Homeopathy Papers

Constitution, Timeline and Temperament

Written by Luc De Schepper

Dr. Luc de Schepper offers a consummate discussion of “Constitution”.

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.

~ Paracelsus

What Does ‘Constitution’ Mean?

The term ‘constitution’ has different definitions in modern homeopathy. Some authors use it to mean the remedy that matches the patient’s totality of symptoms for a chronic condition with particular emphasis on the patient’s personality and temperament. In this usage, the constitutional remedy is the currently-needed chronic remedy in contrast to an acute remedy. The patient may have needed different constitutional remedies at other times of her life depending on the circumstances.

Others use the term to mean the remedy that matches a patient’s individual type and which is unchangeable for life. This lifelong remedy can be any one of hundreds or even thousands of remedies available. Some homeopaths believe that this same life-long remedy will cure any acute condition that arises for the patient, if given in an acute potency.

The constitution can also mean the innate constitution the underlying “stuff” of which the person is made on a mental, emotional, and physical level, but which is not necessarily the curative remedy for the patient’s current condition, whether acute or chronic. In this view, the patient will need different remedies at different times of his life, depending on the different layers formed by traumas or Never Well Since. These remedy layers form on top of the innate constitution, like the layers of an onion.

To clarify the terminology which will be used in this book, ‘constitution’ will follow the third definition, that of innate constitution. The remedy needed for a particular layer can be called the ‘temporary constitution’, in keeping with the first definition, but I have found this to be too confusing, so l call it the therapeutic remedy, the layer remedy, or usually just the remedy. In this system of working with the constitution, the patient receives the remedy for each layer in her timeline, working backwards from the present, and when all the layers and miasmatic states are cleared she receives her constitutional remedy in a 10M potency, 3 pellets dry. The constitutional remedy will, strengthen the patient, prevent recurrence of acute conditions, and help “polish the diamond” by bringing out the best qualities of the constitution and minimizing any weaknesses.

The main difference between this definition of ‘constitution’ and the second one is that in this model there are only seven possible innate constitutions, with any number of possible remedy states imposed on them. At the time of conception a person can be a Sulphur, Phosphorus, Calcarea, CaIc phos., Silica, Lycopodium, or Baryta carb. Most of these are minerals involved in basic physiological processes. Lycopodium and many other polychrests contain a high percentage of one or more essential minerals.

lt is the life experiences which impose a pattern such as Pulsatilla, Nat. mur., or Sepia. If the developing child is strongly influenced by a trauma in utero she can be born with all the qualities of one of these layer remedies. For example, I have often seen in my practice that when a pregnant woman receives terrible heartbreak or shock, her child is born needing a grief remedy like Ignatia or Natrum muriaticum The child of parents with active gonorrhea can be born a Medorrhinum. In these cases, the symptom picture of the acquired remedy is stamped on the baby so early, so profoundly that it is “as if” the patient is a Nat mur or a Medorrhinum.

Clinical Case: I saw a baby at age 4 months whose Chief Complaint was tachypnea (attacks of rapid respiration, more than 80-100/min) Her parents had consulted many specialists to no avail. Since the child was born in this condition, I knew the trauma must have happened intra-utero. I asked the mother if anything had happened in pregnancy. She told me that when she was three months pregnant, the doctors told her that she would probably miscarry the baby (although the mother could not tell me what test this prediction was based on). The Never Well Since was the all-too common “hearing bad news”. I asked the mother exactly how she felt at that moment. She said she felt an enormous sense of loss and lamented, “Why did this have to happen to me?” She sighed and wept for many days until finally she was told that her baby was safe. But the damage had already been done to the baby (and also to the mother, who became very anxious about her baby). The remedy which the mother needed at that point — Ignatia — was also the one the baby needed when she was born. After one month on Ignatia LM1, prn, the baby’s breathing became completely normal. Her allopathic specialist simply said, “She must have grown out of it.”

Clinical Case: I had a patient, a man in his forties, all of whose symptoms pointed to Natrum muriaticum He had had them his entire life, as far back as he could remember. I asked him if he might have had an experience of abandonment in infancy. He promised to ask his mother and found out something he had never known before: she did not want to be pregnant with him, bad decided on an abortion, and was already in the stirrups in the doctor’s office when she changed her mind. The unborn child took this as an abandonment and was born a Natrum muriaticum Nat mur resolved his Chief Complaint (recurrent herpes simplex attacks) and brought out the qualities of his innate constitution (Sulphur).

We find that no matter how many Nat mur qualities a Patient has, for example, we can always see the innate constitution peeking through. A Nat. mur who is a Phosphorus underneath will be different from one who is innately a Sulphur or Calcarea. One important difference is in the sensitivity level. A Phosphorus will need the smallest possible dose of Nat mur or else she will aggravate. A Sulphur will need a moderate-to-strong dose, and a Calcarea may not react at all unless we give her an extra-strong dose of Natrum muriaticum Thus it is essential to determine the constitution in order to adjust our dosage correctly to the patient.

The constitution will show through in many other ways like the energy level and type. A Phosphorus, no matter what her current remedy layer, will tend to have an initial flare-up of enthusiasm and energy at the beginning of a project, then quickly run out of steam, while a Calcarea will always be slow to get going and then be persistent once he has some momentum built up. A Phosphorus will tend to be willowy, a Calcarea stocky or even chubby.

lt is also helpful to know the constitution because each constitution is associated with certain typical acute remedies and layer remedies. Phosphorus being the most emotionally sensitive and impressionable, are the most likely to develop states such as Nat mur, Staphysagria, Causticum, Pulsatilla, and others related to emotional traumas. The high-energy, hard-working Suiphur is likely to develop a Nux vomica state and even a Sepia state Calcareas are the least likely to develop a layer, because they have a sturdy, solid strength which makes them resilient in the face of most life-experiences. However, they have a weak spot they are so devoted to their home and family that a loss in that area can lead them to a Nat mur state, Pulsatilla state (more often seen in girls and little boys) or Stramonium state (more often seen in older boys). Calcarea also has a physical weak spot lax ligaments, leading to sprained ankles and lower back strain which require Rhus tox., one of the acutes of Calcarea.

While each constitution has typical chronic remedies it needs, a strong traumatic blow can impose a layer on a patient of any constitution: for example, a high-impact car accident with a resulting blow to the head can create a Nat. sulph. layer in any constitution.

This understanding of the innate constitution and remedy layers should become more accepted as homeopaths become aware of the concept of etiology; layers, stresses, vaccinations and other complex diseases repressing the true innate constitutional state. I am not alone in this opinion, as I have seen many of the old masters (Compton Burnett, Pierre Schmidt, Margaret Tyler, Foubister, and Shepherd) taking these facts into account in their therapeutic approach. Figure 8-1 illustrates how a patient’s timeline can be used to determine the series of remedies which will be needed, ending with the constitutional remedy (Phosphorus, in this case) in a single 10M dose.

While the innate constitution usually does not change, there is one exception: many children are born Calcarea (about 50% among my American patients, by rough guess) and of those a certain percentage will change into Sulphur, Lycopodium or Calcarea phos. (Many patients are born Suiphur, Lycopodium or Calcarea phos without going through a Calcarea stage.) Dr. Douglas Borland, whose Children’s Types has contributed so much to our understanding of constitutional prescribing for children‚ has noted a change in type in children as they develop. For instance, according to Borland, he often saw typical Calcarea children among 2 and 3 year olds, but rarely after age 3. There was a second period, he said, from about 2 to 8 or 9 years old, during which the child’s type remained fairly constant, although it might have changed from that of the previous period. A third period lasted from about 9 to about 15 years of age during which the child again remained fairly constant, but a type different from the previous one. After the age oft 16, according to Dr. Borland, children gradually developed their permanent adult type.

Looking at my own practice, I see a slightly different phenomenon. I would see the first changes at around age two, and the next big change definitely around puberty when the lifelong constitutional change is achieved. Many Calcarea children remain Calcarea through-out life; of those who change, the majority become Sulphur, some become Phosphorus, and few become Lycopodium. Again at puberty some of the stocky or even chubby Calcareas shoot up and become Calcarea phos. (see Fig. 8-2). Of course, times have changed since D. Borland was practicing: different mental and emotional stresses, foods, and disease expressions, among other factors, may well account for the changes. The important thing for the practitioner is to know that these changes do take place. They do not indicate a mistake in the homeopath’s original assessment of a young child’s constitution.

Key to Fig. 8-1:

Julia, a 35-year-old divorced woman, presents with a chief complaint of recurring yeast infections. She has had them since she was 33 and was given several rounds of antibiotics for the flu.

Current layer: NWS antibiotics. Remedy:Thuja.

In addition, she has had headaches, backaches, memory loss and unexplained crying fits since she was in a serious car accident at the age of 31.

Previous layer: NWS head/spine trauma. Remedy: Nat. sulph.

She has also had recurring urinary tract infections. She traces them to a failed marriage; she says she got married too early, and to the wrong person. He turned out to be abusive to her, mostly verbally (putting her down a lot) but also occasionally physically (slapping her) and sexually (forcing sex on her). She developed recurring UTIs about this time and has had them on and off ever since.

Layer: NWS humiliation, abuse. Remedy: Staphysagria.

Actually, she says, she used to get them a lot when she was a little gin. This man she married kind of reminds her of her babysitter’s boyfriend who used to come over with the babysitter and “fool around with her”. She has no actual memories of abuse but she has a “creepy feeling” when she thinks about him now. Since UTIs are such a typical expression of Staphysagria (one of the top abuse remedies covering sexual abuse in particular) you suspect that in fact she was sexually abused as a little girl.

Layer: possible sexual abuse. Remedy: Staphysagria.

She got married at a time when she was very depressed and was even thinking about taking her own life. Her mother died when she was 17, leaving her with no relatives and no money for college, which had been a lifelong dream of hers.

Layer: loss of everything important. Remedy: Aurum.

She was anorexic as a teenager. She describes herself as very lonely, emotionally withdrawn, perfectionist, self-critical. She was like this ever since she was born (her mother thinks it’s because Julia’s father left when her mother was pregnant with her). Her emotional withdrawal became much more severe when she was a teenager, because she moved when she was 12, leaving behind her only friend; also she was not able to bring her dog to her new home.

She thus has two grief/loss layers: one prenatal, and one from age 12. Remedy: Nat. mur.

Note: remedies are given for purposes of illustration only. Each layer has more than one possible remedy. The point is that the patient will probably need each of the remedies in reverse order. Then, to strengthen her, you give the remedy for her innate constitution, which is Phosphorus.

Two Sides of the Coin

The constitutional types, like all the polychrests, have both a light and a dark side. Depending on the circumstances and life experiences, the same quality can have positive or negative effects. For example, a trait such as boldness may add to an individual’s business success but hinder a relationship with a sensitive, private individual who might consider him an uncaring clod (“too pushy, too business-like”) The role or mood of the observer can also determine how the trait will be received.

And the innate or true constitution contains traits which in themselves are potentially positive but may turn more negative under the stress of illness and disharmony in the system. For instance, a stubborn individual may achieve his goals in business, but this stubbornness may turn into an obstacle when he falls ill and disregards the advice of his well-meaning spouse and physician. So there is an interaction between the constitution and the influences which act upon it.

To take another example, Nux vomicas have courage, drive, competitiveness, and decisiveness. But they are also .pone to anger, frustration and the tendency to dominate others. These qualities can be pathological, depending on the situation and the intensity of their expression. This is true of all the polychrests. Sulphur has a tendency to political, metaphysical, and scientific speculation. These tendencies can be healthy, leading to great accomplishments, but when perverted they can easily become extreme radicalism (as in terrorists), impractical philosophical rationalizations, and fruitless pseudo-scientific theories which lead nowhere.

A particular temperament has a tendency to develop certain pathological symptoms (or morbid signs, as Hahnemann called them). For instance, if a young child suffers from a grief or loss leading to a Nat. mur. state, a constitutionally Sulphur will tend to move on and grow out of it while a sensitive, sympathetic Phosphorus child could remain a Nat mur for the rest of her life. Once a Phosphorus becomes a nat mur she tends to set up situations for herself which reinforce the Nat. mur. state. (I call it “taking the Nat mur road” instead of the Phosphorus road which is her birthright.) The Nat mur road is predictable: Nat mur will not open to others easily, and a Nat mur child may only have one close friends, setting herself up fo another grief if the friend moves away or they are assigned to different schools. Or she may pour all her affection into a pet (typical for a Nat mur, who trusts the unconditional love of a pet), then suffer a grief when the pet inevitably dies or is run over. As a teenager, she will be overly sensitive and easily offended, even more so than her peers, leading to more isolation and suffering. She may suffer from anorexia or bulimia, whose etiology so often shows a grief such as the parents’ separation or divorce.

She will often begin a pattern as an adolescent which she will continue throughout life: choosing an unattainable or unsuitable partner. As a teenager she may get a distant crush on a teacher or on a boy who is unlikely ever to notice her, because this is safe: she cannot be hurt if the relationship never gets beyond the fantasy stage. As a young woman she may choose men who are unsuitable because they are recovering alcoholics or drug addicts or otherwise seem like “good causes” (one of the Nat mur “theme songs”). But she will treat these man as “fixer-uppers”, trying to reform and perfect them until they inevitably grow tired of her nagging and leave her.

Years of repeated grief’s and heartbreaks will make her try to protect herself emotionally, walling off her heart and making it ever more difficult for her to get close to a partner, a friend or even a co-worker. Since she tends to think that these losses are her fault, she will overcompensate by trying to perfect herself, usually by working much too hard, leading her into a Sepia state. She can also get into a Sepia state by crusading to reform something or taking on too many responsibilities as a way to forget her own misery. (Nat mur’s tend to become crusaders because they try to reform the world just as they try to perfect themselves and those around them. Members of MADD, Mothers Against Drunk drivers, provide a perfect example: women whose children have been killed by drunk drivers and who try to channel their enormous grief into a constructive attempt to keep drunk drivers off the road.) We often see Nat mur and Sepia states alternate in these patients. Unless treated homeopathically, they never have a chance to return to the outgoing, upbeat, vivacious and social nature of their innate Phosphorus constitution. This scenario is illustrated in Figure 8-3.

Indications for Constitutional Prescribing

Protection in childhood: Homeopathy will do more to restore children to health when they are to overcome their inherited weaknesses and to prepare them for a healthy and useful life than any other system of medicine. Patients who have had the benefit of good homeopathic prescribing since childhood incur fewer chronic diseases later in life. The best protection comes when the child’s constitutional remedy is given, after removing all the layers. Children usually have far fewer layers than adults, of course, since they have not received as many buffets from life. We can remove the layers relatively quickly and give the child her constitutional remedy (always 10M, 3 pellets dry) to protect her from childhood diseases and bring out the best qualities of her constitution.

Preventing recurrence: When the appropriate acute remedy cures but fails to prevent recurrence illness (as in recurrent otitis media in children), the constitutional remedy will strengthen the Vital Force and prevent recurrence.

Ending the treatment: After treating the patient’s layers, in order to reinforce his health, we give the constitutional remedy as our last therapeutic gesture.

Acute diseases: In acute diseases presenting different symptoms in each patient but resulting from the same morbific agent(childhood diseases), or in acute diseases presenting similar symptoms, but resulting from different morbific agents (such as allergies), the constitutional remedy can prevent recurrence. It is not usually used as the acute remedy. (Occasionally, of course‚ a Phosphorus will need Phosphorus for her cough out of the dozens of possible remedies, or a Sulphur will have a skin condition requiring Sulphur acutely. In these cases the remedy is prescribed by its indications just like any other acute remedy.)

Avoiding aggravations in hypersensitives: While we usually work from the most recent layer to earliest, an extremely hypersensitive patient might react to every remedy, even in the slightest amount and potency, with an aggravation. * While there are many more options like adjusting the LM potency downwards or using the olfactive or skin method, another possibility is to strengthen the Vital Force with the patient’s constitution in an LM potency prn (see Fig. 8-4)

*This discussion applies to the treatment of chronic cases, not acute. I have often found that my students hesitate to use a higher potency in a sensitive constitution such as a Phosphorus. However, if we deal with a strong, acute miasmatic state, we have to counteract with a strong potency of the indicated remedy even in hypersensitives. If a Phosphorus has a heartbreak or bronchitis, do not hesitate to give her a 200c or 1M of the indicated remedy. You do not need to use a 6c for fear she will aggravate.

When Constitutional Prescribing Is Not Indicated

Some homeopaths use only the constitutional remedy, even for an acute attack. (By ‘constitutional remedy’ they may mean the currently-indicated chronic remedy which was acting before the acute situation arose, rather than the innate constitution)

Using the current chronic remedy may in fact work in acute events The question is why it works sometimes and other times not at all. lt will work when the acute disease is not too intense and thus creates a relatively small layer. In these circumstances, the chronic remedy strengthens the patient’s Vital Force so that it can annihilate the acute layer. (Of course, we may not forget that acute conditions often disappear on their own without any help from our remedy.)

But if the acute incident is more serious or long-lasting, it takes on a life of its own (creates a bigger layer), dominating the Vital Force and creating uncomfortable or even life threatening symptoms. For example, a patient who has acute traveler’s diarrhea for several weeks will obviously need acute remedies such as China or Arsenicum while the chronic remedy is suspended.

While it may be true to a certain extent that a patient who needs China or Arsenicum chronically is more susceptible to an acute attack requiring the same remedy; this notion of inherent susceptibility is not enough to explain why people come down with acute illnesses. When the “morbific force” (as Hahnemann called it) of an acute illness is strong enough, people of all constitutions and temperaments are susceptible. For example, when I went to China on a group tour, everyone except me came down with traveler’s diarrhea, and they were definitely not all China and Arsenicum remedy types.

Since giving the chronic remedy in an acute attack may not work, precious time can be lost while waiting to see how the patient responds. At the very least, the practitioner should first assess the strength of the Vital Force and the intensity of the acute event to see if this method is likely to work. If it doesn’t, precious time will be lost, the patient will suffer, and as a result he may resort to suppressive drugs. My own preference is simply to give the indicated acute remedy while suspending the chronic treatment, if any.

Some homeopaths believe that prescribing the innate constitution will treat all the patient’s acute conditions and remove all the layers. Experienced professional homeopaths who follow this system know that there are obvious exceptions to this approach (as in a car accident, for example). But beginners who follow the advice too literally can endanger their patients. For instance, a Phosphorus patient could die from being given his constitutional remedy in a case of acute TB. He will probably need a small lesional remedy like Sanguinaria. Unless the constitutional remedy happens to match the specific acute symptoms, it will take a different and sometimes small remedy before we can use the constitutional remedy to complete a lesional case like this. The strong, even life-threatening, acute layer needs to be separated from the chronic state of the patient. In fact in some advanced states of chronic disease (the “one-sided diseases” described in Chapter 4, Pathology)‚ the constitutional remedy is completely contraindicated. Terrible aggravations can come from ignoring the layers of disease in advanced cases. Even giving the “layer remedy” can be contraindicated during an acute attack. For example, Margaret Tyler said not to give Nat mur during a crisis headache because it can cause a strong aggravation. Instead give Bryonia, the acute, complementary remedy of Nat. mur.

Further Remarks on the Constitution

We can make a distinction between four different remedies:

  1. The constitutional remedy reflecting the mental, emotional, physical, and miasmatic foundation of the person, usually unchanging throughout life (except for the changes noted in the Calcarea constitution).

  2. The miasmatic remedy determined by the inherited miasm.

  3. The functional, therapeutic, or layer remedy needed to cure the current Chief Complaint.

  4. The disease remedy which is needed only in cases of advanced pathology, addressing the symptoms of the pathology.

In choosing rubrics to prescribe on, try to differentiate between those that reflect the patient’s lifelong state (probably belonging to the constitution) and those that date from the same time as the Chief Complaint (probably belonging to the therapeutic remedy). Sample Case 3 in Appendix 4 illustrates how to separate the rubrics reflecting the constitution from those reflecting the layer. However, we must not forget that the constitution often is also the therapeutic remedy, especially in the case of Calcareas, because these types are so non-reactive that they do not tend to form layers.

We have primarily used Phosphorus, Sulphur and Calcarea as examples of constitutional remedies because they are the most common remedy types in this country. They will not be discussed at length in this chapter because portraits of these common polychrests are so easily available elsewhere. *

*My students have found Catherine Coulter’s Portraits of Homeopathic Medicines especially helpful. My personal favorites are Margaret Tyler’s Homeopathic Drug Pictures and Kent’s Lectures on Homeopathic Materia Medica.

The Hippocratic Temperament

One important aspect of the patient’s constitution is the temperament, which could be considered his “emotional climate.” However, unlike the constitution, the temperament can change as different layers are formed. In fact, if the patient displays a temperament which is not in keeping with his constitution, it is a strong indication of the remedy needed. For example, a Nat mur layer can make a normally upbeat and outgoing Phosphorus brooding and withdrawn. If a Calcarea child’s parents are involved in a painful divorce, the normally calm, gentle, and docile child might go into a violent Stramonium state.

The word ‘temperament’ has been used in different ways in homeopathy, just as ‘constitution’ has, leading to some confusion. Kent used it to mean an aspect of what we call the innate constitution:

Temperaments are not caused by provings, and are not changed in any manner by our remedies, however well indicated by symptoms found in persons of marked temperamental makeup. To twist these temperaments into our pathogenics, or symptomatology, is hut a misunderstanding of our homeopathic principles.’

In our understanding of the word ‘temperament,’ the patient’s temperament can change and can be changed by the remedy. Giving Stramonium to the violent Stramonium child can change his temperament back to his naturally phlegmatic Calcarea.

More than two thousand years ago, Hippocrates made a classic four-fold division of human temperaments: sanguine (optimistic, outgoing, loquacious), melancholic (sad, taciturn, cautious, anxious), choleric (angry), and phlegmatic (calm, mild, slow-going). These temperaments correspond to Fire, Water, Wood, and Earth in TCM respectively. The old masters found these Hippocratic temperaments very useful in analyzing their patients, and I have found them useful in my own practice. The rest of this chapter will be devoted to these temperaments since their descriptions are much less easily available than descriptions of the seven basic constitutions.

*It is interesting that the Chinese added a fifth element, Metal. The Metal person is dogmatic, rule-oriented, rigid, and self-controlled to his own detriment; he strives to create a life of routine, devoid of surprises. Kali carb is a perfect example. The correspondence between homeopathic remedy types, the Hippocratic temperaments, and the Five Element types in TCM is discussed further in Appendix 5 on TCM and in my book, What About Men.

In my student days we used to act out a humorous pantomime which depicts the reaction of four different people upon finding a hair in their soup. The first one flies into a rage and throws soup and dish at the waiter (choleric) .The second one makes a face, shrugs it off, picks up his coat and walks out whistling a tune (sanguine). The third one breaks into a crying fit because the most awful things always happen to him (melancholic). The fourth one looks at the hair, leaves it right there, goes on eating and after finishing the dish, orders another portion (phlegmatic) . This skit illustrates how different people can have different reactions to the same situation, and that these actions are spontaneous, not a matter of conscious choice. The choleric cannot respond in a phlegmatic fashion, nor can the melancholy force himself to be cheerful. A vitriolic Nitric acid personality with its vitriolic response pattern cannot be turned into a placid, agreeable Pulsatilla.

The Greeks believed that the body is composed of four elements: earth, water, fire, and air, which gave it the four qualities of dry; cold, hot, and moist, and which generated the four humors: blood, phlegm, yellow bile, and black bile. While the humors literally represented fluids thought to circulate in the body, metaphorically each became associated with a prevailing emotion: blood with joy, called the sanguine temperament (from the Latin sanguis, blood); phlegm with worry and contemplative calm, the phlegmatic temperament; yellow bile with anger, called the bilious temperament; and black bile with sadness, called the melancholy temperament from the Greek roots mela and choler, meaning “black bile”). These four temperaments became known as the Hippocratic types or temperaments. Equilibrium of the humors and moods was necessary for health, and disequilibrium meant disease. Hippocrates’ concept of health and disease may be represented by the following diagram:

Hippocratic types were included in our Materia Medica by Hahnemann, Hering and Allen among others. For instance, Hahnemann says Pulsatilla is suited to the “slow, changeable, tearful, phlegmatic temperament.” On the other hand, he said, quick movements, rapid resolutions and a cheerful mood are more often found in the sanguine temperaments like Phosphorus. This classic division of human nature into four temperaments is based on over two thousand years of astute observation of human nature. However, most people have a mixture of the four temperaments; none of them are found in their pure form in individuals, any more than all the characteristics of a Sulphur would be. Nevertheless, in most people one or two temperaments predominate.

In practice, assessing the temperament is most useful when noting changes in the temperament different from the basic disposition. For example if a phlegmatic type like a Calcarea becomes more aggressive, angry and violent, then he has taken on a choleric temperament temporarily. This change in temperament must be given high priority in prescribing. Hippocrates taught this over two millennia ago: “There are basic states of the constitution but there are also temporary temperaments and humors.” If a sweet Pulsatilla girl is raped, we would expect her temperament to change temporarily. Of course the innate constitution cannot change, especially the physical characteristics such as a stocky or lean build. (Some prescribes incorrectly use physical characteristics like hair and eye color, the shape of the eyebrows, etc. These are not considered morbid symptoms and cannot be used to prescribe on; also, they are lifelong characteristics and not characteristic of the disease layer.)

The following are descriptions of the four temperaments with their associated remedies.


  • Extremely happy by nature and openly emotional.

  • Wants to capture every possible enjoyment in life. This desire sometimes makes her restless, even flighty and dissatisfied.

  • Never feels that life is boring; oversensitive mentally and emotionally to her surroundings.

  • Emotional life is usually the best developed, more active than the mind and the will (ability to follow through on plans and goals).

  • Does not spend a great deal of time in thought or reflection. The attention is usually centered on the present moment: “Carpe diem, tomorrow is another day and I’ll decide about it then.”

  • In sad circumstances is able to express her sympathy fully in a way that others would find comforting (this is the most sympathetic type). Easily demonstrates her own feelings and experiences others’ losses deeply.

  • Has no problems making decisions or resolutions, but has great difficulty taking positive action (great beginners, bad finishers). Forgets plans unintentionally since she so easily becomes involved in something new.

  • Does not think about her goals in life because she is so much involved with the present (forget tomorrow, the excitement is today); therefore goals can be rather hazy and undefined.

  • Her immediate and abundant enthusiasm for a new project and her ability to communicate is infectious to other people and can be responsible for the project’s popularity.

  • Can snap back from failures and setbacks quickly. They do not embarrass her because people know of her good intentions, so she accepts them as due to circumstances beyond her control; besides, she is quickly interested in another new project.

  • Can work rapidly but is not always concerned about the quality of her work, easily distracted so tasks are left unfinished; postpones unpleasant jobs in favor of doing what she enjoys.

  • If not busy with a project, looks for small, effortless but pleasant little tasks; greatest desire in life is enjoyment.

  • Has millions of friends and enjoys them all, calls them all her “best” friends and close confidants; wins friends easily and effortlessly because she is very affectionate and pleasant. However, she rarely thinks about a friend when away from her (even tends to forget about a friend until she meets her again); and when she loses one friend she soon finds another one.

  • Does not like people whose lives and schedules are so planned and premeditated that they are never spontaneous, “let their hair down” or enjoy exploring on a trip or an outing.

  • In crisis situations can express her views freely and eloquently, with much conviction and feeling, even loquacity; yet while others seem to agree with her, her suggestions are often not followed by the group.

  • When people are rude to her it upsets her at the time but she quickly forgets an insult or offense; it does not continue to bother her nor does it affect her future relationship with that person.

  • When she gives advice, it usually comes from the heart; she enjoys giving suggestions and helping people, even volunteering advice when not asked because of her sympathetic nature.

  • It is not important to her to size people up; she is able to enjoy them and accept them as they are.

  • She can lose her temper any say what she thinks but she gets over it very quickly and is very apologetic; she soon forgets the whole matter, moving on from such unpleasantness.

  • Loves talking, especially engaging in gossip and chitchat (“if no news, send rumors!”); the conversation is probably not of world-shaking importance.

  • Today’s problems can upset her a bit but she does not worry about tomorrow.

  • Needs a profession in which she can be creative, free from the limitations and routines of a 9 to 5 job. She enjoys work involving beauty, travel, and/or entertainment, or perhaps her clairvoyant abilities, such as being an artist, hairdresser, cosmetician, dancer, interior designer, actress, tour guide, stand-up comedian, astrologer, singer, musician, or model.

Characteristics: hopeful, sentimental, affectionate, passionate, playful, openhearted, optimistic, restless, compassionate, adventurous, intuitive, forgiving, enthusiastic, friendly, loving, gentle. Weaknesses: can be careless, restless, dissatisfied, wasteful, impulsive, weak-willed, shallow, inconsistent, unreliable, unstable, fragile, dreamy.

Constitution most frequently associated: Phosphorus

Frequently encountered remedies: Lachesis, Ignatia, Aurum (restores the joy of life) Five Elements: Heart/Fire/Joy


  • Has a lot of drive, very practical and not very sentimental or emotional, to the point that his partner will complain of “insensitivity”.

  • Struggles with his surroundings because of the constant drive within him to change existing conditions out of boredom. Since a change, even for the better, is always resisted, there is occasional friction or misunderstanding with others. But he always plays an active part in the world.

  • Impatient, always on the go and thinks everyone else is lazy because they don’t think, move and act as fast as he does.

  • Will-power and decision-making ability are better developed in this type than in others He is the “general of the troops” or the CEO of the company who must turn to another type for advice (his chief of staff will be a thinking Earth type) as well as to a partner who is more emotionally developed.

  • Thinking is clear but can be influenced by the urge to do something or get something done (“straight ahead, top speed” and there is no reverse gear in his car!).

  • If a friend is suffering, he would not say much or feel the sorrow too deeply; but he would find something he could do to show his sympathy through actions rather than words; he would also encourage them to go on, using logical arguments (“there is a business to take over, you have two children to support, make some new goals in life, go to school again,” etc.).

  • He can grasp a situation instantly and see at once what has to be done, then does it. He enjoys making decisions and deliberately puts himself in that position. Although he does not want others to make decisions for him, he has no qualms about making decisions for others; in fact he enjoys and thrives on it.

  • He has very clearly defined goals in sight and seems to know instinctively the best path to reach them; nothing stops him from making definite progress in spite of obstacles. He almost always accomplishes his objectives.

  • In new projects he is the driving force behind them. His energetic will and practical thinking give fire and inspiration to his employees or coworkers.

  • He has very few failures or setbacks in life but is very hard on himself when they do happen, as he feels they are a mark of weakness. Wants to avoid embarrassment and loss of face at all cost and is therefore determined to see each project through to success.

  • Works very rapidly without sacrificing quality can handle many things at the same time and do them all well; work is so important that his whole life centers around it; restless when he is not doing something; feels he must “earn” his rest after working to exhaustion; does not allow his feelings of dislike to keep him from doing a job which needs to be done; believes that those who allow their feelings to influence them are weak.

  • When he is not working you can find him doing something constructive involving physical exertion (exercise machines, Sports); his greatest enjoyment in life comes from opportunities and successes.

  • Independent and self-sufficient, which keeps him from having dose friendships; most of his friendships come from business or work; besides, his friends have to conform to the high standards he sets for himself, with no place for those he considers “lazy,” “dumb” and “superficial” people; his friendships change with circumstances and he must resist the temptation to use friendships for status or goal purposes; he is usually only interested in people with whom he is working on a goal, sport or project; feels he is too busy to acknowledge others; does not want to waste time on idle chitchat or spending time with others merely for the sake of friendship.

  • People who are slow or can’t make up their mind irritate him.

  • In crisis situations, he does not hesitate to take a public stand; he sees immediately what the problem is and how to resolve it; if one or two people have their feelings hurt a little in the process, he feels that this is the price that must be paid to get things done right, so they should just get over it.

  • Often does not note an offense since he is too busy, hut if he is humiliated or offended he is tempted to pay the offender back in some way.

  • Usually too busy with his own projects to give advice but if he does, he expects it to be followed; if not, don’t come back for more! His time is too valuable to waste on those who don’t appreciate it.

  • He has a special ability to evaluate others’ abilities and talents, especially when they are useful to him in accomplishing a project.

  • Has a volcanic temper, touchy and hot-tempered; when he loses his temper he can get violent; usually finds it very difficult to apologize, is more tempted to get even with the other Person or simply to move on and not “waste any more time on that moron.”

  • Talking has to be purposeful; he is too busy to engage in small talk or idle chatter; prefers to act upon a problem rather than to talk about it; is interested in worldly things and philosophical matters, especially when they relate to his business.

  • Problems are not worries but rather challenges; his only worry is providing for his family, but that is usually not a problem for someone of his drive and acumen.

  • Professions in which he excels involve leadership, business acumen, and practical realities: attorney, physician, CEO of a company, army officer, inventor, non-fiction writer, realtor, car salesman, broker, high-powered executive, reporter or TV news anchor.

Other characteristics: daring, enterprising, aggressive, forceful, confident, decisive, determined, leader, witty, creative, logical, great memory, ambitious, faith. Negative qualities: stubborn, self-centered, careless, insensitive, inconsistent, temperamental, cruel, sharp-tongued, authoritarian, bossy, cocky, crafty, impetuous.

Constitutions most frequently associated: Sulphur, Lycopodium

Other frequently associated remedies: Nux vomica, Chelidonium

Five Elements: Liver/Wood-Wind/Anger


  • Slow, calm, steady, and rather unemotional.

  • Prefers a placid uneventful life devoid of inner and outer turmoil. Tends to stay on the sidelines rather than in the hustle and bustle of life (“my home is my castle”).

  • Rarely gets excited about anything, except when her home is threatened: this home by extension means her family, pets, house and little neighborhood.

  • Her mind and willpower tend to be equally well developed: she may surprise everyone with exceptional insight and common sense as well as an excellent ability to handle calculations, whether in schoolwork or a profession such as accounting; while her willpower can go to the extreme of stubbornness, the emotional part is the least developed. The willpower is as often negative as positive, i.e. resistance to change rather than creating something new.

  • Can think clearly and to plan ahead but does not become emotionally involved in plans nor does she feel the drive to act quickly; the mind is not influenced by emotions or will.

  • Being sensitive to “hearing bad news,” she reacts to a catastrophic sad event in a friend’s life with discomfort, not knowing exactly how to deal with it or help; does not feel the sorrow deeply enough to feel that her words would be very helpful; can even feel embarrassed at not expressing more sorrow, but at the same time thinks, “Thank God my own family is safe.”

  • Has no trouble making decisions but takes his sweet time about it. Stays calm even in emergencies, weighing all the options and then choosing the simplest, safest and most common sense one. Ponders for a while, than acts.

  • Slowly but steadily makes progress towards goals, in fact some of them have already been achieved; his calm, keen eye enables him to see the goal clearly and pursue it with great perseverance while temporary setbacks do not cause him to be discouraged; he is like an unstoppable tank, moving with great weight and momentum and deliberate speed, crushing all obstacles to the goal; refuses to be rushed. Because he is resistant to change and comfortable where he is, he needs to move to the goal one step at a time, becoming familiar with each new phase so that it becomes his familiar “home” before moving on.

  • In new projects he will make a good chief administrator. His level-headedness, steady disposition, perseverance, patience and ability to remain cool and collected in times of personality clashes and conflicts will see the project through when others would be ready to give up.

  • Setbacks and failures do not bother him since they are viewed as temporary conditions in his certainty that everything will work out all right. Although he moves slowly, his spirit will persevere until he reaches his goal (his stubbornness will help him with that).

  • Works slowly but very thoroughly and dependably, but don’t pressure him or he gets upset; he likes to mull over his work; it takes a great deal of motivation to start a new task, especially an unpleasant one, simply because he would rather not put the effort into it, but if forced to, he does it thoroughly.

  • When not occupied by a job, avoids strenuous effort and usually prefers to do something sitting down (eating, reading, playing cards, knitting); his greatest desire in life is contentment.

  • He enjoys his friends and is very faithful and accepting of them; but his happiness and contentment in life depend on his immediate family, not his friends; as contented alone as with friends; tends to observe people from a distance.

  • Usually gives advice when specifically asked and is very good at it because she is objective and impartial and usually sees both sides of the coin; makes a great psychotherapist.

  • Is able to size people up if necessary but is not much interested in it; other people’s motives and weaknesses do not bother her.

  • Does not like people who are in a hurry or those who are always fussing about something.

  • In a crisis situation acts as a peacemaker, calmly and tactfully behind the scenes trying to patch things up; everyone will be quite satisfied and no one offended by the compromise she proposes.

  • Thick skinned (not disturbed by offenses), although she notices them; she will not allow herself to become upset right away by the rudeness of others. Sensitive to teasing, though this will take a long time to show.

  • She hardly ever loses her temper, more because of her docile, placid nature than because of any great self-control, even in the face of injustices or wrongs committed against her.

  • Tends to be a quiet person yet cheerful and pleasant even if she does not have much to say; does not often originate a conversation but enjoys conversing if someone else engages her.

  • Avoids worries by striving for simplicity in life.

  • Preferred professions involve the earth, children, or accounting: computer programmer, geologist, park ranger, forester, mathematician, accountant, school administrator, teacher, farmer, veterinarian, landscaper.

Other characteristics: pleasant, passive, serene, calm, cheerful, comforting, diplomatic, diligent, home-loving, efficient, virtuous, gently humorous, peaceful. Negatives: selfish, lazy, indecisive, faint-hearted, follower, dull indifferent, self-righteous, meekness, procrastinator, introverted.

Most frequently associated constitutions: Calcarea, Baryta carb.

Five Elements: Earth/Stomach-Spleen/Worry


  • Somewhat sad, deeply emotional.

  • Senses a conflict with the world around him, hence tends to withdraw into a world created by his hopes, dreams, and aspirations.

  • Rarely free from concern and care; there is always the eternal worry, “What if?”

  • Possesses deep emotions and the ability to think deeply, but decision-making (will power) is poorly developed; procrastination and indecisiveness (irresolution) are marked.

  • His mind probes deeply to the point where too much time is spent thinking; his emotional involvement often tends to influence his thinking.

  • In sad events, can express her sympathy better by writing a note rather than by using spoken words to convey the depth of sorrow felt in her heart.

  • Usually carries decisions out once they are made but often gets stuck in the process of mulling over a problem, weighing all the pros and cons; the more sides he sees of the problem, the harder it becomes to decide.

  • Has very idealistic goals (strives for perfection) but has great difficulty in deciding how to get there; therefore is often frustrated because her goals seem so far off and her progress so slow.

  • A perfectionist in his job and very conscientious, while others might approve of his work, he is apt to criticize himself and find fault with it; he often puts off an unpleasant job because he can’t decide how to do it; but if forced, does a good job because of the high standards he sets for himself.

  • When not busy doing something, his min stays restless and busy (constantly asking, “What if” and worrying about the future), his greatest desire in life is perfection In new projects, tends to be the inventor, the thinker; he had the vision for it, saw the need for it and drew up the ideals, goals and overall philosophy which gave birth to the project.

  • Setbacks and failures discourage her and when experienced, she is ready to throw in the towel; often feels unable to cope with life’s problems; in fact her fear of failure often keeps her from entering areas where she might experience it; failures are often the result of her unrealistically high standards for herself.

  • Always has a few dose friends who mean the world to her; she does not make friends easily but she is exceptionally loyal (to a fault!) once she does; she maintains friends over the years and when she loses one, it leaves an empty spot in her heart.

  • Does not like people who are shallow and superficial; prefers serious conversation about subject that stimulate her, rather than chitchat, when she talks at all; if not, she is bored, although she would try not to show it for fear of hurting others’ feelings.

  • In crisis is too reserved to express her feelings publicly, but she tells several people privately what she thinks should be done; hates to get involved because she is afraid to hurt people or make the situation worse.

  • She feels insults deeply (oversensitive, easily offended); does not seek to get even with the person offending her but finds it hard to forget and stop brooding over it (persisting thoughts) and most of the time an offense will permanently affect her relationship with

  • Although she feels she has good advice to offer, she often hesitates to give it for fear that if it is acted upon, and does not work, it would reflect badly on her; sometimes she sees so many facets of the problem that she is overwhelmed.

  • Has an unusual ability to evaluate people, with insight into their personality and character she easily spots a fake or sees other people’s faults

  • She allows her anger to build up until eventually it surfaces in a big blowup; she tends to bear a grudge for a long time.

  • Her preferred professions involve helping others and/or her perfectionist eye for detail psychotherapist, social worker, librarian, book editor, graphic designer, inspector, private investigator.

Other characteristics: reserved, introspective, contemplative, self-controlled, strong-willed, patient, concrete, elegant, proud, resourceful and analytical.

Negatives: pessimistic, gloomy, cold, revengeful, bored, self-centered, critical, suspicious, frugal, phobic, taciturn, arrogant.

Associated remedies: Nat. mur., Arsenicum

Five Elements: Water/Kidney/Fear

@ The article is reprinted from Dr.Luc de Schepper’s book “Hahnemann Revisited – Hahnemannian Textbook of Classical Homeopathy for the Professional”.

About the author

Luc De Schepper

Luc De Schepper, M.D., Ph.D., Lic.Ac., C.Hom., is a licensed physician and acupuncturist in Europe (since 1971) and the US. (since 1982). He studied and practiced homeopathy extensively for many years, wrote 15 textbooks of homeopathy, alternative medicine and acupuncture and has the largest school of homeopathy in the US. He spends part of his time helping the poor in South Africa, Kenya and Sri Lanka and teaches all around the world, lately bringing homeopathy to China. For more information visit www.drluc.com


  • A comprehensive explanations. Good work done by the doctor. My compliments. I would like to know about allergy. How one could label a drug picture to the patient?

    Best regards.

  • Dear readers
    a short article concerning this topic:

    Dialog concerning classifications in homeopathy

    Question: does a remedy cure because it belongs to a specific class of remedies? (like anti-psoric, anti-sycotic, anti-syphilitic class)

    Answer: No

    Question: Does a remedy cure because it is associated to a particular constitution or temperament or kingdom?

    Answer: No

    Question: When does a remedy cure?

    Answer: 1) it has to resemble symptom similitude to the now present individual disease-symptom-picture, 2) has to be applied in the appropriate way, 3) obstacles have to be removed

    Question: Why has a remedy cured after being selected on a basis of miasmatic classification, a constitution, temperament, kingdom?

    Answer: Because the remedy selected happened to be similar by symptoms to the individual case. —

    Question: If this is the case, then if the symptoms alone were taken into consideration leaving aside miasmatic classification, temperament, constitution, kingdoms, –would not have a remedy found by symptom similitude being curative anyway?

    Answer: Yes.

    Question: could it be, that in a given case it is not perfectly clear, what miasm is active?

    Answer: yes

    Question: could it be, that in a given case it is not perfectly clear, which constitution this person is, or which temperament, or which kingdom the person is associated with?

    Answer: Yes, that can happen.

    Question: could it be ,that the list of remedies of each miasm is incomplete or contains remedies not suitable anymore for the miasm?

    Answer: Yes

    Question: Are there situations, then where a remedy is selected, which seems homeopathic from the list of the diagnosed miasm, which does not cure?

    Answer: Yes, for above reasons.

    Question: are there cases where the miasmatic classification suggests a completely different remedy from the one being selected by disease- individual symptom similitude?

    Answer: yes.

    Question: Are there cases where there is no remedy common to constitution and miasm of the patient?

    Answer: yes

    Question: What is the way forward in these situations?

    Answer: The homeopathic principle is: Cure by symptom similitude!, so the individual disease-symptom- picture forms the prime indication for the selection.

    As a result, we will give these disease- symptoms primacy and set aside any classification.

    Question: If this is so — and obviously there is greater reliability to directly use the individual disease-symptoms, why do homeopaths still diagnose, select from a group?

    Answer: I don’t know, — makes no sense to me, considering, the amount of unnecessary mistakes are made by misdiagnosing, incomplete classes or remedies etc.

    Thanks for you time.

  • Nice points, Hans! These need to be brought out again and again even those people who believe such may be very limited.

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