Lectures on Organon of Medicine – Totality of Symptoms – Understanding Aphorism Seven and Eight

Listen To The Audio Lecture for Aphorism Seven and Eight (MP3/4.97mb)

Today, I will try to cover the 7th and 8th aphorism together because both of them are closely related and are trying to convey the same thing in different words.

The seventh aphorism states:

Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed¹, we can perceive nothing but the morbid symptoms, it must (regard being had to the possibility of a miasm, and attention paid to the accessory circumstances, § 5) be the symptoms alone by which the disease demands and points to the remedy suited to relieve it – and, moreover, the totality of these, its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires – the only thing that can determine the choice of the most appropriate remedy – and thus, in a word, the totality² of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease and to remove by means of his art, in order that it shall be cured and transformed into health.

Footnote 1– It is not necessary to say that every intelligent physician would first remove this where it exists; the indisposition thereupon generally ceases spontaneously. He will remove from the room strong-smelling flowers, which have a tendency to cause syncope and hysterical sufferings; extract from the cornea the foreign body that excites inflammation of the eye; loosen the over-tight bandage on a wounded limb that threatens to cause mortification, and apply a more suitable one; lay bare and put ligature on the wounded artery that produces fainting; endeavour to promote the expulsion by vomiting of belladonna berries etc., that may have been swallowed; extract foreign substances that may have got into the orifices of the body (the nose, gullet, ears, urethra, rectum, vagina); crush the vesical calculus; open the imperforate anus of the newborn infant, etc.

Footnote 2 – In all times, the old school physicians, not knowing how else to give relief, have sought to combat and if possible to suppress by medicines, here and there, a single symptom from among a number in diseases – a one-sided procedure, which, under the name of symptomatic treatment, has justly excited universal contempt, because by it, not only was nothing gained, but much harm was inflicted. A single one of the symptoms present is no more the disease itself than a foot is the man himself. This procedure was so much the more reprehensible, that such a single symptom was only treated by an antagonistic remedy (therefore only in an enantiopathic and palliative manner), whereby, after a slight alleviation, it was subsequently only rendered all the worse.

The eighth aphorism states:

It is not conceivable, not can it be proved by any experience in the world, that, after removal of all the symptoms of the disease and of the entire collection of the perceptible phenomena, there should or could remain anything else besides health, or that the morbid alteration in the interior could remain uneradicated.¹

Footnote 1 – When a patient has been cured of his disease by a true physician, in such a manner that no trace of the disease, no morbid symptom, remains, and all the signs of health have permanently returned, how can anyone, without offering an insult to common sense, affirm in such an individual the whole bodily disease still remains interior? And yet the chief of the old school, Hufeland, asserts this in the following words: “Homoeopathy can remove symptoms, but the disease remains.” (Vide Homoopathie, p.27, 1, 19.) This he maintains partly from mortification at the progress made by homoeopathy to the benefits of mankind, partly because he still holds thoroughly material notions respecting disease, which he is still unable to regard as a state of being of the organism wherein it is dynamically altered by the morbidly deranged vital force, as an altered state of health, but he views the disease as a something material, which after the cure is completed, may still remain lurking in some corner in the interior of the body, in order, some day during the most vigorous health, to burst forth at its pleasure with its material presence! So dreadful is still the blindness of the old pathology! No wonder that it could only produce a system of therapeutics which is solely occupied with scouring out the poor patient.

To understand these aphorisms clearly, you will again need to refer to the medical theories prevalent at the time of Hahnemann. I have discussed these theories in detail in my last lecture on the 6th aphorism and here I will only summarize the key points. The system of medicine prevalent at the time of Hahnemann was still primarily based on varied hypotheses. Disease was attributed to anything from imbalance of humors to excess of blood (plethora). In spite of the ever increasing advancements in the field of anatomy and physiology, nobody knew for sure what caused disease. People gave hypothesis after hypothesis, which were not based on experience nor observation but on imagination, to explain the real cause of disease. Many great brains were trying to find the ‘real cause’ of disease hidden somewhere within the human body. It was against this form of projection, hypothesis and effort to find the cause of the disease in the interior of man, while neglecting that in this spot which was clearly appreciable outside (the symptoms) that Hahnemann raised his voice in these two aphorisms.

What Hahnemann is saying here is that in all cases, where there are no identifiable exciting or maintaining causes, it is the symptoms alone which tell us about the disease and it is the symptoms alone which can guide us to the remedial agent. I have already discussed the exciting and fundamental causes in my lecture on aphorism five, so I won’t go into that in detail here. The core of the matter is that Hahnemann was raising his voice against the various hypotheses trying to assert the real cause of disease while ignoring the ‘presentation’ of disease.

He says –

..the totality of these, its symptoms, of this outwardly reflected picture of the internal essence of the disease, that is, of the affection of the vital force, must be the principal, or the sole means, whereby the disease can make known what remedy it requires – the only thing that can determine the choice of the most appropriate remedy – and thus, in a word, the totality² of the symptoms must be the principal, indeed the only thing the physician has to take note of in every case of disease and to remove by means of his art, in order that it shall be cured and transformed into health.

It clearly highlights the need to study the clinical presentation in every case as a means to find out the internal derangement that leads to the development of the disease. Hahnemann says that the ‘totality of symptoms’ is the only thing that the physician has to take note of to find out what is wrong in the patient and what is it that needs to be cured.

In the second footnote to aphorism seven, Hahnemann ridicules the allopathic practice of treating symptoms in isolation. He says that a single symptom does not give a reliable picture of the disease. Treating a patient by taking care of the isolated symptoms is like guessing who is the man by looking at a toe or a hand. So if you treat the vomiting with an anti-emetic, hypertension with an anti-hypertensive, constipation with a laxative – you are not taking care of the complete disease picture and the cause of the disease. Suppressing such symptoms in isolation does not check the disease and it can often harm the patient. Hahnemann says that allopathic medicines will usually make the symptoms worse after an initial amelioration. Like the constipation will become worse if the laxative is stopped, the blood-pressure will shoot further as the anti-hypertensive is stopped. This is true in nearly all cases except in some acute cases (like acute gastritis) where the vital force recovers on its own and in such cases there will be no aggravation after the allopathic medicine is discontinued.

The part of the 7th aphorism that I enjoy most is the first footnote. Here you are able to see the depth of Hahnemann’s thought and can marvel at his foresight. Today there are very few homeopaths in this world who can extract a foreign body from nose, ear or eye, can apply sutures or give a gastric lavage or open an imperforate anus. Hahnemann knew it very well that not all conditions are amenable to medicine. There are cases where you do not need any medicine, just a slight change in diet and regimen will set the patient right. We have so many life-style related illnesses today and we are still trying to find a ‘chemical cure’ for all of them. And then there are cases which will need some surgical procedure to alleviate the suffering of the patient. It is so sad to see that majority of homeopaths, even in India, are not trained to perform the most basic emergency procedures like suturing, splinting, setting a displaced shoulder, extracting a foreign body from an orifice, conducting a normal delivery or doing a tracheostomy. We don’t need to work as surgeons but these are such basic emergency procedures that irrespective of the ‘pathy’ that one is practicing, every physician should have these skills. If Hahnemann were alive today, he would have surely insisted on this and I am ready to shout myself hoarse over this issue till our colleges and governments are willing to give me an ear.

While Hahnemann was insisting on the importance of symptoms, he (as usual) did not leave any scope for misunderstanding regarding the fundamental cause of disease – our susceptibility. He says:

..it must (regard being had to the possibility of a miasm, and attention paid to the accessory circumstances, § 5) be the symptoms alone..

In brackets he has written that while you take care of the totality of ‘symptoms’, do not ignore the possibility of an underlying miasm and the accessory circumstances that might be contributing to the disease. What he meant to say here is that in a case of arthritis, if you treat the patient based on the symptoms of joint pains (e.g. worse by motion, better by rest), you will not be able to ‘cure’ the underlying disease. In chronic diseases, you have to address the underlying susceptibility, you have to see beyond (not ignore) the ‘totality of symptoms’ and study the past medical history, family history and the physical and mental constitution to understand the ‘totality of the patient’, the predispositions that he was born with, the tendencies that he has acquired and the state of his susceptibility – only then you will be able to find the true simillimum. In addition you have to take note of the accessory conditions like his diet, life-style, culture and environment. These factors can contribute to the disease condition and it will be difficult to cure a case even with the right remedy till we set right any accessory circumstances that might be causing or contributing to the derangement of the vital force and maintaining the sickness. Once you understand the depth of Hahnemann’s words, you cannot but marvel at his sheer genius. He was a master-piece in the history of medicine ..way ahead of his time!

The eighth aphorism seems to be directed toward Hufeland’s criticism of Homeopathy. Hufeland (and some other contemporaries) was of the opinion that while homeopathy can treat the symptoms, it can not cure the disease. Hahnemann was appalled by this statement. He found it foolish. He said that the disease manifests itself in the form of signs and symptoms, so if the signs and symptoms have disappeared, it is natural to believe that the disease, which was causing those symptoms, is not present in the body anymore. In the footnote, Hahnemann explains that this notion of disease being separate from the symptoms arises due to the materialistic notion of the old school. They are unable to appreciate the dynamic nature of disease, the dynamic derangement of the vital force and continue to feel that there is some material cause of disease lurking in the hidden interior of the human organism that persists even after there is no trace of any sickness left. He found Hufeland’s statement ‘an insult to the common sense‘! There is nothing much to explain here as even I feel the same way.

I hope you have enjoyed this discourse, we will meet again next month with an exciting probe into our vital force!

—————————————-

Dr. Manish Bhatia