A scientific understanding of ACUTES and their types with references to Hahnemannian Classification
Keywords: Acutes, Dr. Hahnemann, Types of acutes, internal altered pattern, External state, Formica Rufa, Case witnessing process in acutes
When I asked my collegues, teachers and fellow practitioners how they were treating acutes, and how they understood acutes, I was surprised to hear widely differing perspectives :
- A few of my colleagues thought of acutes as a different state altogether and treated them separately from the constitution. They saw the acute as a temporary condition that differed from the constitutional state, so the remedy to be given would be according to the present acute totality.
- Then there was an exactly opposite view, which said that the presenting acute situation was nothing but a part of the deeper underlying state, and rather was a window to the constitutional state. They thought there was no such thing as an acute and all these episodes were part of one single state. So the remedy was the same as the constitutional simillimum.
With these differing views I also wanted to look up what guidelines Dr. Hahnemann gave us and maybe that would clarify my confusion. Hence I began reading the aphorisms to seek Hahnemann’s view and found the following:
Dr. Hahnemann broadly categorized diseases into Acute and Chronic types, depending upon their period of onset, course, and progression of diseases. He treated acute illnesses successfully right from the beginning, but it was chronic illnesses that he would struggle with. On his journey to understand the chronic illnesses he found that although he would treat an acute episode successfully, there would be a) either a recurrence of similar acute episodes in certain patients or b) some patients would come with recurrent acutes but with a different presenting picture every time. Eventually this led to the discovery of the Miasms. He thus discovered that these recurring isolated attacks of particular syndromes are not many diseases but varied expressions of one continuous progressive morbid process which constitutes the “disease per se”. 
Dr. Hahnemann also distinctly defines acutes in the aphorism 72 of 6th edition of Organon, “The diseases to which man is liable are either rapid morbid processes of the abnormally deranged vital force, which have a tendency to finish their course more or less quickly, but always in a moderate time – these are termed acute diseases…”
Here we see two approaches to how we look at acutes; one, that there are acutes which are self limiting episodes per say, and the other one which states that the acute is a part of the chronic picture. But when a patient is sitting in front of us, how do we identify these in the patient? Does this imply that we generally should treat acute cases with the constitutional remedy?
Whenever a patient visited me with an acute complaint, I would think about what should be my approach while examining this patient in front of me. This question would keep hovering around in front of my eyes, making me wonder whether I was doing justice while treating acute cases. Therefore I began to study acutes in order to have a deeper understanding and this opened the window for me to a better understanding of acutes.
As I began exploring, more and more questions came up:
- Why in acutes do we need different remedies if we believe in one state, one remedy?
- Do I really know what an acute is? What is the real definition of acute?
- What are the possible types of acutes?
- Do we treat individual, sporadic and epidemics cases differently?
- What is acute-on-chronic and how should we treat them?
- Do we have a scientific, simple, reproducible method of case witnessing in acutes?
- How do we construct totality in acutes?
Furthermore I also found myself ending up using “favorites” so to say, favorite remedies in acutes (like Hepar Sulph, Gelsemium, Ars Alb), without actually trying to understand the whole state and going deep enough to understand the whole acute disease phenomenon.
In aphorism no. 123 of the 6th edition of Organon, Dr. Hahnemann himself mentions that “…therefore one will never cure according to nature-that is, homeopathically-unless one considers the mental and emotional changes along with the other symptoms in all cases of disease, even in acute ones, and unless for treatment one chooses from among the remedies a disease agent that can produce an emotional or mental state of its own similar to that of the disease as well as other symptoms similar to those of the disease…”
In fact, if we understand that during the acute illness, the sudden onset of the whole disease process shakes up the entire core of the patient, the intensity of the whole disease phenomenon is so much that the whole disturbed state comes on the surface, the disturbance of the vital force is right in front of us, without any covering. Even the World Health Organization defines acutes as: “The acute illnesses, falling into any category, are intense enough to have a significant and precarious effect on the patient, though temporary.” This intensity although temporary brings out the entire disease picture undraped in front of us, and hence we can get a clearer and deeper picture of the acute. We know that disease is “the crystallization of the whole inner state.”, so the acute illness is nothing but the “Crystallization of the patient’s state’, in the form of acute diseases of short duration”.
During the acute illness, the patient is so shaken up, that the central disturbance is right there, unaltered, and thus the acute disturbance becomes the best opportunity to understand the core of the patient in the shortest possible period of time.
But this whole disturbed state during an acute can be either: the patient’s own disturbed state, that has aggravated, or it can be an external state that has caused its impression on the patient.
Take for example a patient coming to us with an acute upper respiratory tract infection (URTI). Now when we look at this patient in front of us, we may see three possibilities. The exciting factors that have led to this acute episode can be either due to: a] the patient’s own susceptibility; if the internal environment is disturbed, his own susceptibility is down, due to which he is easily affected by the slightest internal or external exciting factors, and here these factors aggravate his own internal state; b] there is a strong external situation which has caused this acute episode, in this case the external state has caused its impression on the patient, for example, a sudden change in the weather, or outbreak of an epidemic, or a strong emotional situation which has shaken the patient’s core and lead to this whole temporary suspension of the patients health and caused an acute disturbance in the health. Or c] the patient suffers from recurrent acute episodes of this type (similar clinical condition every time), and hence it is a part of the ongoing chronic process…so here we see three possible types of acutes.
With this now, let us see how Dr. Hahnemann classified acutes in Aphorism 73 of the 6th edition of Organon, 
Hahnemann classified acute diseases as those that –
a) Attack human beings individually (exciting cause being injurious influences to which they were particularly exposed. Excess in food, or an insufficient supply of it, severe physical impressions, chills, overheating, dissipation, strains, and/ or physical irritations, mental emotions: are self limiting, transient explosion of latent psora)
b) Attack several persons at the same time, here and there – sporadically
c) Attack many persons with very similar sufferings from the same cause – epidemically; these diseases generally become infections (contagious) when they prevail among thickly congregated masses of human beings
The exciting cause and conditions of epidemic cases are –
- The calamities of war, inundations and famine, etc to which a mass of human beings fall a victim to
- Sometimes they are peculiar acute miasms which recur in the same manner (hence known by some traditional name) which
i. Either attack persons but once in a lifetime like small pox, whooping cough etc, or
ii. Such as recur frequently in pretty much the same manner, the yellow fever, Asiatic cholera etc.
So here in this classification Dr. Hahnemann classifies acutes as individual, sporadic and epidemic, and gives us the exciting factors for the epidemic diseases. He also gives us exciting factors for the acute episodes which are self limiting. The classification by Hahnemann explains the acutes which can result because of a strong external situation. But here we do not understand whether the patient’s own internal state would get aggravated or will the external strong state make its impression on the patient. So is the above classification of acutes only for those diseases in which the external state causes its impression on the patient, or does he mean to say that acutes are adynamic diseases? Then what about the acutes which disturb the patient’s own chronic constitutional state and the same remedy helps to cure acute diseases?