Category Archives: Research

The real source of Gout

This is the missing chapter from, “Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health”, by Gary Taubes on Gout.

Disclaimer as requested by Gary:This chapter is in draft form and has not gone through the same fact-checking as the rest of Taubes’ published work, even though there are 32 citations (some incomplete). I wanted to show the writing process at its mid-point. The only deletions I’ve make are “TK”, which–for unknown reasons–is traditional shorthand in publishing for indicating that something is “to come”.

I have bolded several sections for those who would like a 2-3-minute skim of content highlights before digesting the entire piece, which is 7 pages long.

Enter Gary Taubes: –

Gout and the condition known technically as hyperuricemia, or elevated levels of uric acid, are the most recent examples of this kind of institutional neglect of the potential health effects of fructose, and how pervasive it can be.

Gout itself is an interesting example because it is a disease that has gone out of fashion in the last century and yet the latest reports suggest it is not only as prevalent as ever, but becoming more so. Recent surveys suggest that nearly 6 percent of all American men in their fifties suffer from gout, and over ten percent in their seventies. The proportion of women afflicted is considerably less at younger ages but still rises over 3 percent by age 60.(1) Moreover, the prevalence of gout seems to have doubled over the last quarter century, coincident (perhaps not coincidentally) with the reported increase in obesity, and it may have increased five- or even six-fold since the 1950s, although a large portion of that increase may be due to the aging of the population.(2)

Until the late 17th century, when the spread of gout reached almost epidemic proportions in Britain, the disease afflicted almost exclusively the nobility, the rich and the educated, and so those who could afford to indulge an excessive appetite for food and alcohol. This made gout the original example of a disease linked to diet and over-consumption, and so, in effect, the original disease of civilization.

But once gout became easily treatable, in the early 1960s, with the discovery of the drug allopuranol, clinical investigators and researchers began to lose interest. And the pathology of gout has been understood since the British physician Alfred Garrod, in the mid-19th century, identified uric acid as the causative agent; the idea being that uric acid accumulates in the circulation to the point that it falls out of solution, as a chemist would put it, and so crystallizes into needle-sharp urate crystals. These crystals then lodge in the soft tissues and in the joints of the extremities – classically, the big toe — and cause inflammation, swelling and an excruciating pain that was described memorably by the 18th century bon vivant Sydney Smith as like walking on one’s eyeballs.(3) Because uric acid itself is a breakdown product of protein compounds known as purines – the building blocks of amino acids – and because purines are at their highest concentration in meat, it has been assumed for the past 130-odd years that the primary dietary means of elevating uric acid levels in the blood, and so causing first hyperuricemia and then gout, is an excess of meat consumption.

The actual evidence, however, has always been less-than-compelling: Just as low cholesterol diets have only a trivial effect on serum cholesterol levels, for instance, and low-salt diets have a clinically insignificant effect on blood pressure, low-purine diets have a negligible effect on uric acid levels. A nearly vegetarian diet, for instance, is likely to drop serum uric acid levels by 10 to 15% percent compared to a typical American diet, but that’s rarely sufficient to return high uric acid levels to normality, and there is little evidence that such diets reliably reduce the incidence of gouty attacks in those afflicted.(4) Thus, purine-free diets are no longer prescribed for the treatment of gout, as the gout specialist Irving Fox noted in 1984, “because of their ineffectiveness” and their “minor influence” on uric acid levels.(5) Moreover, the incident of gout in vegetarians, or mostly vegetarians, has always been significant and “much higher than is generally assumed.” (One mid-century estimate, for instance, put the incidence of gout in India among “largely vegetarians and teetotalers” at 7%.)(6) Finally, there’s the repeated observation that eating more protein increases the excretion of uric acid from the kidney and, by doing so, decreases the level of uric acid in the blood.(7) This implies that the meat-gout hypothesis is at best debatable; the high protein content of meats should be beneficial, even if the purines are not.

The alternative hypothesis is suggested by the association between gout and the entire spectrum of diseases of civilization, and between hyperuricemia and the metabolic abnormalities of Syndrome X. In the past century, gout has manifested all of the now-familiar patterns, chronologically and geographically, of diseases of civilization, and so those diseases associated with western diets. European physicians in World War I, for instance, reported a reduced incidence of gout in countries undergoing food shortages.(8) In primitive populations eating traditional diets, gout was virtually unknown or at least went virtually unreported (with the conspicuous exception of Albert Schweitzer who says he saw it with surprising frequency.) The earliest documented cases reported in Asia and Africa were in the late 1940s.(9) And even in the 1960s, hospital records from Kenya and Uganda suggested an incidence of gout lower than one in a thousand among the native Africans. Nonetheless, by the late 1970s, uric acid levels in Africa were increasing with westernization and urbanization,(10) while the incidence of both hyperuricemia and gout among South Pacific islanders was reportedly sky-rocketing. By 1975, the New Zealand rheumatologist B.S. Rose, a colleague of Ian Prior’s, was describing the native populations of the South Pacific as “one large gouty family.”(11)

Gout has also been linked to obesity since the Hippocratic era, and this association is the origin of the assumption that high-living and excessive appetites are the cause. Gouty men have long been reported to suffer higher rates of atherosclerosis and hypertension, while stroke and coronary heart disease are common causes of death.(12) Diabetes is also commonly associated with gout. In 1951, Menard Gertler, working with Paul Dudley White’s Coronary Research Project at Harvard, reported that serum uric acid levels rose with weight, and that men who suffered heart attacks were four times as likely to be hyperuricemic as healthy controls.(13) This led to a series of studies in the 1960s, as clinical investigators first linked hyperuricemia to glucose intolerance and high triglycerides, and then later to high insulin levels and insulin resistance.(14) By the 1990s, Gerald Reaven, among others, was reporting that insulin resistance and hyperinsulinemia raised uric acid levels, apparently by decreasing uric acid excretion by the kidney, just as they raised blood pressure by decreasing sodium excretion. “It appears that modulation of serum uric concentration by insulin resistance is exerted at the level of the kidney,” Reaven wrote, “the more insulin-resistant an individual, the higher the serum uric acid concentration.” (15)

These observations would suggest that anything that raised insulin levels would in turn raise uric acid levels and might cause gout, which would implicate any high carbohydrate diet with sufficient calories. But this neglects the unique contribution of fructose. The evidence arguing for sugar or fructose as the primary cause of gout is two-fold. First, the distribution of gout in western populations has paralleled the availability of sugar for centuries, and not all refined carbohydrates in this case. It was in the mid-17th century, that gout went from being exclusively a disease of the rich and the nobility to spread downward and outward through British society, reaching near epidemic proportions by the 18th century. Historians refer to this as the “gout wave,”(16) and it coincides precisely with the birth and explosive growth of the British sugar industry(17) and the transformation of sugar, in the words of the anthropologist Sydney Mintz, from “a luxury of kings into the kingly luxury of commoners.”(18) British per capita sugar consumption in the 17th century was remarkably low by modern standards, a few pounds per capita per year at the turn of the century, but the change in consumption over the next century and a half was unprecedented: between 1650 and 1800, following the British acquisition of Barbados, Jamaica and other “sugar islands”, total sugar consumption in England and Wales increased 20- to 25-fold.(19)

The second piece of evidence is much less circumstantial: simply put, fructose increases serum levels of uric acid. The “striking increase” in uric acid levels with an infusion of fructose was first reported in the Lancet in the late 1960s by clinicians from Helsinki, Finland, who referred to it as fructose-induced hyperuricemia.(20) This was followed by a series of studies through the late 1980s confirming the existence of the effect and reporting on the variety of mechanisms by which it came about. Fructose, for instance, accelerates the breakdown of a molecule known as ATP, which is the primary source of energy for cellular reactions and is loaded with purines. (ATP stands for adenosine triphosphate; adenosine is a form of adenine, and adenine is a purine.) And so this in turn increases formation of uric acid. Alcohol apparently raises uric acid levels through the same mechanism, although beer also has purines in it.(21) Fructose also stimulates the synthesis of purines directly, and the metabolism of fructose leads to the production of lactic acid, which in turn reduces the excretion of uric acid by the kidney and so raises uric acid concentrations indirectly by that mechanism.(22)

These mechanistic explanations of how fructose raises uric acid levels were then supported by a genetic connection between fructose metabolism and gout itself. Gout often runs in families, so much so that those clinicians studying gout have always assumed the disease has a strong hereditary component. In 1990, Edwin Seegmiller, one of the few veteran gout researchers in the U.S., and the British geneticist George Radda, who would go onto become director of the Medical Research Counsel, reported that the explanation for this familial association seemed to be a very specific defect in the genes that regulate fructose metabolism. Thus, individuals who inherit this defect will have trouble metabolizing fructose and so will be born with a predisposition to gout. This suggested the possibility, Seegmiller and Radda concluded, that this defect in fructose metabolism was “a fairly common cause of gout.”(23)

As these observations appeared in the literature, the relevant investigators were reasonably clear about the implications: “since serum-uric-acid levels are critical in individuals with gout, fructose might deserve consideration in their diet,” noted the Helsinki clinicians in The Lancet in 1967, and so the chronic consequences of high-fructose diets on healthy individuals required further evaluation.(24) Gouty patients should avoid high-fructose or high-sucrose diets, explained Irving Fox in 1984, because “fructose can accelerate rates of uric acid synthesis as well as lead to increased triglyceride production.”(25) Although none of these investigators seemed willing to define what precisely constituted a high-fructose or a high-sucrose diet. Was it 50 pounds of sugar a year? 100 pounds? 150 pounds? 300 pounds? And would high-fructose diets induce gout in healthy individuals or would they only exacerbate the problem in those already afflicted? In 1993, the British biochemist Peter Mayes published an article on fructose metabolism in the American Journal of Clinical Nutrition that is now considered the seminal article in the field. (This was in the special issue of the AJCN dedicated to the health effects of fructose.) Mayes reviewed the literature and concluded that high-fructose diets in healthy individuals were indeed likely to cause hyperuricemia, and he implied that gout could be a result, as well, but the studies to address that possibility had simply never been done. “It is clear,” Mayes concluded, “that systematic investigations in humans are needed to ascertain the precise amounts, both of fructose consumption and of its concentration in the blood, at which deleterious effects such as hyperlipidemia and hyperuricemia occur.”(26) Add to this Reaven’s research reporting that high insulin levels and insulin resistance will increase uric acid levels, and it suggests, as Mayes had remarked about triglycerides, that sugar (sucrose) and high fructose corn syrup would constitute the worst of all carbohydrates when it comes to uric acid and gout. The fructose would increase uric acid production and decrease uric acid excretion, while the glucose, though its effect on insulin, would also decrease uric acid excretion. Thus, it would be reasonable to assume or at least to speculate that sugar is a likely cause of gout, and that the patterns of sugar consumption explain the appearance and distribution of the disease.

Maybe so, but this hypothesis has never been seriously considered. Those investigators interested in gout have focused almost exclusively on alcohol and meat consumption, in part because these have historical precedents and because the implication that gouty individuals and particularly obese gouty individuals shy away from meat and alcohol fit in well with the dietary prescriptions of the 1970s onward.

More than anything, however, this sugar/fructose hypothesis was ignored, once again, because of bad timing. With the discovery and clinical application of allopurinol in the 1960s, those clinical investigators whose laboratories were devoted to studying the mechanisms of gout and purine metabolism – James Wyngaarden’s, for instance, at Duke and Edwin Seegmiller’s at NIH – began focusing their efforts either on working out the nuances of allopurinol therapy, or to applying the new techniques of molecular biology to the genetics of gout and rare disorders of hyperuricemia or purine metabolism. Nutritional studies were simply not considered worthy of their time, if for no other reason than that allopuranol allowed gout suffers to eat or drink whatever they wanted. “We didn’t care so much whether some particular food might do something,” says William Kelley, who is a co-author with Wyngaarden of the 1976 textbook, Gout and Hyperuricemia and who started his career in Seegmiller’s lab at NIH. “We could take care of the disease.”(27)

This exodus, however, coincided with the emergence of research on fructose-induced hyperuricemia. By the 1980s, when the ability of fructose and sucrose consumption to raise uric acid levels in human subjects was demonstrated repeatedly, the era of basic research on gout had come to an end. The major players had left the field and NIH funding on the subject had dwindled to a trickle. Wyngaarden published his last research paper in 1977 and spent the years 1982 to 1989 as director of the National Institutes of Health. Kelley published his last papers on the genetics of gout in 1989, when he became dean of medicine at the University of Pennsylvania. Irving Fox, who did much of the basic research on fructose- and alcohol-induced hyperuricemia in Kelley’s lab, went to work in the biotechnology industry in the early 1990s. Only Edwin Seegmiller remained interested in the etiology of gout, and Seegmiller says that when he applied to the NIH for funding to study the relationship between fructose and gout, after elucidating the genetic connection with Radda in 1990, his grant proposals were rejected on the basis that he was too old and, as an emeritus professor, technically retired.(28) “In the 1950s and 1960s, we had the greatest clinical scientists in the world working on this disease,” says Kelley. “By the 1980s and 1990s, there was no one left.”

Meanwhile, the medical journals would occasionally run articles on the clinical management of the gout, but these would concentrate almost exclusively on drug therapy. Discussions of diet would be short, perhaps a few sentences, and confused about the science. On those occasions when the authors would suggest that gouty individuals might benefit from low-purine diets, they would invariably include “sugars” and “sweets” as among the recommended foods with low-purine contents.(29) In a few cases – a 1996 article in the New England Journal of Medicine, for instance (30)– the articles would also note that fructose consumption would raise uric acid levels, suggesting only that the authors had been unaware of the role of fructose in “sugars” and “sweets.” Even when the New England Journal published a report from Walter Willett and his Harvard colleagues in March 2004, this same kind of nutritional illiteracy manifested itself. Willett’s article had reported that men with gout seemed to eat more meat than healthy men. But Willett, who by this time was arguably the nation’s most influential nutritional epidemiologist, later explained that they had never considered sugar consumption in their analysis because neither he nor his collaborators had been aware of the hyperuricemic effect of fructose. Willett’s co-author, Gary Curhan, a nephrologist and gout specialist with a doctorate in epidemiology, said he might have once known that fructose raised uric acid levels, but it had slipped his mind. “My memory is not what it used to be,” he said. He also acknowledged, in any case, that he never knew sucrose was half fructose.

The addenda to this fructose-induced hyperuricemia story may be even more important. When the New England Journal of Medicine published Willett’s gout study, it ran an editorial to accompany it written by the University of Florida nephrologist Richard Johnson. Over the past decade, Johnson’s research has supported the hypothesis that elevating the uric acid concentration in the circulation also damages the blood vessels leading into the kidneys in such a way as to raise blood pressure directly, and so suggests that fructose consumption will raise blood pressure.

This is another potentially harmful effect of fructose that post-dates the official reports exonerating sugar in the diet. And it is yet another mechanism by which sugar and high fructose corn syrup could be a particularly unhealthy combination. The glucose in these sugars would raise insulin levels, which in turn would raise blood pressure by inhibiting the kidney’s secretion of sodium and by stimulating the sympathetic nervous system, as we discussed in an earlier chapter, and the fructose would do it independently by raising uric acid levels and so damaging the kidney directly. If this were the case, which has never been tested, it would potentially explain the common association of gout and hypertension and even of diabetes and hypertension.(31) Johnson is only now looking into this possibility, however. Unlike Willett and his colleagues, Johnson had long been aware of the ability of fructose to raise uric acid levels, and so was studying that phenomenon in his laboratory. But it was only in the summer of 2004, he explained, three months after his NEJM editorial was published, that he realized that sucrose was half fructose and that his research of the past years was even relevant to sugar.(32)

A decade later, Thomas Benedek described the epidemiology of gout in The Cambridge World History of Human Disease this way: “Worldwide the severity and prevalence of gout have changed paradoxically since the 1940s. In the highly developed countries, as a result of the advent of effective prophylactic drug therapy, the disease is now rarely disabling. Elsewhere, however, it has become more prevalent, predominantly as a result of `improved diets.’”

###

Footnotes and endnotes:

The economist and historian Ralph Davis estimates that the supply of sugar from the Caribbean into Britain rose from three or four thousand tons a year in the late fifteenth century to over two hundred thousand tons by the 1770s, or an increase of over fifty-fold. (davis r, the rise of the atlantic economies, cornell university press, 1973, p. 251, 255)

1 Kramer hm, curhan g, the association between gotu and nephrolithiasis: the national health and nutrition examination survey III. 1988-1994. Am J Kidney Dis 2002;40:37-42

2 Arromdee E, Michet CJ, Crowson CS, O’Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002 Nov;29(11):2403-6.

2Interview with choi, sept 16, 2004

2Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH, Heyse SP, Hirsch R, Hochberg MC, Hunder GG, Liang MH, Pillemer SR, Steen VD, Wolfe F. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States.

2Arthritis Rheum. 1998 May;41(5):778-99.

3 gout, the patrician disease, p. 3

4

5 hydrick and fox, p. 748-749.

6 Duncan’s diseases of metabolism, p. 632.

7 Hydrick cr and fox ih, nutrition and gout, in present knowledge in nutrition, fifth edition, the nutrition foundation, Washington dc, 1984, p. 743

8 duncans diseases of metabolism, p. 638

9 Traut ef, rheumatic diseases, diagnosis and treatment, the C.V. Mosby Company, St. Louis, 1952 p. 303.

9benedek, in Cambridge history of diseases

9Trowel hc, a case of gout in a ruanda African, the east African medical journal, oct. 1947, p. 346-348

10 Beighton p et al, 1977, rheumatic disorders in th south African negro, part IV. Gout and hyperuricemia. South Af Med J. 51(26):969-72

11 Gout in the Maoris, B.S. Rose, Seminars in Arthritis and Rheumatism. Vol. 5, no. 2, (November) 1975, pg. 121-145.

12 duncan’s diseases of metabolism, 1947, p. 631

13 gertler mm, et al, erum uric acid in relation to age and physique in health andin coronary ehart disease, Ann Intern Med. 1951 Jun;34(6):1421-31. Reiser S, Uric Acid and Lactic Acid, in REISER S AND HALLFRISCH J, METABOLIC EFFECTS OF FRUCTOSE, crc press, boca raton fl, 1987 p. 113-134

13

14 duncan’s diseases of metabolism, p. 631

14 reaven gm, The Kidney: An Unwilling Accomplice in Syndrome X, Am J Kid Dis, Vol. 30, n0 6, December, 1997: pp. 928-931.

15 Facchini F et al, Relationship Between Resistance to Insulin-Mediated Glucose Uptake, Urinary Uric Acid Clearance, and Plasma Uric Acid Concentration, JAMA, December 4, 1991, vol. 266, no. 21, 3008-3011

16 Wyngaarden and Kelley p. ix

17 mintz

18 Sydney Mintz, Sweetness and Power, The Place of Sugar in Modern History, penguin books, ny 1985 p. 96.

19 mintz p. 64, 66

20 perheentupa j raivio k, fructose-induced hyperuricaemia, lancet, September 9, 1967, p.528531

21 emmerson bt, getting rid of gout

22 mayes pa, metabolism of fructose, ajcn, 1993

22hydrick c fox i, nutrition and gout, in modern reviews of nutrition

23 Seegmiller JE, Dixon RM, Kemp GJ, Angus PW, McAlindon TE, Dieppe P, Rajagopalan B, Radda GK. Fructose-induced aberration of metabolism in familial gout identified by 31P magnetic resonance spectroscopy.

23Proc Natl Acad Sci U S A. 1990 Nov;87(21):8326-30

24 peerheentupa ibid

25 hydrick and fox, p. 748-749.

26 Mayes pa, metabolism of fructose, ajcn 1993

27 Kelley interview

28 seegmiller interview

29 See for instance, fam ag, gout, diet and the insulin resistance syndrome, j. rheum. 2002;29, 1350-55

30 Emmerson BT. The management of gout.

30N Engl J Med. 1996 Feb 15;334(7):445-51

31 get citation from Richard Johnson articles on uric acid and hypertension.

32 Johnson interview, june 3, 2004

Psora. Compton Burnett

……….It is due, let us say, to psora, but we have no clear conception of What psora is.

Psora needs to  be split up into its component parts, no easy task; it roots in the vague, its trunk and boughs run  away into anywhere.

The Psora of the homoeopaths seems somehow true, but it has no proper  beginning, no definite course, and ends in pathological chaos. Perhaps we study it in Hahnemann, and in the best writers on the subject, and after doing our best to master it, we rise  from our studies with no clear idea, and we finally decide to abandon psora as an intangible  myth, and then we proceed with our clinical work; but, before long, we stumble against a very  tangible something, and on looking at the stumbling block, we find writ large upon it the word  Psora! Have I then hit upon a solution of the psora-problem? No; but if we cannot break the
whole faggot, we may perchance break one stick of it.

Video

Psora the short version.

Learning to trust in the Principle

Or why the ‘Principle’ of the homeopathic law does not ever need to descend into allopathic thinking.

  • Pitch plaster recommended by Hahnemann

S. HahnemannAfter speaking of the psoric theory and of the relation between internal and skin diseases, he recommends the use of a plaster under the following conditions :

” Now in order to diminish the morbid projection of the psoric affection upon the smaller and nobler organs, and to procure for this effort of the vital force to keep the internal dyscrasia in abeyance a more extensive surface on which it may expend its virulence, we must apply to the back something that shall at once check the cutaneous transpiration and at the same time be slightly irritant.

“This may be accomplished by means of a plaster composed of six parts of Burgundy pitch to one of turpentine mixed together over a charcoal fire, spread upon soft chamois leather, and applied warm by a uniform close pressure to the skin. It usually happens that a fine rash accompanied by considerable itching is soon produced thereby on the surface of the back.

” If in the course of time the itching should become excessive, the plaster may be removed for a few days but then again applied and continued. When this artificially produced psoric affection of a large extent of skin is in full operation, we shall observe a great diminution in the morbid state of the small, noble organ, and the local disease will thereby be rendered more curable by the internal antipsoric medicine.”

This was sent to Stapf in the letter of August 5, 1830.

He afterwards, in the fifth edition of the ” Organon,” 1833, retracted this advice in the following words : (Dudgeon’s translation of the “Organon,” London, 1893. Preface to 5th Edition.)

” Homoeopathy is a perfectly simple system of medicine, remaining always fixed in its principles as in its practice, which, like the doctrine whereon it is based, if rightly apprehended, will be found to be so exclusive (and only in that way serviceable) that as the doctrine must be accepted in its purity so it must be purely practiced, and all backward straying to the pernicious routine of the old school (whose opposite it is as day to. night) is totally inadmissible, otherwise it ceases to deserve the honorable name of Homoeopathy.

“I am, therefore, sorry that I once gave the advice, savoring of Allopathy, to apply to the back in psoric diseases, a resinous plaster to cause itching, and to employ the finest electrical sparks in paralytic affections.

For as both these appliances have seldom proved of service, and have furnished the mongrel Homoeopathists with an excuse for their Allopathic transgressions, I am grieved I should ever have proposed them, and I hereby solemnly retract them – for this reason also, that, since then, our Homoeopathic system has advanced so near to perfection that they are now no longer required,”

Bibliography:

Stapf’s Archiv. (Brit. Jour. of Hom., Vol. XI., p. 34. Stapf’s Archiv fur die hom. Heilkunst, Vol. ix., part 3, p. 72.)

Hering’s Law: Law, Rule or Dogma?

by Dr. André Saine, D.C., N.D., F.C.A.H.

dr_andresainePresented at the Second Annual Session of the Homeopathic Academy of Naturopathic Physicians in Seattle, Washington, April 16-17, 1988.

Introduction
In homeopathy today, Hering’s law is widely recognized as the second law of cure, the first law of cure being similia similibus curantur, or like cures like. Hering’s law pertains to the direction in which the symptoms of the patient will disappear during a cure under homeopathic treatment.

In his second lecture on homeopathic philosophy given in 1900 to the Post-Graduate School of Homœopathics, Kent said:

  • “The cure must proceed from centre to circumference. From centre to circumference is from above downward, from within outwards, from more important to less important organs, from the head to the hands and feet.”
  • “Every homœopathic practitioner who understands the art of healing, knows that the symptoms which go off in these directions remain away permanently. Moreover, he knows that symptoms which disappear in the reverse order of their coming are removed permanently. It is thus he knows that the patient did not merely get well in spite of the treatment, but that he was cured by the action of the remedy. If a homœopathic physician goes to the bedside of a patient and, upon observing the onset of the symptoms and the course of the disease, sees that the symptoms do not follow this order after his remedy, he knows that he has had but little to do with the course of things.” (1)

Here Kent does not differentiate between acute and chronic disease in the application of the law. It is reasonable to assume, because of the lack of precision, that he meant all diseases, acute and chronic of venereal and non-venereal origin, would disappear in the direction described above.

When first studying homeopathy, I listened to the teachers and read the “classic” modern works, and Constantine Heringassumed, like my fellow colleagues, that Hering’s law had been an irrefutable fact recognized by Hering and the many succeeding generations of homeopaths, and that all patients, (All italics used throughout this paper indicate my own emphasis of pertinent points.) acute and chronic, without an exception, would, at all times, be cured in the afore-mentioned direction under careful homeopathic treatment.

Later as a practitioner, I carefully applied myself to put the general homeopathic training I had received to the test. Since then, I have been able to substantiate most but not all of the rules, principles and laws contained in the homeopathic doctrine promulgated by several generations of homeopaths.

So far, however, I have been unable to substantiate Hering’s law. Indeed, very rarely do I see, for instance, in a patient with chronic polyarthritis, the symptoms disappearing from the head first and then to the hands and feet. More often, the pain and other joint symptoms disappear in the reverse order of their appearance, even if it is from below upwards. In other words, if the arthritis manifested itself, as it happens at times, first in the knees and then in the ankles, the ankles would get better before the knees.

Or in a patient affected by a complex of essentially functional complaints such as fatigue, anxiety, irritability, difficult digestion, joint pain and acne, rarely would I see the disappearance of the emotional disturbance first, then the poor digestion followed by the joint pain and lastly the acne. With the simillimum most symptoms begin to improve simultaneously and disappear in the reverse order of their appearance, and not necessarily from above downwards and from inside outwards. In fact it is not uncommon that in such cases the acne, the last to have appeared, would disappear readily and the emotional state (the oldest symptom) would be the last to completely disappear.

While treating a patient with an acute febrile disease that had progressed in the first stage from chills to fever, then to perspiration and lastly to weakness, I would observe a rapid and gentle recovery but without the patient re-experiencing the perspiration, then the fever and lastly the chills. While recovering from acute diseases under homeopathic treatment, the patient does not re-experience the original symptoms one by one in the reverse order of their appearance. Many more troublesome exceptions similar to the above could be cited.

What was wrong with Hering’s law as quoted above from Kent’s Lectures on Homeopathic Philosophy? Had I misunderstood the law?
According to Webster’s dictionary, a law is defined as a sequence of events that occurs with unvarying uniformity whereas a rule permits exceptions, and a dogma rests on opinion. Was this lack of confirmation of the said law due to “suppressive” homeopathic treatment as suggested by a number of theoretical and perhaps dogmatic homeopaths? If so, why have these so called “purists” not stood up and proven that all their cured cases followed the said law? To my knowledge this proof has not been forthcoming.

Was I the only practitioner in this position?
I questioned teachers and colleagues, some with many years of experience. Few could answer my questions and none has been able to substantiate from their own experience without the shadow of a doubt that Hering’s law was a true law of nature. It seems that most were in the same situation as me, even the supposed authorities would discuss the matter but in private with the author. It seems that we all had classic cases of cure from above downwards, from within outwards, from more to less important organs and in the reverse order of appearance of symptoms. But these absolutely “perfect” cases were only occasional. The majority of cured cases did not fulfill all the four citedcriteria.

So I decided to go back to the sources.
On one hand, neither Kent, in his Lectures on Homœopathic Philosophy of 1900, nor Stuart Close, in The Genius of Homœopathy of 1924, nor Herbert Roberts, in The Principles and Art of Cure by Homœopathy of 1936 while discussing the above law, refer to it as Hering’s law. (1-3) None of these three authors makes any reference to Hering in their lectures on the law of direction of cure. On the other hand, Garth Boericke, in A Compendium of the Principles of Homœopathy of 1929, refers to it as Hering’s rule but not as a law. (4) Confusing, isn’t it? Did Hering ever formulate a law on the direction of cure? If he did, why was his name not clearly associated with the law and was it as a law or a rule? Why was the literature so ambiguous?

At this point, I realized that the sources had to be explored further. The answers would all have to be within the literature of the nineteenth century. After a thorough examination of this literature I have so far been unable to find any of Hering’s famous contemporaries and close colleagues discussing or making any reference to a law of direction of cure. Writings of Boenninghausen, Jahr, Joslin, P.P. Wells, Lippe, H.N.Guernsey, Dunham, E.A. Farrington, H.C. Allen, Nash, etc, were all silent.

When Hering died in 1880, colleagues all over the world assembled to pay tribute to the great homeopath. His many accomplishments were recalled. Strangely, none made any mention of a law of direction of cure promulgated by Hering. (5) Arthur Eastman, a student who was close to Hering during the last three years of the venerable homeopath, published in 1917 Life and Reminiscences of Dr. Constantine Hering also without mentioning a law pertaining to direction of cure. (6) Calvin Knerr, Hering’s son-in-law, published in 1940, 60 years after Hering’s death, the Life of Hering, a compilation of biographical notes. (7) Again no mention is made of the famous law. Not only confusing, but also puzzling.

Obviously, the sources had to be further explored. Here are the fruits of this exploration.

THE HISTORY RELATED TO THE FORMULATION OF HERING’S LAW

  1. Hahnemann – 1811
    With the first publication of his Materia Medica Pura in 1811, Hahnemann inaugurated a new arrangement of the symptoms: from above downwards, from inside outwards, but also from the parts to the generals.
  2. Hahnemann – 1828
    In 1828, Hahnemann published his first observations and theories on chronic diseases. (8) I summarize here the points most pertinent to the present discussion:

    • “All diseases, acute and chronic of non-venereal origin, come from the original malady, called psora. (page 7)
    • “A skin eruption is the first manifestation of psora. (page 38)
    • “The skin eruption acts as a substitute for the internal psora (page 11) and prevents the breaking out of the internal disease. (page 13)
    • “The more the skin eruption spreads the more it keeps the internal manifestations of psora latent. (page 40)
    • “But when the skin eruption is suppressed with an external application or other influences the latent psora goes unnoticed and its internal manifestation increases. Then “it originates a legion of chronic diseases.” (page 12) Incidently, for Hahnemann, a suppressed skin eruption is not driven into the body as it was popularly thought in his time, and even today by most homeopaths, but rather the vital force is compelled “to effect a transference of a worse form of morbid action to other and more important parts.” (Introduction of the Organon of Medicine page 62) (9)
    • “Latent psora, an abnormal susceptibility to disease, will manifest itself as severe diseases after exposure to stress (or as he calls it, unfavorable conditions of life) acute infections, trauma and injuries, exhaustion from overworking, lack of fresh air or exercise, frustration, grief, poor nutrition, etc, and by “incorrect and weakening allopathic treatment”. (page 48)
    • “During the treatment of chronic diseases of non-venereal origin with antipsoric remedies, the last symptoms are always the first to disappear, “but the oldest ailments and those which have been most constant and unchanged, among which are the local ailments, are the last to give way.” (page 135)
    • If old symptoms return during an antipsoric treatment, it means that the remedy is affecting psora at its roots and will do much for its thorough cure (page 135). If a skin eruption appears during the treatment while all other symptoms have so far improved the end of the treatment is close.”
  3. Hahnemann – 1833-43
    In paragraphs 161 and 248 of the fifth and sixth edition of the Organon of Medicine of 1833 and 1843 respectively, Hahnemann says that in the treatment of old and very old chronic disease, aggravation of the original disease does not appear if the remedy is accurately chosen and given in the appropriate small doses, which are only gradually increased. “When this is done, these exacerbations of the original symptoms of the chronic disease can appear only at the end of the treatment, when the cure is complete or nearly complete.” The original symptoms of a chronic disease should be the last to aggravate or become more prominent before disappearing. (10)

    In paragraph 253 of the same work, the author states that in all diseases, especially in quickly arising (acute) ones, of all the signs that indicate a small beginning of improvement (or aggravation) that is not visible to everybody, the psychic condition of the patient and his general demeanor are the most certain and revealing.

    In paragraph 225, Hahnemann states that some psychic diseases are not the extension of physical disease but, “instead, with only slight physical illness, they arise and proceed from the psyche, from persistent grief, resentment, anger, humiliation and repeated exposure to fear and fright. In time such psychic diseases often greatly harm the physical health.” In other words, Hahnemann had recognized the existence of psychosomatic diseases, those diseases which progress from within outwards and from above downwards.

    This is the background that now leads us to Hering, who, among all Hahnemann’s students, was most similar to him. Like Hahnemann, Hering was a true scientist who totally adopted the inductive method in his scientific pursuits.

  4. Hering – 1845
    In 1845, Hering published in the preface of the first American edition of Hahnemann’s Chronic Diseases an extract of an essay which was never published elsewhere, called “Guide to the Progressive Development of Homœopathy”.

    In this essay, Hering writes:

    • “Every homœopathic physician must have observed that the improvement in pain takes place from above downward; and in diseases, from within outward. This is the reason why chronic diseases, if they are thoroughly cured, always terminate in some cutaneous eruption, which differs according to the different constitutions of the patients.
    • “The thorough cure of a widely ramified chronic disease in the organism is indicated by the most important organs being first relieved; the affection passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last. (page 7)
    • “Even the superficial observer will not fail in recognising this law of order.
    • “This law of order which we have pointed out above, accounts for numerous cutaneous eruptions consequent upon homœopathic treatment, even where they never had been seen before; it accounts for the obstinacy with which many kinds of herpes and ulcers remain upon the skin, whereas others are dissipated like snow. Those which remain, do remain because the internal disease is yet existing… It lastly accounts for one cutaneous affection being substituted for another.” (11) (page 8)

    Here Hering assumes that all chronic diseases (it is likely that he is referring here to diseases of psoric origin, i.e., non-venereal) progress from less to more important organs and disappear in the reverse order. This is compatible with Hahnemann’s theory that all chronic diseases of non-venereal origin manifest themselves first on the skin then internally. (Concerning the theories of Hahnemann, Hering wrote in 1836 in the first American edition of the Organon of Medicine: Whether the theories of Hahnemann are destined to endure a longer or a shorter space, whether they be the best or not, time only can determine; be it as it may however, it is a matter of minor importance. For myself, I am generally considered as a disciple and adherent of Hahnemann, and I do indeed declare, that I am one among the most enthusiastic in doing homage to his greatness; but nevertheless I declare also, that since my first acquaintance with homeopathy, (in the year 1821), down to the present day, I hve never yet accepted a single theory in the Organon as it is promulgated. I feel no aversion to acknowledge this even to the venerable sage himself. It is the genuine Hahnemannean spirit totally to disregard all theories, even those of one’s own fabrication, when they are in opposition to the results of pure experience. All thoeries and hypotheses have no positive weight whatever, only so far as they lead to new experiments, and afford a better survey of the results of those already made. (page 17) (12)

  5. Hering – 1865
    It seems that Hering did not further elaborate on this subject, at least in the American literature, until 20 years later. In 1865, he published an article in the first volume of The Hahnemannian Monthly called “Hahnemann’s three rules concerning the rank of symptoms”. Hering states in this article that:

    • “The quintessence of Hahnemann’s doctrine is, to give in all chronic diseases, i.e., such as progress from without inwardly, from the less essential parts of our body to the more essential, from the periphery to the central organs, generally from below upwards – to give in all such cases, by preference, such drugs as are opposite in their direction, or way of action, such as act from within outward, from up downward, from the most essential organs to the less essential, from the brain and the nerves outward and down to the most outward and the lowest of all organs, to the skin… All the antipsoric drugs of Hahnemann have this peculiarity as the most characteristic; the evolution of their effects from within towards without. (page 6-7)
    • “Hahnemann states, in his treatise on Chronic Diseases, American translation p.171: Symptoms recently developed are the first to yield. Older symptoms disappear last. Here we have one of Hahnemann’s general observations, which like all of them, is of endless value, a plain, practical rule and of immense importance.
    • “The above rule might also be expressed in the following words: In diseases of long standing, where the symptoms or groups of symptoms have befallen the sick in a certain order, succeeding each other, more and more being added from time to time to those already existing, in such cases this order should be reversed during the cure; the last ought to disappear first and the first last.” (page 7-8) (13)

    It is very clear here that Hering makes no mention of a law but rather of a rule, that the symptoms ought to disappear in the reverse order of their appearance during the homeopathic treatment of patients with chronic disease of psoric origin, the ones that progress from without inwardly, from less important to more important organs and generally from below upwards.

  6. Hering – 1875
    In 1875, Hering published the first volume of Analytical Therapeutics of the Mind in which he stated that “only such patients remain well and are really cured, who have been rid of their symptoms in the reverse order of their development”. (page 24) (14) Here Hering makes no mention of the three other propositions regarding the direction of cure: from above downwards, from within outwards and from the more important to the less important organs. Why? Were they not considered as important to evaluate the direction of cure as stated in previous years?

    In the same work, Hering also explains that he adopted Hahnemann’s arrangement of the materia medica: “First inner symptoms, then outer ones. This order we have now uniformly preserved throughout the whole work.” (page 21) In explaining why he adopted this arrangement he says: “The arrangement as well as the style of printing, has the one object especially in view, viz.: to make it as easy as possible for the eye, and through the eye, for the mind to find what is looked for.” He makes no mention of this arrangement corresponding to a direction of cure, as it has been suggested by some well wishing homeopaths.

    The origin of the term “Hering’s law”
    Where does the term “Hering’s law” come from as it seems never to have been mentioned in the literature during Hering’s time? The earliest mention I have been able to find in the homeopathic literature dates from 1911, in an article published by Kent in the first volume of the Transactions of the Society of Homœopathicians called “Correspondence of Organs, and the Direction of Cure”. Kent writes:

    • “Hering first introduced the law of direction of symptoms: from within out, from above downward, in reverse order of their appearance. It does not occur in Hahnemann’s writings. It is spoken of as Hering’s law. There is scarcely anything of this law in the literature of homœopathy, except the observation of symptoms going from above to the extremities, eruptions appearing on the skin and discharges from the mucous membranes or ulcers appearing upon the legs as internal symptoms disappear.
    • “There is non-specific assertion in the literature except as given in the lectures on philosophy at the Post- Graduate School.” (15)

    It is reasonable to assume that Kent was the one that officialized the term “Hering’s law” and so inadvertently popularized the concept of the existence of a clear and precise law of direction of cure. (At least up till 1899, at Kent’s Post-Graduate School of Homeopathics, the directions of cure were still called “the Three Directions of cure [given by Hahnemann].) (16) By using the name of Hering it is reasonable to say that Kent thus created false and misleading historical assumptions. Since H.C. Allen had died two years previously (1909), the profession, at least in North America, had no other leaders capable to refute Kent and defend the classic Hahnemannian tradition. (It is to be remembered that in 1908 H.C. Allen had severely criticized the materia medica of the new synthetic remedies that Kent had been publishing since 1904 in The Critique. Kent was at the time the associate editor of this journal in which, almost monthly, he had been publishing the materia medica of a new synthetic remedy, each of very questionable value. During an open session at the annual meeting of the International Hahnemannian Association, Allen and G.P. Waring accused Kent of publishing materia medica that was “without proving or any clinical experience”, which would have been completely contrary to the strict inductive method intrinsic to homeopathy. (17)

    Kent then stopped permanently the publication of these synthetic remedies, even the ones that he had previously promised for upcoming publication in The Critique. (18) Although Kent continued to publish regularly in The Critique until 1911 he restricted his articles to reporting clinical cases rather than materia medica. Never was a synthetic remedy ever published by Kent after the initial criticism of Allen even in his own journal, The Homœopathician, that he founded in 1912. Furthermore, when Kent published the second edition of his Lectures on Homœopathic Materia Medica in 1912 [the first edition was in 1904], all the synthetic remedies published between 1904 and 1908 were omitted.)

    In this same article, Kent says that in the course of treatment of a patient suffering with a psychic disease of the will (problems of affections, grief, anger, jealousy, etc), the heart or liver will be affected as the treatment progresses.

    While in a patient suffering from a mental disease (problems of the intellect), the stomach or the kidney will be affected during appropriate homeopathic treatment. Were these comments on the direction of cure and correspondence of organs based on Kent’s impeccable and meticulous observations or was he rather formulating hypotheses? He does not explain further but he does mention later in the same paper that “through familiarity with Swedenborg, I have found the correspondences wrought out from the Word of God harmonious with all I have learned in the past thirty years. Familiarity with them aids in determining the effect of prescriptions.” (15)

    Nowhere was I able to find in the writings of Kent, including in a collection of not yet republished lesser writings, any other mention of Hering’s law as to the direction of cure.

    Discussion and Conclusion
    First let us briefly review the highlights of what has been so far demonstrated:

    • Between 1828 and 1843, Hahnemann enunciated his theories of chronic diseases and described his observations and rules about the progression and resolution of these chronic diseases. One key point of his theory is that a skin eruption is the first manifestation of psora, which is the source of all chronic diseases of non-venereal origin. In chronic disease the presenting symptoms of the patient (“those ailments which have been most constant and unchanged”) may aggravate and will disappear in the reverse order of their appearance with the correct antipsoric remedies in the correct posology. Possibly, old symptoms may return during an antipsoric treatment. In all diseases, if after a homeopathic remedy the psychic symptoms are the first to improve or aggravate it is a most certain sign of curative change. For Hahnemann this inside outward improvement was not a law but rather a most certain sign of curative change. Finally not all diseases progress from outside inwards but certain diseases (psychosomatic diseases) can progress from within outwards.
    • In 1845, Hering enunciated the original observations of Hahnemann as a law of order in a work never to be published. In this law he mentions essentially four points, that “the improvement in pain takes place from above downward; and in diseases, from within outward… Chronic diseases if thoroughly cured, always terminate in some cutaneous eruption” and lastly “the thorough cure of a widely ramified chronic disease in the organism is indicated by the most important organs being first relieved; the affection passes off in the order in which the organs had been affected, the most important being relieved first, the less important next, and the skin last”. As a reader I do not clearly sense that Hering is officially proclaiming the original observations of Hahnemann as an absolute law but rather that there is a “law of order” during a curative process. Also I was unable to find Hering or any of his contemporaries referring further to this unpublished work or to a law of direction of cure.
    • In 1865, Hering described these observations not as a law but as Hahnemann’s general observations or as plain practical rules. Essentially he emphasizes the proposition that the symptoms should disappear in the reverse order of their appearance during the treatment of patients with chronic psoric diseases.
    • In 1875, Hering now discussed only one proposition, that the symptoms will disappear in the reverse order of their appearance. The three other propositions are now not mentioned at all.
    • All the illustrious contemporaries of Hering seems to remain silent on this point, at least from my review of the literature.
    • In 1911, Kent, almost arbitrarily, calls the original observations of Hahnemann “Hering’s law”.

    Now, with Kent’s powerful influence, most modern works and presentations on homeopathy began to declare Hering’s law as an established fact and seemingly assumed that it has been thoroughly verified since the beginning of homeopathy, although no author, to my knowledge, has so far been able to substantiate what each is repeating from the other. Here is one clear sign which indicates how profoundly the homeopathic profession of today has been cut off from its original and most essential sources. During the years of its decline in the U.S. the profession experienced a gradual discontinuity from its original foundation and started to rely more and more on a neo-foundation dating back to the turn of the present century. Each new generation of homeopaths has readily accepted Hering’s law as a perfect law of cure and so unintentionally perpetuated a misleading assumption. For students it is an attractive concept but we clinicians must stand up and report our observations even if they are contrary to the teaching we have received.

    From reviewing the literature, it seems unlikely that the law formulated by Kent in 1911 is a fair represention of Hering’s overall understanding of a direction of cure and that neither Kent nor anyone else has been able thus far to clinically demonstrate that the original observations of Hahnemann constituted in fact a perfect law of nature. But if we assume, for a moment, that the law formulated by Kent is true, would all symptoms then have to disappear, not only in the reverse order of their appearance, but also from above downwards, from within outwards and from more important to less important organs?

    To comply with this law it would mean that all diseases to be curable must proceed from outside inwards, from below upwards and from less important to more important organs. Many acute diseases and a whole list of chronic diseases such as psychosomatic diseases and others that develop from within outwards (for example cases of arthritis followed by psoriasis), or diseases that develop from above downwards, as in certain cases of polyarthritis, would then be theoritically incurable. Or (since we know this not to be the case) they are curable, but represent notable exceptions to Kent’s formulation of a law of direction of cure.

    In many cases of chronic disease the direction of disappearance of symptoms will contradict at least one of the four propositions. I assume that we all agree that the enunciation of a law must be based on impeccable observations. A law, if it is to be called a law, must explain all observable phenomena of direction of cure. It is unacceptable to use limited or even selected clinical phenomena to confirm a supposed law.

    This situation appears to exist when certain homeopaths in their attempts to defend “pure” homeopathy subscribe to the position that what is observed as contrary to Hering’s law, as formulated by Kent, is only due to poor prescribing, suppressive at times, palliative at best but surely not curative. For them what is wrong, is not the law but the prescription: “the simillimum was not given.”

    Personally I use and can daily confirm the original observations of Hahnemann concerning the direction of cure and have found them extremely helpful to evaluate the evolution of diseases or of cure but I have not been able to substantiate these observations as a law and have not yet found a colleague with such substantiation. I use them as plain practical rules.

    Probably by the end of my career, homeopathy will have become widely accepted. I would then resent it if a group of objective scientists clinically investigate the principles of homeopathy, and find numerous exceptions not abiding to our idealistic or dogmatic conception of Hering’s law; thus renderiing it only “a plain, practical rule“. I would similarly resent having a group of scientists saying that for the last hundred or more years the homeopathic profession has been blindly erring in assuming that Hering’s law was an irrefutable fact.

    Five of the many plagues that have hindered the growth of homeopathy are ignorance, egotism, dogmatism, idolatry and the diversion from the inductive method. In his last address to the profession in an article published in the August 1880 (Hering died on July 23, 1880.) issue of the North American Journal of Homœopathy, Hering warned us that “if our school ever gives up the strict inductive method of Hahnemann we are lost, and deserve to be mentioned only as a caricature in the history of medicine.” (19) Indeed, since its early beginning the tendency to rationalize the practice of medicine has also constantly threatened homeopathy. Hahnemann, who had a thorough understanding of the history of medicine, knew that the only sure way was based on the experimental method. Hering demonstrated the same rigor. Unfortunatively, we can not say the same of Kent. Let us now start carefully observing and reporting any facts that would help to perfect Hahnemann’s original observations. If a direction of cure can be expressed within the context of a law, then so be it. But until demonstrated otherwise, it should remain “a plain, practical rule”. The law that we suspect still needs to be rightly formulated.

    At present it seems appropriate to refer to these observations as the rules of the direction of cure. To refer to these as Hahnemann’s or Hering’s rules may further prolong the confusion. From my personal experience, it appears that the four rules are not applicable to all cases and that there is a hierarchy among them, i.e., they do not have equal value. The first indication that a disease is being cured under homeopathic treatment is that the presenting and reversible (Many symptoms related to irreversible lesions can not be expected to totally disappear; consequently the more a symptom is related to organic changes, the less likely, or more slowly it will disappear. The greater the irreversibility of the pathology the greater the symptoms will linger. The practitioner can easily be confused by these important exceptions, which are often not well perceived. Therefore this rule [of symptoms disappearing in the reverse order of appearance] is generally less applicable to symptoms deriving from organic lesions.) symptoms of the disease will disappear in the reverse order of their appearance.

    This confirms the observations as pointed out originally and plainly by Hahnemann in The Chronic Diseases and later by Hering in 1865 and 1875. This means that during the treatment of patients suffering with chronic diseases of non-venereal origin and also at times with acute diseases, the presenting symptoms of the patient’s chronic dynamic disease (as opposed to the symptoms resulting essentially from gross error of living) will disappear in the reverse order of their appearance. So the presenting symptoms that have developed in the order of A B C D E seem to consistently disappear in the order of E D C B A. This rule seems to have supremacy over the other three rules: from more important to the less important organs, from within outwards and from above downwards.

    The word “presenting” is here emphasized in order to state perfectly clearly that the symptoms that will disappear in the reverse order of the their appearance are only the presenting symptoms, and that it is not at all expected that every ailment experienced by the patient in his past will again be re-experienced under homeopathic treatment. In fact only a few of these old symptoms and conditions will reappear during a homeopathic treatment, usually the ones that have unmistakably been suppressed by whatever influences. Beside antipathic treatment that will suppress symptoms and normal functions of the organism (perspiration or menses) there are other measures which will cause suppression of symptoms, first, dissimilar diseases, natural or artificial; second, external influences such as exposure to cold temperature, (i.e., suppressed menses from getting the feet wet); and lastly, internal influences that cause the person to suppress emotions such as anger or grief. This rule concerning cure in the reverse order of appearance of the presenting and reversible symptoms of the disease is the most important of the four as it is observable in almost all cases. The importance of this rule is well emphasized by Hering in 1865 when he mentioned:

    • “This rule enables the Hahnemannian artist not only to cure the most obstinate chronic diseases, but also to make a certain prognosis when discharging a cases, whether the patient will remain cured or whether the disease will return, like a half-paid creditor, at the first opportunity.” (12)

    The second most important (applicable) rule in the hierarchy is that cure will proceed from more important to less important organs. Third in importance is the rule that cure will proceed from within outwards. Fourth, least important and least often observable, the cure will proceed from above downwards. Hahnemann’s observation thatof all the signs that indicate a small beginning of improvement, the psychic condition of the patient and his general demeanor are the most certain and revealing is seen as the source of the last three rules. “The very beginning of improvement is indicated by a sense of greater ease, composure, mental freedom, higher spirits, and returning naturalness.” (paragraph 253) 10 This original observation of Hahnemann, which is verified daily, does not contradict the first rule in any case because the first sign of improvement can be and is often different than the symptom that would first disappear.

    Consequent to Hahnemann’s theory, (that all diseases, acute and chronic of non-venereal origin, come from the original malady called psora and its first manifestation is a skin eruption) all cases of chronic disease of dynamic origin must develop a skin eruption to be totally cured. As it seems unfeasible to demonstrate, it should at best be used as a working hypothesis and not as a law. For a law to exist it must be demonstrable without exception. Hahnemann had a clear opinion about the role of the physician as theorist when he wrote in the preface to the fourth volume of The Chronic Diseases:

    • “I furnished, indeed, a conjecture about it [on how the cure of diseases is effected], but I did not desire tocall it an explanation, i.e., a definite explanation of the modus operandi. Nor was this at all necessary, for it is only incumbent upon us to cure similar symptoms correctly and successfully, according to a law of nature [similia similibus curantur] which is being constantly confirmed; but not to boast with abstract explanations, while we leave the patients uncured; for that is all which so-called physicians have hitherto accomplished.” (8)

    To end this thesis, I would like to leave you with the spirit of some pertinent thoughts of Constantine Hering. In 1879, in the last two paragraphs to the preface of his last work, The Guiding Symptoms of our Materia Medica, he writes:

    • “It has been my rule through life never to accept anything as true, unless it came as near mathematical proof as possible in its domain of science; and, in the other hand, never to reject anything as false, unless there was stronger proof of its falsity.
    • “Some will say, “but so many things – a majority of all observations – will thus remain between the two undecided.” So they will; and can it be helped? It can, but only by accumulating most careful observations and contributing them to the general fund of knowledge.” (20)

    And finally he wrote in 1845 in the preface of Hahnemann’s Chronic Diseases:

    • “It is the duty of all of us to go farther in the theory and practice of Homœopathy than Hahnemann has done. We ought to seek the truth which is before us and forsake the errors of the past.” (page 9) (11)

    References

    1. Kent JT. Lectures on Homœopathic Philosophy. 2nd Ed. Chicago: Ehrhart & Karl, 1929.
    2. Close S. The Genius of Homœopathy. Philadelphia: Boericke & Tafel, 1924.
    3. Roberts HA. The Principles and Art of Cure by Homœopathy. 2nd Revised Edition. Rustington: Health Science Press, 1942.
    4. Boericke G. A compend of the Principles of Homœopathy for Students in Medicine. Philadelphia: Boericke & Tafel, 1929.
    5. Raue CG, Knerr CB, Mohr C, eds. A Memorial of Constantine Hering. Philadelphia: Press of Globe Printing House, 1884.
    6. Eastman AM. Life and Reminiscences of Dr. Constantine Hering. Philadelphia: Published by the family for private circulation, 1917.
    7. Knerr CB. Life of Hering. Philadelphia: The Magee Press, 1940.
    8. Hahnemann SC. The Chronic Diseases. Trans. by LF Tafel. Philadelphia: Boericke & Tafel, 1896.
    9. Hahnemann SC. Organon of Medicine. Trans. by W Boericke. Philadelphia: Boericke & Tafel, 1920
    10. Hahnemann SC. Organon of Medicine. Trans. by J Kunzli. Los Angeles: J.P. Tarcher, 1982.
    11. Hering C. Preface. In Hahnemann SC. The Chronic Diseases. Trans. by CJ Hempel. New-York: William Radde, 1845.
    12. Hering C. Preface to the first American edition. In the Organon of Homœopathic Medicine. New-York: William Radde, 1836.
    13. Hering C. Hahnemann’s Three Rules Concerning the Rank of Symptoms. Hahnemannian Monthly 1865;1:5-12.
    14. Hering C. Analytical Therapeutics of the Mind. Vol 1. Philadelphia: Boericke & Tafel, 1875.
    15. Kent JT. Correspondence of Organs, and Direction of Cure. Trans Soc. Homœopathicians 1911;1:31-33.
    16. Loos JC. Homœopathic Catechism. Journal of Homœopathics 1898-1899;2:480-488.
    17. Mastin JM. Editorial. Critique 1908;15:277-278.
    18. Mastin JM. Editorial. Critique 1907;14:228-229.
    19. Hering C. Apis. North American Journal of Homœopathy 1880;29:29-35.
    20. Hering C. The Guiding Symptoms of our Materia Medica. Vol 1. Philadelphia: The American Publishing Society, 1879.

Viewed through Proving: Platina – tamed…

Lady Platina feels an arch smile coming on…

Ever experienced this?  You prescribe Platina for a homoeopathy student, or for someone who has read up about remedies.

She looks up and raises an eyebrow (or tries to), with an attempt at an arch smile.
“Really?” she asks, incredulously but with a measure of pure delight, “Platina? I’m Platina?” (in itself a wrong description, no person “is” a remedy)

It’s tantamount to telling a female patient she still has “it”.  And try telling a homoeopathy-savvy patient that Platina is definitely not for her – she will often be deeply insulted…

Definitely time to read the proving, Hahnemann’s notes, and some others who didn’t allow the illusion of Platinum-coated sexuality go to their… well… minds…

The proving symptoms are really fairly tame.  There are some extreme-seeming mentals, such as the classic:

35.          Illusion of the imagination ; on entering the room after walking for an hour, everything around her seemed very small and all persons physically and bodily inferior to her, but she herself great and lofty in body ; the room appears to her gloomy and disagreeable ; attended with anxiety, gloomy and cross humor, a whirling vertigo and discomfort in her surroundings which before were pleasant to her ; in the open air, in the sunshine, everything vanishes at once.[Gr.].

Quite frankly – I was disappointed…with 15 mentions of flatulence (which can ameliorate), no seriously lascivious dreams, more of a strong emphasis on localized discomfort than anything else, the proving just didn’t live up to my lurid expectations (just read any modern materia medica and you too will have lurid expectations…)

What about this one then:

847.        Extraordinary sexual impulse (aft. 6 and 14 d.).

Oops – that’s Lycopodium.  No one gives an arch smile when prescribed Lycopodium.

Hahnemann noted in the introduction:

“When Platina is properly homoeopathically indicated in a case of disease, it relieves simultaneously the following ailments, if present : Lack of appetite ; eructation after eating ; constipation while traveling ; emission of prostatic juice ; induration of the uterus ; weariness of the lower limbs ; cold feet ; stuffed coryza.” (bold print is mine – vr)

Still not very exciting.  But what does “properly homoeopathically indicated” mean here?  Does it mean if there are no extreme mentals or the kind of sexuality that comes more from those teaching Platina rather than the proving itself – Platina cannot be prescribed?

I’d like to quote Carroll Dunham (1828-1877) here.  His words reverberate through the centuries with the steady tone of common sense:

Whether Platina is suitable only for irritable, excitable females, with predominant activity of the sexual functions, as the majority of writers assume, and among them Stapf and Gross, the provers of it, who, by the way, made their provings on a very excitable young woman, I shall leave undetermined.

For myself, I have had frequent occasion to administer Platina, and have obtained the very best curative results in… phlegmatic women of lax fiber…. On critical review… we find that all or by far the greater part of its symptoms bear the character of depression, but not that of erethism...”

And by the way, in case you were wondering:
er·e·thism  
/ˈerəˌTHizəm/

Noun:
1. Excessive sensitivity or rapid reaction to stimulation of a part of the body, esp. the sexual organs.
2. A state of abnormal mental excitement or irritation.

http://pandwisrael.wordpress.com/2013/07/29/viewed-through-proving-platina-tamed/

A thought on Miasms expounded (Background information for the Mallorca Seminar).

 20130125-114718 (1) Disease is due to the presence and infection in the living body of morbific or hostile agencies: Hahnemann calls them miasms and modern  medicine calls  them toxins, bacterial or otherwise.

  (2) The state of illness so produced could only be cured by the reaction of the body itself.

  (3) The sick state is one affecting the body as a whole rather than an isolated part or organ.

  (4) The sound and sensible way to assist  the body in its efforts to cure itself, is to provide it with a specific vital stimulus, or in other words (in the  light of modern medicine) to boost the body’s natural defences.

   (5) That this could  be  done,  perhaps  only  be  done, by applying the “Law of Similars” or in the language of modern medicine,by applying the principle of immunology, that what a toxic agent would cause, that same agent, in suitable form and dosage, could also cure.This is a physiologically reasonable hypothesis. The introduction of a drug or a foreign agent into the body induces a tissue reaction  and  response: this reaction carried to a certain degree will produce symptoms as the result of altered cell-activity and disturbed function. This  alteration in tissue activity can be corrected and the disturbance of function can be reversed, provided the changes have not proceeded too far, by the enhanced reactive capacity of the body itself. Modern research in the animal and plant physiology has demonstrated again and again that a variation in stimulus can produce  exactly opposite  effects, facilitation in place of inhibition, hyposecretion in place of hypersecretion.

filename-dscf3507-jpgHahnemann in his penetrative  wisdom and intuition forestalled the findings of present day research. He said,in effect that the body became sick because its defence forces were fighting a losing battle and he applied the principle of immunology, the  law of similars to cover the whole range of drugs and substances available for medical  purposes.

(6)  The efficacy of similar remedy  is concerned primarily with living pathology, the  disturbed state of the body metabolism as a whole rather than with “isolated findings”  provided by the laboratory or post-mortem table. However these latter are welcome when relevant and by no means to be despised or discounted.

(7)  Indicators of basal sick state are symptoms in their entirety which provide more than a symptom complex to which can be appended a  diagnostic label. They arc the manifestations of and an indicator  pointing to the deviation from the normal function that is causing the sick state of the body. The actual changes associated with this early deviation from the normal functions, may be extremely difficult of detection and consist of:

(a) changes  in the electro-physical or para physical potentials,

(b) changes in enzyme activity,

(c)  changes in vibratory wave-force,

(d) changes in a sphere as yet poorly understood;the sphere of the invisible or non visualisable vital dynamics.

(8) vital reaction.

It is undoubtedly inherent in all living tissues as the capacity to maintain life and defend that life against the harmful effects of hostile agents.  The introduction of a toxic agent into the body stirs up  this defensive reactivity.

(a)  If the reaction is adequate, no damage or at least transitional damage is effected.

[b) If the reaction is inadequate from one cause or another: A sick state of the body will be induced and become apparent sooner or later in the shape of symptoms of which the sick person is aware. These symptoms are evidences of something wrong: they constitute the outward and visible or observable signs of an inward metabolic disturbance. In the absence of  any more satisfactory means of detecting early and occult tissue changes  these symptoms may assume a very poignant therapeutic significance.

(9) The primary aim of all adequate therapy is to assist internal reactions of the body and  to co-operate with nature and not coerce  nature and  possibly interfere  with vital functions, and at the same time certainly not merely to control symptoms at the risk of inducing fresh tissue damage and further disturbance of the metabolic balance.

(10) The cells and tissues of the body are delicate and easily damaged;  the finely poised balance of vital functions, endocrine,  autonomic, bio-chemical, bio-physical is readily disturbed.

Drug therapy is always accompanied by the risk of drug toxicity,  by the unpleasant possibility that in obtaining relief from  symptoms, often  only temporary relief, the underlying basal sick state may be left unchanged or may even be aggravated Never perhaps, was this  more the case than at the present time when the drug-market is being constantly flooded with a deluge of new remedies,  for the most part synthetically prepared and often of very questionable character both as to efficiency and harmlessness. This is a  state of affairs fraught with much frustration and perplexity for the physician  and also with serious menace to the sick.

(11) Holistic attitude in medicine.Unfortunately many laboratory tests and pathological investigations only afford information on isolated bits and samples of morbid material. In the academic thrill of finding some abnormal state of blood, urine, marrow, C.S.F., or other  tissue sample, attention may easily be diverted from the vital question as to “what is going on and possibly going wrong in the body as a whole”::the whole sum of morbidity that constitute the sick state of the individual. When such findings are “post mortem,” as is often the case, they are obviously of meagre value as guide to accurate therapy in life.Treatment, aimed at or based  on the isolated bits of morbidity is, in the very nature of the case, likely to be unsatisfactory and inadequate, it may even be harmful as tending to further metabolic upset.

(12) It  is indeed becoming more and more  apparent that what  should be our chief concern is the nature and extent of the reaction in the cells and tissues of the body as a whole, For it is these changes and alterations in reactivity possibly without any observable alteration in structure that constitute the basal pathology responsible for the body’s state of disease, distress and disability.

 

 

Viewed through proving: Bryonia – expect the unexpected

bryonia_albaViewed through proving: Bryonia – expect the unexpected

In a recent facebook post I asked readers where they would least expect to see the following symptom:

“It is intolerable to him to keep the affected part still, he moves it up and down.”

Understandably, most opted for Bryonia.  Of course.  We know of Bryonia as the remedy for those who have to keep completely still.  For those who are so sensitive that even if you jar their beds slightly they go into paroxysms of whatever they are suffering from at the time.

It is true that when symptoms agree, Bryonia will be relevant in this need to keep still.  Rhus Tox will be relevant in the need to move.  However, to quote from Porgy and Bess – it ain’t necessarily so.  The above symptom appears as symptom 593 in the proving of Bryonia.

Hahnemann writes about this possibility in his introduction to the proving of Bryonia:

The similarity of its [Bryonia’s] effects to many of the symptoms of Rhus Toxicodendron cannot fail to be noticed; in the preface to the latter medicine I have sufficiently dwelt upon this. At the same time Bryonia affects the disposition quite differently, its fever consists chiefly of chilliness, and its symptoms are mostly excited or aggravated by corporeal exertion, although its alternating effects, when the symptoms are relieved by movement, are not very rare.

Hence, when using Bryonia in diseases, there occur cases where the remedy, although chosen as homoeopathically as possible and given in sufficiently small dose, does not render adequate service in the first twenty four hours. The reason of this is that only one, and that the wrong series, of its alternating actions corresponded. In such cases a fresh dose administered after twenty-four hours effects amelioration by the production of the opposite alternating actions. …. This happens with only very few other medicines having alternating actions (vide the preface to Ignatia), but it occurs not rarely with Bryonia.

Rhus Tox and Bryonia are very similar remedies.  This is often overlooked in the way the “better/worse for movement” issue is emphasized by so many.  I have a case at present where I gave Rhus-Tox but it would have been easy to give Bryonia instead.  The differential between the two in this case (which I’ll write up in the future) rested on other modalities and symptoms, not on anything to do with movement.

Although Bryonia’s symptoms are mainly worse for movement or exercise, you can have cases where the patient will be better for movement and all other symptoms will be pointing to Bryonia.  And Bryonia will be the right remedy.

But because Bryonia is one of a group of remedies, which includes Ignatia and Rhus Tox, which produce alternating effects, the first time you give Bryonia, you might get no positive response, no action.  This is because the “flip side” of Bryonia’s actions was called into play, which may not have had relevance to the symptoms.  Hahnemann recommends giving a second dose after 24 hours to call up the alternating process, and bring improvement through the right set of symptoms.

It’s always important to be certain of the prescription, but especially where remedies with alternating actions are concerned, as it may often be necessary to prescribe a further dose of a remedy that does not seem to be helping, and it’s essential to understand the reason why it is not helping.

And with Bryonia, Hahnemann tells us, this can happen quite often.  It is certainly not rare.  Forewarned is forearmed!

I.H.M. senior homoeopathic Practitioner Vera Resnick

http://pandwisrael.wordpress.com/2013/06/26/viewed-through-proving-bryonia-expect-the-unexpected/

INDIVIDUALITY AND PERSONALITY in homoeopathic terms. Things to consider as background to the Mallorca Seminar.

p1

(Click here for a link to the Mallorca Seminar)

The word “Individuality” is derived from the Latin root, “individuous”—in (not) dividuus (divisible). The indivi­dual is unique, not further classifiable—it is what it is. An individual is that which is indivisible, indivisible not in the sense that it is incapable of being divided into parts but that it cannot be so divided in its nature and remain what it is. Essentially an individual is one—not as the numerical concept of the one but as the Greek “monas” or unity and by virtue of its oneness is distinct or simple. Individual is a distinct and indivisible entity, uniting within itself, all possible modes of unity-unity of intrinsic form, cause, pur­pose and action.

Human individuality is the state or condition of subsist­ing as an individual in terms of persistent self-conscious identity. In the process of the emergence of con­sciousness there is formed out of mental, vital and physical experience, an integrating core, a centralisation of surface-consciousness. It is this integrating core of conscious experi­ence which is the ego of a particular being and it is the practical constitution of consciousness which is referred to in common parlance as individuality.

Individualisation is the highest expression of existence just as, Personality is the highest expression of individuality. Instead of an unformed and unconscious mass, one has to become consciousness, cohesive, individualised, that which exists by itself and in itself, independently of its surrounding that which can hear, read, see anything and will not change because of that. It receives from outside only what it wishes to receive. It rejects automatically what does not agree with its purpose, nothing can leave any impression upon it, unless |t wishes to have the impress. It is thus that one begins to be individualised.

What is the underlying reason behind the appearance of this individual variety in spite of individuals being capable of being grouped in classes? The answer comes from a master mind—Each man belongs not only to the common humanity but to the Infinite in himself related to the master mind and is therefore unique. Infinite is capable of producing infinite diversities in unity; and unity in diversity seems to be the master plan of creation. The concept of individuality leads us to the concepts of personality and constitution. Personality, the highest expres­sion of individuality, is a pattern of being marked out by a settled combination of fixed qualities, a determined character. This term, personality is also used to express the continuance of a person’s distinguishing qualities, of one’s personal identity in spite of bodily and mental changes. It is because of this individual personality we come across with individual con­stitution which is manifested by the inherent tendency to respond automatically along certain qualitatively predeter­mined characteristic response-patterns in identical situations. Constitutional differences are differences of these response-patterns compared in identical situations. In other words, constitution is that aggregate of hereditary characters influenced more or less by environment which determines the individual’s reactions, successful or unsuccessful, to the stress of environment.

As homoeopathy is based on individualisation of diseased persons and drugs it has to take note of the concepts of in­dividuality, personality and constitution, but always taking into account the group aspect of location, sensation, modalities and concomittance.

 

 

Hahnemann’s concept of Illness. (Background thinking for the Mallorca Seminar)

palma roomHahnemann’s concept of Illness

(Click here for details of the Mallorca Seminar)

Hahnemann believed that the signs and symptoms of a case of illness represented an attempt by the body to heal itself. According to this view, the signs and symptoms do not represent the illness, but rather the reaction of the person to his illness. The illness and the reaction to illness are separate. Therefore Hahnemann reasoned that physician should administer that medicine to the patient which produced in the healthy signs and symptoms similar to those of the patient. In this manner the natural attempt of the body to heal itself would be re­inforced, rather than neutralised or interfered with. Hahne­mann called this treatment of illness with medicines which produced in the healthy symptoms similar to those of the ill>Homoeopathy (Homois: Similar; Pathos: suffering).

Nature of Cure in illness

If an ill person receives no treatment, he either dies, remains chronically ill or recovers. If he recovers, his pattern of re­covery is like that of all sick persons and separate from his particular disease. As people become ill, old symptoms of previous illness often reappear. The symptoms move from non-vital organs, like the nose and throat, to more vital organs, like the kidneys and lungs. Then there is a period of crisis. Following this crisis, one by one and in reverse order of their appearance, the symptoms move from vital to less vital organs until the patient is well again. This natural response is called auto therapy.

Under homoeopathic treatment an identical response usually follows, rather than the abrupt disappearance of symptoms or the introduction of new symptoms which often follows other types of treatment.

Homoeopathy, from its inception has been based on an inclusive, descriptive attitude towards the patient and the medicine and the response of the patient is equally inclusive in relation to the natural course his illness would have taken without treatment. After he has made his initial, descriptive inclusive analysis of the patient and the medicine, the homoeopathic physician may then indulge in analytic specula­tion. Throughout the 19th century until the present time the majority of scientists have been analytically oriented after accepting as relevant only the information which fits within their particular scheme. In contrast to this Hahnemannian approach to science was pre-Newtonian. It was the same, non-mechanical, descriptive manner in which Cuvier described the botanical kingdom or Dana, the mineralogical world. Or at the other end of the time-scale the same manner in which the present-day physicists are following up Anderson’s discovery in 1938 of sub-nuclear particles and of the fourth great revolution in physics of the world of sub-nuclear energies.

An ultra-mechanistic view-point is characterised by the usual mechanistic concepts, and in addition, it also includes at least the acceptance of a causal, unpredictable, unstable phenomena whose wholes are greater than the sum of their parts. The observer must attempt to be completely inclusive and unbiased in his approach to a field of interest. He must accept the totality of the relationships that make it up. This total approach is called “Holism”. As a result of a total or holistic view of all the phenomena in a field, certain data may be found to co-exist with each other. Jung calls the temporal co-existence “synchronicity”.

Let us now consider the application of this ultra-mechanistic view point in the field of modern physics:

The skeleton of the physical universe in the 19th century was considered to consist of six unrelated functions, viz., 1. Space; 2. Time; 3. Matter; 4. Energy; 5. Gravity; 6. Inertia.

Over a period of 50 years Einstein gradually related each of these functions with each other by means of ingeniously derived formula e.g.,

 (a)      Integration of space and time in his conception of fourth dimension.

 (b)      Matter and Energy are interchangeable as evident by the equation: Energy =mass x velocity of light squared (by application of Planck’s Quantum Theory to the transmission of light).

(c)   In Einstein’s special Theory of Relativity he showed that space-time-energy and Matter are interchangeable, e.g., Mass of a body is a function of its motion. At the speed of light a body would have no weight at all. .

[d] In his gravitational field physics theory Einstein showed that all matter is surrounded by a gravitational field and that inertia is a function of this field. From this it follows that the space is curved, since matter travels in response to this curved field pattern.

(e) Shortly before his death Einstein announced his unified field theory in which he attempted to unite all six com­ponents of our universe in one continuum.

The new physics is concerned with specific, discontinuous energies which are basically uncertain and within certain relative areas are woven together in an acausal, unpredictable manner throughout a space-time-matter-energy-gravity-intertia continuum. It views the universe in an ultra-mechanistic, holistic, descriptive manner.

Homoeopathy is also concerned with the specific, discon­tinuous action of dynamized sub-atomic energies whose action is uncertain and statistical rather than analytic.

The homoeopathic approach to the patient and medicine is descriptively inclusive and holistic.

In future, homoeopathy may take its place as a pioneer approach in medicine toward a therapeutic psycho-somatic synthesis.