In his ever continuing effort to reach perfection, Hahnemann created a legacy that is not easy to understand to say the least. In short: Hahnemann was a brilliant scientist, but not a very good author.
This means within this context that his view on the anamnesis is not shown in one complete detailed aphorism, but spread all over the Organon.
Regarding the art of taking a case itself aph. 3 gives in one very long sentence the essence: ”If the physician clearly perceives what is to be cured in every individual case of disease……..If, finally, he knows the obstacles to recovery in each case and is aware of how to remove them……then he understands how to treat judiciously and rationally and he is a true practioner of the healing art.”
If you investigate what Hahnemann wrote on the origins and cure of disease, you can see a kind of framework as a fundamental basis. Starting in aph. 61, he mentions ‘the homeopathic method’, which he opposes to allopathic methods. The latter not able to cure one single chronic disease (how actual today !). After dividing diseases in acute and chronic ones (aph. 72), you will find in aph. 82:
A summary of what is necessary for a good and permanent cure:
– carefully search for all symptoms and modalities;
– curing chronic diseases is impossible without miasmatic prescription;
– without individualisation there is no cure possible;
– distinction of acute and chronic disease.
These four elements are linked together and realising permanent cure becomes very difficult if you ignore one of them.
Keep in mind that Hahnemann wrote ten aphorisms about the latter one – distinction of acute and chronic disease – so this element is a key factor for success.
Herbert Roberts was the first homeopath who called this basis ‘disease classification’ in his book “The principles of art and cure by homeopathy”, chapter 22 – 31, published in 1936.
Anamnesis means ‘case taking’, containing two words: case and take.
These two words stand for the essence of every anamnesis: it contains a passive part (case), the homeopath carefully – but passively – listening to the patient telling his story and his symptoms in his own words and an active part: the homeopath searching for the real cause of an acute or chronic illness, in order to make his analysis according to Hahnemann’s directions.
In this article I will give my view on taking a case based on Hahnemann’s intentions, as given in his two masterworks: the Organon and Chronic Diseases.
2. The Organonic anamnesis
For taking a case you need two people, the homeopath and the patient.
This means that you have to be aware of the fact that you as a homeopath have other intentions and needs than your patient.
So, it is best to make this distinction very clear in your anamnesis.
a) What do you have to know as a homeopath ?
This information is necessary for analysing the case, making a plan for treatment and finding the right remedies.
Here I refer to the summary of what is necessary for a good and permanent cure in chapter 1 .
In aph. 84 this is explained further: ……….“the physician sees, hears, and remarks by his other senses what there is of an altered or unusual character about him (the patient)…………..”
b) What information is given to you from your patient ?
This information is necessary to distinct and find the remedies which fit the patient best, according to symptoms and modalities.
Aph. 84:”The patient details the history of his sufferings; those about him tell what they heard him complain of, how he has behaved and what they have noticed in him..…….“
3. The basic framework
So, how do you realise this in practice ?
It is best to make a framework, in order to get the right information and as complete as possible.
The framework below is Hahnemann’s vision on the fundamental causes of disease and when you look at its totality you will notice that even today it is as complete and actual as ever. The main parts are necessary to realise a complete anamnesis. Each part requires a complete picture, which is based on the symptoms which can be diagnosed in every individual dis-eased.
After discovering homeopathic remedies and applying them for several years, Samuel Hahnemann based his theory on homeopathy on classifying diseases.
4. Disease classification
In his Organon, starting at par. 72, Hahnemann divides diseases in two categories, acute and chronic.
Acute diseases are intense and relatively short. Acute diseases are divided in individual and collective diseases. Individual acute diseases are known as physical traumas, exhaustion, psychological circumstances, etc. They are bypassing attacks of a latent psora.
Collective diseases are known as epidemics or as acute miasmatic outbursts.
Chronic diseases are divided in:
harmful allopathic actions, both remedies and other kinds of
avoidable harmful influences, caused by own bad actions,
living in unhealthy circumstances, lack of exercise and fresh air,
alcohol and drugs, air pollution, etc.
-true chronic diseases,
known as miasms, which are divided in psora, syphilis and sycosis.
The following scheme is helpful for classifying diseases, which is the basis for prescribing:
|– Individual||– Iatrogenic|
|– Epidemic||– Pseudo chronic|
|– Element of chronicdisease||– Miasmatic:.psoric.sycotic.syphilitic|
5. Acute/chronic diseases
First I must emphasize the way Hahnemann treated illness. Instead of what looks to be mainstream in today’s homeopathy, he focused on diseases and not on the dis-eased. This remark is essential to understand the frame work he designed. In aph. 70 he states the essence: “In short through the totality of that symptoms, the disease points out the relevant remedy…..”
Starting from aph. 71. Hahnemann almost exclusively used the word disease. Here he gives the rules for the relevant treatment:
“There is no doubt that diseases contain groups of certain symptoms…..”
“So the therapy can focus on:
I. How is the physician to ascertain what is necessary to be known in order to cure the disease?
II. How is he to gain a knowledge of the instruments adapted for the cure of the natural disease, the pathogenetic powers of the medicines?
III. What is the most suitable method of employing these artificial morbific agents (medicines) for the cure of natural disease?”
6. Chronic diseases
6.1. Iatrogenic (aph. 74)
The impact of allopathic treatment and medicines can be immense and to Hahnemann’s opinion it was no doubt that allopathic treatment caused chronic disease, known as iatrogenic. Nowadays we can see that at least a quarter of all illnesses is caused by it.
6.2. Pseudo chronic (aph. 77)
Hahnemann pointed out that some chronic diseases are not as chronic as they seem to be. These are caused by circumstances or acts that can be avoided, such as addictions (alcohol, drugs, etc), bad food, bad housing, bad working conditions, bad body culture/maintenance. Avoiding these unhealthy things and a better life style will cure the disease.
Nowadays most diseases are caused by lifestyle, so you have to be keen on this. It is also important to regard lifestyle connected diseases not strictly to the patient’s habits, but also to environmental causes. I mention here the most important one: air pollution, which is recently officially declared carcinogenic by the WHO (2013). It is also obvious that the growth of environmental causes as a disease contributing factor is a growing concern for health professionals. And for homeopaths very difficult to handle.
Also it is advisable to link this subject to the next one (miasms), because there is undoubtedly a link between the patient’s own lifestyle and the miasmatic influence. In other words, adjusting the lifestyle may be not the essence of healing in some cases. E.g. in most alcoholics you may notice that rehabilitation programs will not solve the problem. The nihilistic tendency which is often the cause of drinking problems can be diagnosed as syphilitic. Therefore Syphilinum is an essential remedy in most cases.
Aph. 93 refers to all circumstances which lead to a pseudo chronic disease and the fact that not all patients mention this spontaneously.
So it can be necessary to interrogate this carefully.
Aph. 94 encourages the homeopath to consider and scrutinize all this to ascertain what is in them that may tend to produce or maintain disease. Recovery is only possible by their removal.
In females pseudo chronic diseases can be caused by pregnancy, sterility, sexual desire, menses, etc. both with their peculiar physical and mental symptoms.
The “real natural chronic diseases” (aph. 78) are the core business of homeopathy. Not understanding nor diagnosing the miasms means that a homeopath can not see nor cure the essence of most diseases.
Hahnemann gave us three main miasms, psora – sycosis – syphilis.
It is not my intention to discuss the miasms here extensively. This can be found elsewhere. If you have read this article it will be obvious that in Disease Classification the miasms form one of the two basics.
According to aph. 6 symptoms are all deviations from the formerly healthy state of the dis-eased, including:
- what the patient feels himself;
Aph. 90 discusses how the patient has behaved himself during the consultation; whether he was morose, quarrelsome, hasty etc. The homeopath must ascertain himself how much of that was peculiar to the patient in his healthy state.
- what his companions notice about him;
- what the doctor observes:
Aph. 91 indicates that one must be aware of the influence of allopathic remedies on the condition of the patient. So it is necessary to take notice of the patient’s complaints/symptoms in the period before he started using this medication.
Altogether they form the illness in its full form which means they form the only true and only thinkable image of the illness.
Hahnemann pointed out that particulars are an essential part of the anamnesis. Aph. 5 states that “Useful to the physician…..are the particulars of the most probable exciting cause, of the acute disease as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm.”
So particulars are special or significant qualities regarding the patient, the disease or the cause of it.
This concerns the:
– physical constitution of the patient;
– his moral and intellectual character;
– his occupation, mode of living and habits;
– his social and domestic relations;
– his age, sexual function, etc.
In aph. 86 Hahnemann stipulates that of every symptom must be asked:
– when did it happen
– what kind of pain was it, which sensation
– where was it (which bodypart)
– was it constant, with flares or on different times
– how long did it last
– when was it at its worst or best
– how did the sensation feel exactly
Finally aph. 95 concludes that “The investigation of the signs of disease……..must be pursued as carefully and circumstantially as possible and the most minute peculiarities must be attended to…………..”
According to Hahnemann, this is all the more essential because chronic patients have become used to their ill state and have forgotten the details and characteristics of it.
Hahnemann intended us to create a full picture, both of the disease and the patient. Therefore he started with dividing diseases and splitting them further up. This was not for fun, but to give us a handy tool to analyse the case thoroughly and make it possible to prescribe on the real causes of the disease. It is obvious that miasms have an essential role in this totality, being in most cases the real cause of the disease.
So, as the master said before: copy it, but copy it exactly as I meant it.
Cor van der Meij
“Organon of medicine”, 6th edition by Samuel Hahnemann
“The principles of art and cure by homeopathy” by Herbert Roberts
“Hahnemann verstehen” by Ewald Stoteler
The great and magnificent tool that the physicians had for getting cure the patients is the knowledge of the disease through the well done anamnesis. It´s marvelous finding a clue(s) in the clinical history of our patients when we take the time for making our best work with a good anamnesis.
The miasms, many times, are underlying in the clinical history and with a good anamnesis we can find the way for identifying the miasm and treating adequatly our patients.
I AM OF THE OPINION THAT HAHNEMANN HAS NOT CONFUSED SO MUCH AS THE MODERN HOMEOPATHS ARE DOING. HIS BASIC PRINCIPLE WAS THE ANY SUBSTANCE USED BY A HEALTHY MAN CAUSES SOME SYMPTOMS IN HIS BODY AND THE SAME SYMPTOMS ARE REMOVED FROM THE BODY, IF SMALL POTANTISED DOSE OF THAT SUBSTANCE IS GIVEN TO HIM