CONSTITUTION AND CONSTITUTIONAL APPROACHES IN HOMEOPATHY
Dr. Christian Frederick Samuel Hahnemann, who propounded the system of Homeopathy, conceived the idea of similia principle in 1790, and published his findings in 1796, through an article, Essay on a new Principle for Ascertaining the Curative Powers of Drugs. For the next four years he worked, experimented and codified various doctrines, concepts and theories and in 1810, published the Organon of the Rational Art of Healing, laying down the theoretical and practical principles of Homeopathy. Thus a new and independent system of Medicine called Homeopathy was born. From 1810 to 1843, Hahnemann continued to update, improve and revise this master piece six times, with the name changed from the second edition onwards to Organon of Medicine (Organon der Heilkunst).
Organon of Medicine is a work of intense interest and codification of the medical philosophy. It is the foundation on which the practice of homeopathy remains. Through this, Hahnemann conveys that the physician's high and only mission is to restore the sick to health, what he termed as to cure. Further, he define that the preserver of health (Physician) is the one who has adequate knowledge about the things that derange health and cause disease, and also knows how to remove them. Thus, Organon of Medicine has become a treatise on the application of scientific reasoning to the practical application on curative, preventive and promotive aspects of health care. This is the single most important work on the subject, providing the very basis upon which a truly in-depth study of its single foundation principle (Similia) and its application begun. Hahnemann codified all his wisdom on this new medical paradigm with certain unconventional principles to the knowledge exited at that point of time. Organon gives complete understanding of fundamental laws which endows homeopathic practice with true healing.
Organon (lat. Organum) of Medicine literary means "an instrument for acquiring knowledge; specifically a body of principles of scientific or philosophic investigation". In this sense we can simplify the semantics of ORGANON to a method of scientific investigation or as an instrument of thoughts. Dr. B.K. Sarkar, one of great exponent of Organon of Medicine writes:
“Hahnemann’s Organon is a critique of medical philosophy underlying the art of medicine. An analytical study of Organon as well as that of the history of Homeopathy and the life-story of its founder shows clearly that Homeopathy is a product of inductive logic applied to the subject of Medicine. It is in fact the first as well as one of the most brilliant examples of the application of the inductive method of reasoning to the solution of one of the great problems of humanity viz., the treatment and cure of disease.”
Therapeutic approaches and treatment in Homeopathy
The high and only mission of a homeopathic physician is to restore the sick to health. This includes curative, preventive and promotive care. On this endeavour the Homeopathic physician may encounter with different types of cases in their day-to-day practice and in each type of case, his approach may deferrer depending on the clinical exigencies.
Hahnemann had laid down the fundamental principles in order to achieve the desired result. At the same time he also classified the clinical presentation in to different classes, types, and sub-types with a clear message. Each class of the cases demands a different method of approach. Therefore, it is necessary for the physician to understand the case properly and use the knowledge explained by Hahnemann in the appropriate class as mentioned in the clinical classification of diseases. This in turn helps the physician to select the relevant method of case study, which forms the main source of prescription.
According to the teaching of Organon, in case of indisposition one need not give any medicine and in the case of surgical disorders, the scope of Homeopathy is limited.
In the case of an Acute Dynamic disease, understanding the causative factor is very important. Acute diseases are those come on suddenly with sudden progress and decline suddenly. They can often be traced back to a cause such as exposure to weather extremes, change of climate, cold wind, eating bad food, or lifting heavy objects. Examples of acute conditions are food poisoning, accidents, toothaches, sore throats, and influenza. Most of these acute conditions may resolve themselves, if left untreated or may require some acute medicines for quicker recovery. If they are inappropriately treated or managed incorrectly, they can become chronic.
Chronic diseases are those complaints that have persisted for a long time – sometimes throughout one’s whole life. The symptoms are usually less severe than those of the acute conditions, but they can seriously affect quality of life and become progressively worse over time.
Examples of chronic conditions are insomnia, allergies, recurrent infections, arthritis, thyroid disorders, post-traumatic stress, diabetes, depression, anxiety, panic attacks, back pain, digestive issues, and chronic fatigue and so on. This group of diseases have a slow on set, slow progress and slow decline. 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.
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. Paracelsus
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, constituere, 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.
Hahnemann and Constitution
Dr. Hahnemann gives a fair idea on the importance of the constitution in Aphorism 5 of Organon of Medicine, wherein he sates “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 (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. Thereafter, at least at 20 places he mentions about the constitutions in different context. He mainly refers constitution to the inherent in the natural frame, or inherent nature of the individual. Hahnemann used the word Beschaffenheit in German, which usually translated as constitution in relationship to the Latin root "constiture" in homoeopathic works. Chambers Dictionary defines constitution as the natural condition of the body or mind; disposition.
The term constitution is used at least 16 times in The Chronic Diseases. Pages 30, 34, 35, 48, 75, 90, 98, 99, 101, 103, 142, 143, 145, 181, 242, 243, etc.
Hippocrates taught that all diseases (excluding injuries) were initially general in nature and only become local to provoke a crisis at a later stage. All natural diseases are originally functional and then proceed toward pathological damage over time. He also taught that there was no such thing as a single cause in a natural disease. He taught that causation was of an interdependent origin rather than any one isolated factor. There is always the merging of the susceptibility of an individual or group with a sympathetic pathogenic influence. Therefore, the aetiological constellation includes the predispositions of the physical constitution and mental temperament, the nature of the disease state, as well as environment conditioning factors. Hippocras classified constitution into 2 types, short and thick – is prone to apoplectic conditions and Long and thin – is prone to tubercular affection.
The concept of constitution is widely applied in the practice of traditional Chinese medicine (TCM). Constitutional consideration is an important process for clinical diagnosis and treatment, and it also lays the foundation for health promotion and disease prevention. This concept has been in China for thousands of years. It originated from the famous Chinese Medicine book, Huang Di Nei Jing. The body constitution concept states that every individual has his or her unique body, which reacts in a specific way to environmental influences. Therefore, an essential factor to prevent disease, influence health and balance your body.
As per this concept body constitution can vary from person to person, some are strong, some are weak, some tend to be heat, and some tend to be cold. According to the China Association for Traditional Chinese Medicine (CACM), body constitution can be divided into nine types, named as neutral, qi deficiency, yang deficiency, yin deficiency, blood stasis, phlegm & dampness, damp-heat, qi stagnation and special constitution. Generally, the classification of body constitution is based on physical outlook, personality, common health problems, and adaptation to external environment
There is certain traditional Chinese Medicine concept quite similar to the Homeopathic concept. One such concept is that advocates that different remedy for the same disease and same remedy for different disease. One main reason for this concept lies in the body constitution. Individuals may have the same disease, but their unique body constitution necessitates the use of different remedies that not only work with the symptom but also deal with the root cause, the imbalance in the body constitution. This is why you will see so much variation in Chinese Medicine herbal remedies to treat the same common illnesses, such as flu.
Ayurveda, describes a unique concept of constitution, genetically determined, categorising the population into several subgroups based on phenotypic characters like appearance, temperament and habits. The concept is claimed to be useful in predicting an individual's susceptibility to a particular disease, prognosis of that illness and selection of therapy. According to this concept, the basic constitution of an individual is determined at the time of conception. This constitution is called Prakruti. The term Prakruti is a Sanskrit word that means, "nature," "creativity," or "the first creation." One of the very important concept of Ayurveda is that one's basic constitution is fixed throughout his lifetime. The combination of Vata, Pitta, and Kapha that was present in the individual at the time of conception is maintained throughout his lifetime. This is your base point. Notice that different persons can have different combination of Vata, Pitta and kapha as their basic constitution or Prakruti. This is how Ayurveda can explain the subtle differences between individuals and explains why everyone is unique and that two persons can react very differently when exposed to the same environment or stimuli. One individuals Prakruti is unique to that individual just as the fingerprint and DNA. Thus, in order to understand a person, it is necessary to determine his or her Prakruti. Identifying the prakriti helps in individualising therapy or predicting proneness to a disease.
BAZIN classified constitution into 3 types as SCROFULOUS, GOUTY and SYPHILLITIC
VANNIER’S & ZISSUS
Carbonic constitution – The characteristics of 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 hardwork 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 or 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 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 is characterized 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 mu, 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, Rhustox, Thuja, Dig etc. are the main drugs.
ERNST KRETSCHNER (1921)
By taking a limited number of physical characteristics Kretschner in his book “The character and physique” classified constitution into asthenic, athletic and pyknic.
Asthenic refers to frail, linear physique. A deficiency in thickness combined with an average un lessened height. Lean narrow built with a skin poor in secretion, narrow shoulders, muscles, delicately bones limbs, narrow flat chest, sharp rib angle, and thin stomach.
Athletic constitution is characterized by strong development of the skeleton, musculature and skin, a middle sized man with projecting shoulders, superb chest, firm stomach and trunk tapers in its lower edge so that the pelvis and the magnificent leg seem almost graceful compared with the size of the upper limb particularly hypertrophied shoulder.
Pyknic refers to plump physique.
Relevance constitutions in Homoeopathic literature
Homeopathic prescriptions are made based on the totality of the patients life span that includes past illnesses, family history, constitution & temperament, maismatic background and peculiar symptoms of the present illnesses. Based on these a portrait of the patient is created in the mind of the treating physician and he co relate this diseases partite with that of the portrait of a remedy. When these two portrait matches, a homeopathic response is established and body shall make efforts to cure the illness. This is called the similia principle. In acute cases like a common cold or diarrhoea, such detailed understanding of the patient is considered necessary, however in the case of chronic cases and recurring attacks of acute expression, a detailed case taking is always necessary to find a remedy that is required to effect a cure.
In such cases constitution is an important component in understanding the case.
Clinical repertory by Robin Murphy
The constitutions chapter was first introduced by Murphy in the second edition of repertory. This chapter consist 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 is 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 the 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 is 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, Clarke, John Henry
In 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 type of persons and constitutions.
Organon of Medicine, Samuel Hahnemann, 6th Edition, B Jain Publishes, New Delhi
Clinical Repertory to the Dictionary of Materia medica, together with repertories of causation, temperaments, clinical relationships, natural relationships, Clarke, John Henry, 1904, Homoeopathic publishing co, London
Boenninghausen's Characteristics Materia Medica & Repertory, Cyrus Maxwell Boger, 2008, B Jain Publishers, New Delhi
Repertory of Hering's Guiding Symptoms of our Materia medica, Calvin B. Knerr, M. D., 1896, Philadelphia, F.A. Davis co., For the estate of C. Hering