My initial thoughts when I heard the term ‘constitutional remedy’ were that this represented homeopathic nirvana; one remedy, which given in the correct dose would reach the heart of a case enabling the patient to be well. I felt that this one remedy would subsequently be administered to take care of any future problems for the patient should they arise. Trying to obtain this nirvana placed me under a great deal of pressure and the worries of getting it wrong weighed heavily when it came to the clinical practice of choosing remedies.
Working in an acute clinic, where constitutional prescribing is not expected, I learnt that often a person’s essential constituent or characteristic can change to reflect major event changes in their lives. Each week the clinic deals with women who are making striving leaps forward in understanding their health holistically. These women often start with deep seated fears, worries, anger and imbalance in their lives; but what is common to them all is their desire to find a holistic solution to increased wellbeing.
It often transpires that as individuals’ reach greater understanding of their experiences even though fears, worries and anger are still part of these womens’ life experience, the way in which they are expressed changes. It is as though there is a loss of self when we first see these cases and through homeopathy working alongside other integrated health provisions there is gradual recovery with a growing sense of self. Initially the core characteristics of these women are so influenced by the experiences which have led to their ill health that they are overwhelmed and unable to find who they are separate to their disorder. These cases may require one remedy at one time and another to address the presenting symptoms at a different time when life changing events have had an impact on the individuals developmental process.
The experience of seeing acute cases unfold to reveal changing constitutional characteristics and the administration of remedies appropriate to the presenting state relieved the pressure of missing the ‘one and only, right’ constitutional remedy. It also indicated that my initial belief of a constitutional remedy curing all symptoms throughout a case placed me in danger of fitting an individual into a particular remedy picture when in fact an individuals changing experience is much broader and complex than one remedy can sometimes encompass.
My experiences with the student clinic were completely different to those at the acute in that a more complete case history is taken over the time allotted. In the student clinic there is more time to become familiarised with a patients general demeanour and to get a feel for their overall characteristics. Even though a patient may initially be overwhelmed by their ill health there is a continum of time to be able to focus on opening the case up enough to understand the more inherent factors. Being able to delve deeply into a case in one consultation elicits comonalities in response, thought process, self talk and expression to differing situations. These comonalities form characteristics which belong to the patient at that time and can provide valuable indicators during remedy choice.
Case DH – Male aged 43
Main complaints: severe chronic rhinitis; chronic lower back pain; chronic fatigue; depression and anxiety; psoriasis and haemorrhoids; seasonal affective disorder
- DH believed himself to be nat mur and had self prescribed this remedy over some time. His main concern was his rhinitis and said this was what he wanted help with the most. He spoke very slowly, considering every reply as he systematically worked his way through his disorders in a clinical manner. He felt a great deal of fatigue over all his symptoms and this echoed in his movements, his speech, and sighing which he did frequently. Commonalities came through regarding his sensitivity and disillusionment over worldy change and a belief that people in positions of power are untrustworthy. His political/campaigning thoughts and his feelings about the poisoning effects of stimulants and toxins also echoed throughout the consultation.
Nose – inflammation – inside;
Nose – discharge – eating while;
Nose – coryza – morning;
Nose – coryza – air – open – amel;
Mind – speech – slow;
Mind – sensitive – external impressions, to all.
Nux Vom LM1 was administered
All the remedies covered the physical symptoms of the case however nux stood out regarding the characteristic features of DH’s personality and mind-set at the time of consultation.
The typical Nux appearance tends towards tall, slim, wiry physique with angular sharp features and penetrating eyes, which was very much like DH when he opened his eyes to look at me during consultation. Much like the nux picture DH suffers when chilled, catching cold easily, is worse in the mornings and in the winter preferring to try and maintain his body heat by covering up with thermal underwear. His rhinitis is worse for coffee and tobacco and his mental state is sensitive to noise and tends to become exacerbated by lack of sleep, he also stated that whilst trying to give up smoking he couldn’t sleep and smoking helped with this so he returned to the habit from need rather than desire. The campaigning vigilante type personality is also very marked in nux which Bailey describes as the true warrior. He states that success is not enough; it is winning that gives meaning to life. This feels so true in DH’s case who states that he lost his sense of himself with the failure of the Socialist Party, however regardless of this failure he continues to fanatically strive with his own agenda for the world he wants to live in. It remains to be seen if DH has a tendency towards the violence that can be characteristic of nux, however it feels that the core coverage of both physical and mental/emotional symptoms are very marked in nux
Phosphorus has an affinity with the mucous membranes, is worse for changes in weather and mental fatigue and has a tendency to be easily impressionable from external impressions. They are sensitive to their surroundings and atmosphere and can become easily fatigued. However their fatigue can lead to indifference from a usually excited and animated state which does not fit fully with the picture that DH presents. Feeling more gifted than others as DH explains from his childhood does come through in phosphorus however it comes from a place of self love and a tendency towards narcissism whereas DH mentioned this as a matter of fact and did not dwell upon this thoughts as he seemed to feel it was perceived as an obstacle in the eyes of others. Like DH, phosphorus individuals feel very strongly and are very sensitive however there is innocence present in phosphorus which tends towards irresponsibility and an avoidance of reality, to the point of not getting involved in matters that require commitment and depths of attention. This does not come through in DH’s picture as he has a tendency towards commitment to causes which he feels strongly about.
DH’s physical appearance was very much what would be expected of a lachesis, with slight build towards being bony and sharp facial features. Lachesis is also better for the open air, worse in the morning and for suppression much like DH when trying to not spit his mucous out can lead to vomiting. However the general excitable character of lachesis with a sharp witty tongue, overactive mind and egocentric tendency does not fit the picture that DH presents. This type of character makes the fanaticism and suspicion that both lachesis and DH share come from a different internal sense making the remedy not quite right in this case.
Thuja displays the fixed ideas and tendency towards fanaticism that comes through in DH however the obsession in thuja can tend to be of a selfish nature to the detriment of others which does not echo DH. Although there are some thuja traits such as suicidal depression and being vague and evasive in the consultation situation that come through DH was fine about disclosing his inner truths and did not come across as manipulative or aggressive in order to protect the information given.
This remedy is for those people who are exhausted and run down which runs through DH’s picture however they are brought out of this by physical exertion which is in contradiction to DH’s picture, where physical exertion exacerbates his symptoms of chronic fatigue. Sepia will also be worn out from having too much to do and will feel indifferent to those around them whereas DH is worn out from having campaigned and does not become sulky and indifferent tending more towards disillusionment than irritability however the anger and distrust he feels towards those in authority does come through strongly.
This remedy is for those people who are worn out and exhausted which echoes through DH’s picture however they dislike fresh air and are worse for walking in the fresh air which does not fit with the picture presented. People needing cocculus tend to be uncommunicative and although DH spoke slowly he was very communicative commenting towards the end of consultation that he tends to talk too much. Oversensitivity runs through cocculus however it is from a want to compromise after feeling hurt or insulted whereas DH is oversensitive from not wanting to compromise his feelings.
Although I hadn’t repertorised all DH’s complaints I had them in the back of my mind when I looked at the remedies. I had however added rubrics to cover the commonalities he displayed throughout the consultation which covered the more constitutional characteristics of the case.
Homeopaths disagree about the use of constitutional characteristics; some say that a persons constitution is their healthy state and something not to be prescribed upon. The main argument being that we prescribe on the presenting symptoms, not on constitution so how do we know we are prescribing a constitutional remedy rather than the simillimum to the disease picture. Others say that the constitutional remedy is the one remedy which works on a deep cellular level to bring the body and emotions back to a state of health and balance, by doing so it makes the whole system more resistant to disease and can be administered to clear any problem in that person in the future. I would argue that all remedies act in this manner whether prescribed constitutionally or acutely as the remedy administered benefits the patient most at that time by aiding the body to bring back a state of balance. Once a state of balance has been achieved there can be an essential change to indicate another remedy.
Another argument surrounds homeopaths like Hahneman and kent’s meaning when they used the term constitution. The debate centres on translation of original works and putting them into historical and cultural context. Aphorism 5 of the Organon shows Hahnemanns consideration of objective signs and subjective symptoms alongside predispositions in case taking. Here he shows that a study of the make up of the physical and mental character as well as the individual lifestyle and habits, domestic and social relationships, occupation, age and sexuality should be included in the case history. Kent’s writings show that he considered the individualised way the patient expressed the otherwise common symptoms of disease. However his usage of the term constitutional medicine was to describe remedies used to treat chronic miasms and chronic diseases so as to distinguish them from acute remedies which were used to treat crisis situations.
My thoughts on constitutional remedies had developed through attendance at both clinics. The acute clinic had shown me that the energetic expression of disorder can change over time and the student clinic had highlighted that regardless of this energetic expression there are inherent characteristics which are always present but may become more revealed with time. knowledge of a patients constitution helps to understand the characteristics that condition their disease state. Therefore remedies do not treat constitution, but constitution influences the forms of illness that we encounter and will therefore influence the choice of remedy to treat that illness.
David Little (2001) Constitution and Temperament