The fifth aphorism states:
Useful to the physician in assisting him to cure 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. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration.
It will help the physician to bring about a cure if he can find out the data of the most probable occasion of an acute disease, and the most significant history of a protracted wasting sickness, enabling him to find out its fundamental cause. The fundamental cause of a protracted wasting sickness mostly rests upon a chronic miasm. In these investigations, the physician should take into account the patient’s:
- discernible body constitution (especially in case of a protracted disease),
- mental and emotional character,
- lifestyle and habits,
- civic and domestic relationships,
- sexual functions, etc.
When you are treating an acute case with homeopathy, one of the most important points to know is the ‘exciting cause’ – not the virus or bacteria – but that cause which made the body susceptible to an illness, the ’cause’ which ‘excited’ the susceptibility.
In conventional medicine, the occurrence of an acute disease is very simply understood – you come in contact with a pathogen and you catch that cold or fever or diarrhoea or any other acute disease. You ask them why some people are more prone to catching colds ..and the simple answer is ‘they have weak immunity’. But in homeopathy, we go beyond such simple and superficial explanations of acute diseases. We believe that there are innumerable factors which can disturb our homeostasis, derange or vitality and make us prone to an illness. These factors which ‘excite’ our susceptibility can vary from physical factors like exposure to heat, cold, rain. dampness, sun, or factors like overeating or overindulgence in anything – be it food, drinks or sex; mental factors like too much stress about studies or watching too much television, emotional factors like loss of a loved one or a heart-break etc. Many of these factors, if persist for a long time, can lead to chronic conditions. But often the first reaction to any such stress is an acute.
Let me give some examples of ‘exciting causes’ of acute diseases: If constipation sets in after a mental shock or nervous strain, Mag-carb could be the remedy; if you get a cold after getting a hair-cut (not a hair-do but a shave or a crew-cut), then Nux-vomica or Belladonna might be your remedy; if you get a cough after eating rich food, then Mag-mur or Pulsatilla might be you remedy, if you get a diarrhoea after drinking cold water on hot days, Vertrum-album might be your remedy. I can go on to give hundreds of other examples but the point to understand here is that the ‘nervous-strain, the ‘hair-cut’, the ‘rich food’ etc do not by themselves cause disease. They just disturb the fine equilibrium in our body, make it more prone to the action of pathogens, which ultimately leads to the development of ‘disease’ symptoms.
Another important thing to remember is that the correct remedy should not just cover the ‘exciting cause’ but also the presenting symptoms.
Treating an acute condition is not always easy, as the ‘exciting cause’ is not always very evident. Still the process of finding the remedy for an acute case is straight forward, when compared to the treatment of chronic cases. A person suffering from chronic gastric disturbance is very unlikely to tell you about the Typhoid that was mal-treated when he was three. A person suffering from Alzheimer’s’ might not even remember the name of his first crush – leave aside telling you the agony ‘her’ affair with someone else caused. A person suffering from congestive heart failure is unlikely to relate a theft in his house 20 years ago as the starting point of his sickness. So it’s not always easy to pin-point one ‘exciting’ cause that triggered a chronic illness.
So how do we treat a chronic disease systematically? If we just start treating the ‘current complaints’ in a chronic case, we will not be able to move beyond ‘palliation’ in the majority of cases. Just like in an acute case, in chronic cases we also have to chart the complete course of illness. But how? In acute cases, it’s easy to record changes by minutes and hours but how do you chart a chronic illness spanning many decades? Hahnemann gave the answer – take note of ‘the most significant points in the whole history of the chronic disease‘.
A chronic illness doesn’t develop overnight and often the patients come to us with case histories running into decades. During the whole life span of the patient, there are usually episodes of significant acute illness, some starting point where the chronic ‘disease’ is identified, followed by some treatment (usually conventional/allopathic), after which there is a gradual increase in the intensity and variety of complaints as well as medicines! When you start treating a chronic case, you have to gather all this information to treat judiciously. But how does all this information help in treatment? How does the past history help in selecting a remedy and managing a case? Hahnemann says that all this information – the backward tracking – enables him to discover its fundamental cause, which is generally due to a chronic miasm – that is, it allows you to identify the underlying miasm (susceptibility) of the patient, which is usually the ‘fundamental cause’ of a chronic disease.
Let me give you an example. Suppose you have got four Asthma patients. All of them will show the common signs and symptoms of asthma like breathlessness, wheezing respiration, aggravation by cold and exertion and often night too, dry cough etc. This is the presenting picture of the chief complaint. So do we give the same remedy to all of them? Let’s delve a bit deeper into their histories: One of them was declared asthmatic in infancy and both of his parents were asthmatic. The second one had eczema on both legs ten years ago. It was suppressed with corticosteriods for years and gradually he developed occasional episodes of breathlessness. The third one, used to suffer from frequent colds, which were usually treated with antibiotics. Later he developed allergic rhinitis with sensitivity to dust, mites, pollens, strong odors and many other things. He kept taking anti-allergic drugs for years and gradually symptoms of dry cough and dyspnoea started manifesting. The fourth one is a miner and has worked in coal mines for 20 years. His breathlessness has increased gradually over the years. The first case with strong family history is clearly Sycotic and the medicines that might work for him are Natrum-sulph and Medorrhinum, the second case with history of suppression of skin disease is clearly Psoric and the medicine for him is most likely Sulphur, and the third one with marked hypersensitivity, is very much Syphilitic and the medicine that might work for him is Merc-sol. The last one suffers from a pseudo-chronic or an occupational disease. Hahnemann has said – “fundamental cause, which is generally (NOT ALWAYS) due to a chronic miasm”. The last case falls into this category, where the fundamental cause is NOT a chronic miasm. The medicine that might help this case is Stannum.
This is just a gross example of how the origin and the course of disease affects our remedy selection. There might be finer variations depending upon the complete case details and modalities.
But our work does not end here. In chronic cases, apart from finding the fundamental cause, we also need to find out about the physical and mental constitution of the patient, his occupation, mode of living, habits, life-style, relationships and much more. To understand the importance of all these factors in detail, we will need another lecture. So till we meet again, digest the importance of the exciting and fundamental causes in homeopathic treatment.
Dr. Manish Bhatia