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Acute Intercurrents and Crisis Remedies
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© David Little 1996-2007, all rights reserved.
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Hahnemann's View of Disease

The Organon of the Healing Art is the text on which the Homoeopathy is based. In this grand work Samuel Hahnemann teaches his students how to use the cardinal principles: similars cure similars, the single remedy, the minimal dose, and the potentized remedy to cure disease. This simillimum is chosen by the totality of the symptoms of the sufferer but what does this really mean? How id Hahnemann use this term? Vide §6 of The Organon.

"All these perceptible signs represent the disease in its ENTIRE ESSENCE, that is, together they form the only conceivable GESTALT OF THE DISEASE."

The characteristic signs, befallments and symptoms of the mistuned vital force are the essence (§6) of the disease. In classical Homoeopathy the essence represents the complete gestalt of human experience (§6, 91, 92 &175). This is the totality of the symptoms.

The first instruction on case taking is for the homoeopath to record all the significant momenta within the complete case history about the nature of the aetiology and chronic miasms as well as the 7 constitutional factors which form a basis for constitution and temperament (§5). These 7 rubrics are constitutional general symptoms of the innate constitution, predisposition, and natural temperament (nature), as well as reactions to the environmental conditioning factors that affect individuals and groups (nurture). The pathogenic timeline, the aetiological constellation, the chronic miasms and the 7 constitutional factors are combined with the objective signs, coincidental befallments and subjective symptoms to make the complete homoeopathic gestalt. Hahnemann listed the 7 constitutional factors in the second part of §5.

1. The discernible body constitution (esp. in protracted cases). This category includes diathetic constitution such as the scrofulous, lymphatic, venous, nervous, tall or thin, short or fat, loose tissue or tight tissue types, etc. These rubrics can be found in Hering's Guiding Symptoms and Knerr's Repertory. These are physical generals.

2. The mental and emotional character (character of the Geist (spirit) and Gemut (the emotional disposition). Hahnemann uses the term 'character' of mental and emotional dispositions. This implies a full psychological work up of the clients innate and acquired mental rubrics. This also includes innate and acquired Hippocratic temperaments. These are mental general symptoms

3. The occupation. The occupation that a person chooses is often characteristic of the individual because of their own innate talents. It also is an area which reveals many maintaining causes (occupational hazards) which keep up the disease state. These can be general symptoms.

4. Lifestyle and habits. These are cardinal general symptoms. How a person chooses to live and what they like to do are very characteristic symptoms. They represent the person and are general symptoms.

5. Civic and domestic relationships. This includes the family situation as well as social relationships. How a person relates to their mates, family, friends, and society in general, is a very important source of general symptoms.

6. Age. Stages of life is a very important part of time and progression in Homoeopathy. Some remedies work particularly well on babies while other are more suited to the elderly. Some work well at both extremes of life. Hering recorded this is the section of the Guiding Symptoms called States of Life and Constitution.

7. Sex and sexuality. Some remedies are more characteristic of females while some are more reflective of males. Some cover problems unique to the female and vice versa. Sexuality is an important part of the general symptoms.

These 7 constitutional general rubrics are the foundation of the general symptoms. Without these constitutional generals the totality of the symptoms is incomplete. What do they look like? What is their character like? What do they do? How do they live? How do they relate to people? What is their age and sexuality like? These are all constitutional factors. This is included in the Organon because it gives insight into the make up of the body and soul of the entire living organism. Vide aphorism. 6.

 He goes on to say the unprejudiced observer.

"perceives nothing in each single case of disease other than the alterations in the condition of the body and soul, disease signs, befallments and symptoms, which are outwardly discernible through the sense."

What is altered? The make-up of the body and soul (Leibes und Seelenbeschaffenheit). How is this alteration known? By the nature of the constitution, the aetiological constellation, and the totality of the disease signs, coincidental befallments and symptoms. Lastly, in Org, § 7 he states:

"The totality of these symptoms is the *outwardly reflected image of the inner wesen [essence, nature, being] of the disease, that is, of the suffering of the life force."

Hahnemann was the first to integrate the cardinal factors such as the inherited constitution, spiritual and emotional temperament, the instinctive vital force, inheritance, predispositions, susceptibility, miasms, infections as well as the complete signs, befallments and symptoms. Hippocrates is normally thought of as the father of constitutional healing but Hahnemann brought it to its perfection in Homoeopathy.

The gestalt of a disease includes all phenomena related to the physical constitution, spiritual and emotional character, innate predisposition, aetiological constellation, and the chronic miasms (§5), as well as, the totality of the objective signs, coincidental befallments, and subjective symptoms (§6). In the advanced methods we stress the importance of viewing the field of homoeopathic information in homogeneous groups families and species*. These genus groups include Hippocratic temperaments, diathetic constitutions, aetiologies, miasms, and symptom syndromes, as well as viewing the mineral, plant and animal remedies and nosodes as genus families.

*homogenous, similar owing to common origin.

Hahnemann called all his homoeopathic remedies "the specificum" (§147) of The Organon. In Hahnemannian Homoeopathy there are five case analysis strategies depending on the nature of the aetiological constellation and the character of the symptomatology. In this way it is possible to treat individuals (§153), a homogeneous group suffering a disease of common cause and similar symptoms (§101, 102), and the individual, within a chronic miasm genus group (§83-103).The homoeopathic specificum is the perfect simillimum because it matches constitution, the nature of the disease process, as well as the signs and symptoms of the mistuned vital force.

Hahnemann's Definition of Homoeopathic Specifics

Hahnemann explains in aphorism 143 how true homoeopathic specifics are tested for their affects on the healthy to collect the pure materia medica. He also points out these proven symptoms are those which demonstrate the  similar therapeutic indications of the remedies. In Homoeopathy the specific remedy is chosen by the totality of the symptoms. The old homogenic medicines were called specifics in accidental cures because their therapeutic indications were completely unknown. Vide Organon §143.

"It is only by proving a considerable number of simple medicines on healthy individuals, and carefully and faithfully recording all the disease elements and symptoms that each medicine (as an artificial disease potence) is capable of engendering, that we can have a true materia medica. A true materia medica is a collection of the genuine, pure, unmistakable modes of the action of simple medicinal substances. It is a codex of nature:

In which stand recorded from each efficacious medicine thus investigated, a considerable set of particular condition-alterations and symptoms as they came to the notice of the observer, and in which are present in similitude, the disease elements which are homoeopathic to several natural diseases to be cured by them one day. The disease elements contain artificial disease states that offer, *for similar natural diseases states*, the only true homoeopathic (i.e., specific) curative implements for certain and permanent recovery."

To use a homoeopathic remedy as a specific it must be proved so that its particular condition alterations and symptoms are known. This is because a true homoeopathic specific is chosen by the totality of the symptoms.

Hahnemann viewed disease as a mistunement of the life force as expressed by the totality of the signs and symptoms. Hahnemann prescribed on the totality of the strange, rare and peculiar symptoms of the individual being not the symptoms common to all diseases. In fact, this is exactly what Hahnemann calls the specific remedy. Vide §153.

"In the search for the HOMOEOPATHIC SPECIFIC REMEDY, that is, in the comparison of the complex of the natural disease's signs with the symptom sets of the available medicines (in order to find, among them an artificial disease potence that corresponds in similarity to the malady to be cured), the more *STRIKING, EXCEPTIONAL, UNUSUAL, AND ODD (characteristic) signs and symptoms of the disease case are to be especially and almost solely kept in view. *These, above all, must correspond to very similar ones in the symptom set of the medicine sought* if it is to the most fitting one for cure. The more common and indeterminate symptoms (lack of appetite, headache, lassitude, restless sleep, discomfort) are to be seen with almost every diseases and medicine and thus deserve little attention unless they are more closely characterized"

As far as the use of specifics in chronic miasmatic diseases we can refer to §82.

"With the discovery of psora, that great source of chronic diseases, and with the finding of more specific homoeopathic remedies for psora, the medical art has come some steps closer to the nature of the majority of disease to be cured. Even so, the homoeopathic physician's duty to carefully apprehend the investigable symptoms and peculiarities of the diseases remains just as indispensable as before, for the formation of the indicator for each chronic (psoric) disease to be cured. No genuine cure of the psoric diseases, or any of the remaining diseases, can take place without the strict individualized treatment of each case of disease."

Thus to find the specifics in Homoeopathy you must individualize the remedy by the constitution, disposition, causations, signs and symptoms. Hahnemannian Homoeopathy has specific anti-miasmic remedies which must be individualized by the totality of the symptoms to suit the individual. Without this "No genuine cure" can take place.

Homoeopathic remedies are specific because they are individualized by the totality of symptoms. This includes all data related to the physical constitution, spiritual and emotional mind, aetiology, miasms (§5) and the objective signs, coincidental befallments and subjective symptoms (§ 6,7,8). This is the totality of the symptoms in Hahnemannian Homoeopathy.

The Three Types of Acute Disorders

The Organon teaches that there are three forms of acute crisis (§73). These are the acute indisposition, the acute miasm, and the acute-like acerbation of a chronic miasm. The first type of acute diseases are those that attack individually. They are usually brought on by an exciting causes such as stress and strain, overheating, being chilled, over eating or bad food, strong physical and mental impressions, etc. They are usually acute acerbations of the chronic miasms stimulated into activity by by a strong exciting cause. If such crisis is slight the best treatment is simple rest, appropriate diet and nursing. When an acute disorder is strong it will repress the chronic symptoms and display a new symptom image. Under these circumstances the intercurrent remedy is the remedy of choice. After the crisis has subsided complementary constitutional treatment is needed to remove the underlying cause.

The second type of acute disease attack individuals sporadically They are caused by atmospheric, meteoric and telluric influences, unseasonable weather, and the like. These are true acute indispositions, and if severe, should be treated with acute remedies as they are prone to complications. These diseases form acute layers which repress the constitutional picture until they have run their course or are removed by homoeopathic remedies. Constitutional and anti miasmic treatment helps the individual to become more resistant to these natural causes.

The third type of acute diseases are the acute miasms. They are caused by microorganisms which are self-limiting but tend to form quick crisis and end with either complications, death or convalescence. They are of two types; those that provide immunity after one attack like measles, mumps, chicken pox, and those which reoccur like viral flu and colds, cholera, typhoid, etc. They should be treated with remedies which reflect the picture of the acute miasms only. Follow up treatment with constitutional and anti miasmic remedies helps supply immunity by removing the underlying susceptibility.

Acute Intercurrents in The Chronic Diseases 

Acute intercurrent remedies are used during temporary disruptions of the chronic treatment (The Chronic Diseases page 224). For example Hahnemann suggests; "Staph: vexation, with indignation, deep internal mortification (attended with throwing things away that was held in the hand." Also, "Ars, taking cold in the stomach by eating fruit (by smelling of Arsenicum). These remedies are chosen by the exciting cause and the active acute symptoms so that they do not disrupt the deeper layers associated with the fundamental cause and constitution. They are crafted to be superficial on purpose so they do not interfere with the complementary constitutional treatment. The acute intercurrent is a specialized specific which deals with disruption of the chronic treatment by occasional exciting causes that would delay the cure. Many modern "constitutionalists" do no believe in acute remedies and say they are suppressive. They say they are following the teaching of James Kent but is this how Kent viewed the relationship between acute and chronic remedies? Vide the article called The Examination of the Patient (Continued) from Kent's Lectures on Homoeopathic Philosophy.

"It is important to avoid getting confused by two disease images that may exist in the body at the same time. A chronic patient, for instance, may be suffering from an acute disease and the physician on being called may think that it is necessary to take the totality of the symptoms; but if he should do that in an acute disease, mixing both the chronic and acute symptoms together, he will become confused and will not find the right remedy. The group of symptoms that constitutes the image and appearance of the acute miasm must now be prescribed for. The chronic symptoms will not, of course, be present when the acute miasm is running, because the latter suppresses or suspends the chronic symptoms, but the diligent physician, not knowing this is so might wrongly gather together all the symptoms that the patient has in a lifetime. "

Kent truly followed the teachings of the Organon. He correctly reminds homoeopaths that when a strong crisis mistunes the vital force it suspends the chronic symptoms while the acute disease runs its course. If you give a remedy by the chronic symptoms during an acute crisis it runs the risk of serious disruption of the nature of the symptom patterns. Many of our modern constitutional homoeopaths are much like the diligent physician of whom Kent was speaking. They mix all the symptoms of the acute diseases, chronic miasms and innate constitution altogether without even realizing it as they pay little attention to layers and always search for the 'one remedy' that covers everything at once. This can be a great mistake in a strong acerbation of a chronic miasm, and acute shock or trauma, physical injuries and virulent acute miasm. The proper treatment for true crisis is the acute intercurrent remedy.

Study Guide: The acute acerbation of chronic miasms are brought on by strong exciting causes, acute indispositions are caused by environmental conditions, and the acute miasmic diseases are caused by susceptibility to micro-organisms. There are two treatment strategies for the acute miasms which are the acute anti miasmic remedy for the individual, and the genus epidemicus remedies for a homogeneous group of sufferers. The practitioner should study the nature of acute and chronic diseases closely to master the complete case management procedures of Classical Homoeopathy.

Boenninghausen on Acute Intercurrents

The use of acute intercurrents for disruptions of chronic treatment was included in "A Systematic Alphabetic Repertory of Homoeopathic Remedies (1832)" written by Baron von Boenninghausen with a Foreword by Samuel Hahnemann. This early work was a repertorium for the materia medica for the anti miasmic remedies found in the Hahnemann's The Chronic Diseases. This work deals exclusively with the treatment of chronic miasms but also has a chapter titled Intercurrent Remedies in Chronic Disease and a subchapter titled Interruption of the Antipsoric Cure. This chapter offers a list of acute intercurrent remedies and their symptoms in crisis. These therapeutic hints are characteristic keynotes of the acute intercurrent remedies. The homoeopath must refer to the materia medica for confirmation and comparison with other remedies. The acute intercurrents must be followed with complementary chronic remedies to be complete the cure.

1. Some of the rubrics are listed like materia medica rubrics. For example:

"Coffea, too great sensitiveness and painfulness of the affected parts, irritability and sleeplessness

Magnes. arct., excessive irritation with trembling, great restlessness in limbs causing change of position, great distension of the hypogastrium, mental anxiety and apprehensiveness, great nervousness.

Nux Vomica, the nervous system is deeply affected and irritated, hypersensitive of the senses, fearfulness, anxiety, inclination to lie down, aversion to open air; passionate, peevish, obstinate disposition or when the menses are too early or prolonged.

Mesmerism for nervousness in general."

2. Other examples are listed in a comparative more like the repertorium. For example:

"Stomach, overloading of,

deranged with gastric fever, chill and coldness with eructations after eating, qualmishness, Bry..

and inclination to vomit, Ant-c.

by fatty food, esp. pork, Puls.

Chilled as from fruit, Ars.

Weakness caused by loss of fluids, as sweat, pollutions, etc, China."

Most of the rubrics in the Baron's list have their origin in Hahnemann's, The Chronic Diseases. The remedies are chosen by the exciting cause and the active acute symptoms so that they do not disrupt the deeper layers associated with the fundamental cause and constitution. They are crafted to be superficial on purpose so they do not interfere with the complementary constitutional treatment. The acute intercurrent is a specialized specific which deals with disruption of the chronic treatment by occasional exciting causes that would delay the cure.

Among the remedies listed are non miasmic remedies like Coff., Bry., Ign., Ip., Cham., Acon., Arn., Rhus-t., Ant-c., etc. They are used for acute hysterical states, emotional crisis, accidents, digestive problems, weakness from excessive discharges, vomiting., diarrhoea, dyspoenea, fever, coryza and catching acute miasms like colds and flus, etc. One might ask the question, "why is a deep acting remedy like Arsenicum in this list?" It is in this acute list because it is being given for a deranged stomach chilled by fruit. If it had a deeper relationship to the individual's case history it should not be used during a serious crisis. The acute intercurrent is chosen by the aetiology of the location, sensation, modifications and concomitants of the acute complaint only.

This approach certainly covers more situations then you can find at the local drug store and does so homoeopathically. This list in Boenninghausen's work is only fragmentary but it does set the standard for the use of acute intercurrents to treat symptoms that interrupt the progress of constitutional and anti-miasmic treatment. This should only be taken up when it is absolutely necessary and not for every trifling pain or discomfort. Acute intercurrents should be taken up only when the crisis needs special attention. A homoeopath should treat strong acute miasms, painful acerbations of chronic states, and dangerous crisis whenever necessary. This is certainly a pragmatic approach for handling crisis conditions that appear during treatment without using allopathic drugs. I would agree, however, that if the condition becomes intolerable and is  dangerous to the person's health then allopathic palliation may have to be used.

I would like to add that I have not seen relapses from using the correct acute intercurrents during an true crisis. In fact, in some cases I find them to be complementary to the action of the chronic remedies. I have seen a chronic remedy continue to work after the crisis resolves with an intercurrent remedy without reintroduction. Acute intercurrents are specifics that are similar only to the acute layer of symptoms.

The use of deeper acting remedies is contraindicated at this time as they may disrupt the natural symptom layers. This method is enhanced by the use of the medicinal solution instead of the dry dose of pills. This is because the dose can be adjusted with more precision. Most strong aggravations are produced by the primary action of the remedy due to improper posology. If one carefully adjusts the dose to fit the sensitivity of the individual and the nature of the disease state, most aggravations will be only very slight. For more information refer to Posology.

Suppression

There seems to be a lot of confusion about what to do when an crisis appears while an individual is on chronic treatment. Some homoeopaths are of the belief that it is safer to use OTC drugs such as Aspirin or Tylenol, than to give a acute remedy because it may interfere with treatment. These analgesics will suppress the pain but what if the person gets a high fever, starts vomiting, gets severe diarrhoea, discharges, eruptions, bleedings, dizziness, etc.. Are you going to use more drugs? allopathic drugs? Is this the best alternative for a homoeopathician? Is this the way the founders of Homoeopathy and their followers managed their cases?

Drugs are toxic and prone to side-effects and in addition they suppress the active symptoms at a moment of vital expression. Aspirin, and the like, suppress pain. Every remedy produces an equal and opposite reaction which cannot be avoided once the substance takes effect. Since the primary action of an allopathic drug is opposite (analgesic, sedative, antipyretic, etc,) to the symptoms to be treated (pain, hysteria, fever) it produces an antagonistic secondary action by the vital force (a change to the opposite state of the drug) which takes the organism into a new posture (compensation). This then changes the functions of the vital force (new position) and alters the constitution (change of the vitality level). If the constitution is strong it may overcome this influence on a single occasion but I have witnessed many relapses from using drugs to treat various crisis. The use of drugs is not a safe or easy way out when case management becomes complicated and the moment confusing. If one stays true to our homoeopathic principles there is an alternative that is rapid, gentle and permanent without side-effects. When there is too little time, and too great a danger, allopathic drugs and life support are needed. This may give us a second chance to cure the individual.

Summation

An acute intercurrent can be any remedy (deep or superficial) in the materia medica that suits the crisis symptoms but it is chosen by the exciting cause and acute symptoms only. A acute intercurrent is also used when there is an acute appearing acerbation of a chronic miasm. Boenninghausen called it a a "palliative intercurrent" because it is not "curative" of the underlying fundamental cause. Deep acting remedies which have a relationship to the miasm or deeper constitution of the individual are avoided. Many times the acute intercurrent is a complement of the chronic remedy. For example, Natrum mur constitutions often develop the acute symptoms of Apis, Ignatia and Bryonia or a Sulphur temperament will develop the symptoms of Acon, Nux-v or Aloe. If there is a psychological crisis Bell., Stram., Hyos., Ign., Mochus,Valerian may also be indicated.

1. In aphorism 73 Hahnemann first speaks of acute diseases that strike individually These are often an acute acerbation of a chronic miasm brought on by various exciting stressful causes. If there are only slight changes then fasting, changes in diet, rest and lifestyle may be all that is needed. Then you can follow up with a constitutional remedy without giving an acute medicine.

2. If the acute state is more severe one may have to use an acute remedy. This should be selected by the location, sensation, modification, and concomitants of the acute layer. In fact, this is not the time to give them their constitutional remedy. This is because the strong acute layer represses the constitutional symptoms while they are active. If you give a constitutional remedy at this time it may activate everything at once producing severe aggravations. The constitutional remedy should be given after the crisis has passed.

3. If a person is already on a constitutional remedy and an acute acerbation of a chronic miasm takes place one has to be more cautious with an intercurrent remedy because we do not want to interfere with the action of the constitutional remedy. If there is no obvious exciting causes it may been a healing crisis brought on by the remedy. One might use measures such as fasting, light food, rest, massage, hot and cold water treatment to make the person more comfortable. Only if the acerbation is moderate to severe do you may want to intervene with intercurrent remedies as an emergency measure. This remedy should be chosen by the location, sensation, modifications and concomitants of the exciting cause and the active layer. The remedy chosen should be more superficially acting so that it will calm the symptoms at the moment without acting too deeply on the case.

The source for the rubrics of the psychological trauma and physical injury remedies, and acute intercurrents, are provings and clinical confirmations. Vide the Materia Medica Pura by Hahnemann, page 89, the lecture on Arnica Montana.

"The symptoms of all injuries caused by severe contusions and lacerations of the fibers are tolerably uniform in character, and, as the following record shows, these symptoms are contained in striking homoeopathic similarity in the alterations of the health which arnica developed in the healthy human subject."

Notice that Hahnemann says that the SYMPTOMS of such injuries are of a TOLERABLY UNIFORM CHARACTER to the PROVINGS. Because of the strong common cause most human constitutions will initially react with the similar symptoms. For this reason Arnica is a first aid specific for such accidents.

I hope this helps our understanding.

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