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Female Patient

Presenting Symptoms

Sciatica during pregnancy (28 weeks)

-         can’t deal with it

-         can’t roll over in bed

-         left hip extending to ankle

-         pain        – grabs – can’t move and can’t handle not moving

- must stop whatever she is doing

– must move into a less painful position

– pain catches you

- < having an argument with husband

Issues       - money as husband is very money oriented

- feels like she wants to run away

- always been a bit of a runner

Freedom    - always been a big issue

- go wandering on her own all the time

– wanted to go travelling

– been engaged three times before being married

– being her own boss

– do what she wants to do when she wants to do it

– doesn’t want to feel trapped

– has moved house a lot

– now she feels stuck

Has a short fuse – she counts to 3 instead of 10 when waiting for the children to do something.

Wants things done now or she smacks them.

Stuck with position (work), with family.

Feels she has more to do than her job.

Has her own car – has her freedom.

Pregnancy is a way of escaping from her job, but at the end of a pregnancy she goes stir-crazy because she cannot move, cannot do what she wants.

Husband is not very affectionate, so if she withdraws it there is none in the relationship.

Husband runs her down – she always gives in to him, always the peacemaker.

Inability to decide what she wants to do.

Feels she must do something really important with this life.

Feels she is running out of time, that the world is running out of time.

Feels she is wasting this life – has always achieved things before.

Something important is raising peoples’ consciousness, more tolerance, giving with your heart, leading by example, showing people a better way of living, making changes in someone else’s life.

She had a goal since childhood to be the first female prime minister, but she feels politics is full of lies and deceptions. ‘

She actually ran for public office once, put her heart and soul into it, but realised that in politics you have to compromise.

When she is angry, she slams doors, breaks into tears, gets really heated, rants and raves.

She expresses herself better when angry.

She is able to achieve her goals when angry, gets really focussed – “I’ll show them” attitude.

Pain - grabs really tight

-         feels like it will break

-         grasping, as if someone grabbed your arm really tight

-         spasmodic

Analysis:

Sensation (physical) is one of being grabbed, as if a hand had grabbed her.

Sensation (non-physical) is one of being stuck in her life, of being less than she could be (smaller).

Her reactions to this sensation are to feel caught (passive) and to want to get free (active), to keep moving , to be bigger than she is.

This leads us to the Cactaceae (cactus) family.

Miasm is represented by the desire to run, the need for freedom, the feeling of being trapped, the desire to travel, the desire to go wandering, and most importantly the feeling that she is running out of time.

This leads us to the Tubercular miasm.

The remedy that lies at the connecting point between the Cactaceae family and the Tubercular miasm is Cereus Bonplandii.

One of the key mental characteristics of Cer-b is the desire to be useful.

Quotes taken from a case by Dr. S. King:

“...doing big important political work.”

“ I want to make a contribution to something bigger than myself.”

“It is easier to devote myself to a group, to be a visionary, to do what is needed. Big and important things, useful things, relating to a community outside myself. “

Prescription = Cer-b 200, 10 drops once only.

Reaction: No noticeable aggravation. Almost completely pain free. Whole life has turned around. Feeling much better in herself. Much more positive attitude to life. Doesn’t feel trapped anymore. Work has turned around – several people suddenly joined her group which has made it easier and more financially viable. She has been considering studying natural therapies for awhile now, but could not decide which one. She wants to study homoeopathy, as she cannot believe how easy and effective it is.

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Replies to This Discussion

Hans, I do not understand what  you are doing. The patient was cured, but you are apparantly trying to prove that I did not cure her. Why are you doing this?

You do not know what any other remedy would do. I know what Cer-b did. All of this is just theorizing. It could have been Cimic, it could have been Sepia, it could have been any other number of remedies. But the FACT of the matter is that I gave Cer-b and it cured the patient with no relapse and no other symptoms or diseases arising. The improvement remained for several years without needing further management. I know what cure is, I use Hering's Law constantly in practice to ensure that any reaction to treatment is actually curative.

What does Hahnemann say about cure? That is generally the benchmark I use. Your assertions that I actually suppressed the case seem based on nothing but pure speculation considering you do not know the patient nor did you see them. I could also speculate that your remedy choices would have been partial similars or mere palliatives. Considering that I know what actually happened when I gave Cer-b, I would have more justification for making such statements than you do.

The Tubercular miasm is well established in homoeopathy now - I do not believe I have to justify its use in practice.

I made sure that I reread the sections in Spirit of Homoeopathy before I posted a reply here. He does not say Delusion is the core of a case. He says it is the core of the mental state. He is very clear about that. He is also clear that disease comes from the derangement of the vital energy which he calls the Central Disturbance. The Core Delusion refers only to the mental symptoms, which are only part of the totality (albeit an important part).

So I think that we could argue endlessly about what have might have been, but the patient was cured and no argument is going to change that one particularly relevent fact. We all know that it is possible to cure a case with more than one medicine, that the simillimum is actually a sliding scale, a measurement, rather than a single concrete thing. Anyone who has been in practice for long enough discovers that.

Could other remedies have brought her to the same point?  I cannot say nor can you.

 

Dear David, dear members

Before continuing this debate, I want to clarify the following:

this is a debate about a case and not about Persons, their attitudes and personal believes.

Arising personal issues during this debate will be dealt with in privat.

I see this discussion as a brilliant opportunity to take on the viewpoint of various methods and then analysing the case ie.  finding a remedy, which according to the method is curative.

All these methods including Davids own have in common to call themselves homeopathic and claim, that they lead to the selection of curative remedy, some even to finding a "simillimum".

Thanks for the clarifications regarding Sankaran's teachings of the 90' and early 2000'. As I was quite involved with his method at the time directly and indirectly, I stand by my view, that he took the central delusion as the cause of disease, which he saw then as the creator of the central disturbance, which in turn expresses itself in signs and symptoms on the outside.

In the "Spirit of homeopathy" he wrote, that if it becomes clear what the central delusion a case can be cured without a homeopathic remedy, only by telling the patient this delusion. He goes on to say, that in the bible Jesus in a way did nothing else when curing people.  I am sure you are aware of these lines.

Classical homeopathy, uses the term miasm as well established by Hahnemann. Of particular interest forthe classical homeopath are the CHRONIC miasms.

\org.: 78 - 82,204et al. including foot notes should be consulted here as well as the theoretical part of the chronic diseases. 

It is noteworthy, that all relevant symptoms of the so called Tuberculinic miasm are found in the lists of latent and active PSORA.

Hering already theorized on a fourth (tubercular) miasm, but soon found out (after translating the CD), that it actually does not exist as a separate entity.

However with Allen's book Psora and pseudo Psora, the door was opened for insulating more that the 3 already known chronic miasms. The majority of homeopaths in the classical era stuck to the3 miasms discovered by Hahnemann.

Hering’s law of cure occur only when suppression is present, when no suppression, it is not necessary that symptoms disappear according hering’s law of cure, this case is absolutely cure, because it justifies according to knowledge of Organon of medicine. The patient’s well being feeling on spiritual level indicates that cure is genuine.  

We could say, that this is dr. Habib Khan's view, but most other classical homeopaths hold onto Herings law.

Hering's law is universal according classical Homeopathy, and applies to every case.

As for the particular system of miasmatic classification you use, I prefer to use something that is of more practical use. Miasmatic theory has two basic functions. Firstly, it provides a justification for why we explore cases in such detail and develop pictures of disease based on more than just the immediate manifestation. Miasm is a deeper understanding of totality, perceiving disease as not just what we see right now, but an evolution of disease requiring the element of time or history to be added to our analysis. It is not just what we see in the present that matters, but what has happened to a patient over the lifetime of their disease.

 

In order for us to be able to deal with this chronic manifestation, we need to be able to see medicines in the same way (in order to match them to the patient). Miasmatic classification therefore serves a second function, to allow us to catagorize medicines according to their miasmatic (chronic, historical, lifetime) similarity. Obviously, the perception of miasms did not come from provings. It came from experience with patients with chronic disease. It was a theory developed from clinical situations, and it is in clinical situations that it continues to be refined. There is a great deal more clinical data available to us than there was a century or two ago. That clinical data has been used to further define and classify the chronic patterns that have been observed amongst the sick.

Too many patients were being described as 'syco-syphilitic' or 'syco-psoric' and so on for a system based on three catagories to remain useful to us. Such a limited set of catagories also became more unwieldly the more remedies that were added to our materia medica.

Would Hahnemann or some of the older homoeopathic masters stuck to 3 catagories were they privy to another 100 years worth of clinical data and provings? Personally I don't believe so, and obviously the trend amongst homoeopaths has been to look to expand the system to give more precision to our prescriptions. However, as a system of classification for the purpose of selecting a medicine, it is a tool made by men for the use of men, rather than some kind of universal truth. It is practical, and as such can be utilized in a variety of forms, depending on the skill or needs of the practitioner. I use the 10 miasm system because it allows me to catagorize remedies into smaller groups, whereas a 3 miasm system provides far less direction in deciding on a medicine. In fact, a miasmatic classification system that places medicines in all 3 catagories seems to provide little practical help to a practitioner, and anything that does not help us to prescribe is useless at best, confusing and obstructive at its worst.

The number of miasms used to classify chronic patterns, and to classify medicines, does not undermine the original theory of chronic disease. Therefore whichever system you use, be it 3, 5, 10 or 0 miasms, remains part of the preferred case-taking method of the practitioner, and so is part of the 'art'.

And lastly, in response to Dr. Khan's comment about Hering's Law, I have to agree with him. My experience with Direction of Cure/Direction of Disease is that you do not need to see old symptoms returning when there has been no suppression, little pathology (tissue change), or a simple progression of illness. You will definitely see it in the opposite situations - where there has been a lot of suppression and palliation, where the disease has manifested significant physical changes to the body, and where the disease has been long-standing and has evolved through different phases which can be clearly differentiated.

The vital force will use the least amount of energy necessary to correct the imbalance. It will only create old symptoms when it is necessary to do so. It does not do so because it is a law of nature (like gravity). The law the vital energy obeys is one of conservation. It uses only what it must to create the change it needs to come back into a healthy state. If this can be done without recreating the entire historical complex of symptoms and diseases, it will do so. This is most likely to occur when the disease is primarily functional and least likely to occur when the disease is altered the very structure of the body.

I see Direction of Cure in a large number of my patients, but in some, those with good vitality and with less complex diseases, you simply see aggravation and then improvement, much as you would in genuine acute illnesses.

Dear David

BTW. personally I don't use any miasmatic classification.

I am not a classical homeopath and don't follow any method which emphasizes on one part of the case and at the same time disregarding the other.

For further reference see my paper on MIASM:

http://www.facebook.com/groups/302151859854069/doc/356307011105220/

Hans,

Dr. Sankaran never said that delusion causes disease. That is a misunderstanding. He only ever said that the mental state was usually of primary consideration in selecting the remedy, which reinforced the attitude that Hahnemann expressed in the Organon. I suggest you reread those sections in Spirit of Homoeopathy where he talks about the Vital Energy causing disease, and the creation of symptoms through the PNEI axis which he considered the control system of the vital energy (not the other way around). Unfortunately, it is a common misconception. The PNEI axis consists of three components which are not mental but physical/general. The axis is considered the means by which the vital force manages the health of the organism. The Psyche is only one element of the axis.

I have attended many seminars by Dr. Sankaran and his colleagues. This is the correct interpretation of their work as clearly stated by them. The sections of his book where he talks about delusion are referring to the mental state, not the entire state.

When he talks about curing the mental state leading to a cure of the general state, he is talking about the weight we give to those symptoms. He says that even if use the peculiar mental and general state (symptoms) of the patient to prescribe, it is much more likely to cure the physical particulars in the case even if they are not directly covered by the remedy. He says that it is much less likely to cure if you approach the case from the other way around, even if they particulars are peculiar. Again this is an echo of the attitude expressed by Hahnemann.

The idea that the entire disease complex arises from a single or central delusion is a misunderstanding. The concepts discussed in his books can be summarised in the following way, which should make it clearer.

Disease arises from a disturbance in the vital force. The vital force alters the PNEI axis, which in turns creates the mental, general and particular symptoms. The Psyche specifically affects the mental state. The mental state can be distilled down to a central or core delusion, out of which the specific mental symptoms arise. The other general symptoms will arise out of the interplay of the other elements of the axis (including psychological).

When choosing a remedy, the chance of curing a patient rises in relation to how closely its picture matches the deepest level of disturbance. The closer it matches the vital disturbance itself, the more likely it is to cure. Matching a remedy to the particulars is less likely to cure, as it is a long distance from the vital disturbance. Matching a remedy to the general symptoms is more likely to cure as that distance has now been shortened. Matching a remedy to the state of the PNEI axis is again more likely to cure, as the axis creates those general symptoms. The axis can be equated to the idea of 'state' (the larger picture formed by the symptoms). In regards to to the axis itself, the Psychological aspect has particular weight, because it is more likely to show the peculiarity of the vital disturbance. If the remedy covers the mental state, the chance of cure of the whole state is greater than if you weight the physical state.

The misunderstanding seems to have come from the weighting of the mental state. Its importance does not suggest causation, but its natural quality towards peculiarity and individualisation (by its nature the mind is a more individual and unique part of a human being, than the physical body whose features we all tend to share).

Recent work done by Dr. Sankaran and the Mumbai group has been to find ways to perceive deeper than the PNEI axis, to attempt to perceive the vital disturbance itself. This has caused controversy (use of source language, use of gestures and body language etc) and understandibly so.

It is important to note that Hering's 'law' was only an observation. It is not a law like Similarity is. As such, observations change over time with more observation, and they also change according to the situation (according to what is being observed or to the environment in which it is being observed). Direction of Cure is a guideline for us, to keep us from making the same mistakes that the allopaths make. However the patient themselves are the main determination on how we are going to see that direction appear during treatment.

It has been observed that rather than all symptoms appearing in reverse order of appearance, you will often only see some symptoms. My experience, which again aligns with what Dr. Khan has said, is that it is generally the symptoms that were suppressed or otherwise mistreated that will reappear. The order they reoccur in may also tend to be based on how damaging such suppression was to the organism, with the most damaging appearing first. Where the current disease/symptom complex was a direct result of suppression, the suppressed symptoms will reappear first and often quite quickly (and with force).

This may mean that 'reverse' order may actually not be strict order of historical appearance, but in order of historical importance to the health of the organism.

There is also another consideration. The vital force will always prioritize survival over anything else. This means that if a strict adherence to a 'reverse order' will recreate a disease or set of symptoms in a location or organ that would jeopardise the survival of the organism, then it will not do so. Hering's law cannot conflict with the natural law of survival. If a patient had a heart attack in the past, or a stroke, or suffered failure of some other organ, it will not be recreated at all since to do so may kill or otherwise severely damage the organism.

This basic principle of survival also means that any reoccurance will tend to be in the least dangerous location it is possible for the vital force to utilize to rebalance health. If a vital organ is weak, rather than recreate a set of symptoms there, it will seek a less dangerous outlet (which might be painful but should not compromise the survival of the patient). The observation that symptoms move from within to without (from more important/dangerous to less important/dangerous) is the most frequently observed aspect of Hering's law since this is in most accord with the natural law of cure. It has also been for me the most reliable guideline, but requires a good understanding of the hierarchy of organs and locations in the body.

I rarely see 'top to bottom' in any process of cure, except in very localized ways (top of the leg to bottom of the leg), as the vital force will actually move any imbalance immediately to the safest location it can. A patient with pathology in the heart for example may see symptoms move to the mucous membranes of the throat or mouth for example, as this ensures a safe process of cure since those locations are less dangerous.

I have however seen occasional almost perfect parades of symptoms coming and going in the order they originally appeared in. This has been unusual and I do not see any better level of cure from it happening. Patients who have not had this happen have still remained symptom-free and in a good state mentally, spiritually, generally, for up to 10 years or longer after  treatment. In fact they have been in as good health as the patients who had this strict 'reverse order' reaction.

 

On Sankarans thinking / method etc. we have to agree to disagree for the moment, as it may well be, that he changed his views within the past 10 years.  I haven't been following developments closely, so future will tell.  I will keep your explanation in mind.

Herings law:

My paper explains the matter:

http://www.facebook.com/groups/302151859854069/doc/323068067762448/

Dear David, dear members

CONCLUSION:

This fruitful discussion brought out a few points:

1) There are several distinctly different methods of selecting a remedy popular in homeopathic circles.

2) Each method focuses on some aspects of the case.

3) Each method shown relies on some sort of diagnosis, be it of a miasmatic kind, kingdom kind any other kind, or a combination of them for the selection of the remedy

4) Each method arrives at a remedy, which makes sense in the context of the chosen method.

5) Each method favours a different remedy

From above we can see, that it is not the patient, his/her symptoms which determine the remedy but rather the choice of method applied in the given case.

All above methods also have in common, that they don’t fulfill all the requirements set out in the Organon. Here is not the place to discuss this in detail. I have already shown these points in detail many times over the past 10 years.

I want to leave it with an concise instruction directly drawn from the Organon:

Hahnemann treated diseases, not the patient!

 

In case taking all information is taken in , but only some of it used for the determination of the now needed remedy.

 

This is the full picture.

 

This full picture contains the disease-symptom-picture.

left out of this disease-symptom-picture are the following:

 

  1. Things falling under par.:5 Org are left aside.
  2. Things which happened in the past but are not present are left aside
  3. constitutional signs, temperament, personality, normal habits.

 

The most ailing problem has to be looked after first, others can be left to a later stage.

 

By this process we arrive at the HERE and NOW.

This HERE and NOW is our disease-symptom-picture (DSP) which forms the basis of our prescription.

 

From this all what is common to the type of disease is put to one side, all what is uncommon, singular individual to this case of disease to the other side (par.: 153) including the moods (211)

 

These individual singular peculiar symptoms of this individual case are to be taken into consideration first. This is the individualized DSP.

 

This brings us to a very concise list of momenta / elements for which we have to find a remedy having those very momenta in characteristic and even Cure-combinable manner and in similitude

Hans, for the most party I am in agreement with what you have said above. While I do include a history of the disease when tackling chronic cases, the presenting symptoms form the focus for the exploration and in fact should form the 'core' shape of the disease. I also believe that including things which are not obviously disease (the personality of the patient for example) is likely to steer the practitioner in the wrong direction. It is a serious problem when a homoeopath cannot tell what is to be cured in disease. I believe there has been a great deal of confusion over what is disease and what is not, amongst practitioners, amongst lay persons, and this has resulted in some very strange forms of analysis and treatment to arise. During my time as a lecturer in homoeopathy, one of the most common misconceptions students presented with in their first year was this idea that homoeopathic prescribing was like astrology - all these positive or neutral character traits were part of the picture used to prescribe remedies.

I also would like to say that I appreciate being able to debate issues of philosophy, method, cure etc with someone who clearly is an able thinker and obviously knows what he is talking about (not always my experience when involved in discussions about homoeopathy on internet forums). As such I would like to state that while we might differ over some things, I very much respect your ideas and experience.

However, did not Hahnemann state in the Organon that when prescribing for chronic disease it is often necessary to establish the history of the illness, that you will not be able to get a proper picture of the the true and complete shape of the disease from just the one consultation, and that in fact if you treat only what you see without looking at the history of the patient's disease you will not be able to cure the chronic tendency to relapse? I don't have my Organon with me today so I cannot quote specifically where he says this so I would have to reread those sections to see exactly what he says. I do remember him mentioning disease that has been complicated by allopathic treatment (suppression) which requires going back to the original symptoms present before the treatment was started.These symptoms may now only be historical, as they have been replaced by new symptoms either as a result of the disease evolved or because they were directly suppressed. I believe Hahnemann developed his theory of chronic disease in response to the fact that he observed in his own patients, that when he only treated what he saw (current symptoms only) that such patients would return with new diseases, more serious diseases, or the same disease often in a worse form.

 

 In my practice, such allopathic suppression is practically the norm now so I see a lot of complicated disease. I have found Hahnemann's advice (along with Kent and other old masters) to go back through the case to find the symptoms of the natural or original disease to be quite valuable in sorting out such situations.

I think that it is important, if you are going to use historical information, to concentrate on tracing the picture of the disease over time, and not just include all the different events that might happen to a person during their lifetime. How anyone could make sense of so much information without concentrating on the disease is beyond me. If you include this kind of information, remain focused on the disease. Use the presenting complaint as the window through which you perceive its evolution, and do not become distracted by all the other incidents any person's life might contain.

 

 

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