Dear colleagues and students,
I only have one thing to say about the argument about the patient versus the disease - the patient and their disease is one! How can we separate them? Both come together in such a manner they cannot be separated. No disease - no patient. No patient - no disease.
Each an every patient reacts to the same complaint in the a different manner and will have different concomitant symptoms. Why is this? The answer is the variations in constitution, temperament and predispositions as well as environmental factors. Constitution and temperament (Nature) are the number 1 conditioning factors that individualizing the signs and symptoms. The number 2 factors are environmental influences, time and circumstances (Nurtrue).
In 1828 Hahnemann wrote that the physical constitution of a person and their hereditary dispositions, habits, lifestyle, turn of mind, morality, education as well as diet are the major conditioning factors in the development of the symptoms of chronic diseases. In this statement Hahnemann used the Latin rooted word "konstitutionen" showing he meant the constitution in a traditional medical sense. Vide the Chronic Diseases, Theoretical part, page 102, B. Jain).
"The awakening of the internal Psora which has hitherto slumbered and been latent, and as it were, kept bound by a good bodily constitution and favorable external circumstances, as well as it breaking out into more serious ailments and maladies, is announced by the increase of the symptoms given above as indicating the slumbering Psora, and also by a numberless multitude of various other signs and complaints. These are varied according to the difference in the bodily constitution of a man, his *hereditary disposition*, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc."
The above data resembles the information collected under aphorism 5 of the 5th and 6th Organon. This aphorism assess the physical constitution, mental character, occupational factors, lifestyle, habits, social and domestic relationships, age, sex, etc.. Ten individuals with a "kind of arthritis" respond to their disease in a variety of different fashions depending on their predispositions and sensibilities. They will all share some of the common symptoms of the disease like "sore joints" but one patient may be cold and another hot; one patient is > motion and another is < motion; one patient is depressed, sad and quiet and another is animated, angry and yells.
G. H. G Jahr looked deeply into the relationship between the patient and their disease. He gave his views in The Doctrines and Principles of the Entire Theoretical and Practical Homoopathic Art of Healing published in Stuttgart in 1857. German Homoeopath, Gaby Rottler, who is an excellent German-English translator, introduced me to the depth of Jahr's views. She has written and article called Constitution and Chronic Diseases - The Value of Constitutional Symptoms as Seen by G. H.G Jahr. This is one of the earliest examples of what might be called "constitutional prescribing", although it is very different then the approach of James Kent. I would advise anyone who is interested in Jahr's work to refer to Gaby article.
Jahr separated the rubrics into the pathognomic symptoms and the "constitutional additional symptoms" (constitutionellen Nebensymptome), i.e. which may be called the constitutional concomitants. The pathognomic symptoms are related to the location, sensations and modalities of the disease complaint. The constitutional concomitants are general symptoms that are not part of the disease pathology but they do reflect the patient's individual state. Jahr wrote that the origin of many diseases involve an "acquired or inherited diathesis" making these symptoms so merged with the "individual constitution" that the patient doesn't even think of communicating those symptoms because they don't consider them pathological.
For example, one of our arthritic patients has joint pains with red swellings and stitching pains < on motion. These are the pathognomic symptoms of the main complaint. At the same time, they desire open air, are very thirsty for cold drinks, and like to walk in the evenings. Is it a pathological condition to desire open air or be thirsty for cold drinks? No. Do they help us in finding the correct remedy? YES! These are personalized concomitant symptoms that make one patient different from the other. Ideally the remedy should have both the pathognomic symptoms and the constitutional concomitants. Nevertheless, Jahr opine that in chronic diseases the constitutional concomitants are often the defining characteristic that point to the remedy. This is how one treats the patient and their disease.
This method is an excellent way of separating the pathologic symptoms (many of which are common to the disease) from the symptoms that are uncommon and unique to the patient. Jahr noted that some cases could be cured on the basis of constitutional concomitants alone even if the remedy does not match the pathognomic symptoms. Kent was not the first to think that a remedy that has the general symptoms can cure a particular disease for which it is not yet known. In this way, we learn more about the possible curative powers of remedies over specific diseases. This idea comes from Jahr, a close companion and student of Hahnemann.
This brings up another area where just saying, "one should only look at the disease symptoms" is far too simplistic for the homoeopath. Many of the constitutional concomitant symptoms may not be "disease symptoms" per se. They may not even have any logical connection to the disease state. In fact, Boenninghausen considered such non-logical concomitants to be characteristics of the highest order. Desiring to sip warm water, wishing to eat fish and disliking meat are not pathological symptoms in themselves. Nevertheless, they do help us to understand "who" we are treating and individualize remedies.
Many symptoms are on the borderline between the disease and the patient. For example, some of the modalities that connected to pathological complaints are individualized by the constitution and may be the same in general as well as particular. Those symptoms that lay outside the pathological complaint, however, are under the control of constitution, temperament and predispositions. As the local sensations and modalities are the defining features of the disease state - the constitutional concomitants are the defining features of the patient. In this way we treat the patient and their disease.
I was already looking at the difference between the pathological symptoms and those common to the disease and the general concomitants more indicative of the patient. I used this to give order to the rubrics and help in the judgment of the characteristic value of symptoms. It is not that the pathological symptoms do not sometimes carry clear characteristics symptoms but the common disease symptom are often less useful. A strange sensations, a marked discharge or discoloration, and a local modality can be part of a redline characteristic. They are still important but the constitutional concomitants are often the defining factor. As the modalities are often the defining factors of the local complaint - the constitution concomitants are often the defining factor of the totality of the symptoms. This is slightly different from Boenninghausen's approach where the concomitants can include other locations, regions and disease states. Here we separate the pathognomic symptoms from the constitutional concomitants.
I use a similar method when studying the symptoms of the inherited and chronic miasms. I separate the group symptoms of the miasms from the constitutional and mental concomitants of the patient. I will explain this. The group symptoms common to all miasmatic suffers tell one the genus of the miasm in question. For example, the "itching-burning" aspect of psora is a pathologic symptom common to the miasm. Symptoms like this puts the patient into the category of those that need an anti-psoric remedy but it does not tell you which anti-psoric remedy that patient needs out of the anti-miasmatic group. Hahnemann speaks of this situation in the first part of aphorism 82.
"With the discovering 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 diseases to be cure."
This statement refers to all the remedies that form the antipsoric group. They are found by taking a group anamnesis of a great many persons suffering from psora. All these remedies have the pathognomic symptoms of the miasm like skin eruptions, itching, burning, etc. All psoric patients will suffer from some of the common symptoms of the psoric miasm. This tells you want group of homogeneous remedies to look at but does not help in selecting the best remedy out of this group for the individual patient. Then Hahnemann says that the careful investigation of all the peculiarities of each cases is still as indispensable as it was before he introduced the antipsoric remedies.
"No genuine cure of the psoric diseases, or any of the remaining diseases, can take place without strict individualized treatment of each case of disease."
The pathognomic symptoms common to psora are collective in nature and lead to the antipsoric group of remedies. Now it comes time to assess the "constitutional and mental concomitants" of the individual patient in order to find their personal anti-miasmatic remedy. These concomitants are those general sensations, modalities, thermals, aversions, desires, and emotional and mental symptoms that affect the whole individual. The pathognomic symptoms of the disease tell you which anti-miasmatic group to search ((psora, sycosis, pseudopsora, syphilis, etc.) and the constitutional concomitants tell you which remedy the patient needs out of that group. In this way one treats the miasm and the patient as a unity.
Lastly, I would once again repeat that to separate the patient and their disease is impossible. Once can, however, look at the interdependent synergy of host and disease from different angles. I am very pleased with this aspect of Jahr's work because I look at cases in a very similar manner. I had already noticed that the main complaint with their locations, sensations, and modifications reflected the disease state whereas the general concomitants (constitutional concomitants) said much more about the patient's individuality. I noted that these concomitants often carry the differential rubrics that point to the correct remedy. Jahr, however, made the entire situation extremely clear.
A patient reported with severe abdominal and stomach pains that came on with a sense of constriction and extended through the chest to the throat as well as passed through to the back. The symptoms work him up at 3AM in the morning. These are the locations, sensations and modifications of the pathognomic complaint. Once the patient woke up he could not go back to sleep and would have to keep himself busy. He would stay up for many hours until he went to work. This made him feel tired and sleepy in the day. He was a dry, thin, firm, angular, choleric temperament who was working hard in a self-owned competitive contracting business. It was hard for him to keep up with all the details of the job that made him irritable. These were the constitutional concomitants. The pathognomic and constitutional concomitant symptoms pointed directly to Nux Vomica.
Some people think that using the locations, sensations, modifications and concomitants is somehow exclusively Boenninghausen's method. This is not so. Hahnemann's Symptomlexicon was divided into four chapters according to locations, sensations, modification and extra signs and concomitants long before Boenninghausen came to homoeopathy. Hering also used locations, sensations, modifications and concomitants but in a manner almost exactly the opposite of Boenninghausen.
Boenninghausen broke up the words of the provers and redistributed the symptoms in abbreviated form in different chapters. There are few (if any) complete sub-rubrics in the entire Therapeutic Pocketbook. It is very good for forming dependable new combinations of the symptoms of around 120 remedies but it does not reflect some of the "million dollar" redline characteristics that come as complete symptoms with distinct combinations of locations, sensations, modalities and concomitants in the provings. The golden symptoms of the provings and well proven clinical confirmations get lost in the "mix" of indexing, abbreviating, redacting, and distributing rubrics in different chapters. There are no major sub-rubrics carrying various defining conditions to the symptoms in general in the regions.
Hering wished to keep the symptoms and concomitants as close as possible to the provers words. He felt many combinations of symptoms and concomitants were extremely characteristic, and should not be broken up. He did not think that all the symptoms should be separated, redacted and redistributed. He felt that too much was being lost in the process. He did allow for some generalizations and using symptoms in general throughout the regions of the body but he wished to maintain the integrity the sub-rubrics. That is why one finds such great sub-rubrics with concomitants in Knerr's Repertory to Hering's Guiding Symptoms.
Hering specialized in the study of mental concomitants to bodily ailments and collected a good amount of material on the subject. Hering wrote a special repertory on mental concomitants called An Analytical Repertory of the Symptoms of the Mind. This wonderful little book opens the door to unique combinations of physical and mental symptoms taking place in the same patient. Hering's "mental concomitants" include groups of physical and psychological symptoms that form joined redline characteristics.
Jahr used the locations, sensations, modifications and concomitants in a different fashion.. His separation of the pathognomic symptoms common to the disease from the constitutional concomitants of the patient was brilliant and helps in judging the characteristic value of the symptoms. Jahr is one of the Founder's of Homoeopathy, along with Hahnemann, Boenninghausen and Hering.
The above represents three unique ways of using concomitants. I have integrated all of these into my case taking methods. There are so many gems in Homoeopathy that we have yet to address. Let us not get lost in modern debates without investigating what the Founder's taught. Such investigations often clear the air. I hope this is food for thought.
Sincerely, David Little