Part 9: Direction of Cure
How do we know that the remedy is working, namely that a cure is taking place? This is the question that rightfully occupies each practitioner.
Dr. Hahnemann gives us some guidance for how to determine whether cure is taking place in terms of the expansive (improvement) and contractive (worsening) aspects of the patient that can be discerned (which requires some supersensible knowing) by the knowing physician.
§253.1. Among the signs which show a small beginning of improvement or aggravation (not visible to everyone) in all diseases, especially the rapidly arising (acute) diseases, the state of mind [Gemüt] and of the entire behavior of the patient is the surest and most enlightening.
§253.2. In the case of an ever-so-slight beginning of improvement — a greater comfort, an increasing composure, freedom of spirit, increased courage, a kind of returning naturalness.
§253.3. But in the case of an ever-so-small beginning of aggravation — a more self-conscious, helpless state of mind [Gemüt], of the spirit, of the whole behavior, and of all attitudes, positions and actions, drawing more pity to itself, which [state] allows itself with exact attentiveness to be easily seen or shown but not to be [easily] described in words.
Hahnemann also spoke of the disease proceeding from the less to the more noble organs, a hierarchical observation based on the structural functions of living organisms. The curative process is here the opposite of the process followed by suppressive treatment (allopathic).
1.4. It falsely deems the maladies located on the outer parts of the body as merely local and existing alone there by themselves, and imagines them to have been remedied if it has driven away the same by external means, so that the inner malady now is necessitated to break out at a more noble and critical place.
45.2. … this expulsion of the local symptom onto other more noble parts;the patient got dangerous eye-inflammations, or deafness, or stomach-cramps, or epileptic seizures, or asthmatic or apoplectic attacks, or mental or emotional [Gemüt] disease, etc., for it.a]
§.205.1.a]1 …the Sustentive Power of Life is therefore necessitated to transfer the focus for the great internal malady to a still more noble site (as it does with all metastases) and allows blindness, deafness, insanity, suffocative asthma, dropsy, apoplexy, etc. to follow.
§.216.1. The cases are not rare when a death-threatening so-called somatic disease — a suppuration of the lung or the corruption of any other noble organ, or another heated (acute) disease, e.g. in labor, etc., degenerates by rapid ascent of the hitherto mind symptom into an insanity, a kind of melancholy, or a frenzy and thereby makes all deadly peril of the somatic symptoms vanish; in the meantime the somatic symptoms improve almost up to the point of health, or rather decrease to such a degree that their crepuscular presence can only be discerned by the steadfastly and subtly observing physician.
891 … This in time passes away again, when the psora again lifts its head, either with the same disease symptoms as before, or with others similar but gradually more troublesome than the first, or with symptoms germinating in nobler parts.
Hahnemann also spoke in general terms about the improvement in well-being (Wohlseyn) and soundness (Gesundheit). For Hahnemann, this was a function of kennen – a deeper, inner knowing based on the Gemüt – and would be determined as part of the observation following the prescription. However, one of his closest followers, Constantine Hering, a fellow German who emigrated to the United States and corresponded closely with Hahnemann in his latter years, has provided us with some guidance.
These guidelines are often referred to as Hering’s Laws or Principles of Cure. Dr. Hering based his guidelines on Hahnemann’s and his own observations. He set them out in the prologue to Hahnemann’s first American edition in English of the Chronic Diseases, New York, 1845. In this prologue he borrows from an earlier essay he had written, Guide to the Progressive Development of Homoeopathy. These guidelines are used widely by those in the natural health field.
First, Hering describes the natural development of a disease:
As acute diseases terminate in an eruption upon the skin, which divides, dries up, and then passes off, so it is with many chronic diseases. All diseases diminish in intensity, improve, and are cured by the internal organism freeing itself from them little by little, the internal disease approaches more and more to the external tissues, until it finally arrives to the skin.
Next he states the principle that he derives from this observation:
Every homoeopathic physician must have observed that the improvement in pain takes place from above downward; and in disease, from within outward.
After further emphasising the importance of the skin eruption in preventing a more serious disease, Hering goes on again to spell out the principles:
The thorough cure of a chronic disease is indicated by the most important organs being first relieved; the disease passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last. Even the superficial observer will not fail in recognizing this law of order. An improvement which takes place in a different order can never be relied upon.
Hering then claims that all this is based on Hahnemann’s important rule to attend to the moral symptoms [mental/emotional], and to judge of the degree of homeopathic adaptation existing between the remedy and the disease by the improvement which takes place in the moral condition (morale), and the general well-being of the patient.
In summary, Hering’s observations are as follows:
1. The “improvement in pain takes place from above downward…”
Note that this direction of cure relates to pain or pathology. Pain is a sensation that is mainly physical and superficial, in terms of the main nerve endings. A painful rash would move down from head to toe, as does the characteristic rash of measles.
2. “…and in diseases, from within outward.” “The thorough cure of a chronic disease is indicated by the most important organs being first relieved…”
Hering now turns to the disease itself. The order of remediation is here from deeper in the organism to the outer layer, the skin, from the centre to the periphery. This accounts for the numerous skin eruptions during treatment even where none had existed before. However, Hering also qualifies this, as does Hahnemann, by stating that the order is of importance – from more important to least important. Hahnemann always speaks of “nobler” organs, implying a hierarchy of organs, including those of the emotional mind (Gemüt). Thus, the direction of cure here is not simply spatial, but dynamic and functional.
3. “…the disease passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last.”
Here Hering again refers to a given disease. He further specifies that this order of “within outward” is the same order as the disease process.
Let’s take an example, which reflects any acute miasm or acute epidemic disease:
Indeed, just like symptoms appear first in the psychic sphere, then in the organs and lastly on the surface, healing follows the same order because in this case there is no difference between the order of getting ill and of getting cured. Infections, eruptive diseases which, in a few days, allow us to observe objectively and clearly what happens in an acute case are typical examples. At the beginning the child is sad, depressive and changes his temper (psychic symptoms). Then he has chills after which he feels terribly tired, has fever (he can get very thirsty), suffers from anorexia, etc. (general symptoms). Lastly, the eruption appears starting by his face, neck, trunk, limbs, and ending in the same order. Before the eruption is cured, the psychic and general symptoms have already been normalized, and this proves Hering’s observation is correct. The same happens with chronic pathological manifestations. (all the above quotes of Hering as well as this one taken from Eizayaga, Treatise on Homeopathic Medicine, p. 105).
What happens if you have more than one disease in a patient?
In fact, we can observe in nature that their cure proceeds from one disease to the next, in the reverse order of time. Let’s see how this was expressed almost a century ago by one of the most influential homeopaths in the United States, James Tyler Kent:
…The first prescription antidotes the drug and liberates the patient from the drug disease, and then you see the most acute or last appearing natural disease which comes back first. This is in accordance with fixed law; the last miasma or the last symptoms that have been made to disappear will be the first to return and go away to appear no more. (Kent, Lectures on Homeopathic Philosophy, p. 121)
Thus, within a disease, the curative process is in the same order as the disease. However, between diseases the curative process is in the reverse order of the diseases, that is, in the reverse order in which the diseases were acquired, the most recent going first. Hahnemann also notes this in his Chronic Diseases:
998 …but the oldest maladies and those which have been most constant and unchanged, among which are the constant local maladies, are the last to give way, and only after all the remaining disorders have disappeared and health has in all other respects almost totally returned.
Glossary No. 10
Direction of Cure:
a) Within a given disease, the local symptoms (involving pain or pathology) move from above downward, from the more important organs to the less important organs (importance being a matter not only of space, but of function or “nobility”), and in the same order as the disease process itself.
b) Between given diseases, that is, where there is more than one disease in a patient (see Aphorisms 40-42), the cure of each disease occurs in the reverse order of their occurrence in the patient, setting up a sequentiality of treatment of multiple disease states in a patient.
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Rudi Verspoor is Dean and Chair Department of Philosophy Hahnemann College for Heilkunst, Ottawa. He served as the Director of the British Institute of Homeopathy Canada from 1993 to early 2001 and helped to found and is still active in the National United Professional Association of Trained Homeopaths (NUPATH) and the Canadian/International Heilkunst Association (C/IHA).
Part of his time is spent advising the Canadian government on health-care policy and in working for greater acceptance of and access to homeopathy. His publications include:
Homeopathy Renewed, A Sequential Approach to the Treatment of Chronic Illness (with Patty Smith);
A Time for Healing; Homeopathy Re-examined: Beyond the Classical Paradigm (with Steven Decker);
The Dynamic Legacy: Hahnemann from Homeopathy to Heilkunst (with Steven Decker).
Visit his website at http://www.heilkunst.com/