A. W. Woodward’s Similarity in the Sequence of Affected Organs and Tissues As a Therapeutic Guide

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Homeopath Katja Schütt discusses Dr. Alfred Wheelock Woodward‘s idea that the sequence of symptoms appearing in the patient and in the proving can help guide us to the simillimum. A chart of sequences appears at the end of the article.

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Homeopathy is based on the law of  “Like cures Like“. Based on the proving of remedies on healthy human beings‘ homeopathy aims at finding the remedy whose symptom totality is similar to that of the patient. The strange, rare and particular symptoms are to consider in particular, as these express the individuality of the patient’s disturbed vital force. Similarity, however, can also be found in other aspects between remedies and ill patients, such as between keynotes, locals, the intensity of symptoms etc., and these have been used as a therapeutic guide by other medical practitioners for a long time.

Alfred Wheelock Woodward (1839-1902) was an American homeopath and one of the foremost physicians in the West. He agreed with Hahnemann, that “the remedy must meet the totality of symptoms“, that each disease arises from a different cause and is characterized by different individual symptoms, so that patients, even when suffering from the same disease, may need a different remedy. He argued, that the constitutional peculiarities of each patient, their hereditary tendencies and clinical history, account for the different ways of development of their disease and for the difference in the aggregate of their symptoms. Emphasizing the predisposing role of the constitution he wrote in his book:

The soil in which a disease is planted often modifies, almost beyond recognition, the symptoms of the disease itself. [1]

However, he often found it difficult to find the appropriate remedy even by the aid of repertories and wanted to find a way to support the remedy choice. Analyzing cases, Woodward had observed on one hand that each patient displayed a certain sequence of affected organ systems. On the other hand, he observed in provings of the same drug, that symptoms obtained at the same time in different patients differed symptomatically – but that the result may be alike if the effects were interpreted physiologically.[2]

It means a train of physiological disturbances which is alike in the majority of provers, and, later, a group of physiological derangements corresponding thereto which is peculiar to itself. [3]

Woodward concluded, that for a remedy to cure, its action must be similar in primary, secondary and tertiary points of attack:

The curative remedy must begin its action in like manner as the disease. [4]

Once more to quote Woodward:

The clinical history is the basis upon which every disease is grafted in each individual, the remedy, that corresponds in its sequence of physiological effects, to the clinical history of the patient, becomes his constitutional remedy. [5]

Suggesting that the sequence of involved organs and tissues corresponds in the natural disease and the similar artificial remedial disease requires one to know the involved parts and sequence of their affection for prescribing. Searching for these sequences, Woodward differentiated between several systems which can be deranged physiologically and listed the order of drug action for a variety of examined remedies. He emphasized that reliability varies with each remedy. No remedy has been listed for which the evidence with regard to the order of the affected first, second and third functions were not reliable to him and he pointed out, that the fourth and fifth affected functions are more difficult to determine and required further experiments for clarification.

Discussion

To be a rational practitioner of the healing art, Hahnemann required the prescriber to know in each case what is to be cured, to know the curative powers of remedies, and to chose and apply the remedy accordingly. (§3 Organon) It is through the knowledge of our remedies that we are able to apply them according to the law of similars.

Since Hahnemann established the basic rules and principles of homeopathy, other homeopaths have tried to find additional ways to support a secure prescription. Woodward endeavors for a secure prescription and his clinical observations let him to investigate his cases and to formulate the thesis that with the homeopathic remedy, the sequence of involved organs and tissues corresponds in the natural disease and the artificial remedial disease. Investigating the sequences of remedies his aim was to learn more about the individuality of each remedy, its relative influence upon all parts of the economy, and to find characteristics which distinguish remedies from each other.

Considering the seven possible physiological systems which might be affected in a certain sequence, there is a high but limited number of possible combinations in the order of their possible affections. The number of potential remedies, however, is theoretically unlimited, which would mean that some remedies must share the same sequence. Thus, the order of affected physiological systems can’t constitute a reliable basis for prescription.

Nevertheless, Samuel Hahnemann pointed out the advantage of knowing the order of succession of symptoms in provings in §130 Organon:

If, at the very commencement, the first dose administered shall have been sufficiently strong, this advantage is gained, that the experimenter learns the order of succession of the symptoms and can note down accurately the period at which each occurs, which is very useful in leading to a knowledge of the genius of the medicine, for then the order of the primary actions, as also that of the alternating actions, is observed in the most unambiguous manner.

Early materia medicas such as Richard Hughes A Cyclopedia of Drug Pathogenesy  list the order of appearance of symptoms, allowing one to analyze the sequence of affected physiological systems. However, contemporary materia medicas merely list symptoms per se alphabetically and assigned to the parts of the body, without their context and the sequence of their appearance, thereby depriving the remedy pictures of an important characteristic.

For prescribing according to Woodward’s approach it is important to know the affected parts and the order in which they were deranged, one after another. This is difficult in cases where no complete clinical history is available as with animals or, when there is a deficient, unsatisfactory case anamnesis. As pointed out by Woodward, acute cases have to be sufficiently developed to see the sequence of affected organs and tissues, constituting a difficulty in bringing acutes to a halt in their early stages.

Cyrus Maxwell Boger listed the primarily affected regions in his Synoptic Key of the Materia Medica. For him the affected parts come last in order of importance to determine the truly homeopathic curative remedy – being preceded by modalities, mind symptoms, sensations and objective aspects. However,  Boger advised in his book that we elicit the evident cause and course of the sickness, to which all the things which now seem to interfere with the patient’s comfort will be added. While it is recognized that the causa constitutes a modality of paramount importance and is considered accordingly, the consideration of the course of the disease remains a subject of much controversy to date. Homeopaths following the so-called Kentian paradigm advocate the lifelong constitutional simillimum, whereas others opt for the layer approach to homeopathy. One of the foremost homeopaths favoring the layer approach to homeopathy was Francisco Xavier Eizayaga, an Argentinian homeopath, who differentiated between several layers within a complex model of layers, which requires to divide the symptoms of the case into these different layers for treatment. Verifying Woodwards thesis could help decide between these options, as with a different layer there would be a completely new course of the sequence of affected physiological systems.

Woodward differentiated between first and second class remedies. First class remedies are for morbid conditions caused by irritation of the nervous system, while  second class remedies are for morbid conditions arising from tissue irritation. Whilst beginning treatment with a remedy of a certain class a complementary remedy of the other class might be required – questioning the approach of prescribing one lifelong constitutional  simillimum.

Boger also pointed out that:

Laying too much stress upon some particular factor at the expense of the disease picture as a whole, destroys symmetry and forms a distorted conception of the natural image of the sickness, what often makes a cure hard.

The existence and knowledge of a definite sequence of affected organs and tissues for remedies would help in understanding the individuality of remedies and assigning them to the patient’s disease picture as a whole.

Woodward emphasized the importance of constitution and heredity, asking the question, What is hereditary?

This ghost of past generations – he declared: We can define it only as an endowment of vitality, by which we receive a different measure of endurance in our various bodily functions; one part is strong and resistant, others are weaker, others again are feeble and yield to every assault, the strong remain strong to the last, the weak are frequently deranged. Experience seems to prove that when sickness comes to its victim, it disturbs first the organs and tissues of the weakest functions; and each successive illness, that is not a repetition, will involve another feeble part; thus each experience, from infancy to old age, forms a link in a pathological chain, which, together, constitute the clinical history of that patient, and is a material expression of his hereditary weaknesses.“[6]

In my opinion, the heredity of miasms, which greatly shapes constitution, may suggest that the beginning of the disease can lie in our ancestors. Then patients may show symptoms starting at a later point of the sequence, making it difficult to see a clear sequence in the patient.

Woodward made an exception for the constitutional approach in epidemic influences, noxious environments, infectious disorders and toxical agents (external causes). He argued, that there are morbific influences superseding the individual history and weakness and producing uniform results. But after the disease has matured, the uniformity of symptoms may cease to exist and develops in those organs which had been previously weakened, hence the personal tendencies again become the guiding indication for treatment.[7] Hahnemann too advised to first treat the acute disease, and to treat the chronic disease afterwards. However, clinical experience and research could help determine whether there can really be a supremacy of external causes so that only this related remedy might help or, whether there is always a constitutional factor operating upon the vital economy so that the constitutional remedy might help too.

Alcohol is listed with the given sequence of affecting the Cutaneous, Circulatory, Spinal, Digestive, Mental System seriatimd. Being used as a vehicle for the preparation of homeophatic remedies it is for sure not inert and might distort the symptom picture.  As each substance has an energetic imprint, milk sugar too, must be considered to carry its own vibration.

It would be worthwhile to investigate several patients who have been cured by the same remedy, reciprocally, to see whether the order of their affected organs and tissues agrees, or whether the journey of the disease is much more individual, even for a particular remedy.

That the last symptoms shall be the first to disappear with the disappearance of other symptoms in the reverse order of their appearance has been stressed by homeopaths such as Hahnemann, Hering and Kent, and has been formulated as part of Hering’s rule. Hahnemann wrote in The Chronic Diseases: 

Tthe symptoms which appeared the last, are the first to disappear with anti-psoric treatment, whereas the longstanding and unchanging maladies disappear the last, and only, after all other ailments already disappeared.“[8]  In agreement with this Kent pointed out: that symptoms which disappear in the reverse order of their appearance, will stay away forever.

To see, whether cure follows in the reverse order of the development of the disease, with the related disappearance of symptoms is important to ensure a proper case management and permanent cure. Interestingly, for all investigated remedies the sequence of affected physiological systems starts with cutaneous or digestive disorders – thereby starting from the less important organs (ectoderm and endoderm) and progressing to more vital organs.

To quote Kent once more:

The development of chronic diseases is centripetal, from outside in, from periphery to center. All chronic diseases appear first at the surface, and from there they proceed eating to the vitally important centers. [9]

This relates to the requirement of cure to proceed from the most to less important organs, that is, from inside out, which is also part of Hering’s rule.

Woodward mentioned the difficulty of attributing reflex symptoms to the respective physiological system, and that a particular symptom is often the product of several deranged functions. To solve this dilemma, he advised  interpreting each symptom as belonging to the organ or tissue where it appears.

Since the early materia medicas of homeopathy have been written, much materiaol more or less useful and reliable – has found its entrance into contemporary reference works. Woodward was meticulous in his work and self-critical enough to call for a verification of his thesis and the completion of his research with regard to already examined remedies and the investigation of sequences for further remedies of the materia medica. His findings might constitute a valuable addition to the materia medica if shown to be reliable in confirming the choice of the remedy. However, to date, there remains much to research and the validation of his thesis. Nevertheless, Woodward can be said to have been an ardent homeopath with the commendable endeavor to make the most appropriate prescription and find an additional way to support remedy choice. Being convinced about the limitless power of homeopathic remedies to restore health, Woodward opined:

However complicated the case, however remote the causes, the remedy is equal to the situation. [10]

If our prescription fails, we either haven’t fully understood what is to be cured in the case or not accomplished knowing the truly curative powers of the remedy – or didn’t apply it appropriately.

The results of analyzed provings and their particular sequence of affected organs and tissues:

 

System of physiological derangement

Skin and sensorial organs – Cutaneous
Digestive – Gastric
Spinal
Respiratory
Circulatory
Genito-Urinary: Genito-Urinary / Renal / Urinary / Sexual
Mental Functions

 

CLASS I

 

Sequence of systems
Acon napellusCutaneous, Gastric, Respiratory, Spinal, Mental
ChamomillaCutaneous, Digestive, Respiratory, Mental, Spinal
CantharisCutaneous, Digestive, Genito-Urinary, Respiratory, Spinal,
ArnicaCutaneous, Digestive, Mental, Spinal, Respiratory,
CocculusCutaneous, Digestive, Mental, Spinal, Genito-Urinary,
CyclamenCutaneous, Digestive, Mental, Respiratory, Genito-Urinary,
Nux vomicaCutaneous, Spinal, Gastric, Respiratory, Mental
IgnatiaCutaneous, Spinal, Digestive, Respiratory, Genito-Urinary,
Rhus toxicodendronCutaneous, Spinal, Respiratory or Circulatory, Gastric, Mental
RhododendronCutaneous, Spinal, Respiratory, Digestive, Genito-Urinary,
Tarentula hisp.Cutaneous, Spinal, Respiratory, Genito-Urinary, Mental,
RanunculusCutaneous, Spinal, Respiratory, Digestive, Mental,
Lilium tig.Cutaneous, Spinal, Genito-Urinary, Respiratory, Digestive,
Gelsemium Cutaneous, Spinal, Mental, Gastric, Respiratory
HypericumCutaneous, Spinal, Mental, Genito-Urinary, Digestive,
Apis mellificaCutaneous, Respiratory, Gastric, Spinal, Renal
LachesisCutaneous, Respiratory, Digestive, Mental, Spinal,
Secale cornutumCutaneous, Respiratory or Circulatory, Spinal, Gastric, Genito-Urinary
CrotalusCutaneous, Respiratory, Spinal, Digestive, Mental,
HamamelisCutaneous, Respiratory, Spinal, Genito-Urinary, Mental,
Naja trip.Cutaneous, Respiratory, Spinal, Mental, Digestive,
Cactus grand.Cutaneous, Respiratory, Spinal, Mental, Genito-Urinary,
CamphoraCutaneous, Respiratory, Mental, Spinal, Digestive,
BelladonnaCutaneous, Mental, Spinal, Respiratory or Circulatory, Gastric
MezereumCutaneous, Digestive, Spinal, Respiratory, Genito-Urinary,
GraphitesCutaneous, Digestive, Spinal, Respiratory, Mental,
Arsenicum albumGastric,  Cutaneous, Spinal, Respiratory, Mental
FerrumGastric, Cutaneous, Spinal, Respiratory, Genito-Urinary
LycopodiumDigestive, Cutaneous, Respiratory, Spinal, Renal
Plumbum acet.Digestive, Cutaneous, Respiratory, Spinal, Mental,
Zincum Gastric, Cutaneuous, Respiratory, Mental, Spinal
StannumDigestive, Cutaneous, Respiratory, Genito-Urinary, Spinal,
Argentum nitricumGastric, Cutaneous, Mental, Spinal, Renal
Cuprum acetDigestive, Cutaneous, Mental, Respiratory, Spinal
Nitric acidDigestive, Cutaneous, Mental, Respiratory, Genito-Urinary,
Mercurius solubilisGastric, Spinal, Cutaneous, Mental, Renal
Mercurius corros.Digestive, Spinal, Cutaneous, Respiratory, Genito-Urinary,
HeloniasDigestive, Spinal, Genito-Urinary, Cutaneous, Mental,
AletrisDigestive, Spinal, Genito-Urinary, Mental, Respiratory,
Bryonia albaGastric, Spinal, Mental, Cutaneous, Respiratory
ColocynthisDigestive, Spinal, Mental, Cutaneous, Genito-Urinary,
PhosphorusGastric, Respiratory, Cutaneous, Spinal, Mental
TerebinthinaDigestive, Respiratory, Cutaneous, Mental, Genito-Urinary,
IpecacuanhaGastric, Respiratory, Spinal, Cutaneous, Urinary

CLASS II

Sequence of systems

SulphurCutaneous, Gastric, Circulatory, Spinal, Mental
SepiaCutaneous, Gastric, Circulatory, Genital, Spinal
Croton tig.Cutaneous, Digestive, Circulatory, Spinal, Genito-Urinary,
PhysiostigmaCutaneous, Spinal, Digestive, Circulatory, Mental,
Cicuta vir.Cutaneous, Spinal, Digestive, Circulatory, Genito-Urinary,
Hyoscyamus nigerCutaneous, Spinal, Gastric, Circulatory, Mental
Conium maculatumCutaneous, Spinal, Circulatory, Sexual,Gastric
Veratrum alb.Cutaneous, Spinal, Circulatory, Digestive, Mental,
Helleborus nig.Cutaneous, Spinal, Circulatory, Digestive, Genito-Urinary,
Salicylic acidCutaneous, Spinal, Circulatory, Mental, Digestive,
Cimicifuga race.Cutaneous, Spinal, Genito-Urinary, Circulatory, Digestive,
Clematis erect.Cutaneous, Spinal, Mental, Circulatory, Genito-Urinary,
Sambucus nig.Cutaneous, Spinal, Mental, Circulatory, Digestive,
CinchonaCutaneous, Circulatory, Gastric, Spinal, Mental
TabacumCutaneous, Circulatory, Spinal, Digestive, Genito-Urinary,
AlcoholCutaneous, Circulatory, Spinal, Digestive, Mental,
Cannabis ind.Cutaneous, Circulatory, Spinal, Genito-Urinary, Mental,
CocaCutaneous, Circulatory, Spinal, Mental, Digestive,
CoffeaCutaneous, Circulatory, Spinal, Mental, Genito-Urinary,
GlonoineCutaneous, Circulatory, Mental, Gastric, Spinal
OpiumCutaneous, Circulatory, Mental, Spinal, Gastric
Calcarea Cutaneous, Gastric, Spinal, Circulatory, Sexual
SiliceaCutaneous, Gastric, Spinal, Circulatory or Respiratory, Mental
Thuja occidentalisCutaneous, Gastric, Spinal, Tenal (or Sexual), Circulatory (or Respiratory)
Hepar sulph. cal.Cutaneous, Digestive, Spinal, Mental, Circulatory,
Natrum mur.Digestive, Cutaneous, Spinal, Circulatory, Mental,
Pulsatilla nigricansGastric, Cutaneous, Circulatory, Spinal, Genito-Urinary
BaptisiaDigestive, Cutaneous, Circulatory, Spinal, Mental,
Chelidonium majusGastric, Cutaneous, Circulatory, Renal, Spinal
HydrastisDigestive, Cutaneous, Circulatory, Genito-Urinary, Mental,
Carbolic acidGastric, Cutaneous, Circulatory, Mental, Spinal
AloesDigestive, Spinal, Cutaneous, Genito-Urinary, Circulatory,
PodophyllumDigestive, Spinal, Cutaneous, Genito-Urinary, Mental,
Hydrocyanic acidDigestive, Circulatory, Spinal, Mental, Cutaneous,
Ammonium carb.Digestive, Circulatory, Cutaneous, Genito-Urinary, Spinal,
Kali bichromicumDigestive, Circulatory, Cutaneous, Spinal, Genito-Urinary
Rumex crisp.Digestive, Circulatory, Cutaneous, Spinal, Mental,
IodiumDigestive, Circulatory, Cutaneous, Renal, Spinal
SanguinariaDigestive, Circulatory, Cutaneous, Mental, Spinal,
BromineDigestive, Circulatory, Cutaneous, Mental, Genito-Urinary,
Tartar emeticDigestive, Circulatory, Spinal, Cutaneous, Mental,
AntimoniumGastric, Circulatory, Spinal, Cutaneous, Mental

References

  1. W.Woodward, Constitutional Therapeutics, Bjain Publishers
  2. William Harvey King, History of homoeopathy and its institutions in America; Palala Press
  3. Cyrus Maxwell Boger, A synoptic key of the materia medica, B.Jain Publishers, New Delhi
  4. Francisco Xavier Eizayga, Treatise on Homeopathic Medicine, Ediciones Mareceles, Buenos Aires
  5. Samuel Hahnemann, Die chronischen Krankheiten
  6. James Tyler Kent, Zur Theorie der Homöopathie
  7. https://archive.org/stream/bradford035-jpg10-mediumsize-pdfx/bradford035-jpg10-mediumsize-pdfx_djvu.txt
  8. https://www.yumpu.com/de/document/view/11800695/predictivehomeopathydrprafullvijayakar-heilpraktiker-fur-/3
  9. http://www.rolandmethner.de/pdf/Das%20M%C3%A4rchen%20von%20der%20Hering%C2%B4schen%20Regel,%20HK%202010.pdf

Quotes

[1] A.W.Woodward, Constitutional Therapeutics, p.27

[2] A.W.Woodward, Constitutional Therapeutics, p.81

[3] A.W.Woodward, Constitutional Therapeutics, p.81

[4] A.W.Woodward, Constitutional Therapeutics, p.24

[5] A.W.Woodward, Constitutional Therapeutics, p.30

[6] A.W.Woodward, Constitutional Therapeutics, p.21

[7] A.W.Woodward, Constitutional Therapeutics, p.41

[8] Samuel Hahnemann, Die chronischen Krankheiten, p.168

[9] James Tyler Kent, Zur Theorie der Homöopathie, p.19

[10] A.W.Woodward, Constitutional Therapeutics, Bjain Publishers, p.79

About the author

Katja Schuett

Katja Schuett

Katja Schutt, Msc, HP, DHM, PGHom, DVetHom, has studied homeopathy with several schools, amongst which David Little’s advanced course stands out as it offers a really deep insight into homeopathic philosophy and materia medica (simillimum.com). Her current focus lies in working with animals and studying history, the old masters, and research.

7 Comments

  • Woodward emphasized the importance of constitution and heredity, asking the question, What is hereditary?
    This ghost of past generations …….we call miasma
    Thanks for the great article Katja

  • I’m pleased to see Dr Woodward’s method described. I discovered his book years ago and have found a remedy based on a clearly made out sequence to work very well. The difficulty in most chronic cases is in establishing the sequence, something Woodward mentions, but which is much more difficult today. It is a wholly original method, to my knowledge unique in the whole field of medicine, and quite different from any other way of doing homeopathy. His sequence idea also forms an interesting prognostic system, as he describes in his example of the man who falls from his horse and fractures his malar bone. I recommend a close study of his “Constitutional Therapeutics”.

    • Thanks for your comments, Richard. Woodward’s book is a gem, indeed, as so many pieces written by the old masters!

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