Importance of Constitution and Diathesis in Homoeopathy

Abstract: Diathesis and constitution are integral parts of a person, which helps in individualization. Diathesis is a state or condition of the body or a combination of attributes in an individual causing a susceptibility to disease. Throughout homeopathic literature attributes of it are given usually in scattered form.

Keywords: Diathesis, Constitution, Homoeopathy, Repertory

Introduction:  The word diathesis was known to the world before the discovery of modern science. Dr. Hahnemann never used the word diathesis. He used the word predisposition. In § no.7 in Organon of Medicine, he used the word accessary circumstances.

Diathesis represents certain deviations in susceptibility. This concept has a long history in medical terminology. The word diathesis derives from the ancient Greek word ‘Diatithenai’. The Greek verb diatithenai means ‘to dipose’.

Diathesis is not a disease, but a predisposition, which under certain conditions of the external environment can be transformed into a disease.  It is: ‘A condition of the body which makes the tissues react in the special way to certain stimuli and thus tends to make the person more susceptible to certain diseases.’³

The dictionary meaning is, “A hereditary predisposition of the body to a disease or a group of diseases.” This word was related to the humor (body fluids) theory of temperament and disease.

Dr. Compton J. Burnett was the first person to describe this state to homeopaths. He called it CONSUMPTIVENESS and he wrote a book, ‘New Cures for Consumption by its Own Virus’. He explains the word diathesis as a borderline state between disposition and expression. He defines it as “A borderline state between normal susceptibility and expression of the disease”. He classifies it into: Tubercular Diathesis and Scrophulous Diathesis.

Diathesis is a state or condition of the body or a combination of attributes in an individual causing a susceptibility to disease.⁵ According to Dr. M. L. Dhawale, diathesis represents certain deviations in susceptibility which are not sufficient to label the disease. Many types of diathesis are described by different stalwarts and some of them are:

• Lymphatic Diathesis
• Dyscratic Diathesis
• Rheumatic or Gouty Diathesis
• Tubercular Diathesis
• Hemorrhagic Diathesis
• Scrofulous Diathesis

CLASSIFICATION

1. Lymphatic diathesis –Psoric factors lead to the development of a lymphatic diathesis in childhood. This is identical with Lymphatism and the Exudative diathesis. It first involves the skin, the mucosa and finally internal organs and systems. Milk crust, dermatitis, intertrigo, weeping eczema are often present during the first weeks of life. They are followed by coryza, bronchitis, repeated cold. Development tends to be retarded, and the child is late in learning to talk and walk. Tendency to rickets and spasmophilia. Lymphoid tissues – even normally very active in childhood – grow hypertrophic and prone to disease.

2. Dyscratic Diathesis –The dyscratic diathesis belongs to the syphilitic range of constitutional disorders. In humoral pathology, the term dyscrasisa was used to define a deprived state of humours, a state of imbalance. The diathesis is less clearly defined than the others as it relates to the end states of processes arising through Psoric, Sycotic and above all Tuberculinic taints.

The diathesis often provides the background for the development of carcinomas and other malignant tumours and malignant blood disorders (leukemias).  Degenerative diseases of the nervous system such as tabes and paralysis may also be considered to come under the dyscratic diathesis.

3. Rheumatic or Gouty or Uric acid Diathesis –Within the Sycotic range of constitutional disorders one often comes across the uric acid diathesis. Synonyms are lithaemic diathesis, rheumatic-gouty diathesis, Hydrogenoid diathesis (Von Grauvogl). All rheumatic conditions, gouty deposits in joints, tendons, concretions in the urogenital system, inflammatory conditions, metabolic disorders, liver and bile diseases and arteriosclerosis come under this diathesis. Benign tumours ranging from warts to fibroids, adenomas and uterine myomas.

4. Tubercular Diathesis– these people have a history of tuberculosis or whooping cough, asthma or asthma bronchitis, bronchopneumonia etc. They are emaciated and weak with muscle wasting. Tendency to have cough and cold. Symptoms are ever changing. Rapid response to any stimulus and  for this reason it is also known as reacting miasm.

5. Hemorrhagic Diathesis –An inherited predisposition to a number of abnormalities characterized by excessive bleeding. It is an unusual susceptibility to bleeding (hemorrhage) mostly due to hypo-coagulability.

6. Scrophulous Diathesis –It is similar to tubercular lymphangitis. There is induration leading to sinus or fistula formation with subsequent healing with scar formation.

Discussion: Different people get sick in different ways, even if they have experienced a similar stress, whether physical or emotional. This will cause different forms of illness in different people based on their diathesis. It indicates the type of susceptibility towards the disease.

In the § 76 of Organon of Medicine Dr. Hahnemann considers pathogenic diseases or patients who develop chronic side effect of drugs, which was termed “drug miasm.” Hahnemann clearly perceived the diathesis development as being due to the continued doses of non-conventional medicine.

When the manifestations of Psora, Sycosis and Syphilis insidiously make a rich ground to susceptibility it produces diathesis. It occurs where the disease manifestations have a fertile soil to grow and manifest a particular disease.

In homoeopathy, the choice of remedy is based on a consideration of the totality of an individual’s symptoms and circumstances, including personality, behavior, fears, responses to the physical environment, food preferences and so on.

Utility of Diathesis – 

The diathesis makes a simillimum in medicine therapeutic. This is also important from the standpoint of preventive medicine. In certain psychosomatic condition, we correlate to the development of a certain disease by knowing the pathogenesis of these diseases. We could anticipate nature and can arrange some protective measures to prevent the development of these diseases in the predisposed individual. It also helps to the individualize the disease.

Constitution

Chronic diseases do not resolve themselves, but can be treated with the help of well-chosen homeopathic remedies known as constitutional remedies. To select such a constitutional remedy, knowledge about the constitution is necessary.

Paracelsus: ‘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.’

Constitution is defined as the structure, composition, physical make up or nature of a person, comprising inherited qualities and modified by the environment. The English word, constitution, comes from the Latin root, constitution, which means constitutes: to set up, to establish, to form or make up, to appoint, to give being to.

In homoeopathy, the choice of remedy is based on a consideration of the totality of an individual’s symptoms and circumstances, including personality, behaviours, fears, responses to the physical environment, food preferences and so on.

Homeopathic concepts

BAZIN classified constitution into 3 types: SCROFULOUS, GOUTY, SYPHILLITIC

VANNIER’S & ZISSUS

Carbonic constitution – The characteristics of the carbonic constitution are mentally and physically upright persons, having square white regular teeth, slight acute angle between lower-arm and upper-arm, orderly, undemonstrative, responsible and capable. Cal carb, Kali carb, Mag carb, Nat carb, Graph, Carbo veg, Carbo anim are the drugs having this constitution.

Phosphoric constitution has scrofulous or tubercular diathesis. Tall, thin delicate, easily tired persons with long yellow teeth but well fitted. Arm forms perfect straight line when stretched. Dislike hard work but orderly and fastidious. Calc. Phos., Phos acid, Kali phos, Phos, Mag phos are the main drugs.

Flouric constitution is characterized by unbalanced irregular body formations with obtuse angle or outstretched arm, teeth irregular and ill fitted, untidy, cunning and unreliable. Capable or heroism, sanctity and wickedness. Predisposed to diseases of nervous system, dislocation of the joints and suicide. Flouric acid, Calc flour are the main drugs.

Von Grauvogl classified constitution as Oxygenoid, Carbo–nitrogenoid and Hydrogenoid

Oxygenoid constitution is characterized by the accumulation of excess of oxygen with resultant destruction of tissues. Body is thin and thus ill on change of season. Destructive disorders involving the genitalia and diseases of the central nervous system. Body is prone to ulcerations and self destruction. Numerous white spots on the nails. Calc phos, Ferr phos, Nat phos, Phos, Phos acid, Iod, Sil, Calc, Nat mur, Hell, Tuberc, Syph, Merc sol are the main drugs.

Carbo – Nitrogenoid constitution ischaracterized by excess of carbon and nitrogen and suffers from functional disorders of body and mind, diminution of the absorption of oxygen by the tissues. Psora, eczema, arthritism, marked by erratic working or the heart, lungs, kidneys, liver, spleen etc. Ars., Ars. iod, Calc. phos., Carbo veg., Hep., Iod., Kali bich., Lach., Lyco., Natr. mur, Sulph, Zinc met. etc. are the main drugs.

Hydrogenoid Constitution is characterized by the excess of water in the body. They are aggravated by moisture and humidity, prone to dropsy and anasarca, and suffers from tissue growth of benign type. They are slow, fatigued, without life, apathetic, heavy, and indolent. Slow nutrition. Asthmatics, rheumatics, obesity. Ars., Dulc., Nat sulph., Nit.acid, Phytolacca, Rhus tox., Thuja, Dig. etc. are the main drugs.

Diathesis is an integral part of constitution, which helps in individualization. Throughout the homeopathic literature, attributes of it are given, usually in scattered form. In the repertory, rubrics related to constitution and diathesis are found throughout the sections related with generals.

Calvin Knerr in his repertory, “The Repertory of Hering’s Guiding Symptoms of Our Materia Medica” gave the rubrics related to Temperament and Diathesis where a number of medicines were, more than any other work, related to subject and the choice of rubrics were precise but profound. He gave due recognition to this aspect.

Clinical Repertory by Robin Murphy

The constitutions chapter was first introduced by Murphy in the second edition of the repertory. This chapter consists of all the genetic dispositions and body types from the Generals chapter. Extensive additions were gathered from Hering’s guiding symptoms. The constitution chapter contains: constitutions, temperaments, body size, body type, hair in general, complexions, age, growth, gender, habits, defects, miasms, infants, inheritance, children, boys, girls, elderly people, men, occupations, women, young people.

Repertory of Hering’s Guiding Symptoms of our Materia Medica
In Knerr’s repertory the rubrics related to the constitution are included under the chapter, Stages of Life and Constitution. In this chapter rubrics related to various age groups are included under headings like children; old age etc. The rubric Constitution has many sub rubrics. Most of the rubrics of Murphy’s constitution chapter are based on the constitution rubric of the stages and constitution chapter of Knerr’s repertory.

Boger – Boenninghausen’s Characteristics and Repertory

Most of the rubrics related to constitutions are in the chapter Sensations and Complaints in general such as Constitution – Carbo- nitrogenous, Constitution- dyscratic, Constitution- hydrogenoid, Constitution- oxygenoid and so on.

Clinical Repertory to the Dictionary of Materia Medica – John Henry Clarke

The clinical repertory by J. H. Clarke is divided into five chapters. One of them is Repertory of the Temperaments, Dispositions, Constitutions and States. In this chapter are given the remedies which have been found to act most beneficially in certain types of persons, temperaments, sex and age. There are also included complaints and conditions of particular types of persons and constitutions.

Rubrics in different chapters of Calvin B. Knerr Repertory:

Rubrics are arranged alphabetically under each section along with symptoms in original form as sub-rubrics. Following is the list pertaining to rubrics for Diathesis: ⁶

• Headache, drawing; intermittent, in rheumatic, gouty or nervous diathesis, I(chapter- Inner head pg no- 125)
• Headache, neuralgic; intermittent, in rheumatic, gouty or nervous diathesis, I(chapter- Inner head pg no- 132)
• Headache, tearing; Intermittent in those of rheumatic, gouty or nervous diathesis, I(chapter- Inner head pg no- 140)
• Hemicrania, intermittent: in those of rheumatic, gouty or nervous diathesis, I(chapter- Inner head pg no- 143)
• Cornea, inflammation (keratitis); superficial, involving epithelial layers, caused by injuries, colds or in scrofulous diathesis, I (chapter-Eyes, pg no- 178)
• Cornea, pannus; pannus, in patients of strumous diathesis, I(chapter-Eyes, pg no- 179)
• Lower jaw, lancinating; in inferior maxillary, with cancerous diathesis, II Sil. (chapter-Lower face, pg no- 311)
• Lower jaw, pricking: with cancerous diathesis, II Sil (chapter-Lower face, pg no- 313)
• Vomiting, at night; sudden attack, gouty diathesis (acute inflammation of pancreas),I (chapter- Hiccough, Belching, Nausea and Vomiting, pg no- 445)
• Vomiting, saliva; without admixture, gouty diathesis (acute inflammation of pancreas), I(chapter- Hiccough, Belching, Nausea and Vomiting, pg no- 445)
• Liver, scrofulous diathesis: I(chapter-Hypochondria, pg no- 481)
• Constipation, eruption; in subjects of herpetic diathesis, I(chapter- Stool and Rectum, pg no- 535)
• Diarrhoea, at night; sudden attack, gouty diathesis (acute inflammation of pancreas), I(chapter- Stool and Rectum, pg no- 543)
• Rectum, tenesmus (involuntary straining); irritability of bladder, depending upon gouty diathesis, I(chapter- Stool and Rectum, pg no- 554)
• Bladder, irritability; gouty diathesis, I(chapter- Urinary Organs, pg no- 584)
• Bladder, irritability; with tenesmus, depending upon gouty diathesis, I(chapter- Urinary Organs, pg no- 584)
• Urine, albuminous; rheumatic diathesis, Sal. Ac (chapter- Urinary Organs, pg no- 604)
• Urine, diabetes mellitus, with gouty diathesis, I(chapter- Urinary Organs, pg no- 607)
• Urine, sediment; with calculous diathesis, I (chapter- Urinary Organs, pg no- 613)
• Urine, sediment; with gouty diathesis, I (chapter- Urinary Organs, pg no- 613)
• Menses, premature (too early too soon) during course of septic or zymotic disease, or other toxaemic states, as Bright’ s disease, or in hemorrhagic diathesis, blood dark, fluid, offensive, Crotal. (chapter- Female sexual organs, pg no- 653)
• Vagina, granulations; in scorbutic diathesis, I (chapter- Female sexual organs, pg no- 683)
• Cough, dry; Tuberculous diathesis, I (chapter-Cough and Expectoration, pg no- 750)
• Cough, Hacking; With tuberculous diathesis, I (chapter-Cough and Expectoration, pg no- 753)
• Inner chest, dropsy (hydrothorax); often with heart disease or gouty diathesis in old people, l (chapter-Inner chest and lungs, pg no-787)
• Lungs, consumption (phthisis, tuberculosis); tuberculous diathesis, dry hacking cough, I(chapter-Inner chest and lungs, pg no- 809)
• Blood, anaemia; deep-seated chronic, with tubercular diathesis, II(chapter-Heart, Pulse and circulation, pg no- 820)
• Blood, chlorosis; deep-seated, chronic, with tubercular diathesis, II (chapter-Heart, Pulse and circulation, pg no- 820)
• Blood, haemorrhage; hemorrhagic diathesis, Sec (chapter-Heart, Pulse and circulation, pg no- 822)
• Neuralgia, rheumatic; gouty-rheumatic diathesis, IColoc (chapter- Nerves, pg no-1029)
• Eruption, scarlatina; in children of psoric diathesis prone to skin affections, I (chapter- Skin, pg no-1165)
• Age, children; feeble, scrofulous diathesis, frequently troubled with diarrhoea from debility, IINux m. (chapter- Stages of life and constitution, pg no- 1185)
• Age, old people; heart disease, gouty diathesis, Aspar. (chapter- Stages of life and constitution, pg no-1187)
• Constitution, gouty; uric acid diathesis, II (chapter- Stages of life and constitution, pg no-1190)

Conclusion:  Study of these traits helps in understanding the constitution of medicines as well as of patients. Recognition of diathesis helps the physician to understand the morbid constitution of a person. These two traits are part of individualization. A very helpful repertory is Repertory of Hering’s Guiding Symptoms of our Materia Medica by Calvin B. Knerr.

References:-

1. [Internet] Cited on 2018 July 7. Available from: https://www.merriam-webster.com/dictionary/temperament
2. Robert HA. The Principles and Art of Cure by Homoeopathy. Reprinted. New Delhi: B Jain Publisher (P) Ltd ;2008.
3. Burnett JC. The New Cure of Consumption by its Own Virus. 4^thNew Delhi: B Jain Publisher (P) Ltd ;1898.
4. Dhawale ML. Principles & Practice of Homoeopathy. 4^thNew Delhi: B Jain Publisher (P) Ltd ;2014.
5. Knerr CB. Repertory of Hering’s Guiding Symptoms of our Materia Medica. Reprinted. New Delhi: Jain Publishing Co.; 1982.