| The fifth aphorism states:
Useful to the physician in assisting him
to cure are the particulars of the most probable exciting cause
of the acute disease, as also the most significant points in the
whole history of the chronic disease, to enable him to discover
its fundamental cause, which is generally due to a chronic miasm.
In these investigations, the ascertainable physical constitution
of the patient (especially when the disease is chronic), his moral
and intellectual character, his occupation, mode of living and
habits, his social and domestic relations, his age, sexual function,
etc., are to be taken into consideration.
OR
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 history of a protracted
wasting sickness, enabling him to find out its fundamental cause.
The fundamental cause of a protracted wasting sickness
mostly rests upon a chronic miasm. In these investigations, the
physician should take into account the patient's:
- discernible body constitution (especially
in case of a protracted disease),
- mental and emotional character,
- occupations,
- lifestyle and habits,
- civic and domestic relationships,
- age,
- sexual functions, etc.
When you are treating an acute case with homeopathy, one of the
most important points to know is the 'exciting cause' - not the
virus or bacteria - but that cause which made the body susceptible
to an illness, the 'cause' which 'excited' the susceptibility.
In conventional medicine, the occurrence of an acute disease is
very simply understood - you come in contact with a pathogen and
you catch that cold or fever or diarrhoea or any other acute disease.
You ask them why some people are more prone to catching colds ..and
the simple answer is 'they have weak immunity'. But in homeopathy,
we go beyond such simple and superficial explanations of acute diseases.
We believe that there are innumerable factors which can disturb
our homeostasis, derange or vitality and make us prone to an illness.
These factors which 'excite' our susceptibility can vary from physical
factors like exposure to heat, cold, rain. dampness, sun, or factors
like overeating or overindulgence in anything - be it food, drinks
or sex; mental factors like too much stress about studies or watching
too much television, emotional factors like loss of a loved one
or a heart-break etc. Many of these factors, if persist for a long
time, can lead to chronic conditions. But often the first reaction
to any such stress is an acute.
Let me give some examples of 'exciting causes' of acute diseases:
If constipation sets in after a mental shock or nervous strain,
Mag-carb could be the remedy; if you get a cold after getting a
hair-cut (not a hair-do but a shave or a crew-cut), then Nux-vomica
or Belladonna might be your remedy; if you get a cough after eating
rich food, then Mag-mur or Pulsatilla might be you remedy, if you
get a diarrhoea after drinking cold water on hot days, Vertrum-album
might be your remedy. I can go on to give hundreds of other examples
but the point to understand here is that the 'nervous-strain, the
'hair-cut', the 'rich food' etc do not by themselves cause disease.
They just disturb the fine equilibrium in our body, make it more
prone to the action of pathogens, which ultimately leads to the
development of 'disease' symptoms.
Another important thing to remember is that the correct remedy
should not just cover the 'exciting cause' but also the presenting
symptoms.
Treating an acute condition is not always easy, as the 'exciting
cause' is not always very evident. Still the process of finding
the remedy for an acute case is straight forward, when compared
to the treatment of chronic cases. A person suffering from chronic
gastric disturbance is very unlikely to tell you about the Typhoid
that was mal-treated when he was three. A person suffering from
Alzheimer's' might not even remember the name of his first crush
- leave aside telling you the agony 'her' affair with someone else
caused. A person suffering from congestive heart failure is unlikely
to relate a theft in his house 20 years ago as the starting point
of his sickness. So it's not always easy to pin-point one 'exciting'
cause that triggered a chronic illness.
So how do we treat a chronic disease systematically? If
we just start treating the 'current complaints' in a chronic case,
we will not be able to move beyond 'palliation' in the majority
of cases. Just like in an acute case, in chronic cases we also have
to chart the complete course of illness. But how? In acute cases,
it's easy to record changes by minutes and hours but how do you
chart a chronic illness spanning many decades? Hahnemann gave the
answer - take note of 'the most significant
points in the whole history of the chronic disease'.
A chronic illness doesn't develop overnight and often the patients
come to us with case histories running into decades. During the
whole life span of the patient, there are usually episodes of significant
acute illness, some starting point where the chronic 'disease' is
identified, followed by some treatment (usually conventional/allopathic),
after which there is a gradual increase in the intensity and variety
of complaints as well as medicines! When you start treating a chronic
case, you have to gather all this information to treat judiciously.
But how does all this information help in treatment? How does the
past history help in selecting a remedy and managing a case? Hahnemann
says that all this information - the backward tracking - enables
him to discover its fundamental cause, which is generally due to
a chronic miasm - that is, it allows you to identify the
underlying miasm (susceptibility) of the patient, which is usually
the 'fundamental cause' of a chronic disease.
Let me give you an example. Suppose you have got four Asthma
patients. All of them will show the common signs and symptoms
of asthma like breathlessness, wheezing respiration, aggravation
by cold and exertion and often night too, dry cough etc. This is
the presenting picture of the chief complaint. So do we give the
same remedy to all of them? Let's delve a bit deeper into their
histories: One of them was declared asthmatic in infancy and both
of his parents were asthmatic. The second one had eczema on both
legs ten years ago. It was suppressed with corticosteriods for years
and gradually he developed occasional episodes of breathlessness.
The third one, used to suffer from frequent colds, which were usually
treated with antibiotics. Later he developed allergic rhinitis with
sensitivity to dust, mites, pollens, strong odors and many other
things. He kept taking anti-allergic drugs for years and gradually
symptoms of dry cough and dyspnoea started manifesting. The fourth
one is a miner and has worked in coal mines for 20 years. His breathlessness
has increased gradually over the years. The first case with strong
family history is clearly Sycotic and the medicines that might work
for him are Natrum-sulph and Medorrhinum, the
second case with history of suppression of skin disease is clearly
Psoric and the medicine for him is most likely Sulphur,
and the third one with marked hypersensitivity, is very much Syphilitic
and the medicine that might work for him is Merc-sol. The
last one suffers from a pseudo-chronic or an occupational disease.
Hahnemann has said - "fundamental cause,
which is generally (NOT ALWAYS) due to a chronic miasm". The
last case falls into this category, where the fundamental cause
is NOT a chronic miasm. The medicine that might help this case is
Stannum.
This is just a gross example of how the origin and the course of
disease affects our remedy selection. There might be finer variations
depending upon the complete case details and modalities.
But our work does not end here. In chronic cases, apart from finding
the fundamental cause, we also need to find out about the physical
and mental constitution of the patient, his occupation, mode of
living, habits, life-style, relationships and much more. To understand
the importance of all these factors in detail, we will need another
lecture. So till we meet again, digest the importance of the exciting
and fundamental causes in homeopathic treatment.
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Dr. Manish Bhatia |