Knowledge of Medicine

Do you remember my lecture on the third aphorism? Let us recollect a little about it. The third aphorism states:

If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that the recovery must ensue…

In the first aphorism we discussed the mission of a physician, in the second we discussed the highest ideal of cure and in the third, we discussed what knowledge is required by a physician to effect a cure. From aphorism 4 to 18, we discussed the first requirement – knowledge of ‘what is to be cured in disease’. If you remember, in those aphorisms Hahnemann talked about the importance of symptoms and how they reflect the internal essence of the disease. The aphorisms 19 to 34 elaborate the second form of knowledge, that is, ‘what is curative in medicines’ and from 35 to 69, we will discuss how to adapt our knowledge of medicine to cure sick patients.

To understand ‘what is curative in medicine’, we will explore aphorisms 19 to 34 and will try to understand what Hahnemann said about finding the curative powers of medicines. We will do this in 3 parts:

1.      Understand what is the curative power of a medicine (19-25)

2.      Nature’s Law of Cure (26-27)

3.      Understand why we react more to medicines in the diseased state. (28-34)

The Curative Power of Medicine

Hahnemann discussed the curative powers or our medicines in aphorisms 19 to 25. In the 19^th aphorism he says that disease is nothing but an altered state of health and to affect a cure, we need to change the diseased state back to the healthy condition. So the medicines must have the power to alter our state of health and indeed their curative power arises solely from their ability to alter our state of health. Let us read the aphorism now. It says:

19 - Now, as diseases are nothing more than alterations in the state of health of the healthy individual which express themselves by morbid signs, and the cure is also only possible by a change to the healthy condition of the state of health of the diseased individual, it is very evident that medicines could never cure disease if they did not possess the power of altering man’s state of health which depends on sensations and functions; indeed, that their curative power must be owing solely to this power they possess of altering man’s state of health.

The aphorism looks very simplistic but it lays down the first characteristic for a medicine – it should not be inert. It should have the potential to alter the health of a living being. Now some of you might say that many homeopathic medicines are derived from inert substances like Lycopodium and Silica. The source of these medicines could be inert but the form (potentized) in which they are used is not inert. How powerful the effect of these medicines could be, can only be learned through experience.

I’ll share a small incident here. I developed premature graying of hair after a bout of Typhoid at age 10. When I was a first year medical student, I read that Lycopodium is indicated for premature graying of hairs. Without thinking much I took a dose of Lycopodium 1M. A couple of days later I started getting a sensation as if I had a swelling in my right inguinal region. I was frightened by the thought of having inguinal hernia. I would check the area repeatedly, do the cough-test for hernia repeatedly but the swelling was never there. But the sensation was always there! I later realized that I was proving Lycopodium and it took more than one year for the sensation to go. That was my first lesson in understanding the power of the potentized medicines, their ability to alter a man’s state of health!

So coming back to the aphorism, the form in which we intend to use a medicinal substance should not be inert. It should have the power to alter a man’s state of health.

Now let us move on to the next aphorism, which states:

20 - This spirit-like power to alter man’s state of health (and hence to cure diseases) which lies hidden in the inner nature of medicines can in itself never be discovered by us by a mere effort of reason; it is only by experience of the phenomena it displays when acting on the state of health of man that we can become clearly cognizant of it.

So after saying that a medicine should have the power to alter our health, Hahnemann tells us how to identify or discover the medicinal powers of a substance. He says that we can only find out about the effectiveness of a medicine by understanding its effect on human body. We need to study how a medicine alters the state of health to understand its sphere of action. He further says that the power of medicines to alter man’s state of health is ‘spirit-like’. Here again the spirit-like just stands for something that is invisible and has no religious or spiritual connotations.  The first line of this aphorism is actually targeting those conventional medicine contemporaries of Hahnemann, who used to proclaim the medicinal effect of various substances, without actually testing them. To such people Hahnemann says that the medicinal properties of a substance are hidden in its interior, they cannot be seen by examining the substance or by making theoretical assumptions. The only way to find the curative powers of a substance is to find out its effect on healthy human beings.

Now in the next aphorism, that is aphorism number 21, Hahnemann goes ahead further and tells us that the effect that the medicinal substances have on our body, can be perceived through the signs and symptoms that they produce. Let us read what he said:

21 - Now, as it is undeniable that the curative principle in medicines is not in itself perceptible, and as in pure experiments with medicines conducted by the most accurate observers, nothing can be observed that can constitute them medicines or remedies except that power of causing distinct alterations in the state of health of the human body, and particularly in that of the healthy individual, and of exciting in him various definite morbid symptoms; so it follows that when medicines act as remedies, they can only bring their curative property into play by means of this their power of altering man’s state of health by the production of peculiar symptoms; and that, therefore, we have only to rely on the morbid phenomena which the medicines produce in the healthy body as the sole possible revelation of their in-dwelling curative power, in order to learn what disease-producing power, and at the same time what disease-curing power, each individual medicine possesses.

Here initially he repeats what he said in the last aphorism that the medicinal power of a substance is its potential to alter the state of health. Now things become interesting here. He further clarifies “particularly in that of the healthy individual”. This clarification is important. Conventional medicines are often tested on the sick to find out their therapeutic sphere. And in such tests medicines often do not reveal their full effect on the human body because the sick body is already working in a compromised state. So he stresses that the study of alterations that are produced on a healthy body are most useful to find out the therapeutic sphere of a medicine. But the point to note here is that he has used the word ‘particularly’ and not ‘only’ or ‘exclusively’. This implies that while the proving symptoms are most important, the clinical symptoms may be of some use as well.

What he has also said here is that the medicines are able to cure symptoms because of their ability to produce similar symptoms. Now theoretically speaking this is a corollary, a kind of assumption similar to:

A=C and B=C therefore A=B

(‘A’ medicine produces ‘C’ symptoms. ‘B’ disease produces ‘C’ symptoms. Therefore ‘A’ medicines removes ‘C’ symptoms in disease ‘B’.)

Had this been a purely theoretical construct, this would have failed or received more criticism. But Hahnemann was writing from his experience. He had tested the medicines (like salts of Mercury and Silver, Borax, and China etc) with known therapeutic action and had observed that medicines often produce symptoms in healthy individuals, which they are known to cure in sick. So the above construct was reverse engineered from something like this:

‘A’ medicine cures ‘B’ disease. ‘B’ produces ‘C’ symptoms. ‘A’ also produces ‘C’ symptoms. Therefore the ability in ‘A’ to produce the ‘C’ symptoms must be the property which helps it to cure disease ‘B’.

Now in the next aphorism, he tells us how this ability to produce symptoms, helps to remove symptoms or to cure disease and which type of medicine we should choose to treat the sick. Let’s read it!.

22 - But as nothing is to be observed in diseases that must be removed in order to change them into health besides the totality of their signs and symptoms, and likewise medicines can show nothing curative besides their tendency to produce morbid symptoms in healthy persons and to remove them in diseased persons; it follows, on the one hand, that medicines only become remedies and capable of annihilating disease, because the medicinal substance, by exciting certain effects and symptoms, that is to say, by producing a certain artificial morbid state, removes and abrogates the symptoms already present, to wit, the natural morbid state we wish to cure. On the other hand, it follows that, for the totality of the symptoms of the disease to be cured, a medicine must be sought which (according as experience shall prove whether the morbid symptoms are most readily, certainly, and permanently removed and changed into health by similar or opposite medicinal symptoms¹) have the greatest tendency to produce similar or opposite symptoms.

¹ The other possible mode of employing medicines for diseases besides these two is the allopathic method, in which medicines are given, whose symptoms have no direct pathological relation to the morbid state, neither similar nor opposite, but quite heterogeneous to the symptoms of the disease. This procedure plays, as I have shown elsewhere, an irresponsible murderous game with the life of the patient by means of dangerous, violent medicines, whose action is unknown and which are chosen on mere conjectures and given in large and frequent doses. Again, by means of painful operations, intended to lead the disease to other regions and taking the strength and vital juices of the patient, through evacuations above and below, sweat or salivation, but especially through squandering the irreplaceable blood, as is done by the reigning routine practice, used blindly and relentlessly, usually with the pretext that the physician should imitate and further the sick nature in its efforts to help itself, without considering how irrational it is, to imitate and further these very imperfect, mostly inappropriate efforts of the instinctive unintelligent vital energy which is implanted in our organism, so long as it is healthy to carry on life in harmonious development, but not to heal itself in disease. For, were it possessed of such a model ability, it would never have allowed the organism to get sick. When made ill by noxious agents, our life principle cannot do anything else than express its depression caused by disturbance of the regularity of its life, by symptoms, by means of which the intelligent physician is asked for aid. If this is not given, it strives to save by increasing the ailment, especially through violent evacuations, no matter what this entails, often with the largest sacrifices or destruction of life itself.

For the purpose of cure, the morbidly depressed vital energy possesses so little ability worthy of imitation since all changes and symptoms produced by it in the organism are the disease itself. What intelligent physician would want to imitate it with the intention to heal if he did not thereby sacrifice his patient?

The 22^nd aphorism states two basic things. First, if a disease becomes evident through signs and symptoms and the only manifest action of medicines on human beings is their ability to produce symptoms, it is therefore deduced that the ability of a medicine to produce symptoms is what cures the sick.

Now the symptoms that a medicine can produce could be similar or opposite to the symptoms of disease. The second thing that Hahnemann says is that a remedy must be chosen which has the greatest tendency to produce similar or opposite symptoms. He further says that experience will teach us whether the medicines that produce similar symptoms are able to cure quickly and permanently or the medicines that produce opposite symptoms are more effective in providing a rapid and permanent cure.

I think time has certainly shown that conventional medicine is not able to cure the disease. The antipathic mode can only palliate or suppress symptoms. That is why we have so many ‘anti-’ things in the conventional medicine – antibiotics, anti-inflammatory, anti-depressants, anti-hypertensive, anti-pyretics etc.

In a long foot-note to aphorism 22, Hahnemann discusses a third form of treatment, which he called ‘allopathic’. The application of medicines that have similar effect was called Homeopathy and the application of medicines that have opposite action was called Antipathy. The application of medicines or treatment that had neither similar nor opposite action, was called Allopathy. The conventional medicine of his time was full of such methods and medicines, like using diuretics, diaphoretics, medicines used for purging the alimentary canal and procedures like blood-letting as treatment for nearly every possible disease. Hahnemann was strongly against the use of such untested medicines and methods and even called their application ‘murderous’.

Even today the conventional medicine is known as ‘Allopathy’ in many parts of the world. But today’s conventional medicine is primarily antipathic. There is no separate antipathic school today. Antipathy and Allopathy have merged to form one entity, which is either called allopathy or conventional medicine today.

If you read the footnote more carefully, you will observe one more important thing. Hahnemann says “When made ill by noxious agents, our life principle cannot do anything else than express its depression caused by disturbance of the regularity of its life...”

This means (and is very obvious too) that when we are sick, our vital force or life principle or the thermodynamic energy system is depressed. He further says that the use of allopathic medicines decreases the vitality further. This is something that you can experience very easily, even today. It is so common to experience low energy, bad taste and indigestion after a round of antibiotics used for any acute illness. The infection goes away but the body does not feel fit and it often takes many more days and sometimes weeks for the body to recover its lost vitality. Compare this to the homeopathic medicines, where we look for and notice a change in vitality as the first sign of cure!

Now in the next aphorism, Hahnemann says experience has shown that medicines that produce opposite symptoms usually do not cure permanently. In fact after the symptoms are palliated with some antipathic medicines, they often rebound with greater intensity. Try withdrawing the pain-killer of an arthritis patient or the anti-hypertensive of a hypertensive patient and see how the pain and B.P. shoot up. Let us read the 23^rd aphorism. It says:

23 - All pure experience, however, and all accurate research convince us that persistent symptoms of disease are far from being removed and annihilated by opposite symptoms of medicines (as in the antipathic, enantiopathic or palliative method), that, on the contrary, after transient, apparent alleviation, they break forth again, only with increased intensity, and become manifestly aggravated (see � 58 - 62 and 69).

We have already discussed the essence of this aphorism but I would like to point your attention towards the use of the phrase ‘persistent symptoms of disease’. This is significant because Hahnemann is clearly stating that the antipathic method will always fail in curing the persistent symptoms, that is, the chronic diseases. In treatment of chronic diseases the symptoms often persist or rebound after an initial amelioration, when the allopathic medicines are used, but the same is not true for acute diseases. In acute diseases, the cause of the symptoms, which is commonly some form of infection, is often removed by the antipathic measures and you usually do not see a relapse unless the patient has very low vitality or the acute is actually an acute exacerbation of an underlying chronic complaint. That is why we often do not see a rebound of diarrhea or fever after a course of antibiotic. But do not assume that the antipathic mode is good for treating acute conditions. We might not see a rebound phenomenon in acute diseases but we often see lowered vitality as mentioned in the last aphorism. We also see increased susceptibility, more suppressions and increased tendency for chronic diseases. When modern medicine was not ‘modern’ enough, the epidemics were usually of acute diseases but with the advent of all the anti-medicines, the acute diseases and epidemics might have gone down but the chronic diseases have blown out to pandemic proportions. So the antipathc mode may be useful at times but it should not be the preferred first line of treatment in most conditions.

In the next aphorism, Hahnemann derives the conclusion that only a similar remedy is able to affect a cure. Let us read what he says:

24 - There remains, therefore, no other mode of employing medicines in diseases that promises to be of service besides the homoeopathic, by means of which we seek, for the totality of the symptoms of the case of disease, a medicine which among all medicines (whose pathogenetic effects are known from having been tested in healthy individuals) has the power and the tendency to produce an artificial morbid state most similar to that of the case of disease in question.

In aphorism 22^nd, Hahnemann stated that only those medicines should be used which have a known similar or opposite action on the disease condition. In the 23^rd aphorism, he then exposes the failure of antipathic mode in treating chronic diseases. So in this aphorism he lays down his conclusion that the only acceptable mode of employing medicines on sick is the homeopathic method. And only those medicines should be applied whose action has been documented by testing on healthy individuals.

Apart from this, I would like to draw your attention to a phrase that Hahnemann has used in this aphorism. He used the words ‘the case of disease’ twice in this aphorism. This is significant because many modern teachers teach to ignore the nosological disease while focusing entirely on the mental and emotional symptoms or the PQRS symptoms. Hahnemann has nowhere said so. He did ask us to individualize each case of a disease and he did say that the mental and emotional symptoms and PQRS symptoms are often more important. But nowhere has he said not to use the information and knowledge about the disease. People think that thinking about the ‘disease’ in classical homeopathy is a crime. They only have to think about ‘the case’. They forget that had there been no 'dis-ease' and no 'disease', there would be no case!

Now in the next aphorism, Hahnemann reiterates the importance of symptom-similarity and also lays down the fact that the potency and dilution are also very important. Let us read what he says:

25 - Now, however, in all careful trials, pure experience,¹ the sole and infallible oracle of the healing art, teaches us that actually that medicine which, in its action on the healthy human body, has demonstrated its power of producing the greatest number of symptoms similar to those observable in the case of disease under treatment, does also, in doses of suitable potency and attenuation, rapidly, radically and permanently remove the totality of the symptoms of this morbid state, that is to say (� 6 - 16), the whole disease present, and change it into health; and that all medicines cure, without exception, those diseases whose symptoms most nearly resemble their own, and leave none of them uncured.

¹ I do not mean that sort of experience of which the ordinary practitioners of the old school boast, after they have for years worked away with a lot of complex prescriptions on a number of diseases which they never carefully investigate, but which, faithful to their school, they consider as already described in works of systematic pathology, and dreamed that they could detect in them some imaginary morbific matter, or ascribe to them some other hypothetical internal abnormality. They always saw something in them, but knew not what it was they saw, and they got results, from the complex forces acting on an unknown object, that no human being but only a God could have unraveled - results from which nothing can be learned, no experience gained. Fifty years of experience of this sort is like fifty years of looking into a kaleidoscope filled with unknown colored objects, and perpetually turning round; thousands of ever changing figures and no accounting for them!

Hahnemann makes a couple of very important statements in this aphorism.

1.      Pure experience using proved medicines is the high and only source of knowledge for the healing art.

2.      A medicine that has produced the maximum number of similar symptoms during a drug proving on a healthy human being removes the totality of symptoms of a diseased state.

3.      The medicine has to be given in suitable potency and dilution to be most effective, that is, to be able to cure rapidly, totally and permanently. This is again of great significance as many modern day teachers claim that potency and dose is of little significance, it is the similarity alone that counts. There are people who treat every case with a 30C or a 1M. These people should read the Organon again.

4.      Now to make it clearer – Hahnemann has said that a diseased state will be removed quickly, totally and permanently – IF the medicine selected is known to produce very similar symptoms during drug proving AND is given in suitable potentised and diluted doses. This implies that the more similar the medicine, the more rapid the cure. But ‘similarity’ is a relative word. There could be many remedies with different degrees of similarity to a given case. So this also implies that the less the similarity, the less rapid is the result – but the result could still be there! Of course the remedy should not be totally off-the-hook. Otherwise there won’t be any results. This explains why we are able to get decent results even with partially similar remedies. Another implication is that if the remedy is less similar, the result may not be ‘radical’ and ‘permanent’. Such a remedy may only be able to palliate or remove some set of symptoms but will not be able to cure the patient in totality. So the result that we get will depend upon the degree of similarity. If the remedy is ‘the simillimum’, we will see radical and rapid cure. If it is a very close simillimum, we will still manage to cure, though not as rapidly as is the ideal. And if it is still less similar, we will be only able to palliate or remove partial set of symptoms.

5.      In this aphorism he also says that when the symptoms are removed in totality, no part of the disease remains and the health is restored. This line has been written to counter the claims of some people, who used to say that by using homeopathic remedies, the symptoms may disappear but the disease remains within. Hahnemann has made it clear at many points that the symptoms are the language of the disease. The symptoms are indicators of the disharmony within. If there are no symptoms, it only means that the disease has been cured in totality and the health of the individual has been restored.

So we see that Hahnemann has explained in great detail about the knowledge of medicine in these aphorisms. We will continue this discussion next month when we will explore Nature’s Law of Cure and will try to find out why we are more susceptible to our remedies in the diseased state. Till then try to absorb this lecture.

I wish you all a very Happy and Homeopathic New Year!

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Dr. Manish Bhatia