I posted this case several years ago but I think it’s been deleted. I am posting a new, updated version as I believe it’s helpful for understanding the nature and treatment of complex chronic diseases. This is a good case study because it exemplifies some of the characteristic manifestations of psora and because the symptom-gestalts are easily discernible (at least I think so).

In this case, as in many miasmic cases, the symptom-gestalt changes with each dose of the simillimum in LM1, which acts far more efficiently than the centesimals. While most constitutional practitioners (and even some of the self-proclaimed Hahnemannians) consider this a failure on the part of the homeopath, this is actually how many of these cases proceed. With each simillimum, the patient (especially those sensitive psorics) will generally experience a pronounced feeling of improved well-being on a deep level, so it’s not difficult to assess the homeopathicity of the remedy. Even if this improvement is accompanied by therapeutic aggravations, it is still perceived to be far preferable than how the patient feels without the simillimum. The psoric, whose energy may be severely deficient, will benefit greatly by the resonance and stimulation of the correct remedy. Once the simillimum has exhausted its action, the new symptom-gestalt manifests, calling for the next simillimum. Healing progresses in this way; the patient gets immediate amelioration while the life force is re-tuned incrementally. It can take several years and literally hundreds of simillima for a complete cure. No doubt, this is not what most homeopaths want to hear as 1) it contradicts the constitutional approach they’ve learned in school and is widely believed and supported in the homeopathic community; and 2) it’s an incredible amount of work over a long term. And yet, this is what is called for in these cases. We cannot make the the vital force (Nature) conform to what we would like it to do (i.e. heal with a single simillimum). While this would be most convenient it is merely wishful thinking, and to impose this treatment model on cases for which it is not appropriate will only invite disaster.

While each miasmic case is unique, this is a good example of how psora can affect the sufferer.

49 y.o. male, has stopped urinating after several years of feeble stream. The allopaths want to insert a hot metal rod into the urethra to “clear out the blockage”.

This symptom is a manifestation of the deficiency characteristic of psoric miasm. The fact that urination has stopped can be viewed as a kind of paralysis.This is the primary reason for treatment and an important symptom for consideration in prescribing.


Eczema – dry, red, flaky, itchy patches on face and scalp < by driving = nervous anxiety. This nervous anxiety caused by driving increases as week goes on - has to drive for work.

Eczema is the characteristic “itch” and most obvious symptom of psoric miasm, whether it exists in the patient himself or in one or more family members. (Sycosis has the obvious “sycotic excressences” of warts, moles, skin tags, cysts, etc. to aid in diagnosis.) Notice that the eczema is aggravated by stressful activity, which causes nervous anxiety. Nervous anxiety is the result of a deficient vital force and is common among psorics. Notice also that this becomes worse as the week goes on (because the vital force wears down). I’m assuming that he has a chance to rest up over the weekend and then the cycle starts all over again.

While these manifestations are definitely “symptoms” in the larger scheme of things, they are really more alterations in the overall feeling and functioning of the patient, caused by the deep energetic imbalance. They are not, however, terribly useful for the purposes of prescribing. So while they contribute to the larger picture of miasmic imbalance, they are not specific enough to contribute to the symptom-gestalt that is considered in prescribing.


Gets bored easily; thinks too much, “makes up problems in head”, mentally beats up self for not doing things or not doing them right; feels guilt, depression; was a ‘hyper’ child.

These symptoms are characteristic of deep psoric imbalance. He gets bored easily because he hasn’t the energy (mentally and otherwise) to fully participate in life, so he “makes up problems in [his] head.” The ability to think clearly and to function is impinged upon by the miasm. We’ve heard that the psoric is totally “theoretical”. That’s because he lacks the basic energy to manifest himself in the world. The thinking runs in never ending self-referential circles, and the patient is unable to focus attention outward in meaningful and productive ways. The results are these kinds of psychic processes, a living hell from which the only reprieve is appropriate homeopathic treatment.


Doesn’t sleep well, feels “wary” at night.

This symptom was helpful in selecting the simillimum.


Severe heartburn and acid reflux; ulcers; gas pain which goes from upper abdominal area into upper back; stomach pain is described as being so bad he “just wants to die”; didn’t eat much until the invention of Tagamet because it was too painful; stomach problems < coffee and vegetables like onions and peppers.

Digestive disturbances are associated with psora. This symptom was also quite helpful in selecting the remedy.

Has had hernia and had appendix removed. Had squamous cell on head at age 40 and melanoma on foot in 1997.

September 25, 2000 – Causticum LM1, one #10 pellet taken by olfaction.

In analysing a miasmic case, I have no need to speculate on the hidden interior workings of the psyche (things I cannot know for sure) in order to properly understand the patient or the case. The “why” of this case is obvious and I need look no further than psoric miasm. There are no deep, dark, hidden psychic processes that are going to make this case any clearer, and any such speculation or interpretation could just cloud the picture.

The symptoms I used for prescribing were:

Urinary paralysis – the chief complaint. From Clarke: “Causticum is one of the great polychrest medicines of the Chronic Diseases… The leading feature of the Causticum effects is paralysis, showing itself both in voluntary and involuntary muscles... Paralysis of bladder is apparent.”

Doesn’t sleep well, feels “wary” at night. Clarke: “Fearfulness, esp. at night. –Afraid at night… -Nocturnal sleeplessness, caused by anxiety, inquietude…”

Severe heartburn…stomach pain is described as being so bad he “just wants to die”. Again, Clarke: “Burning, indeed, is one of the notes of Caust. Guernsey gives ‘sensation as if lime were being slaked in the stomach.’”

“Lou” reported the following day that he felt better overall and his urination had returned and was quite strong. I could sense from this that Causticum was correct.


September 28: I retook the case; the Causticum had already exhausted its action and the symptom picture had changed to that of the next simillimum. I know this must seem confusing and hard to believe if you don’t understand this process. I only understand it so well because I have personally experienced it for some time now, after many other failed treatments including 3+ years of constitutional homeopathy, which left me in far worse condition. This approach was the only thing that saved me and that is why I’m such an outspoken advocate for it. I have seen it work for others as well, but it does require a tremendous amount of skill in prescribing and case management.

After giving the remedy, I usually check back in a day or so to assess whether or not it was correct. The LM’s act quickly and efficiently and since miasmic patients are frequently sensitive, it can be easy to assess the remedy response. Usually, as I’ve already stated, the patient will report feeling better overall with the simillimum (this is a well known fact). During this initial period, it’s also important to assess:

1) how the patient responds to the simillimum – does she aggravate and how does she aggravate? Is it brief or prolonged? It’s important to get a feel for the patient’s vital force and how it responds to the remedies;

2) remedy duration – how many doses are needed before the remedy exhausts its action and the vital force produces the next symptom-gestalt? Many miasmic cases only require a single dose of LM1 by olfaction before such changes occur. This is a dynamic process. Progress is made with each simillimum and the case is moved forward a tiny bit each time. In some of these miasmic cases, remember, the life force is deeply altered and cannot be simply corrected with a single remedy. Much more complex treatment is needed.

It’s also worth noting that, unless these miasmic cases are properly understood, they can seem like constitutional cases on the surface. If one lacks perspective on the depth of the derangement, the presenting symptom-gestalt will appear to be all there is. If the homeopath isn’t looking carefully, she will miss the emerging new picture after the opening simillimum has completed its action. If one cannot make a definitive miasmatic diagnosis, it may be impossible to know if a chronic case is complex (requiring many remedies) or simple (requiring only one or a few rems). That’s why it’s important to watch the vital force very carefully early in the case so that one can get a proper feel for it. In these more complicated cases, what appears to be the “constitutional” remedy is only the opening simillimum, which opens up the case and gets the ball rolling.

Well, I think that’s enough for now. If anyone’s interested I’ll post more on this later.

[ 11. September 2003, 20:17: Message edited by: Tomi C. ]

tomi, i'm reading and interested if you need encouragement to post more.

why use the term "constitutional"? [it belongs to the school that you rejected.]

boenn's case notes show that he used 200's in a similar way, often changing the remedy after a week or two when new symptoms arose - the 200's acting less swiftly than the LMs presumably. though his cases did not tend to be those that dragged on for years, as i see today [one can never be sure if boenn could have solved the current cases fast or if circumstances of today's living preclude the possibility.]

i find that one dose of the LM, even when it aggravates, sometimes requires repetition in due course, because, although the symptoms improve, they remain within the same symptom picture.

Hi Tomi,
This is very interesting, thanks.
I'd be happy if you could elaborate what you explain as the difference in percieving the need for miasmatic analysis of a case as against constitutional analysis of a case in choosing the similimum. We have been working on that presently and I think that is a wonderful broad approach in undertanding this...

...without trying to "reject" schools of thought...!

(sorry Anna, could not resisit that! WHy do the post of Hans' students sound so biased? Is it necessary to push down someone else to be seen? State your view point and let it be taken for the value it is, right?)

Thanks,
doctorleela

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hello drleela, this term "constitutional" is usually recognised by homoeopaths who prescribe on symptoms alone, as erroneous, so its use in this context seemed anomalous. however, that is a side issue compared to the methodlogy discussed, and i hope it will not waylay discussion.

this issue of timing in a chronic case is interesting.
on the one hand there are reasons to wait wait and wait again for the action of the remedy to come forth - and many case examples from the masters to demonstrate the value of this, also the third of hahnemann's "precautionary rules" and the footnote to par 64 of the organon.

on the other hand there appears from boenninghausen's own casenotes many examples of not allowing the remedies to act out for very long, and his use of intercurrent remedies [giving a remedy during or immediately after the action of another, and then reverting to the original remedy, or using a different one] appears to be a mainstay of what he was able to achieve for his patients.

the only working generalization i have been able to make about timing is that if one can see a symptom picture with a clearly indicated similimum coming through, different from the last remedy given, and the patient is distressed by those symptoms, then it might as well be given, regardless of when the last remedy was administered. i would be interested to hear what tomi thinks of that.

Tomi, I, too, would like to encourage you to continue.

If you do find the need to repeat an LM (or any potency) via olfaction, does the same procedure of succussing apply? Or would you move to the next higher potency if a second dose was needed? I've read that Hahnemann, in his later years, used 30C (in water/alcohol) more so than the Q/LM remedies. (is this true, do you know?) I remember wondering about succussing the liquid to alter it as one would a medicinal dilution, if repeated dose was required, because he indicated the vial could be used for years.

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Sometimes on Earth, you can find something that resembles a little piece of Heaven. And sometimes on Earth, a little piece of Heaven can find you.

Anna, Dr. Leela, gpm,

Thank you all so much for your interest and encouragement.


Anna, your question on why I use the terminology of a school I reject is warranted. After writing for hours and trying to justify my use of that term, I realize that you are right. From now on, I’ll refer to such cases as “simple” in order to differentiate them from the miasmic cases requiring more complex treatment.

Patients aggravate in different ways and some not at all. This particular patient just got rapid and pronounced improvement with no aggravation (the best possible scenario). And, of course, each patient is unique relative to remedy repetition, some requiring more doses than others. Obviously, the remedy should not be changed as long as the symptom picture remains the same.

In miasmic cases that present with clear and discernible symptom pictures, one can easily see it change if one is looking for it. That was the point of presenting this case and I will show how that works later (I’m tired now from writing all that stuff I’m not posting). The patient’s distress is usually a good indicator that a new rem is needed (if the last one was determined to be correct). (I cringe when reading GV’s discussion of miasmic treatment and how the patient must be made to suffer to the limits of his endurance.)


Dr. Leela, I think that all cases presenting with chronic complaints should be screened for miasms. Basically, this involves looking for miasmatic indicators and patterns of miasmic imbalance within the individual and also within his or her family. If the case is miasmic, then chances are it will require complex treatment with a series of remedies. If these indicators are not found, then miasm can be ruled out as the cause of disease. I’ll write more on this later…


gpm, I don’t know if Hahnemann used more of the 30C in his later years. I seem to recall David Little saying that he was using a lot more LM’s as he had twice as many in his medicine chest when he passed away (1600 vs. 800 C’s). I normally just give LM1 by olfaction (no succussion as you need water to do that) until it exhausts its action. So far, I have not needed to go higher in potency; I think that’s only needed if you’re giving the same rem over a long period of time (in which case I would give it in water and have it succussed each time).


Again, thanks for your responses and encouragement. I’ll write more next week (if I’m not having aggravations ).

[ 18. August 2003, 02:53: Message edited by: Tomi C. ]

Tomi, i think the key to the terminology is found in organon par 7. That little aside "along with regard for any contingent miasm..." not to mention "and with attention to the attendant circumstances."
non-miasmatic cases with no adverse circumstances are simple; whereas if either of the two is present, one has one's work cut out.

you wrote:
this is another issue i am coming up against in practice. if one is looking, things do come up. where is the balance between prescribing [frequently] for every picture [which could overload the vital force] and on the other hand, not missing a valuable opportunity to knock back some of the chronic miasm.

perhaps i should be patient, and let your case report unfold, so i can see how you are working with that. you give a pointer to your answer above, in terms of the patient's distress.

hans weitbrecht shed light on managing miasmatic cases by pointing out that the miasms mutate. given this, one can see the need to repeat the same remedy sometimes, and the need for running up on the LMs, indeed, the need for having developed the LM's.
i don't think boenninghausen fully understood this [at least not in some of his lesser writings] because he thought that a remedy would do all it could in the first dose and would not produce anything beneficial by repetition [which is reasonable if you don't consider miasms as living mutating disease entities] without the use of an intercurrent.

gpm, in blw p190, boen states that he had been in correspondence with h until 2 mths prior to his death, and that h "even up to the last continued to diminish the doses."

Anna,

To answer your question about when to change the remedy, one needs to discern whether those things coming up constitute a new symptom picture or not. This can be fairly obvious in those cases that present with clear pictures. Although, I suppose it looks clear to me because I have a lot of experience with it. And this is where I differ from the others on the BB: my work in homeopathy is based on my own experience of living with severe miasm, suffering under the effects of poorly applied homeopathic medicine, and finally healing myself through a long and intensive process (which is still on-going). I have also had the opportunity to work with a few others in this same way and to see the results in those cases as well.

In contrast, other homeopathic practioners are more or less healthy individuals who began their studies with lots of book learning and then moved on to clinical practice. They have started with the theoretical aspects and moved on to the experiential (on others, which is still not the same as personal experience). Because we perceive events based on already held beliefs, homeopaths will then interpret their clinical experiences based on what they “know”, whether or not that knowledge is an accurate representation of what goes on in homeopathic healing. I understand that this is where you and the other Hahnemannians take issue with the constitutionalists. Hahnemann, being a scientist and advocate of the inductive method, shunned theories that were not supported by experience/experiment (this was one of his grievances against the allopaths). [I understand that the German translation of proving simply means experiment.] As for my own work, I can tell you that it is based on experience (rather than theory) and can be repeated in those cases that present with clear and discernible symptom pictures (many don’t).

I am reluctant to go on with my case at this point because I would like to discuss in more detail the different schools of thought and their underlying worldviews. I think that having a larger perspective on this might help to shed some light on homeopathic practice in general. You make reference to par. 7 of the Organon, and this issue of what exactly is a symptom is problematic and differs greatly between the two schools. I’m going to work on developing an epistemological profile of homeopathic practice so that we can gain a deeper understanding of these differences and how they color the various views and practices of homeopathy.

[ 11. September 2003, 20:16: Message edited by: Tomi C. ]

Dear Tomi
Sound observations!
This story comes to mind:
Psora is like the robbers stealing away the health. They are on the run in a car, which is well camouflaged. You start to chase them down with homeopathic remedies—if you can catch them you steel their energies. Now, these boys have a lot of tricks—they can change the direction and if you don’t see the change of the tracks they leave behind, then you lost them--, or they can throw things at you—the active outbursts—where you either dodge, or use an non-psoric remedy to neutralize them -- just to return to the pursuit again. Eventually after nipping away most of their energy [by the use of anti-psorics] they start to become slow, and they cannot change the direction that quick anymore, nor do they have a lot left to throw into your face. Don’t sit back—keep taking away the energy—[and that is the time where I go through the LM’s step by step higher and higher]—till at some stage the original symptoms reappear. Now you know—if I treat this curatively—then I succeeded to cure the entire malady.

__________________
Hans Weitbrecht
Consultant Homeopath

Tomi,
IT will be very interesting to hear your experiences.
regards,
Doctorleela

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