Patient and their Disease 1. G.H.G. Jahr
Posted: Thu Jun 03, 2004 5:54 am
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
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