facts and theories1

7/28/2019 Facts and Theories1

1/23

Facts and Theories Hahnemanns Balancing Act

Concepts of Health and Disease in Hahnemann

To the year 1 students (intake 2009) of the Centre for Homeopathic Education, London.

After I had discovered the weakness and errors of my teachers and books, I

sank into a state of sorrowful indignation, which had nearly altogether

disgusted me with the study of medicine. (S.Hahnemann,Aesculapius in

the Balance, p.410)

Over the last 15 years it has been my experience that there is no better way

to deepen ones understanding of homeopathic philosophy than to read and

reread the writings of Samuel Hahnemann. This article is concerned with

concepts of health and disease as formulated by Hahnemann in his Organon,

Chronic Diseases and some of his pre-Organon writings. A focus of this

article is the productive tension which exists between Hahnemanns theories

(in particular the miasm theory and the concept of the Vital Force) and his

phenomenological approach in practice. Having a good understanding of

Hahnemanns homeopathy establishes a standard by which all other, later

developments in homeopathy, can be measured against. Such an approach

can help to avoid confusions surrounding the different so-called

methodologies.

Homeopathy as restorative art

It has become a commonplace to speak of homeopathy as a science and an

art. Hahnemann himself speaks of the healing art, by which he means more

1


2/23

than just homeopathy. Some have taken this to mean that homeopathy is not

just a rigorous, rational discipline (the science part), but also a creative art

where individual practitioners can freely add ideas to the already existing

structure. The meaning of art as it appears in the Organon is different. In

ORG VI, 1 and 2 Hahnemann says of the highest ideal of cure that it is to

make the sick healthy and a rapid, gentle and permanent restoration of

health. Hahnemann stresses homeopathy as a restorative, not a creative art.

The goal of homeopathy is to restore the patient to a previous state of health,

which is at the same time the baseline for homeopathic treatment. On the

one hand, that seems a fairly conservative undertaking, as it does not include

any improvement of the persons previous state of health, but simply a return

to it. On the other hand, it introduces great clarity when it comes to the

treatment goal, which is explicitly not to change or better the person to be

treated, but simply to return that person, whatever their shortcomings, moral

or otherwise might be, to a state of capacity, which allows them to continue

their life unhindered by disease. From the following passage one can see that

Hahnemann does not think it is the role of the homeopath to change a

persons usual, healthy state of mind, whether that state of mind appeals to

others or not:

For example, one often encounters patients with the most painful, protracted

diseases, who have a mild, gentle emotional mind such that the medical art-

practitioner feels impelled to bestow attention and sympathy upon them. If the

physician conquers the disease and restores the patient again (which is not a rare

possibility with the homeopathic mode of treatment) the physician is often

astonished and startled at the dreadful alteration of the patients emotional mind.

The physician often meets with ingratitude, hard-heartedness, deliberate malice and

the most degrading, the most revolting tempers of humanity qualities that were

2


3/23

precisely those possessed by the patient in former, healthy days. (ORG VI, 210,

footnote).

By calling the former days healthy despite ingratitude, hard-heartedness,

deliberate malice, degrading and revolting tempers, it is clear thatHahnemann was neither judging nor treating his patients according to their

moral imperfections.A bad temperper se was not necessarily pathological;

it only became so if that had changed with the onset or duration of the

disease. For Hahnemann, health was the absence of disease, and disease the

deviation from a previous state of health. No more, no less.

Knowledge of disease what does that mean?

In ORG VI, 3 Hahnemann writes: To be a genuine practitioner of the

medical art, a physician must: Clearly realise what is to be cured in diseases,

that is in each single case of disease (knowledge of disease). Disease,

according to Hahnemann, can only be recognised in each individual case of

disease. There is no abstract disease, but only individual cases of disease.

Still, Hahnemann does not advocate ignoring conventional pathology. He

just makes important distinctions as to its importance. Pathology consists of

two aspects:

a) the disease label, e.g. arthritis, and b) of signs and symptoms, which in the

case of pathology are called pathognomic symptoms, e.g. pain, redness,

heat, swelling, nodules, etc. The disease label is an abstraction, an

interpretation; it belongs into the meaning category. A series of individualsigns and symptoms add up, in the pathology books, to the meaning

arthritis. The pathognomic symptoms belong to the category of facts and

data, including the felt experience of disease in an individual. Hahnemann

was not at all concerned with disease names (ORG VI, 73 footnote). By

3


4/23

themselves they have no value in homeopathic case assessment (including

case analysis and prescription of remedies). However, he did think it was

important to know what type or form of disease the patient suffers from, for

the simple reason that individualisation of a case of disease is carried out

within pre-defined parameters. These are mainly set by the existing materia

medica and Hahnemanns hypothesis that the many varied diseases can be

traced back to three infections (psora, syphilis and sycosis). Already at the

time of the 1st edition of the Organon (1810) (ORG I, 123; ORG II, 152)

Hahnemann considered the number of well proven remedies sufficient for

the infinitely many disease states in nature (thanks to the truth of the

symptoms and the abundance of the disease elements that each one of the

efficacious medicinal substances has shown in its impinging action on

healthy bodies). (ORG VI, 145) If there would be no grouping of disease

forms (according to miasms) or of the remedies there would indeed be the

need for the strictest, self-standing individualisation, something which

would make homeopathy an impossible undertaking. Hahnemann did not

postulate treating every single case of disease as a free standing, peculiar

disease, totally out of any context. Rather, he was looking for the peculiar

form or variance of a familiar (known) and general disease species. G.H.G.

Jahr compared the strictest, self-standing individualisation with declaring

every single animal or plant as a peculiar animal or plant without having

defined beforehand what species or family the animal or plant belongs to,

e.g. whether the plant one talks about is an oak tree or a carnation, whether

the animal is a donkey or a cat. Hahnemanns miasm theory, which has an

explanatory (nature of disease) and classifying function (type of disease), is

an attempt to do this fact justice (see ORG VI, 103). Well return to the topic

of miasms later.

4


5/23


6/23


7/23

constitutional traits, be they physical or mental, and some homeopaths even

elevate the profession of a patient to an indication for a prescription. As can

be clearly seen from ORG VI, 5 and ORG VI, 208, this was not the intention

of Hahnemann.

ORG VI, 6 deals with what we perceive in diseases. The unprejudiced

observer, he says, perceives nothing in each single case of disease other

than the alterations in the condition of the body and soul. Only [] the

deviations from the former healthy state of the now sick patient are

perceived. They are perceptible to the patient himself, by those around him

and observed by the physician. Hahnemann contrasts this with futile

metaphysical speculations which are not borne out in experience. (ORG

VI, 6) ORG VI, 7 specifies further how disease is defined in homeopathy:

In cases of disease where there is no obvious occasioning cause (causa

occasionalis) to be removed, we can perceive nothing but the disease signs.

Therefore, it must be the symptoms alone by which the disease demands and

can point to the appropriate medicine for its relief, along with regard for any

contingent miasm and with attention to the attendant circumstances. When

Hahnemann speaks of disease without qualifying it any further, e.g.

indispositions or iatrogenic diseases (ORG VI, 74-77), he means the

deviations from health (ultimately due to a miasm) which are expressed in a

combination of signs and symptoms which are to be matched up with a

combination of signs and symptoms in a remedy: comparison of the

complex of the natural diseases signs with the symptom set of the available

medicines. (ORG VI, 153) Both consist of data and facts, not opinions,

interpretations or conjectures. What is to be cured cannot therefore remain

concealed in the unfathomable depths of obscure speculation, or be diffused

throughout the boundless void of conjecture; it must be accessible, readily

7


8/23

accessible to us, within the sphere of vision of our external and internal

perception faculties. (The Medicine of Experience, p.439) That which

reveals itself to the senses in symptoms is the disease itself. (ORG VI, 6,

footnote). Homeopathy, according to Hahnemann, only deals with concrete

phenomena, perceptible signs and symptoms. What has to be elucidated in

diseases are these concrete data, what is undoubtedly sick. Equally, our

materia medica consists of concrete combinations of signs and symptoms.

The more abstract, general, undefined the disease or proving symptoms are,

the less useful they are, because of their lack of individualisation. (ORG VI,

153) In ORG VI, 21 Hahnemann writes:

Since the curative wesen in medicines is not, in itself, discernible (which no one can

deny), and in pure experiments conducted with medicines [i.e. in provings] the most

sharp-witted observer can perceive nothing about medicines that can constitute

them as medicines, or curative means, except their power to bring forth distinct

alterations in the condition of the human body, and especially their power to

differently tune the healthy person in his condition and to arouse several peculiar

disease symptoms in him, then it follows that when medicines act as curative

means, they likewise can only bring their curative capacity into execution through

this, their power to differently tune the human condition by means of engendering

peculiar symptoms.

Hahnemann does not tire to stress that similarity is established on the level

of concrete phenomena, never between abstract concepts, ideas or such like.

Despite this, Hahnemann employed two speculative theories, which have

become for some the cornerstones of homeopathy, for others, stumbling

blocks: the concept of the Vital Force and the miasm theory. Both concepts

have a peculiar relationship with the sense data, the facts, and the

phenomena. This will be looked at now before we return to the topic of

certainty.

8


9/23

The Vital Force explanation or obfuscation?

Despite Hahnemanns protestations that nothing can be perceived in disease

than signs and symptoms expressing a deviation from a former healthy state,

he hypothesises that the essence of the disease is the disturbed vital force.

(ORG VI, 7) And he speaks of disease as a state of being of the organism

dynamically untuned by a disturbed vital force, [] an alteration in the state

of health. (ORG VI, 8) Why do we need the concept of the vital force when

he points out that the vital force itself cannot be seen, that as humans we are

not equipped to perceive the inner working of the vital force directly, but

that we can only see its effects: we can perceive nothing but the disease

signs. Therefore, it must be the symptoms alone by which the disease

demands and can point to the appropriate remedy. (ORG VI, 7) Does the

concept of the vital force add anything to our understanding of disease?

Does the concept of the vital force help us to make our prescriptions more

accurate (the one thing Hahnemann aimed for all his life)?

The theory of the vital force explains why potentised remedies are needed to

cure diseases. Since the pathological disturbance is a dynamic one, it needs a

dynamic intervention. Vital Force signals the immaterial nature of

diseases, and why it is necessary to use immaterial substances for their

treatment: The physician can remove these pathological untunements

(diseases) only by acting on our spirit-like vital force with medicines having

equally spirit-like, dynamic effects that are perceived by the nervous

sensitivity everywhere present in the organism. (ORG VI, 16) In his essay

Spirit of the Homeopathic Doctrine of Medicine he speaks of the organs of

the higher rank and of the vital force.

9


10/23

Further, the concept of the vital force gives Hahnemann an opportunity to

separate himself from those who engage in metaphysical speculations

regarding the nature of disease, as doctors as well as the so-called nature

philosophers of his age did. What Hahnemann aimed to do by postulating a

vital force is to give a scientific explanation of what animates and organises

the material body. In ORG VI, 9 he states: In the state of health the spirit-

like vital force (dynamis) animating the material human organism reigns in

supreme sovereignty. It maintains the sensations and activities of all the

parts of the living organism in a harmony that obliges wonderment. What

Hahnemann describes here sounds very much like the modern concept of

homeostasis, of which a definition reads: Metabolic equilibrium actively

maintained by several complex biological mechanisms that operate via the

autonomic nervous system to offset disrupting changes. In ORG VI, 16

Hahnmemann writes: The physician can remove these pathological

untunements (diseases) only by acting on our spirit-like vital force with

medicines having equally spirit-like, dynamic effects that are perceived by

the nervous sensitivity everywhere present in the organism. Looking at the

following quote from a standard textbook on anatomy and physiology it is

clear that Hahnemann grappled with scientific rather than metaphysical

concepts: Nervous tissue detects changes in a variety of conditions inside

and outside the body and responds by generating nerve impulses. The

nervous tissue in the brain helps to maintain homeostasis. (Tortora, p.104)

As always, Hahnemann chooses his words carefully. He speaks of spirit-

like, denoting an invisible and immaterial, but still substantial, force. That

the vital force must be real can be seen from its effects, its manifestations. It

is part of what Marilynne Robinson calls the finer textures of the physical.

10


11/23

What is the force that holds atoms together, that forms molecules, which in

turn form elements? etc. Can we name that force?

Can we explain only the processes or also the force driving these processes?

An analogy from science might make it clearer what Hahnemann tried to

articulate: This is what it says in a modern textbook on anatomy and

physiology: To synthesise proteins, the information encoded in a region of

DNA is first transcribed (copied) to produce a specific molecule of RNA

(ribonucleic acid). Then the information contained in RNA is translated

into a corresponding sequence of amino acids that forms a protein

molecule. (p. 86-87) What is the information? Where does it come from?

Where is it made, produced? It seems our knowledge starts when the

information becomes manifest. However, the information is obviously

real. Science glosses over the fact that we do not actually know what this

information is. It explains it by its material manifestations, although these

are the products of this mysterious information. Hahnemann was more

honest by stating the existence of the vital force (by logical deduction), but

at the same time drawing a line by saying that we cannot qualify it any

further. All we know is that it must exist because it clearly manifests in the

physical. Another passage in the same book reads: During transcription,

which occurs inside the nucleus, the genetic information representedby the

sequence of base triplets in DNA serves as a template for copying the

information into a complementary sequence of codons in a strand of DNA.

The base triplets are not the information itself, they representit. What,

then is the information? By the same token, the physical manifestations

(disease phenomena) representthe Vital Force, which itself remains

invisible. Being invisible, and recognisable solely by its effects on the

organism, it can express itself and reveal its untunement only by

11


12/23


13/23

diseases in which the symptoms of mental and emotional mistunement that

is peculiar to each disease heightens itself as the somatic symptoms diminish

[] (see ORG VI, 215). Vital Force and physical manifestations of vital

force are one and the same.

The philosophical framework of Hahnemann informs homeopathic practice

directly: The only indications for diseases are: Totality of symptoms (and

the accompanying circumstances are to be taken into consideration for case

management ORG VI, 5). (ORG VI, 15) Despite the fact that Hahnemann

introduces theoretical concepts he always returns to the concrete, the facts,

the data when it comes to the type of information we need in daily practice,

which begs the question what the rle of the miasms is.

Rle of the miasms

The miasms are Hahnemanns second great speculative theory. Whereas the

Vital Force may well be vindicated as a theoretical concept with explanatory

power, the miasms have less of a chance of surviving new medical insights.

With the psora theory Hahnemann tried to explain the multi-faceted nature

of so many disease forms which have ultimately one origin, and he

introduced with it the concept of diathesis, the predisposition of

individuals to certain diseases. He strictly adhered to a model of infectious

diseases (primary infection not properly treated leads to latent or secondary

psora with all its problematic sequelae. They develop chronic character and

undermine the health gradually). His best available example (and analogy

for psora) was syphilis. He modelled psora on this disease process. (A good

modern example is borreliosis, Lyme disease). We now know that we cannot

say that all chronic diseases are due to an original infection (some are, of

course, e.g. a whole host of viral and bacterial diseases). Apart from

13


14/23


15/23

The need for strict individualisation includes the demand of finding the

remedies through the study of the sources, not by taking shortcuts via

repertories.

With the great conscientiousness which should be shown in the restoration of a

human life endangered by sickness more than in anything else, the Homoeopath, if

he would act in a manner worthy of his calling, should investigate first the whole

state of the patient, the internal cause as far as it is remembered, and the cause of

the continuance of the ailment, his mode of life, his quality as to mind, soul and

body, together with all his symptoms (see directions in Organon), and then he

should carefully find out in the work on Chronic Diseases as well as in the work on

Materia Medica Pura a remedy covering in similarity, as far as possible, all the

moments, or at least the most striking and peculiar ones, with its own peculiar

symptoms; and for this purpose he should not be satisfied with any of the existing

repertories, -a carelessness only too frequent, for these books are only intended to

give light hints as to one or another remedy that might be selected, but they can

never dispense him from making the research at the first fountain heads. (CD,

121)

Although Hahnemann speaks of specific remedies for the treatment of

chronic diseases, this does not imply a dispensation from strict

individualisation, which for Hahnemann always involves the study of the

provings: The search for the remedy that is homeopathically the most

suitable, in all regards, for a given disease state is a laborious, occasionally a

very laborious, pursuit. While there are praiseworthy books for facilitating

this process [i.e. repertories and materia medica] it is still necessary to study

the sources themselves [i.e. reports of provings]. (ORG VI, 148, footnote)

15


16/23

Certainty and the logic of homeopathy

This brings us back to the topic of how we can achieve any certainty in

prescribing homeopathic remedies. It was mentioned above that the

undertaking of finding a remedy rests on two subjective factors: the report of

the patient and the reports of the provers, which are to be matched in order

to find the most similar remedy. As C.Meinhard pointed out the report of the

patient remains inevitably subjective, we have no way of assessing its

veracity. The patient simply has to be believed. On the other hand, the

process of provings allows us to introduce objective standards to tone down

the potential subjectivity. In provings it is the frequency with which a

sign/symptoms or a combination of signs and symptoms appears. The more

often these appear in different provers the less likely it has its origin in the

imagination of the prover. Hahnemanns footnotes toIgnatia inMateria

Medica Pura point to that fact. That this process is precarious there is no

doubt, since provings are often based on just a few provers. On the other

hand, clinical confirmation of these few symptoms strengthens the degree of

objectivity. And it should not be forgotten that Hahnemann undertook

repeated provings for individual remedies, which over time, revealed the full

extent of the objective combinations of signs and symptoms.

The complex of all disease elements which a medicine is capable of engendering is

only brought near completeness by means of multiple observations employed upon

many differing qualified persons, both male and female. One can only be assured of

having thoroughly proven a medicine for the disease states which it can arouse (i.e.

for its pure powers in altering the human condition) when subsequent provers can

notice little about the medicine that is new and they almost always perceive in

themselves the same symptoms that have already been observed by others. (ORG

VI, 135)

16


17/23

Those symptoms, which only appear in a few provers, the so-called

idiosyncrasies, are made objective by confirmation in cases of disease.

A further way of making subjective symptoms objective is to break down

whole proving symptoms into their constituent parts. Boenninghausen was

the first to recognise that homeopathic symptomatology has an inherent

logic. A symptom can be broken down into parts such as location, sensation,

modality and concomitant. In practice we are not looking for a match

between a complete symptom of a prover and that of a patient, but between

the characteristic elements which can be observed in both. An example,

provided by C.Meinhard, will make this clearer.

Symptom 278 of Mag-m in Chronic Diseases reads: Violent shooting pain

in the left hypochondrium, like splenetic stitches, in the afternoon, when

walking; worse when taking a breath; it ceases in sitting (during the

menses). If we wanted to match this whole symptom with a patients report,

we would have to wait a long time for a precise match in a case of disease.

However, if we break the complete symptom down into its constituent parts,

the situation looks very different.

The various elements contained in this symptom are:

Location: hypochondrium sub-location: left

Sensation: Shooting closer description: violent

Time modality: afternoon

Modality according to circumstance: when walking, when taking a breath.

Amelioration: when sitting.

These are the possible combinations of signs and symptoms:

Shooting, left

Shooting, violent

17


18/23

Shooting, afternoon

Shooting, worse when walking

Shooting, worse when breathing in

Shooting, better when sitting

It is evident that it will not take much time to meet patients with such

combinations in practice. The important thing is to keep any meaning or

interpretation out of these combinations. They have to be pure phenomena,

facts, data, repeatedly confirmed in provings. If Mag-m. has repeatedly

produced the following, then we can say with some certainty that it is

unlikely to be only the subjective experience of the prover:

Different pains on the left hypochondrium

A shooting pain, on the left side, in different places

A violent shooting

A shooting pain in the afternoon

A shooting pain which is worse on walking

A shooting pain which is worse on breathing in

A shooting pain which is better when sitting

This is the best kind of certainty we can have.

As C.Meinhard points out, the smallest common denominator between the

disease of the patient and the effect of the remedy is not the subjective

symptom, but the combination of signs which make up that symptom. It is

these signs which we can most certainly know, which is free of all

conjecture and interpretation, and which can be ascertained as belonging to

the remedy if these signs repeatedly occur in different provers. The

concentration on that which is undoubtedly diseased (ORG VI, 3) fulfils

Hahnemanns requirement for a reliable materia medica: Let all this is

supposition, merely asserted or even fabricated, be entirely excluded from

18


19/23

such a materia medica. Let everything be the pure language of nature,

carefully and sincerely interrogated. (ORG VI, 144) As already mentioned,

if we confuse the levels of meaning and facts we end up with all these

different methodologies, which are a constant source of confusion for

todays students of homeopathy. To the level of meaning belong the

diagnosis of the disease in hand; the homeopathic assessment concerning

obstacles to cure; maintaining causes; observations regarding the

constitution (the so-called attendant circumstances in ORG VI, 5); and the

patient management with respect to diet, mental frame of mind (as one

which supports or hinders treatment), etc. However, all these aspects are not

relevant for the pharmacological aspect of our work. When it comes to that

we need to stick with facts and phenomena. ORG VI, 3 outlines precisely

what falls into this category: knowledge of what is curative in remedies;

knowledge of what is undoubtedly diseased; application of the simila

principle. A confusion of these two categories will inevitably lead to

different methodologies.

Hahnemann was fully aware that one of the main stumbling blocks for the

successful practice of homeopathy is mans (including homeopaths!)

inclination to theorise and speculate, instead to observe. In this period of

nearly two thousand years was the pure observation of disease neglected.

(Aesculapius in the Balance,p.421)

Physicians no longer tried to see diseases as they were; what they saw did not

satisfy them, but they wished by an a priori reasoning to find out the undiscoverable

source of disease in regions of speculation which are not to be penetrated by

terrestrial mortals. Our system-builders delighted in these metaphysical heights,

where it was so easy to win territory; for in the boundless region of speculation

19


20/23


21/23

observation. That is why Hahnemann said that all we need for taking a case,

for practising homeopathy successfully is: freedom from bias, healthy

senses, attention while observing and fidelity in recording the image of the

disease. (ORG VI, 83) That sounds easy enough, but is of course difficult to

practise, because homeopathy, according to Hahnemann, is a narrow path to

which we must stick if we do not want it to become a caricature, a distorted

image of what once was.

This essay does not want to suggest that what is presented here is the only

homeopathy around. That is so patently not the case. There are now many

schools of homeopathy which have different philosophical foundations to

the one described here with resultant different practices. However, what this

essay wants to suggest is that the homeopathy outlined here is homeopathy

according to Hahnemann. Anyone who claims to follow Hahnemann would

have to follow these premises and practices. Nobody has to follow these, of

course, but whoever does not, should not claim to do as Hahnemann said

and did. We could spare us a lot of confusion if we taught homeopathy

strictly from Hahnemann instead of combining contradictory views and

methods without explaining their origin. As always, Hahnemann has set a

standard by which we can measure other developments and practices today.

The great Mark Twain once said: How empty is theory in the presence of

facts. Hahnemann might well have agreed with that, knowing the power and

limitation of both.

21


22/23

Literature:

S. Hahnemann (1996) Organon of the Medical Art (6th edition), (ed. Wenda

Brewster OReilly), Birdcage Books, Redmond.

S.Hahnemann (2001 reprint edition) Chronic Diseases, B.Jain Publishers,

New Delhi.

S.Hahnemann (2002) The Lesser Writings of Samuel Hahnemann, B.Jain

Publishers, New Delhi.

Relevant articles from theLesserWritings for this essay are:

Aesculpius in the Balance (1805)

On the Value of the Speculative Systems of Medicine, especially as viewed in

connexion with the usual methods of practice with which they have been

associated(1808)

Spirit of the Homoeopathic Doctrine of Medicine (1813)

Examination of the Sources of the Ordinary Materia Medica (1817)

G.J. Tortora and S.R. Grabowski (latest edition))Principles of Anatomy and

Physiology(9th edition), John Wiley and Sons, New York.

22


23/23

facts and theories1

Documents