Disease Index Homeopathy Papers

The Threefold Principle Applied In Anorexia Nervosa

Written by Jeroen Holtkamp

Jeroen Holtkamp elaborates further on his threefold principle in homeopathy, analyzing anorexia nervosa as an example. From this perspective he suggests remedies that may better cover this ailment. The purpose of life, health and disease must have a purpose too.

People have shown a sincere interest in my therapeutic approach, which is based on the threefold principle. They also indicated that they would be helped if I could clarify the threefold approach in more detail through a case presentation. I am really grateful to have been given the opportunity to share a case with like minded colleagues. However, at this point in time I am not in the position to present cases responsibly, because I didn’t elaborate on the threefold classification structure yet. Measures have been taken to be able to publicise case histories in my book, which I hope to publish near the end of 2013. Alternatively I will demonstrate how the threefold principle can be useful in deepening our understanding of anorexia nervosa (Homeopathy for Anorexia Nervosa) and how it can be helpful in its treatment. Hopefully this will help the reader satisfactorily. First I will give a recap of the threefold principle and elaborate a little more on it.

The purpose of life, health and disease

In my opinion life has a purpose and so health and disease must have a purpose too. As a consequence health and disease are the two sides of the one coin, namely development. One can compare it to learning how to walk. You can’t learn how to walk without falling. Falling is the downside to learning how to walk and likewise disease is the downside of our development. Disease is the part of our development that we simply don’t like. We have the on-going intention to improve the circumstances of ourselves and to a lesser degree of the other. The better we know ourselves the better we know what we really need to improve in our lives. This process of realising one’s self here and know, also known as self-actualisation, is the most essential activity in human existence. Self-actualisation is a very individual process, which leads to acceptance of the burdens of life and a truly realistic outlook. Self-actualisation leads to an increased sense of completeness.

The threefold principle

The threefold principle is based on the individual experience via all physical senses and receptors. Somewhere and somehow the signals produced are transformed into real vivid sensations, impressions and experiences. Even though we acknowledge that each individual experiences the world in a different way, we all have in common that we perceive, reflect and attempt to be self-aware in relation to our experiences. Each individual without a disability and an open mind can, irrespective of time and location, investigate and come to a similar conclusion with respect to the threefold principle. There are 3 primary states of awareness in relation to the physical senses, namely:

  1. Perceptive awareness requires us to connect with the senses and increases sensitivity. Being too much involved in the senses is experienced as over-sensitivity.

  2. To become aware of our reflections we have to withdraw from the senses and turn inward. When we reflect we relate our experiences and impressions functionally to one another. Through reflection we create our concepts of the world, which we are inclined to protect and control.

  3. The third and highest state of awareness in relation to our physical senses and receptors, emerges when impressions and reflections lead to a development of self awareness. It’s the conclusion of BEING here and now and is characterised by increased acceptance of life’s circumstances.

Just like the similarity principle, the threefold principle can, in contrast with the concept of miasms, also be discerned in other fields of science. The materia medica is basically threefold for the same reason. The essential need for self-actualisation is a relatively new phenomenon that came up with the collapse of social conventions and the increase of individualism. With these changes, also new challenges and related diseases occurred. These related problems are nothing but accidents on the way to self-actualisation. Nowadays effective homeopathic help in all cases requires a complete acceptance of the individual and his/her point-a-view, which above all, includes the acknowledgement of self-actualisation.

The acuteness of self-awareness development and its therapeutic approach:

Truly individualising symptoms are obtained from the struggle to self-actualisation that takes place here and now. This tendency to completeness in each patient is facilitated by a form of case taking in which the spotlight illuminates the positive experiences, the negative experiences and the aspects of life that the patient has learned to accept. It is really worthwhile to ask specifically for the positive experiences and to search for the things the patient really wants to do, because it provokes spontaneous expressed highly individualising mental, emotional and general symptoms. That is what we want for making the application of the similarity principle really effective. This way of interviewing also helps the patient to make sense of it all during the consultation. The questions have to demonstrate a genuine interest in the whole person, creating an atmosphere of complete acceptance. This will increase the chance that the homeopathic practitioner really meets the patient. It’s the moment when you realise that if you were in the same situation as the patient, you might for example have committed similar sadistic acts. But instead of condemning them you will perceive them as very serious accidents; accidents for which the patient nevertheless has to take responsibility in order to heal.

Satisfaction of life:

A personal measure for wholesome health is happiness or the satisfaction we derive from life. We will obtain the highest degree of satisfaction from a realistic outlook which is based on acceptance of the ordeals and enjoyments through self-actualisation. The possibility for self-actualisation increases with age. Infants and children are predominantly in a development of perceptive awareness; teenagers more or less in a development of reflective awareness and in young adults a development of self-awareness might become dominant. This self-awareness has, to a certain extent, always been there since approximately the age of three. In young adults however self-awareness is, like a guitar, sufficiently tuned-in with other instruments so that it is able to contribute to harmonising the whole.

If the ability to derive satisfaction from a dominant developmental state is frustrated or impossible, it will be compensated by one or two of the other sources of awareness. Take for example the frustrated desire for a toy in infants. The only thing infants can do in accordance with their undeveloped nature is to cry out for it in their own individual way. In teenagers a reflective-awareness development becomes more dominant alongside their already existing perceptive-awareness. Teenagers have more and better possibilities for satisfaction of life than young children. Beside that, they have also more ways to compensate frustrations of fulfilment, or of its complete absence. These compensation mechanisms form the essence of BEING ill. In the threefold approach it is important to understand:

  1. What developmental process is compensated?

  2. If or what alternative state(s) of awareness is/are involved?

  3. What is the objective of this specific compensation?

The conventional perspective on anorexia nervosa :

Many of you will – or have encountered cases of anorexia nervosa. As one of the eating disorders, anorexia nervosa is especially prevalent among teenage girls, but can also manifests in young men. Binge eating (bulimia) followed by induced vomiting and the use of laxatives and diuretics (binge-purge behaviour) occurs in 50% of anorexics.i Self-imposed starvation can lead to a range of physical health problems depending on the chronicity. The following signs and symptoms are beside the obvious emaciation often seen in anorexics: Gastrointestinal complaints like abdominal pains and constipation resulting from starvation and abuse of laxatives. Starvation causes also a disruption of the endocrine system, which manifests firstly in amenorrhea and on the longer term in unusual hair growth on face, back, arms and legs. Increased or decreased urination, anaemia and are anaemic appearance are also common. A healthy functioning of the liver is at stake which might be apparent from the yellow discolouration of the skin, especially on the palms of the hands. Most alarming however are the cardiac, fluid and electrolyte disorders which manifest among other things in arrhythmia, dehydration and metabolic acidosis.

Researchers are currently attempting to identify the particular gene or genes that might affect a person’s tendency to develop this disorder. Other evidence has pinpointed to a dysfunction in a part of the brain, the hypothalamus (which regulates certain metabolic processes), as contributing to the development of anorexia. Other studies have suggested that imbalances in neurotransmitter levels in the brain may occur in people suffering from anorexia.ii

While some professionals remain of the opinion that family discord and high demands from parents can put a person at risk for developing this disorder, the increasing evidence against the idea that families cause anorexia has mounted to such an extent, that professional mental-health organizations no longer ascribe to that theoryiii.

General psychological characteristics, like fear of failure, perfectionism, sadness and many more, are not really helpful as they are not individual enough for effective application of the law of similarity.

The threefold principle applied in anorexia nervosa:

The threefold principle is what all individual expressions of health and disease have in common. That is why the threefold principle can help us to gain insight into conditions, like anorexia nervosa, that validates the individual point of view. Knowledge derived from the application of the threefold principle complements knowledge from the dualistic point-a-view.iv

Take for example a 16 year old girl. Like many other teenagers she is predominantly in a development of reflective awareness. Of foremost importance is that she can develop her individuality in an atmosphere of love and affection; that she feels, as an emerging individual, first of all accepted and appreciated by her parents and siblings. If for some reason the vital love and affection is not sufficient or not present at all, she will have to compensate it. The love and affection which confirms her whole being is compensated (compensation 1) with the satisfaction that she derives from the perfection of her bodily appearance. The objective of this compensation is the unification with what the senses have to offer. That type of satisfaction is limited but her need for love and affection is infinite. She becomes a prisoner of her own body.

She will be depending on the control of her own desires to supplement the lack of love and affection even further (compensation 2). The objective of this compensation is to evade her dissatisfaction through letting go of ideals that hinder her satisfaction from control.

Here I think of ideals like friendship or an intimate love relationship. Definitely this attempt to compensate will result in the contrary. It will not increase her possibilities to feel loved and will possibly result in hostility towards her own body (compensation 3). She might tell you that she hates her body and admits that she gives in to self-harm, like starving herself or self-induced vomiting. The reader might find it hard to accept this as compensation, but it is. When self-harm has become a reasonable option, she attempts to lead the situation herself in a decisive direction through which she intends to annihilate those aspects (the objective of compensation 3) that obstruct a satisfying existence.

What we see is:

  1. Increased perceptive awareness of her physical appearance, of which the symptoms are usually interpreted as characteristics of Psora. But now we know better.

  2. Increased reflective-awareness development, because she relates her perceptions to a false concept of beauty. We associate symptoms of a desire to control and to hide the ‘true’ identity commonly but unjustifiably with Sycosis. The false and realistic concepts are the two sides of a reflective-awareness development.

  3. As a result her will is weakened and distorted to something she does but not really want to do. Her will, that is a little developed as she is only 16, is made dependent on her bodily appearance alone and she is not able to exist satisfactory. The harm she inflicts on herself is commonly, but by no means justified, ascribed to a Syphilitic nature.

So the spring of pure will is the self-aware being here and now. The things we need for our perceptive and reflective satisfaction are, in comparison to the pure will, mere tendencies lacking freedom. Freedom is very limited in the perceptive-awareness and less in the reflective-development.

In accordance with Hering’s principle I would treat first what came up last. She is able to distance herself from her reflections and perceptions. She might say “I am fat,”, but that is not an answer to the question of who she is. Who she really is and not becomes clear from what she really wants to be here and now. Again, I would like to emphasis that it is important to distinguish unwell BEING from its consequences. Her unwell BEING here and now is, in accordance with Hering’s law, literally what came up last and needs to be treated first. The self-harm is clearly the most urgent matter. Hering’s principle initially related to the concrete physical organs. Experience however has taught us that Hering’s principle manifests in cure and suppression of the intangible psyche as well. In the psyche, cure progresses when we see a shift from a mental state of self-awareness development to a more emotional state of reflective-awareness development. A prescription for a patient with advanced anorexia nervosa based heavily on, for example fanaticism and a desire for control, would in my opinion definitely lead to suppression, resulting in more self-harm and perhaps even suicide.

Early stages of anorexia nervosa :

The true totality of disease in this example of anorexia nervosa and in all cases are the mental, emotional and physical symptoms that are directly related to the warped and weakened ‘will’ that results from the compensation mechanisms. The early stages of anorexia nervosa in teenage girls is characterised by a withdrawal from family. The reason for this withdrawal and self-isolation can be found both in and outside the family.

Natrum Muriaticum is a very universal remedy that covers the essence of unwell BEING in many remedies. Natrum mur. is useful for the consequences of not being loved, or the lack of it over a longer period of time. Natrum mur. represses dissatisfactory love and affection through the DISSOLVING effect of reflection. Natrum mur. compensates through a diversion of dissatisfactory realised ideals, such as friendship, love and affection, through a satisfaction that is derived from control over life. Throughout our lives the activity of letting go of such ideals is a frequent returning theme, and it starts with taking leave from our mother. Any traumatic event in a period of major reflective-awareness development could trigger the Natrum mur. Compensation, which requires intensified reflection in solitude. This need for solitude and satisfaction from control, at the cost of relationship ideals, increases the isolation from parents and siblings.

There are many remedies that share this Natrum mur. essence, which might be useful in the early stage of anorexia nervosa. Here follow a few examples.

Ambra Grisea could be beneficial in early stages of anorexia nervosa where a young teenage girl is traumatised due to an inappropriate sexual incident with the father, like sexual abuse or the witnessing of her father in sexual contact with another woman. This causes uncertainty about her identity in relation to boys. It increases her need to reflect in solitude. Just as in Natrum mur., she gets into a vicious circle of reflection due to past disagreeable occurrences and fixed disagreeable fancies. She might become depressed. Music reminds her of harmonious moments which she wants to divert through reflection, to fulfil her need for control. (< music) Other symptoms:

Ambra is suitable for excitable-, nervous children and THIN nervous patients. Loss of love of life. Flitting, flighty talk in modern society girls. Effects of domestic shock, business worry. v Ambra can also be beneficial in cases where severe trauma to the central nervous system, caused by a blow to the head, results in a disability to reflect on the love and affection that has been given in the past. In those cases the inability to reflect is central to the typical Ambra symptoms that might develop.

I can not avoid mentioning Natrum Sulphuricum, which is the remedy we think of first when the perceived cause is trauma to the head or spine. Also there is a great inclination to reflect and a strong desire for things that are beneficial for reflection. Her need for solitude can cause estrangement from her family and an inability to appreciate the loving care that is offered. Other symptoms:

Dislikes to speak or be spoken to… (Conversation requires reflection) …Lively music saddens. Has to use all self-control…. (The self-control she might use in a later stage in her aim to reach bodily perfection)… to prevent shooting himself. Objective; realistic; always adheres to matters of fact. Emotions not involved in love; not impulsive; not spontaneous. Only moved by music and soft light. Inability to think.vi

Aurum metalicum could be given to highly idealistic teenage girls whose being is disturbed during a decisive moment in family life, like the start of a family company or the exclusion of an important friend. The feelings of injustice brought about by the parents well meant intentions makes it difficult for her to accept their love and affection. She doesn’t give up striving for her frustrated ideals of which music is a reminder. Music makes her generally feel better; it relieves her body and mind from the pain and hardship she encounters in realising her ideals. She might have an unusual responsibility and is troubled with self-reproach and self-criticism. She needs people to make her ideals reality and on the other hand, she needs religious/spiritual solitude to deeply reflect as a means to regain control over her life. Other symptoms:

Disposed to shun people. Sadness when alone. Forsaken feeling. Anger at absent person. Ailments from: grief, disappointed love, unusual responsibility. Extreme disposition to be offended.vii

Ferrum Iodatum is also a remedy that has the Natrum mur. essence in common. This remedy can be beneficial in the early stage of anorexia nervosa that is triggered by an on-going quarrel outside family life, in which she is not able to stand up for herself. She could for example be the victim of bullying in school were another person is constantly domineering and pestering her through manipulation of other students. Ferr-i. has a few characteristics in common with a predisposition to anorexia nervosa. Here I think of the tendency to exclude oneself from family life; dissatisfaction with her body that is experienced as too fat and also the desire to let her will govern her personal circumstances persistantly. Like all Ferrums she is inclined to enforce her envisaged ideals, such as her bodily appearance. Ferr-s. could also be considered in cases of anorexia nervosa with the Ferrum characteristic. I have found Jan Scholten’s “Homeopathy and the elements” very helpful for the study of the Ferrums.

Advanced stages of anorexia nervosa:

The following remedies can be useful in advanced cases of anorexia nervosa that cover the three compensation mechanisms mentioned earlier. Thanks to Jan Scholten’s approach to the elements, my understanding of the remedy Aurum Sulphuricum increased by leaps.viii In my opinion Aur-s. must be considered in cases of relapse near the most critical stage, when the patient is about to give up, or succumbs to her disease. In the description that Scholten has given us of Aur-s. we can discern the typical causes underlying anorexia nervosa, such as the perceived loss of love and affection from parents and/or siblings. Certainly if this loss was felt in her mid-teens during her development of reflective awareness, she will possibly first of all compensate it through the satisfaction from bodily perfection. Her need for control over her appearance might go hand in hand with her need for satisfying her development of self-awareness through responsibility for others. Aur-s. can be useful in cases were self-neglect/self-harm by starvation and self-induced vomiting, is combined with the responsibility for the well-being of others.

Plantago is known for it beneficial action in complaints of earache, toothache and enuresis. The threefold principle can be used to determine other possible beneficial effects that are to my knowledge not documented yet. I start from the very valid premise that almost every remedy has a sexual nature and/or an issue that is not necessarily mentioned in the materia medica, even though it plays an important role in relationships. When applying the threefold principle to the mental and emotional symptoms of Plantago, one can determine that this remedy is clearly in a perceptive awareness development. Patients in such a development are delivered to the on-going changeable impressions of their physical senses. The effects on their expressions and behaviour could be characterised as over-sensitive, changeable, impulsive, rejection/attraction, restlessness, exaggeration, capriciousness, sympathy/antipathy, etc. Plantago fits into that category because of the following symptomsix:

Restlessness, Hurry in occupation; Desire to do several things at once; Undertakes many things, perseveres in nothing; Acute hearing; Sensitive skin …Beside those symptoms one can discern symptoms that indicate a disability for reflective development, such as: … Feelings of great anxiety from mental exertion; intolerant to contradiction… Striking to me is the concomitance of symptoms of a perceptive awareness – and a reflective awareness development in … Impatient, restless mood & dull, stupid feeling in brain.

The satisfaction that Plantago derives from sex is likely to be characterised by impatience too. Actually, her itchy and sensitive skin which aggravates from scratching/rubbing might be responsible for a strong sex drive. If Plantago’s instant sexual needs can not be met because of a disability of her partner, she will have to complement it. Because she is in a perceptive development she can do nothing but complement her sexual dissatisfaction, with the satisfaction she derives from bodily perfection. In my opinion, Plantago also has a strong disposition to anorexia nervosa. I hypothesize that the caring nature in some Plantago cases is based on a beauty ideal, instead of compassion. The coloured glasses we all look through have in Plantago the effect that she actually mal-nourishes her disabled partner, because she feels that what’s good for me is good for him.

I find similarities between Plantago and Aluminium phosphoricumx: < Tobacco; hurriedness; skin itchy and sensitive < scratching/rubbing; hypothetically the mal-nourishment of the partner; the combination of hurriedness and a disability for reflection; constipation.

Physical modalities that have an effect on the whole person, like the general aggravation by scratching/rubbing in Plantago and Alumin-p. do affect the ill BEING in the core. Aggravations with a general effect are therefore, together with the mental and emotional symptoms that cover the compensation mechanisms, very valuable in determining the most similar remedy. Local physical symptoms and their modalities are the consequences of BEING ill and are of secondary importance, when it comes to the determination of the most similar remedy.

JanScholten deduced the characteristics of Astatinumxi with the help of the now well proven periodic table approach of remedies. One of the important characteristics in relation to anorexia nervosa, is the sensation of being swollen, feeling inflated, heavy and full. This sensation is an expression of dissatisfaction with ones bodily appearance. The delusion of being a king in power reflects a completion of a reflective development, as one is temporarily able to enjoy complete satisfaction from their false and/or relatively true concepts of reality and the control of it. Astatinum states can come about when this power is taken from a young girl by domineering parents, when she is in the midst of her reflective awareness development. The parents might criticize her friends unremittingly or even forbid her to have contact with them. This might lead to feelings of humiliation and being offended. As a consequence the girl becomes isolated from her friends and estranges from her parents, due to a growing distrust. She feels alone. Her parents took over the power and she has not many values developed of her own. This is a recipe for anarchist behaviour. The satisfaction from love and affection is compensated with extreme self-criticism and detailed control.


The initial experience of lacking vital love and affection predisposes some, predominantly female, teenagers and young adults for anorexia nervosa. It is important to distinguish between BEING ill and its physical consequences. BEING ill in the early stage of anorexia nervosa is characterised by withdrawal and isolation from family and friends. The early stage is an increased reflective-awareness development. Natrum mur. matches the compensation mechanism underlying the downside to every reflective-awareness development. There are many remedies that matche Natrum mur.’s essence and that could be beneficial in early stages of anorexia nervosa. A few examples are: Ambr., Nat-s., Aurum and Ferr-i. Three compensation mechanisms are essential to BEING ill in advanced cases of anorexia nervosa, namely:

  1. Compensation of lack of love and affection by bodily perfection.

  2. Compensation of lack of bodily perfection by satisfaction from control.

  3. Compensation of lack of control by annihilation of obstacles to a satisfactory existence.

The remedies Aur-s., Plan., Alumin-p. and Astatinum could be considered in advanced cases, because they cover the three compensatory mechanisms which have been derived from the threefold principle.

The compensation of a lack of love and affection with the satisfaction derived from bodily perfection also underlies the appearance of acute ailments related to sexuality. Depending on the severity of this compensation, the need for control and/or hostility towards one’s own, or the others body, can take excessive forms. The urgency is not the sensory appearance of disease. The accumulation of things one has failed to do, because of this compensatory mechanism, is what people experience as BEING ill, and is what needs to be treated first. Unfinished things are keeping people from taking leave of their past and hinder them living here and now and ready for the future. Acceptance of disease is the first essential step to recovery.

The physical symptoms associated with the syndromes Sycosis and Syphilis are not directly linked to the inability of self-actualisation here and now. Rather, they are only the consequences of BEING ill. The anti-miasmatic approach to disease makes us believe that we can take measures to avoid being sick in the future. Often the analogy of weeds is used to explain the miasmatic approach: We like the flowers in the field but not the weeds. Cutting the weeds is not sufficient though. With the anti-miasmatic remedies we are able destroy the roots of the weeds, so that only a field of flowers remains. That is indeed a colourful analogy, but it doesn’t reflect the reality of life. This frequently used analogy suggests that the fruits of life are only derived from the pleasant. People have to avoid deriving life satisfaction only from the pleasant, because it will decrease the alertness for the well-being of the other, with a weakening of social cohesion as a result. When one persists on that path of the pleasant, one will be more likely to give in to crime and/or the satisfaction through sexual abuse or assault. It is of utmost importance to gently convey the following message to patients and students when appropriate: We need disease and the unpleasant things in life to develop and become stronger.

I will elaborate on the above extensively in my commentary on the happiness of the other. The happiness of the other, as a personal objective, guaranties more lasting personal satisfaction for the practitioner and the patient alike. I intend to let this commentary appear in several volumes that will describe the BEING from a non-conceptual approach; an approach from an undefined therapeutic attitude that is aided by a complete openness, which characterises the BEING from the point of view of the patient.

One says: “Ignorance is bliss”. And that is what I try to make clear, namely that we need to learn to accept that, beyond all preconceived differences for which our conventions and cherished concepts are responsible, we share the same divine nature. In my opinion the real BEING in freedom and responsibility is only possible in the complete attention for the other in the interest of the good cause, namely the unification of the BEING with the divine here and now on Earth.

i The Merck Manual Sixteenth Edition, published by Merck Research Laboratories 1992, page 2279.

ii http://www.medicinenet.com/anorexia_nervosa/article.htm

iii http://www.medicinenet.com/anorexia_nervosa/article.htm

iv The dualistic approach as explained in my first article.

v Frans Vermeulen, Concordant Materia Medica, Emryss bv Publishers, Haarlem, the Netherlands, 1997

vi Frans Vermeulen, Concordant Materia Medica, Emryss bv Publishers, Haarlem, the Netherlands, 1997

vii Frans Vermeulen, Concordant Materia Medica, Emryss bv Publishers, Haarlem, the Netherlands, 1997

viii Jan Scholten, Dutch version of “Homeopathy and the elements”, page 742, Stichting Alonnissos, Utrecht, the Netherlands, 1996

ix Frans Vermeulen, Concordant Materia Medica, Emryss bv Publishers, Haarlem, the Netherlands, 1997

x Jan Scholten, Dutch version of “Homeopathy and the elements”, page 273, Stichting Alonnissos, Utrecht, the Netherlands, 1996

xi Jan Scholten, Dutch version of “Homeopathy and the elements”, page 801, Stichting Alonnissos, Utrecht, the Netherlands, 1996

About the author

Jeroen Holtkamp

Jeroen Holtkamp, I.S.Hom. studied homeopathy in the Netherlands and has been practising in Ireland since 2003. From his mid teens Jeroen has had a passionate interest in physics, philosophy, psychology and spirituality. Throughout his study and professional career he maintained and gradually developed, an independent but integrative vision on health, disease and homeopathy which benefitted his practice immensely.


    • Dear Manfred,

      Thanks for reading my article. Perhaps, if time is at your hand, you might find an opportunity to write something about your findings. Could you please let me know in what way the threefold approach is beneficial to you as homeopathic practitioner?

      Thank you in advance,

      Jeroen Holtkamp, I.S.Hom.

    • Dear Dr. Vatsala,

      Thank you very much for reading my article. I am curious to know to what path the threefold approach has led you. Hopefully my next article on the importance of our therapeutic intention will be published in this months issue.

      Best regards,

      Jeroen Holtkamp, I.S.Hom.

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