Constitutional treatment!

[Ardavan Shahrdar]

Dear all,

I thought that my article 'Is Homoeopathy a
Constitutional Treatment' is relevent to the current
discussions on Minutus. I hope that it helps.

'Is Homoeopathy a Constitutional Treatment?'
By Ardavan Shahrdar - 2000

It has been quoted that a person came to see one of
the Zen masters to ask him some questions, but instead
of listening, he was constantly speaking about his own
views. After some time, the master started to pour him
some tea and he kept on pouring until the cup was
overflowing with tea. The guest who could bear it no
longer , said: ‘Can’t you see that the cup is full and
cannot contain any more tea? The master replied,
‘Quite right. Like this cup, your mind is also
overflowing with your own thoughts. How can you ask me
for Zen, when you cannot even give me an empty cup !!

The works of Hahnemann have to be studied with an open
mind and without any pre-assumptions.We have to
reconsider the definitions of homoeopathy. Otherwise
the concepts will appear so incompatible and strange
in comparison with the previously held beliefs, that
we will either lose hope and discontinue or we will
wander aimlessly through a maze of confused thoughts
while endeavouring to reconcile the old concepts with
the new.

It is imperative that we start with a discussion on
the meaning of constitution and we therefore dedicate
this article to this topic. For reasons, which the
reader will in due course come to understand, the
results of this study are extremely important.

In order to study the history of perception of man’s
constitutional characteristics, we have to travel far
into the past. The philosophers of ancient Greece hold
a special place in establishing and developing the
intellectual approach to defining man’s temperament.
After the fall of the age of mythology and gods, which
through the works of poets and writers such as Homerus
and Hesiodus had a tremendous influence on ancient
Greek culture , thinkers started to search for the
mysteries of universe by concentrating on nature. By
believing in the outward appearance of plurality in
the universe, they tried to set up doctrines of reason
to explain the plurality of forms by a unifying
approach. Zeus or the god of Gods gave its place to
the Essence of matter and each philosopher looked at
the world from his own special viewpoint. Thales, the
Maltese philosopher regarded water as the essence of
the world and the source of all elements. Anaximene
considered air to be the source of all living things.
Xenophanes attributed this role to water and earth,
Heraclitus to fire and Pythagorus who had a special
value for numbers, thought that an invisible fire was
the axis of the world.

Empedocles, who was a philosopher in the fifth century
B.C, believed that four elements with interactive
effects formed the world. In one of his two important
books called "On Nature" which has been written in
verse, he writes. "First, consider the four roots of
all creatures: the brilliant Zeus, the life-giving
Here, Aidoneus and Nestis whose tears cause the flow
of the essence of human." Empedocles considers the
four elements to be fire, earth, water, and air and he
has named them after four ancient greek gods, Zeus,
Here, Aidoneus and Nestis. In his books, he explains
the story of creation as the interaction between these
elements.

Among the great thinkers of this century, we have to
mention Hippocrates who played a crucial role in
revolutionising the history of medicine. Hippocrates,
the ancient greeks’ skilful doctor, who was a
contemporary of Empedocles, believed that by
interaction between the four elements many phenomena
were formed and he submitted many theories in
connection with man’s temperament and basic
constitution. He claimed that the four humours of man,
are each made up of the four elements, one
constituting the dominant factor and the other the
secondary one. The four humours are blood, phlegm,
bile, and atrabile. Blood is mainly made up of fire
and to a lesser extent, water. The main constituent of
phlegm is water and the secondary element is cool air.
The dominant element in bile is dry earth and the
minor one is fire. Black bile or atrabile is mainly
made up of cool air and to a lesser degree from dry
earth. In Hippocrates’ view the dominant humour in
each person creates the temperament particular to that
domiant humour. As a result , the dominance of blood,
phlegm, bile and atrabile create sanguine, phlegmatic,
choleric, and melancholic temperaments, respectively.
In this traditional classification, each of the four
temperaments comprise a particular group of mental and
physical characteristics, which apply even when a
person is enjoying good health and balance. But even
in case of a disruption in this balance by an increase
in the humour particular to that person, the same
conditions apply. Persons with a sanguine constitution
usually have a hot, damp, fleshy, muscular and
triangular body. Their faces have a red colour and
they are generally happy and optimistic but inclined
to pride, passion and cruelty. People with a
phlegmatic temperament usually have a cold, soft,
round or oval body, with a tendency to retaining
fluids. Their faces are light. They are sensitive and
compassionate but are prone to becoming frightened, to
crying and to being sad. People with a choleric
temperament, have a warm, dry , rectangular or square
body which is hard. Their faces have a yellow colour
and they are practical and logical but at the same
time inclined to anger, provocation, and impatience.
Persons with a melancholic temperament have a cold,
dry and thin body with a greyish face. They have an
intelligent and complicated mind but have a tendency
to withdraw into themselves, to be restless and
depressed.

After Hippocrates, the works of Aristotle, Galen, and
Avecinna played an important role in expanding the
above-mentioned theories in the following centuries.
In this method of diagnosis, cure was obtained by
either balancing the conflicting elements in a
person’s constitution or by abstaining from those
factors which provoked the excess humours. Although in
the history of western medicine, treatment by using
the afore-mentioned classifications was gradually
abandoned, the use of the four terms remained
effective as a means of describing temperaments, for a
very long time.

Samuel Hahnemann was closely acquainted with the works
of Hippocrates and his descriptions of the four
elements. But it is obvious from his writings that he
only used them for definition purposes and the concept
of balancing temperaments had no place in his works.
In his Materia Medica Pura, in the introduction to the
remedy Pulsatilla, we read : "Hence the medicinal
employment of Pulsatilla will be all the more
efficacious when, in affections for which this plant
is suitable in respect to the corporeal symptoms,
there is at the same time in the patient a timid,
lachrymose disposition, with tendency to inward grief
and silent peevishness, or at all events a mild
yielding disposition, especially when the patient in
his normal state of health was good tempered and mild
(or even frivolous and good-humouredly waggish). It is
therefore especially adapted for slow, phlegmatic
temperaments; on the other hand, it is but little
suitable for persons who form their resolutions with
rapidity, and are quick in their movements, even
though they may appear to be good tempered." Here,
Hahnemann has used the term phlegmatic merely to
convey to us the accepted concept associated with this
term. In the introduction to the remedy Nux vomica, he
has pointed out the suitability of this remedy for
people with a sanguine/choleric constitution without
directly using this term. "Among these may me
mentioned, that it is more frequently required by
those persons who are of an anxious, zealous, fiery,
hot temperament, or of a malicious, wicked, irascible
disposition." In his book "Chronic Diseases",
Hahnemann quotes from the experiences of the
eighteenth century doctor and researcher, Ludwig
Christian Juncker. "He observed that with young people
of a sanguine temperament the suppression of itch is
followed by phtisis, and with persons in general who
are of a sanguine temperament it is followed by piles,
hemorrhoidal colic and renal gravel; with persons of
sanguino-choleric temperament by swellings of the
inguinal glands, stiffening of the joints and
malignant ulcers (called in German Todenbruche); with
fat persons by a suffocating catarrh and mucous
consumption; also by inflammatory fever, acute
pleurisy and inflammation of the lungs. He further
states that in autopsies the lungs have been indurated
and full of cysts containing pus; also other
indurations, swellings of the bones and ulcers have
been seen to follow the suppression of an eruption.
Phlegmatic persons in consequence of such suppressions
suffered chiefly from dropsy; the menses were delayed,
and when the itch was driven away during their flow,
they were changed into a monthly hemoptysis. Persons
inclined to melancholy were sometimes made insane by
such repression; if they were pregnant the foetus was
usually killed…" In the same book, Hahnemann refers to
one of Juncker’s patients who had a sanguine
constitution and by repressing his skin disease, he
developed a stomach ulcer. In his autopsy, the cause
of death was diagnosed as the same ulcer.

Hahnemann uses the German word ‘Beschaffenheit’ in the
different aphorisms of the book Organon. The
translator of this book from German to English,
William Boericke, has used the word ‘Constitution’ as
the equivalent of the german word. The latin root of
the word ‘constitution’ is the verb ‘constituere’
which means to build or to form. Constitution or
temperament refers to the way in which something has
been constituted or formed. When this term is applied
to humans, it means the basic make-up of each person
which makes that person look and act differently from
others. The concept of constitution or temperament
includes all the mental and physical characteristics
of a person. Although the term ‘temperament’ is used
mainly in describing mental characteristics, but to be
precise, the concept of ‘temperament’ also includes
physical peculiarities. We now have to consider what
Hahnemann meant by using the word constitution. It has
to be noted that in this article, we have used the
terms ‘temperament’ and ‘constitution’ alternately.
The word ‘temperament’ was used by the early greek
philosophers, whereas Hahnemann used the word
‘constitution’. Because of the similarity in meaning
and concept, we will continue to use both terms
alternately.

We can conclude from the works of Hahnemann that from
his point of view constitutions can be strong or weak.
And also different constitutions are prone to
particular diseases. In his view, constitution and
temperament contain the disease and although
indirectly they can guide us in the treatment, but
they themselves are not the aim of the treatment. In
the fifth aphorism of the Organon, Hahnemann writes,
"Useful to the physician in assisting him to cure are
particulars of the most probable exciting cause of the
acute disease, as also the most significant points in
the whole history of the chronic disease, to enable
him to discover its fundamental cause, which is
generally due to a chronic miasm. In these
investigations, the ascertainable physical
constitution of the patient (especially when the
disease is chronic), his moral and intellectual
character, his occupation, mode of living and habits,
his social and domestic relations, his age, sexual
function, etc., are to be taken into consideration."
In the discussions regarding chronic diseases,
particularly Psora, Hahnemann repeatedly emphasises
that even strong constitutions cannot prevent chronic
miasms or their progression. In the 78th aphorism of
the Organon, regarding chronic miasms , he writes,
"The true natural chronic diseases are those that
arise from a chronic miasm, which when left to
themselves, and unchecked by the employment of those
remedies that are specific for them, always go on
increasing and growing worse, notwithstanding the best
mental and corporeal regimen, and torment the patient
to the end of its life with ever aggravated
sufferings. These, excepting those produced by medical
malpractice, are the most numerous and greatest
scourges of the human race; for the most robust
constitution, the best regulated mode of living and
the most vigorous energy of the vital force are
insufficient for their eradication." In his book
‘Chronic Diseases’, Hahnemann dwells particularly on
this point. Hahnemann’s other use of the word
constitution is applied to each constitution’s
particular reaction to provings and also to explaining
the various manifestations of the Psora miasm.

In the 81st aphorism, the diversity of human
constitutions is one of the reasons for the variety of
diseases which have a psoric root. In "Chronic
Diseases", the unique characteristics particular to a
constitution determine the direction in which Psora
will progress. In the 117th and 136th aphorisms, while
explaining the idiosyncrasy in provings, Hahnemann
points out that although idiosyncratic symptoms are
results of primary action of remedies, the small
number of provers showing that symptoms can be
attributed to the special sensitivity of the different
constitutions. For this same reason, in the 135th
aphorism, a proving is only complete if it has been
carried out on several subjects of both genders with
different constitutions. As far as Hahnemann is
concerned, determining the degree of sensitivity and
the power of the constitution are the pre-conditions
for choosing the correct dose of medicine.

As we can observe, although Hahnemann was aware of the
traditional classification of humours and occasionally
he used terms such as phlegmatic for definitions and
for conveying certain concepts, and he believed in the
diversity of the many human constitutions as far as
strength and sensitivity were concerned, he never used
these classifications in his writings. In Hahnemann’s
view, homoeopathy was not a constitutional treatment
but a treatment of diseases, but not disease as is
commonly known in medical circles. In near future, I
will discuss in detail, the concept of disease from
Hahnemann’s point of view.

We cannot see any of these constitutional or
temperamental classifications in the writings of
Boenninghausen. He also does not refer to
constitutional treatments. Boenninghausen was the
closest person to Hahnemann as far as ideology was
concerned. By studying the writings of Boenninghausen,
we can see the many similarities between his thoughts
and Hahnemann’s. The only difference between them was
in the techniques used by Boenninghausen in finding,
registering and evaluating the remedies which were
always applauded by Hahnemann.

Constantine Hering was a homoeopath and one of the
greatest genius disciples of Hahnemann. His unique
services to homoeopathy are undeniable. He played a
particularly vital role in enriching the homoeopathic
Materia Medica. His book , "The Guiding Symptoms of
our Materia Medica" which is available in 10 volumes
for all homoeopaths, is one of his greatest
masterpieces. One of the distinguishing factors of
this book, is the addition of a part titled, "Stages
of Life, Constitution" under each remedy. In this
section Hering describes his experiences in treating
patients and also the relative prevalence of people
used for proving. To describe these conditions, he
uses expressions connected with the classifications of
constitutions such as the four temperaments of
Hippocrates, the Grovgyl types, or definitions such as
lymphatic temperaments. For example under the heading
of the remedy ‘Aconitum’ he refers to people with
strong bodies, black hair and black eyes. In his book,
‘Analytical Repertory’ which has been indexed with the
aid of Knerr, in a chapter called ‘Temperaments and
Constitutions’, he writes of his experiences in this
milieu along with those of other homoeopaths such as
Hahneman, Franz,Stapf, and Bute.

In this chapter Hering uses the two terms
‘Temperament’ and ‘Constitution’ as having the same
meaning. In the introduction to this chapter, Hering
makes it perfectly obvious that he only uses these
terms in their descriptive context as a guideline for
the reader. His emphasis is on observing the symptoms
of the patient and he reproaches those who consider
the classifications instead of observing the patient.

The different diatheses such as hemorrhaging and
rheumatic diatheses, are the other descriptive tools
used by Hering. Diathesis means the tendency of each
constitution to a particular disease. It has to be
emphasised again that although Hahnemann considered
the particular characteristics of each person’s
constitution to be important in the external symptoms
of diseases, specially Psora, he didn’t believe that
the patient’s condition was a result of temperamental
disorders or the disruption of balance in that
person’s constitution. In fact, from Hahnemann’s point
of view, diathesis in its active form was part of the
disease and not part of the constitution, as far as
his concept of constitution was concerned.

James Tyler Kent is one of the other famous
homoeopaths in the history of homoeopathy. His
eloquent and informative lectures are one of his
valuable legacies. Although he did not know about the
latest revision of the Organon, his writings display
his precision and his loyalty to homoeopathic
principles. His opinions regarding constitution and
constitutional symptoms are put forward in an article
headed ‘Temperaments’ in his book called ‘Kent’s Minor
Writings on Homoeopathy". In this article he points
out that the most accurate criteria for homoeopathic
diagnoses are all the symptoms and indications of the
patient’s disease, and not symptoms such as hair and
face colours. In a section of this article Kent writes
"The color of the hair and eyes, the form or shape,
the tall or short, are not generally considered
morbid, nor do they take any part whatever in the sick
image of any given totality of symptoms. The bilious
temperament is too vague and too variable, even when
morbid, to guide to a remedy; for he may be better or
worse from motion, cold air, warm air, changes of
weather, exertion, and so on to the end of our
modalities. No two observers mean the same thing when
they speak of a bilious condition or temperament. If
the mental predominates, it would mean half the
remedies in our materia medica, even if he is morbid
in the mental make-up. The motive temperament is found
in a large number of our most active and steady
workers in both physical and mental employment. The
sanguine temperament is found in many who are sound in
body and mind, and the words do not recall a single
proving. Temperaments are not caused by provings, and
are not changed in any manner by our remedies, however
well indicated by symptoms found in persons of marked
temperamental make-up. To twist these temperaments
into our pathogenesis, symptomatology, or pathology is
but a misunderstanding of our homoeopathic
principles." Although in the book ‘Lectures on Materia
Medica’, Kent uses constitutional definitions as a
means of explaining the usual vessels accepting
different medicinal diseases, like Hahnemann, he too
concentrates on what is inside the vessel, i.e. the
symptoms of the disease in the same way as medicinal
diseases have meanings in the provings. He
specifically states that homoeopathy is not a
constitutional treatment.

Roberts who was one of the homoeopaths of the first
half of the twentieth century, in an article entitled
‘Temperaments’ in his book called ‘The Principles and
Art of Cure by Homoeopathy’, places great emphasis on
using the symptoms of disease. He also considers
constitutional symptoms to be a secondary guideline in
prescribing. In part of this article he writes
"Prescribing on types, or temperaments, is at best a
slack method of using blessings of homoeopathy. It is
really keynote prescribing and then not on any
morbific symptoms, but on a general stature that is
present from birth. Keynotes may often give us a clue
to the indicated remedy, but this clue must not be
allowed to overbalance our judgement in weighing the
whole symptom picture."

As can be seen, the belief that prescribing remedies
should be based on the symptoms of disease, was shared
among all the great homoeopaths of the nineteenth and
early twentieth century. But unfortunately homoeopathy
was gradually led along a mistaken course which was
called the slack method by Roberts. Although terms
such as choleric and phlegmatic have become distant
from the language of homoeopathy but instead we are
witnessing Pulsatilla, Nux Vomica and Sulphur
constitutions! Smaller remedies which can hardly be
imagined as constitutional, are either acute or of
lesser importance! Unfortunately the majority of
homoeopaths, even classic ones, use a limited number
of key symptoms for prescribing. The criteria for
treatment is comprised of a few constitutional
symptoms and a few modalities. For a blond, chubby
woman with a mild temperament who is sensitive and
emotional and cries easily, does not sweat very much
and has little thirst, Pulsatilla is prescribed and
these symptoms are considered to be adequate. In this
case isn’t the introduction to the remedies in Materia
Medica Pura enough since we are not using any other
symptoms? Isn’t such prescribing a limited and
wrongful misuse of the vast source of homoeopathic
remedies available? Isn’t Pulsatilla effective in
treating a thin and dark-skinned man? Applying the
term constitutional to the remedies has no use except
limiting their applications. We have no patient with a
Causticum or Dulcamara constitution. But we have
remedies by these names which with their particular
capabilities can have a share in curing chronic or
acute diseases. Hahnemann believed that the method of
treating chronic diseases was by prescribing
anti-psoric remedies in succession which in each stage
should be similar to the totality of symptoms of the
patient’s disease and if needed a series of
intercurrent remedies must be used to treat the other
two miasms. Are there any similarities between the
usual constitutional approach to remedies and this
method which has enjoyed unrivalled success?!
=====
"Life is beautiful, if you look at it in a beautiful way."

Dr Ardavan Shahrdar, MD, DIHom
President of Iranian Homeopathic Association
Email: ashahrdar@yahoo.com
Website: http://www.minutus.com
Mailing list: http://www.yahoogroups.com/group/minutus

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