Constitution:Introduction:

"We frequently speak of constitution and of constitutional remedies. Yet, when we ask ourselves what constitution actually is we find we are at a loss for an answer. A definition like Bauer's 'the sum total of an individual's characteristics as they are potentially determined at the moment of fertilisation' means really very little because it means too much and is too general. If every characteristic is looked upon as constitutional, we still lack a yardstick to measure what represents the differentiating elements between constitutional and non-constitutional factors." (Edward Whitmont)In your reading of Hahnemann, Kent, Whitmont, Vithoulkas, Ortega, Sankaran and any other homeopathic or non-homeopathic sources you consider to be relevant, discuss the different ideas about 'Constitution' and arrive at a well-argued conclusion which goes some way to provide the 'yardstick' that Whitmont mourns the lack of.

DEFINITIONS:

Constitution [n. constitution \ Lat.: Constitūtĭo - Arrangement]

Constitutions [pl. constitutions < constitution]

Homeopathic constitution:

[Homeopathic constitution < homeopathy + constitution] That description (arrangement) which fits the homeopathic type or archetype and totality. 

Those "descriptions" are being giving since the beginning of homeopathy (Hahnemann) and "constitute" the whole description of the image which fits a situation, type of a person or homeopathic remedy and totality.

The constitution can be expressed in physical and psychological terms and is an holistic expression because the homeopathic remedy, expressing the constitution, is from an external source and has equal characteristics as the person with the "constitution".

This should be equal to the homeopathic simillimum.

(CHAMBERS ENGLISH DICTIONARY)

Constitute : (vt) To set up; to establish; to form or make up; to appoint; to give being to

Constitution:(n) The act of constituting; the natural condition of body or mind; disposition; a system of laws and customs established by the sovereign power of a state for its own guidance; an established form of government; a particular law or usage; in chemistry, molecular structure, taking into account not only the kinds and numbers of atoms but the way in which they are linked.

Constitutional: (adj.)

Inherent in the natural frame; natural; agreeable to the constitution or frame of government; essential; legal; reigning subject to fixed laws; supporting the existing constitution.—n. a walk for the sake of one’s health.

[Latin- constituere, constitutum — con intens, statuere to make stand, to place]

(WEBSTERS NEW TWENTIETH CENTURY DICTIONARY)

Constitute : (vt.) [L. constitutus, pp. of constituere, to set up, establish; from com-, together, and statuere, to set.]to set up (a law, government , institution, etc.); establish.to set up (an assembly, proceeding, etc.) in a legal or official form.to set up as; appoint; ordain; as, the students constituted him their spokesman.to make up; form; compose; be the components or elements of; as, twelve people constitute a jury.to make up or form of elements, material, etc.

Constitution:(n.) [ME. constitucion; OFr. constitution; L. constitutio,

from constituere, to establish; from com-, together, and statuere, to set.]

A setting up; establishment. an appointing. a making up; composition.

The way in which a thing is made up; structure; organisation; make-up.

The way in which a person is made up; physical or mental make-up; as, a man of strong constitution.

The way in which a government, state, society, etc. is organised.

The system of fundamental laws and principles of a government, state, society, corporation, etc., written or un written.

A document or set of documents in which these laws and principles are written down.

Constitutional : (adj.)

Of, pertaining to, or inherent in, the constitution of a person or thing; basic; essential.of, in, authorised by, subject to, dependent on, or in accordance with the constitution of a government, state, society, etc.upholding the constitution.beneficial to or having the tendency to benefit the constitution; good for one’s health; as, a constitutional walk.

(ROGET'S THESAURUS)

Constitution:

Intrinsicality.—N. Intrinsicality, inbeing, inherence,inhesion, immanence; subjectiveness; ego; essence; essentialness, etc; essential part, essential stuff, substance, quintessence, incarnation, quiddity, gist, pith, core, kernel, marrow, sap, life-blood, backbone, heart, soul, life, flower; important part, etc.

Principle, nature, constitution, character, ethos, type, quality, crasis, diathesis.

Habit; temper, -ament; spirit, humor, grain, disposition, streak, tendency etc.

Endowment, capacity; capability, etc.; moods, declensions, features, aspects; peculiarities, etc.; idiosyncrasy; idiocrasy; diagnostics.

The difficulty in defining the nature of constitution and constitutional remedies to which Whitmont refers in the opening paragraph of his essay on ‘Constitution and Disposition’ is inherent in the very meaning of the words, shown above in the definitions from Chambers and Websters Dictionaries.

To constitute is both to bring something into being, and the way in which that being is made up.

A constitution can simultaneously be ‘the sum total of an individual’s characteristics as they are potentially determined at the moment of fertilisation’ (or conceivably an even wider definition should the influence of past lives — or even the fundamental interconnectedness of all forms of life — be taken into account) as well as various more narrowly focused descriptions of the form elements or patterns that constitute the perceived totality of an individual at a defined space-time singularity, (ie. at a particular time and place within our linear conception of time).

The difficulties to which Whitmont addresses his essay are not just those of the particularly homœopathic definition of the terms, but are in the nature of the difficulties posed philosophically and semantically by any attempt to describe particular contingent forms of a dynamic continuum, of which only a tiny part is apparent to our present level of perception.

The Tao that can be expressed is not the eternal Tao; The name that can be defined is not the unchanging name.

Non-existence is called the antecedent of heaven and earth;

Existence is the mother of all things.

From eternal non-existence, therefore, we serenely observe the mysterious beginning of the Universe;

From eternal existence we clearly see the apparent distinctions.

These two are the same in source and become different when manifested.

This sameness is called profundity. Infinite profundity is the gate whence comes the beginning of all parts of the Universe. (Lao Tzu. Ch 1.)

Since the Universe is holographic, one could well say ‘so what?’ — within the narrow definition is implicit the wider (and vice versa).

But this does not address the problem highlighted by Whitmont: how can a differentiation be made between what is constitutional and what is not constitutional? How do we define the boundaries of the individual, particularly if we are attempting to tune our perception of the world to accord with systems theory? How can the term constitution be grounded and given a practical and useful role in medicine? How does it relate to concepts such as susceptibility, symptom totality, miasmatic inheritance and distinctions such as those between common and characteristic symptoms?

BY STUART CLOSE:

Constitution is that aggregate of hereditary characters influenced more or less by environment, which determines the individuals reaction, successful or unsuccessful, to the stress of environment.

BY DR.J.T.KENT:

Physical constitution is the external disorder in the man, the vital force.

INTERPRETATIONS OF THE TERM 'CONSTITUTION':

In homœopathy, the term constitution seems to be used most frequently when referring to ‘constitutional prescribing’ to indicate the consideration of a wider, deeper totality than that called for by an acute episode. It is also used to differentiate between ‘types’ of patients by describing them according to various systems of classification, and in determining common and characteristic symptoms of disease.

Constitutional prescribing is not the same as chronic prescribing, since the patient does not have to exhibit any sign of chronic disease pathology to require a constitutional remedy. Constitutional prescribing does not simply address the present disturbance, but also the past and future. It is treating the patient’s susceptibility (which may include the propensity to repeated acutes and any existing chronic disease), by addressing the inner disturbance which gives rise to outward disease symptoms. It treats the manifest, the previously manifest, and also the potential to manifest. In this sense, it links in to the definition cited by Whitmont above, as does Margery Blackie’s statement, ‘The constitutional remedy is a picture of the sum total of the strengths and weaknesses of the person, mentally, emotionally and physically. It is in the early undiagnosable stages of illness that we must find the constitutional remedy.’ (Blackie, 1986. p14)

Boger appears to regard the constitution as that which produces the characteristic, as opposed to common, symptoms of the disease (Bannan, 1994. p77). It is perhaps from this standpoint that Whitmont's complaint about a lack of differentiation between constitutional and non-constitutional factors arises.

The idea of constitutional typing arose long before homœopathy: ‘The conception of a patient in terms of healing agent is found even in Paracelsus … ‘stress in our drugs the cure and not the causes because

the healing shows us the cause’.’ (Leeser, 1935. p27) and has its uses — ‘According to the recognition of characteristic traits of a patient in an image of drug actions, one speaks in homoeopathy of a lachesis case, of a sulphur man or a phosphorus type. The originally practical therapeutic consideration becomes a fruitful discovery and division principle for constitutions.’ (Leeser, 1935. p26) However, like any model, the conception has also been misused. In Kathleen Priestman’s introduction to Borland’s Homoeopathy in Practice (Borland, 1988. pviii) she states, ‘It has been found that certain remedies are indicated very frequently, and that many people exhibit symptoms which correspond to the symptom picture or ‘drug’ picture of each of these remedies. … Unfortunately, over the years, it has become a common habit for homoeopathic doctors to speak of the remedies as if they were the patients and vice versa.’

Hahnemann himself makes no reference to constitutional prescribing or typing, either in the Organon or in Chronic Diseases. He appears, with several of the earlier homœopathic writers, to have used the term constitution purely to describe the makeup of the individual. Most often, the impression given is that he has in mind the physical form — all but one reference to constitution in the Organon refer specifically to the ‘discernible body constitution’ which is differentiated from ‘mental and emotional character’ as early as paragraph 5. Only in paragraph 136, which deals with provings, does he introduce a different dimension when he writes: ‘A medicine, during its proving in the healthy state, cannot bring forth all of its condition-alterations in one person, but only in many different, diverging body- and soul-constitutions.’ (Hahnemann, 1842. (b) §136)

Early homoeopaths seem to have understood constitution largely in terms of the physical makeup of the body. There appears to have been a vogue for constitutional typing during the 19th century. The four traditional temperament types (melancholic, phlegmatic, choleric, sanguine) used in medicine for centuries were elaborated and redefined by many during this period, including Edward von Grauvogl (1811-1877) who proposed the classification of body types into hydrogenoid, carbo-nitrogenoid, and oxygenoid. Later divisions were proposed by A Nebel (carbonic, phosphoric, tubercular and fluoric) and H Bernard (carbonic, sulphuric, phosphoric, and fluoric) who based his types on embryological layer predomination, in common with the later well-known stratification of mesomorphs, endomorphs and ectomorphs. There were also many classifications which were based on pathology. Ortega traces these from

Trousseau’s concept of disease ‘diathesis’, citing the various classifications of Czerny, Kretschmer, Pende, Romero and Maranon.

Kent was evidently aware of the tendency to constitutional typing as he cautions against it: ‘It is a fatal error to classify constitutions, as no two are sufficiently similar, when observed by a genuine homœopathician to form even a common class. Human beings are a thousand times more complex than the chess-board in the hands of most skillful players. …Nothing leads the physician to failure so certainly as classification.’ (Gypser, 1987. p651 and Kent, 1994. p272) And again, ‘The colour 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. …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 makeup. To twist these temperaments into our pathogenesis, symptomatology, or pathology is but a misunderstanding of our homœopathic principles. One who knows how to find a homœopathic remedy for sick people does not pause long to take the measure of the normal constitution of his patient, who has changed from the normal to the abnormal constitution.’ (Gypser, 1987. p650 and Kent, 1994. p377. Emphasis added) Note that Kent regards the constitution (temperament) as essentially unalterable, contrasting with later understanding such as that stated by Leeser; 'In the undertaking of a constitutional therapy there is already the implication that the constitution is not an unalterable state.' (Leeser, 1935. p39)

Foubister also warns against prescribing on constitutional type, stating ‘The fact that anyone can be fitted into a type, even accurately, does not mean that the remedy for that type is required at any given time.’ (Foubister, 1989. p26)

This view is modified by Roberts, who sees some value in constitutional typing: ‘The homœopathic prescription is often biased by the temperament to the extent that certain temperaments bring out certain symptom pictures much more readily than do other so-called temperaments. … Just so far as the temperaments as classified develop symptoms in their conventional lines may we depend upon them as

guides in the selection of the remedy.’ (Roberts, 1942. p170) Roberts bases his classification on the classical temperaments — nervous, bilious, sanguinous, phlegmatic — but cautions against typing by remedy: ‘…the remedy indicated by the conditions of disturbed balance is the one that will most quickly restore the equilibrium, regardless of the temperament.’ (Roberts, 1942. p171)

Ortega, however, takes a different slant on constitutional typing. ‘The quest for the constitutional basis which modifies human suffering has been the task of all the great masters of medicine. …[Their] ultimate aim … may be reduced to: the recognition, the presentation of evidence, and finally, the classification of the human species into modes of suffering, forming groups, which somewhat reduce the heterogeneity of ailments and constitute entities with enough in common to make them more easily understood in their different ways of manifesting their anomalies.’ (Ortega, 1980. p9-10) The difference in his approach stems from his understanding of constitutional types as being miasmatic-, rather than remedy-based. He regards Hahnemann’s classification of psora, sycosis and syphilis as being his contribution to constitutional typology.

Leeser traces this line of thought to its origin in his extensive exploration of the subject of constitution: ‘Hahnemann's theory of chronic diseases at first glance has nothing to do with the doctrine of constitutions. In contrast, the division into syphilis, sycosis and psora is distinctly related to exogenous causes of disease. Further, Hahnemann expressly stresses that even the most robust constitution cannot remove a psora which has once succeeded in developing. According to him only the form and manifestation of the psora will be modified by the constitution of the individual concerned, furthermore, by the influence of the milieu, fate, mode of living and weather influences. And still the three divisions of Hahnemann have become an important part of the conception of constitutional disease and therapy in the homœopathic school. This has its basis in that, according to Hahnemann, the three forms of life damage are so fundamental that they bequeath definite predisposition to disease from generation to generation. So it seems likely, opposed to Hahnemann's conception, to permit three uniform causes to become the principles of division and from this three types of disease relationships and anlages. A further basis for this interpretation is found in that Hahnemann has prescribed definite drugs or groups of drugs for the three chronic evils. … This union to related drugs gives the triple division, a classification principle which we have discovered as

characteristic for the homœopathic conception of constitution.’ (Leeser, 1935. p36)

Close also regards Hahnemann's miasmatic theory as a major contribution to medicine, adding occupational or drug diseases to the three miasms to give four fundamental classifications. However, in his chapter on the General Pathology of Homœopathy, he writes purely about the classification of disease, not patients, divorcing the connection to constitution more evident in Leeser and Ortega. (Close, 1993. pp87-121)

In Vithoulkas' writing, the term is generally used in the context of its strength (ie. a strong or weak constitution) when describing the response of an individual to morbific influences. He does not appear to advocate any kind of constitutional typing. ‘The most important contribution of Hahnemann's exploration into the miasms is the concept that there exist layers of predisposition which underlie the waxing and waning of temporary ailments; these must be taken into account in treatment intending to be completely curative. In such cases, complete cure will take a relatively long time, while the prescriber systematically peels off layer upon layer of predisposing weaknesses by carefully prescribing each remedy based on the totality of symptoms in the moment.’ (Vithoulkas, 1986. p127) Hahnemann's miasms are extended to include all major disease diatheses as well as allopathic drugs and vaccines. However, many people regard Vithoulkas as one of the prime exponents of constitutional typing by remedy, resulting from his method of presenting remedies by their 'essences' and describing them in terms of patient personalities. Whether or not this was his original intention is not clear.

Underpinning the whole debate is the basic human tendency to classify experience into meaningful groupings in response to underlying form patterns. As Yasgur states, ‘Typing or classifying the ‘human animal’ is something which has been with us for thousands of years. It is in our nature to group and dissect, to categorise and deconstruct. It is part of human nature to constantly strive to understand the world and our fellow man. It is no wonder that ‘typing’ is so ubiquitous in the makeup of world cultures.’ (Yasgur, 1994. p175) The recognition of ‘the manifest importance of the predisposing ‘terrain’ which virtually generates, or at least moderates, the sickness’ (Ortega, 1980. p12) is what, at base, prompts all attempts at constitutional typing. But as with any set of data, it is open to formulaic, unthinking approaches as much as to intelligent and pragmatic interpretation. It is also in large measure subjective: given

‘that inseparable quantum interconnectedness of the whole universe is the fundamental reality’ (Bohm, D in Capra, 1983. p150) different patterns of connections will be perceived by different people — and all will be equally valid viewpoints of a part of that reality.

CONCEPTION OF ‘CONSTITUTION’:

It deals with the physical and mental makeup of an individual. In this state, a man can able to enjoy his life harmoniously without any hesitation and his vital operation as regard both sensation and function can freely employed for the higher purpose of our existence. New endeavours to think in constitutional terms are apparent in all the efforts made towards preventive medicine. In this field the analysis of risk factor is gaining increasing relevance. It is evident that risk factor are to be found not only in the environment but particularly also in the individual person of the patient, in his inherited and evolving constitution; most chronic diseases originate in the patient’s constitution.

There is some confusion in the mind of some regarding good constitution and well built physique. Built is something more than the well formed body. It is not affected easily by infringing the laws of health; on the other hand a man with bad constitution is made sick by any infectious disease. Moreover he may fall prey to degenerative disease even though he is a good body builder.

TOWARDS A REDEFINITION OF 'CONSTITUTION':

Whitmont himself offers the following definition — ‘…constitution is the inherent tendency to respond automatically along qualitatively predetermined individual, characteristic patterns. Constitutional differences are the differences of response patterns to identical situations. Constitutions can be characterised by characterising these fixed response patterns.’ (Whitmont, 1980. p45. Emphasis added.)

The difficulty with this definition is that it does not adequately reflect the dynamic nature of constitution. Whitmont implies a fixity of response patterns which, while they may very well remain essentially constant over long periods of time (even a lifetime) are nevertheless capable of change. If change does occur, do we then say that a person’s constitution has changed, implying that they have moved from one constitution to another? Or implying that only the nature or dynamic of their constitution has changed? And what is an acceptable definition of change, since there are no such things as completely ‘identical situations’?

Sankaran’s views come in at this point. He does not write at any length about the nature of constitution, defining it simply — ‘Each person has a specific constitution. By this, we mean that each person has a specific, individual body, mind and disease.’ (Sankaran, 1991. p112) However, he devotes a large part of his later work to classification of disease, following Lesser and Ortega in regarding Hahnemann's miasmatic theory as the basis for his interpretations of disease as delusion. He equates the miasms (with the addition of an acute miasm) to stages of life (childhood, youth, middle age, old age) and also to the psychiatric classifications of functional, neurosis and psychosis (Sankaran, 1994. p27), but while describing personality types typical of each miasm and deriving a situational analogy for each, he emphasises that each case is invariably a combination of two or more miasmatic states. He devotes a chapter in The Spirit of Homœopathy to the subject of ‘Treating the Present State’ in which he emphasises the need to treat the totality of the present. In this he distinguishes between previous states which have left their still-visible imprint on the patient and presenting states in which what needs to be cured is the only reliable guide to the remedy.

Jeremy Sherr's view is that the constitution is that which is calling out for the constitutional remedy.

Twentyman takes the anthroposophical perspective, and throws a different light on the nature of hereditary predispositions: ‘The soul as individual entity enters into a body borrowed from the parents. The body is determined by hereditary forces and must present an obstacle to the soul seeking expression in this world. This body is not yet the creation and expression of the individuality seeking to embody itself therein … up until the change of teeth, this soul spirit entity is building its own body using the inherited body as a model, rather as an artist may use another picture as one for his own creation. From this point of view we can envisage that a strong individuality will be able to transform the inherited traits for its own use in building the bodily instrument for its life work. Even inherited handicaps can be used as obstacles to call forth further creative activity and in a deeper sense may even have been chosen for such a purpose. Their very opposition can become a stimulus. A weaker individuality may not be so able to work upon these hindrances and may have to bear them.’ (Twentyman, 1989. p295)

All the above diverse viewpoints are valid at some level, some to a greater extent than others. The difficulty in arriving at a comprehensive definition of ‘constitution’ is in representing a synthesis of all of them; in

particular, fulfilling the basic human need to ‘type’ and using the understanding gained by so doing with intelligence, while simultaneously accepting the ultimately unique nature of every individual. This is not a new problem — Hippocrates stated that: ‘A measure, however, be it weight or number, serving as directive, you will not find; there is no other than the body’s sensation.’ (Gutman, 1986. p12).

Whitmont’s complaint about a lack of useful yardstick (or method, as later amended) on one level seems irrelevant; on another, a genuine challenge. But homœopathy is all about recognising and resolving paradoxes. Our language lags some way behind in being capable of articulating them. This returns to Lao Tzu, and it is from this ancient but timeless treatise that an acceptable definition of constitution can perhaps be derived: —

An individual's constitution is the sum total of that individual's being which is manifested at a particular moment in time. It comprises the form patterns which their life, inheritance and experience up to that point have produced which, by implication, include the influence of past diseases and the malaises of the present, as well as the susceptibility to future imbalances from the perspective of the present. It is a dynamic continuum subject to constant change while being similar in essence from the moment of conception to the moment of death. It includes the susceptibility to disease patterns (and hence remedy patterns), but is greater than these. The constitutional remedy is that which resonates most closely with the sum of the presently manifest imbalances within the individual's constitution.

CHARACTERS OF CONSTITUTION:

1) It means the inherited and acquired physical, emotional and intellectual make up of a person.

2) It is that which indicates the type to which the individual belongs.

3) It is constant and immetable.4) It is not modified under external or internal influence.5) So it clearly understood that while constitution is constant factor

in the individual.6) The constitution of an individual is to place him in the genus to

which he belongs.7) The constitution of the subject which is a static state.

8) The constitution of the subject is determined by observation, study of form particularly by examination of the relationship between the different parts of the body.

9) These relationships vary according to the constitution under observation but they never undergo a fundamental change in the course of life. As they were at birth so they will remain.

10) No treatment can modify them, the only exception being orthodontics, applied at a suitable age for correcting the deformity of the mouth in the fluoric subject.

11) So constitution is the state what actually exists.

IMPORTANCE OF CONSTITUTION:

1) Constitution is accurately signified by signs whose presence enables us to have a good knowledge of the whole psychological and morbid entity.

2) A study of biochemical investigation made it clear that each morphological constitution was a related to a chemical status, which appeared to be fairly well determined.

3) Therapeutic study – while study this constitution and observing the sensory and functional phenomena which appeared to be matched by certain objective sign, a surprising discovery was made showing their frequent relation with three great homoeopathic remedies:-

a) Calcarea carbonica.b) Calcarea phosphoric.c) Calcarea flourica.

4) It is perfectly easy to recognize the objective signs of different constitution and to realise that they are invariable matched by certain hereditary manifestation and by physical, dynamic and psychological possibility which are also revealed.

5) It helps to distinguish clearly between typological entitles and temperamental entitles.

6) The practical interest of this description about constitution is surely diagnostic and even prognostic but also therapeutic.

7) Thorough study about constitution seems to make easy the selection of a remedy.

CLASSIFICATION OF CONSTITUTION:

A) The German homoeopath DR.VON GRAUVOGL, who describes towards 1870 three biochemic constitution, constituted by the four fundamental elements of living matter, the carbon, oxygen, hydrogen and nitrogen.

1) Carbonitrogenous constitution.2) Hydrogenoid constitution.3) Oxygenoid constitution.

CARBONITROGENOUS CONSTITUTION:a) A slow oxidation resulting an overrange by metabolites,

perturbation of secretions.b) Tissues do not absorb sufficient oxygen.c) There is hepatic insufficiency.

Examples: Lycopodium, Cuprum Met.

HYDROGENOID CONSTITUTION:a) Slow intake of nutrition.b) Puffines, retension of water in the cells.c) He is easily affected by humidity.d) A retension of hydrochloride giving place to an infilrtrative

condition, swollen, hydropexic.

Examples: Natrum Sulfuricum, Thuja Occidentalis.

OXYGENOID CONSTITUTION: a) Over activity of oxydating power.b) Rapid assimilation and disassimilation.c) Easy demineralisation.d) Retracted and emaciated.e) Hypohydric aspect with dryness of the skin, & mucouses.

Examples: Acid Nit., Carbo Veg.

B) According to a French homoeopath DR.LEON VANNIER

1) The carbonic type.2) The phosphoric type.3) The fluoric type.

THE CARBONIC TYPE:

It is characterised by:

Morphology:

General aspect :

Short limbed, Thick Set, Square Or Sphere. Developed in width. Thick skeleton. Rigid articulation.

Mentality:

Guided by the reason and the sense of responsibility. Stubborn. Stranger. Detector. Reasonable. Speaks very little and only about what he knows, Respects

order necessary and in matter. Listens to and applies the advises given to them.

THE PHOSPHORIC TYPE:

Morphology:

Long limbed. Predominance of the cranium. Thorax long and flat forward from behind. Rachis supple. Vaulted.

Shoulder blade prominent. The lower belly fall infront. Saddle backed.

Mentality:

Nervous. Sensitive. Imaginative. Emotive. Intuitive. Dreamer. Distracted. Superficial. Easily excited and soon depressed. Horror of reality, of facts. Easy vanity or dominating. Care for elegance. Does not like neither regularity nor rule.

THE FLUORIC TYPE:

Morphology:

Leanness. Asymmetric. Skin dry and cracked.

Mentality:

Unstable. Cannot take any decision. Rapid assimilation. Disorderly. Restless. Intuitive. Unforeseen and lively reaction but not durable. Cannot continue. Capricious. Versatile. Easily vulgar.

Horror of rules and of solitude. Fantastic. Brilliant but unstable.

THE ESSENCE IS THE GESTALT OF THE DISEASE:

Hippocrates was the first to write of the constitutional nature of the human organism. He taught that all diseases (excluding injuries) were initially general in nature and only become local to provoke a crisis at a latter stage. All natural diseases are originally functional and then proceed toward pathological damage over time. The old master also taught that there was no such thing as a single cause in a natural disease. He taught that causation was of an interdependent origin rather then any one isolated factor. There is always the merging of the susceptibility of an individual or group with a sympathetic pathogenic influence. Therefore, the aetiological constellation includes the predispositions of the physical constitution and mental temperament, the nature of the disease state, as well as environment conditioning factors.

There are some who are averse to the use of the word "constitution" in any manner. They are even more averse to the term "constitutional remedy". This term was introduced by James Kent to indicate a chronic or anti-miasmaticmedicine that affects the whole patient. This term was complementary to the "acute remedy", which was more suitable for the transitory local phenomena associated with acute crisis. Kent’s constitutional medicine had nothing to do with giving remedies by classical constitutions or temperaments. It was simply the remedy that was most suited to treat chronic diseases and miasms. In truth, Kent spoke out against the use of classical constitutions and temperaments in Homoeopathy in his Lesser Writings.

Any negative changes in the human constitution and temperament are simply signs that may become part of the totality of the symptoms when characteristic. One does not give remedies for constitutions or temperaments per se. Taber’s Medical Dictionary defines the term "constitutional" as something that affects "the whole constitution" and is not "local". Something that is constitutional pertains to the "whole constitution". Hahnemann certainly made it clear that deep acting homoeopathic remedies affected the whole patient through the medium of the vital force. In this sense, chronic medicines are certainly "constitutional remedies".

Hahnemann used his knowledge of the Hippocratic Canon to understand the nature of the constitution, temperament and predispositions and their relationship to the signs, befallments and symptoms. The first instruction on homoeopathic case taking is for the homoeopath to record all the significant momenta of the complete case history, the potential causations including miasms, as well as the 7 attendant circumstances. This information forms the basis of understanding the patient (nature-inheritance) as well as the environmental conditioning factors that affect the development of symptoms (nurture-situation). Vide Organon §5 (O’Reilly edition).

"It will help the physician to bring about a cure if he can find out the data of the most probable occasion [Bold by DL] of a acute disease, and the most significant factors in the entire history of a protracted wasting sickness, enabling him to find out its fundamental cause [Bold by DL] . The fundamental cause of a protracted wasting sickness mostly rests upon chronic miasms. In these investigations, the physician should take into account the patient's

1. Discernible body constitution (especially in cases of protracted disease) [Bold by DL]

2. Mental and emotional character (character of the Geist and Gemuet) [Bold by DL]

3. Occupations,

4. Lifestyle and habits,

5. Civic and domestic relationships (relationships outside and within the home)

6. Age

7. Sexual function, etc."

The significant factors of the entire medical history (the disease timeline), acute and chronic causations (the aetiological constellation), the chronic miasms, and the 7 attendant circumstances form the basis of proper case taking (§5). On this solid foundation the objective signs, coincidental befallments and subjective symptoms of the body and soul are recorded in detail (§6). The 7 attendant circumstances are:

1. The discernible body constitution (especially. in chronic cases). This category of symptoms includes a comparison of the physical constitution during a time of relative health with the negative changes brought on by diseases. It also includes Hippocratic diathetic constitution (the scrofulous, lymphatic, venous, nervous, rheumatic constitutions, etc.), a description of the physique (tall or thin, short or fat, loose or tight tissue types, etc) and the state of the vitality (weak, strong, unstable, etc). Rubrics of this nature are found in Hering’s Guiding Symptoms and Knerr’s Repertory as well as throughout many repertories.

2. The mental and emotional character. This refers to the character of the Geist (intellect) & Gemuet (emotional disposition). In this statement Hahnemann uses the term "charakter", which means personality rather than just transient mental conditions. This implies more than merely recording unrelated mental symptoms. One must understand "who" they are treating by constructing a complete psychological profile. This includes all the qualities related to emotional disposition, rational spirit and intellect as well as the soul. Rubrics related to these states are found through the mental sections of most homoeopathic repertories. Rubrics related to Hippocratic temperaments (choleric, phlegmatic, sanguine, melancholic) are found in Hering’s Guiding Symptoms and Knerr’s Repertory. Strictly speaking, these temperamental rubrics relate to the complete mind/body complex.

3. The occupation. The occupation that a person chooses is often characteristic of the individual's innate talents and desires. It also is an area that reveals many occupational hazards that may produce diseases as well as maintaining causes that obstruct the cure. These areas can reveal important symptoms as well as being relevant to the case management procedures.

4. Lifestyle and habits. These are cardinal general symptoms. How a person chooses to live and what they like to do are very characteristic symptoms. These symptoms offer great insights into the personality of the patient and their negative mental states. Investigating how a person lives often reveals indiscretions in diet, rest, and exercise as well as substance abuse and other areas that produce unneeded stress and strain.

5. Civic and domestic relationships. These rubrics include family dynamics as well as social relationships. How a person relates to their mate, family relations, children, friends, co-workers and society offers many signs and symptoms. These situational rubrics are a very

important source of significant symptoms. Dysfunctional relationships produce illness as well as forming maintaining causes that keep up the disease state.

6. Age. Stages of life are a very important part of time and progression in Homoeopathy. The critical times are conception, birth, childhood, puberty, adolescence, middle age, and old age. Some remedies work particularly well on babies while other are more suited to the elderly. Some work well at both extremes of life. Hering recorded this is the section of the Guiding Symptoms called States of Life and Constitution.

7. Sex and sexuality. Some remedies are relatively more characteristic of females while some are more reflective of males. Some cover problems unique to the female and others male. The sexuality of a human being is closely connected to their physical and emotional health. The frustration of the orgasm reflex and the human need for intimacy leads to physical and psychosexual disorders. A person’s sexual ethics, sexual fantasies, sexual performance, and their sense of sexual satisfaction are a rich source of symptoms.

The time and progression, causation, the physical constitution, mental temperament and the 7 attendant circumstances are the foundation of homoeopathic case taking. Without these internal and situational rubrics the totality of the symptoms is incomplete. Who are they? What do they look like? What is the mental and emotional character like? What kind of lifestyle do they have? What are their habits? How do they relate to other people? What are their family relationships like? How are they aging? What is their sexuality like? These areas of study include personal and group factors. This is very important if the homoeopath is to understand the layers by which complex chronic diseases have formed and recognize the reversal of the symptoms during cure.

On the basis ofthe study of the timeline, constitution, temperament, causation, miasms and the 7 attendant circumstances the detailed study of the disease symptoms is continued. On this solid foundation Hahnemann introduces the totality of the symptoms in aphorisms 6, 7, 8. It is very important that the homoeopath understand what makes up the essential nature of the characteristic symptoms of the disease state. What is the Esse in Hahnemannian Homoeopathy? Vide aphorism 6 of the Organon.

"The unprejudiced observer, even the most sharp-witted one – knowing the nullity of supersensible speculations which are not born out in

experience -perceives nothing in each single case of disease other than the alterations in the condition of the body and soul, disease signs, befallments and symptoms, which are outwardly discernible through the sense. That is, the unprejudiced observer only perceives the deviations from the former healthy state of the now sick patient, which are:

1. Felt by the patient himself,

2. Perceived by those around him, and

3. Observed by the physician.

All these perceptible signs represent the disease in its entire extent [Gr. Wesen, essence, nature, being – DL], that is, together they form the only conceivable gestalt of the disease [Bolds by DL]."

The Esse is the alteration of the condition of the body and soul that make up the Gestalt of the disease (§6). The disease-Gestalt is composed of the symptoms that mark the progression from the state of health to the state of disease. The essence is the individualized nature of the complete experience of suffering (§6, 91, 92 & 175). In this study Hahnemann included changes in the innate constitution and personality as well as the negative states brought on by the disease.

One cannot separate the susceptibility and predispositions of the mind/body complex from the disease suffered by the patient. They form an inseparable whole because the innate constitution and temperament are the major conditioning factors in the experience of suffering. The mechanists tried to reduce the entire disease state down to a single cause or disease name. As Hahnemann said, one symptom is no more the disease than one foot is an entire human being.

What is it that is altered when a person suffers a disease? It is the condition of the body and soul (Gr. Leibes und Seelenbeschaffenheit). How is this alteration known? It is known by the essential nature of the totality of the objective signs, coincidental befallments and subjective symptoms. What is at the root of these disease phenomena? Vide aphorism 7 of the Organon.

"The totality of these symptoms is the outwardly reflected image of the inner wesen [essence, nature, being - DL] of the disease, that is, of the suffering of the life force."

The inner essence of a disease (the suffering vital force) is invisible but the disease-Gestalt can be witnessed through the signs, befallments and symptoms. In this way, one can know the essential nature of the mistuning of the vital force and find appropriate medicine. This is the Esse in Hahnemannian Homoeopathy.

Hahnemann was the first physician to fully integrate into medicine the innate constitution, the spiritual, mental and emotional temperament, the instinctive vital force, inheritance, predispositions, single and multiple causations, susceptibility, infection, acute and chronic miasms as well as the complete objective signs, coincidental befallments and subjective symptoms. Hippocrates is normally thought of as the father of constitutional medicine but Hahnemann brought this study to its perfection in Homoeopathy.

The healthy state represents a harmonious tuning of all vital operations (§9). Disease is the mistuning of this harmonious tone by a dissonant dynamic influence (§11). It is the disease-tuned life force that manifests as the essence of the disease-Gestalt through the totality of the symptoms (§12). Homoeopathic remedies cure through their power to similarly alter the tuning of the human condition (§19). The primary action of a homoeopathic remedy over-tunes the disease and elicits a secondary healing response that retunes to the state of harmonious health. This is the Esse of Hahnemann’s treatment method.

THE SPIRITUAL-BODILY ORGANISM:

Throughout Hahnemann's writings he uses the phrases, the unity of life, the complete whole, laws of the organic constitution, our living human organism, the bodily constitution, temperament, the make-up of the body & soul, the spiritual-bodily organism, etc. What is this whole the Hofrath is speaking of? Vide Organon.

"It was next to impossible for the them [the materialists] to acknowledge the nature of the spiritual-body organism as a highly potentized wesen, to acknowledge that the changes of its life in feeling and function, which one calls disease, had to be determined and produced mainly (in fact almost solely) through dynamic (spirit-like) impingements and could not be produced differently. [Bold by DL]" (Organon of the Medical Art, O'Reilly edition, Introduction, page 12.)

In the German text Hahnemann used the term, beschaffenheit (make up), which is usually translated into English as the word "constitution". This, however, does not reflect all the usages of the German term. This term can be used in a variety of ways that have nothing to do with the human constitution. The root word "schaffen" means "to do, to make, to work". Beschaffen is a verb that means, "to procure, make something available", and as an adjective it means, "constituted".

The English word, constitution, comes from the Latin root, constituere, which means constitutes: to set up, to establish, to form or make up, to appoint to give being to. Beschaffenheit is usually translated as constitution in relationship to the Latin root "constiture" in homoeopathic works. Chambers Dictionary defines constitution as: the natural condition of the body or mind; disposition. In this sense constitutional means; inherent in the natural frame, or inherent nature.

The W. Turner’s Dictionary, published in Leipzig in the 1830s, defines the German term, Beschaffenheit, as nature, quality, temper, condition, constitution, disposition and circumstance. Therefore, the term Beschaffenheit may include any circumstance, condition or quality related to the physical constitution and mental temperament as well as dispositions. This shows how the term was used in Hahnemann's lifetime. Modern German may not clearly convey this meaning. The homeopathic usage is related directly to the practice of medicine not the common usage of a layperson on the street. The term constitution is used at least 16 times in The Chronic Diseases. Pages 30, 34, 35, 48, 75, 90, 98, 99, 101, 103, 142, 143, 145, 181, 242, 243, etc. The term "beschaffenheit" may have the following meanings in German.

1. A quality of someone or something that is inherent or a characteristic trait that serves to define or describe its possessor.

2. The make-up or way something is composed or arranged, its constitution, composition, construction or nature.

3. A medical term for inherent traits and qualities of the human being [constitution; make-up and qualities of the body and/or soul].

The meaning of Beschaffenheit in English depends the context in which it is used. For example, in aphorism 5 we find the term "die

erkennbare Leibes-Beschaffenheit", which means ascertainable or recognizable bodily make-up. This term "Leib" is not commonly used in modern German but in older times it meant the body with special emphasis on the abdomen. This area is a key center for storage of vitality in the organism. The vitalists and Mesmerists considered the vital energy to have two major centers of force. These are the energy of the spirit in the brain and pineal gland and the reserves of vital power stored in the abdomen. This reference to the objective make-up of the 'center of the body' refers to the nature of physical constitution and vitality of the individual that is being investigated.

Diathetic Constitutions

In Aphorism 81 of the German Organon Hahnemann uses the term "angebornen Koerper-Constitutionen", which means the congenital bodily constitution. The genetic constitution represents the essence of the paternal and maternal lineages. This represents the inherited diathetic constitution and temperament including all its predispositions. The interdependence of the mind/body constitution is as inseparable as the link between the essential nature (Gr. wesen) and the instinctive vital force (Gr. Lebenskraft). One does not appear without the other. Such relationships are called functional polarities and complementary opposites. This bipolar phenomenon is innate in nature.

Hahnemann saw the unity of the organic whole while the orthodox school fell under the sway of reductionist pathology and disease names. The Founder pointed out that the mechanist looks at the products of disease and mistakes them for the cause of the disease and the disease itself. 'Tolle Causum' they cry yet they do not yet realize that the cause of an event can never be at the same time, the event itself. Even in early Homoeopathy the constitutional view of the human organism was clearly defined and the local basis of disease refuted. Vide § 42 of the 1st Organon (1810).

"But the human organism in its living state is a complete whole, a unity. Every sensation, every manifestation of power, every affinity of the component parts of one part is intimately associated with the sensation, the functions and the affinities of the component part of all other parts. No part can suffer without all other parts. No part can suffer without all other parts sympathizing and simultaneously undergoing more or less change." (Organon of Medicine 5th & 6th edition, Dudgeon and Boericke, Appendix, page 194, B. Jain, Delhi, India

What is the "human organism"? Let’s look at the definition of "organism" in O'Reilly's glossary to her edition of The Organon of the Medical Art.

"Organism: An organized or organic system; a whole which consists of dependent and interdependent parts. The human organism is more than just a body's accomplishments (e.g., Fending off malignities) and developmental capacity (e.g., the ability to become more seasoned through provings). The human organism houses the mental, emotional and bodily faculties, that is, it comprises of the body, the Geist (spirit) and Gemuet (emotional mind). (§ 9, 11, 26)"

Homoeopathy views the spiritual-bodily organism as a highly potentized essential being with spirit, mind, vital force and body. This synergy of natural forces composes a whole human being, which is more than the sum of its parts. Hahnemann integrated the ancient Hippocratic teachings on temperaments, physis, diathetic constitutions and miasms into Homeopathy and brought them up to date for his time. References to this subject can be found throughout Hahnemann’s writings and the Paris casebooks.

Although modern Homoeopathy has greatly expanded the psychological aspects of our materia medica few persons understand how Hahnemann used the terms constitution and temperament and their practical ramifications in the clinic. To appreciate this material the homoeopath must be familiar with the medical history of the vitalist lineage and its greatest practitioners as well as Hahnemann's original works. This dynamic view of mind/body constitution has its roots in Pythagoras, its trunk in Hippocrates, its branches in Paracelsus, and its fruit in Hahnemann. This fruit carries the seeds for a new generation of healers and will be part of De Medicina Futura.

Hippocratic constitutional Temperaments:

Samuel Hahnemann used temperamental portraits that include both positive natural qualities during the time of health compared with the negative changes brought on by diseases. He utilized such constitutional information within the totality of symptoms when prescribing his homoeopathic remedies. The Hofrath gives a complete portrait of Pulsatilla in the *Materia Medica Pura, 3rd edition, 1833, page 345. This example includes the use of classical temperaments.

"The employment of this, as of all other medicines, is most suitable when not only the corporeal affections of the medicine correspond in similarity to the corporal symptoms of the disease, but also when the mental and emotional alterations peculiar to the drug encounter similar states in the disease states to be cured, or at least in the temperament of the subject of treatment.

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 a tendency to inward grief and silent peevishness, or at all events a mild and 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. [Bolds by DL]"

The above quote is a constitutional portrait. Hahnemann's picture includes attributes of the natural constitution (timid lachrymose disposition, slow phlegmatic temperament), positive natural traits during a time of health and happiness (good tempered, mild, good humouredly waggish) and negative emotions brought on by disease (inward grief, silent peevishness). This portrait includes natural, positive and negative qualities. As one can see from the above quotes this information was included within the totality of the symptoms.

Pulsatilla is "adapted for slow phlegmatic temperaments", while on the other hand it is less suitable for those who "form resolutions with rapidity' and are "quick in their movements". Such data establishes constitutional portraits as well as the use of temperamental counter indications as elimination rubrics. Pulsatilla is rarely indicated in those constitutions that make quick resolutions or move rapidly because this remedy does not normally suit that type of patient. This temperamental picture demonstrates several of the essential elements of the Pulsatilla proving. This demonstrates that Hahnemann was the first to open the field of investigation into constitution and temperament in Homoeopathy.

Hahnemann's Paris casebooks show that the Founder used Hippocratic terminology. Rima Handley noted in her Later Hahnemann that the Founder wrote in his casebooks that Mme del a Nois was "sanguine" and Eugene Perry was "choleric" Hahnemann also occasionally used the

diathetic terms. For example, he wrote that Claire Christallo (DF-5) was "disposed to scrofula" and called another patient "lymphatic". Ms. Handley wrote that Hahnemann did not seem to use constitution, temperament or diathesis in his prescribing. While it is true that Hahnemann did not give remedies because a person was "sanguine", this is not the complete picture. Negative changes in a formerly healthy constitution and temperament are part of the totality of the symptoms.

Boenninghausen made it very clear in his writing that it was important to assess the physical constitution, mental temperament and predispositions during case taking. He felt it was important enough to include in his case taking directions. In Judgment of the Characteristic Value of Symptoms (Lesser Writings) Boenninghausen wrote the following under the title Quis, which means "who":

"Quis? As a matter of course the personality, the individuality of the patient must stand at the head of the image of the disease, for the natural disposition rests on it.

To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both if possible, separated according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice. The greatest and most important variations are here found mostly in the states of the mind and spirit, which must be scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies."

Boenninghausen made it extremely clear how to use this information in case taking and remedy selection. He wrote that those things that "differs little or not at all" from the healthy natural state require little attention but "everything that differs in a striking or rare way there from deserves a proportionate notice". This means that the homoeopath is to assess the changes from the state of health that are produced by disease. Therefore, the healthy state of the constitution is of little or no use while the changes from the healthy state to the state of illness are important. The more striking or rare these negative changes are in the constitution and temperament - the proportionately more important they are to the selection of the remedy. For example, if a formerly obese, jovial person becomes thin, emaciated and depressed

these symptoms are striking and rare for that patient. Therefore, these symptoms can be used in the case and may help in finding or confirming a remedy.

It is easy to see that Boenninghausen’s statements are intimately connected to aphorism 5 of the Organon and Hahnemann’s portrait of Pulsatilla in the Materia Medica Pura. To really understand this material the homoeopath must be somewhat familiar with the medical history of the vitalist lineage. Rima Handley also wrote that Hahnemann had no idea of the modern usage of constitution or essence. This is most certainly true in the sense of "essence constitutional prescribing" advocated by a few Neo-Kentian practitioners in the 1970s. Although Hahnemann did not use their method of so-called "essence prescribing", he most certainly did introduce the idea of the Wesen (essence, nature and genius) in The Organon. Hahnemann’s essence is the Gestalt of a disease as expressed by the characteristic symptoms of the mistuning of the vital force. This Esse contains the essential nature of the totality of the characteristic symptoms that leads to the most suitable homoeopathic remedy. This is the true Esse.

Hahnemann included the observations of Ludwig Christian Junker in the main body of text of The Chronic Diseases. This quote shows how the four classical temperaments and various diathetic constitutions condition the signs and symptoms produced by the suppression of psora. Vide The Chronic Diseases, Volume I, page 17.

"A brief survey of the manifold misfortunes resulting thence is given by the experienced and honest LUDWIG CHRISTIAN JUNCKER in his Dissertalio de Damno ex Scabie Repulsa, Halle, 1750, p. 15-18. He observed that with young people of a sanguine temperament the suppression of itch is followed by phthisis, 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 found 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 haemoptysis.

Persons inclined to melancholy were sometimes made insane by such repression; if they were pregnant the foetus was usually killed. Sometimes the suppression of the itch causes sterility, in nursing women the milk is generally lacking, the menses disappear prematurely; in older women the uterus becomes ulcerated, attended with deep, burning pains, with wasting away (cancer of the womb). [Bolds by DL]"

This quote clearly shows that constitution and temperament are primary factors in conditioning the nature of the symptoms developed after the suppression of the psora. This same is true with sycosis, pseudopsora, syphilis and any other chronic miasm. Junker noted that the suppression of the itch miasma tended to produce phthisis in young sanguine persons, dropsy in the phlegmatic temperament, and insanity in the melancholic temperament. He noted in the obese there was a tendency to produce suffocating catarrh and mucous consumption. Junker makes a direct link between suppression and the development of pseudopsora TB symptoms like consumption and phthisis. Each innate constitutional temperament has its own unique reactions to stimuli. For this reasons the same pathogen will affect the 4 temperaments and their 12 mixtures in a different manner.

For example, the phlegmatic (water-wet and cold) and melancholic temperaments (air-cool and dry) are usually aggravated by cold while the choleric (earth-dry and warm) and sanguine temperament (fire-hot and moist) are usually ameliorated by cold. If this is not the case, these symptoms become more strange, rare and peculiar. In each of the 4 major biological constitutions the environmental and situational circumstances are modified by the nature of their innate temperament. That Hahnemann understood how the mind/body temperament conditioned the signs and symptoms is shown by his inclusion of Junker’s observations in the main text of The Chronic Diseases.

Physiognomy constitution and Temperaments:

The use of Hippocratic temperaments (choleric, phlegmatic, sanguine and melancholic) expands the study of constitution in Homoeopathy because it includes physiognomy and the natural groupings of human beings into four major and twelve minor mind-body types. This 2, 500 year old system is the oldest living tradition in western medicine. These classical methods offer much insight into the nature of the innate constitution and temperament as well as potential diathesis toward particular signs, befallments and symptoms. Physiognomy is defined as:

"Physiognomy, the art of judging character from the appearance, esp., from the face; general appearance of anything; character, aspect-Greek- physiognomy, a shortened form of physiognomoni-physis, nature, gnomon-onos, an interpreter."

A homoeopathic physiognomist is an interpreter of natural temperament, heredity, predisposition, miasms and constitutional diathesis, as well as the present state of the spirit, mind and body. Let us look at the definition of the key terms, temperament, and constitution. What does temperament mean? The word temperament has different levels of meaning depending on usage.

Temperament from Latin, temperare; to temper, restrain, compound, moderate.

Temperament means a state with respect to a predominance of qualities; an internal constitutional state; a natural disposition; a proportioned mixture of qualities. Specifically it refers to the Hippocratic temperaments, the choleric or bilious, phlegmatic, sanguine and melancholy constitutions.

Temper-noun; a mixture or balance of contrary qualities; the constitution of the body and/or mind; a natural temperament; an innate or acquired disposition; a frame of mind; a mood; composure; to exert self control; to be uncontrolled, a fit of anger.

Temperament is also a musical term for a system of compromise in tuning. An equal temperament is a system of tuning by which the octave is divided into twelve equal intervals. The octave is a system of eight notes that make up the major or minor scale. The twelve note series of tones is called the chromatic scale.

Constitution, temperament, the spiritual body organism, the make up of the soul and body are synonyms for the living whole represented by a complete living human being. It is interesting to see that these major terms also have musical definitions. Even the word 'organism' is an archaic name for a musical instrument. The organism (musical instruments) supports the temperament (division of 12 notes of the chromatic scale-natural qualities), which is tuned (German-stimmung-tuning, voice, pitch and mood) by the vital force.

Disease is the mistunement (verstimmung) of the life force that causes disharmony in the temperament (the scale of notes -the natural qualities) of the organism (the instrument). Is this the Odes of Pythagoras and the

theory of life as music? After all, Pythagoras introduced the 7 note major scale (diatonic scale), the five elements (ether, air, fire, water, earth) and the Mappa Mundi (geometric map of the macro & microcosm)) into western culture. These hold the keys to understanding the complete system.

The four major constitutions are called the choleric, phlegmatic, sanguine and melancholic or nervous temperaments. The twelve minor types are mixtures of the major type. They are the cholero-phlegmatic, the sangino-phlegmatic, the nervo-phlegmatic, the phlegmo-choleric, the sanguino- choleric, nervo- choleric, the cholero-sanguine, the phlegmo-sanguine, and the nervo-sanguine, the cholero-nervous, phlegmo-nervous and sanguino-nervous. Each of these temperaments represents a natural grouping of constitutional types that have similar mental and physical qualities.

Hering's Contribution

When temperament is used in a general way it means the mental and emotional disposition, state, mood, composure, etc. There are other references to disposition and temperament in Hahnemann’s writings. Vide Materia Medica Pura, lecture on Nux Vomica, page 223.

"Some practical instructions may be of use, deduced from the results of the careful experience of many years. Among these may be mentioned, that is more frequently required by those persons who are of an anxious, zealous, fiery, hot temperament, or of a malicious, wicked irascible disposition."

When temperament is used specifically it means the Hippocratic constitutional temperaments, the choleric, phlegmatic, sanguine and nervous melancholic. Hering expanded this temperamental portrait by adding the names of the Hippocratic temperaments and physical descriptions of the patient in the portrait. The source of this information is the observation of the Hippocratic temperaments during the provings and recording which constitutions developed the most characteristic symptoms. This was then combined with clinical confirmations in patients under treatment. Hering created a separate section for constitution and temperament in his materia medica called Stages of Life and Constitution. Vide Guiding Symptoms, Volume VIII, Nux Vomica, page 168.

"II. For very particular, zealous persons, inclined to get angry or excited, or of a spiteful, malicious disposition. II. Ardent character or a disposition disposed to anger, spite or deception; always irritable and impatient. II. Nervous, melancholic people, troubled with indigestion; venous constitution, with tendency to hemorrhoids. II. Suits thin, irritable, choleric persons with dark hair, who make great mental exertion or lead a sedentary life. I. Bilious temperaments. (hepatic affections) I. Patients addicted to use of much wine or coffee and to those of sedentary habits combined with considerable mental exertion. II. Debauches, thin, of an irritable, nervous disposition. II. Drug subjects."

In Hering's 5-point system of grading remedies II (5) is the highest grade, I (4) is the second grade. We find similar rubrics in Allen's Keynotes under the title "adapted to". Allen includes temperaments, miasmic tendencies, diathetic constitutions and symptoms in these rubrics. These are all constitutional general rubrics.

The above rubrics are an extension of Hahnemann's original portrait of Nux Vomica. This temperamental portrait includes natural temperament (bilious, choleric, melancholic, nervous dispositions with their traits), diathetic constitutions (melancholic with venous constitution), mental rubrics (angry, spiteful, impatient, etc), physical descriptions (thin, dark hair), lifestyle (sedentary or great mental exertion), habits, (addicted to wine, coffee, drugs), as well as predispositions to regional symptoms (tendency to hemorrhoids, indigestion, hepatic affections). On this constitutional basis the signs, befallments and symptoms are further investigated for those rubrics that are strange, rare and peculiar to the individual organism (Org. §5.6.7). To utilize this method completely one must understand the teachings of Hippocrates as well as Hahnemann, Boenninghausen and Hering.

Hering's proving collection and his clinical confirmations are the source of constitutional characteristics such as: Nux Vomica is well adapted to angry, irritable, dark, thin, dry, bilious, choleric persons; Pulsatilla is well adapted to gentle, blond haired, blue eyed phlegmatic temperaments; Phosphorus is well adapted to tall slender persons of sanguine temperament, fair skin, delicate eyelashes, fine, blond or red hair, with quick perceptions, and very sensitive nature; Arsenicum is well adapted to the over anxious, chilly, nervous anxious temperaments. Such symptoms do not automatically lead to remedies by themselves, as they are only part of the totality of the symptoms.

One might ask, what is a phlegmatic temperament? How does Hahnemann’s statement that Pulsatilla is "especially adapted to slow phlegmatic temperaments" fit into the overall picture? The next chapter in our study contains a review of the essential rubrics of the phlegmatic constitutional temperament. This should help to put Hahnemann’s statements into perspective.6hhhssshhhhpes

OTHER CONSTITUTIONAL TYPES:

When choosing a treatment for someone, mental and emotional types should be taken into consideration; including such matters as the individual’s fears and anxieties. An individual’s temperament also needs consideration, this means looking at whether they are generally happy, tearful, sad, confident, lazy etc. Then other factors that may affect the individual need to be looked at to ascertain whether or not these factors affect the condition itself; such as how they respond to noise, if they are bright and alert in the morning, if they prefer to be in groups or on their own. Physical factors are also important; looking at whether the patient is short or tall, fat or thin, long or short limbed, under or overweight, their eye colour, hair colour, hair type, preferred type of clothing and so on.

Once you have determined a constitutional type it is easier to prescribe a more effective treatment. For example, if someone is suffering from stomach pains. The best remedy for stomach pains is A, B, or C. The best remedy for the emotional aspects of a person is B and C. The best remedy according to the person’s constitution is B, so B will be the best remedy. Remedy A would still have done some good being a known treatment for stomach pains but B would be more effective as it suits the symptoms and the person involved.

MAIN CONSTITUTION TYPES

The Argent Nit. Type

Appearance: Pale complexion, looking older than actual age due to worry and tension.

Mental and emotional aspects: Cheerful and impressionable. Often anxious and worried. Always in a hurry and can be impulsive. Finds it difficult to control emotions. Readily laughs, cries and loses temper. Quick thinking and adept at solving problems. Tends to be extroverted to hide true feelings.

Physical weaknesses: Nervous system. Eyes. Digestive system. Ailments tend to the left side. Dietary factors: Likes chocolate, candy, salt and cheese. Dislikes chilled foods.

The Argent Nit. child: Always moving around and never wants to sit still. Prone to nervousness and can experience upset stomach when stressed. May react badly to new situations like moving house. Can be prone to insomnia due to worry. Prone to bedwetting.The Argent Nit. Types tend to have weak mucous membranes in their eyes.

The Arsen. Alb. Type

Appearance: Usually thin or slim. Often well groomed and stylish. Fine facial features with fine, delicate skin. Frown lines can appear on the forehead.

Mental and emotional aspects: Restless person. Perfectionist at work and at home. Can be critical and intolerant. Strong opinions. Can have a deep fear of being alone. Obsessive and compulsive behaviour, especially concerning cleanliness and tidying-up; this can hide a hoarding mentality. Can pull out of plans early if they think it is not going to work 100%. Pessimistic in nature with a need for constant reassurance.

Physical weaknesses: Digestive system. Skin. Respiratory system (coughs, asthma and colds) Dietary factors: Likes fatty foods, warm foods and drinks, in particular coffee, candy, alcohol and sour tasting foods. Dislikes large amount of fluid.

The Arsen. Alb. child: Highly sensitive and highly-strung. Easily upset by loud noise. Can become exhausted after periods of exertion. Active imagination can create nightmares in dreams. Increasingly mentally and physically agile with age. Can worry overly about parent’s well being. Dislikes mess and being messy, keeps room tidy.

Warm drinks and sweet foods are favoured by the Arsen. Alb. Types.

The Calc. Carb. Type

Appearance: Overweight or gain weight easily. Sluggish, bloated and tired in appearance.

Mental and emotional aspects: Impressionable, sensitive and quiet. May become withdrawn due to fear of failure. Can dwell too much on a

particular problem. May be greatly upset by cruelty to children and animals. Needs motivation to succeed in tasks. Can be prone to mild depression when unwell. Reassurance helps to improve condition.

Physical weaknesses: Ears, nose and throat. Skeletal system, may manifest as back ache. Digestive system, may be prone to irritable bowel syndrome and feeling bloated. Skin. Teeth. Exhaustion, prone to chronic fatigue syndrome. Prone to depression.

Dietary factors: Likes dairy products, eggs, candy, salt, desserts, chocolate, carbohydrates, iced drinks and ice cream. Dislikes fatty meats, boiled food and boiled milk.

The Calc. Carb. child: Plump and overweight. Placid and calm. Slow to walk and talk and teeth are slow to develop. Can fall over easily. Scared of the dark and can be prone to waking up due to bad dreams. Often lazy and may need encouragement with homework because may give up easily.

Ears, nose and throat are weak areas of the Calc. Carb. Type.

The Graphites Type

Appearance: Prone to being overweight and has a large appetite. Blushes easily. Can have a rugged, windswept appearance. May have rough, dry skin that can crack easily. Dry hair, usually dark. Flaky scalp.

Mental and emotional aspects: Takes time to work things out and solve problems. Deep concentration on a task can create irritability. Not always willing to change habits and routines. Not an early morning person. Possible mood swings, tearful and despondent then impatient.

Physical weaknesses: Skin. Nails. Slow metabolic rate. May often have sores in corner of mouth, be exhausted, have bad breath, nose bleeds, styes in eyes and suffer from travel sickness. Dietary factors: Likes sour and savoury foods. Dislikes sweet foods, salt, seafood and hot drinks.

The Graphites child: Feels the cold and gets chills quickly. Timid, hesitant and anxious. Does not like travelling great distances because of travel sickness.

The Graphites type like savoury foods, such as vegetables and salads.

The Ignatia Type

Appearance: Slim build. Prone to dark circles under eyes. Expression may be tired and drawn and may also suffer from involuntary twitches of mouth or eyes. Dry lips. Dark to mid range colour hair. Sighs a lot.

Mental and emotional aspects: Very highly strung. Rapid and extreme mood swings. Can jump from tears to joy then back to depression in the blink of an eye; prone to suppression of grief. Possible difficulty in ending relationships and seeing this as a weakness. Coffee and cigarette addiction is common.

Physical weaknesses: Nervous system. Endless list of problems caused by emotional trauma. Common ailments include hysterical grief over bereavement, leading to headaches, sore throat, coughs and colds, constipation, twitching and grinding teeth. Dietary factors: Likes coffee (even though not good for them), sour and savoury foods, dairy products, carbohydrates. Dislikes sweet foods.

The Ignatia child: Highly strung, excitable and sensitive. Finds it difficult to function when stressed. Divorce of parents almost impossible to deal with, causing outbursts of anger, crying and poor grades at school. Prefers not to be alone. May experience headaches, choughs, sore throats. Responds well to encouragment.

The Ignatia type like dairy foods.

The Lachesis Type

Appearance: May appear bloated or lean. Strong, fixed expression. Usually has pale complexion with occasional freckles. Strong, staring eyes. May lick lips a lot.

Mental and emotional aspects: Very ambitious and creative. Mind can become crowded with thoughts. Jealous and possessive. Talkative. May be sensitive to noise. May view self as sinful when religious. Suspicious of strangers.

Physical weaknesses: Circulation and nervous system. Hyperactivity, varicose veins, menopausal problems, sore throats and asthma, bad sleep and insomnia, palpitations and panic attacks. Prone to left-side problems. Physical ailments made worse when trying to sleep and lay still.

Dietary factors: Likes coffee, alcohol and seafood, cool drinks, sour and savoury food and carbohydrates. Dislikes sweet drinks.

The Lachesis child: Full of spite, can be hurtful to peers. Hyperactive and jealous of brothers and sisters, especially new babies. Prone to bad dreams and nightmares. May suffer from Attention Deficit Hyperactivity Disorder.The Lachesis types often lick their top lip.

The Lycopodium Type

Appearance: Tall and lean with worry and frown lines on head. Often look older than their years. Facial twitching. Thinning hair in men. Dislikes wearing light clothing.

Mental and emotional aspects: A drama queen, creating mountains out of molehills. Insecure and hates change. Avoids commitment. Anxious over important events. Deep fear of being alone and of the dark. Forgetful. Finds trivial mistakes disproportionately irritating. Hates being contradicted.

Physical weaknesses: Digestive disorders, kidney stones, prostate, sore throats, male baldness. May be prone to chronic fatigue syndrome. Right-side problems.

Dietary factors: Likes sweet foods and warm drinks, onions, garlic and seafood. Dislikes cheese and strongly flavoured meats.

The Lycopodium child: Insecure and shy, though can be dominant and bossy with children they know. Prefers indoor pursuits over outdoors. Conscientious and achiever academically.

The Lycopodium type men can lose their hair early.

The Merc. Sol. Type

Appearance: Medium build. Skin on face may appear shiny due to moisture from perspiration, with grey translucent look. Hair may be fair to medium colour.

Mental and emotional aspects: May struggle internally with emotions. Resentment and lack of trust in others may cause insecurity. Dislikes criticism directed and self and taking orders. May explode with rage and anger. Poor memory with thought patterns becoming muddled in later life.

Physical weaknesses: Sore throat, swelling of glands and exhaustion. Sensitive skin with allergies being common. May be prone to chronic fatigue syndrome and Season Affective Disorder (depression during the darker winter).

Dietary factors: Likes cold drinks, carbohydrates and citrus fruits. Dislikes strongly flavoured foods.The Merc. Sol. child: Irritating behaviour. Shy and cautious. May stammer. Susceptible to ear nose and throat complaints.The Merc Sol may suffer from changes in the weather or SA

The Nat. mur. Type

Appearance: Pear-shaped build in women. Solid, strong and lean build in men. Skin can be puffy and oily with frequent swelling. Watery, red eyes. Dry cracked lips. Medium to dark hair.

Mental and emotional aspects: Will suppress emotions such as, fear, anger, guilt and loneliness, which can lead to depression. May suppress feelings over lost loved ones. May become very depressed after relationship break-up. Will possibly wish to cry but find self unable. Suffer in silence rather than ask for help. Down to Earth with mind set on career.

Physical weaknesses: Nervous system. Depression, premenstrual syndrome, anorexia; skin problems; mouth ulcers and cold sores; palpitations and headaches.

Dietary factors: Likes cold drinks, sour and savoury foods and craves salt and most carbohydrates. Dislikes coffee and bread.

The Nat. mur. child: Small for their age. Slow development. Well behaved. Loves animals. Very good academically but can become extremely hurt if criticised at school. May suffer from headaches under pressure.

The Nat. mur. type may be professional and career minded.

The Nux Vomica Type

Appearance: Slim, especially when young. Smart appearance. May look stressed and tense. Ages prematurely. May have dark circles under eyes. Face becomes flushed when angry or excited.

Mental and emotional aspects: Can suffer from addictions and overindulgence. May have cravings for alcohol, coffee, cigarettes. Can be addicted to sex. Finds it difficult to relax. Can be very ambitious. Impatient. Intolerant of imperfection in others. Failure is the worst thing that can happen.

Physical weaknesses: Digestive disorders from hangovers and overindulgence. Migraines and headaches. Hernia and hay fever. Feels better after sleep.

Dietary factors: Likes fatty and rich food, cheese and cream, alcohol, coffee and spicy foods. Dislikes the effects of some spicy food even though they like eating them.

The Nux Vomica child: Irritable and easily bored. May be prone to Attention Deficit Hyperactivity Disorder. May have temper tantrums. Competitive as a teenager. Because they like to be rebellious they may become addicted to drugs or alcohol.

The Nux Vomica type may become dependant on drugs or alcohol.

The Phosphorus Type

Appearance: Tall and slim with long limbs. Likes to be stylish. Artistic and creative in appearance. Fine skin. Can have fair to dark hair.

Mental and emotional aspects: Needs a lot of love and attention. Good fun to be around but can become demanding. Likes to be the centre of attention and like being cared for when upset or unwell. Expressive, affectionate and not afraid to show emotions. Needs reassurance regarding looks and image. Short attention span. Can be hard work for partner.

Physical weaknesses: Nervous system – especially fear and hypersensitivity. Circulation problems. Dizziness. Coughs and colds. Weakness of the lungs. Headaches. Left-side problems. Dietary factors: Likes sour and savoury foods, salt, spicy food, carbonated drinks, alcohol, mild cheeses and sweet foods. Dislikes strongly flavoured fish and fruit.

The Phosphorus child: Tall and slim with ling legs and arms. Nervous. Likes to be with people and centre of attention. Loves to receive attention. Strong fear of the dark.

The Phosphorus type like mild cheeses and sour and savoury foods.

The Pulsatilla Type

Appearance: Can be slightly overweight. Gentle and kind appearance. Can look younger than actual age. Hair is fair and skin has a rosy complexion. Blushes easily. Often rests with hands behind head.

Mental and emotional aspects: Shy and easily embarrassed. Kind and gentle and makes friends easily. Likes to be supported by others. Not assertive and can be indecisive. Cries easily, in particular over cruelty to children and animals, tragic news or weepy movies. Also laughs easily. Avoids confrontation. Loves animals. Can suppress guilt and anger. Occasionally prone to obsessive or compulsive behaviour.

Physical weaknesses: All female reproductive problems. Catarrh. Irritable bowel syndrome. Skin problems. Varicose veins. Styes. Physical symptoms can fluctuate and change rapidly.

Dietary factors: Likes sweet foods, cold foods and cold drinks. Dislikes fatty foods such as cream and butter, and very rich, spicy foods.

The Pulsatilla child: Fears the dark and dislikes bedtime. Sensitive to changes in the weather. Becomes tearful and weepy when overtired. Prone to coughs and colds.

The Pulsatilla types often rest with their hands behind their heads.

The Sepia Type

Appearance: Slim and tall. Often sits with legs crossed. Likes to look attractive and elegant. Medium to dark hair, often with brown eyes.

Mental and emotional aspects: Can be irritable and easily offended. Tendency to be aggressive to loved ones. Cannot handle too much stress and tries to avoid pressure and deadlines. Can feel better after weeping, but does not like it when others are fussing around. Avoids crowds but fears being alone. Hates being contradicted, as holds strong opinions.

Physical weaknesses: These include all menopausal problems. Headaches and migraine. Skin problems. Other common ailments include constipation and haemorrhoids, chronic fatigue syndrome and

depression. Conditions usually improve with exertion. Physical problems mostly occur on left side.

Dietary factors: Likes spices, sour and savoury foods, citrus fruits, sweet foods and alcohol. Dislikes dairy products, especially milk, rich and strongly flavoured meets and fatty foods.

The Sepia child: Greedy. Prone to constipation. Can become a bedwetter. Moody. Feels the cold and can become tired easily. Does not like being alone.

The Sepia type doesn’t like crowds but fears being alone.

The Silicea Type

Appearance: Often thin or slim, with a large forehead. The head can appear too large for the body. Delicate, fine features; almost doll-like in appearance. The skin of the lips goes grey and can be cracked. The palms of the hands feel sweaty to the tough and nails can be brittle.

Mental and emotional aspects: Appears to have low confidence from a young age. Prone to mental exhaustion. Can become overburdened and overwhelmed. Responsibility weighs heavily on the Silicea type. Can be indecisive about taking on new projects, moves and new jobs. Fear of failure may surface in form of being a workaholic. Fear of failure can also spread into personal relationships. May stubbornly resist advice from friends and loved ones in order to hide true feelings.

Physical weaknesses: Problems with nervous system, especially due to burnout from new projects. Exhaustion. Slowness in healing and getting well. Respiratory illnesses and weaknesses including chest infections and low resistance to coughs and colds. Constipation. Skin problems. Headaches. Feels the cold.

Dietary factors: Likes cold foods such as salads and raw vegetables. Dislikes meet and dairy products, especially cheese and milk. Dislikes very hot food.

The Silicea child: Can be smaller than children of a similar age, with petite appearance, apart from large head. Feels the cold. Not sporty as has little stamina. Can be shy. Usually tidy and well behaved.

The Silicea type may have brittle nails and slow-healing skin.

The Sulphur Type

Appearance: May be slim with poor posture. May look untidy. Hair may be course, dry. Skin and lips can be prone to redness.

Mental and emotional aspects:Mind can be cluttered. Can be critical. Likes to argue. May lack willpower and self-esteem. Might not complete ideas and projects.

Physical weaknesses: Prone to skin and circulation problems; haemorrhoids and constipation; hot, burning feet; body odour.

Dietary factors: Likes sweet foods, fatty foods and stimulants such as coffee and chocolate. Likes alcohol, spicy foods, citrus fruits, salads and seafood. Dislikes dairy products, especially milk and eggs. Dislikes most hot drinks.

The Sulphur child: Untidy looking. Can be hyperactive in the evening. Does not like showers, bathing or washing hands. Has a very healthy appetite.

The Sulphur type enjoys sour foods such as citrus fruits.athy - Constitution Types

CONSTITUTION AND PREDISPOSITION:

SUSCEPTIBILITY AND PREDISPOSITION:

Hahnemann presents a complete system of constitution,

temperament, heredity, disposition, idiosyncrasy and susceptibility in his

writings. Aphorism 31 deals directly with the subject of the living

organism and its disposition toward disease. Vide Organon.

"The-partly psychical and partly physical-inimical potencies in life on

earth (which we call disease malignities) do not possess an absolute

power to morbidly mistune the human condition. We become diseased

by them when our organism is just exactly and sufficiently

disposed and laid open to be assailed by the cause of disease that

is present and to be altered in its condition, mistuned and displaced

into abnormal feelings and functions. Hence these inimical potencies do

not make everyone sick every time."

This aphorism points out that the susceptibility of the human

organism is partly psychological and partly physical. It has been well

proven that physical and mental stress lowers the immunity and makes

individuals and groups more susceptible to particular illnesses.

Therefore, susceptibility is related to both constitution and

temperament. To be susceptible the organism must be sufficiently

disposed to specific inimical disease powers. Without this sympathetic

relationship there will be no disease. This is why pathogenic agents do

not affect every person nor the same person all of the time. The patient

must be sufficiently susceptible according to the time and

circumstances. Susceptibilities may be inherited as well as acquired.

In the Sacred Diseases Hippocrates opined that most diseases are

based on hereditary predispositions. He noted that the diseases found

in the mother and father are often found in the offspring. Lamarck, who

is considered the founder of modern genetics, published his research

on inheritance between the years 1809 and 1822. By 1828 Hahnemann

was integrating information about inherited depositions in his dynamic

healing system. He speaks of inheritance and predisposition in both the

Organon and The Chronic Diseases. Vide aphorism §78 and its note

78.

"The true, natural chronic diseases are those that arise from a

chronic miasm. When left to themselves (without the use of remedies

that are specific against them) these diseases go on increasing. Even

with the best mental and bodily dietetic conduct, they mount until the

end of life, tormenting the person with greater and greater sufferings."

Note 78.

"In the most blooming years of youth and with the commencement

of regular menstruation, coupled with a beneficial lifestyle for spirit,

heart and body, these chronic diseases often remain indiscernible for

several years. Those afflicted appear in the eyes of their relatives and

acquaintances as if they were completely healthy and as if the disease,

implanted in them through infection or heredity, were completely

vanished. However, it inevitably comes to the fore again in later years

and with adverse events and relationships in life. The more the life

principle has been deranged through debilitating passions, grief and

worry, and especially through inexpedient, medicinal treatment, the

more rapidly the disease increases and the more onerous its character.

[Bolds by DL]"

This establishes several important features in homoeopathic

pathology and philosophy.

1. First of all, Hahnemann was the first to suggest a complete

theory of susceptibility and infection. He makes it very clear that the

miasms are infectious in their primary state. He also taught that the

microscopic microorganisms he called "animalcule" were the infectious

agents of the contagious miasms. He noted that the process of infection

includes susceptibility, a moment of infection, incubation period,

prodromal stage and primary, latent and secondary or tertiary

symptoms. He classified miasms into three categories, the acute, half-

acute and chronic and recorded the symptoms in individuals as well as

groups affected by the same miasm. On this basis, he established a

materia medica of anti-miasmatic remedies in the Chronic Diseases.

2. Second, Hahnemann stated that miasms are transmitted by

infection or inheritance. Hahnemann notes three means of transmitting

miasms, i.e., by contact with the infected host, congenitally through the

mother's womb or by nursing and by heredity. Inherited miasms

produce predispositions in the offspring to particular disease states

associated with the miasms.

3. Third, Hahnemann records the effects of stress as an activator of

inherited and acquired chronic miasms. He points out that mental and

emotional stress greatly increases the damaging effects of the chronic

miasms. The effects of stress on the human constitution and

susceptibility to disease have been discovered by modern medicine but

Hahnemann recorded the entire syndrome in 1828 and integrated it into

homoeopathic philosophy and treatment.

Hahnemann's view of the global effects of universal chronic miasms

is closely linked with his theory of pathogenesis. In his writings he

mentions three factors in the evolution of degenerative diseases. These

are the suppression of the symptoms of the miasms by allopathic

means, the transmission of the miasms through the generations, and

the increase of stress caused by modern civilization. Who else has

done such a deep study of factors related to the individual as well as to

groups suffering from diseases of common cause and similar

symptoms? Not only this, Hahnemann established a special section of

the materia medica to treat these chronic illnesses!

Hahnemann’s writings demonstrate the important relationships

between the congenital constitution, inheritance, predisposition and

diathesis. The individual constitution and temperament is the most

important feature in individualizing the symptoms of the chronic miasms.

In the Chronic Diseases Hahnemann pointed out that the physical

constitution, the mental temperament, hereditary dispositions, habits,

lifestyle as well as environmental factors like diet are the most important

conditioning factors in the symptoms of the miasms. This careful

assessment of inheritance (nature) and environmental factors (nurture)

is found in no other system of healing. Vide page 102 of the Chronic

Diseases.

"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 its

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. [Bolds

by DL]"

Hahnemann wrote that the same disease state (such as psoric

miasm) is varied according to the differences in "bodily constitution" and

"hereditary disposition" as well as the patient’s turn of mind, morals,

diet, etc. This is because the human constitution and temperament

(Nature) are the most important influences in the development of

disease signs and symptoms. The next most important factors are

environment, climate, diet and stress (nurture). For these reasons, a

homoeopathic remedy should be similar to the negative changes found

in the constitution and temperament as presented by the signs,

befallments and symptoms. Hahnemann repeats a similar refrain in

aphorism 81 of the Organon where he discusses the influence of the

congenital bodily constitutions (angebornen Koerper-Constitutionen).

" It is, to some extent, understandable how psora could now unfold

itself in so many countless disease forms in all the human race since

this age-old infectious tinder has gone, little by little, through many

millions of human organisms over the course of hundreds of

generations, thus attaining incredible proliferation. This is all the more

understandable when we consider the multitude of circumstances

that have tended to contribute to the formation of this great

diversity of chronic diseases (secondary symptoms of psora), as well

as the indescribable variety of human congenital bodily

constitutions, which already, in and of themselves, deviate so

greatly from one another. [Bolds by DL]"

The diversity of human constitutions and the environments in which

human beings live are a major contributing factor in the development of

the manifold symptoms of psora and the miasms. As the infectious

agents of the miasms have been passed through millions of human

beings over the course of hundreds of generations its symptoms have

greatly mutated. For hundreds of thousands of years the infectious

miasms have been present either in endemic pockets or as universal

epidemics. The effects of the miasms have been found in the remains of

the most ancient human beings and are found on every continent in

every culture. It is no wonder that the symptoms produced by the

universal miasms have been mistaken for manifold different diseases.

DIATHESIS, INHERITED AND ACQUIRED CONSTITUTIONS:

The idea of a diathesis is very closely linked with the inherited

constitutional predispositions to particular symptoms. What does

Diathesis mean? The Greek term, diathesis, is very closely linked with

the inherited and acquired miasms and constitutional predispositions to

particular symptom syndromes.

1. A diathesis is an inherited or acquired condition of the organism

which makes it susceptible to peculiar disease states; a constitutional

predisposition toward certain disorders. From the Greek, diathesis, dia-

asunder and tithenai-to place.

2. A constitutional state which mistunes the body, and/or mind.

3. Diathetic constitutions are a category of constitutional

predisposition or susceptibility to certain disorders, i.e., lymphatic,

venous, leuco-phlegmatic, scrofulous, psoric, sycotic, etc. A diathesis is

a permanent (hereditary or acquired) condition of the body that renders

it liable to certain special diseases or affections; a constitutional

predisposition or tendency. This word comes from the Greek for

disposition or state. Thus a diathesis is a constitutional state that can be

physical and psychological as well as inherited or acquired. The

concept of diathesis is closely linked to both predisposition and the

inherited miasms in Homoeopathy. This material is very cryptic to most

modern homoeopaths yet those who have put this system to work find it

practical and indispensable to daily practice. Homoeopathic reference

works have recorded a great amount of information on constitutional

diathesis and dynamic remedies that reflect a similar state. Hering and

Knerr recorded a large amount of material in their writings.

For example, Knerr's Repertory to Hering's Guiding Symptoms

includes the following rubric in the general section.

CONSTITUTION (DIATHESIS):

In this section Knerr gives rubrics of various diathetic constitutions

and their remedies. The source of this information is Hering's Guiding

Symptoms in the section called Stages of life and Constitutions. Here is

a sample of the types of rubrics included and a few examples.

1. Rubrics related to constitutional diathesis include; Hysterical,

constitutions; Hemorrhagic, constitutions; Lymphatic, constitutions;

Venous, constitutions; Plethoric, constitutions; Rheumatic, constitutions;

Scrofulous, constitution; Paralytic, constitutions; Gouty, constitutions;

Tubercular, constitutions; Asthmatic constitutions; and their similar

remedies.

Example:

"Lymphatic, constitutions -am-c., Apis, arn, ars, aster, aur-m., bapt,

BAR-C., Bar-m, BELL., CALC., calc-ar., Cann-i., Carb-v., Chin., dulc.,

FERR., GRAPH., Hep., kalm., Lyc., MERC., murx., Nat-m., nit-ac.,

Petr., phos., Puls., Rhus-t., Sep., Sil., Sulph., thuj."

2. Rubrics related to the bodily constitution include; Lean, thin people;

Large fat, people, bloated; Emaciated constitutions; Fibre, lax,

constitutions; Fibre rigid, constitutions; Tall lean, constitutions; Dwarfish,

constitutions; and their similar remedies.

Example:

"Fibre, lax., constitutions-agar., bar-c., bor., CALC., calc-p., Caps.,

cinnam., hep., KALI-C., MAG-C., MERC., OP., PHOS., SABAD., Sil.,

spong."

3. Rubrics related to the Hippocratic temperaments and humours

include; Bilious, constitutions; Choleric, constitutions; Phlegmatic,

constitutions; Sanguine constitutions; Melancholic, constitutions;

Nervous, constitutions and their remedies.

Example:

"Bilious, constitutions; acon., Aesc., ail., ambr., ant-c., ant-t., ars.,

Bell., berb., BRY., cann-i., CARD-M., Cham., CHEL., CHIN., chion.,

chol., Cocc., Ip., iris., Lach., lept., mag-m., Merc., nat-s., NUX V., Phos.,

plat., ptel., PSOS., Puls., sang., sep., Sulph."

Rubrics related to the miasms include; Psoric, constitutions; Sycotic

constitutions; Tubercular, constitutions; Syphilitic, constitutions;

Cancerous constitutions (mixed miasms).

Example:

"SYPHILITIC, constitutions-Ars., aec-t., AUR., Benz-ac., Clem., Cor-

r., Crot-h., cund., euph., ferr-i., Fl-ac., Guai., Kali-b., KALI-I., MERC.,

Merc-c., Merc-d., Merc-i-f., Mez., NIT-AC., Petr., Phos., Ph-ac., Phyt.,

Sars., Sil., Still., sulph., SYPH., Thuj."

There are literally 100's of rubrics on this subject in the old materia

medicas and repertories. These are general symptoms of the

constitution, temperament, diathetic states and miasms. A miasm can

produce a number of diatheses depending on the constitution and

temperament and conditioning factors. For example, pseudo-psora TB

miasm tends to produces a hemorrhagic diathesis while sycosis tends

to an arthritic rheumatic diathesis. If the individual is of a sanguine

temperament and acquires the TB miasm the chance of dangerous

hemorrhage is increased greatly. This is because the fiery sanguine

temperament that rules the warm/moist blood humour and the TB

miasm both have an easy tendency to bleed. Such knowledge forms the

basis of the homoeopathic view of constitution, temperament,

susceptibility, miasms and diathesis.

CONSTITUTION AND CONCOMITANTS:

Hahnemann paid close attention to the constitution in both acute and

chronic diseases. Vide Sycosis, The Chronic Diseases, the footnote on

page 150.

"The miasm of the other common gonorrhoea seem not to penetrate

the whole organism, but only to locally stimulate the urinary organs.

They yield either to a dose of one drop of fresh parsley juice, when this

is indicated by a frequent urgency to urinate, or a small dose of

Cannabis, of Cantharides, or of the Copaiva balm, according to their

different constitutions and other ailments attending it. [Bolds by

DL]"

In this example Hahnemann suggests using the constitutional

concomitant symptoms to help in the selection of a remedy. He expects

homoeopaths to understand that the term "constitution" simply means

the whole living organism. All chronic remedies are "constitutional" in

this sense as they reflect the essential nature of the totality of the

symptoms.

I think we have proved beyond a doubt that Hahnemann had a deep

understanding of classical constitution, temperament, inheritance,

susceptibility, diathesis and miasms. He also introduced temperamental

pictures that included both the natural traits of the individual when

healthy compared with the negative changes brought on by illness.

Hahnemann’s writing and the Paris casebooks include Hippocratic

terms like the choleric, phlegmatic, sanguine and nervous

temperaments. Each of these temperaments is associated with positive

and negative qualities and predispositions toward certain disease

states, signs, befallments and symptoms. They are also prone to

particular diathetic states such as the venous, lymphatic and leuco-

phlegmatic constitutions. If one studies material of the first generation of

homoeopaths they will find such references with their concomitant signs

and symptoms.

BIBLIOGRAPHY: Bannan, Robert, ed. 1994. C M Boger Collected Writings.

Churchill Livingstone, Edinburgh, London, Madrid, Melbourne, New York, Tokyo.

Blackie, Margery. 1986. Classical Homœopathy. Beaconsfield Publishers, Beaconsfield.

Borland, Douglas. 1988. Homœopathy in Practice. Beaconsfield Publishers, Beaconsfield.

Capra, Fritjoff. 1983. The Tao of Physics. Flamingo, London.

Chambers English Dictionary. 1988. W&R Chambers, Cambridge, etc.

Close, Stuart. 1993. The Genius of Homœopathy. B Jain, New Delhi.

Foubister, Donald McD. 1989. Tutorials on Homœopathy. Beaconsfield Publishers, Beaconsfield.

Gutman, William. 1986. Homœopathy: the Fundamentals of its Philosophy, the Essence of its Remedies. Homœopathic Medical Publishers, Bombay.

Gypser, Klaus-Henning. 1987 (republished 1988). Kent’s Minor Writings on Homœopathy. B Jain, New Delhi.

Hahnemann, Samuel. 1842. The Organon of Medicine. 6th edition.

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