Hahnemann's Direction of Cure and Hering's Laws.

[David Little]

Dear students and colleagues,

It has become popular in certain circles to criticize Hering and Kent and call the postulates known as Hering's laws spurious. Some say that none of Hering's laws can be found in Hahnemann's writings. Others admit that the reversal of symptoms is found in The Chronic Diseases. Now a major target is the maxim from within to without. They say that healing does not progress from with to without because the internal and external cure happen at the "same time". The opine that all externalizations are the fruitless efforts of a diseased vital force that have nothing to do with healing and are only the outcome of improper treatments.

Over the years Hahnemann noticed that the vital force tried to remove disease from the more important internal organs by setting up local affections in the less important external parts of the body. At the same time, the vital force was willing to sacrifice a great deal of its energy, humours and tissues in an effort to preserve the organism through crisis. These efforts as self-healing cannot cure a chronic disease.

During the processes of homoeopathic healing the primary action replaces the natural disease with stronger but temporary medicinal diseases. The secondary action of the vital force seeks to remove the remedy disease from without while restoring homeostasis within with renewed vitality. During the homoopathic healing process the action of the vital force is similar to its actions in the natural disease but it is not the same. In the place of painful and unproductive crises there appears definite curative signs associated with proper direction of cure.

Hering wrote about the direction of cure in the Preface to the American edition of The Chronic Diseases in 1845. He that there was a "law of order" which Lippe called it the "law of cure" and Kent called "Hering's laws". The essence of Hering's postulates are based on Hahnemann's teachings on the development of psora and the reversal of the order of the symptoms while under antipsoric treatment. Vide The Chronic Diseases, Theoretical part, p 230.

"The latest symptoms that have been added to a chronic disease which has been left to itself (and thus has not been aggravated by medical mismanagement) are always the first to yield in an antipsoric treatment; but the oldest ailments and those which have been most constant and unchanged, among which are the constant local ailments, are the last to give way; and this is only effected, when all the remaining disorders have disappeared and the health has been to all other respects almost totally restored."

In The Chronic Diseases (p. 203-204) Hahnemann wrote that a when a well chosen remedy is acting the patient may feel a moderate headache, sore throat, diarrhea, pains in one part or other that they experienced in the past. This is no reason to give a new remedy because these are a "sign that this medicine acts deeply into the very essence of this disease, and that consequently it will be more effective in the future". The return of old unresolved symptoms is closely related to the maxim of the reversal of the symptoms but the situation is slightly different. In the reversal of symptoms the signs just disappear in order, while in the return of old symptoms old unresolved diseases states and suppressions reappear before being removed.

Hahnemann wrote that it is essential to treat the internal psora rather than suppress the external lesion. He stated the healer should "first of all treat the internal malady, whereby the cutaneous eruption will, at the same time be removed and destroyed and all the subsequent innumerable life long chronic suffering springing from the Psora be prevented or, if the are already embittering the life of the patient, be cured." (Page 47, Theoretical Part, Chronic Diseases). Statements like this have been taken out of context to say that internal and external healing takes place all at once.

The meaning of these statements are that one should treat the internal psora because this will treat the external eruption at the same time without external treatment. This statement does not mean that the newest (the most serious developed secondary organic pathology) and oldest symptoms (the original skin eruptions) are healed at the exact same time. Let us study this maxim in its original paradigm, the cure of psora.

In the Chronic Diseases Hahnemann taught that the primary stage of psora began with an infection of the skin that dynamically permeated the human organism with internal psora and then produces a skin eruption. This external eruption acts as a "pressure value" that slows the advance of the internal malady. If the psoric lesion is suppressed or spontaneously leaves the skin, the internal psora enters a latent stage that is associated with certain functional symptoms. As the patient ages, or if they are placed under undue physical and mental stress, the internal psora breaks out into secondary psora associated with organic pathology in the vital organs.

1. The 1st stage of psora includes the primary symptoms of psora on the SKIN, the most external part of the body. This appears as innumerable kinds of infectious skin eruptions. Hahnemann wrote "The local symptoms has it place on the least dangerous part of the body, the external skin" (CD, page 167).

2. The 2nd stage is latent psora which produces systemic functional symptoms. Hahnemann recorded 60 symptoms of latent psora in The Chronic Diseases. This includes paleness of the face, bad smell from the mouth, perspiration, tedious catarrhal discharges, obstruction of the nose, cough, breathing difficulties, digestive upsets, flushes of heat, falling out of hair, twitching, itching of anus, dark urine, painful joints, dry skin, itching vesicles here and there, etc.

3. The 3rd stage is secondary psora where psora transforms from functional states to organic pathology disorders involving damage to the major vital organs and systems. Hahnemann list around 400 secondary symptoms and over 100 pathologic states including consumption, lung disease, heart disease, kidney disease, diabetes, bone diseases, intestinal diseases, stomach diseases, liver diseases, diseases of sexual organs, paralysis, strokes, convulsions, epilepsy, deafness, dropsy, goiter, cancer, etc., etc.

Now according to the reversal of symptoms:

1. The 1st set of symptoms to be removed is the organic pathology in the internal vital organs as these secondary symptoms are the last to appear. This would include the 400 symptoms and 100 organic pathological states of secondary psora. This shows that the chronological reversal progress begins within the most important internal vital organs and systems.

2. The 2nd set of symptoms to be removed would be the general functional states associated with the 60 symptoms of latent psora. The cure carries on from the functionally disturbed internal systems toward the more external skin, the first and oldest symptom. Thus the reversal of the symptoms continues with the movement of the disease from organic pathology in the vital organs to the systemic functional changes. Hahnemann wrote "When the treatment is about half completed, the diminished disease commences to return into the state of latent Psora; and the symptoms grow weaker...." (CD. page 231)

3. The 3rd set of symptoms to be removed is the eruptions on the skin as these were the first to develop and are the oldest most external and least dangerous symptoms. The direction of the cure is from within to without ending less important and less dangerous external lesions on the skin. If the skin symptoms were suppressed they may return as this is an aspect of the maxim of the return of the old unresolved symptoms. Once the external skin eruptions are completely cured the entire internal and external psora is cured.

The disease symptoms developed from stages 1 to 2 to 3. This means the disease direction is from the most external, less important skin to the more important functional systemic symptoms, to the most important organic pathology in the inner vital organs. The reversal of symptoms is from stage 3 to 2 to 1. The healing direction is from the most important organic pathology of inner vital organs to the less important functional states, to the least dangerous external skin lesions.

The direction from above to below may be involve in the healing process, especially if the original symptoms began in the lower parts of the body and then moved upward. They would naturally pass from above to below as the developmental order of the symptoms are reversed. Therefore, the reversal of the order of the symptoms, the movement from within to without, the return of old symptoms, and the pains being relieved from above to below come together because they are all part of the same healing process.

Hering wrote in his Preface to the Chronic Diseases (p. 8) that the cure is marked by an improvement in the mind and general state of well-being. "Hence it is that Hahnemann inculcates with so much care the important rule to attend to the moral symptoms, and to judge of the degree of homoopathic adaptation, existing between the remedy and the disease, by the improvement which takes place in the moral condition, and in the general well-being of the patient".

This observation has its origin in Hahnemann's Organon in aphorism 253. Hahnemann wrote "When there is a ever-so-slight beginning of improvement, the patient will demonstrate a greater degree of comfort, increasing composure, freedom of spirit, and increased courage - kind of returning of naturalness". Hahnemann also wrote that the "strength of the patient" ought to continually "increase" from the commencement to end of the treatment (CD, page 233).

There are 8 observations of the direction of cure found in Hahnemann and Hering's writings.

1. Pains are removed from above to below
2. Diseases are removed from within to without
3. Symptoms are removed from the more important to the less important areas.
4. Symptoms are reversed from the newest to the oldest.
5. During the process of cure old unresolved symptoms may arise.
6. An amelioration takes place in the mental condition of the patient.
7. The strength and vitality of the patient increases during treatment.
8. The opposite of these progressions are signs the disease is getting worse or is being suppressed. That is the pains travel from below to above; from without to within, from the less important to the more important; the symptoms increase; complaints the patient never had appear; the mental state gets worse; and the patient gets weaker. These are sign that the disease is getting worse or is being suppressed.

Sometimes persons try to use examples where cure did not follow the direction of cure to refute the entire teaching. Hahnemann made it clear that the direction of cure can be disrupted by drugging and suppression and that sometimes "constant local ailments, are the last to give way; and this is only effected, when all the remaining disorders have disappeared and the health has been to all other respects almost totally restored." This is the source of the exceptions to the rule.

The eight factor of healing are interrelated and represent different facets of one total phenomenon. It is not easy to say where one maxim ends and another begins because they all find their source in the unity of the vital force. Where one maxim is not totally applicable another maxim may take its place. It is difficult to tell whether a patient is improving or declining from just one factor alone. To form a proper prognosis it must be supported by several confirmatory symptoms.

Perhaps one of the symptoms appears to be moving downward but the others are moving inward toward the more important organs while the mental state and the vitality are declining. This would cast great doubt on the idea that the patient is getting better. Perhaps an old local pathology remains while other older symptoms have already been removed. This may be one of the exceptions to the rule Hahnemann spoke of in The Chronic Diseases. If the patient has improved emotionally, has more energy and other symptoms are being relieved in an orderly manner, the cure is still progressing in the right direction.

The reversing of the order of symptoms is the basis of the direction of cure because it inherently includes the return of old unresolved states as well as the movement from within to without, from the most important to the less important, and from above to below when the disease clearly developed this way. This process also includes a beneficial change in the mental state, an increased sense of well-being and increased vitality.

What is true for psora is also true for sycosis and syphilis, etc. Sycosis may start with suppressed gonorrhea and/or burnt off HPV warts and progress to organic pathology in inner vital organs. In this case the internal symptoms would be the first to be removed, and in some cases the suppressed discharge or burnt off warts may return before being completely cured. If syphilis began with contact of the sexual parts and progress to the brain then the process of cure would first start in the brain and progress from within to without and from above to below to the skin of the sexual glands. Sometimes the organism is so suppressed and weakened that it cannot reproduce the original primary symptoms. In this case, the organism may produce a surrogate eruption or discharge that takes the place of the original symptoms as best as possible. A similar process is witnessed in the TB miasm and cancer diathesis, etc.

That beneficial externalizations take place during the process of cure is well documented. For example, Hering had a case of where the syphilitic chancre was suppressed and the patient developed more symptoms. He tried several remedies but nothing really worked. Then he gave syphiline as an intercurrent nosode and the old suppressed chancre came out . After this externalization the cure was completed by remedies that formerly did not work. This demonstrates the symptom "When well chosen remedies do not work" and role of the chronic intercurrent nosode in removing obstacles to the cure.

The best cure is simply the rapid restoration of health without any excessive remedy actions. When the patient is healing they usually feel better emotionally with more energy. Any return of old symptoms and eliminations are often so slight that they are hardly noticeable and do not bother the individual. The old symptoms that manifest the strongest are often the symptoms that were heavily suppressed and closely connected to the development of pathology. This is a very important moment in the cure that should not be misunderstood. Such symptoms should pass through quickly and be followed by an increased sense of well-being and more vitality.

When old symptoms return that are *stronger and more prolonged than the original symptoms - this is a sign of remedy caused aggravation*. For example, a person may have originally suppressed a skin eruption that was the size of a walnut. What if the skin symptom returns and spreads all over there body? Some persons would sign that this is a "good sign". The truth is that this is a excessive medical action caused too large a dose, too high a potency and/or repeating the remedy when it is not needed. These reactions are not in harmony with Hahnemann's teachings on a rapid, gentle and permanent cure.

Some of the crises in Kent's cases were actually excessive aggravations caused the posology mistakes. This is because Kent did not believe that the size of the dose (1 or 1000 pills) mattered in the action of a remedy and tended to give high C potencies. Hahnemann taught that the more accurate the remedy, and the higher the potency, the MORE the size of the dose matters! I have been pointing this for many, many years. Nevertheless, Kent was a great homoeopath who cure many 1000s of persons (most without excessive crisis). We all make our mistakes and it is best if others learn from them. Let those who are perfect be the first to cast stones. No such persons exists. Those who live in glass houses should not throw rocks!

Patients do not need to experience all the pains they suffered in the past or every eliminations and eruptions. Many times the symptoms are relieved in a order fashion without the return of old symptoms or externalizations. Prolong reactions are a sign of over medication and signal to be very careful with the remedy, dose and potency. If such conditions do arise it is important to know what they mean and what to do about them. To call them a "healing crisis" and let the patient suffer while continuing to do the same thing is not the proper way forward. If the over reaction is mild enough one only needs to wait and watch for the improvement to come. In some very strong crisis one may have to intervene with a remedy or remedies to correct the situation.

Lastly, I would like to say that there is no reason to throw out the baby (the homoeopathic maxims on the direction of cure) with the bath water (excessive reactions due to improper posology and case management). The direction of cure as introduced by Hahnemann and expanded upon by Hering has been observed 10,000s of times over a 160 year period and proved its worth in the clinic. For this reason it is best to take good care of the baby, and of course, change the bath water when necessary.

Similia Minimus
Sincerely, David Little
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"It is the life-force which cures diseases because a dead man needs no more medicines." - Samuel Hahnemann

Homoeopathic Online Education (H.O.E)
Visit David Little's website:
http://www.simillimum.com
David Little © 2006

[Ellen Madono]

Dear David,
I have the 1998 Jain edition of The Chronic Diseases (Theoretical Part). I can't find the page 230 reference that you make. Should I be looking at another edition?
Thanks,
Ellen Madono

[David Little]

At 03:31 AM 9/24/2007, you wrote:
Dear Ellen,

The copy of The Chronic Diseases (Theoretical Part) by B.Jain I am
speaking about is a small book that does not contain the materia medica
section. The quote in this copy is definitely on page 230 of this copy. Are
you looking in the same publication or the larger book containing the
materia medica?

Sincerely, david Little
- - - - - - - - - - - - - - - -

"It is the life-force which cures diseases because a dead man needs no more
medicines." - Samuel Hahnemann

Homoeopathic Online Education (H.O.E)
Visit David Little's website:
http://www.simillimum.com
David Little © 2006

[Chris_Gillen]

In the 1992 B.Jain edition, the quote is on p.135. Perhaps it's the same in the one you have?
Chris.

[Chat]

Dear Ellen,
In any edition you should be able to go to the end of the Psora chapter and count back 24 paragraphs. It starts as David has it, "The latest edition ..." (page 156 in the 2005 edition)
Best wishes, Elizabeth
________________________________

[Ellen Madono]

Thank-you, I found it.
Ellen
________________________________

[Soroush Ebrahimi]

Dear David
I must thank you for such fantastic articles that you send for us. My this long continue.
Regarding Psora you state below:
" 3. The 3rd stage is secondary psora where psora transforms from functional states to organic pathology disorders involving damage to the major vital organs and systems. Hahnemann list around 400 secondary symptoms and over 100 pathologic states including consumption, lung disease, heart disease, kidney disease, diabetes, bone diseases, intestinal diseases, stomach diseases, liver diseases, diseases of sexual organs, paralysis, strokes, convulsions, epilepsy, deafness, dropsy, goiter, cancer, etc., etc. "
Are you saying that without ANY involvement of Syc and Syph maismatic traits, ie just 'PURE PSORA' you would expect to see such pathology?

Regards

Soroush

[David Little]

At 05:19 PM 9/28/2007, you wrote:
Dear Soroush,

I will try to send articles on what I think are important subjects
every once in a while. I don't have the time or extra energy to enter into
the day to day discussions, much of which I have already commented upon in
the past. There are many experienced persons to take care of most of the
questions these days.

Saying that the direction of cure has nothing to do with Hahnemann's
teachings is not historically correct and I pointed this out in the past.
At least now some finally admit that the reversal of the symptoms is in the
Chronic Diseases. Some still seem to be in denial about the fact that the
return of old unresolved symptoms is also in the Chronic Diseases. I agree
that some aspects of the law of cure have been misused in the past, and I
have written about this myself, but to say all the observations are just
the side-effects of harmful cures is going too far. For this reason, I am
going to post Hahnemann's Direction of Cure and Hering's Laws II soon. I
going to put a cleaned up versions of these articles on my website.

As to your question:

I know that H.C. Allen taught that psora was only functional disorder
and did not produce pathological states. This has become a keynote of psora
in certain circles. Hahnemann, however, had quite a different view. To him
psora was a source of a great number of serious pathologies and untimely
deaths. My 30s years of clinical experience supports Hahnemann's view. I
have seen suppressed skin diseases progress to serious organic pathology of
the vital organs and systems.

So yes, suppression of the primary infections and secondary eruptions
of psora can produce organic pathology in the vital organs. In The Chronic
Diseases Hahnemann gives 97 examples of serious conditions (including
deaths) caused by suppressing the itch miasma. Complex miasms may produce
pathological ultimates more quickly than psora alone. What might take psora
many years to produce may take place much quicker when psora is mixed with
sycosis, pseudopsora, syphilis, etc.

As Hahnemann noted, the nature and site of the final pathological
symptoms somewhat depends on the constitutional predispositions of the
patient as well as the time and circumstances. The final name of a
pathology such as "heart disease" can be caused by psora, sycosis and
syphilis but the pathway of the disease and symptoms that developed along
the way are different.

Psora will have the physical and mental concomitant symptoms of psora;
sycosis the physical and mental concomitant symptoms of sycosis, and
syphilis the physical and mental concomitant symptoms of syphilis. Even the
target pathology may develop differently, e.g. Psora tends to produce
inflammation and hypertrophy, sycosis fatty degeneration and blockages and
syphilis necrosis of the heart muscles and arteries.

It is quite possible that some of the example symptoms and disease
states Hahnemann attributes to Psora in the Organon and Chronic Diseases
include of mixed miasms. Nevertheless, Psora does not just produce
functional states. The first stage of psora is the prodromal and primary
stage where the eruptions are on the least dangerous area on the skin. Then
comes suppression, or spontaneous progression to the latent stage of psora.
This is when psora produces functional disorders. Then as the patient ages,
or is placed under excessive physical and emotional stress, the secondary
stage with organic pathology in the vital organs and symptoms breaks out.

So the main question is *can psora can produce organic pathology*?
Hahnemann and I would say "yes" it can, especially the 3rd stage of its
development.

Sincerely, David Little
"It is the life-force which cures diseases because a dead man needs no more
medicines." - Samuel Hahnemann

Homoeopathic Online Education (H.O.E)
Visit David Little's website:
http://www.simillimum.com
David Little © 2006