of investigation listed in Organon par 5 are best not termed "rubrics" because this could confuse them with symptom "rubrics". it is more straigtforward to think of these as seven points of background information to the case; to be used to identify what is going on in the case, prior to tackling the case homoeopathically. a healer of any discipline should investigate these points before launching into treatment.

chris wrote:"The bodily constitution contains the objective signs of disease..." NO. the bodily constitution does NOT contain the disease picture. it is independent from it.
according to the greeks the constitution gives indications for pathological propensity, and this seems to have some truth.

chris:"These objective signs are confirmed by the subjective symptoms revealed by the patient through the remaining rubrics in the Aphorism." a run-through of aphorism 5 with a patient does not equal case-taking. it is a preliminary to par 6 etc, as you [chris] cite above.
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Old 2nd September 2003, 10:20 AM
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Anna Bryant
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shirley wrote:
"In the provings, people of certain constitutions were more apt to develope symptoms to various substances."

[shirley's following assertions about practice depend on this primary statement]

in the early proving of pulsatilla, hahnemann makes a connection with a certain body constitution and temperament. please cite any other reputable provings in which such a connection was made.
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Old 2nd September 2003, 11:13 AM
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Dear Members
Here are my own bits of thoughts on this subject.
Org.: Pr.: 5 lines out:
‘’Als BEIHILFE der Heilung--- [useful for the ASSISTANCE OF--]
Throughout the par.: 5 he does not use the term Symptom at all, but contrasts it in par.; 7 where he writes:
--‘’be the symptoms ALONE, by which the disease demands’’--
And further on to par.: 50 where he writes:
Cure by symptom similitude.

I want to be very clear, that the indications for the curative remedy are the SYMPTOMS.
The data referred to in par.: 5 are no symptoms and therefore do not form part of the disease.

One might ask rightfully why not? Why are those things no symptoms,, as they seem to be deviations of normality.

The answer lies in the term ‘’symptom’’.
Hahnemann refers to Heilkunst as the title of his book indicates. Heilkunst can only do one thing: it can cure diseases. Diseases can only be observed as changes in the flow of time and space, as an alteration in both areas. Therefore symptoms, being the outside expression of disease have to fulfil the same requirements in order to be not only mere appearances
So—there has to be the conditions of time and locality, which make any appearance a symptom.
Take this for an example: someone is obese.
All what we can say from that bit of information is, that this obese is an appearance. Whether it is a symptom or not depends on the above pre-conditions.
The locality is not a problem—but without knowing whether this had a start or not we cannot say, whether this is a symptom or not. Provided, it started at a certain age and remained, than it is a symptom. Provided there is no definite start, then it is not. Whether it is constitution or not is of secondary interest for the execution of the Heilkunst.
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Old 2nd September 2003, 03:44 PM
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Dear Members

In continuation to my earlier post, I want to draw the attention to Par.: 71 Org:

--1] How is the physician to ascertain what is necessary to be known in order to cure the disease? = Indications for the remedy to be selected.
---2] how is he to gain knowledge of the instruments adapted for the cure of the natural disease, the pathogenetic powers of the medicines? == the provings.
----3] What is the most suitable method of employing these artificial morbific agents [medicines] for the cure of natural disease.

I dealt in my earlier post with the aspects arising from the first area of interest in homeopathy, and want to comment on the other two areas now.

2] As much as the size age sex and disease-status were noted before the start of the test, the constitution of the probate was described. In comparison of different constitutions within the proving of one remedy differences were noted and included into the provings. These observations were kept separate from the artificial disease symptoms as they were mere observations. Their value, however comes to light in looking into the third area.

3] the most suitable form of application of the curative remedy depends on various individual parameters, some of them are determined by the disease, others by the remedy in general, and others by the constitution and other circumstances. And here the observations from 2] form valuable indications. Not only is it good to know how each constitution reacts to homeopathic remedies in general, but also the reactivity of the individual remedy in the constitution-types helps the decision regards the potency / strength of the remedy. In a similar way Boenninghausen’s hair-colour rubrics can be utilized, even though they don’t form part of the decision regards the remedy-selection.

In conclusion it can be said, that the remedy-decision is based on the disease-symptom-picture, which excludes constitutional elements, but the constitution is to be taken into consideration when deciding about the best form of application of the remedy to be found curative in the individual case.
In the case of re-provings the constitutional information is of help, as it gives indications for the strength necessary to excite reaction in the individual prover.

There are two situations in general outlined where remedies are used in homeopathy:
1] to treat diseases and 2] for the proving.

It is evident, that a remedy is prescribed on constitutional matter does not fall under 1] and therefore cannot be curative and likewise can cause proving reactions if the dose is strong enough.
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Old 2nd September 2003, 04:36 PM
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Quote:
There are two situations in general outlined where remedies are used in homeopathy:
1] to treat diseases and 2] for the proving.
I am of the opinion that some individual constitution is there and it may be related to his Body type(physical appearances),chracter,structure,temprament etc. and this may represent inherited pre-dispositions or suppressions at birth and their ultimate manifestations like a mole at birth increases in size etc.(can be indicative of some diseases) as the age progress. If these pre-dispositions are very prominent than higher potency of constitutional remedy will work and if these are weak than lower potencies can work. Other prominient therapies have also mentioned about constitutions like in Ayurveda, VATA,PITTA & KAPHA and their furthur sub-divisions. In astrology there are 12 constitutions matches with the ascendants signs which can be furthur sub-divided upto 28&gt;&gt;112&gt;&gt;360 if minutes details are required. Three basic constitutions i.e Carbo-Nitrogenoid,Oxygenoid & Hydrogenoid are well known which may represent VATA,PITTA & KAPHA and four basic elements of our body i.e Carbon,Nirogen,Oxygen and Hydrogen forming most of our organic structure.
Apart from curing disease and proving, homeopathic remedies can also be used (3) Inherited or constitutional pre-dispositions(4)Aquired chronic pre-dispositions behavioural or functional type may be miasmic.
Persistance or tendancy of any symptom for long or life long can be the major symptom of Contitutional and Miasmic manifestations

[ 02. September 2003, 17:39: Message edited by: kayveeh ]
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Old 2nd September 2003, 06:53 PM
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Anna Bryant
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hans wrote:
Quote:
2] As much as the size age sex and disease-status were noted before the start of the test, the constitution of the probate [edit: prover?] was described. In comparison of different constitutions within the proving of one remedy differences were noted and included into the provings. These observations were kept separate from the artificial disease symptoms as they were mere observations. Their value, however comes to light in looking into the third area.
shirley also alludes to it above, chris has mentioned it previously; where is that information to be found please?
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