Constitutional Medicine - Constitution and Temperament

From: The Homoeopathic Compendium by David Little. Excerpt from Volume V : Constitution, Temperament and Maps of Consciousness – Chapter 1 : Constitutional Medicine http://friendsofhealth.com/

Constitutional Medicine starts with an exposition of the teachings of Hippocrates on constitution and temperament and explains the system used by the Greek naturalist to assess the most common genotypes. The text examines the use of the classical four temperaments (choleric, phlegmatic, sanguine and melancholic) in Homœopathy and the materia medica. It reviews statements on the relevance of various constitutions by Hahnemann, Boenninghausen, Hering, Jahr, Kent, Allen, Roberts and Whitmont. It also provides a discussion of aphorism 5 of the Organon and its importance in the study of the whole human being and its relationship to environment.

The Hippocratic Corpus

Hippocrates was born on the island of Cos around 460 BC. In the apocryphal biography the Father of western clinical medicine was born into a medical family that traced its lineage to Asclepius and Hercules. He placed great emphasis on the innate constitution of human beings because it intermingles with and conditions all responses to environment. In The Nature of Man Hippocrates discusses the make-up of the human constitution and how it interacts with nature as a whole. He recorded many of his clinical observations of the effects of environment, food, and water on the human constitution in his famous work Air, Water and Places. He followed the Pythagorean system of primordial homœomeries, which are the similar archetypal qualities that constitute all phenomena.

The Pythagoreans called these unchanging roots the immaterial ether and the four physical elements composed of air, fire, water and earth. Hippocrates carefully avoided the intellectual debate about which one of the five elements was the primary power. He was more interested in the direct observation of the five elements and four humours in the constitution of his patients and their symptomatology.

Hippocrates summed up much of his clinical philosophy in the first paragraph of Aphorisms of Hippocrates with the epigram: “Ho bios brachys, he de techne makre (L. Ars Longa — Vita Brevis).” This statement may be translated as “Art is Long — Life is Brief”. The old master wrote that it takes a long time to develop the true arts while life passes quickly, crisis is fleeting, experience is perilous, and decisions are difficult. The healing artist must do what is correct according to their ethics and understanding as well as seek the cooperation of the patient, assistants, family and friends. They should do everything in their power to make the external circumstances harmonious so that the goal of true health may be accomplished. For these reasons, the practitioner should approach the study of Homœopathy with sincerity and great perseverance.

In the course of one’s career one will face many serious situations involving difficult decisions that can only be made properly with experience. The task is not easy, the situation multifaceted, and the responsibility great. Even when one conceives a plan it is sometimes difficult to get the full assistance of the patient and their family. The healing artist should be willing to be with the patient and their family at difficult times like birth, accidents, misfortunes, illness and death. They must be a combination of minister, counselor, and psychologist as well as medical practitioner.

Hippocrates was extremely practical in his approach to clinical medicine. He based his system on the observation of Physis, the living power of nature found in the human organism. He was well aware of the healing properties of similars. In the Organon Hahnemann quoted Hippocrates’ “remarkable words” (in On the Place of the Things which Regard Man, Basel: Froben, 1538, page 72) as an example of ancient Homœopathy.

Disease is born of like things, and by the attack of like things people are healed…

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Introduction, page 57.

One of the most important teachings of Hippocrates is the doctrine of the aetiological constellation and interdependent origin. Most disease states do not have one single isolated factor that can be called its sole cause. A mixture of susceptibility, virulence, exposure and time and circumstances is involved in most illnesses. Every human being possesses an innate predisposition and a certain amount of vitality that may be utilized in the form of adaptation energy. A person’s essential susceptibility is based on the nature of their congenital constitution and natural temperament as well as the amount of exposure to mental and physical stress at any given time. For this reason, Hippocrates taught that all diseases are constitutional in nature and only become local as the last resort to promote crisis.

Throughout medical history there has been a great debate about which comes first in importance, constitutional susceptibility or the pathogens that cause disease. This question was at the root of the disagreement between Claus Barnett and Louis Pasteur. Barnett felt that the host constitution was the prime factor in disease whereas Pasteur placed more importance on the role of the pathogen. Many people carry the streptococcus bacteria yet remain healthy under normal circumstances. If they are subjected to excessive mental or physical stress many of them are likely to develop symptoms. Other individuals are very susceptible to streptococcus and will become seriously ill if sufficiently exposed. Some people will never suffer from streptococcus under any circumstances. What is the true cause of the disease then?

Hippocrates placed the most emphasis in the congenital constitution although he did not deny the influence of external stress factors and pathogens. Toward the end of Pasteur’s life he realized that Barnett’s view was more correct. The fundamental cause of disease is so closely related to the predispositions of the constitution that it is impossible to ignore its primacy. Great physicians like Hippocrates, Paracelsus, and Hahnemann were well aware of the importance of the constitution in the art of healing.

Definition of Constitution and Temperament

Hippocrates introduced the tradition of studying the constitution and temperament into clinical medicine more than 2,500 years ago, which makes it one of the oldest living traditions in western medicine. The term constitution is derived from the Latin noun, constitutio, which means an arrangement or physical make-up and the verb “constituere”, which means to establish or constitute. To constitute means to establish, to create, to set up, to form, to make up, to appoint, to give being to, etc. The term, constitution, may be defined as an act of creating or constituting; the way something is made up or formed; the rules and regulations governing an organization; the principles, laws and personal rights on which a state is founded; the physical make-up, state of health, nature of the temperament, etc.

When the term, constitution, is used specifically as a medical term it relates to the make-up, nature, qualities, health and condition of the physical body and the mental temperament. Constitutional means that which affects the whole; the inherent natural make-up or structure of a person or thing; the way something is arranged in reference to its composition, construction or nature; that which relates to the physical and mental health or make-up. The term, constitution, is closely related to the word, diathesis, which means an inherited or acquired constitutional disorder. Therefore, there may be inherited and acquired dispositions and diseases that affect the whole constitution.

Hippocrates observed diseases from the vantage point of constitutional syndromes, and their symptom pictures, rather than by pathological names alone. He carefully studied the physical constitution and its relationship to the mental disposition while recording the effects of stress and pathogens on his patients. Through observation Hippocrates recorded the predispositions and symptoms of his patients according to the most common biological types called the four temperaments. Hippocrates called these constitutions the choleric, phlegmatic, sanguine and melancholic temperaments. The essential qualities of the four temperaments and four humours are related to the four archetypal elements of earth, water, fire and air. The doctrine of the four temperaments is closely linked with the tradition of the vital airs and the humoural physiology.

Modern science says that 80% of the human body is composed of humoural fluids, which are the medium of life. A humour in the classical context is defined as a fluid of the animal body, especially the four that are considered in Hippocratic physiology to determine temperament or the disposition of mind. This is the basis of defining the word, humour, as the specific temperament or state of mind. This is the root of statements like “she is in bad humour” and “he has no humour” or “they are out of humour”.

The four major animal fluids are the bilious (bile), pituitious (clear fluids), sanguineous (red blood), and atrabilious (blackbile) humours. Each of these four humours has a particular mood, atmosphere and quality. The earthy yellow bile is angry, dry and hot, the watery pituitous phlegm is weepy, moist and cold, the fiery sanguine blood is passionate, hot and moist and the airy black atrabile is melancholic, cold and dry. A derangement of these humours produced by inner or outer causes generates a specific syndrome of signs, befallments and symptoms.

Hippocrates also taught that diseases could be caused by disturbances of the three vital factors; the vital breath, air or wind as well as heat and cold. Diseases of the vital airs produce nervous disorders, difficulty breathing, lack of coordination, alternating states, wondering pains, shaking, spasm, hiccups, constipation, belching, gas, etc. Diseases of cold produce chill, trembling, low body temperature, poor circulation, low energy, hypofunction, excess mucus, excess fluids, etc. Diseases of heat produce fever, thirst, dryness, plethora, excess energy, hyperfunction, rashes, pimples, boils, etc. Although the physiological concepts of the four humours and three factors may seem outdated, their related clinical pictures are still very accurate. This is because the ancient homœomeries are symbols for archetypal energy patterns that have been observed for millennia.

The genes of the paternal and maternal lineages and the natural qualities of the incarnate soul produce the innate constitution. Positive and negative hereditary tendencies contribute to the make-up and function of the inborn constitution and natural temperament. The inherent constitution and temperament compose a functional polarity that is closely aligned with inherited predispositions. These predispositions are natural tendencies that condition the desires and aversions of the individual and their reaction to their environment. The interdependence of the physical constitution and mental temperament is as inseparable as the vital force and the essential Wesen. These are complementary opposites that make up one whole called a human being.

The root derivation of the word temperament is the Latin, temperamentum, which means a proportioned mixture or state with respect to the combination or predominance of internal humours, qualities and climates. An innate temperament is an inborn constitution that permanently affects a person’s psychological and physiological make-up and vital functions. The ancient Greeks taught that the four temperaments are associated with a preponderance of one of the four humours i.e., yellow bile, phlegm, blood and blackbile. These constituents affect the state of the constitutional equilibrium, the nature of its predispositions, and the make-up of the humoural types i.e., the choleric, phlegmatic, sanguine, and melancholic temperaments.

Our generation has advanced the study of psychology related to Homœopathy but Hahnemann understood several aspects of constitution and temperament that are little known in contemporary practice. An investigation of the constitution and temperament is closely related to the study of inherited and acquired diatheses. A diathesis, the Greek word for disposition, is a particular condition or bodily habit that predisposes a person to a particular disease state. The term, temperament, has a number of definitions that were interrelated in the ancient healing arts.

Temperament is a proportioned mixture; a state with respect to a combination or predominance of specific qualities; internal constitution or natural state; mood and disposition; a type of physical and mental organization.
Temperament is a person’s natural character or disposition that governs the way they behave, think and act.
When temperament is used classically it refers to the four Hippocratic constitutions, i.e., the choleric, phlegmatic, sanguine and melancholic temperaments, which are based on mixtures of bile, phlegm, blood and blackbile.
Temperament may be used to describe a sensitive, creative, excitable and emotional personality (to be temperamental).
The word, temper, comes from the Latin, temperare, which means to mix in due proportion. When it is used as a noun it means a mixture or balance of different or contrary qualities; the constitution of the bodily temperament; a disposition; a habitual or actual frame of mind; characteristic state of the psyche, mood or humour. It also means a state of composure and self-control (even-tempered) or the lack of composure and loss of control (losing one’s temper); a state of anger and rage (bad-tempered) or ill humour, irritability, peevishness (out of temper). The verb, temper, means to mix in due proportion; to modify by blending of a mixture; to moderate; to soften something; to make something less severe or rigid; to adjust; to tune; to attune; to adjust the mood or temperament; to bring to a favorable state of mind.
The word, distemper (Fr. destemprer, to derange) means a mental or physical ailment. In Shakespearean English this word was used to describe a person’s unpleasant behavior (a distempered mind) or a liver condition from drinking (distempered liver), etc. Distemper is still used to describe a number of infectious diseases of animals, especially a particular viral infection in dogs.
Temperament is a musical term for a system of compromise in tuning that allows for the adjustment of the intervals between notes so an instrument can be played in any key. An equal temperament is a system of tuning in which notes are tuned in twelve equal intervals called the chromatic scale. An octave is a series of eight notes between the first and eighth note of a major or minor scale, e.g., from a lower C to a higher C.

All of the above definitions have relevance to the healing arts. As a general term, temperament means the mood, disposition, demeanor or the emotional tone of a person. When the word, temperament, is used specifically it refers to the four major and twelve mixed constitutional temperaments. One must remember, however, that there are innate and temporary temperaments in the Hippocratic tradition. A temporary temperament is a transient state that affects the intellect, emotional disposition, mood, composure and/or the vital physiological functions. An innate temperament is the inborn make-up of the bodily constitution and mental character that conditions the structure of the psyche and soma. It is possible for an individual to have both innate and acquired mistunements of the constitutional temperament in layers that form complex disorders.

The physical constitution and mental temperament is the meeting point of the collective (prenatal-inherited) and individual (postnatal-acquired) aspects of human experience. In the ancient Greek tradition the terms constitution and temperament are interchangeable because of the intimate link between the physiological make-up and the innate personality. In physical terms this demonstrates the connection between the functions of the brain, nervous system and glandular secretions and how they affect the body and mind simultaneously. Following in the footsteps of Father Hippocrates, the great Paracelsus asked healers to return to the root of a problem if they wished to cure disease.

No knowledge is perfect unless it includes an understanding of the origin — that is the beginning; and as all man’s diseases originate in his constitution, it is necessary that his constitution should be known if we wish to know his diseases.

Constitutional Medicine, with special reference to The Three Constitutions of Dr. Von Grauvogl; J. H. Clarke, Title Page.

In Search of the Lost Chord

In the 6th century BC Pythagoras discoursed on the music of the spheres, which is applicable to the microcosmic and macrocosmic worlds. He opined that the universe produces a series of vibrations resembling a sequence of notes that makes up various scales and melodies. For example, the Sun, Moon and the planets all have their own vibratory tones that create the music of the solar system. These ideas are in harmony with the concepts of modern physics, which has confirmed this hypothesis in many ways. The use of the spectrometer and radio telescopes has shown that each heavenly body has its own frequencies of light and sound that offer much information about their construction. It was said that an advanced Pythagorean master could “hear” the sound of these celestial vibrations during meditation and receive knowledge about their origins.

Temperament means tuning in both a musical and medical sense. The musical definition of equal temperament is the tuning of an instrument into a scale of 12 semi-tones that make up the harmonic structure of western music. On the basis of the 12-note chromatic scale, Pythagoras developed the lyre and the 8-tone Ionian mode that composes the major scale. The chromatic scale forms the background for different combinations of 8 notes that are the source of the 7 melodic modes of classical music. These modes originated in the ancient Mediterranean world where music was an integral part of the healing arts. They are called the Ionian, Dorian, Phrygian, Lydian, Mixolydian, Aeolian and the Locrian modes.

According to the ancients, the 12 constellations of the zodiac are similar to the 12 semi-tones of the chromatic scale and the 7 visible planets (Mercury, Venus, Earth, Mars, Jupiter, Saturn, Sun and Moon) are similar to the 7 notes at the root of all melodies. This universal temperament is reflected in the human organism as the 12 parts of the zodiacal being expressed by the 12 astrological signs. Each of these signs rules a part of the body. Aries rules the head; Taurus the throat, Gemini the lungs; Cancer the breast; Leo the heart; Virgo the abdomen; Libra the kidneys; Sagittarius the hips and thighs; Capricorn the knees; Aquarius the calves; and Pisces the feet.

The 7 notes of the scale are related to the 7 vital centers (gonads, adrenals, pancreas, thymus, thyroid and parathyroid, pituitary and pineal glands) and the 7 major nerve centers (coccygeal plexus, sacral plexus, solar plexus, cardiac plexus, carotid plexus, cavernous plexus, cerebrum). The brain, lungs, heart, liver, spleen, kidneys, stomach and intestines are called the vital organs because the rhythm of life depends on them. Each nervous center, gland and organ must function in harmony for the individual to be healthy and happy. Even the word, organism, has the “obsolete” definition of a musical instrument showing the link between the human constitution and musical terminology.

Thus one can see that in the music of life the tone, rhythm and harmonies of the human organism are all interrelated. The four modes that provide classical music with its moods or atmospheres are intimately related to the nature of the four temperaments. These are risoluto (resolute-choler), mesto (melancholic-atrabile), giocoso (playful-sanguine) and tranquillo (peaceful-phlegmatic). Each of these modes induces a particular feeling tone that reflects the moods and atmospheres associated with the four constitutional temperaments.

The esoteric traditions often used numerology to hold information symbolically. The important numbers in this series are 3, 4, 7 and 12. They are related to the 3 vital forces, the 4 elements and 4 temperaments, the 7 vital centers and the 12 mixed temperaments. In aphorism 9 Hahnemann wrote that in the healthy human state the spirit-like “vital force” is the dynamis that enlivens the “material organism” and keeps all parts in “harmonious vital operations” so that the “indwelling rational spirit” can use this “healthy instrument for the higher purposes of our existence”. This passage reflects the trinity of the psyche, vital force and physical constitution, which synergistically act to produce the harmonious human temperament (scale of life).

The Pythagoreans also taught that the vital forces, organs and tissues within the human body have their own vibratory tones, which could either be in tune or out of tune with the state of health. To have tone is to be harmonious and to be off tone means a state of dissonance or discord. People still speak in terms of feeling “in tune” or “out of tune” in modern English. A person may have a “bad temperament” or be “off key” meaning that they are out of tune. Doctors often talk about “toning up the system”, which means to bring the organism to a higher state of health. They refer to the constitution, nervous system, muscles and tissues as “lacking tone” when a person is ill. Tone is also the root of the word “tonic”, meaning a medicine used to induce a better state of health and increased vitality.

Even when we want to know what a person feels about something we ask, “How was their tone?” It is common to speak of various emotional states as having different “feeling tones” in relationship to a person’s emotional moods. The terms organism, having tone, lacking tone, tonic, being in tune, being out of tune, temperament, harmony, discord, mood, atmosphere, rhythm, pulse, beat and timing are common in music as well as medicine. All of these usages are part of instinctive body language although the origin of the words has been long forgotten.

The meanings of these terms are also related in German. Langenscheidt’s German-English, English-German Dictionary defines the English word Temperament as Charakter [character], Laune [temperament] and Stimmung [tuning]. Therefore, the words tuning and mistuning have their common source in the ideas of temperament and character, which is related closely to mood and disposition. The root of the German word Stimmung is stimmen, which means to be right as well as tune and is closely related to the word, Stimime, which means voice as well as vote (voicing one’s opinions). Stimmung can mean the correct tone, being in tune, the right pitch, a good atmosphere, a nice mood and a pleasant air or aura. In harmony with the original Pythagorean use of musical terms in the healing arts, the German words, Stimmung and Verstimmung, were translated as tuning, tunement, mistuning and mistunement in the Kunzli and O’Reilly editions of the Organon.

Verstimmung may be defined as mistuned, mistunement, untuned or mistuning but it also means deranged, upset, distressed, disturbed, disordered as well as ill humored, feeling bad or being in a negative mood, etc. When speaking in general about the whole state of health as related to the constitution, temperament, psyche, vital force, nervous system, bodily condition and vitality one may think in terms of “tone” and feeling “in or out of tune”, but when speaking of the specific organs like the liver and stomach, one thinks in terms like “my liver feels disordered” or “my stomach is upset”.

Therefore, to always translate Verstimmung as mistuning may be awkward in places and appear strange in some contexts. This has led some to object to the use of tuning and mistuning in association with the vital force but these individuals are not aware of the links between the vital pneumatic forces, the human temperament, tone, tuning and mistuning in medical history. The idea of tone, tunement, pleasant mood, good humour, balanced atmosphere and strong aura has been associated with harmonious health since the time of the ancient Greeks. Tone represents a state of balance, harmony and homeostasis (Gk. a similar state). The nervous system, muscles and tissues have their tone and a lack of tone in the nervous system, muscles and tissues is equated with disease. In aphorism 88 Hahnemann uses the term Gemueths-Stimmung, the tuning of the emotional disposition, which relates to the mood of the emotional temperament. Many of these terms are still in common use in modern medicine although their original source has been lost in the mist of time.

The vitalists explained alterations of the life force and the organism in terms of hyperfunction and hypofunction, which are related to overtuning and undertuning. Tonic, sharp and flat notes in music are the tonic state of balance, hypertension and hypotension. Even in common speech one refers to persons as either sharp (bright and energetic) or flat (dull and weak). The Organon uses terms like tune or tone altering (Gr. umstimmen) and over-tuning (Gr. uberstimmen) as well as tuning or toning down (Gr. herabstimmen). Tune altering is a change of a condition; over-tuning means to override something and toning down is the lowering of amplitude or force.

People often speak of a person “changing their tune” when they change their mind and we ask someone to “tone it down” when their voice is too loud. Hahnemann spoke of a homœopathic remedy “over-tuning” (overriding) the natural disease in such a manner that it replaces its affects in the vital force. A homœopathic remedy does not “over upset” the natural disease or “derange down” a condition. In this context these words may be translated in accordance with the original Greek derivations related to the Pythagorean School because they possess additional significance not found in modern language.

When the human organism (the instrument) is tuned in a harmonious natural temperament (scale of adaptation) the person’s constitution is vigorous and their tone, mood, humour, rhythm, timing, air and aura (Gr. Stimmung) are right (Gr. Stimmen). When disease powers mistune the healthy tone of the organism, the vital force (Gr. Lebenskraft) becomes mistuned (Gr. Verstimmung) and the outcome is a disturbed temperament, a weak constitution, poor tone, negative moods, ill humour, broken rhythms, bad timings, an unhealthy air and a weak aura. The teachings of the ancient Greeks hold the keys to understanding the deeper meanings of terms like vital force, tuning, mistuning, constitution, temperament, causation, psora, miasms, suffering and the signs and symptoms. This is one of the reasons why it is important to study medical history.

In aphorism 16 Hahnemann speaks of health as a “harmonious play of life”, which relates to a correct tuning of the life force, constitution, temperament, organs and tissues. Symbolically, it might be said that vital force is the conductor that guides the melodies, rhythms and volumes of the orchestra of the human organism. The vital systems, glands, organs and tissues are like strings, woodwinds, brass and percussion instruments that must work in synchronization. When the conductor is confused and the instruments out of tune the outcome is discord and dissonance. Even if one instrument is not tuned properly, it can throw the entire orchestra out of sync forcing the conductor to focus on the discord and seek to reinstate harmony! The great metaphor of live and health as music is a reflection of Pythagorean harmonics and the music of the spheres.

Physiognomy

The term physiognomy is derived from the Greek word, “physiognomoni” (physis, nature and gnomon, an interpreter), which means an interpreter of nature. The art of interpreting nature is based on the principles of similar correspondences and the “as if method”. Physiognomy is the science of judging character from the appearance of an individual. It uses outer observable phenomena as a mirror to understand the inner essence or nature of a person. In the classical Greek system the human constitution is linked symbolically to the four physical homœomeries, earth, water, fire and air. Ether is spiritual in nature and related to the psyche. On this basis, the human genus is classified into four major and twelve mixed temperaments.

A homœopathic physiognomist interprets the signs of the natural temperament to assess heredity, character, structure, sensitivity, predispositions, miasms and diathesis. This offers insight into the make-up of the congenital constitution and temperament and its tendencies toward particular signs, befallments and symptoms. The make-up of the mind and body is based on a single blueprint that manifests in the nature, quality and activities of the entire organism. This constitutes the genotype of the patient, which conditions all the individual’s reactions. Words like the organism, constitution and temperament are synonyms for a whole, which is greater than the sum of its parts. For thousands of years healers have noticed a connection between certain morphological structures and character traits. In Homœopathy this methodology is used to assess the patient’s signs and symptoms as well as to find similar homœopathic remedies.

The Four Cardinal Temperaments

Each of the four temperaments has a predominance of one of the four humours that affects the state of their constitution and disposition. Each of these constitutions has its own predisposition and reacts to the environment in a particular way.

The choleric temperament has a predominance of the bilious humour that gives them a warm, dry, lean, rectangular or square body, tight muscles and connective tissue, yellowish coloring and a tendency to be irritable, angry and impatient. This predisposes the choleric temperament towards liver complaints as well as digestive and intestinal disorders and skin eruptions.

The phlegmatic temperament has a predominance of the pituitious humour which gives them a chilly, moist, round, oval-shaped body with soft, loose, watery tissue, pale or whitish coloring and a tendency towards tearfulness, timidity and indecision. This predisposes the phlegmatic temperament towards weight gain, edema, lymphatic stagnation and genitourinary problems.

The sanguine temperament has a predominance of the blood humour that gives them a hot, moist, triangular or barrel-shaped body with strong, muscular, fleshy tissue, reddish coloring and a tendency towards pride, optimism and violence. This predisposes the sanguine temperament towards high blood pressure, blood disorders, strokes and heart disease.

The melancholic temperament has a predominance of the atrabilious humour which gives them a cool, dry, rectangular or thin body, lack of tissue, thin pipe-stem bones, ashy gray or dark coloring, and a tendency towards pensiveness, depression and nervousness. This predisposes the melancholic temperament toward hypochondria, disorders of the brain and nervous system, and respiratory complaints.

In Homœopathy there are well proven observations linking remedies with the classical temperaments. For example, Phosphorus is adapted to tall, slender persons of sanguine temperament, fair skin, delicate eyelashes, fine, blond or red hair, with quick perceptions, and very sensitive nature; Pulsatilla is best adapted to gentle, blond-haired, blue-eyed phlegmatic temperaments; Bryonia suits irritable, bilious individuals of choleric temper; and Arsenicum is well suited to the nervous disposition. These are reflections of Hippocratic constitutions as aids in the choice of homœopathic remedies. This method has its roots in Pythagoras, its trunk in Hippocrates, its branches in Paracelsus and its fruit in Hahnemann. Many practitioners do not understand the vast historical foundation on which the Organon is based. Homœopaths should become familiar with medical history if they wish to understand the complete picture.

The Twelve Mixed Temperaments

The four major constitutions are the choleric, phlegmatic, sanguine and melancholic (nervous) temperaments. There are twelve temperaments that are mixtures of the four major types. These are the cholero-phlegmatic, the sanguino-phlegmatic, the nervo-phlegmatic; the phlegmo-choleric, the sanguino-choleric, the nervo-choleric; the cholero-sanguine, the phlegmo-sanguine, and the nervo-sanguine; the cholero-nervous, phlegmo-nervous and sanguino-nervous. Each of these temperaments represents a natural grouping of constitutional types that have similar mental and physical qualities. They reflect two elemental patterns rather than one. A cholero-sanguine is predominantly a hot and moist sanguine temperament but also demonstrates secondary symptoms of the dry and hot choleric temperament. The combination of two hot elements intensifies the internal heat of the individual while the presence of moisture and dryness is balancing.

Each innate constitutional temperament has its own unique reactions to stimuli. For this reason, the same pathogen will affect the four temperaments and their twelve mixtures in a different manner. For example, the phlegmatic temperament (water; wet and cold) and melancholic temperament (air; cool and dry) are usually aggravated by cold, while the choleric temperament (earth; dry and warm) and sanguine temperament (fire; hot and moist) are usually ameliorated by cold. When this is not the case, the symptoms become more striking, exceptional, unusual, and odd. The effects of environmental factors are modified by each of the four major biological types.

Hippocratic Terms in Every Day Life

The archetypal images of the Hippocratic temperaments and humours are still in common use even in the modern English language. For instance, the word “temperamental” still means to be very sensitive or overly emotional. At the same time to be in “good or bad humour” denotes a happy or distressed state of mind. A person may also be “full of humour” or “humourless” depending on the nature of their personality. Somebody may be referred to as being in a “dark mood” or to be “melancholic” when he or she is depressed. The word, melancholic, is derived from the word “black” (L. melan) added to the Greek root “chole” meaning “bile” which denotes a dark blue-black humour or inwardly sullen state of mind. We also say that some people have a “bitter temperament” while others have a “sour disposition”. To be bitter is defined as a state of intense antagonism or hostility like the choleric temperament whereas to be sour is defined as being austere, morose, or peevish like the melancholic temperament.

Terms like these have their roots in the tastes of the four humours i.e., bitter (bile), sweet (blood), salty (phlegm) and sour (atrabile). To be “jaundiced” not only means to turn yellow because of excess bile, but also to be prejudiced, envious and resentful. To “turn white” is a common expression associated with a state of anxiety or fear. To “see red” describes someone in a violent rage and is related to the term “sanguinary” which means to be ready to shed blood. This is what it means for one’s “blood to boil”. To feel “blue” is defined as being depressed in spirits, dejected or melancholic. These terms are closely related to the colors of the four humours; yellow (bile), white (phlegm), red (blood) and atrabile (blue-black).

All of these terms are based on the doctrines of the ancient Greeks and on instinctive, innate body language. The Hippocratic theory of temperament is closely related to the psychological and the physiological functions of the psycho-neuro-endocrine system (PNE) and its relationship to morphological structures. The intrinsic connection between constitutional development and the neuro-endocrine system is well known in modern medicine, but the 2,500 year old Hippocratic system is much more advanced in its observations of human beings and their symptomatology than its modern counterpart.

Constitution and Temperament in Homeopathy

There seems to be much confusion on the role of constitution and temperament in Homœopathy. This is because the word constitution, and in some cases temperament, has been used in a number of ways depending on the circumstances. First of all, it would be helpful to review some of the most common ways the term constitution has been used over the years by various sources.

Kent used the term ‘“constitutional medicine” to describe the remedies he used to treat chronic diseases and miasms to set them apart from remedies given for acute conditions. He used the terms acute remedies (remedies for crisis) and constitutional remedies (chronic remedies) in this fashion. This was his way of drawing the distinction between medicines Hahnemann called apsoric and psoric remedies. This title, however, has absolutely nothing to do with constitution and temperament in the classical sense. As chronic diseases affect the whole organism rather than only one of its parts, Kent called his chronic remedies, constitutional medicines. In Kent’s terminology the constitutional remedy simply means a chronic remedy and has nothing to do with genotypes per se. Some critics of Kent accuse him of introducing the concept of “constitution” into Homœopathy, but in truth Kent spoke out against any sort of typology and was against the inclusion of classical temperaments in the materia medica.
Vithoulkas and his students have used the term “constitutional prescribing” and “constitutional remedy” since the early 1970s. This is actually a neo-Kentian version of the constitutional remedy that became associated with so-called “essence prescribing”. This usage of the term deviates from James Kent’s teachings because the chronic miasms are not considered to be part of the equation. Kent considered the anti-psorics, and other anti-miasmatic remedies, to be synonymous with the constitutional remedy. Most of these persons tend to be 4th Organon prescribers who are likely to start cases on single dry doses of the 200C or 1M and then have the patient come back in one month. Like Kent, this group pays no special attention to classical diathetic constitution or temperaments.
Today there are some one-sided constitutionalists who only give “constitutional remedies”. They believe in the so-called “one remedy for all situations”. Many of them do not believe in giving remedies for acute diseases or treating chronic miasms and some claim that such conditions do not exist. This, however, is contrary to all of Hahnemann’s teachings and modern science. Oddly, some of the individuals would rather have the patient take antibiotics than an acute remedy! They somehow seem to ignore the fact that antibiotics and other drugs are deeply toxic as well as suppressive and will only complicate the case. They do not pay any attention to the constitution and temperament in the traditional or modern sense. So as one can see from these first three examples, the Kentian and neo-Kentian use of the term “constitutional remedy” has nothing to do with the constitution per se. It simply means constitution in the sense that it treats the entire human organism and is therefore “constitutional”.
Dr Eziaga and his students profess the fourth popular usage of the term “constitutional remedy”. The good doctor was dissatisfied with the Kentian use of the constitutional remedy and decided that many cases needed to be treated in layers. He stratified his treatment to address the pathological layer, the miasmatic layer, the general layer and the constitutional layer. These remedies are called the lesional, anti-miasmatic, general and constitutional remedy accordingly. This method is associated with treating in layers although the layer concept did not originate with him. Ironically, it was Kent who first used the term layer although this method has no relationship with his techniques.

In Eziaga’s method the “constitutional remedy” is supposed to be given after the removal of the various layers of disease as a prophylactic to prevent future problems. This remedy is used to treat the innate constitution and temperament and remove predispositions. The use of this term is almost the opposite of the neo-Kentian constitutional prescribers and the one-sided constitutionalists. However, it does not include any direct references to the classical diathetic constitutions or innate temperaments.

There has been an ongoing debate about the role of constitution, temperament, disposition and even heredity in Homœopathy. On one side are those who say they are giving the constitutional remedy, but at the same time spurn the concept of innate constitution in any way. On the other side there are those who attack Kent for using the term constitutional remedy at all. There are also some who refute the idea that miasms can be inherited and have any affect on the innate constitution or symptoms. Then there are those who integrate the innate constitution in their layers concept. Some European schools are interested in the relationship of remedies to morphological body types. Now with all these various ideas about constitution and temperament, is it any wonder that there is confusion? Do any of these methods have anything to do with the teachings of Samuel Hahnemann, Baron von Boenninghausen, Constantine Hering, and G. H. G. Jahr?

Hahnemann on Constitution and Hereditary Disposition

The Western tradition of constitution and temperament has its origin in the theories of Pythagoras and became highly developed under the clinical observations of Hippocrates. Hippocrates taught that all natural diseases are originally constitutional in nature and later form local symptoms in an effort to provoke a healing crisis in one of the regions or systems. He also taught that many chronic diseases were hereditary in nature and were passed through the generations. The early Greek naturalists considered the innate constitution and temperament and environmental conditioning to be the number one conditioning factor in the development of the symptoms of chronic diseases. Hahnemann held similar views of the importance of the physical constitution, hereditary disposition, and environmental factors in the development of the chronic miasms. When speaking of the great variety of the symptoms of psora Hahnemann wrote:

These are varied according to the difference in the bodily constitution of a man, his hereditary dispositions, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc.

The Chronic Diseases (Theoretical Part); S. Hahnemann, Nature of Chronic Diseases, page 102.

In the original German text, Hahnemann used the term “Koerper-Konstitutionen” not “Leibes Beschaffenheit” for bodily constitution, showing that he was clearly speaking of the innate constitution not just conditions that may affect the physical organism. The fact that this term is associated with the words, hereditary disposition (Gr. Erb-anlagen) confirms that he is speaking of the genetic constitution and its inherited tendencies. Hahnemann makes it quite clear that the bodily constitution and its hereditary predispositions (nature) and environmental forces (nurture) are strong conditioning factors in the development of the symptoms of the chronic diseases. For this reason, all those who suffer from psora, and the other miasms, share certain complaints in common but also have unique signs and symptoms.

Hahnemann continues with a similar theme in aphorism 81 of the Organon and its footnote. Here he suggests that the “angebornen Koerper-Constitutionen” (congenital constitution) and circumstances like climate, locations, upbringing, stress on the mind and body, life relationships, human emotions, customs, practices and habits, all play an important role in conditioning the symptoms of psora. During the process of infection and inheritance psora has been transmitted through a great number of corporeal constitutions living in different times and under different circumstances. This has caused psora to mutate into a vast number of secondary symptoms that are now associated with manifold different disease conditions.

Hippocrates considered the seeds of disease to exist in the congenital constitution of the patient, which is greatly influenced by heredity. Epilepsy was generally called the “sacred disease” because some of the ancients thought spirits caused it. Hippocrates taught that diseases were based on natural causes not the influence of spirits, demigods or supernatural powers. In the Sacred Diseases he wrote that epilepsy was no more divine than any other disease. He opined that epilepsy had its own nature and cause and was no less curable than any other complaint unless the pathology was stronger than the medicine applied. He felt its primary origin was “heredity, like many other diseases”. He wrote that a phlegmatic person is often born from a phlegmatic person, the bilious from a bilious, the phthisical from the phthisical, and those with a spleen complaint from those suffering a spleen complaint.

The old Asclepiad asked what prevents the passage of similar diseases from the mother or father to the offspring? He reasoned that if the se-men and egg are the essences of all the parts of the body, then healthy cells come from healthy parts and unhealthy cells from unhealthy parts. Hippocrates’ astute observations have been confirmed by modern science. At the same time, Hippocrates wrote about the important influences of culture, climate, food, drink and customs in Air, Water and Places. Hahnemann also wrote that chronic miasms like “psora” could be passed through “infection and heredity” (6th Organon, fn. 78) and that hereditary dispositions and environmental factors condition the nature of the signs and symptoms (The Chronic Diseases, page 102). Modern science has confirmed that heredity factors are the number one conditioning factor in states of health and disease followed by environmental factors. This is another area where Hahnemann was far ahead of his times and misunderstood by some of his followers.

Temperaments in the Materia Medica Pura

Hahnemann first mentioned the role of temperament in Homœopathy in his lecture on Pulsatilla in the Materia Medica Pura. In this discourse the Founder spoke of how the intellectual and emotional aberrations of the patient are just as important as the physical symptoms. For this reason, the best remedy is one that fits the corporal symptoms of the disease as well as mental symptoms of the patient. This is a groundbreaking maxim that makes Homœopathy different from any other medical system. No other materia medica emphasizes the mind and body in an equal manner or records the psychology of remedies and patients in such detail.

The homœopathic employment of this, as of all other medicines, is most suitable when not only the corporeal affections of the medicine correspond in similarity to the corporal symptoms of the disease, but also when the mental and emotional alterations peculiar to the drug encounter similar states in the disease to be cured, or at least in the temperament of the subject of treatment.

Materia Medica Pura; S. Hahnemann, Volume II, Pulsatilla, page 345.

In aphorism 212 of the Organon Hahnemann stated a “chief ingredient of all diseases” are changes in the mental and emotional state of the patient, and at the same time, every medicine alters the mental and emotional state of the prover in a characteristic ways. “For this reason,” he said in aphorism 213, “one will never cure in accordance with nature unless one attends to the symptoms of the mental and emotional state, together with the other symptoms, in every case of disease”. He also notes that the innate temperament of the subject under treatment may be considered when selecting homœopathic remedies. In the following quote Hahnemann refers directly to the teachings of Hippocrates on the phlegmatic temperament.

Hence the medicinal employment of pulsatilla will be all the more efficacious when, in affections for which this plant is suitable in respect to the corporeal symptoms, there is at the same time in the patient a timid lachrymose disposition, with a tendency to inward grief and silent peevishness, or at all events a mild and yielding disposition, especially when the patient in his normal state of health was good tempered and mild (or even frivolous and good humouredly waggish). It is therefore especially adapted for slow phlegmatic temperaments; on the other hand it is but little suitable for persons who form their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered.

Materia Medica Pura; S. Hahnemann, Volume II, Pulsatilla, page 345.

The above portrait includes the psychological state of the patient in a time of health and happiness as well as the changes brought on by the alterations of disease. There are some who say that one should pay no attention to natural temperament, heredity or any positive states or mood, as they are not part of the presiding disease. They say such things are “not included in Homœopathy”. They do not understand that Hahnemann introduced the rubrics “well adapted to” which deal directly with diathesis, constitution, temperament and disposition in various materia medicas. His instructions in aphorism 5 ask the homœopath to assess the condition of the body and constitution as well as the character of the intellect and emotional disposition as part of the attendant circumstances. In harmony with these ideas, the Founder’s portrait of Pulsatilla includes the qualities of the natural temperament (timid lachrymose disposition, slow phlegmatic temperament); positive moods (good tempered, mild, good humouredly waggish); and negative emotions (inward grief, silent peevishness).

After listing the qualities of the natural temperament and negative moods, Hahnemann says that Pulsatilla is useful “especially” when the patient’s normal state is “good tempered and mild (even frivolous and good humouredly waggish)”. This portrait clearly shows the skillful use of natural temperamental states and positive moods in comparison with negative moods. This complete psychological assessment offers deeper insights into the personality of the patient. Although happy moods are not a disease they provide attendant circumstances related to character that might be helpful in selecting a remedy. This is because natural temperament contains both positive and negative dispositions that condition the way in which an individual expresses their mood swings. Once again the complete portrait of the patient and their disease involves a healthy balance between cause, miasms, disease symptoms and concomitant circumstances.

Hahnemann wrote that Pulsatilla is well “adapted for slow phlegmatic temperaments”, but it was less useful in those who “form resolutions with rapidity” and are “quick in their movements”. This usage of the term phlegmatic temperament implies much more than just an emotional mood or tone. The gentle, sentimental, empathic, sympathetic feeling tones of the phlegmatic temperament naturally come along with a moist smooth, graceful constitution that moves in wave-like motions. Pulsatilla has some of the symptoms of the nervous temperament and may appear hysterical or impulsive at times. Nevertheless it is much less indicated in the pure nervous type.

During the formative years of the materia medica at Leipzig (1818–1820), Hahnemann introduced the concept of using contradictory temperamental qualities to eliminate the incorrect remedies. These ideas were later introduced into the main body of the teachings in the note to aphorism 213.

Thus aconite will seldom or never produce either a rapid or permanent cure if the patient’s emotional state is quiet and uniformly calm. Nux vomica will not cure if the patient has a mild and phlegmatic emotional state. Pulsatilla will not cure if the patient’s emotional state is glad, cheerful and stubborn. Ignatia will not cure if the patient’s emotional state is unchangeable and not inclined to fright or vexation.

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), footnote, Aphorism 213.

This forms the basis of elimination of the unsuitable remedy by constitutional and temperamental counter-indications. Aconite is counter-indicated in mild, placid temperaments because it is more suited to plethoric, full-blooded, sanguine individuals. Nux Vomica is counter-indicated in mild, changeable individuals because it works best in the choleric rather than the phlegmatic type. Pulsatilla is not suitable for extroverted sanguine persons because it is better adapted to the tearful phlegmatic temperament. Pulsatilla is not very useful in persons who form resolutions rapidly and are quick in their movements. Lastly, Ignatia is not suitable for those who are of steady, even disposition because it works better in extremely nervous temperaments with a hysterical nature and quirky symptoms.

Hahnemann separated mental disorders in two major categories, the psychosomatic and organic. Psychosomatic disorders are based on psychological and ethical causes that affect the soul (spirit), intellect (head-sensorium) and emotional disposition (heart). Many of the organic mental disorders are caused by inherited and acquired miasms. Psychological counseling ameliorates the psychosomatic disorders yet aggravates the organic mental diseases. This is why psychiatric therapy often fails in the mentally distressed patients without the aid of homœopathic remedies. Many mental disorders have a genetic basis often related to inherited conditions and chronic miasms. These inherited dispositions affect the very make-up of the physical constitution and mental temperament.

Temperaments in The Chronic Diseases

Hahnemann noted that the classical temperaments, like the physical constitution, conditioned the nature of the symptoms that were produced after the suppression of psora. For this reason, he included the observations of “the experienced and honest” Dr Junker in the main text of The Chronic Diseases.

A brief survey of the manifold misfortunes resulting thence is given by the experienced and honest LUDWIG CHRISTIAN JUNCKER in his Dissertatio de Damno ex Scabie Repulsa, Halle, 1750, p. 15–18.

He observed that with young people of a sanguine temperament the suppression of itch is followed by phthisis, and with persons in general who are of a sanguine temperament it is followed by piles, hemorrhoidal colic and renal gravel; with persons of sanguino-choleric temperament by swellings of the inguinal glands, stiffening of the joints and malignant ulcers (called in German Todenbruche); with fat persons by a suffocating catarrh and mucous consumption; also by inflammatory fever, acute pleurisy and inflammation of the lungs. He further states that in autopsies the lungs have been found indurated and full of cysts containing pus; also other indurations, swellings of the bones and ulcers have been seen to follow the suppression of an eruption.

Phlegmatic persons in consequence of such suppressions suffered chiefly from dropsy; the menses were delayed, and when the itch was driven away during their flow, they were changed into a monthly hemoptysis. Persons inclined to melancholy were sometimes made insane by such repression; if they were pregnant the foetus was usually killed. Sometimes the suppression of the itch causes sterility, in nursing women the milk is generally lacking, the menses disappear prematurely; in older women the uterus becomes ulcerated, attended with deep, burning pains, with wasting away (cancer of the womb).

The Chronic Diseases (Theoretical Part); S. Hahnemann, Nature of Chronic Diseases, page 48–49.

This document shows that the suppression of a skin lesion causes a noticeably different syndrome in each of the four Hippocratic temperaments. It also demonstrates the fact that the innate constitution and temperament is the major conditioning factor in the development of the individual signs, befallments and symptoms. The second most important factor is the presiding psychical and physical environmental influences that directly affect the patient. For these reasons, the homœopath should pay special attention to the exciting, maintaining and fundamental causes, unresolved miasms, and all the signs, befallments and symptoms as well as accompanying circumstances.

When one compares the statements made in The Chronic Diseases and the Organon it becomes obvious that Hahnemann considered that the innate constitution and hereditary dispositions as well as the environment played a very important role in the development of the signs and symptoms of chronic disease. These conditioning factors are responsible for the great number of differing chronic diseases that may be produced by the miasms and suppression. No individuals share exactly the same physical constitution or hereditary tendencies nor do they have exactly the same upbringing, education, lifestyles, habits, customs, diet, occupation, mental temper or ethics and morality. For these reasons, no two individuals suffer exactly the same characteristic symptoms although they may share certain symptoms more common to the miasm.

The information found in these passages is very similar to the data to be recorded during case taking as expressed in aphorism 5 of the Organon. Here Hahnemann suggests assessing the exciting causes of acute diseases as well as the most significant factors in the entire history of a degenerative chronic disorder to find its fundamental cause, which usually rests on a miasm. In these investigations the healing artist should take into account the condition of the physical body and constitution (especially when the disease is chronic), the character of the intellectual and emotional disposition, occupation, lifestyle and habits, domestic and social relationships, age, sexual function, etc.

On the solid foundation of aphorism 5, aphorism 6 then goes on to collect the presiding objective signs, accidental or coincidental befallments and objective symptoms of the body and soul felt by the patient, perceived by those around them, and observed by the healing artist. This data forms the only conceivable Gestalt of the disease. The combination of the aetiology, miasms, the significant factors of the medical history and the attendant circumstances (§5) as well as the totality of the presiding symptoms (§6) offers a view of the essence of the disease state, which is the mistuning of the vital force (§7).

In aphorism 7 Hahnemann states in cases where there are no “occasioning or maintaining causes” one can perceive “nothing but the disease signs”. Therefore, it is the “symptoms alone” that point to an appropriate remedy “along with regard for any contingent miasm and with attention to attendant circumstances (§5).” In aphorism 18 Hahnemann says that there is nothing but the “totality of the symptoms with consideration of the accompanying circumstances (§5)” by which diseases show how they may be cured. Therefore, he opines that the “complex of all the symptoms and circumstances” are the “only indicator, the only reference in choosing a remedy”. The theme that the sole indicator of a remedy is the totality of the symptoms (§6) and concomitant circumstances (§5) is repeated in aphorisms 7, 18, 24, 85 and 245.

To understand the complete case it is important to assess how the physical constitution and mental temperament of the patient interacts with the mental and physical environment. What is the condition of their body? What is their constitution like? What is their mental and emotional character like? What are the occupational factors or hazards? What is their lifestyle like? What are their customs and habits? What are their familial and social relationships like? What stage of life are they in and how is the aging process affecting them? What is their sex and what is their sexuality like? What other circumstances are affecting the patient’s life? These constitutional and environmental factors form the basis of the case history because they offer insights into “Who” we are treating. Aphorism 5 provides information on the patient while aphorism 6 provides the data about the essential nature of the disease state. This balance of the patient and their disease makes up a complete case.

On the basis of the causation, miasms and concomitant circumstances one then assesses the nature of the totality of the signs, befallments and symptoms. What is the nature of the main complaints? What are the locations, regions, systems, organs and tissue that are affected? What sensations, feelings and pains do they experience? What are the times and modalities that make them feel better or worse? What concomitant symptoms does the patient experience? One must ask them where do they feel discomfort? What does this discomfort feel like? Are there any times, positions or circumstances that affect this discomfort for better or worse? Are there any other complaints that come along with this discomfort? Are there any other complaints that seem to be independent of this discomfort? If so, what are the locations, sensations and modifications of these concomitant symptoms? This investigation completes the circle of the totality of the symptoms and provides a deeper understanding of the attendant circumstances.

There are some who say one must treat the patient and others who say one must treat the disease. These individual argue at great length about this dichotomy. “One must treat the patient and not the disease” — “Oh, no! One must treat the disease and not the patient!” And round and around in circles it goes, where it stops nobody knows! Why? This is because these views express mutually opposite dualistic concepts not the middle path of common sense. No one can separate the patient and their disease because they come together as a unity of experience. No patient — no disease. No disease — no patient.

Why is this? The simple answer is the very definition of a “patient” is one who is suffering from a “disease” who consults a healing artist. If they did not suffer an illness they would not need relief nor would they see a healer so they would not be patients! It is that simple. What Hahnemann is offering in aphorisms 5, 6, and 7 is a method of treating the patient and their disease as a unity in a practical manner. Aphorism 5 concentrates on the cause, miasms, former symptoms and the concomitant circumstances affecting the patient and aphorism 6 concentrates on the essential nature of the disease case at hand. Aphorism 7 unifies all these factors together in such a manner that the patient and the disease provide all the information necessary for finding the most appropriate remedy.

Confirmations from the Paris Casebooks

Samuel Hahnemann’s Paris casebooks confirm that the Founder was well aware of the Hippocratic temperaments and diathetic constitutions. Hahnemann, Boenninghausen, Hering and Jahr, and most of the first generation, took this knowledge for granted. Rima Handley records in In Search of the Later Hahnemann that in his casebooks the Founder described Mme de la Nois as a sanguine temperament, and called Eugene Perry choleric. Hahnemann called Reverend Everest (DF-5, p. 270) “melancholic” and repertorized the rubric hypochondriacal temperament (Gr. Hypochondrische Laune) and wrote down the remedies: Anacardium, Natr., Nux-v., and Zinc (p. 328).

Jahr used the term, diathesis, to denote an inherited or acquired constitutional disposition. In the Paris casebooks Hahnemann uses diathetic terms like the lymphatic constitution. In the case of Eliane Christille (DF-5, p. 397) Hahnemann notes that the patient, a young child of three years, was disposed to scrofula. Scrofula is a state where the patient appears dirty, dishevelled and malnourished, with a tendency to swollen glands, suppurations and skin eruptions. This is the origin of the idiom a “scruffy look”. Hahnemann used his knowledge of the Hippocratic Canon to understand the nature of the physical constitution, character, and predispositions and their relationship to clinical signs and symptoms. The first instruction in case taking is to record the significant diseases found in the medical history, the causations, the chronic miasms and the seven attendant factors. This is the foundation for understanding the constitution and inherited and acquired predispositions and miasms.

Boenninghausen on Constitution and Temperament

Boenninghausen made it very clear in his writing that it was important to assess the physical constitution, mental temperament and predispositions during case taking. The Baron’s inspiration for collecting this data is clearly aphorism 5 of the Organon. He felt it was very important and included these details in an article called Brief Directions for Forming a Complete Image of a Disease for the Sake of Homœopathic Treatment. Boenninghausen wrote:

He should give a general image of the patient by stating the age, the sex, the constitution, mode of living, occupation, and especially the disposition when the person was well. In many cases it is also of importance to know other peculiarities, such as, e. g., the complexion, the color of the hair, leanness or corpulence, whether slender or thickset, etc., and this should be added.

The Lesser Writings; C. M. F. Boenninghausen, Brief Directions for Forming a Complete Image of a Disease for the Sake of Homœopathic Treatment, page 286.

Hering on Temperaments

During Constantine Hering’s extensive provings, special attention was given to the physical constitution and mental temperaments of the provers of the remedies. This was useful because it provided examples of observable physical constitutions and temperaments during the state of health, and shows how they were transformed by the provings. At the same time, it demonstrated which constitutions were affected the most by the actions of homœopathic remedies during the provings and clinical trials. If during these provings it was observed that certain remedies brought out more symptoms in a particular constitutional type, these observations were recorded. These remedies were then tested in clinical trials for confirmations, and if found to cure consistently, carefully recorded in the materia medica.

This is the source of rubrics such as the following: Nux Vomica is well adapted to zealous, angry, thin, bilious patients; Pulsatilla is well adapted to gentle persons of a phlegmatic temper; Phosphorus is well adapted to tall slender persons of sanguine temperament with fair skin, delicate eyelashes, fine hair with quick perceptions and sensitive nature; Arsenicum is well adapted to overanxious, chilly, nervous temperaments. Once the characteristic symptoms of the individual are recorded, the homœopath may conclude that this slow, tearful, gentle temperament is a morbus phlegmatica Pulsatilla, or that fat, chilly, costive, indecisive temperament is a morbus phlegmatica Graphites, etc.

The recording of the constitution, temperament, and predisposition is also applied to crisis, acute disorders and acute miasms. For example, Aconite and Belladonna are well known to have the deepest action in plethoric individuals with inflammatory sanguine states. So the use of constitution, temperament and predisposition is equally applicable in acute, half-acute and chronic states as well as chronic degenerative diseases.

Hering recorded the following diathetic constitutions and temperaments under Calcarea Ostrearum in the Stages of Life and Constitution section of the Guiding Symptoms.

II Leucophlegmatic, light complexion, blue eyes, blonde hair, fair skin.

I Fat persons.

I Persons inclined to grow fat.

I Leucophlegmatic temperament.

I Light-haired youth, growing rapidly.

II Young who grow too fat and heavy.

I Fair, light complexion, grows too rapidly. Tuberculosis.

I Fat, flabby children, with red face, who sweat and catch cold easily.

I Fat, unhealthy children.

I Darkish yellow complexion, spare habit.

I Nervous temperament, delicate constitution.

I Black hair, dark complexion, blue eyes.

I Nervous temperament, dark hair and gray eyes.

I Nervo-bilious temperament, black hair, dark complexion.

I Climacteric years; hysteric women who have not been married; who have had profuse catamenia.

I Plethoric woman.

I Full habit and ebullitions.

I Sanguine temperament, muscles soft, flabby.

I Persons subject to nightly emissions.

I For drunkards.

Guiding Symptoms of our Materia Medica; C. Hering, Volume III, Calcarea Ostrearum.

Everyone is familiar with the lighter skin, flushed face, cold, slow, sweaty, flabby, phlegmatic and leucophlegmatic temperament of Calcarea the Oyster. Hering also notes a thin, dark-colored nervous temperament and a nervo-bilious temperament. He points out that this remedy has an effect on the sanguine type with soft flabby tissue rather than those with a muscular frame. This reflects the use of the Hippocratic constitutions as aids in collecting the totality of the symptoms. These symptoms do not lead to remedies by themselves but they are part of the overall pattern of the signs and symptoms and represent a part of the general symptoms. Modern homœopaths have seen such references to diathetic constitutions and temperaments in our literature many times, but do we know what they really mean or have we forgotten?

Jahr on Constitution and Temperament

Jahr occasionally included references to classical temperament, diathetic constitution and other symptoms mentioned by Hahnemann in aphorism 5 of the Organon. For example, in his Manual of Practice he wrote: “Pulsatilla is especially adapted to ailments of the female sex, or to individuals with a gentle, good — naturedly — mischievous disposition, who easily laugh or weep, with phlegmatic temper and inclination to melancholy, lymphatic constitution, pale face, blue eyes, and blonde hair, freckles, disposition to catarrh, leucorrhoea, or other kinds of blennorrhoea.” Under Aconite Jahr noted: “Aconite is particularly suitable to persons with bright redness of the cheeks, especially young girls of a plethoric habit, disposed to rushes of blood, who are lively, nervous, irritable, and lead a sedentary life.”

Under Belladonna Jahr recorded that: “Belladonna is particularly suitable for complaints of plethoric individuals disposed to phlegmonous inflammation; or for complaints of lymphatic, scrofulous individuals liable to glandular swellings: diseases of children, females, and young people of mild temper, blue eyes, blond hair, delicate skin, and red complexion.” Under Sepia he wrote: “Affections of the female sex, particularly of feeble delicate individuals, with fine, sensitive, delicate skin.” In The Homœopathic Treatment of the Diseases of Females, and Infants at the Breast Jahr noted under Cocculus: “Difficult menstruation, with colic and uterine cramps; weakness and frequent hysterias; aversion to open air; scrofulous engorgements; gentle and phlegmatic disposition; sad.”

James Kent on Constitution and Temperament

James Kent did not approve of the use of the Hippocratic temperaments in Homœopathy. He questions the nature of such information in his Lesser Writings and criticizes Hering for introducing it into Homœopathy. In Kent’s Lectures on Homœopathic Materia Medica he quotes the physical descriptions of the remedies from Hering’s Guiding Symptoms but left out any information related directly to the classical temperaments. He complained that the idea of the constitutional types was outdated and too closely related to astrology and other forms of the “pseudo-sciences” to be of any practical use. Kent rejected the use of any biological constitutions as an aid to case taking or understanding the patient.

What benefit is it to pursue the study of biology to discover the difference in the natural constitution of human beings, when it must be the sick (morbid) condition in the constitutions of human beings that must be fully and extensively evolved to guide the physician in healing sick people?

Kent’s Lesser Writings; J. T. Kent, Temperaments, page 377.

Kent did not realize that it was Hahnemann not Hering who introduced diathetic constitutions and innate temperaments to Homœopathy. The Founder was capable of reading the original Greek, Latin and Arab medical texts and integrated the most relevant material into Homœopathy. Boenninghausen taught that it was important to understand the natural constitution in the state of health in order to perceive what is strange, rare and peculiar during disease. He summed up his view by requesting that a special section of the materia medica be made which contains all the information related to age, sex, physique and constitution. Constantine Hering fulfilled this request in his Guiding Symptoms in the section called Stages of Life and Constitution.

Kent did not seem to understand that the symptoms related to natural constitutions are based on predispositions and disease symptoms not healthy states. No one gave a remedy to a patient just because they had a sanguine temperament. Phosphorus, however, might be given to a tall, slender person of sanguine temperament with fair skin, delicate eyelashes, fine hair, with quick perceptions and sensitive nature who suffered a hemorrhagic diathesis in which small wounds bleed greatly and produce great weakness and prostration with nervous debility and trembling of the whole body from loss of vital fluids, etc. Sanguine temperaments are predisposed to these types of disease states, and when the totality of the symptoms agrees, Phosphorus has cured many such patients.

Kent did not seem aware of the depth of research that the original disciples of Hahnemann accumulated on the constitutional aspects of homœopathic remedies nor the source of their inspiration. His only comment on the adaptability of Pulsatilla to blue-eyed phlegmatic blondes was to ask sarcastically if “Pulsatilla ever produced light colored hair or has ever changed dark hair to blond.” The early homœopaths noted which of the four temperaments and their mixtures produce the most characteristic symptoms during the provings of a homœopathic remedy. The information gathered from the provings was then confirmed by performing successful cures of similar constitutions in the clinic. Provings and clinical confirmations are the source of this information not astrology or any so-called pseudo-science. The study of the constitution, temperament and disposition represents 2,500 years of clinical observation and is the oldest living tradition in western medicine.

Hahnemann suggested Pulsatilla suited phlegmatic temperaments with certain characteristic symptoms. Hering confirmed his ideas and also found that Pulsatilla worked very well in gentle, blond-haired, blue-eyed, tearful phlegmatic females. That is how Hering expanded Hahnemann’s constitutional portrait of Pulsatilla through clinical confirmations. This is not to say that Pulsatilla will not produce cures in males, or people with dark eyes and brown hair, but most patients share the basic traits of the phlegmatic temper. Although Hering used the classical temperament in his cases he warned against the use of typology as convenient boxes in which to pigeonhole patients. Having given this careful warning, Hering continued the study of the action of homœopathic remedies on the Hippocratic constitutions and temperaments because he found it practical.

Kent is right in saying that the bulk of the information on constitution and temperament found in the materia medica originally came from Hering, but he did not realize that Constantine got his inspiration directly from Hahnemann. There are also references to Hippocratic temperaments in the writings of Jahr, Hartmann, Stapf, Gross, Raue, Knerr, Teste, Hughes, Hale, Hamilton, Burt, Hoyne, Farrington, Guernsey, Duncan, King, Clarke, J. H. Allen, H. C. Allen, Roberts, Cowperthwaite, Nash, Pulford, Tyler, etc. References may also found in many old homœopathic provings and articles. Unfortunately most modern provings no longer carry descriptions of the constitution and temperament of the tester in their records and do not record which genotypes provided the most characteristic symptoms. This practice should be reintroduced.

H. Allen on Temperament

The modern classifications of the constitutions into glandular and morphological types involve very few symptoms and modalities. The four classifications of the ancient naturalists include typology, symptomatology, and modalities. This system is not to be overlooked as it has thousands of years of clinical experience behind it. There is a substantial amount of information on this subject in the works of the homœopaths of the past. The illustrious homœopath, J. H. Allen, emphasized the place of temperaments in case taking.

Temperament can not well be left out of any case in making up our anamnesis, for as we study temperament closely we see that a peculiar temperament is predisposed to certain forms of disease. In this we see a fixed law, or principle, involved. As an illustration of this we might take for example the bilious temperament so characteristic of a nux vomica patient. We know, with a positive certainty, the diseases to which he is predisposed. Are they not hepatic, gastro-intestinal, directly or indirectly, the result of an abuse or excesses peculiar to his mental makeup, and moral weakness, peculiar to himself?

The Chronic Miasms, Psora and Pseudo-Psora; J. H. Allen, Volume I, Predisposition, page 154.

H. Allen was of the opinion that knowledge of innate temperament and predispositions was an essential part of case taking and the materia medica. The study of temperament offers a deep understanding of the patient and aids in dietary and lifestyle counseling. The advice given to a choleric person is almost exactly the opposite of advice suited to the phlegmatic type. What is helpful to a sanguine temperament may be damaging to a nervous melancholic type.

H. A. Roberts on Temperaments

Dr Roberts wrote liberally on the temperaments in his classic book, The Principles and Art of Cure by Homœopathy. He supported the classical view of the four temperaments as an aid to understanding the patient and selecting homœopathic remedies. This discourse was written in 1936. Herbert wrote:

These temperaments are to a very large extent physiological, but besides the stature of the patient the matter of temperaments implies coloring, functional tendencies of circulation, elimination, respiration, and so on, and at the same time mental and emotional tendencies in reaction to the environment and circumstances. The matter of temperaments is closely allied with the basic dyscrasias, which we have discussed at greater length. Our concern at this time is particularly in relation to the temperament as it has been considered an element in prescribing the homœopathic remedy.

The Principles and Art of Cure by Homœopathy; H. A. Roberts, page 169.

Roberts opined that the temperaments are cast at the very moment of conception when the parent cells first unite. The temperament is the basis of the congenital constitution that does not change over a person’s lifetime, although there is much room for adaptation to external influences. Nevertheless, homœopathically indicated remedies have the power of maximizing the potential to the greatest degree. Correct treatment of infants and young children removes predispositions toward specific diseases before they manifest and may be considered a curative and prophylactic treatment.

The morbific influences that are attracted to temperamental tendencies are amenable to treatment and can be removed by the homœopathic remedy; this in itself is greatly preventive of the dangers arising from temperamental weaknesses.

The Principles and Art of Cure by Homœopathy; H. A. Roberts, page 170.

Homœopathic prescriptions are often based on temperamental qualities, knowingly or unknowingly, because they express characteristic symptom pictures. For example, the phlegmatic temperament is often cold, sluggish and lachrymose which is opposite of the hot, active, easily elated sanguine constitution. Roberts was of the opinion that the classical temperaments offer a deeper view of the underlying conditions than we can see from looking only at the superficial symptoms.

If we look into the case further, in the light of the hereditary dyscrasias that tend toward certain developmental changes, we will see more clearly the indications for our remedies than if we merely look at surface groupings.

The Principles and Art of Cure by Homœopathy; H. A. Roberts, page 170.

At the same time, Roberts warned against jumping to quick conclusions by the superficial similarity of well known remedies to certain constitutions. A blond blue-eyed woman with a phlegmatic temperament is not automatically a Pulsatilla patient. This is little more than one-sided keynote prescribing without the benefit of the totality of the symptoms. There are many remedies that can be suited to a phlegmatic patient depending on the signs and symptoms.

We often hear patients classified in snap judgments as a Pulsatilla patient, a Nux vomica patient, or perhaps a Phosphorus patient, because of the general build and colouring associated with these remedies. Many mistakes have been made in prescribing on this so-called type method.

The Principles and Art of Cure by Homœopathy; H. A. Roberts, page 170.

The study of temperaments is based on the provings and clinical confirmations. Nux Vomica brought out the most symptoms in choleric and nervous males with dark coloring. This does not mean, however, that Nux Vomica did not bring out symptoms in persons with different constitutions. To limit any remedy to one specific type is incorrect. These indications are meant to be used when they are confirmed by the totality of the symptoms. When the essential nature of the signs and symptoms and the congenital constitution and temperament fit the known picture of a remedy one can rest assured that the medicine will be very deep acting. The main role of temperament is to deepen one’s understanding of the patient and expand the choice of remedies rather than limit it to one stereotyped picture.

Whitmont on Temperaments

Edward Whitmont, Jungian psychologist and homœopath, describes how in his student days they used to act out a pantomime called “the hair in the soup”. This depicted the different reactions of various individuals to finding an unwanted substance in their food. He uses this as analogy of the unique manner in which the innate classical temperaments would react to the same situation. The first person flies into a rage and throws the soup at the waiter. The second person is shocked and disgusted but shrugs it off and walks out whistling a tune. The third breaks into a crying fit because they feel the most awful things always happen to them. The fourth looks at the hair, leaves it alone and then orders another portion.

This pantomime, evolved from naïve observation of the traditional four temperaments, actually casts light upon the more essential aspect of our problem. For it depicts nothing less than four different characteristic reactions to one and the same situation; or to be more exact, three different reactions and one failure to react adequately. Moreover, and this is important, it depicts these reactions in a way which makes it quite obvious that the reactions are preprogrammed and compulsive, not elective. Each individual reacts according to an innate, predetermined emotional pattern that makes it impossible for him to respond otherwise. The choleric cannot respond in a phlegmatic fashion nor can the sanguine or phlegmatic person, even if he wanted to, work up a real affect. If any of them tried to do so, let us say by willpower and self-discipline, they would at best partially succeed, and only as far as surface appearance is concerned. But this artificial reaction would be stilted and unconvincing; it would be at the price of a disproportionate expenditure of energy and of a conflict between the energy of the pattern which they try to thwart and the energy of the suppressive disciplinary attempt. For the automatic responses are of the nature of conditioned reflexes and are therefore compulsive.

Psyche and Substance; E. C. Whitmont, page 36.

Predisposing factors in the constitution and temperament condition the reactions of different individuals to the same stimuli in instinctive ways. Even if a choleric person wished they could be as optimistic as a sanguine person, their contrived hopefulness would only appear unconvincing. It is important for those with a choleric temperament to balance their rational nature, control their anger and refine their tendency toward pessimism. The responses of each individual are based on the organization of their mind-body complex and how they unconsciously adapt to the environment. The consciousness factor only has the ability to temper these reactions and bring them into a semblance of balance. This is expressed on the old saying, “a tiger cannot change its stripes”.

Constitutional Prescribing

In truth, there is no such thing as “constitutional prescribing” in isolation from the totality of the signs, befallments and symptoms. In the above sense the word “constitutional” is used by its definition as “the whole” in reference to treating the entire chronic disease that affects the whole patient. Hahnemann, Boenninghausen, Jahr, Hering and Kent did not prescribe exclusively for the “constitution” per se. Nevertheless, one can see that the Founder and the first generation of homœopaths had a much deeper understanding of the role of innate constitution, temperament and predisposition than most modern practitioners. They used their knowledge of the Hippocratic teachings combined with their own contemporary observations and integrated their experience into their clinical work.

As Hahnemann wrote, one must study the condition of the physical body and mental character as well as the occupational factors, lifestyles and habits, domestic and social relationships, age and sexuality and include this data in the case history. Boenninghausen made it clear in his case taking instructions that we must understand constitution and temperament and the other attendant circumstances so we know “who” we are treating. Hering reviewed the provings and clinical confirmations and included precise details on which remedies suited certain ages, sexes, diatheses, constitutions and temperaments in the chapter called Stages of Life and Constitutions found in his Guiding Symptoms. Jahr separated the symptoms common to the disease state from the constitutional concomitants of the patient and taught that these constitutional rubrics are often the most characteristic by nature.

Hahnemann, Boenninghausen, Hering and Jahr are the four pillars of the homœopathic paradigm and modern practitioners should not underestimate their contributions. Paradoxically, it was James Kent (who used the term “constitutional remedy”) that left their work on constitution behind. Although Kent thought his remedies had nothing to do with the innate constitution and predispositions, the symptoms he collected most certainly did! This is because the constitution, temperament and disposition are the number one conditioning factor in the development of the signs and symptoms. Strangely, Kent is blamed by some for introducing the concept of constitution into Homœopathy, when in truth he wrote against the subject! Constitution, temperament and disposition was introduced by Hahnemann, expanded on by Boenninghausen, clarified by Jahr, and recorded in the materia medica by Hering. Such is the irony of history in which every individual plays a role in a greater world drama not totally of his or her making.

A Review of Aphorisms Five, Six and Seven

Many great masters of the past taught the importance of the constitution, temperament and disposition in the pathogenesis of disease. The Hippocratic physis represents the natural forces that maintain homeostasis, provide adaptation energy and reign over defensive reactions. The ancients viewed pathology (study of suffering) as a synergistic triad of the pathogen (stress of the causative factors), ponos (strain of adaptive reaction) and pathos (suffering the symptoms). The mechanists only look at the removal of a one-sided cause while ignoring the concomitant circumstances. For example, allopaths wish to kill the “germ” while ignoring the related causes such as low vitality, weakened constitution, poor nutrition, poor sanitation, emotional stress and bodily strain. The orthodox school has forgotten the Hippocratic teachings as well as the deeper meaning of the Hippocratic oath.

There is a great difference between the one-sided concept of tolle causum (remove the cause) of the orthodox school and the synthesis of host, terrain, pathogen and the aetiological constellation in the vitalist school. Hahnemann begins his instructions on how to take a case history with aphorism 5 of the Organon. In this paragraph he introduces causation, acute and chronic disease, the infectious miasms, and seven attendant factors that include one’s innate characteristic traits (nature) and environmental conditioning (nurture). Aphorism 5 contains the essence of the breakthroughs found in The Chronic Diseases in a nutshell.

It will help the physician to bring about a cure if he can find out the data of the most probable occasion of an acute disease, and the most significant factors in the entire history of a protracted wasting sickness, enabling him to find out its fundamental cause. The fundamental cause of a protracted wasting disease mostly rests upon a chronic miasm. In those investigations, the physician should take into account the patient’s:

discernible body constitution (especially in cases of protracted disease),
mental and emotional character [character of the Geist and Gemuet],
occupations,
lifestyle and habits,
civic and domestic relationships [relationships outside and within the home],
age,
sexual function, etc.

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 5.

The first sentence of the passage introduces the theory of causation and points to the acute and chronic nature of disease. On this basis, one is asked to record the complete time and progression of the entire history of the chronic diseases, which are often based on inherited or acquired diatheses. To investigate the symptomatic effects of these causes, one must study the condition of the patient’s physical organism, their innate constitution as well as intellect and emotional character, occupational factors and talents, habits and mode of living, social and domestic relationships, the stage of life and affects of the aging process, and sex and sexuality. This all contributes to an understanding of the cause, nature, time and progression of the disease state including its layers of dissimilar diseases and complex miasms.

In aphorism 7 Hahnemann called these seven factors “the attendant circumstances”. They provide information about the condition of the physical organism and the mental temperament as well as individual responses to personal, familial, professional and social situations. Hahnemann’s seven attendant factors include information that Jahr considered to be sources of constitutional concomitant symptoms. These seven areas of study may, at times, have little to do with the main complaints or the pathology yet they often provide ample characteristic symptoms of the patient. Jahr opined that these constitutional concomitants were the most important characteristics in determining the selection of the remedy.

The first subject raised in aphorism 5 concerns aetiology and disease states. The Introduction of the Organon offers a review of Western medical history, and elucidates the foundations of homœopathic philosophy. As in all classical texts, the Founder’s work first deals with the subject of the origins of suffering and its causes. As long as human beings have walked this planet they have suffered individually, or collectively, from disorders produced by physical and moral causes. The idea of ethical and physical causes establishes a philosophical as well as a clinical basis to Homœopathy.

The suffering of an individual human constitution is based on a unique aetiological constellation, while the suffering of a group is based on diseases of common cause and similar symptoms. Rooted in these twin categories, the Founder developed one case taking method for the individual specific (§152), and another to find group specifics for the acute, half-acute, and chronic miasms (aphorisms 100, 101, 102, 103). The stress of modern civilization, rapid urbanization, overpopulation, environmental degradation, and breakdown of social ethics has compounded the effects of disease in suffering groups and individuals. Faulty physical and psychological treatments, toxic drugs, and widespread suppression have increased the problem dramatically. This is the history of humanity.

Hahnemann viewed the evolution of disease in humanity as a whole and as collective groups of people as well as unique individuals. On this basis he predicted an increase of chronic degenerative diseases in modern society. He notes that since the time of Hippocrates there has been a great quickening in the pace of these events. In the last fifty years these negative transformations have increased exponentially bringing on a global crisis. Many of these disorders are now called “diseases of civilization” in reference to their notable increase in modern western cultures and in developing countries that take on rapid modernization. The orthodox school still looks outward at a single cause because it does not understand that the proximate cause cannot be at the same time identical with the event itself. Cause and effect arise interdependently but they are not identical in either time or space. The conditions of the origin do not exist in the middle or end of a process yet they all represent the movement of the same pathogenic timeline.

To construct a complete history one needs to review the timeline of the complex disorder from its beginnings to the present moment and make a prognosis as to its future. This holds the key to understanding the direction of cure and the reversal of the symptoms during the healing process recorded in Hering’s laws. Each category of dominant causation may require a different analysis strategy and case management procedure. No study of causation is complete without the symptoms and no study of the symptoms is complete without a study of causation.

Review of Causation

In the Medicine of Experience in 1805, Hahnemann began to write of the differences between single and multiple causations and the nature of the infectious miasms. Boenninghausen reviewed the homœopathic causal doctrine in an article called “On the Judgment of the Characteristic Value of Symptoms” in his Lesser Writings. In this work the Baron introduces a 7-rubric case taking method, which is based on an ancient theological hexameter. The Baron asks the seven questions: Who? What? Where? With what? Why? What modes? When? Under the question Why? he elucidates the nature of inner and outer causations and records seven categories of causes commonly found in Homœopathy.

The Proximate Cause. The proximate cause is the deepest aspect of causation as it lies within the constitution, temperament, and their predispositions (Who?). According to Hahnemann this innermost cause is based on unethical thoughts and deeds. All other causes are external in this respect. There is a close relationship between the proximate cause and the fundamental cause as inherited miasms, since they are part of the innate constitution and temperament at birth.
The Fundamental Cause. The chronic miasms have the power to disease-tune the vital force causing disharmony in the constitution and temperament. Here the miasmic layers are dominant over the natural constitution and display the signs and symptoms of their syndromes. These miasms may be dormant, latent or active. There is an intimate relationship between the proximate cause and fundamental causes and the susceptibility to other exciting and maintaining causes.
The Maintaining Cause. These are factors that maintain the disease state. If the maintaining cause is removed before it has produced pathology the vital force will retune to the state of harmony. Maintaining causes produce illness, form obstacles to the cure, and may cause degenerative states if prolonged. These causes may include diet, environmental factors, as well as chemical, electromagnetic, and mechanical stressors. It also includes symptoms maintained by the soul (psychosomatic factors).
The Occasioning or Exciting Cause. These are acute disorders that are separated into categories of individual, sporadic and epidemic. Also included in this category are the half-acute miasms. The susceptibility to acute disorders is closely connected to the fundamental cause that lies in the chronic miasms. Psora, pseudopsora, sycosis, and syphilis all cause a heightened susceptibility to related groups of acute miasms, and their complications.
The Toxic Cause. These are diseases caused by poisons, toxins and drugs. This includes alcohol, tobacco, drugs, medicines, and pollution. Some of the cases are based on a single strong cause while others involve multiple aetiologies. These causes may be individual or collective. Environmental toxins such as air or water pollution may affect an entire suffering group, whereas drug abuse affects individuals. Many toxic causes are related to lifestyle, habits, and occupation. In some cases, natural toxins are also in the environment and may affect an individual or homogeneous group of sufferers.
Iatrogenic Cause and Suppression. These are diseases caused by faulty medical practice. This is often related to the toxic cause but the suppression syndrome plays a larger role. Suppressions are dynamic in nature as they disease-tune the vital force producing antagonistic secondary reactions that may damage the organism and drain the vitality. The constitutional remedy usually addresses minor suppressions during the course of healing but there are times when they form obstacles to the cure. When the miasmic diseases are suppressed they repress the natural symptoms producing obstruction to the cure. This category also includes side-effects caused by invasive testing and treatment.
The Traumatic Cause. These include physical injury as well as acute mental shocks. The initial effects of a cause like a blow or a sudden fright are similar enough that they are subject to the use of group specifics. The more time that has passed since the original trauma, and the more complications that have arisen, the less likely it is that a group specific may be indicated by the symptoms. These more chronic sequels demand greater individualization. If shocks to the constitution are not removed they may cause long lasting suffering or become repressed forming obstacles to the cure. The homœopathic materia medica offers first aid specifics for the first responder and a detailed study of the remedies that suit the potential complications. It also includes remedies for the long-term effects of trauma. In such cases the rubrics associated with the aetiological constellation are compared with the signs and symptoms.

A Review of the Seven Attendant Circumstances

To know the causes or observe the coincidental befallments is not enough to find a simillimum. We must understand whom it is that we are treating to complete the picture. Boenninghausen pointed out that the first question in case taking is “Who?” The homœopath must know “whom” they are treating if they wish to know “what” they suffer from and “why”. Without knowledge of the physical constitution, innate temperament, the predispositions, and causations, one cannot understand the nature of the disease process or the meaning of its signs and symptoms. “Who” is just as important as “what and why” they suffer.

The seven attendant circumstances are essential for taking a complete homœopathic case. Although some modern homœopaths think that constitutional factors play no role in Homœopathy, Hahnemann, Hering, Boenninghausen and Jahr certainly thought differently. They studied the effects of the remedies on constitution and temperament in their provings and observed them in further clinical confirmations. The following review offers a deeper understanding of each of the seven major factors in the order they are presented in the Organon.

The Observable Physical Constitution (The Condition of the Body)

Boenninghausen clarified some of the data recorded in regards to constitution and temperament. This included a psychological profile, as well as a full description of the condition of the physical constitution. By knowing the disposition when the individual is in health one can tell what is strange, rare and peculiar to the present disease. These changes in the natural disposition are very important because they represent the immaterial being that makes up the deepest aspects of the body and soul.

At the same time, a careful investigation of the physical constitutional attributes of the individual must be carried out. This includes the nature of the constitutional vitality and the physique, color, tone, make-up and condition of the physical body. What is their vitality like? What is their physique? Are they tall or short? Are they thin or obese? What is their bony structure like? Do they have tight or loose tissue? What is the shape of the head? What does their face look like? What is their chest cavity like? What color are their eyes and what do they express? What is their complexion and hair color? Do they look sweaty or do they have dry skin? Do they move fast or slow, or make resolutions quickly or hesitantly? What emotions are expressed on their face and by their movements?

This category includes Hippocratic diathetic constitutions like the scrofulous, lymphatic, venous, nervous, hemorrhoidal, herpetic, hysterical, or rheumatic constitutions, etc. and the state of vitality. This category also includes the physical and mental symptoms associated with the psoric, pseudopsoric, sycotic, and syphilitic miasms as well as the cancer diathesis. Do you see the marks of the chronic miasms in their structure? Do they have the thin chest and thin bones of TB miasm, or are they gaining watery weight and flesh like sycosis? Does their skin show the clear translucency and circumscribed reddishness of the TB miasm or do you see the hairy, dark marks, moles, and warts of the sycotic miasm? Do you see the copper colors, asymmetrical bony structure and congenital deformities of the syphilitic miasm? Does the patient have the malnourished look, rough skin, dirty complexion, and itchy eruptions of psora? Do you see a mixture of these miasmic signs and the signs of cancer diathesis? These are examples of the types of signs that should be collected by the homœopath, especially in chronic diseases.

These are all objective constitutional signs that are based on careful observation. They are general symptoms and indications of the fundamental causes, the miasms. A simple example of such rubrics is that Phosphorus is best adapted to sanguine, tall, slender, narrow-chested, tubercular constitutions that suffer from excess and exhaustion. Natrum Sulphuricum is more suited to the hydrogenoid or sycotic constitution and phlegmatic temperament with suicidal depression and violent images. Such knowledge is essential for understanding the disease, forming a prognosis, developing a case management strategy, and selecting a remedy. To study rubrics related to diathetic constitutions please refer to Hering’s Guiding Symptoms and Knerr’s Repertory. These are important general symptoms.

The Intellect and Emotional Disposition

Next comes the study of the intellectual and emotional character, which includes the qualities of the Geist (intellect, rational or sensible spirit) and Gemuet (emotional disposition), which are unique to the nature of that human being. Hahnemann uses the German term “character” of the mental and emotional nature. The word, character, implies a study of innate traits, as well as recording presiding mental symptoms as part of the totality of the symptoms. These rubrics include the choleric, phlegmatic, sanguine and melancholic/nervous temperaments and their mixtures, as well as innate dispositions like the calm or hysterical personalities. These are mental general signs and symptoms. Refer to Hippocratic temperaments and dispositions in Hering’s Guiding Symptoms and Knerr’s Repertory. The temperament of the patient must be carefully recorded as part of the complete picture.

These symptoms relate to the essence of the immaterial being, and therefore, they are considered to be of the highest quality. These psychological rubrics form important characteristic symptoms of the remedies as they truly individualize the patient. The image of Pulsatilla as a passive, sympathetic, changeable, tearful person who craves sympathy is just the opposite of Natrum Muriaticum who is more reserved and closed, represses their tears and is averse to sympathy. The homœopath can hardly miss the difference in temperament between these two remedies. The state of the emotional disposition is so characteristic that Hahnemann wrote that it is often the most useful sign in deciding which remedy is to be given.

Hahnemann rightfully calls the state of mind the most important observable sign in the homœopathic anamnesis. The mental state often tips the scales in favor of one remedy over another. The signs are something we can see with our eyes, hear with our ears, feel in our heart, and perceive with our intellect. This helps the homœopath to put the rest of the symptoms into perspective as it reveals the condition of the inner constitution and temperament.

The Occupation

The occupation that a person chooses is often characteristic of the individual’s innate talents and desires. It also is an area that reveals many maintaining causes that keep up the disease state. These are general symptoms as they are characteristic of the whole. A person’s occupation, as well as the way they approach their work, often reflects the physical and mental temperament of a person. A study of the work place also helps to reveal any occupational hazards or excessive stress a person may experience on the job. Certain remedies relate to different occupations, as they are expressions of the temperament of an individual. For example, Nux Vomica suits the classic Type A businessperson who is very aggressive about their work. This is quite different from Sulphur who is more inclined towards philosophical pursuits and gets little physical work done. Natrum Muriaticum suits those occupations that involve counseling because these people have a sympathetic ear, but also enough emotional detachment to remain objective.

Remedies like Lachesis, Lac Caninum, Lilium Tigrinum, and Sulphur undertake many things but finish few, whereas Argentum Nitricum, Lycopodium, and Silica will undertake nothing new because they fear failure. Sanicula feels better by changing their work. Tuberculinum, Calcarea and Phosphorus feel better if their work involves traveling. Graphites may be useful in diseases of farmers and other workers who do manual labor. Medorrhinum and Lachesis work best at night. Remedies such as China, Coffea, Lycopodium, Nux Vomica, and Sulphur like to make many plans, which Coffea and Nux Vomica will probably complete and Lycopodium and Sulphur will not. These are just a few examples that help to demonstrate how we may use the occupation and attitude toward work as clues to find a suitable remedy. We must also investigate the mode of living of the patient to find any exciting or maintaining causes that may engender or help keep up the disease.

Lifestyle and Habits

The lifestyle of the patient should be taken into consideration because their patterns of behavior reveal many characteristic symptoms of our remedies. What are their lifestyle and habits? Do they stay out late at night to drink, dance and party, or are they a morning person who stays home and shuns society? How do they live their lives? Fluoric Acidum is known for addiction to sex, nightlife and gambling; Origanum is known for addiction to sex and masturbation; Nux Vomica is known for addiction to work, wine, liquor, coffee, spices and drugs; Ipecac is known for addiction to morphine and heroin; Staphysagria can become addicted to abusive relationships. Palladium loves parties and is very bright during social events but suffers symptoms afterwards. They love to be appreciated and liked. Sulphur dislikes the social norms and prefers antiestablishment and alternative circles. Sulphur doesn’t care what the average person thinks about them but they want their peers to think they are special. Remedies such as Aletris Farinosa, Argentum Nitricum, Gelsemium, Niccolum Carbonicum, Niccolum Sulphuricum, and Sulphur suit literary persons. These are only a few examples.

A person’s lifestyle also reveals symptoms related to the miasms and cancer diathesis. For example, psora makes one more fitful, manic depressive or lazy and sedentary while pseudopsora burns the candle at both ends and parties until the end if possible. Psora has eccentric personal habits and prefers an unconventional lifestyle. Pseudopsora likes to be seen with the beautiful people or jet set crowd and do what is fashionable. Sycosis likes secretive affairs and illicit acts and appears to have no conscience while syphilis is obsessed with guilt for every little action but cannot resist temptations. Sycosis likes hard drink and drugs, hard-core sex and violent movies. Syphilis appears as an unconventional genius with a touch of madness that drives them to do dangerous things, which are manifestations of an inner death wish. Those with cancer diathesis care for others at the expense of their own personal lives and tend to die after loved ones die. They take on the suffering of animals, friends and relatives while not dealing with their own repressed emotions.

Customs and culture condition a person’s lifestyle. These have a tendency to produce group pictures that can form collective diseases of a common cause and similar symptoms. Customs accepted as normal in an Asian or Middle Eastern culture are very different than those accepted as normal in Europe or America. How these cultures view roles of men and women may be vastly different and attitudes to sexuality vary greatly. Nevertheless, all cultures suffer from double standards and underground activities regardless of the so-called cultural or religious norms. These standards and double standards are a source of many potential symptoms.

At the same time, countries and cultures can suffer from group psychosis such as the present obsession with Crusades and Jihads against the “evil doers”. Each side in this “clash of cultures” considers God to on their side and the other party to be possessed by Satan. Both consider the other culture as inferior and immoral and believe they are chosen people. This is a form of collective madness that can be investigated by the collective anamnesis to find a group of remedies that suits these states.

On the other hand, there are cultural norms and those who stand outside the norms. For example, it is a custom in some places in India that women cover their heads in public or around their elders. If a western woman acted in this way it would indeed be strange, rare and peculiar, and therefore, a characteristic symptom of the individual. If an Indian woman rejected such customs it would be a rebellion against the establishment, which is very uncommon. How the person reacts to their cultural norms is most significant as it reveals their innate temperament and dispositions. Sometimes, such opinions can only be expressed intellectually or emotionally, which may be discovered during the interview. These are important general symptoms that expose many aversions and desires to the careful observer. These areas of investigation help to reveal what is common to a person in their environment and what is truly striking, exceptional, unusual, and odd about the individual.

Social and Domestic Relationships

How people relate to their family reveals many traits of their personality. How are the family dynamics? How do they treat their spouse, their children, and their parents? Are they faithful to their partners, or do they have affairs? Do they hold on and control their families like the Kali group or do they lose love and flee from their families like Sepia? Do they love children and hug them like Pulsatilla or do they become short-tempered and strike them like Nux Vomica? Remedies like Fluoric Acid easily leave their mates and search for new partners, Lycopodium won’t take responsibility and abandons their children, and Staphysagria fears bringing up their family yet stays even under abusive situations. Social relationships also offer many rubrics. For example, Chamomilla, Natrum Muriaticum and Bryonia are averse to company, whereas Arsenicum Album, Phosphorus, and Pulsatilla desire companionship. Anti-venereal remedies like Anacardium, Medorrhinum, and Syphilinum are known for their criminal or antisocial behavior. How a person relates to their mates, family, friends, and society in general, is a very important source of general symptoms. To understand the full picture the homœopath must speak to the family, friends, and colleagues of the patient.

Age

The age of the patient must be taken into consideration because some homœopathic remedies have specific relationships with different stages of life. This includes important transitional times such as infancy, puberty, middle age, menopause, old age, and death. Certain remedies are more suitable for these different periods of development. For example, the remedy Baryta Carbonica is well suited to stunted children as well as old people who are fat, weak and childish in their behavior. Agaricus Muscarius is useful in nervous, chilly, old people who have weak, indolent circulation, light hair, and lax skin and muscles. In contrast, other remedies such as Borax, Calcarea, and Chamomilla are more often indicated in young children than adults.

The remedy Calcarea Carbonate suits the state of infancy but must be used with caution in the aged. Some of Calcarea’s best known keynotes center on children who grow fat, chalky, have red faces, large bellies that look like inverted saucers, large heads, with open fontanels and sutures, flabby muscles, pale skin, soft bones, who sweat easily, especially on the back of the head and neck. Other remedies such as Gelsemium, Phosphorus, and Pulsatilla are well known for their relationship to puberty, and Graphites, Lachesis, Sepia and Sulphur are commonly used at menopause. There are also remedies, such as Arsenicum, Latrodectus Mactans, and Tarentula Hispania, which are useful to ease the process of death. Of course, each of these remedies can be used at any time during a person’s life, but they are very often indicated during these critical stages.

Sex and Sexuality

Some remedies are more characteristic of females while some are more reflective of males. For example, Nux Vomica is more frequently used for men while Ignatia is given more often to women. These relationships, however, are very relative in nature and cannot be considered to be exclusive or absolute. The basis of this information comes from the provings where certain remedies brought out more symptoms in males than females and vice versa. Remedies like Murex produced very strong symptoms in women, especially in the sexual spheres yet had a less profound effect on males. In the chapter called “Stages of Life and Constitution” in Knerr’s Repertory of Hering’s Guiding Symptoms of our Materia Medica there is the rubric, Age, men, with 41 remedies. Underneath the main rubric he offers sub-rubrics with concomitants like “addicted to drinking and sexual excesses, with disposition to gout and hemorrhoids, apoplexy, I Sepia” This rubric combines the factors related to age, habits, sex, sexuality and diathetic constitutions.

Psychologists such as S. Freud, W. Reich, and C. G. Jung have pointed out that there is a connection between libido, the functions of the subconscious mind, and certain psychological states. Sexuality is deeply connected to the root of life and the deepest instincts of the vital force. The sexual vitality of the client as well as their level of desire and attitude toward sexuality must be carefully investigated, as these symptoms are very characteristic. Certain remedies like Sepia often tire of sex or become averse to sexual contact while Platina craves sexual intercourse to release tensions and is prone to excesses. Symptoms that relate to impotence, premature ejaculation, and lack of orgasmic pleasure must also be studied. In females the nature of their menstrual cycles, their health during pregnancies, and the difficulties experienced during childbirth and nursing should be taken into account.

Assessing the Attendant Circumstances and Constitutional Concomitants

The seven accompanying circumstances are concomitant symptoms that reflect the entire mind/body complex of a human being and its interaction with the environment. Without these constitutional concomitants the essential nature of the totality of the symptoms is incomplete. What do they look like? What is the nature and condition of their physical organism? What is the character of their intellect and emotional disposition? What do they do? How do they live? How do they relate to people? What is their age? What is their sex and sexuality like? These are all-important constitutional factors.

These rubrics reflect the nature and condition of the complete body and soul of the individual and tell us how they relate to others and the world. I pay very special attention to the word choice and word associations of each individual. This offers a glimpse into the unconscious regions of the psyche. Sometimes, what they say is not as important as how they say it. It may seem that they have answered my questions in a manner that revealed little but if they speak of their disease in terms of fighting the enemy, being persecuted or being based on their past sins, they are showing their innate character. These word associations might be called “mental sensations as if” and they often are “Freudian slips”. Such observations are all part of refining the art of reading the clinical signs and symptoms. This subject will be taken up more deeply as we investigate the deeper aspects of psychology related to Homœopathy.

Every homœopath should pay special attention to these seven basic areas when taking their cases because the constitution, the psyche, the personal habits, the sexual nature, as well as an individual’s relationship to work, family, and society, form important components of most cases. Investigation into these matters often leads one to the discovery of the exciting causes of acute disorders and the fundamental causes of chronic diseases. It is also essential in discovering those causes that maintain disorders and form obstacles to the cure. These obstructions to the cure must be removed by educating the patient to avoid them, and their negative influences should be removed with homœopathic remedies. The fundamental causes of disease are often linked to the condition of the natural constitution, the innate predispositions and the effects of the inherited chronic miasms. Understanding these three factors make it possible to find the correct simillimum for hereditary diseases and help manage the case effectively through proper counseling.

Sometimes, it takes a deep investigation to find a remedy, and at other times the choice of a remedy is perceived almost instinctively by the intuition. It is as if the collective subconscious perception of the remedy is revealed to the conscious mind spontaneously. This artistic style of case taking may proceed to the name of the curative remedy with surprising results. The prescriber’s perceptions are mostly based on the impression made at the time of first meeting the patient. This is observed through their physiognomy, body language, and their natural character traits as they interact with the homœopath and others present.

It is often a person’s physique, eyes, facial features, movements, and their first words that offer the homœopath an image of a remedy. The physical aspects of the symptom complex associated with the constitution includes a description of the physique, stature, shape of the head, facial features, hands, coloring of the hair, eyes and complexion, nature of the morphological tissues, structure of the bones, and the reaction of the vital forces to stimuli and the level of sensitivity, etc. All of these general constitutional signs should be integrated in case taking in the same spirit as Hahnemann expressed in aphorism 5, 6, and 7 of the Organon. This forms the basis for the totality of the characteristic symptoms.

The signs are as important as the symptoms. Most individuals do not see their own shadow and are not capable of describing themselves without compensation by the persona. It is hard for them to tell you what is really happening, especially when it comes to family dynamics, issues of personal power, and sex. You should begin to write down your observations of the client as soon as you see them enter the room. Write down exactly what they look like and what disease signs you see. Write down a description of their movements and mannerisms and continue to record such signs as you take the case.

One must also write down a complete description of their intellectual and emotional qualities. Are their intellectual traits creative, artistic, scientific, or mechanical? Are their minds focused, scattered, indifferent, or spaced? Do they talk loudly or softly with subconscious anger in the voice? Do they move quickly, slowly or in an erratic manner? Are they waiting for you to speak or are they dominating the conversation? Do they speak in a trembling voice or with an air of command? Who are they?

I do not let the patient see my case notes because they may be thinking they are really impressing me with their knowledge while I am writing down that they have a sanguine temperament, latent psora, are full of pride, puff out their chest when they talk, have starting eyes, are loquacious, flush on emotion, and have illusions of grandeur. One can see such things in their face, hear it in their voice, note it in their gestures and movements; and feel it by the way they present their persona. They simply don’t see themselves that way.

Image of a Homœopath

Each member of Hahnemann’s Homœopathic Society was given a beautifully designed diploma that contained several symbols of the ancient Greek mystery schools. The certificate is adorned at the top with the rising sun of wisdom surrounded by an oak wreath. In the center Asclepius and Hygeia are standing by a central altar. Asclepius is holding the snake-entwined staff of the healer, which is a symbol of his divine authority. His daughter’s name, Hygeia, is the root of the word, hygiene, which is symbolic of the prevention of disease. Above the altar appears the divine spirit of wisdom drinking from an offering cup. Beneath the altar is written “Similia Similibus” and “Only for the deserving” in acknowledgment of the attainment of the membership. Hahnemann’s personal seal features an image of Asclepius with the healer’s staff. Hahnemann was very knowledgeable about the symbols of the ancient Greek schools and their inner meanings.

Today some are looking to the oriental cultures of China and India to fill a void in the modern western model of health. These traditional medicines are much more holistic than allopathy and include physiognomy, constitution, temperament and disposition. Homœopathy, however, already contains the Hippocratic legacy brought up to date in a very practical manner. These images are directly related to European and American culture and directly reflect the genetic inheritance of its Caucasian inhabitants. This information, however, is also applicable in all cultures and to all races because it is universal in nature. The ancient Greeks developed a symbolic schematic that was used for storing the formulas related to the nature of constitution, temperament and the environment. This geometric form is called the Mappa Mundi, the Map of the World.

The Homoeopathic Compendium (6 Volumes, 4500 pages) offers an extensive study of classical and modern approaches to homoeopathy which provides an excellent foundation for medical practice. The series covers a wide range of subjects, described in detail and with a deep insight into homeopathic principles. This innovative work restores important lost teachings and explains unusual aspects of the healing arts with a wealth of rare information. The homoeopathic healing arts require many years of study and experience. Whether you are a student or an advanced practitioner, The Homoeopathic Compendium will open up exciting new possibilities and greatly enrich your understanding and practice of Homoeopathy. Visit www.friendsofhealth.com to read 5 free chapters and other excerpts adding up to over 300 pages of free material from The Homoeopathic Compendium by David Little.

2 Comments

David Jr says:

May 25, 2015 at 4:50 am

Hi We would love to hear any feedback/comments and thoughts that you might have after reading through this Chapter excerpt from The Homoeopathic Compendium by David Little a special thanks to the HPathy editing team for their help and support in publishing this article.

Martin Earl says:

June 11, 2015 at 12:53 am

This is like a liberal arts course in homeopathy. It gives perspective on the historical development of medical ideas and then connects all the dots and shows how ideas were derived/developed. It has a wonderful, easy to understand progression that brings the reader along in a logical manner. It seems that nothing is left out. Just as a question would form in my mind, it was answered. It’s just very well written, very accurate and very complete. Thank you!

Constitutional Medicine – Constitution and Temperament

The Hippocratic Corpus

Definition of Constitution and Temperament

In Search of the Lost Chord

Physiognomy

The Four Cardinal Temperaments

The Twelve Mixed Temperaments

Hippocratic Terms in Every Day Life

Constitution and Temperament in Homeopathy

Hahnemann on Constitution and Hereditary Disposition

Temperaments in the Materia Medica Pura

Temperaments in The Chronic Diseases

Confirmations from the Paris Casebooks

Boenninghausen on Constitution and Temperament

Hering on Temperaments

Jahr on Constitution and Temperament

James Kent on Constitution and Temperament

H. Allen on Temperament

H. A. Roberts on Temperaments

Whitmont on Temperaments

Constitutional Prescribing

Image of a Homœopath

About the author

David Little

2 Comments

Leave a Reply to David Jr X

The Hippocratic Corpus

Definition of Constitution and Temperament

In Search of the Lost Chord

Physiognomy

The Four Cardinal Temperaments

The Twelve Mixed Temperaments

Hippocratic Terms in Every Day Life

Constitution and Temperament in Homeopathy

Hahnemann on Constitution and Hereditary Disposition

Temperaments in the Materia Medica Pura

Temperaments in The Chronic Diseases

Confirmations from the Paris Casebooks

Boenninghausen on Constitution and Temperament

Hering on Temperaments

Jahr on Constitution and Temperament

James Kent on Constitution and Temperament

H. Allen on Temperament

H. A. Roberts on Temperaments

Whitmont on Temperaments

Constitutional Prescribing

Image of a Homœopath

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About the author

David Little

2 Comments

Leave a Reply to David Jr X