Werkboek Klassieke Homeopathie

By David Little

The Mappa Mundi is a symbolic geometrical design that holds the essential teachings of Hippocrates on Constitution and Temperament (Nature) and its interaction with the environment (Nuture) One might ask why is it important to study this information and what is its relationship to the Homoeopathy? First of all, the Mappa of Mundi helps one to understand one’s patients better because it offers insights into nature of their pre-dispositions and shows how this conditions their signs, befallments and symptoms. It also offers insights into sensitivity and the functions of the vital force as well as the interlocking of the symptoms.
This geometric design has eight principle areas based on the cross and its intermediate points. The cross represents the four homoeomeries, which are similar archetypal patterns that make up all phenomena. These are symbolized by the earth, water, fire and air. Ether makes up the space or dimensions in which these patterns function. For example, there are four universal forces in physics, the strong and weak nuclear forces as well as gravity and electromagnetism. In the inner universal all of our genes are made up of only four chemicals in different combinations. This is an example of the primordial homoeomeries found in the macrocosmic and microcosmic universes.
The geometric design of the Mappa of Mundi (Latin, Map of the World) is based on the cross and its intermediary points. This makes up eight major categories of phenomena. The cross (+) represents earth, water, fire and air and the place where the vertical and horizontal lines meet represents the ether. The earth is dry and solid, the water is moist and fluid, the fire is hot and radiant and the air is cool and light. The ether represents space, time and consciousness. The four intermediate points (x) represents the unique combinations of the homoeomeries that makes up the four temperaments, the choleric (dry and warm), the phlegmatic (moist and cool) the sanguine (hot and moist) and the melancholic (cold and dry).

These combinations of the four forces are related to the production of the yellow bile humor, the pitutious humor, the blood humor and the blackbile humor. These forces and humors are viewed as dynamic patterns that carry out physical as well as psychological functions in the human organism. This system has its origin in Pythagoras and reached its acme with Hippocrates. It was not until the time of Aristotle and Galen that the system become corrupted and more mechanistic. For more information on the design of the Mappa Mundi please refer to my website article. Now this begs the question - How does all relate to Homoeopathy?
First of all, Samuel Hahnemann was scholar who read Greek and Latin. The Founder was well aware of the Greek classics and found his greatest inspiration in the works of Hippocrates. Much of the foundational basis of homoeopathy is based on the teachings of the old Asclepiad. In the Hippocratic works one finds the vital force (pneuma), similar cure similars, the single remedy and the minimal dose. We also find the idea all diseases begin constitutionally and only become local as pathology develops. Hippocrates taught that all diseases have natural causes and discussed the necessity of observing the signs and symptoms in detail. He taught that most chronic diseases had a basis in hereditary and related this to the predispositions of the four temperaments and their mixtures. All of these ares we integrated into the medicine of the future by Samuel Hahnemann.

Nevertheless, there seems to be much confusion on the role of constitution and temperament in Homoeopathy. First lets review some of the ways the term "constitution" has been used in our healing art.
1. Kent used the term ‘"constitutional medicine" to describe remedies used to treat chronic miasms and chronic diseases to set them apart from remedies given for acute conditions. He used the terms acute remedies (remedies for crisis) and constitutional remedies (chronic remedies) in this fashion. Kent’s constitutional remedy simply means a *a chronic remedy*. Nothing more - nothing less.
2. The term "constitutional prescribing" is a term was used by Vithoulkas and his students in the 1970s. This version of the "constitutional remedy" became associated with ":essence prescribing". This is a Neo-Kentian approach that deviates from James Kent’s teachings in that it does not address the miasms with anti-miasmic remedies. Kent was a full supporter of Hahnemann teachings in the Chronic Diseases and miasms.
3. Today there are some "constitutionalists" that only give "constitutional remedies". They believe in the "one remedy for all situations". Many of them do not believe in giving remedies for acute diseases or treating chronic miasms because they only like to use their so-called constitutional remedies. They do not pay any attention to the constitution and temperament in the traditional or modern sense.
4. Another type of "constitutional remedy" is professed by Dr. Eziagas and his students. He stratified his treatment into the lesional remedy, anti-miasmatic remedy, general remedy and constitutional remedy. Here the term "constitutional remedy" is supposed to be given after the removing of the various layers of disease symptoms as a prophylactic to prevent future problems. They use this term in almost the opposite manner of the Neo-Kentian constitutional prescribers and the one-sided constitutionalist.

Now with all these various types of constitutional prescribing is it any wonder that there is confusion? Do any of these methods have anything to do with the teachings of Samuel Hahnemann, Baron von Boenninghausen, Constantine Hering, and G. H. G. Jahr? They all spoke about the constitution and temperament but none of them used the term "constitutional remedy" or "constitutional prescribing." Let us review the subject starting at the foundation.

HAHNEMANN ON CONSTITUTION AND TEMPERAMENT

The first place on should look for the role of constitution and characterology in Homoeopathy is the 5th and 6th Organon of the Healing Art. The importance of the make up of the physical constitution and mental character is introduced in the aphorism 5 of the 5th and 6th edition.
"It will help the physician TO BRING ABOUT A CURE if he can find out the data of the most probable occasion of an acute disease, and the most significant factors in the entire history of a protracted wasting
sickness,enabling him to find its fundamental cause. The fundamental cause of a protracted wasting sickness mostly rest upon a chronic miasms. In
these investigations, the physician should take into account the patient’s:
1. Discernible BODY CONSTITUTION (ESPECIALLY IN CASES OF PROTRACTED DISEASES),
2. Mental and emotional CHARACTER (character of the Geist and the Gumuet)
3. Occupation,
4. Lifestyle and habits,
5. Civic and domestic relationships (relationship outside and inside the home)
6. Age,
7. Sexual function."

First of all, Hahnemann wrote that "it will help the physician TO BRING ABOUT A CURE" if the study the complete case history of a chronic disease includes acute and chronic causation, acute and chronic miasms as well as the observable BODILY CONSTITUTION (especially when the disease is chronic) and the mental and emotional CHARACTER. Hahnemann use of this ter character shows that he was speaking of much more than the random recording of the emotional symptoms. Character relates to total personality, the emotional and intellectual make up, and the innate disposition.
This quote clearly shows that in chronic disease one is to assess all the observable facts about the nature of the physical constitution and psychological character. On this basis he recommends a complete study of the occupation factors, lifestyle, habits, civic and domestic relationships, factors related to age and sexual function. All of these areas are influenced by the nature of the physical constitution and mental character. How a person lives, what their habits are, what their lifestyles is like, and how they relate to family and society are all conditioned by the innate constitution and temperament.

Some might try to say that the physical constitution and mental temperament are to be ignored in case taking but Hahnemann clearly says that this information is important in bringing "ABOUT A CURE". He notes that the assessment of the physical constitution is "especially" important when treating "protracted cases". When these areas provide objective signs and subjective symptoms that are characteristic they may help in the selection of a remedy. The make up of the innate body and mind is related to innate predispositions and inheritance as well as acquired conditions.
In most places Hahnemann uses the German word, Beschaffenheit, which means the "make up" of the body and mind. 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 condition, quality or circumstance related to the physical constitution and mental temperament. This show how the term was used in Hahnemann’s lifetime. The homeopathic usage is related directly to the practice of medicine not the common usage of a lay person. Modern German may not clearly convey this meaning.

Hahnemann wrote that the physical constitution of a person and their "HEREDITARY DISPOSITIONS", habits, lifestyle, turn of mind, morality, education as well as diet are the major conditioning factors in the development of the symptoms of miasms and chronic diseases. He Hahnemann used the Latin rooted word "konstitutionen" showing he meant the constitution in a traditional medical sense. Vide the Chronic Diseases, Theoretical part, page 102, BJain).
"The awakening of the internal Psora which has hitherto slumbered and been latent, and as it were, kept bound by a good bodily constitution and favorable external circumstances, as well as it breaking out into more serious ailments and maladies, is announced by the increase of the symptoms given above as indicating the slumbering Psora, and also by a numberless multitude of various other signs and complaints. These are varied according to the difference in the bodily constitution of a man, his *hereditary disposition*, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc."

In the Organon the Hahnemann used the term "angebornen Korper-constituitionen" (the congenital bodily constitution §81). Once again he is speaking of the genetic constitution. He notes the great variability of the congenital constitutions and how the congenial constitution customizes the symptoms of the psora. It is the inherited constitution and its interplay with the environment that conditions the signs and symptoms. This shows an important reason for understanding the make up of the constitution and temperament and inherited predispositions in medical sciences. Knowledge of such areas make one a better homeopath. Hahnemann also spoke of the inherited psora in the footnote to aphorism 78 in the 6th Organon. Hahnemann’s belief in the importance of inherited psora was also confirmed in a letter he wrote Boenninghausen in 1840.
"These 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."
Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), footnote, Aphorism 78.

Hahnemann was also well aware of the nature of the Greek classical temperaments (e.g. choleric, phlegmatic, sanguine, melancholic) and diathetic constitutions and referred to them in the Materia Medica Pura and the Chronic Diseases, as well as in the Paris casebooks. This was because it was part of his overall biomedical view. This is not surprising as it is the oldest tradition in Western Medicine. In the the Materia Medica Pura Hahnemann wrote:
"The homœopathic 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 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 TEMPERAMENT; 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.
Materia Medica Pura; S. Hahnemann, Volume II, Pulsatilla, page 345.

The above portrait includes the psychological state of the patient in the state of health as well as the changes brought on by the alterations of disease. Hahnemann’s symptoms include the qualities of the natural temperament (timid lachrymose disposition, slow phlegmatic temperament); positive moods (good tempered, mild, good humouredly waggish), and negative emotions (inward grief, silent peevishness). Rima Handley noted that Hahnemann called M. Le Comte de Quelin a choleric, and described Mme de la Nois as having a sanguine temperament. There are several references to patients a "melancholics". Hahnemann’s discussions of constitution and temperament lead to the use of the characteristic rubric "Well adapted to".
Constantine Hering followed up on this hint and included many redline symptoms about constitution and temperament in his Guiding Symptoms in the chapter called Constitution and Stages of Life. For example, Hering wrote that Nux Vomica is well adapted to "Nervous, melancholic people, troubled with indigestion, venous constitution, with tendency to hemorrhoids." and "Suits thin, irritable, choleric persons with dark hair, who make great mental exertion or lead a sedentary life." One only needs to review the symptoms of Nux Vomica in the materia medica to witness a great number of symptoms related to the bilious humor and choleric temperament as well as the atribilious humor and the melancholic temperament. All of these symptoms relate to Mappa Mundi and the earth and air element and their mixtures. This is only one example of many in the materia medica.

One embittered critic claimed that Hahnemann they looked through all of Casebook DF-5 (1837-1842) and could not find any mention of diathetic constitutions or classical temperaments. The truth is that they conveniently ignored that fact that Hahnemann referred to Elaine Christille, age 3, has having a "scrofulous disposition" (DF-5 page 397) and to Mr. Everest as "melancholic" (DF-5 page 296). There are more of these types of references throughout the Paris casebooks (1935-1843). When one is blinded by their prejudices they will see nothing in all of this!
Like the physical constitution, Hahnemann noted that the classical temperaments conditioned the nature of the signs and symptoms that were produced after the suppression of Psora. For this reason, he included the observations of "the experienced and honest" Dr. Junker in the made text of the Chronic Diseases ((Theoretical Part), Nature of Chronic Diseases, page 47-49.)
"A brief survey of the manifold misfortunes resulting thence is given by the experienced and honest LUDWIG CHRISTIAN JUNCKER in his Dissertatio 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 hemoptysis. 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)."

As we can see the innate constitution and temperament are the chief conditioning factors in the development of the signs and symptoms. The suppression of psora and the miasms in the four temperaments tends to follow particular pathways of disease. Therefore, knowledge of constitution and temperament offers insights in to the sensitivity of the patient, their predispositions, the pathways of disease, and the nature of the objective signs, coincidental befallments and subjective symptoms. Therefore, the better on understand the predisposition of the physical constitution and mental temperament, the better the are able to prescribe a remedy and manage the case as treatment progresses.
I hope some of my colleagues find this area of discussion interesting.

Sincerely, David Little