Published in Advent of Homoeopathy ( Dec 2006)
We frequently speak of constitution & of constitutional remedies. Yet, when we ask ourselves what constitution actually is we find we are at a loss for an answer. Inspite of referring number of books & articles of the great Homoeopaths, this term constitutional is not yet cleared. How can a differentiation be made between what is constitutional & 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 & given a practical & useful role in medicine? How does it relate to concepts such as susceptibility, symptom totality, miasmatic inheritance & distinctions such as those between common & characteristic symptoms? And so on……
So, let’s try to understand the term ‘Constitution.’
According to Stuart Close, “Constitution is that aggregate of hereditary characters, influenced more or less by environment, which determines the individual’s reaction, successful or unsuccessful, to the stress of environment.”
Dr. Kent says, “Physical constitution is the external disorder following disorder in the man, the vital force.”
'Constitutional' - in homoeopathy this term is often used with various meanings. Hahnemann used the word 'constitution' only once in the 81st aphorism in the 6th edition of German Organon, though he already used the word here and there in his writings. Hahnemann writings demonstrate the importance of the congenital physical constitution (inheritance) to predisposition and diathesis. The individual constitution and temperament are that which individualize the symptoms syndromes of the chronic miasms. In the Chronic Diseases again he speaks about how Psora can produce so many different signs and symptoms in different individuals. He points out that the individualizing factor is the bodily constitution, psychology, and hereditary dispositions as well as the mode of living, environment, etc. Hahnemann includes both inheritance (nature) and environment (nurture) in his pathological theory. Vide page 102 of The Chronic Diseases.
Interpretation of the term Constitution
In homoeopathy, 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 & 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 & 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 & also the potential to manifest.
So, the constitutional remedy is a picture of the sum total of the strengths & weaknesses of the person, mentally, emotionally & physically.
Jahr says that the choice of the right remedy is the most difficult in chronic diseases. Not only because there are often only few symptoms, but also because the symptoms that should determine the choice of the remedy are often not presented to the eye of the observer. One of the reasons is that
"here, because of the origin of the disease in an acquired or inherited diathesis, they are often so intimately amalgamated with the individual constitution of the patient that he doesn't even think of communicating the constitutional anomalies, which he doesn't often even consider as pathologic, to the doctor."
This, Jahr concludes, is the reason, that homoeopaths weren't able to select the remedy in chronic diseases like gout, asthma, epilepsy etc. according to the pathogenetic signs, but simply gave remedies according to their confirmed good results in such diseases, more or less in a way of trial and error.
When these remedies - which seemed preferable by their pathognomic symptoms - failed the question arose 'what to do' next. Jahr states that Hahnemann himself had been in similar doubts and consequently developed the theory of the chronic diseases - these being only symptoms of one basic diathesis. Hahnemann then searched for remedies that were able to produce not all, but at least many symptoms which are usually produced in chronic diseases. These remedies, according to Jahr, are marked by a lot of single, not very characteristic symptoms, which are similar to the single constitutional signs of chronic patients - and which can only be regarded as essential, but not characteristic symptoms. In every individual, he says, all single morbid appearances, physiologic and organic anomalies are characteristic signs for this constitution. Likewise, in antipsoric remedies of long duration the essential signs can be regarded as characteristic, when they appear several times in different provers.
But what I feel is that the SUPPRESSION OF SYMPTOMS is the main factor which is not allowing us to understand the typical constitution & thereby the main reason behind our failure to treat a patient as a whole. If symptoms are suppressed, how are we to get clear homoeopathic pictures?
This is a very important point especially in this modern world of suppression. Suppression is going on all over the world. Physical, emotional, and iatrogenic suppression. The symptoms are being driven inside. There are fewer expressions of symptoms. So, constitution and temperament (gestures and postures of each person) gives an unadulterated picture of the disease. In this present world there are many emotional suppression, disappointments, grieves, broken relationships. Even if a person says, "I have a strong craving for sugar, but I know sugar is not good for health and there are a lot of cookies on the table and I would like to have it but I won't." This is also a suppression of emotion. The iatrogenic suppression comes from drugs: steroids, antibiotics, cortisone and vaccinations. Also there can be suppression from homeopathic remedies from repeated use, too frequent use, polypharmacy, too many homeopathics etc.
The suppression is day by day increasing. In Hahnemann's Organon, section 173, he writes, "The only diseases that seem to have but few symptoms, and on that account to be less amenable to cure, are those which may be termed one-sided, because they display only one or two principal symptoms which obscure almost all the others. They belong chiefly to the class of chronic diseases." As a result of suppression, the symptoms are being driven inside and if the symptoms are not present on the surface, how can you make a totality of the individual. These days we see more and more of one sided symptoms- insomnia, anorexia, chronic fatigue syndrome, anxiety neurosis, etc. The symptoms are a result of suppression. They can be physical, emotional or iatrogenic (drugs and vaccinations).
We will have to first deal with SUPPRESSION OF SYMPTOMS and then the MIASMIC TAINT. A miasm can produce a number of diathesis 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 which rules the warm/moist blood humour and the TB miasm both have a easy tendency to bleed. Such knowledge forms the basis of the homeopathic view of constitution, temperament, susceptibility, miasms and diathesis. When symptoms are suppressed then Hahnemann said we have to look for the "reaction of the person to the disease." The reaction is through the gestures and postures.
A homoeopathic consultation starts his consultation with the moment a person enters in a homoeopath's consulting room. All it starts with the way a person looks, how he / she enters in the consulting room.
What is the significance? When any remedy is prescribed on the basis of the constitution of a person it cures the ailment permanently. In homoeopathy the remedies are based on behavioral pattern of the person. If you study in depth the symptoms of homoeopathic remedies then you will find as if you are getting your self introduced a new person. When a person grows up develops unique appearance looks, thinking process, different than others. When a person faces a stressful situation then the responses differ from person to person.
As well the physical appearances do matter along with mental make up of the person. The moment a right constitutional remedy is prescribed most of the clinical conditions responds to it. A remedy can be defined as constitutional when - by virtue of its symptomatology - it covers the basic chronic or acute symptomatology of the person throughout his life; in spite of the fact that such a person may suffer, in different stages of his life, from different nosological entities like otitis media, lumbago, sciatica, bronchitis, or psoriasis, the indicated remedy remains always the same. Every remedy has some basic characteristic symptoms in its mental emotional and physical pathology and if these characteristics are observed in the patient we tend to say that this is the constitutional remedy of such a patient. So a constitutional remedy is one that will actually prevent the pathology from manifesting.
Many fine prescribers claim that their grasp of a similar remedy is intuitive, but probably in addition to a sixth sense, they are using a vast unconscious store of wisdom and information and experience. The editing of our case taking is perhaps the most important point in homoeopathy: to be able to sense what Germaine is, what is primordial and what is poignant in a case.
The Homoeopath who is worthy of the name knows that only by being an artist can you arrive at exactitude. To give Bryonia for pneumonia, Rhus-tox for rheumatism, Sulphur for eczema or Nux for indigestion, is not really homoeopathy. The more exact the similarity between the patient's symptoms and the single remedy given, the fuller and more salient the totality of the symptoms elicited, the more swift and brilliant the cure because of the precision of the prescription.
The secret precision is in individualization and not in trying to put the parts in place of the whole. As is well said, "Perfection in its finality is not when nothing can be added, but when nothing can be taken away."
Hence, to conclude, 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 & experience upto that point have produced, by implication, includes 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.