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Below is an extraction of the discussion regarding Aphorism 3.
Aphorism 3 is the crux of homoeopathy, encapsulating all elements of homoeopathic prescribing and case-management.
The three main points are as follows:
1. The physician must clearly perceive what is to be cured in every individual case of disease
2. The physician must perceive what is curative in each individual medicine
3. The physician must know how to choose the most suitable medicine, to give the proper dose with appropriate repetition
On looking in more depth at 1, 2, and 3, several elements become clear.
1. What is to be cured.
Hahnemann emphasizes that this relates to each individual case of disease. The homoeopath is not looking for named diseases, but for the individual expression of disease in each patient. In addition, the homoeopath must only take symptoms which are “undoubtedly morbid in the patient”. These are clinically observable pathological symptoms, clearly part of the individual disease state as expressed by the patient. Guesswork, assumptions and speculations have no place here.
Individual expression of the disease may be defined most clearly through looking at causation, modifying factors, and those symptoms which are peculiar to the patient in nature or severity.
Here we see how this first point in the aphorism presents the structure for using information gained from the patient regarding his background, possible causation or chronic elements related to lifestyle or medical history – Aphorism 5 – and the information regarding changes in his health, Aphorism 6, where the changed pathological symptoms are the center of initial case-taking and prescription.
Although the changed pathological symptoms presenting “the true and only conceivable portrait of the disease” central to the case, in chronic cases they may not be able to help us individualize the case enough to hone in on the most suitable remedies. While we will want all these symptoms to be present in the chosen remedy, we may not be able to use them in order to locate it.
Where the patient keeps getting sick, we must go back to Aphorism 5, to the patient’s medical timeline, to see if there is a miasm (i.e. the resulting symptom picture from having been infected in the past), if there is a pattern. It is possible in such cases that we will even take symptoms which are not currently present in the patient’s disease picture, seeing the patient’s symptoms over a longer period of time as one disease state.
2. What is curative in medicines:
Where knowledge of medicines and their qualities is concerned, it must be absolutely clear – substances do not produce disease. They produce states of disorder – artificial states of disease.
Just as we individualize the patient’s disease in case-taking, during study of remedies it is important to individualize the disorders produced by substances in provings. As with patients, the same tools come into play – causation, modifying factors, and individual expressions of disorder which are peculiar to the remedy, the anxiety in Aconite for example, or the glazed eyes in Belladonna.
3. Adapting what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient.
During this process, we are treating the individualized expression of disease in the patient, the morbid pathology. We are not treating a named disease. Here we must match that individualized expression in the patient, with a substance that can cause such a symptom pattern.
In Boenninghausen’s pointers on symptoms (Concerning motion and rest
Translated from the allg. hom. zeit., vol., 65, p. 141) he emphasizes the value of symptoms relating to movement and positions. If a person is aggravated on beginning movement, this narrows the case down to a small number of remedies. The same is true for aggravation on continued motion, or after motion. The differentiation is to be found within the modifying factors.
The prescribing symptoms used for this matching process are those that represent the state of the disease most clearly. This may be found through identifying modalities, as stated above, or through discerning an ongoing pattern with periodical disorders and recurring symptoms, or through a combination of both. Where particular modalities or pathological symptoms can be traced as recurring through the patient’s medical history, they are invaluable for prescribing.
Here are some more examples of this process.
If a patient is getting sick and exhibiting great anxiety, together with inflammation and perspiration, a fever may well be developing. Aconite will abort a developing fever, as the state as presented in the proving has apprehension and anxiety together with fever.
A patient has been diagnosed with measles, and is past the prodromal period. No substance will cause measles. However there are substances which will cause eruptions, fever, periodicity, discharges, and clinical observable mental states which are similar to the way in which this particular individual has been affected by this particular disease state. It is then necessary to look deeper and find the state which is strongly predominant in the individual, in order to locate the remedies in this group where a similar state is strongly expressed.
A patient presents with a sore throat, slight redness on the margins of the tongue, fever, glassy eyes and paleness of the face. This is an individual response to infection. Further examination shows intense redness of the fauces and tonsils with heat, inflammation, fever and lassitude. This state is peculiar to Belladonna, which will also be modified by aggravation from swallowing. In this case, we are individualizing the disease and individualizing the drug which produces the state. Although the sore throat is presenting, it is all the other information which enables us to come to the appropriate remedy. The sore throat in Belladonna is a result of its direct effect on the mucous membrane.
In another example, the patient is (apparently) a quiet, peaceful person, suffering from cancer of the stomach. In further conversation it emerges that the patient has has suppressed emotions relating to major life events, in order not to upset others. In keeping their feelings pent-up, such patients poison their own bodies. Although the clinical diagnosis is cancer of the stomach, the mental state here is also morbid, if not causative. Based on clinically observed symptoms, Natrum Mur will be one of the prescribing options.
Long-term chronic cases present the greatest difficulty, as causation usually cannot be used and the homoeopath must focus on the expression of the disease, often over many years. The patient may have experienced a series of ear infections, after which the disease locus may have moved to the throat, and then to the stomach. The entire history must be brought into play as these are all expressions of the same infection, termed “miasm” by Hahnemann. The current state before you is not sufficient, as it is the result of a progression which brought the patient to that particular current state.
On examination of long-term chronic cases, a symptom may suddenly fall into focus as having appeared in every disease state experienced by the patient – no matter what disease they are suffering from at the time. For example, some patients, in every disease state, suffer from left-sided symptoms. This modality must then be understood to be characteristic of the patient’s entire disease state, not just the current disorder.