Patient and their Disease 1. G.H.G. Jahr

[David Little]

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 are 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, BJain).

"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 Homœopathic Art of Healing published in
Stuttgart in 1857. I was introduced to the depth of Jahr's views by German
Homoeopath, Gaby Rottler, who is an excellent German-English translator.
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 speak to Gaby and read
her articles.

Jahr separated the rubrics into the pathognomic symptoms and the
"constitutional additional symptoms" (constitutionellen Nebensymptome), i.e
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 can 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 diseases 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" were 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 judgement 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
are the pathologic symptoms 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 one can not separate the
patient and their disease. Once can, however, look at the interdependent
synergy of host and disease from different angles. I was very please when
Gaby shared this aspect of Jahr's work because I was looking 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 which 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 carry 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 feel 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 seperated, redacted and
redistributed. He feel 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 way one find 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.

This is my "post of the week" in which I try to raise an interesting
subject.
Similia Minimus
Sincerely, David Little

[APEX PRECITECH]

David Little wrote:

I only have one thing to say about the argument
about the patient
versus the disease - the patient AND their disease are
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.

Dear David,
This needs further insight. The patient is the owner
of the body and mind.
It is his possessions which are sick. The influence is
an "external agent
inimical to life". Health and sickness are expressions
of the patient
(vital Principle ?)and executed by the vital force. Do
you agree ?

Apparently you used this to explain the concept of
'constitution'. You
have tried (imho) to relate the constitutional
symptoms as
symptoms of the patient himself. But they are all
'expressions'
nevertheless. The Kentist notion of 'Symptoms of man
Himself' are
what is meant here (as he explained the rare ,peculiar
and strange
symptoms).

Now to Jahr and his theory of constitutional symptoms:
These const. sx
are none but part of the chronic sickness underneath.
It leads to the the
theory that everyone is chronic . As said earlier,
the acute
(True acute and exacerbations)and the chronic can be
only the expressions
of man and can not become synonymous with him. If in
health, he may not
show the craving for fat which he used to gulp by the
gallons.Health is
man minus symptoms.It is the highest ideal state where
the vital force
is turned inward for "higher purposes" (rather than
fight with the disease).

I think Jahr's const sx are none but the chronic
picture.Roberts says
if you want to see the chr. pic. just wait till the
end of an acute
condition. There you will see the the true chronic.A
classic
example is of the influenza (acute) that ignites some
old ailments.

My humble opinion is
1. It is the man who is sick
2. The man is not sickess itself.
Pl don't see this a confrontation but my humble
opinion:-)

Regards
Venkat-

________________________________________________________________________
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[Ellen Madono]

Dear Venkat,

There are philosophical/religious systems where without enlightenment, all life is suffering. What is enlightenment is a question to be approached in those system (many of them Asian). My yoga students turn inward for a "higher purpose" and they can also have severe homeopathic symptoms. I personally believe that awareness of the underlying causes of suffering helps us to work with our physical and mental reactions to what the remedies bring out in us. This awareness is not a philosophical activity. It is a meditative way of being. I am not sure where homeopathic treatment ends and the turning inward for higher purposes begin. I have a feeling that at the higher levels of spiritual development, they are deeply intertwined. Also, I have worked with people who were spiritually highly developed and very ill. None of this clarifies your question. I question whether homeopathy could answer them. They are spiritual/philosophical questions that each homeopath much choose.

Blessings,
Ellen Madono
Health is
man minus symptoms.It is the highest ideal state where
the vital force
is turned inward for "higher purposes" (rather than
fight with the disease).
[Non-text portions of this message have been removed]

[Rosemary C Hyde PhD]

That's an interesting concept -- that the patient is "owner" of his body and mind." Usually I think of "owners" as being able to put their possessions away, control them as they wish. In contrast, the patient cannot be separated from body or mind -- indeed body-mind-emotions all express one being, seamlessly, that of the patient. Rosemary

[Homoeopathy]

HAHNEMANN'S DEFINITION OF DISEASE. by; C. J. Hemple M. D.

Hahnemann is professedly a vitalist. In the 9th paragraph of the
Organon, he expresses himself as follows:

" In the healthy condition of man, the immaterial vital principle which
animates the material body, exercises an absolute sway and maintains all
its parts in the most admirable order and harmony, both of sensation and
action, so that our indwelling rational spirit may freely employ these
living, healthy organs for the superior purposes of our existence."
" The material organism deprived of its vital principle, is incapable of
sensation, action, or self-preservation; it is the immaterial vital
principle only, animating the former in its healthy and morbid
condition, that imparts to it all sensation, and enables it to perform
its functions."

Disease arises from, or rather consists in, a disturbance of the
harmonious action of the vital principle caused " by the dynamic
influence of a morbific agent which is inimical to life." Hahnemann
expresses this idea more fully in Sect. II. of the Organon in the
following language: " In disease, the spontaneous and immaterial vital
principle pervading the physical organism, is primarily deranged by the
dynamic influence of a morbific agent which is inimical to life, only
the vital principle thus disturbed, can impart to the organism its
abnormal sensations, and incline it to the irregular actions which we
call disease ; for as an invisible principle which is only cognizable
through its operations in the organism, its morbid disturbances can be
perceived solely by means of the morbid sensations and actions of the
organism which are perceptible to the senses of the physician and
bystanders; in other words, by the MORBID SYMPTOMS, and can be indicated
in no other manner."

These perceptible symptoms, and the actual disturbance of the vital
action are so much alike, that they may be looked upon as an UNITARY,
INSEPARABLE, morbid condition. This is manifestly meant by the
following statement in Sect. XV. of the Organon:. " the suffering of the
immaterial vital principle which animates the interior of our bodies,
and the mass of symptoms produced by it in the organism, which are
externally manifested, and represent the actual malady, CONSTITUTE A
WHOLE, they are ONE and the SAME. The organism is, indeed, the material
instrument of LIFE; but without that animation which is derived from the
instinctive sensibility and control of the vital principle, its
existence is as inconceivable as that of a vital principle, without an
organism; consequently, both constitute an UNIT, although, in order to
facilitate our comprehension, our minds may separate this UNIT into two
distinct ideas."

Nevertheless, although Hahnemann does not object to this separation of
the perceptible symptoms and the morbid state which they represent; and,
although he looks upon disease as a disturbance of the vital harmony of
the organism by influence of some foreign hetergeneous agent: yet it
must not be supposed, on that account, that disease is a peculiar and
distinct something in the human organism. " Disease," says Hahnemann in
Sect. XIII. of the Organon, " considered as it is by the Alloeopathic
School as something distinct and separate from the living organism and
from the vital principle which animates it, as something hidden
internally and as something material, how subtle its nature may be
supposed, is a nonentity, which for ages has given to medicine all those
pernicious deviations that constitute it a mischievous art."

These various statements seem to imply a contradiction; but upon a
closer examination it will be found that Hahnemann reasons consistently.
As there is no life without a vital principle and without an organism
which is its necessary material embodiment or form, so there is no
disease without a morbific principle and the phenomena which constitute
its form in the living organism.

The morbific principle is of the same order or quality as the vital
principle itself, and is similarly related to the organism.

Alloeopathic physicians have been in the habit of looking upon disease
as a mass of impurities scattered through the living organism; as a vast
dung-hill, if you please, that had to be swept out of the organism by
physical force as it were, driven out by the skin by means of
sudorifics, expelled from the bowels by purgatives, ejected from the
stomach by emetics. All such gross notions are very properly rebuked by
Hahnemann, and yet, a truth is embodied in the doctrine that disease is
the result of an invasion of the living organism by some hostile
morbific agent. In the third part of this work, this view of disease
will be elucidated more fully, and substantiated by more comprehensive
reasoning. (go to page 181)
..............................................from ORGANON OF SPECIFIC
HOMOEOPATHY
An Inductive Exposition of the Principles of the Homoeopathic Healing
Art
by Charles J. Hempel, M. D.
..............................................
Best Wishes to All, Anthony Gunterman

.

[Julian Winston]

At 1:12 PM -0400 6/5/04, Homoeopathy@webtv.net wrote:
Not sure where the error is, you or the source, but the name is
HEMPEL not HEMPLE-- as seen at the bottom.

This is an extract from Hempel's Organon of Specific Homeopathy.
It is a most interesting book.
See my "Heritage of Homeopathic Literature" (pg. 167) for a small
synopsis/review.

Hempel was NOT convinced of the efficacy of many of the remedies we
now use. He thought that all the symptomology of Nat mur was a
fabrication and that it had no medicinal use, although it could be
used as a seasoning in food. He questioned the use of Agaricus, Carbo
veg, Nitric acid, and Lachesis. He thought that cures reported by
these drugs were doubtful and the result of poor observation.
He thought that homeopathy, as proposed by Hahnemann, was too
abstract, and the materia medica was useless.
If we were to follow Hahnemann's ideas about case-taking, we would
have so many symptoms that it would be impossible to select a remedy.
He obviously had no idea or understanding of the concept of
"characteristic symptom."
Since he was so lacking in understanding, his work is a plea to find
the remedies that are useful for specific conditions (i.e., Aconite
in fevers) and to stick with them.
His third section is a complete babble of flowery writing (common at
that time) on the meaning of life and the meaning of God (all couched
in Swedenborgian terms) and a plea for a simple Materia Medica.
Hempel's translations of Hahnemann's works into English (done for the
publisher William Radde), were the first-- and brought homeopathy to
many in the English speaking world-- but they were all found to be
flawed and full of errors, resulting in other translations eventually
being done.
Hering (a fellow Swedenborg) though Hempel was a fake, and had no
understanding of homeopathic materia medica.

The excerpt presented was interesting, but has to be seen in the
context of the whole book. In the end, Hempel though little of
Hahnemann's ideas, although he thought that the principle of Similars
was a workable concept when applied to specific diseases.

JW

[APEX PRECITECH]

-Dear Ellen,
The context of the posting, I think, you have missed.
That is, what is
the better soil for grooming spirituality ? Only the
man whose body
and mind are free from the distracting influences of
disease. True,
one can start searching when in disease, BUT only when
the disease
allows him to. Those who are fortunate enough, in
that, the disease
has not touched their mind can do this.Others with
minds not
seriously affected can also start.

But what I am referring to is the ideal ground. The
treatment need
not be homeopathic alone. But, in a purely hom
context, the path
towards higher purpose is the EASIEST with a healthy
man since
he is free from all perversions,imbalances, and
prejudices.

This is the Highest Ideal.Do you Agree ?

Regards
venkat

-- Ellen Madono wrote: >
Dear Venkat,

________________________________________________________________________
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[Ellen Madono]

Dear Venkat,
I have trouble thinking in the ideal because I tend to think of what is before my eyes (what I believe I see). I have experience with people (constitutional types) who do not seek for higher spirituality. It is simply not part of their life journey. They can be physically healthy independent of that lack of spiritual concern. They can be diseased and still a spiritually enlightened journey is unrelated to their recovery. It puzzles me, but I have to accept what is before my eyes. Perhaps I lack eyes to see their form of spirituality.
Blessings,
Ellen