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Without pathology there is no therapeutics - A Critique of Classical Homeopathy

Without pathology there is no therapeutics
(A critique of classical Homeopathy)

Dr. M. A. Usmani

Usmani Resource Page

Copyright 2011-15/All rights reserved © Dr Usmani 
Contact author for permission to use


A patient comes to you with the presenting complaint of bloody expectoration in morning only; and no such thing at any other time of the day. He has no cough, no fever and no pain in throat or chest, or anywhere. No alteration in any routine of life. No anorexia and no bad taste. He is normal in every sphere of his body and health. No preceding complaints, nor following and no concomitants. And he is as enthusiastic to work as ever. Throat examination revealed nothing. He is, in fact, my old friend. I know that his sister died of T.B. Acalypha Indica was prescribed and after 10 days, when he came to report, he was totally o.k. His symptom had gone since the fourth day of the medicine.

The moral question that arose in my mind was: ‘should I feel complacent, as a classical homeopath, as to his health, as having wiped away the symptoms, and declare him cured, or should I go for a full laboratory checkup of the patient?’ This is a crucial question. As far as classical homeopathy is concerned he is cured. According to the edict when all the symptoms of the patient disappear under a prescription and he is left with nothing to complaint for, there is no disease left in the patient. That is he is ‘CURED’, homeopathically speaking.

This is how I say that classical homeopathy discourages knowledge.

What is knowledge here? This is the science of Pathology, along with the stupendous advancements in all medical fields, including the laboratory techniques. Modern science says: Only after the determination of the pathology comes the treatment. But the saying of the classical homeopath, classically expressed is: ‘what you are suffering from is no concern of mine and what I’m prescribing to you is no concern of yours.’ This is a pet dictum of a classical homeopath, deeply influencing his attitude towards diseases.

‘Classical homeopathy’ is defined as the homeopathy before the advent of the Theory of Miasms. Why did Hahnemann invent this theory? He had a bitter realization that the cases treated on the basis of the Law of similar did get help and were relieved, but their relief was not permanent. The ailment did appeared times and again, in the same form or somewhat transmuted. This discontent brought him the realization that what was ‘cured’ under the law of similia was something superfluous, and not the real disease. The unmitigated disease could reappear in any garb and in any other organ or system of the body. That is, the patient, in reality, was not ‘cured’. Such realization was the dawn of the ‘Theory of the Miasm’, and, with it, the place for Pathology in the body of homeo-therpeutic was solemnized. But, historically speaking, when the realization of the place of pathology came the way of homeopathy, the territory of pathology was already fully occupied by the dominant school. Pathology and the pathologic sciences and the diagnostic methodologies and techniques have grown so vast that encompassing them is a Herculean task.

Envy those days when homeo-therapeutic was so simple as  after taking a detailed case, the whole matter of therapeutic boiled down to a sedulous symptom matching—brainlessly and non-methodically—and patting your back if you have discovered a medicine that covers or matches the maximum number of  the jumble of  symptoms. Such a medicine is elatedly called the similimum. Now Acalypha has proved to be such an one, but the matter is still lurking as dubious. Conscience is muddy as to the real status of the cure. The patient must be medically checked up in full detail to wipe out all sorts of suspicions. May it not be needed or done immediately now.  It can be postponed for few weeks, or months, or a year or after more than a year. If the disease is still there it will definitely show up in a marked manner in future. If the Acalypha has not cleared the miasm, the symptom will recur, with more vigor and insistence, for the disease was not cured in the first instance. Matter will be decided after detailed pathological tests.

Without checking for the possible pathology a case cannot be decided. Sound knowledge of the science of Pathology is primary and fundamental for any system of therapeutic worth the name. Historically most of the great luminaries of homeopathy were professionally MD’s, before converting to this new therapeutics. So they were fully conversant with the science of pathology of their times and age. But, after becoming homeopaths, they could not keep pace with the advancements of medical sciences, especially the researches in pathology, micro-biology, histology, histo-pathology, patho-physiology etc.,etc. They felt contented with what they had. They could practice without bothering about pathology.  Most of them relinquished their passion for pathology; they got so enamored of the bewitchment of the new system of medicine. But there remained quite few who never lost the sight of the logical importance of new researches and findings in the whole medical sciences. Among them we can count Cowperthwaite. His Textbook of Materia Medica and Therapeutics is a classical monument. He divided, in three parts, every description of a medicine: viz. General Analysis, in which he determines the organ affinity of the drug, and its mode and sequence of action; then the normal schematic materia medica entries of the remedy, and the third part on Therapeutic, which is, in reality, the clinical scope of the remedy. Let me quote, from him, as an illustration. Under ACONITUM he tells us, under the heading of  General Analysis:

            “Predominantly it acts on cerebro-spinal nervous system producing an exalted activity in the arterial circulation…giving congestion and inflammation of brain, spinal cord and mucous membranes…secondarily it paralyses their function and impairs the reflex response of the spinal cord… It does not produce any organic changes, its power being only functional; it is frequently useful in the course of organic diseases of the heart and other organs, for the removal or palliation of symptoms.” Under the last section, I mean the Therapeutics he mentions: “inflammatory fevers, bronchitis, pneumonia, pleurisy, all respiratory catarrhs, meningitis, rheumatism, pericarditis, endocarditis, angina pectoris, miliary fevers, measles, conjunctivitis, neuralgia, convulsions, etc., etc. “

Similarly Dr. Clarke, in his Magnus Opus: A Dictionary of Practical Materia Medica, gives a list of pathological complaints, under the title of Clinical. He also authored a separate treatise, viz. Clinical Dictionary.

Dr. William Boericke is another authority who always gives a terse account of the patho-physiological action of every remedy before laying down the schema in his ubiquitously popular Pocket Manual of Homoeopathic Materia Medica. I quote from his Cocculus chapter. How scientifically he explains the patho-physiological actions of this important remedy. He says:

            “Within the sphere of action of Cocculus are many spasmodic and paretic affections, notably those affecting one-half of the body. Affects the cerebrum, will not cure             convulsive seizures proceeding from the spinal cord. Painful contracture of limbs and trunk; tetanus. Many of the effects of night-watching are relieved by it….”.

Dr. William H. Burt wrote an exclusive materia medica, entitled :Physiological Materia Medica in 1882. According to him it is the drug pathology that should be compared, under the law of similia, with the disease pathology, not with the arbitrary symptoms. His ideas are best for quoting.

  • A physician who cannot diagnose the pathology of a drug, need not to expect to be successful in the treatment of disease.
  • We are fully persuaded that to endure the crucial test of science, the Materia Medica of the future must stand upon a physiological basis.
  • The first thing to learn about a drug is its physiological and pathological action upon the healthy human organism. To know what tissues it acts upon, and just how it affects them, leads directly to its curative action.
  • The knowledge of this localized action gives us the key to its therapeutics; for a reflex symptom is far less valuable than a primary and idiopathic’s one. (ibid. p.6)

Homeopathy is a paradise for the uninitiated. All the homeopaths of yore were not essentially medical men professionally and academically. It was Dr. Clarke who created a progeny of the so-called lay-practitioners. He did it all in good faith to increase numeric strength of homeopathic professionals—it was the need of the time. But this peculiar feat of his gave many great and famous homeopaths to the profession. Among them we can proudly mention Ellis Barker, Noel Puddephatt, Philis Speight, et al. Boenninghausen was also not a medical doctor. His field was botany. But he was a great friend and disciple of Hahnemann. Hahnemann gave him the responsibility of constructing a repertory. To be a lay practitioner is not a derogatory thing. Every medical professional should be fully conversant with the sciences of physiology and pathology, and keep himself fully abreast with all the researches and new discoveries in the field.  One should never be complacent to keep oneself ignorant.

Diagnostic sciences have taken miraculous strides, and laid bare the areas that were never thought to be accessible to human prying. Modern means of diagnosis are extensive and invasive and can pinpoint the real kind of disease and to what extent it has spread. They are also predictive, and can tell the pathologist as to what is brewing in the interior of the patient, and with what speed. The therapeutics dependent on these findings would be essentially creative and innovative. The physicians could be able to annul the predicted fate, or at least slow the pace of the onset, or entirely arrest the progress of the impending disaster. A therapeutics that is ritualistically dependent on set rules, regulations and edicts will naturally lose the spirit of creativity. Innovation and mastery in dealing with normal or odd situations is the hallmark of science.

“An important benefit from the study of the genetics of human disease is to predict the risk that individuals may have of succumbing to a particular disease. Knowledge of this risk can then be used by the clinician in prevention, diagnosis, prognosis, and treatment.” [cf. Genome Res. Oct 2007; 17(10): 1520–1528. doi:  10.1101/gr.6665407 PMCID: PMC1987352]

Classical homeopaths, from apparent reasons, are not knowledge seekers, in as far as pathology and advancements in all other related sciences are concerned. What modicum of pathology they ever need to know is for the singular purpose of excluding all those symptoms that belong to the pathology of the case from the whole, well taken, case, and prescribe on those symptoms that belong to the personality and temperament of the patient, plus some those symptoms that are very peculiar and strange in the whole symptomatology of the case.

For a successful homeopathic practice they need two books: First, the source-book, i.e. Materia Medica, which is a repository of all the symptoms of the homeopathic provings of the drugs. It’s a unique book, comprising a mine of information culled from the massive ‘day-books’ of the provers, and arranged according to the anatomical schema of the body. Now this information is for learning by rote; the more of this data you have committed to your memory, the more successful you will be in your daily practice.  Second, the rules-of-conduct book, that is, The Organon, which consists of rules (called Aphorisms) as to how the symptoms of the sick should be compared with the symptoms of the Materia Medica, on the basis of similarity, in all its nuances, and how the selected remedy be applied according to the tenets and statutes laid down in the Organon. Since the data of the Materia Medica has grown to such a limit that is humanly impossible to be committed to the memory. There is a third book as a helping gadget, called The Repertory, which is an organized index of all the available symptoms of the Materia Medica. This gadget enables the practitioner to fine-tune his prescription. They need not bother about what modern findings say about the pathology and the prognosis of the case; and what new symptom that emerges after their first prescription they are at once prompted to clad it with some conceptual tight jacket: ‘as tracing back the anamnesis, or the back history.’ They can never think that the new symptom can possibly be the sign that the disease is not arrested but advancing instead. Nothing could be more perilous than this behavior. One cannot know the gravity of the situation without the knowledge of the pathology. The modern means of laboratory investigation provides unprecedented advantages to predict and forewarn about diseases that are brewing in the interior and in the cells of an individual. Laboratory can also tell you weather or not your prescription is working, or doing any good.

So, modern medicine provides us vital information against the future’s possible health hazards and alerts us to guard ourselves from the imminent dangers of postponing the required urgent preventive measures (or actions).

Sometimes only one symptom leads us to very grave diagnosis, especially when it is not mitigated with the usual measures or the indicated remedy. An unresponsive headache, as I’ve mentioned in my previous article, can lead us to the grave diagnosis of renal failure.

Now when the diagnosis is made through the modern laboratory techniques, the whole scenario is changed. You have now come to know the real disease, you have also come to know how to proceed; what measures to adopt, and what dietary restrictions to prescribe. Since prescribing the right diet is as crucial as prescribing the right medicine. In ignorance one can be the undoing of the other. And diet cannot be regimented without the solid and comprehensive knowledge of pathology and the related subjects. With the knowledge of the disease—as in the above example—you  prohibit potassium rich foods, and allow calcium rich diet. And protein is strictly restricted. Now such dietary measures should never have come to mind for the headache that was the only symptom that the patient had. Would not have we played havoc with the patient if we did not know the disease? We would have killed him in ignorance. So accept the fact that the perceptible symptoms cannot always be the whole disease, nor the annihilation of the same a definite cure.  

We conclude by stressing the importance in therapeutics of determining the exact pathology with all its ramifications. Most of the great homeopaths became lesser gods by relinquishing and ignoring—rather ridiculing, these subjects. We should shed our prejudice against pathology, patho-physiology and laboratory sciences. Our difference, with the dominant school, is only in therapeutic approach, not in the acquisition of knowledge of medical sciences. The colossus of Burnett stands on the solid pedestal of pathology. His unparallel knowledge of pathology and related subjects, with deep insight into medicines made him a demigod. Only such a seasoned physician can utter such impregnable words:

“The similimum of the symptoms may, or may not be the similimum of the malady; if of latter, we have an ideal therapy beyond which there is nought to be desired; if of the symptoms only we are apt to keep on curing our patients till they die.” (Best of Burnett, p.94)



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