Modern Homoeopathy

Monthly E- Newsletter August 2008

Heringís Preface to the Chronic Diseases (1845)


Dr. David Little

Dr. Heringís Preface to the 1845 American Edition
of The Chronic Diseases, Translated by Dr. Hempel

(The following article has been kindly furnished by Dr. Hering of Philadelphia, In German. The Editor is responsible for the translation.)

"Hahnemannís work on chronic diseases may be considered a continuation of his organon; the medicines which will follow the present volume may therefore be considered a continuation of his Materia Medica Pura. As the principles and rules of general therapeutics have been developed in the organon, so does Hahnemann develop, in the present treatise, the principles and rules which ought to prevail in the treatment of chronic diseases, whose name is "legion." In the Materia Medica Pura Hahnemann describes to us the symptoms which the general remedies that he tried upon healthy persons, are capable of producing; the present treatise, on the contrary, will be succeeded by an account of those remedies, which Hahnemann specially employed in the treatment of chronic diseases, which he therefore called "anti-psorics". In the Organon Hahnemann tries to establish the fat that the principles "Similia Similibus Curentur" is the supreme rule is to be followed in the treatment of diseases; whereas in his treatise on chronic diseases, which is based upon the organon and does not, in the least, modify or alter its teachings, Hahnemann shows that most chronic diseases, originating in a common source and being "related amongst each other, a special class of remedies designated by Hahnemann as anti-psorics," should be used in the treatment of those diseases. This common source of most chronic diseases, according to Hahnemann is Psora."

Comments: The Organon and The Chronic Diseases are companion volumes which offer a complete view of the Homoeopathic healing art. The Organon establishes the supremacy of the law of similars, Similia Similibus Curentur and emphasis the maxim "if the symptoms are removed Ė the cause is removed". The Chronic Diseases emphasizes the use of anti-miasmatic remedies and the maxim Cessante Causa, Cessant Effectus Ė If the cause ceases the effects cease. In the Organon Hahnemann stresses the signs and symptoms while in The Chronic Diseases the Founder highlights the aetiological constellation and causation. In this way, these companion volumes are complementary opposites that form the functional polarity of homoeo-therapeutics.

In the 1st through 4th edition of the Organon the Founder taught that the cause of most diseases was usually a mystery that lay beyond the observations of the healing artist. He also thought it was very difficult to understand the inner working of disease process in any reliable manner. This he made clear in aphorism five of the 4th Organon.

"It may be conceded that every disease is dependant on an alteration in the interior of the human organism. But this alteration is only be guessed at by the understanding in a dim and illusory manner from what the morbid symptoms reveal concerning it (and there are no other data for it in non-surgical diseases); but the exact nature of this inner invisible alteration cannot be ascertained in any reliable manner."

Organon of Medicine, 5th & 6th Edition, Hahnemann, Dudgeon & Boericke Editions, Appendix, 4th Organon, Aphorism 5, page 183.

In his early years Hahnemann taught that principles of similia and individualization were sufficient to treat all cases of disease. At this time, Homoeopathy was the simple matching of the symptoms of the patient to the symptoms found in the materia medica. This central doctrine was introduced to rebut the obsession of the orthodox school with removing their one-sided version of the "total cause", which was usually related to a disease material somewhere in the body. In its place the early Organon taught the importance of removing the totality of the symptoms of each individual case. It was Hahnemannís failure to permanently cure chronic disease that caused him to reassess his clinical approach. This led to an eleven year study of chronic disease that produced a fundamental change in his views of etiological factors as well as the how he view the signs and symptoms. As early as The Medicine of Experience (1805) he discussed the need to study causation but he did not see the bigger picture until the 1830s.

The 5th edition of the Organon presents a radical change in Hahnemannís views of causation and the process of pathology. This is most obvious in the changes he made to aphorism 5 of in 1833. This paragraph includes the ramifications of his prolonged study of causation, constitution, character, disposition, susceptibility, miasms, and collective disease states.

"Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the complete history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration."

Organon of Medicine, 5th & 6th Edition, Hahnemann, Dudgeon & Boericke Editions, 5th Organon, Aphorism 5.

This aphorism contains many of the breakthroughs first published in The Chronic Diseases in a nutshell. In the 4th Organon causation, and the pathological process of disease, were something that lay outside human observation. In the 5th Organon it was necessary for the homúopath to understand the exciting causes of acute diseases as well as the complete history of a chronic illness to ascertain its fundamental cause, which is often due to the miasms. Hahnemann now classified his remedies into two great categories, the apsoric and anti-psoric medicines.

The anti-psoric remedies are those medicines which have the potential to remove the entire syndrome of the psoric miasm because they are similar to its entire disease process in its human sufferers. In order to remove all the symptoms of a chronic disease it is necessary to remove its cause. If only one aspect or another of the underlying disease state is treated the illness will either be suppressed or palliated. When the leaves and branches of a weed are cut without removing the root the weed only grows again. In the same way, if the root of the miasm is not removed the symptoms will surely return.

Dr. Heringís preface continues:

"The shallow opponents of Homoeopathic (and we never had any other!) pounced upon the theory of the psoric miasm with a view of attacking it with their hollow and unmeaning sarcasms. Making Psora to be identical with itch, they sneeringly pretended that according to Hahnemannís doctrines the itch was the primitive evil, and that this doctrine was akin to the doctrine of the original sin recognized by the Christian Faith*."

[This statement of Heringís is accompanied by a note from the editor, Dr. Hempel.]

*Note of the Editor: "I beg pardon of my distinguished and learned friend for annexing a few remarks to this passage. In doing so I merely anticipate what I intend to express more fully on this subject some other occasion."

"As it would be absurd for a philosophical Christian to reject the doctrine of original sin, so it is absurd for any one who professes to have a clear perception of Homoeopathy, to reject the doctrine of an hereditary morbific miasm. Both these doctrines must stand and fall together; and, as truth is one and indivisible, they both hold and illustrate each other. If we admit with Rousseau that every thing which leaves the hand of God, is perfectly holy, then the first created man must have been perfectly pure, and must have appeared in the image and likeness of his maker. It seems to me absurd to suppose that something perfectly pure can, of itself, by its own free and orderly development, produce things impure and evil. We do not know how far God permitted an adaptation to evil to co-exist in the first man together with an adaptation of goodness. But this we certainly know that evil fruits must be the results of evil forces. In a certain moment man, or God through man, permitted the adaptation to evil to prevail in his nature; and instaneously the forces of evil, be they called the serpent, devil, or otherwise, invaded manís nature, engrafted themselves upon it, and have, up to this moment, perpetuated their existence in it. This is relatively speaking, a fall, although, this fall, having been the first necessary phases of human development, it may, in reality, be considered a progress. Manís destiny consists in reuniting himself again with the Divine Life through the universal expansion of all the facilities of his soul, and the realization of all the celestial harmonics in the germ of which God had depositi8ed in his nature, and towards the construction of which science and art will furnish him the means. The principle of division or dissolution which man had suffered to be introduced into his spiritual nature, must necessarily have embodied itself in the corresponding principle in the material organism. It is this principle which Hahnemann calls Psora. In proportion as manís spiritual nature becomes developed and purified, this psoric miasms will be diminished, and will finally be completely removed form the life of humanity. This complete physical regeneration of human nature will necessarily be attended with great changes in all the external relations of man, education, mode of laboring, living, etc., etc.

The principle of division or dissolution existing in the human organism as an established and constituted fact, does not preclude the possibility of this organism being invaded by acute miasms. The psoric principle marks the general adaptation to evil, recognized and inherently received by the human organism by the forces of evil which I have named subversive forces in my preface. Those sudden invasions could never have taken place without man having first admitted the psoric principle to be constitutional in his organism."

Comments: The above note by Hempel contains a number of interesting statements that related directly to the development of Homoeopathy and the teachings of later masters. First of all, it points to the Deist teachings of Rousseau, the great French philosopher of the 18th century. Samuel Hahnemann was taught the works of Rousseau by his father from his youth and Deism continued have a great influence on the Founder throughout his entire life. This is confirmed in Hahnemannís private letters, and the Deist teachings found in his written works. Rousseau pointed out that far from human beings being essential "evil"; they were based on a perfection that proceeds from the Godhead. This perfection is a reflection of those who were made in the image of the loving Creator. For this reason, there was a time when human beings lived in accordance with Godís laws and experience a life of harmony. This period is symbolized by the archetypal Garden of Eden and the early part of the story of Adam and Eve.

What led to the fall of humanity and how did disease enter the human organism? Free will is a gift instilled in human beings that allows them to act as independent creatures for better or worse. The actions of human beings have a direct relationship with the condition of their internal and external environment. The fall, however, is a natural part of the evolution of human beings so that they eventually use their own free will to seek to reunite themselves with God and live in tune with the laws of nature. Right thinking, proper diet and a balanced life style are conditions that perpetuate a harmonious state of health while wrong thinking, bad food and unhealthy habits lead to a fall into the state of illness.

Such ideas bring one automatically to the subject of the susceptibility to disease as part of the aetiological constellation of the illness itself. In The Chronic Diseases Mental and emotional stress, improper diet, unhygienic practices, and poor living and working conditions are situations that potentiate the susceptibility to psora, as well as ignite the flare up of latent psora in those who are relatively healthy. Hahnemann also noted that psora can be a heredity disease and effect the vary make up of the human constitution and its susceptibility to disease in general. The condition of the congenital constitution and acquired miasms also forms the basis for a personís susceptibility to acute illness and miasms.

James Tyler Kentís Lectures on Homoeopathic Philosophy echoed a similar vision of the origin and the fall of humanity and its relationship to chronic diseases. Boenninghausen taught that innate predispositions were the proximate cause and that the fundamental cause was psora. Although the psora stems from prior infection, its ramifications go back to the ancient of human days, and have affected the constitution of the entire human race.

"Psora is the underlying cause, and is the primitive or primary disorder of the human race. It is a disordered state of the internal economy of the human race. This state expresses itself in the forms of the varying chronic diseases, or chronic manifestations. If the human race had remained in a state of perfect order, psora could not have existed."

Lectures on Homúopathic Philosophy, James Kent, Chronic Diseases, Psora, page 146.

James Kent did not teach that psora was the original sin. This term originated in Hering and Hempelís debate with the critics of the psora hypothesis. He was careful to point out that the fall from the state of perfection was the proximate cause that produced the susceptibility to psora and the other miasms. About the deeper aspects of the genesis of disease James said:

"It is altogether too extensive, for it goes to the very primitive wrong of the human race, the very first sickness of the human race, that is the spiritual sickness, from which first state the race progressed into what may be called the true susceptibility to psora which in turn laid the foundation for other diseases."

Lectures on Homúopathic Philosophy, James Kent, Chronic Diseases, Psora, page 146.

The fall of humanity from perfection is based on an ethical decline but hitting the external ground is psora, the mother of all miasms. From this tainted soil springs the predispositions to all the other chronic miasms. From this time the "sins of the fathers have been passed on to the sons through the generations". James Kent preserved many older teachings and passed them on to a new generation in the late 19th century before they were lost. This includes Hempelís discussion of Rousseauís teachings and the origin of disease, the doctrine of heredity and the miasms, and Heringís laws. Although Hahnemann stressed the fact that psora was based on prior infection he did acknowledge that this miasm could be inherited as well as acquired.

Hahnemann elucidated the moral causes and physical causes of disease in the first paragraph of the Introduction of the Organon.

"As long as humanity has existed, people have been exposed, individually or collectively, to illnesses from physical or moral causes. In the raw state of nature few means of aid were needed, since the simple way of life admitted but few diseases. With civilization, however, the occasions for falling ill, and the need for help against diseases grew in equal measure."

Organon of the Medical Art, Hahnemann, OíReilly 6th Edition, Introduction, page 8.

As long as human beings have walked this planet they have suffered individually and collectively from disorders produced by physical and/or ethical causes. The Founder acknowledged the ethical, moral and spiritual aspects of the human decline and emphasized the universal vision of the original Deists. The sufferings of a individual human organism is based on a unique aetiological constellation while the suffering of homogeneous groups are caused by diseases of common origin and similar symptoms. Hahnemann developed an advanced aetiological doctrine that included both individual and collective causes of physical and mental character.

Psora and the other chronic miasms are universal disorders of a collective nature that were originally spread by infection, but they have now ingrained themselves so deeply on the human condition over millennia that they now affect the make up of all humanity. The pathogenic effects of natural disease have been compounded by the strain produced on the human organism by improper medical treatment and the stress of modern civilization, rapid urbanization, overpopulation, environmental degradation and the breakdown of the family and loss of natural ethos. Although Hahnemann did speak of going back to "Eden", his approach to the psoric miasm was grounded in the realties of our present human condition. The simple natural life associated with the archetype of Eden is a paradise lost to a modern world of high stress, moral degradation, weapons of mass destruction and environmental calamity.

Dr. Heringís preface continues:

"With the same impudence with which they had, on former occasions, asserted, that Hahnemann rejects all pathology in his organon, they now asserted that he himself advanced a pathological hypothesis, and that the true which it contained was not new, nor the new true.

Equitable judges will not fail to recognize in this treatise on chronic diseases the same carefulness of study and observation which the great author of Homoeopathy has shown in all his other writings. Hahnemann had no other object in view except to cure. All the energies of his great should were directed to this one end. His object was not to overthrow pathology, although the pathology of his time has been set aside as a heap of foolish speculations, and has been replaced by other systems, that may perhaps suffer the same fate in fifty years; he merely contended against the foolish and presumptuous application of pathological hypotheses to the treatment of disease. He rejected and overthrew the foolish belief which had been driven like a rusty nail, into the minds of the Profession and, by their instrumentality, into the minds of the people, that the remedies should be given against a name, against an imaginary disease, and that the name of this imaginary disease indicated the remedy. Up to this day physicians have been engaged in accrediting that superstition. Whence should otherwise spring the desire which so many patients manifest, of inquiring into the name of the disease, as if a knowledge of that name were sufficient to discover the true remedy against the disease. Many patients are disconsolate when the doctor cannot tell them what is the matter with them. Do we gain anything by being able to say that the disease is rheumatism, dyspepsia, liver-complaint? Does it avail the patient any to be able to repeat his doctorís Ipse dixit "that he is bilious, nervous, etc.?" Do these words mean any thing definite? Are there yet physicians foolish enough to believe that their speculative explanations mean any thing? Des not every body acknowledge that they are mere igines fatui flitting to and fro upon the quagmire of the old decayed systems of pathology."

Comments: Constantine Hering rightly points out that Hahnemann did not refute the science of pathology but rejected the orthodox version of the study of disease which is based on various one-sided names such as dyspepsia, lumbago and neuritis. Although the physician must have a method to communicate with his patients who are in need of a diagnosis, Hahnemann suggested in the Organon they these conditions be described as "a kind" of dyspepsia or neuritis. What kind? That can only be ascertained by a study of the causes, signs, befallments and symptoms. One patient may be a Nux vomica kind and another Anacardium kind. Hahnemann jettisoned the unreasonable parts of orthodox pathology and replaced it with the homoeopathic pathology found in the Organon, The Chronic Diseases and those articles found in his Lesser Writings. Although todayís pathology has advanced greatly over the pathology of Hahnemann's as well as Heringís days, the reductionist view of disease has predominately remained the same. This mechanistic view of a human being focuses on the individual parts while it fails to understand the whole. It offers meaningless titles like "gastritis" which describes the inflammation of a part but says nothing of its causes and signs and symptoms, let only the concomitant mental and physical states that always accompany such a complaint. The treatment of such an "itis" is still the use of drugs that produce an opposite affect in the local area which merely suppresses the local symptoms and do not remove the cause. Misguided by Galen, who lived thousands of years ago, they still believe opposites cure opposites. All of this ancient confusion is carried out in the name of "modern science". Homoeopathy may be tailored to suit a wide variety of clinical conditions including those diseases which a cause can be deduced as well as those diseases that are idiopathic. For this and other reasons, Homoeopathy may truly be called De Medicina Futura.

Dr. Heringís preface continues:

"Hahnemann teaches that the remedies should be chosen according to the symptoms of the patient. The physician should be governed by what is certain and safe, not by that which is more or less uncertain and unsafe, and which is changed according to fashion. Both in the organon and his treatise on the chronic disease, Hahnemann insists upon the remedies being chosen in accordance with the symptoms.

It is not an easy matter to choose a remedy according to symptoms. This may be inferred from the manner in which tyros in homoeopathy and physicians of the old school, who come over to us, go to work. They constantly rely upon names, giving a certain remedy in scarlet fever, because some one else had found it useful; or a certain remedy in pulmonary inflammation, because it had been successfully exhibited upon a former occasion; whereas Hahnemann teaches that, because a remedy has help before, this is no reason why it should help again in a similar disease. The symptoms and not the name are to point out the remedy. This is also the case in chronic diseases. In the treatment of chronic diseases Hahnemann has been taught by experience to give preference to the anti-psoric remedies. This preference is not theoretical, and is constantly subordinate to the general principle."

Comments: There are those who come to homoeopathy without understanding the cardinal principles that make Homoeopathy a safe and effective medicinal system. These cardinal principles are based on the maxims; individualization, similars cure similars, the single remedy, potentized medicine and the minimal dose. When one or more of these basic principles is ignored Homoeopathy becomes progressively more dangerous. Many individuals are professing "new and improved" systems of so-called Homoeopathy that have more similarity with allopathy than Hahnemannís gentle healing art. The selection of remedies by one-sided causations, the names of disease and pathological conditions, as well as the use of mixtures is not uncommon. More subtle than this is the habit of prescribing medicines which one is familiar with or have work in the past rather than truly individualizing each and every case by the objective signs and subjective symptoms. It may not always be easy to select a remedy according to symptoms similarity, but it is the most effective method under most circumstances.

The Period Table, the Antipsoric Remedies,
and Heringís Laws

In part one of Doctor Heringís, Preface to the 1845 American edition of The Chronic Diseases, subjects related to the anti-psoric remedies and the general practice of Homoeopathy were introduced. In this section, Dr. Hempel offered an inspirational interpretation of Hahnemannís Psora doctrine in light of the teaching of Rousseau, one of the original Deist philosophers. Hahnemann was brought up on the teachings of Rousseau and was a confirmed Deist and Mason. The teachings of these philosophical systems had a strong influence on Samuel and form the basis of some of the views found in his medical writings. His affinity for these teachings is even more apparent in his private letters and records of his discussions with this friends, patients and colleagues. His religious, philosophical and medical views were predominately practical in the nature and based his on empirical observations rather than pure speculation or faith. For this reason, the Founder was careful not to let his metaphysical views get in the way of his scientific writings although he often refers to the role of Providence in the development of Homoeopathy. Hering also had a strong interest in the teachings of the Deist philosophers and the writings of Swedenborg. He also had the largest library of books written by Paracelsus in the Americas. In this commentary Hempel first proposes several ideas that we later witness in Kentís Lectures on Homoeopathy. It was Kent who is responsible for passing on the idea presented in the Heringís Preface to succeeding generations of homoeopaths. This includes what is now called "Heringís laws".

In the second part of our review we begin with Constantine Heringís discussion of the importance of the elements and minerals in the treatment of Psora and most universal diseases. This is followed by Heringís original rendition of the order of cure, a stirring call for homeopaths to work for the improvement of our art, and a final eulogy offered to Samuel Hahnemann.

Dr. Heringís preface states:

"Hahnemann has never said that the principle constituents of mountains, which are the most important materials in nature the metals for instance are the most important remedies for the cure of the most universal diseases. However, he has pointed out the oxydes or salts of ammonium, potassium, sodium, calcium, aluminium, magnesium, as the most important anti-psoric remedies. Hahnemann has said nowhere that the most important metalloids constitute the most important remedial agents although he has introduced sulphur, phosphorus, silicea, chlorine and iodine, in one form or another, as anti-psoric remedies. In selecting a remedy Hahnemann has never been guided by theories, but always by experience. He chose his remedies agreeably to the symptoms which they had produced upon healthy persons, looking at the same time their remedial virtues having been tested by practice. This is the reason why general views which have been expressed just now did not prevent him from admitting as chief anti-psorics borax and ammonium carbonicum, anacardium and clematis."

Comments: In the above paragraph Doctor Hering points out a most interesting fact most of Hahnemannís anti-psoric remedies come from the mineral kingdom and are based on the elements of the period table. This is not to say, however, the minerals can not be used in acute diseases and that plants are not effective in chronic conditions. The mineral constituents are the building blocks of the human body and form the basis of our physical structure. There elements may literally be call the "salts of life". It is not surprising that they play a central, although not exclusive role in the treatment of chronic diseases. Hahnemann, however, was not completely unaware of the essential role play by the minerals in the treatment of the chronic miasms. Hahnemann wrote:

"As a rule it was developed from their pure symptoms that most of the earths, alkalis and acids, as well as the neutral salts composed of them, together with several of the metals, cannot be dispensed with in curing the almost innumerable symptoms of Psora. The similarity in nature of the leading antipsoric, sulphur, to phosphorus and other combustible substances from the vegetable and mineral kingdoms led to the use of the latter, and some animal substances naturally followed them by analogy, in agreement with experience."

The Chronic Diseases Their Peculiar Nature and Their Homoeopathic Cure, Hahnemann, The Medicines, page 244.

Hahnemann was the first to study the similarity of the minerals to miasmic states as well as the complementary relationships of the remedies of the three kingdoms. The Founder taught the importance of "analogy in accordance with experience" in the study of the relationships of the remedies of the three worlds. When homoeopaths work in this manner they often uncover homogeneous relationships between individual medicines and remedy families found in the materia medica.

In 1828 Hahnemann published the theory of chronic miasms and a materia medica of anti-miasmatic remedies. The Materia Medica Pura contained 67 remedies of which only 16 are minerals, 47 are plants, and 4 are animal remedies. Of the 48 anti miasmic remedies in The Chronic Diseases, 32 are minerals, 13 are plants, and 3 are animal remedies. Of 28 new remedies introduced by Hahnemann between the years 1828-1839 there are 23 minerals and 5 plants. This is because the mineral remedies are at the core of the treatment of inherited and acquired chronic miasms. Hahnemann introduced the study of the three kingdoms (mineral, plant and animal) to the homúopathic materia medica. This has become an important aspect of contemporary Homoeopathy.

Dr. Heringís preface continues:

"Why, it may be asked, has a great number of homoeopathic physicians, neither recognized Hahnemannís theory of psora nor the specific character of the anti-psora remedies? Why have some even gone so far as to set the theory sneeringly aside, and to decry the anti-psoric as less trustworthy then the other remedies?

For the same reasons that the astronomical discoveries of our Herschel are doubted by people who have no faith in the discoverer, and are not able to verify his discoveries. To do this, knowledge, instruments, talent, care, perseverance, opportunities, and many other things are required. Not one of all these things can be found with those who are mere dabblers in practice, scribbling authors opposing their own opinions and imaginations to facts and observation.

Or, for the same reason that Ehrenbergís discoveries cannot be appreciated by those who have either no microscope, or who have one which is not good, or who have a microscope without understanding the difficult art of using it; or else who know how to use it, but do not use it with the same exactness or carefulness as Ehrenberg, who discovered in the chalk dust of visiting cards the shells of new species of animals, simply making the cards transparent by means of the oil of turpentine.

Or lastly, for the simple reason that physicians find it more easy to write something for print, then to observe nature; that it is more easy to impose upon people than to cure the sick, and because the greater number of physicians is affected with the delusion that things which they do not see, do not exist.

If such physicians succeed in effecting a cure, they are at once ready to boast of their exploits, whereas the cure the cure was due to Hahnemannís doctrine, to the remedies which he has discovered, to the research of other physicians, to their instructions or examples, or to so-called chance. But if they do not succeed they impute their failure to anything but themselves: It is homoeopathy that is deficient; this or that rule is not correct; the materia medica is at fault; or, if something in Hahnemannís system does not suit them, they are prone to say that they have never seen this or that, that they cannot agree with it. And in talking in this way, they really imagine to have said something against the matter itself."

Comments: It has been said that there is nothing new under the sun. One can see that even during Heringís time there were those who wished to personally take credit for any and all successes in healing and blame Homoeopathy and Hahnemann for any failures. It is much easier for some to criticize the Founder and his system for their failures than to accept oneís own lack of understanding in the application of Homoeopathy in the clinic. The path of the true homoeopath, however, is one of examining of oneís personal failures and the constant reassessment of oneís practice. This process begins on day one of oneís clinical practice and is a never ending story. Such a path is for the brave who realize that the healing arts are a service in which one can never be complacent. Those that feel they need to be in 100% perfect control will find little comfort in the practice of clinical medicine. Every patient is born, every patient gets ill, every patient gets old, and every patient dies. It is only a question of who dies first the patient or the homoeopath!

Dr. Heringís preface continues:

"Upon the same ground that Hahnemann carefully distinguished from the disease the symptoms which owed their existence to dietetic transgressions, or to medicinal aggravations; upon the same grounds that he acknowledged as standing and independent diseases the acute miasms, known as purpura, measles, scarlatina, small pox, hoping cough, etc, or that he distinguished the venereal miasm into syphilis and sycosis, We may afterwards, if experience should demand it, subdivide psora into several species and varieties. This is no objection to Hahnemannís theory. Hahnemann has taken the first great step without denying the faculty of progressive development inherent in his system. But let improvements be made in such a way as to become useful not prejudicial, to the patients. We ought to raise our superstructure upon Hahnemannís own ground, in the direction which he has first imparted to his doctrine."

Comments: Hahnemann taught the importance of symptomatology but he also emphasized the importance of the aetiological constellation and the classification of diseases into different categories. This includes singular states that find their origin trauma, diet and hygiene, psychology and somatic derangements, as well as the acute and chronic miasms which are of a collective nature. Hering also points out that clinical realties may demand that psora be subdivided into several varieties such as bacteria, fungi, viruses and mites. There has also been a need to include new miasms such as hepatitis and AIDS. Hahnemann was the beginning of Homoeopathy not the end. In order for the Founderís healing art to reach its full potential every generation of practitioners must expand the body of general knowledge. At the same time, the evolution of our healing art must be based on the primary principles that make Homoeopathy a safe and effective system. The suppositions that fulfill this requirement is already in place and what is needed is to carry these principles to new heights. Too many individuals have decided that they can overthrow the timeless laws of nature that Hahnemann perceived and replace them their own prejudices based on transient fancies. This leads one down the slippery slope of old mechanistic concepts in new age packages that are little more than old wine in new bottles.

Dr. Heringís preface continues:

"Every homoeopathic physician must have observed that the improvement in pain takes place from above downward; and in disease, 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. This cutaneous eruption may be even perceived when a cure is impossible, and even when the remedies have been improperly chosen. The skin being the outermost surface of the body, it receives upon itself the extreme termination of the disease. This cutaneous eruption is not a mere morbid secretion having been chemically separated from the internal organism in the form of gas, a liquid or solid; it is the whole of the morbid action which is pressed from within to outward, and is characteristic of a thorough and rally curative treatment. The morbid action of the internal organism may continue either entirely or more or less in spite of this cutaneous eruption. Nevertheless, this eruption always is a favorable symptom; it alleviates the sufferings of the patient, and generally prevents a more dangerous affection.

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.

Even the superficial observer will not fail in recognizing this law of order. An improvement which takes place in a different order can never be relied on. A fit of hysteria may terminate in a flow of urine; other fits may either terminate in the same way, or in hemorrhage; the next succeeding fit shows how little the affection had been cured. The disease may take a different turn, it may change its form, and, in this new form it may be less troublesome; but the general state of the organism will suffer in consequence of this transformation.

Hence it is that Hahnemann inculcates with so much care the important rule to attend to the moral symptoms, and to judge the of the degree of homoeopathic adaption, existing between the remedy and the disease, by the improvement which takes place in the moral condition, and in the general well-being of the patient."

Comments: Constantine Hering now takes up the basis of what James Kent called "Heringís laws". Kent is the person most responsible for bringing the attention of the homoeopathic community to the importance of these healing maxims. Heringís postulates are based on observations that Samuel Hahnemann elucidated in the Organon and The Chronic Diseases. When speaking of the removal of pain, Doctor Hering speaks in terms of the relief taking place from above to below. Although the pain is felt in the areas under stress, the highest center in the human body for experiencing pain is in the brain. If the brain can not register the pain reflex, no pain will be felt, although the part may be damaged. The image of the entire body resides within the brain as it registers all functions in a holographic manner. Do homeopathic remedies work first on the pain in the higher regions and then spread this relief downward through the organism? Although this maxim has not as readily confirmed as some of the others factors, ample confirmations of this phenomenon have taken place in the clinic. Many times the painful symptoms are relieved from the head toward the lower body and extremities. Sometimes it appears as if a wave of healing energy is passing through the organism from the crown to the feet.

When Hering refers to the removal disease states, he speaks in terms of the cure taking place from within to without. The natural movement of the vital force is from within to without because the life force is a central aspect of the human essence (Wesen). Disease is not intrinsic to the life force, whose primary role is the maintenance of homeostasis. Sickness is a superficial impingement by a negative force upon the Lebenskraft, the inner power of natural life. Homeopathic remedies cure by replacing the disease with a similar but more powerful transient medicinal disease (primary action). The life force then attempts to assert its authority by extinguishing this external impingement from without while reinstating homeostasis and vitality within (curative secondary action). The natural movement from within to without is innate to the natural healing process because it is innate to the lifeforce and human organism.

In the case of psora, a healing process often ends with the appearance of an eruption on the skin. Hering points out that this eruption may emerge in those illnesses that are incurable as a method that the life force uses to palliate the internal complaint to the best of its ability. This eliminative process is intimately related to the nature of the miasms involved because the vital force cures by returning its focus to the original primary symptoms and removing the cause. In the case of sycosis this progression tends to end with a discharge, and in the case of syphilis, an ulcer. The same type of manifestation is witnessed in non-miasmatic disorders and suppressions in general. This brings us to the next of Heringís maxims, from the more important to the less important spheres and the order of the removal of symptoms.

Hering noted that the cure of chronic disease takes place from the most important organs to the less important regions. This dovetails very closing with the ideas of above to below and from within to without yet points out a slightly different angle. The brain and the neuro-endocrine system are considered the most important physiological systems followed by the vital organs like the lungs, heart, liver and kidneys. A human being can live without a spleen, a gall bladder, or an arm or a leg, but they can not live without the brain and the vital organs. The brain may also be considered the organ which reposes in the highest position in the human body and is the most essential of the physical parts.

In aphorism 16 of the Organon Hahnemann speaks of the nervous system as the medium by which the vital force perceives the tone altering potential of homoeopathic remedies. This means that the brain is the first physical organ to receive the tunement altering energies of a simillimum. Therefore, the re-tuning of organism to the state of health begins in the highest and most central structure of the human body, the brain and neuro-endocrine systems. Therefore, the curative reaction begins with the lifeforce, and passes through the brain and vital systems, and then to the most affected organs of the body in order of importance. Indeed, this shows healing does take place from above to below and in the most important regions first. This concept also includes the intellect and emotional disposition, which are the most subtle "organs" in the human body.

Nature functions through natural laws that demonstrate a higher order. Psora begins with a skin eruption (either in the patient or their ancestors) and progresses to more complex internal states until secondary pathology is produced. As disease states follow a natural progression so does the innate processes of healing. Psora begins with an external lesion and ends with the return of the original eruptions. Hahnemann was the first to clearly point out the essential role of the reversal of the chronological order the symptoms during healing. Vide The Chronic Diseases.

"The latest symptoms that have been added to a chronic disease which has been left to itself (and thus has not been aggravated by medical mismanagement) are always the first to yield in an antipsoric treatment; but the oldest ailments and those which have been most constant and unchanged, among which are the constant local ailments, are the last to give way; and this is only effected, when all the remaining disorders have disappeared and the health has been to all other respects almost totally restored."

The Chronic Diseases Their Peculiar Nature and Their Homúopathic Cure, Hahnemann, Psora, page 230.

The Founderís version of the reversal of the developmental order of the symptoms contains several points that were not included in either Heringís or Kentís renditions. First of all is the fact that suppression and medical mismanagement may disrupt the natural order of the reversal of symptoms. Second is the observation that certain old protracted conditions and constant local ailments may be the last to be removed regardless of the timeline of the disease state. These ailments will only be relieved when the state of health and vitality is such that the vital force has the sufficient resources to remove such resistant pathologies. Hahnemann also noted in the 6th Organon that old one-sided pathologies and local complaints may linger after the general health is restored and may require an increase in the size of the dose, the potency and repetition for complete health to be reinstate.

Doctor Hering also implies that the systems more affected disease begin to heal before those areas less affected. As noted above, Psora begins with a skin eruption that is usually not extremely dangerous to the patient unless there are complications. When the itch lesion is suppressed or spontaneous progresses to the inner spheres, the internal symptoms increase in intensity. During the growth of Psora the internal organs become more affected than the original site of the primary lesions. A similar process takes place in all the miasms as they advance from their primary lesions to latent states and then secondary and tertiary symptoms. During the reversal of symptoms the more affected internal systems are relieved first followed by the presently less affected external areas of the body.

Hering also reconfirms Hahnemannís assertion that the amelioration of the psychological symptoms of the patient is a most important sign. The functions of the Geist (rational spirit) and the Gemuet (the emotional disposition) are considered more intrinsic than the functions of the human brain by the vitalist. The functions of consciousness are considered essential aspects of the Soul rather than merely the outcome of chemical transactions within the brain. Changes in the psychological sphere as well as the general sense of vitality and well-being are often the first signs that show the healing process has begun. A sense of spiritual quiescence, mental harmony and physical well-being are complementary aspects to maxims of above to below, from within to without, and from the most important to the lesser important. In many cases the state of mind may be considered more important than the physiological condition, as in the end, the mental condition of a person is more important than the state of their body. How a person approaches the mysteries of birth, sickness, old age and death is the final deciding factor of the level of evolution of the human Spirit.

Symptom patterns that follow the opposite direction of the laws of healing are a sign that the disease is uncured and increasing. In some cases the pains may travel from the extremities and lower body to the upper regions. In other situations the disease pattern may progress from the more external areas to the more internal organs and systems. In some patients the morbid processes may mutate from the lesser important regions to the more important spheres. Many times new symptoms will develop while the case is under treatment. The unfortunate patient may experience a decline in their psychological state and general sense of well-being as well as vitality. These negative manifestations may come singularly, in different combinations, or all at once. The more components involved in the negative evolution of the symptoms, the more serious the case has become. These pathological signs accompany an increase of the disease state as well as the phenomena associated with the suppression syndrome. The signs of disease, suffering and death are the exact opposite of the signs of healing, relief and life.

It is apparent that there are more aspects to the direction of cure introduced by Hahnemann, explained by Hering, and codified by Kent, than is commonly understood. In this new light Hahnemannís direction of cure has seven major aspects.

1. Pains are removed from the human organism from above to below.

The most essential organ in the physical body is the human brain as it is the set of consciousness and controller of both the autonomic and voluntary nervous systems. During the process of healing the nervous and endocrine systems are the first areas to begin the process of normalization. For this reason, there is often an amelioration of the mental disposition as well as general state and vitality before improvement of the physical pathology takes place. The corresponding relief of pain often flows from the regions from the mind, brain and head; to the essential vital organs; to the organs of elimination; and finally to the bodily extremities.

2. Derangements are relieved from within to without.

The immaterial vital force is the most intrinsic power in the human organism followed by the brain and neuro-endocrine system and the vital organs. For this reason, curative action begins with the vital energy in the innermost regions of the human Wesen and passes from the intrinsic internal organs to the periphery of the body. In Mesmerism, a science practiced by Samuel Hahnemann, the human organism is viewed as a bio-magnet in which the positive and negative poles of the vital force reside in the brain (+) and solar plexus (-). This animal magnetism naturally flows from within to without through the energetic aura and natural magnetic meridians as well as the brain and nervous system. This energy pattern is considered by Mesmerist to be more central and intrinsic than the physical organism. The presence of the bioelectrical field and its aura has been confirmed by modern science and is considered an important essential of all physiological functions.

3. Mistunements are relieved in the most important systems and organs first.

Healing begins on the functional level by first retuning the lifeforce, the psycho-neural system and the vital organs. This provides the harmony and energy necessary to the removal of physical pathology. This maxim is intimately related to the ideas that healing takes place from above to below and from within to without. This is because the most important inner systems are those that reside in the higher to lower regions of the body like the brain, lungs, heart, liver and kidneys. The return of vital functions is a precursor to the healing of organic pathology.

4. Diseases are removed in the reverse order of their original development.

Nature demonstrates an inherent order in all its functions, even those that appear most chaotic on the surface. Psora begins with a skin eruption and then progresses inward to produce more complex secondary complaints in the organs, systems and tissues. As the mother of all chronic miasms, Psora sets the pattern that pseudopsora TB, sycosis, syphilis, hepatitis, AIDS and vaccinosis follow. The cure of these chronic diseases takes place by the reversal of chronological development and end by reproducing the original primary symptoms and removing the fundamental cause. The exceptions to this rule are as follows:

a. The chronological reversal of symptoms may not take place in cases disrupted by suppression and other medical malpractices. These iatrogenic states disrupt the natural progression of the symptoms and may alter the timeline by which the disease is removed.

b. The chronological reversal of the symptoms may not take place with protracted and unchanged pathologies and constant local and one-sided complaints. In such conditions the complete healing of these areas may take place until the organism is nearly healthy in all other respects.

5. The symptoms are first relieved in the more affected organs, and then in the lesser affected systems, and finally the most superficial regions. In the case of Psora, the more severe secondary complaints improve and the patient gains strength before the return of the original eruptions. Other miasms present a similar process.

The miasms begin with superficial symptoms and mutate to more dangerous conditions. No one has died from a simple itch infection but many have died prematurely due to the outcome of the suppression and mutations of internal psora. As long as the eruptions are present on the skin they act as a pressure value that slows to some degree the internal expansion of the symptoms. When the vital force is denied this external pressure release through suppressive methods, or spontaneous mutation, the internal symptoms become progressively more dangerous. On receiving a homoeopathic remedy, the vital force begins by relieving the derangements of the more affected organs and systems before dealing with the more superficial aspects of the disease. This is because, at present, the internal organs are in need of aid than the outer regions that were the original seat of the miasms primary symptoms.

6. The amelioration of the symptoms of the intellectual and emotional spheres as well as the general sense of well-being and vitality are signs that healing is taking place in the proper manner and on the deeper levels.

In the Organon, Hahnemann pointed out that one of the first signs of a correct remedy is an amelioration of the intellectual and emotions symptoms. This is often accompanied the return of a sense of well-being and an increase in energy. The patient begins to feel better in spirit and experience more vitality as the more important areas of the organism is regularized by a simillimum. This may take place even though the disease symptoms are slightly aggravated as a sign that amelioration will soon take place. The Founder noted that this process is most obvious when the size of the dose is kept as small as possible. Large doses tend to produce the opposite affect thus aggravating the mind and destabilizing the vitality by producing antagonistic counter actions by the vital force.

7. The symptoms of decline and disease are the exact opposite of the signs of the direction of cure.

When the pains go from below to above; symptoms from without to within; derangements from lesser important organs to more important organs; new states appear; and the more affect organs begin to decline; as well as the mental state becomes worse; this is sign that the disease state is getting worse. The order of the signs of disease progression is the exact opposite of the order of the signs of healing. This may take place because the disease process is increasing because the chosen remedy is having no effect, or through suppression of the superficial aspects of the disease by an incorrect remedy. In either case, such signs are a bad prognosis that shows remedial and corrective measure must be applied immediately.

The above seven factors are all interrelated and relative in nature. It is not easy to say where one maxim ends and another begins because they all find their source in the unity of the vital force and the way in which the human organism reacts to disease and medicine. Where one maxim is not totally applicable another maxim may take its place. The fact that every example of healing may not follow the exact patterns of the direction of cure as commonly understood has caused some individuals to reject the entire hypothesis. They are unknowingly throwing the baby (the exceptions) out with the bathwater (the time honored observations). These maxims are interdependent relative truths not absolutely rigid fixed dogmas. Hahnemann clearly pointed out in 1828 that not all disease processes follow this exact pattern. There are reasons for these exceptions, although they may not always be perceivable to our intellect in each and every case. The number of cases which have demonstrated aspects of the order of cure far outweighs those cases that have not.

Dr. Heringís preface continues:

"But alas!, the rules which the experienced founder of Homoeopathy lays down in the subsequent work with so much emphasis, are not always practiced, and therefore cannot be appreciated. Many oppose them; cures which otherwise might be speedy and certain, are delayed; much injury is being done by the wiseacres who intrude themselves into our literature and mix with it as chaff and wheat. On all this we may console

The law of order which we have pointed out above, accounts for the numerous cutaneous eruptions consequent upon homoeopathic treatment, even where they never have 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 of the internal disease is yet existing. This law of order also accounts for the insufficiency of violent sweats, when the internal disease is not yet disposed to leave its hiding-place. It lastly accounts for one cutaneous affection being substituted for another.

This transformation of the internal affection of such parts of the organism as are essential to important functions, to a cutaneous affection- a transformation which is entirely different from the violent change effected by means of Autenriethís ointment ammonium, croton-oil, cantharides, mustard, etc.- is chiefly effected by the anti psoric remedies.

Other remedies may sometimes effect that transformation even the use of water, change of climate, of occupation, etc; but it is more safely, more mildly and more thoroughly effected by the anti psoric remedies.

This latter is altogether an individual opinion; others may have different opinions relative to the same subject; This needs not to prevent us from aiming all of us at the same end side by side in perfect harmony."

Comments: Hering rightly points out that the true phenomena associated with the direction of cure may be witnessed with different modalities but it is most consistently and gently carried out by Homoeopathy. For this reason, there is no reason to dogmatically call all other healing methods "suppressive". It is not methods such a herbology, acupuncture, etc. that are inherently suppressive but it is how they are often applied that does the damage. Any healing methodology that demonstrates principles similar to Hahnemannís direction of cure is truly carrying out the healing process. The reversal of symptoms and other maxims is not the sole possession of our science. Nevertheless, in Homoeopathy the process is carried out with clear intend and knowledge, whereas in most healing arts, it is more by accident than incident. Most important is that homoeopaths become truly conversant with the laws of natural healing as introduced by Hahnemann and elucidated by past masters of our noble healing art.

Nature is based on an eternal order that transcends the limited intellect of human beings. No matter how advanced modern science may appear today it will largely obsolete in the not too distance future. The only data that will remain will be those facts that are truly based on natureís primordial order. These principles stand eternal although our understanding of them is partial. Homoeopathy is a glimpse into the future where energy medicine will supplant chemical medicine as the primary methodology of healing.

Dr. Heringís preface continues:

"It is the duty of all of us to go further in the theory and practice of Homoeopathy than Hahnemann has done. We ought to seek the truth which is before us and forsake the errors of the past. But wo unto him who, on that account, should personally attack the author of our doctrine; he would burthen himself with infamy. Hahnemann was a great savant, inquirer, and discoverer; he was as true a man, without falsity, candid and open as a child, an inspired with pure benevolence and with a holy zeal for science.

When at last the fatal hour had struck for the sublime old man who had preserved his vigour almost to his last moments, when it was the heart of his consort who had made his last years the brightest of his life, was on the point of breaking. Many of us seeing those who are dearest to us engaged in the death-struggle, would exclaim: "Why shouldíst thou suffer so much!" So to exclaimed Hahnemannís consort:"Why shouldíst thou who hast alleviated so much suffering, suffer in thy last hour? This is unjust. Providence should have allotted to thee a painless death."

Then he raised his voice as he had often done when he exhorted his disciples to hold fast to the great principals of homoeopathy. "Why should I have been thus distinguished? Each of us should here attend to the duties which god has imposed upon him. Although men may distinguish a more or less yet no one has merit. God owes nothing to me, I to him all."

With these words he took leave of the world, of his friends, and his foes. And here we take leave of you, reader, whether our friend or our opponent.

To him who believes that there may yet be truths which he does not know and which he desires to know, will be pointed out such paths as will lead him to the light he needs. If he who has sincere benevolence and wishís to work for the benefit of all, be considered by Providence a fit instrument for the accomplishment of the divine will, he will be called upon to fulfill his mission and will be led to truth evermore.

It is the spirit of truth that tries to unite us all; but the father of lies keeps us separate and divided.

Philadelphia, April 22, 1845."

Comments: It is the duty of all homoeopaths to go beyond Hahnemann and help to improve the theory and practice of Homoeopathy and bring our healing art up to date for our times. Each generation of practitioners has added much experience to the repertory, materia medica and pharmacy as well as clinic application of healing through similars. My generation is no exception. The errors of the past should be removed and replaced with the realties of the present but without perverting the underlying truths that are universal and timeless in nature. Alas, there is great difference in improving on the work of an established tradition and changing something to suit oneself. Too many have sought to change homoeopathy before they understood the fundamentals of the art in the first place. Others have tried to make new improve versions of Homoeopathy when they lacked the weighty knowledge supplied by long years of clinical experience. Some have bitterly criticized Hahnemann as a person and professional in order to set themselves up as enlightened "instant experts". Such individuals have failed to learn the lessons of mythology as well human history patience, perseverance in the truth and humility. Their Hubris Knows No Bounds. But as Hering said: it the truth that unites all true healers, and lies that keep us apart.

Hahnemann lived a long and noble life, and whatever his human faults may have been, he was one of the greatest medical personages that every lived. For this reason, he can truly be called the "second Hippocrates" and the Founder of the medicine of the future. Hahnemann was quite aware when he fell ill in the spring of 1843 that it would be his last ailment and shortly he would take rest in his Heavenly Abode. Nevertheless, he continued to work in his clinic until he became too ill to continue and took up his dead bed. As the Founder looked back on his long life he knew that he had carried out the mission which Providence had place upon him to the best of his abilities. For this reason, even though he suffered painful difficulties in breathing, he was able to tell his beloved Melanie, "God owes nothing to me, I to him all." With such words passed the great medicinal savant, Samuel Hahnemann, who was one without a second among the men of his time.

This completes the commentary on Hering's Preface to the 1845 American edition of The Chronic Diseases by Samuel Hahnemann. I hope you have enjoyed this review as much as I have.

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