WHAT IS CLASSICAL HOMOEOPATHY?
I have been asked by my colleague, Dr. Manish Bhatia, to comment on the subject of traditional and modern methods in Homoeopathy. First of all, it is important to establish what is meant by classical and modern methods. To do this one should refer to the dictionary definitions of the terms classical or traditional methods. The true meaning of the word “classical” refers to a well established tradition with a recognized style or form or a set of procedures that follow a well known traditional pattern. Classical also refers to the period when a tradition of excellence was established such as ancient Greece or Rome. The term, “classic” is a closely related word which means something made of or belonging to the highest quality or a tradition that is established as the best. It also means something that is neat and elegant, especially a traditional style that will last irrespective of fashion and fads. The term, modern, means something that belongs to the present or recent times rather than being old or ancient. Non-classical or non-traditional refers to a system that is contemporary and has no roots in a time tested tradition recognized for its excellence.
Keeping in mind the above definitions it would become apparent that the term “classical Homoeopathy” should refer to the philosophy and praxis founded in the “classics” of the homoeopathic healing art. These classics begin with the Organon of the Healing Arts, The Chronic Diseases, and the Lesser Writings of Samuel Hahnemann. All of the methodologies that originate in these works certainly qualify as being “classical” in the true sense of the word. At the same time, the term classical refers to the period of great renaissance when our revolutionary art of healing was developed. This was the time of Samuel Hahnemann, Baron von Boenninghausen, Constantine Hering, G.H.G Jahr and the first generation. It is these individuals who developed the philosophy, recorded the first provings, wrote the first materia medicas, constructed the first repertories, and did the earliest experiments with potentized medicines.
Every established classical system is associated with certain maxims that express its core values. The four cardinal aphorisms of traditional Homoeopathy are Similars Cure Similars, the single remedy, the minimum dose and the application of the potentized remedy. These cardinal principles are then applied a number of ways that can be tailored to suit a wide variety of clinical situations. The principle of similar remedies was recognized by Hippocrates (c. 560 B.C.) showing that this method dates back to the classical age of Greece. He used a minimal amount of one medicine at a time, although his grandsons introduced “Hippocratic mixtures”. Nevertheless, the application of similar remedies was somewhat dangerous, e.g. the use of crude Helleborus in convulsions. Paracelsus (1493-1541) used single remedies by similars transmuted by alchemy but the inherent toxicity of many remedies remained. It was the perfecting of the potentized remedy by Samuel Hahnemann that opened up the use of similar medicines to general medical practice.
The use of the single remedy has been interpreted by some modern homoeopaths to mean that only one remedy should be used throughout a complete treatment. This, however, was not Hahnemann’s original intention as the single remedy refers to the administration of one, single uncompounded medicine at a time. This distinguishes Homoeopathy from systems that use mixtures common to polypharmacy. The minimal dose has been interpreted by some modern homoeopaths to refer to the small amount of the original substance found in a potentized remedy. This, however, was not Hahnemann’s original intention as the minimal dose refers the small amount of medicine contained in the homoeopathic pills. This distinguishes Homoeopathy from systems that use large amounts of medicine as a dose. The potentized remedy is the final key that opened the door of the materia medica to any substance found in the mineral, plant, and animal world. This distinguishes Homoeopathy from systems that use crude doses and chemical medicines. These cardinal principles make up a system of checks and balances that makes Homoeopathy a safe and effective healing art. Any school of practice that stays true to these cardinal principles has based their practice on classical Homoeopathy.
Hahnemann was of the opinion that the gathering of information about medicinal substances should be based on symptoms brought out in living persons. For this reason, he based his materia medica on the records of medicinal actions observed in patients in traditional medical works, over doses and poisonings, provings on healthy volunteers, and symptoms brought out in patients under treatment. All of these methods are mentioned in the aphorisms of the Organon. Each of these methods has one thing in common. They are all based on symptoms brought out in living persons rather than analysis through secondary means such as chemistry, taste, color, or the doctrine of signatures, etc. This is the most ethical and accurate method of “animal testing”.
In my study of Hahnemann’s public writings, personal letters and clinical casebooks, I have been able to document the methods used by the Founder on his patients. Certainly, the techniques that the Founder presented in his writings and used in the clinic must be considered “classical” in the true sense of the word. This includes a wide spectrum of medicinal applications such as the use of acute remedies; acute intercurrents; acute genus epidemicus remedies; chronic Gestalt remedies; chronic intercurrents; chronic anti-miasmatic genus remedies; and prophylactic medicines. Hahnemann’s clinical praxis included the use of a single remedy where one medicine was used for longer periods; the alternation of two remedies; tandem remedies where a single dose or few doses of one remedy was placed before a series of another remedy; intercurrents where one remedy was placed between the administration of another remedy; trios in which three remedies were rotated; and a series of remedies in a sequence spread out over time. All of these methods must be considered “classical” because they originate in the true classics of Homoeopathy, i.e. the written works and clinical methods of Samuel Hahnemann. This opens the applications of remedies far beyond what some consider “classical Homoeopathy”.
Today, some parties seem to have a rather narrow definition of “classical Homoeopathy” that is often associated with the term the “constitutional remedy”. This term is defined by some as the “one remedy for all situations” and others as the “one remedy for life’. Is this method truly classical in the true sense of the word or is it a modern concept? The term, constitutional remedy, was introduced by James Tyler Kent in the late 19th and early 20th century. Kent applied this term in a specific way which has nothing to do with many of its contemporary usages. For example, under the remedy, Baryta Carbonica in Lectures on Materia Medica Kent wrote:
“Bar-c. is an interesting study, because it is fully proved and a constitutional remedy. Such remedies are always more interesting than the short-acting, superficial ones. They take hold in deep-seated, longer lasting, miasmatic troubles.”
Kent’s term, the constitutional remedy, was used to make a distinction between the remedial powers of the chronic remedies that had anti-miasmic properties and shorter acting acute remedies. This concept is in complete harmony with Hahnemann’s original teachings on acute and chronic medicines.
It is important to point out that Kent’s term, constitutional remedy, has nothing to do with the idea of one remedy that treats both the acute and chronic conditions of the patient. Kent did not believe that one should use constitutional remedies in acute disorders where a crisis produced an active acute layer that suppressed chronic conditions. This teaching originates in what Hahnemann wrote in aphorism 38 of the Organon and other passages. In his Lectures on Homeopathic Philosophy, page 206, Kent states:
This illustrates the doctrine of not prescribing for an acute and chronic trouble together. Never prescribe for any two conditions, unless they be complicated. Only chronic diseases can be complicated with each other. The acute is never complicated with the chronic; the acute suppresses the chronic and they never become complex.”
When Kent spoke of a “Calcarea Constitution” in his Lectures on Materia Medica his definition has nothing to with a particular genotype such as the classical Greek temperaments, the choleric, phlegmatic, sanguine and melancholic types. Although references to classical Greek temperaments were used by first generation homoeopaths like Hahnemann, Hering and Jahr, Kent did not approve of such titles. Kent made it clear that a “Calcarea case is to be known by the symptoms” not a constitutional mind-body type. The idea that there is one remedy for every patient for life is another modern idea that originated in the last 20 years. How many of us can show documented cases where the patient has been given the same remedy from the cradle to the grave over a period of 75 years? Nevertheless, the idea of using the deepest acting remedy over long periods in a number of different potencies is not new. One should always use as few remedies as possible not as many remedies as one can.
If one reviews all the relevant material it becomes apparent that many so-called “classical methods” are actually quite modern yet they are inspired by traditional methods. The fact that these evolutes did not originate with Hahnemann or Kent does not mean that they are invalid solely for this reason. We have to be open to the evolution of our art as long as the innovations include the cardinal checks and balances that make our system safe and effective. I have seen patients who reflected the same basic state of a particular remedy for many years. It is as if this one remedy suits them so well that it covers the deepest levels of their constitution and temperament. These cases, however, are usually fairly straightforward and not overly complicated by several divergent causes, layers of dissimilar symptoms, and complex chronic miasms.
In my experience the myriad of differing clinical situations varies far too much to be pigeonholed into one therapeutic absolute. For example, a chronic Pulsatilla patient may develop acute-like symptoms such as a bland discharge from the ears with very changeable pains. This acute-like crisis may be only an intensification of the similar symptoms of the chronic Pulsatilla state in that particular patient. Therefore, the acute-like symptoms are not strong enough to suspend the chronic state creating a true acute crisis. If the crisis becomes so severe there is the appearance of new dissimilar symptoms like convulsions with a cold body and a hot head, the patient may need an acute remedy like Helleborus, which is an acute complement of Pulsatilla. These are clinical situations that demand a differential diagnosis not absolutist theories like the one remedy for the acute and chronic state regardless of the symptoms, time and circumstances.
In some advanced chronic states with organic pathology the chronic remedy may be counter indicated because it can cause prolonged, unfruitful aggravations that increase pathology and weaken the patient. Therefore, the idea that the acute and chronic remedy may be the same is applicable in some conditions but it should not be regarded as a supreme truth that is valid in all patients at all times. There are patients in whom organic pathology becomes so advanced over the years that what was once their constitutional remedy is now counter indicated. This is why Kent said in his Lectures on Materia Medica under Kali Carbonica;
“Do not give that constitutional medicine that should have been administered to these patients twenty years ago, because there is not reaction enough in the life of the patient to turn him into order, and he will be destroyed. It seems paradoxical to say it, but to cure him is to kill him. The vital action that is necessary to restore him to health would practically tear his framework to pieces.”
When I studied the treatment of tuberculosis in 1980 with Dr. Isaac in Kerala, India there was a doctor at the hospital that believed in the exclusive use of “constitutional remedies” regardless of the nature of the symptoms or pathology. He ignored the warnings that such methods can be dangerous in serious pathological cases with compromised vital organs. He gave an advanced TB patient Lycopodium and the patient went into crisis, hemorrhaged and died. This is a perfect example of when NOT to give that constitutional remedy that a patient needed 20 years ago! Seriously ill patients often need to be treated carefully in layers with more superficially acting remedies until the organic pathology is reduced and they gain vitality. This layered treatment sometimes makes it possible to give them the constitutional remedy they may have needed 20 years ago to complete the cure. Therefore, one has to understand when it is appropriate to give deep acting chronic remedies and when it is best to treat the patient in layers stage by stage until they regain some semblance of health. Those that teach the one constitutional remedy for all situations for life should take into account these clinical realities.
A QUESTION OF BALANCE
There are some practitioners who are ultra-classical and some practitioners who are ultra-modern. On the one hand, some wish to return to what they perceive as the Golden Age of Homoeopathy and only use methods from the 1800s. They see themselves as the only persons doing pure Homoeopathy and speak as if they profess the sole true doctrine. On the other hand, there are those who scoff at anything old and only believe in new methods developed by current teachers. These persons feel that the traditional materia medica is outdated and they depend mostly on modern essences. Some proudly declare they don’t even need to use a repertory! It has been said that reading the Organon is like studying the aeronautical drawings of the Wright brothers’ plane in an age when we have already gone to the moon! Obviously, there must be a middle view that transcends these extremes and represents a point of balance that harmonizes classical and contemporary thought.
Einstein introduced the principles of nuclear physics and the theory of relativity at a time when going to the moon seemed almost impossible but the truths he elucidated helped make it achievable. Equations like E=mc2 are just as valid today as they were at the beginning of the 20th century. Hahnemann is the Einstein of Medicine in that the truths he postulated in the first half of 19th century are just as valid today as they were in his day. This is because both Einstein and Hahnemann uncovered universal principles that are part of the laws of Nature and introduced a new paradigm in their fields. Nevertheless, every generation must apply these universal truths to their respective fields and bring them up to date for their times. In this way the applications of timeless principles evolve.
Hahnemann is the Alpha of Homoeopathy not the Omega. If one studies Hahnemann’s German and French casebooks one sees Homoeopathy as an infant growing into maturity. In most of his casebooks he only used around 60 remedies and he rarely went outside his top 100 medicines. His repertories were limited to his handwritten Symptomlexicon, Jahr’s Repertory and Boenninghausen’s Repertory of Antipsoric Remedies and Repertory of Non Antipsoric Remedies. Most of the published information was limited to the 125 remedies found in the Materia Medica Pura and the Chronic Diseases. The Founder points the way to the Medicine of the Future but many are looking at his finger instead of where he is pointing. This is why Hering wrote the following in 1845.
It is the duty of all of us to go further in the theory and practice of Homœopathy than Hahnemann has done. We ought to seek the truth which is before us and forsake the errors of the past. But woe unto him who, on that account, should personally attack the author of our doctrine; he would burthen himself with infamy. Hahnemann was a great savant, inquirer, and discoverer; he was as true a man, without falsity, candid and open as a child, and inspired with pure benevolence and with a holy zeal for science.
The Chronic Diseases; S. Hahnemann (Hering’s Preface to the 1845 American edition translated by Hempel), page 9.
It is the responsibility of all to help in advancing the science of Homoeopathy in harmony with the universal principles on which it is founded. Homoeopathy is no longer Homoeopathy if the cardinal principles are removed any more than nuclear physics is still nuclear physics if Einstein’s equations are ignored. Energy and mass will be convertible as long as this universe exists just as Similars Cure Similars, the single remedy, the minimal dose and the potentized medicine are the key to homoeopathic healing. How these principles will be put into practice should evolve with every new generation of practitioners.
In our times we have extensive computerized repertories and materia medicas with around 500 well proven remedies and another 500 on which we have at least some dependable information. We can search 100s of volumes in a few seconds and analyze symptoms from a number of vantage points. Homoeopathy has entered the age of information technology and the WWW, which allows homoeopaths to network worldwide in an instant. Homoeopathy has grown greatly since Hahnemann’s time and he would be amazed by our technology. Nevertheless, the vision of the healing arts found in the 4th, 5th and 6th Organon is still more advanced than any modern textbook. In fact, today’s modern homoeopaths are only using a certain percentage of the Founder’s original paradigm in the clinic. Now is time to recover all the lost teachings of Samuel Hahnemann and bring them up to date.
SYSTEMS VERSUS SYMPTOMS
There is much discussion about the three kingdoms of nature in contemporary Homoeopathy. Who was the first homoeopath to speak in terms of the mineral, plant and animal worlds? The answer is Samuel Hahnemann in The Chronic Diseases.
As a rule it was developed from their pure symptoms, that most of the earths, alkalis and acids, as well as the neutral salts composed of them, together with several of the metals, cannot be dispensed with in curing the almost innumerable symptoms of Psora. The similarity in nature of the leading antipsoric, sulphur, to phosphorus and other combustible substances from the vegetable and mineral kingdoms led to the use of the latter, and some animal substances naturally followed them by analogy, in agreement with experience.
The Chronic Diseases Their Peculiar Nature and Their Homœopathic Cure; S. Hahnemann (Theoretical Part), The Medicines, page 244.
In the above quote Hahnemann discusses the elements of the periodic table and explains how it is possible to use “analogy in agreement with experience” to uncover related properties in the plant and animal remedies. This established a system in which the symptoms of the remedies of the three kingdoms and their families can be compared. This method was taken up by Professor E. A. Farrington M.D. in his lectures at Hahnemann Medical College, which was founded by Hering.
“We are now ready to begin our study of the various drugs composing the Homoeopathic Materia Medica. For this purpose I have arranged the remedies in three grand divisions, according to the kingdom of nature from which they are derived.”
A Clinical Materia Medica, E. A. Farrington, Lecture I. page 14.
Hering so was impressed with Farrington’s knowledge of remedies that he said, “When I am gone Farrington must finish my materia medica”. It has been noted from an early period that each of the three kingdoms has its characteristic symptoms. In his lectures Dr. Farrington offers insights into the remedies of the animal world including the theme of “violence and intensity”. The great teacher wrote:
You will find, too, that these animal poisons are apt to affect the mind, especially the emotions. They arouse the lowest qualities in human nature, and produce a condition which is truly shocking. Some of them arouse the filthiest lust, the most intense anger, and passions of a kindred nature.
A Clinical Materia Medica, E. A. Farrington, Lecture I1, Animal Kingdom, page 25.
In Homoeopathy and Minerals, Jan Scholten develops a series of themes for the elements of the periodic table that use the method of group analysis in a creative manner. For example, Jan’s essences for the Magnesium group are Pacifism; Aggression; Fear of loss; and Pain. His essences for the Muriaticums are Self pity; Care and Nurturing; Mother; Attention; and Self-awareness. By combining the essences found in Magnesium with Muriaticum, Jan has postulated the following essential themes of Magnesium Muriaticum: Aggression leads to the loss of care from the mother; aggression is necessary to forcefully ask for care. Other combinations might include aggression to get attention or any combination of the main components. These themes are based on a synthesis of the characteristics found in the two elements that lead to a more developed picture of the composite remedy.
In Homoeopathy and the Elements Scholten further expands on his method by introducing a series of themes related to the evolution of the 7 horizontal periods and 18 vertical groups of the periodic table. By using this method of group analysis and the synthetic approach he has assigned certain symptoms to proven and unproven remedies. For a more complete understanding of Jan’s methods please refer to the original publications.
The use of the synthetic prescription is not new to Homoeopathy. For example, Dr. Clarke said, “Bar-i. has been used empirically, especially in cases of glandular enlargement and new growths, on indications suggested by its two elements”. Clarke was showing that if one has a decent understanding of Baryta and Iodium it may be possible to prescribe the remedy, Baryta Iodata. Hering offered a similar opinion about the use of remedies like Calcarea Arsenicosa. Other hints are found scattered throughout out homoeopathic literature. Nevertheless, some have questioned the very origins of this method. Where did the idea of synthetic prescribing originate?
The earliest recorded experiment of a synthetic prescription was in 1843 when Samuel Hahnemann gave Robert Everest (Casebook DF-14, page 13) Cinnabaris (Red Sulfide of Mercury) based on the combined symptoms of Mercury and Sulphur found in two rubrics in Boenninghausen’s repertory. This is a clear example of keeping one’s eyes open for the possible combination of elements while analyzing the symptoms of the patient in our reference works. This means that the synthetic method has been with Homœopathy since the beginning!
Dr. Rajan Sankaran is well known for his contributions to Homoeopathy which includes the central disturbance, core delusions, compensation, dream interpretation, etc. His more recent offerings include Insight into Plants, Volumes I and II and The Vital Sensation. His latest works introduce a new approach to the patient’s main complaint that focuses on the “vital sensation”, which is present in the symptoms of the body as well as the mind. Through the generalization of each plant family he presents what he believes to be the important sensations found throughout the entire family. At the same time, he notes which miasm is the most similar to each species found in the family in accordance with his sequence of ten miasms running from the acute to the syphilitic.
On this basis Sankaran has developed a grid of botanical medicines that is similar to the system Scholten developed for the mineral remedies. This schematic presents the vital sensations of the families and the miasms of each individual plant in a manner that is easy for cross reference. By matching the vital sensation with the corresponding miasm one may locate a plant remedy for the patient. Dr. Sankaran is now applying his new method of case taking to the mineral, plant and animal kingdom.
The methods of Scholten and Sankaran are considered by many to be the cutting edge of contemporary Homoeopathy. Nevertheless, is the new “systems approach” being used by some in such a one sided manner that it is overturning the cardinal principles of our healing art? Are unproven remedies being used in a way that lacks the consistency of the classical standard? Has the inductive reasoning of the Organon been replaced by methods that are based mostly on speculation? Hahnemann felt that the study of the natural kingdoms could provide hints about the potential use of homoeopathic remedies but he opined that provings and symptoms brought out on patients under treatment were essential to the method. In Essays on a New Principle Hahnemann wrote.
I am far from denying, however, the many important hints the natural system may afford to the philosophical student of the materia medica and to him who feels it his duty to discover new medicinal agents; but these hints can only help to confirm and serve as a commentary to facts already known, or in the case of untried plants they may give rise to hypothetical conjectures, which are, however, far from approaching even to probability.
The Lesser Writings of Samuel Hahnemann; S. Hahnemann (Dudgeon Edition), Essay on a New Principle for ascertaining the Curative Powers of Drugs, page 257.
Drs. Scholten and Sankaran are very experienced classical homoeopaths but their experimental methods are being taken up by students and practitioners new to the art. This method is being used by persons that have not yet mastered the traditional methods in a reasonable manner. They do not understand how to use the repertory or materia medica properly. They depend mostly on flow charts of essences rather than rubrics of our reference works. Others think they have found a short cut to the “highest method” and don’t really need to use the repertory. Some of these persons cannot even recognize a simple Calcarea or Arsenicum case standing right in front of them yet they are trying to use unproven and lesser known remedies by a simple two dimensional grid on paper.
Many practitioners do not have the background to understand when these experimental methods are leading in the wrong direction. In some cases the use of these new methods has become a fad or fashion, which is the antithesis of the term “classical”. When the use of the systems approach is supported by the classic methods of the repertory and materia medica the outcome may add very valuable insights. When these new methods replace the traditional techniques they lack the stability and consistency of the classical practice. The truth is that a well constructed systems approach is based on the generalizations of the symptoms approach and is not a separate system. The symptom and system approach should be used together in a balanced and practical fashion.
THE GESTALT OF THE DISEASE
Homœopathy is based on a Gestalt philosophy in which the whole is more than the sum of its parts. This holistic awareness is at the root of the philosophy that makes up the background for Samuel Hahnemann’s world view. For example, it is impossible to locate an object in space with just one vector. It takes at least three vectors to easily pinpoint an object’s position. That is why Hering said that we have to have at least three good characteristic symptoms to find a remedy. This idea is at the base of Hering’s famous “three legged stool”.