A Conversation with Elaine Lewis, CHom
Alan: Elaine, do you think all cases can be handled with a single remedy covering all the symptoms?
Elaine: This is an important topic. Andre Saine has a somewhat famous case he tells over and over again if you listen to his conference tapes, as I do. It’s about a patient of his with renal failure.
She needed many remedies, he wrote numerous prescriptions for her over the years. Finally one night he was called to her bedside by the husband. The husband says, “She’s really had it this time, Andre, she’s gone.” There she lay in a uremic coma.
Andre gave her Opium CM. Her eyes opened. Andre said, “Do you need air?” She nodded. He gave her immediately Carbo veg. The Carbo veg. Rx immediately led to something else, perhaps chest pain, for which he may have given Naja. Next came nausea, for which another Rx was made, perhaps Ipecac. What you see here is the unwinding of the case, going back the way it came! It ends in, guess what? Apis, of course! And the renal failure is over and the patient lives!
Now, who in their right mind would have taken a constitutional case here? Of what point or value would it have been to know the constitution at this point? But these cases appear before us and what are we going to do? Ask these patients if they like ice cream? Are they better at the sea shore or worse for cold damp air? Should we ask them, “If you were an animal, which one would you be?”
Most of our patients are going to have something wrong with them! Maybe two or three things wrong! Healing takes place in reverse order–Hering’s Law. Where does the constitutional remedy lie? At the beginning, doesn’t it? Is this where we are in these cases, at the beginning? We can’t go in thinking that every case, every patient, needs his constitutional remedy–the one remedy, the single remedy that’s going to cure the whole case. How is that possible when these cases have add-ons, are complex, have multiple etiologies?
Alan: You’re saying you address whatever needs addressing. And you’re not talking about combining remedies, correct?
Elaine: Andre wasn’t combining remedies. He saw a state and would prescribe for it. His point was, once you start treating these end-stage cases, they are going to unwind with rapidity and you are going to have to be there every step of the way, ready to treat the next presentation that comes up!
We have to recognize that people in middle age and older are going to come to us with all the disorders associated with poor eating habits, drugging, alcohol, cigarettes, kidney failure from diabetes, digestive complaints, sleep disorders from a lifetime of taking sleeping pills, etc. What did Hahnemann call this? Complex disease, meaning many diseases existing alongside each other. Drugs and junk food are mostly to blame. You’ve got multiple etiologies.
Unfortunately, in homeopathy today, the emphasis is on finding the “simillimum”, whatever that means in a case like this. There’s nothing wrong with constitutional prescribing when it’s appropriate but I think popular homeopathy is leaning so far towards one side that many homeopaths actually don’t know what to do with patients who have pathologies! They will either mistakenly give them the “constitutional” remedy, or will pass on the case altogether!
I recently left an end-stage patient with roughly five or six remedy bottles. I said, “This is for your kidney failure, this is for your liver cancer, this is to antidote the side effects of morphine, this is for the edema in your arm and hand due to kidney failure, this is for the cancer pain, and this one’s for heartburn. Don’t take them all at once, spread them out.” I also gave him vitamin C and acidophilus and told him to eat raw fruits and vegetables, no junk food, no cooked food and to drink carrot juice. (I don’t think he complied with too much of that advice!) A week later he was remarkably improved. All the edema had gone out of his arm and hand, urination had increased from once a day to four times a day.
I think we’re neglecting the treatment of these types, leaving them to allopaths and certain death while we treat only “healthy” people.
Alan: And you’re not suggesting all cases be handled this way.
Elaine: Wouldn’t it be nice if people came to us before they were dying!? But in the example I gave, clearly the Serum anguillae 30C I gave for kidney failure is not going to do a bloody thing for the liver cancer, for which I gave Hydrastis; and Hydrastis isn’t going to antidote the side effects of morphine, for which I gave homeopathic morphine; and so on.
All these issues/complaints are active at once–the kidney failure, the cancer, the effects of morphine…. Then there’s the edema for which you need Apis. And yes, we do have such a thing in homeopathy as “organ affinities”, remedies that have an action on certain organs, the way Serum anguillae has an affinity for the kidneys, Hydrastis for the digestive organs and cancer. Clark said Hydrastis cured more cancer than any other remedy.
Alan: So, even while adhering to classical homeopathy, we should understand that certain remedies have affinities to certain organs and certain systems?
Elaine: Yes, I do believe we have so-called “disease” polychrests that we rarely, if ever, use as constitutional remedies; remedies like Hydrastis, Conium, Kali bich., Phytolacca, Asterias rubens, Secale and so on; so, I do believe there is a kind of homeopathy for illness which is not about taking the constitutional case, per se.
In some cases the “essense” remedy will not cure and is inappropriate, as the essence is not the top layer, and healing takes place in reverse order, remember from Hering’s Law? The disease must be treated first. In the case of a person having many diseases at the same time, you may have to ask, “What is the worst thing for you right now?” Or you might have to determine what the worst thing is for yourself.
On the other hand, you may see a clear mental/emotional picture of a remedy which is part of the pathology! Arsenicum is such a prime example of this, as its mentals are so often seen in end-of-life cases, just as the Pulsatilla mentals are so often seen as concomitants in childhood disease–the clinginess, the crying, the “better for consolation”–making it a prime contender in almost all childhood diseases; similarly, the neediness of the dying patient, the fear of death, the anxiety, the restlessness, the suspicious nature, make Arsenicum a prime contender in end-of-life situations, regardless of what the disease is; so, in that sense, is Arsenicum the “constitutional” remedy at that point in time? Perhaps it is! Perhaps we have to rethink what we mean by “constitutional”.
Alan: What does Hahnemann say about treating multiple diseases in the same patient?
Elaine: In Aphorism 40 of The Organon, Hahnemann talks about Complex Disease. He says it is possible for two or more dissimilar diseases to co-exist in the same body and that one remedy won’t cure these cases, and that remedies for each disease have to be alternated, which is pretty much what I’ve been talking about here.
There is debate over the use of two remedies in the same patient. Some people say that Hahnemann would never do this. Well, he did! But please don’t confuse “Complex Disease” with your average acute which consists of many symptoms! A flu which has nausea, vomiting, sore throat, prostration, headache, muscle aches, runny nose with anxiety, restlessness and fear of death isn’t a “Complex Disease”! You don’t give a remedy for the diarrhea, another remedy for the vomiting, another one for the sore throat…. no! This is an Arsenicum flu! One remedy will clear this whole case. There is one diagnosis here, flu. One thing. Most patients have many things, many diseases at one time. Sometimes it’s simply mind-boggling!
If a patient comes to you with kidney failure, rheumatoid arthritis, side effects of pain killers among other things–your average case in the USA, basically–then you would most likely have to alternate a kidney failure remedy with an arthritis pain remedy and something to deal with the side effects of Prednisone, etc. and then there’s their diet, which is probably the chief cause of everything that’s wrong with them–junk food!
And the question then is, what do we do, take a constitutional case? I think that that’s what most people think is proper because of this “belief” that Hahnemann is known to have proclaimed that you give a single remedy! But we can see in The Organon that this is not ALL that Hahnemann said, and that is my only point, to make people aware of that.
Here is an excerpt from an article called “Boys Will Be Boys” by Dr. Tim Dooley from Homeopathy Today (April 2003) which I think exemplifies what we’ve been talking about. The author’s son was in a roller skating accident and needed more than one remedy:
Boys Will Be Boys
I gave him a dose of 200C pellets because that’s what was in my first-aid kit. I would not have hesitated to give any available potency. I repeated the Arnica every few minutes in the early stages, and then decreased the dose to every few hours as things stabilized. I also repeated the Aconite a couple of times over the next 20 minutes or so until he was calm and reassured.
The point is that in first aid it is perfectly acceptable to repeat remedies frequently and to change remedies freely, as indicated. I mention this because in treating patients with chronic illness, we are more cautious about repeating and changing remedies – and many people are unaware that the rules differ with injured patients.*************************************************
So! The rules differ with injured patients. In many ways, our patients with multiple diseases and end-stage pathologies are just like injured patients, they’re hurtling from one outbreak of discomfort to the next! And herein lies the conundrum in homeopathy–do I treat the pathology or find out the person’s constitutional remedy? One thing you can do is ask yourself, “This patient’s complaints–did they spring from his inner core personality or are they the result of degenerative disease and a toxic environment?” Even if it’s the latter, you may find a “personality” concomitant with it! Think of the Chamomilla patient who’s inconsolable and angry with his pain. Or the Arnica patient saying, “Oh, I’m fine, really; never been better, nothing wrong here!” These people have just told you what their “current” constitution is! Think no further, the case is solved! But what if there are no mentals in the case? Then, as I said before, find out what the worst thing is–it’s usually the most recent thing, then you have to take the case of that, find out: what’s the sensation? What’s the location? What makes it better or worse? What was the cause of it, what activates it? What do you do to make yourself feel better? That’s how you take a case.
Alan: So you’re saying that the rules for treating injuries may apply in other kinds of cases.
Elaine: Yes. Should Andre Saine’s patient, who was in a uremic coma and barely breathing, have been given Phosphorus because that was her constitutional remedy? Should that have been given when she was in an Opium state?
Now we are again at the place in the conversation where we ask, When is it proper to give the constitutional remedy?
It has been said that advanced pathology is not at all like acute prescribing or emergency prescribing, because such things as injuries come from without; hence, no need to take a constitutional case.
I would suggest that advanced pathology also comes from without. It tends to be the result of eating junk food, taking drugs, drinking alcohol, smoking and other errors in living. Consider a drug addict who destroys his liver and kidneys. Where does the constitutional remedy fit in here? He has poisoned himself.
I just want to point out that the Hydrastis I prescribed for the liver cancer patient DID fit the case. There’s nothing that says the disease remedy you choose shouldn’t fit the case! There are often lots to choose from; but sometimes there are only a few, with one in BOLD. There were many aspects of the case that went for Hydrastis. Regarding the kidney failure remedy, I’ve only found that rubric in Murphy’s Repertory, the ”Clinical” chapter. It contains seven remedies, two in bold (Ser-a. and Apis) I gave both of them (at different times), the swelling of the patient’s arm and hand suggested the need for Apis.
The morphine was a bigger threat to his life than the cancer! For that he got homeopathic morphine. None of these elements of the case came from within. None of them were constitutional. I honestly feel the comparison with acute prescribing which Dr. Dooley described previously is analogous; namely, that remedies can be repeated and switched as needed in these types of cases.
However, be careful of potency! I gave mostly 30 C’s. Andre gave opium CM because his patient was practically dead! Don’t throw high potencies around recklessly and indiscriminately. Have a reason for going there! (“Well, I tried 30C and nothing happened; so, I’m going up to 200 now.” That would make sense.) AND, if you’re going to repeat a remedy, put it in bottle of water and succuss a few times before each subsequent dose; otherwise, you run the risk of antidoting the last dose you gave and landing your patient right back at square-one!
Ser-a. and Apis would not have helped the liver cancer my patient had. Hydrastis would not have helped the kidney failure. He had both! Something had to be done to counter the devastating effects of morphine. The constitutional could not possibly have been homeopathic to all these different presentations!
The original question was, can you use more than one remedy in a case, and, what would Hahnemann say? Would we be muddying the concept of classical homeopathy, setting a bad example and creating confusion? It appears that Hahnemann was very much familiar with the kinds of cases that we’re talking about, which he called Complex Disease. He said that remedies in such circumstances would have to be alternated. Hence, I think we ARE being classical. (I just wish more people would read the Organon!)
Should you give Phosphorus, the constitutional remedy, to a comatose patient who is displaying a keynote of Opium – the puffing of the lips during respiration? Which remedy is homeopathic to the case at that point in time? It’s not Phosphorus.
Alan: Thanks Elaine, we’ll see you in The Quiz section, as always!
Elaine: Let me hurry and get down there then!
Alan: But wait, can I ask one more thing? What about combination remedies, numerous remedies in one “pill”?
Elaine: Alan, I haven’t needed them, except for a few times. All the instances were acutes and it was before I became a homeopath. The first time was in 1980, I had a concussion, and I started taking Bioplasma every 15 minutes, and it worked like a charm! Why? Bioplasma contains Nat-sulph. which is our main “ailments from head injury” remedy! What can we learn from this? That the body ignores all the remedies in the combination that it doesn’t need? Maybe. I don’t know. The second time I was on a plane, I got sick from eating the plane food, and luckily I had a homeopathic “Indigestion” bottle with me. It worked slowly, but it worked! Finally, on my honeymoon, I got diarrhea from the hotel water. I had a homeopathic “Diarrhea” bottle with me, and that worked too — again, slowly. Maybe because these combinations tend to be in the 6X potency when what is really needed is a 30 or 200C. But I can only say that there is a place for these combinations especially when you’re selling to the public. Whether this is the way to treat chronic disease or whether they have any place outside of emergency situations like I’ve described, I don’t know.
Alan: Thanks again, Elaine!