The patient or the disease
Francisco Eizayaga’s ideas deviate in many respects from Hahnemann’s teachings. The most profound discrepancy arises from his viewpoint that the patient and the disease itself, which he views as the lesional pathology, have to be treated separately.
Hahnemann clearly points out in the Organon that it is always the whole being who is ill and that there are no local diseases.
“It is the morbidly affected vital force alone that produces disease. Therefore disease is not to be considered as an inwardly hidden wesen separate from the living whole, from the organism and its enliving dynamis, even if it is thought to be very subtle. Such a phantom can be conceived only by materialistic minds.”
§12 and §13 Organon
The disease constitutes the derangement of the dynamic vital force, which comprises the whole patient. Hence, there are no such things as “diseases” in the abstract to treat, only diseased person.
The indicated remedy, chosen according to the totality of symptoms, balances the vital force. Through this stimulus, a vital reaction is started and homeostasis reestablished. If signs and symptoms are removed, the totality of the disease with all its manifestations, is removed. Therefore, rebalancing the vital force means cure of the patient with their disease. The patient and their disease cannot be separated, but are one. This implies that there cannot be two different remedies indicated at the same time, one for the patient and the other for the disease.
When Hahnemann was searching for the “specific” remedy he referred to the individual remedy indicated in a given case. Each patient suffers from his/her own “individual” disease, which never before appeared in the same manner. Hence no true cure can take place without strict individualization. In each case, we find besides the common and pathognomonic symptoms, some characteristics that give the case its individuality and cause it to differ from all other cases. By considering the individual reaction of each patient through strange, rare, peculiar and characteristic symptoms, we treat the patient with their disease.
To view local manifestations as the disease itself rather seems to adhere to the allopathic concept, which views all diseases as local and of the cells, and disease manifestations as self-contained entities. In homeopathy the disease manifestations in one part are considered in their relation to the whole man, and the only means of cure is to treat the whole patient. Homeopathy is primarily concerned with the primary, dynamic aspect of the disease, not its pathological manifestations, which are but the results of disease, and not in any sense the disease itself. In homeopathy the human is not only considered as an individual, but also as a complete unit in himself. Kent warned us, that:
“He who considers disease results to be the disease itself, and expects to do away with these as disease, is insane. Most of the conditions of the human economy that are called diseases in the books are not diseases, but the results of disease. All that we can possibly know of “Disease” is expressed in symptoms only.”
J.T.Kent, lectures on Homoeopathic philosophy
The fundamental and the lesional disease
In Eizayaga’s layer model the fundamental and lesional diseases are treated separately based on the assumption that the local pathology is a self contained entity.
Hahnemann elucidates the purpose of local manifestations in chronic diseases:
“It is evident that man’s vital force, when encumbered with a chronic disease which it is unable to overcome by its own powers instinctively, adopts the plan of developing a local malady on some external part, solely for this object, that by making and keeping in a diseased state this part which is not indispensable to human life, it may thereby silence the internal disease, which otherwise threatens to destroy the vital organs (and to deprive the patient of life), and that it may thereby, so to speak, transfer the internal disease to the vicarious local affection and, as it were, draw it thither. The presence of the local affection thus silences, for a time, the internal disease, though without being able either to cure it or to diminish it materially. The local affection, however, is never anything else than a part of the general disease, but a part of it increased all in one direction by the organic vital force, and transferred to a less dangerous (external) part of the body, in order to allay the internal ailment.”
Local manifestations in chronic diseases serve the purpose of alleviating the internal malady, yet they express and still belong to the same dynamic disease.
“The organs are not the man. The man is prior to the organs. From first to last is the order of sickness as well as the order of cure – from man to his organs and not from the organs to the man.”
J.T.Kent, Lectures on Homoeopathic Philosophy
Regarding their treatment, Eizayaga writes that local symptoms represent themselves by modalities of aggravation and amelioration, sensations, concomitants and alternating symptoms. As these do not always coincide with the modalities of the general symptoms, “it is possible that one single remedy is unable to cover the totality of mental, local, and general symptoms, where the “similar” of the local picture is one remedy, and that of the psychical and general symptoms is another“. 
If all manifestations belong to the same disease it is practically impossible to separate the symptom picture into different entities. By prescribing for isolated symptoms one misses the general review of the whole case as an entity. Hahnemann clearly stated that the patient’s symptoms should be taken as a totality and a remedy chosen that covers the whole.
“From this indubitable truth, that besides the totality of the symptoms with consideration of the accompanying circumstances nothing can by any means be discovered in disease wherewith they could express their need of aid, it follows undeniably that the sum of all the symptoms and conditions in each individual case of disease must be the sole indication, the sole guide to direct us in the choice of a remedy.”
“The physician should never lose sight of this great truth, that of all known remedies there is but one that merits a preference above all others, viz.: that whose symptoms bear the closest resemblance to the totality of those which characterize the malady.”
S. Hahnemann, Organon
Eizayaga’s rationale is that it usually occurs, in most cases, “that the symptoms of the patient do not correspond, in their characteristic’s, to the fundamental remedy. These symptoms may be local, general, and even mental, and are those that express the recent pathological activity of the patient. These symptoms correspond to a medicine proper to the actual state and take the name of similar medicine“.
So even if he individualizes the symptoms of the lesional disease by using modalities and concomitants, he still does not consider the true totality of the case and will necessarily fail with the prescription, unless the taken symptoms are strange, rare, peculiar or uncommon, and thereby truly individualizing. The symptoms of location may furnish characteristic symptoms, yet are most often the characteristic general symptoms which held the key to the case. Kent reminded us:
“The physician spoils his case when he prescribes for the local symptoms and neglects the patient. Localization is at all times a secondary state or the result of disease, while changed feelings are the primary manifestations.”
J.T.Kent, New remedies
That the patient’s simillimum does not cover the local symptomatology does not necessarily mean it will not cure. Kent also addresses this subject when writing on The value of symptoms:
“In ninety-nine cases of a hundred you can leave out the particulars, for the particulars are usually contained within the generals. If there be but one remedy that has the numerous generals, and covers those generals absolutely and clearly and strongly, that will be the remedy that will cure the case. There may be a lot of little particulars that may appear to contra-indicate, but they cannot; for nothing in particulars can contra-indicate generals.”
J.T.Kent, The Art and Science of Homeopathic Medicine, p.210
I would like to point out, that even if Kent evaluated the case from generals to particulars, he still considered the strange, rare and peculiar symptoms as the most important in prescribing. These may occur among mentals, generals, or particulars and must therefore be of varying importance and rank !
In § 169 Organon Hahnemann also gives us guidance on how to proceed if two similes are seen in the patient’s case. If confronted with the dilemma of perceiving two different remedies, he advised us to select the remedy which is more homeopathic to the case, and to retake the case after its beneficial action has ceased, and not to give the other remedy automatically.
Eizayaga’s prescribing procedure for cases with lesional pathology agrees with the prescribing procedure for acute cases, in which merely the actual symptoms are taken into account:
“In chronic lesional cases and in the acute cases the disease is repertorized with the modalities of the individual himself in order to treat the disease independently of the chronic patient.”
He suggests for lesional diseases, that “the past and not present symptoms (at the moment of registering a case) must be taken into account only after the prescription based on the present symptoms have been tried and have failed“.
Again Kent gives us clear guidance as how to approach the case: “Examine the image of the case where the order was lost because that is where the image must be found… The patient’s disease has not been cured, it has only been changed and modified; but it is the same patient, and the same sickness, and requires the same medicine.“
Rectifying the application of the “fragmentary” similar remedy, Eizayaga refers to §162 Organon where Hahnemann writes:
“Sometimes happens, owing to the moderate number of medicines yet known with respect to their true, pure action, that but a portion of the symptoms of the disease under treatment are to be met with in the list of symptoms of the most appropriate medicine, consequently this imperfect medicinal morbific agent must be employed for lack of a more perfect one.”
§ 162 Organon
Both argue that it may be admissible to apply partially indicated remedies, yet their rationale is completely different.
For Hahnemann it may be necessary to apply a partially indicated remedy due to the lack of remedies, and in one-sided diseases due to lack of symptoms. One-sided diseases display only one or two principal symptoms which obscure almost all the others. The principal symptom can either be an internal complaint, or a more external complaint. If the principal symptom is an internal complaint, the defective symptom picture often occurs due to the inattentiveness of the observer ! Also, local manifestations have their origin in the internal disease and arise or grow worse because the patient is inwardly ill and the entire organism involved.
“Among the one-sided disease an important place is occupied by the so-called local maladies, by which term is signified those changes and ailments that appear on the external parts of the body. Till now the idea prevalent in the schools was that these parts were alone morbidly affected, and that the rest of the body did not participate in the disease – a theoretical, absurd doctrine, which has led to the most disastrous medical treatment.”
To treat one-sided diseases successfully one chooses the remedy that, based on these few symptoms, is the most homeopathically indicated. Cure is likely to happen when these few morbid symptoms are strange, rare, uncommon, peculiar or characteristic. A incompletely homeopathic remedy may not cure, but it will serve the purpose of completing the display of the symptoms of the disease, and in this way facilitates the discovery of a second, more accurately suitable, homeopathic medicine.
Eizayaga however is prescribing a “fragmentary” remedy due to limiting a-priori the prescription on a fragmentary symptom picture, which can necessarily never reflect the totality of symptoms. But Hahnemann required us always to evaluate the whole case and to base the prescription on the totality of symptoms, not fragments. It is clear that if we only consider fragments of the case we will only get a fragmentary symptom picture and a remedy that that will only partially cover the case.
“So it is the totality of symptoms, the outer image expressing the inner essence of the disease, i.e. of the disturbed vital force, that must be the main, even the only, means by which the disease allows us to find the necessary remedy, the only one that can decide the appropriate choice. Briefly, in every individual case of disease the totality of the symptoms must be the physician’s principal concern, the only object of his attention, the only thing to be removed by his intervention in order to cure, i.e. to transform the disease into health.”
Hahnemann generally condemned all treatment methods which focus only on one of many symptoms that diseases present, and reminds us, that “a single symptom is no more the whole disease than a single foot a whole man“.
Eizayaga further refers to §163 Organon in which Hahnemann writes:
“In this case we cannot indeed expect from this medicine a complete, untroubled cure; for during its use some symptoms appear which were not previously observable in the disease, accessory symptoms of the not perfectly appropriate remedy. This does by no means prevent a considerable part of the disease (the symptoms of the disease that resemble those of the medicine) from being eradicated by this medicine, thereby establishing a fair commencement of the cure, but still this does not take place without those accessory symptoms, which are, however, always moderate when the dose of the medicine is sufficiently minute.”
After applying a simile no complete cure can be expected. Kent expressed this best with the following sentence:
“Power comes in the direction of similitude, not of intensity, and gains power only in proportion, as it is similar.”
That means, in a case where a close simile is given, some light accessory symptoms may appear which pass without undue suffering and do not prevent the cure.
“The small number of homoeopathic symptoms present in the best selected medicine is no obstacle to the cure in cases where these few medicinal symptoms are chiefly of an uncommon kind and such as are peculiarly distinctive (characteristic) of the disease; the cure takes place under such circumstances without any particular disturbance.”
But no favorable results can be expected from a distant simile that is unhomeopathic to the case, as this will not improve the patient on the deeper planes, and tends to change the symptom picture by bringing out new increasing and persisting symptoms. The greater the dissimilarities between the symptoms of the remedy and patient, the more distant the remedy gets from the simillimum, and the more unhomeopathic symptoms will appear after its application and combine with the symptoms of the progressing natural disease.
“If, however, among the symptoms of the remedy selected, there be none that accurately resemble the distinctive (characteristic), peculiar, uncommon symptoms of the case of disease, and if the remedy correspond to the disease only in the general, vaguely described, indefinite states (nausea, debility, headache, and so forth), and if there be among the known medicines none more homeopathically appropriate, in that case the physician cannot promise himself any immediate favorable result from the employment of this unhomeopathic medicine.”
The simillimum is the best indicated remedy and will cure rapidly, gently and permanently, so nothing should motivate us to limit ourselves in the choice of the remedy by prescribing on fragmentary symptom patterns. However, Hahnemann stated that it is impossible to find a remedy that fits the patient’s symptom picture exactly. Therefore, it is theoretically impossible to apply a remedy without any accessory symptoms. But if the true simillimum is applied and taken in a small enough dose, these will be hardly noticeable.
This means, the lesional remedy will only provide a true cure if the considered symptoms were truly individualizing, and the selected remedy resembles the characteristic, peculiar, uncommon symptoms of the case. In this case it must be supposed to be the patient’s simillimum.
It is clear that Eizayaga has to consider the therapeutic limitation of the similar remedy which merely aims at curing the “present disease” without treating the individual as a person. For this the patient’s simillimum has to be applied.
Eizayaga advises that in incurable cases it is “not adequate to use the simillimum remedy, but the one which covers the present sufferings“, and that the constitutional or fundamental remedy may provoke serious reactions in patients lacking vitality. This agrees with the often pronounced warning that a deep acting constitutional or miasmatically chosen remedy should not be applied in advanced pathology, as this could weaken or overwhelm the vital force.
Even in advanced pathology the local malady does not exist without participation of the whole organism and relationship to other organs, and arises or grows worse because the patient is inwardly ill and the entire organism involved.
In practice two different therapeutic approaches are being used: Some homeopaths find they are more successful with constitutional prescribing even in advanced pathology, and include in their prescription the past symptoms if no current totality can be found. Others, like Luc de Schepper and David Little, suggest using a layered approach in cases that have advanced pathology, vital organ pathological changes or present with one-sided pathology. Here one should restore the function and vitality of the organ first, and work the patient backward from the one-sided state in the vital organs by reversing the symptoms until the disease returns to a more constitutional condition. As the symptoms are reversed over time one introduces deeper acting remedies and follows up with more constitutional remedies later. That is, the more active lesional layer should not be treated with a deep acting or miasmatically acting remedy. Only when the one-sided disease is subdued and the older chronic disease reappears, should it be addressed with a deeper acting, miasmatically chosen remedy. This approach allows the vital force to recuperate so it will now be able to encounter and tolerate deeper-acting remedies with a positive curative response.
If advanced pathology is suspected, treatment needs to begin with the very low potencies in judiciously given doses (usually 6C), working one’s way up with increasing potencies, and preferably LM’s. This latter “layer” approach differs from Eizayaga insofar as it focuses on advanced pathology and a too weak vital force, instead of including all lesional diseases in general.
In truly incurable cases the natural disease has overpowered the vital force which is therefore unable to generate symptoms. Only palliation is possible. Acute prescribing is necessary for the more superficial symptoms with preferably vegetable remedies which act less deeply than animal or mineral remedies and are easier for the vital force to handle. These patients can only improve to a certain point, but can never be cured, only palliated during acute outbursts according to the changing symptom picture. It is best to use Hahnemann’s advanced methods of applying the remedy in water, because the dose can be readily adjusted to the sensitivity of the patient.
Boenninghausen and Boger’s repertorization methods are worth mentioning as being especially suited to one-sided cases with paucity of symptoms. Boger’s method is also suited for cases rich in particulars with marked modalities and concomitants, pathological generals, clinical symptoms, objective symptoms and pathological symptoms with absence of characteristic symptoms, and cases without many mental symptoms. Boenninghausen’s method is best to use for cases representing complete symptoms, prominent concomitants, marked sensations and modalities, when generals are lacking or strongly marked mentals are not available, in cases having suffering in few parts but no modalities for all the suffering parts, or scattered modalities. Based on a different conception of the Totality of Symptoms there are different repertorization methods, each of them emphasizing different aspects to form the totality of a case, yet they all have their origin in the Organon. It is important for a homeopath to be familiar with these subtle differences so that one may apply them depending upon the prescribing data elicited from the patient.
The word constitution comes from the Latin word constituere or constitute and means to form, establish or make up.
There are different concepts of constitutional prescribing depending on the definition:
- Some homeopaths refer to the constitutional remedy as the remedy that covers the patient’s individual type and which is unchangeable for life.
- Other homeopaths refer to the remedy that covers the patient’s totality of symptoms for a chronic condition, with particular emphasis on personality and temperament.
- For others it relates to the innate constitution. Depending on the layers that form on top of the innate constitution, the patient may need another remedy for his current condition.
Eizayaga’s concept agrees with the third definition. He distinguishes between the genotypical and phenotypical constitution. The genotypical constitution relates to the innate constitution, whereas the phenotypical constitution relates to the layer that forms on top of the genotypical constitution, and is called the fundamental disease by Eizayaga.
The innate constitution is the sum total of an individual’s characteristics as they are potentially determined at the moment of fertilization. It displays an inherent tendency to respond along predetermined individual characteristic patterns, and has lifelong characteristics which do not change and which are not considered morbid symptoms. The innate constitution and temperament are the major conditioning factors in the experience of suffering, they condition signs and symptoms and the development of disease. Paracelsus has written:
“All man’s diseases originate in his constitution.”
The constitutional prescription is based on the argument that a particular person with a particular constitution and temperament has the tendency to develop certain pathological symptoms, and therefore has a particular affinity for a particular remedy and responds positively to it. All constitutional types contain healthy and positive qualities, but are also prone to certain unbalanced and negative tendencies that may develop depending on the life experiences and the influences which act upon it. Most homeopaths argue that patients who respond to the same constitutional remedy all their lives and which also covers their innate constitution, are rare today. This would mean for Eizayaga’s concept that the genotypical and phenotypical constitution agree, that is, that the remedy that covers the traits of the constitution is also the therapeutic remedy for the patients fundamental disease.
However, the genotypical and phenotypical constitutional remedy may be different. When determining the fundamental remedy of the phenotypical constitution, the homeopath has to differentiate between the features belonging to the patient’s innate constitution and the layer of the fundamental disease, reflecting those ailments and symptoms that date from the time this layer started.
When all layers are treated and the miasmatic terrain is cleared, the patient receives the remedy that relates to the innate, genotypical constitution. This is to strengthen the patient and to prevent further diseases. Luc de Schepper states that it helps “polish the diamond, by bringing out the best qualities of the constitution and minimizing any weaknesses”. 
Eizayaga distinguished the four possible genetic constitutions Sulphur, Calcarea carbonica, Calcarea phosphorica, and Calcarea fluorica.
Other homeopaths like Luc de Schepper opine that there are seven possible innate constitutions at the time of conception, with any number of possible remedy states imposed on them. He names Sulphur, Phosphorus, Calcarea carbonica, Calcarea phosphorica, Silicea, Lycopodium, and Baryta carbonica. Most of these are minerals involved in basic physiological processes, or plants which contain a high percentage of minerals.
Although Hahnemann mentions the importance of the constitution, it was only later homeopaths who developed the concept of constitutional prescribing. Based on observation, Hahnemann mentioned in the Materia Medica Pura that Pulsatilla and Nux vomica are most likely to benefit in persons with certain constitutional and temperamental features. However, he did not define constitutional features as a prescribing rule for curative treatment, these are definitely the totality of signs and symptoms.
Miasms are like an invisible substance that overpowers the vital force and creates a weakness in the patient and a tendency to suffer from particular diseases. If not eradicated with antimiasmatic treatment they persist throughout life and are transmitted to subsequent generations.
Hahnemann clearly points out in the Organon, that knowledge of the miasms will help the physician to bring about a cure (§5 Organon), and that the indicated remedy has to cover the totality of symptoms as well as the active miasm:
“Since one may know a disease only by its symptoms, when there is no obvious exciting or sustaining cause to be removed, it is evident that only the symptoms, together with any possible miasm and additional circumstances, must guide the choice of the appropriate, curative remedy.”
§ 7 Organon
All true chronic diseases arise from a miasm. Hence miasms and constitution are closely related, and chronic treatment should include miasmatic treatment at any point of prescription.
Eizayaga’s comments that the action of the indicated remedy may be prevented due to a miasmatic block, is a well-known fact and has been confirmed in practice. In these cases the corresponding nosode needs to clear the terrain before the indicated chronic remedy can work. However, to treat miasms as a separate layer, rather seems to be escapist. His comments on miasmatic treatment are somewhat contradictory, stating at one point that they have to be treated with the corresponding nosode(s), and on another occasion he requires applying the remedy or the nosode that corresponds to the miasm to solve the case, and points out that all miasms have their typical remedies.
When analyzing his cases he rather seems to adhere to the latter alternative, which agrees with Hahnemann’s concept of miasmatic prescribing as outlined in §78-82 Organon and The Chronic Diseases.
At the time Hahnemann was investigating miasms, he distinguished Psora, Sycosis and Syphilis. Eizayaga also considers Cancer and Tuberculosis.
Francisco Eizayaga demonstrates the treatment of patients with the lesional, fundamental and constitutional remedy with case studies (see appendix). He emphasizes: “In all cases, absolutely in all, the constitutional underlying condition, or miasmatic or susceptible latent condition must be treated“. Yet, when analyzing the described cases it is obvious, that chronic cases are presented as having been cured without the application of nosodes or the genotypical constitutional remedy.
Patients with lesional diseases:
- Case no.1.Repertorization of the present lesional condition: Thuja constitutional type; Simillimum repertorization: Natrum mur; prescription: Thuja, intercalating Med and Carc; years later Apis. Note by the author: The patient was “cured” although the repertorized simillimum was never prescribed. It is unclear how Thuja can be the constitutional type and Natrum mur the simillimum as both refer to the fundamental disease according to Eizayaga’s terminology (Thuja is not a genotypical constitutional remedy).
- Case no.2. Prescription based on present symptoms: Thuja constitutional type; intercalating other remedies now and again. Note by the author: All conditions improved without prescribing a nosode. Thuja is considered as the fundamental, phenotypical constitutional remedy that also covered the lesional disease. No nosode or genotypical constitutional remedy was administered.
- Case no.3. Natrum mur has been the patient’s simillimum years before and was prescribed, but without results; Ars and Apis ameliorated. Note by the author: No nosode or genotypical remedy was applied.
Patients with fundamental diseases:
- Case no.4. Calcarea carbonica was repertorized and prescribed.
- Case no.5. Natrum muriaticum was repertorized and prescribed; the autonosode made of the sputum was also applied.
- Case no.6. Natrum muriaticum.
- Case no.7. Calcarea carbonica.
In these cases no nosode were prescribed. In the where case Calcarea carbonica was applied, no information was provided as to whether the fundamental, phenotypical remedy possibly agreed with the genotypical remedy.
Eizayaga also mentions certain chronic states which could only be solved based on past constitutional symptoms which the patient had previous to the present pathology, but which are not present in the patient’s actual state. These especially applied to cases in which the “illness” in terms of pathology was cured, but certain aspects of the patient’s personality did not change. Note of the author: As the remedy only ameliorated partially (and possibly against Hering’s law) it must be seen as a simile that did not cover the whole case. However, whether the first applied remedy was truly curative and had to be followed by a complementary remedy to complete the cure, or whether the first prescription was merely palliative and caused a dissimilar aggravation that called for the application of the truly indicated remedy, cannot be judged due to missing details about the cases.
Eizayaga provides food for thought and raises many questions with his perceptions and case studies. To understand his way of thinking it is best to read his book entirely. Unfortunately, there are several contradictory comments which make it a difficult read, so that I would definitely not recommend it to the newcomer in the field of homeopathy.
Lynn Amara, who has studied and worked with Francisco Eizayaga, commented on his approach, that “it is a mistake for homeopaths to interpret his work as saying to treat the Lesional layer first. He encouraged treating as deeply as you could. It is as if the client comes with a pocket full of change, some pennies, nickels, dimes and quarters. The pennies are the Lesional, the nickels are the Fundamental, the dimes are Miasms and the quarters are the Constitution. We would like to find the constitutional remedy right from the beginning, but what if all that is brought to you are pennies from a car accident. You may need to prescribe on the Lesional layer and treat the sequelae of the car accident. But if someone brings you 25 pennies, well then, do consider how that came about and treat as deeply as you can.”
Jose Eizayaga points out, that some points in the book Treatise on Homeopathy “do not agree with Francisco Eizayaga’s way of thinking at the end of his life, but represent antiquated ideas which do not agree with the reality.” Unfortunately, till now no further writings have been published or provided to evaluate his further thinking and amendments.
Although the book Treatise on homoeopathic medicine contains some misrepresented facts and contradictory comments, it is still full of gems and insights of a dedicated homeopath. My advice for every homeopathy student and practitioner is: Read and study as much as you can, and gain as much practical experience as possible, to arrive at your own conclusions !
Copyright: This article is reprinted from Dr.Francisco Xavier Eizayaga’s book Treatise on homoeopathic medicine with friendly permission of Jose Eizayaga.