Friday, February 4, 2011

Constitution,Temperament & diathesis....

Part 1: Constitution, Temperament and Diathesis
The Essence is the Gestalt of the Disease
Hippocrates was the first to write of the constitutional nature of the human organism. He taught that all diseases (excluding injuries) were initially general in nature and only become local to provoke a crisis at a latter stage. All natural diseases are originally functional and then proceed toward pathological damage over time. The old master also taught that there was no such thing as a single cause in a natural disease. He taught that causation was of an interdependent origin rather then any one isolated factor. There is always the merging of the susceptibility of an individual or group with a sympathetic pathogenic influence. Therefore, the aetiological constellation includes the predispositions of the physical constitution and mental temperament, the nature of the disease state, as well as environment conditioning factors.
There are some who are averse to the use of the word "constitution" in any manner. They are even more averse to the term "constitutional remedy". This term was introduced by James Kent to indicate a chronic or anti-miasmatic medicine that affects the whole patient. This term was complementary to the "acute remedy", which was more suitable for the transitory local phenomena associated with acute crisis. Kent’s constitutional medicine had nothing to do with giving remedies by classical constitutions or temperaments. It was simply the remedy that was most suited to treat chronic diseases and miasms. In truth, Kent spoke out against the use of classical constitutions and temperaments in Homoeopathy in his Lesser Writings.
Any negative changes in the human constitution and temperament are simply signs that may become part of the totality of the symptoms when characteristic. One does not give remedies for constitutions or temperaments per se. Taber’s Medical Dictionary defines the term "constitutional" as something that affects "the whole constitution" and is not "local". Something that is constitutional pertains to the "whole constitution". Hahnemann certainly made it clear that deep acting homoeopathic remedies affected the whole patient through the medium of the vital force. In this sense, chronic medicines are certainly "constitutional remedies".
Hahnemann used his knowledge of the Hippocratic Canon to understand the nature of the constitution, temperament and predispositions and their relationship to the signs, befallments and symptoms. The first instruction on homoeopathic case taking is for the homoeopath to record all the significant momenta of the complete case history, the potential causations including miasms, as well as the 7 attendant circumstances. This information forms the basis of understanding the patient (nature-inheritance) as well as the environmental conditioning factors that affect the development of symptoms (nurture-situation). Vide Organon §5 (O’Reilly edition).
"It will help the physician to bring about a cure if he can find out the data of the most probable occasion [Bold by DL] of a acute disease, and the most significant factors in the entire history of a protracted wasting sickness, enabling him to find out its fundamental cause [Bold by DL] . The fundamental cause of a protracted wasting sickness mostly rests upon chronic miasms. In these investigations, the physician should take into account the patient's
1. discernible body constitution (especially in cases of protracted disease) [Bold by DL]
2. mental and emotional character (character of the Geist and Gemuet) [Bold by DL]
3. occupations,
4. lifestyle and habits,
5. civic and domestic relationships (relationships outside and within the home)
6. age
7. sexual function, etc."
The significant factors of the entire medical history (the disease timeline), acute and chronic causations (the aetiological constellation), the chronic miasms, and the 7 attendant circumstances form the basis of proper case taking (§5). On this solid foundation the objective signs, coincidental befallments and subjective symptoms of the body and soul are recorded in detail (§6). The 7 attendant circumstances are:
1. The discernible body constitution (especially. in chronic cases). This category of symptoms includes a comparison of the physical constitution during a time of relative health with the negative changes brought on by diseases. It also includes Hippocratic diathetic constitution (the scrofulous, lymphatic, venous, nervous, rheumatic constitutions, etc.), a description of the physique (tall or thin, short or fat, loose or tight tissue types, etc) and the state of the vitality (weak, strong, unstable, etc). Rubrics of this nature are found in Hering’s Guiding Symptoms and Knerr’s Repertory as well as throughout many repertories.
2. The mental and emotional character. This refers to the character of the Geist (intellect) & Gemuet (emotional disposition). In this statement Hahnemann uses the term "charakter", which means personality rather than just transient mental conditions. This implies more than merely recording unrelated mental symptoms. One must understand "who" they are treating by constructing a complete psychological profile. This includes all the qualities related to emotional disposition, rational spirit and intellect as well as the soul. Rubrics related to these states are found through the mental sections of most homoeopathic repertories. Rubrics related to Hippocratic temperaments (choleric, phlegmatic, sanguine, melancholic) are found in Hering’s Guiding Symptoms and Knerr’s Repertory. Strictly speaking, these temperamental rubrics relate to the complete mind/body complex.
3. The occupation. The occupation that a person chooses is often characteristic of the individual's innate talents and desires. It also is an area that reveals many occupational hazards that may produce diseases as well as maintaining causes that obstruct the cure. These areas can reveal important symptoms as well as being relevant to the case management procedures.
4. Lifestyle and habits. These are cardinal general symptoms. How a person chooses to live and what they like to do are very characteristic symptoms. These symptoms offer great insights into the personality of the patient and their negative mental states. Investigating how a person lives often reveals indiscretions in diet, rest, and exercise as well as substance abuse and other areas that produce unneeded stress and strain.
5. Civic and domestic relationships. These rubrics include family dynamics as well as social relationships. How a person relates to their mate, family relations, children, friends, co-workers and society offers many signs and symptoms. These situational rubrics are a very important source of significant symptoms. Dysfunctional relationships produce illness as well as forming maintaining causes that keep up the disease state.
6. Age. Stages of life are a very important part of time and progression in Homoeopathy. The critical times are conception, birth, childhood, puberty, adolescence, middle age, and old age. Some remedies work particularly well on babies while other are more suited to the elderly. Some work well at both extremes of life. Hering recorded this is the section of the Guiding Symptoms called States of Life and Constitution.
7. Sex and sexuality. Some remedies are relatively more characteristic of females while some are more reflective of males. Some cover problems unique to the female and others male. The sexuality of a human being is closely connected to their physical and emotional health. The frustration of the orgasm reflex and the human need for intimacy leads to physical and psychosexual disorders. A person’s sexual ethics, sexual fantasies, sexual performance, and their sense of sexual satisfaction are a rich source of symptoms.
The time and progression, causation, the physical constitution, mental temperament and the 7 attendant circumstances are the foundation of homoeopathic case taking. Without these internal and situational rubrics the totality of the symptoms is incomplete. Who are they? What do they look like? What is the mental and emotional character like? What kind of lifestyle do they have? What are their habits? How do they relate to other people? What are their family relationships like? How are they aging? What is their sexuality like? These areas of study include personal and group factors. This is very important if the homoeopath is to understand the layers by which complex chronic diseases have formed and recognize the reversal of the symptoms during cure.
On the basis ofthe study of the timeline, constitution, temperament, causation, miasms and the 7 attendant circumstances the detailed study of the disease symptoms is continued. On this solid foundation Hahnemann introduces the totality of the symptoms in aphorisms 6, 7, 8. It is very important that the homoeopath understand what makes up the essential nature of the characteristic symptoms of the disease state. What is the Esse in Hahnemannian Homoeopathy? Vide aphorism 6 of the Organon.
"The unprejudiced observer, even the most sharp-witted one – knowing the nullity of supersensible speculations which are not born out in experience -perceives nothing in each single case of disease other than the alterations in the condition of the body and soul, disease signs, befallments and symptoms, which are outwardly discernible through the sense. That is, the unprejudiced observer only perceives the deviations from the former healthy state of the now sick patient, which are:
1. felt by the patient himself,
2. perceived by those around him, and
3. observed by the physician.
All these perceptible signs represent the disease in its entire extent [Gr. Wesen, essence, nature, being – DL], that is, together they form the only conceivable gestalt of the disease [Bolds by DL]."
The Esse is the alteration of the condition of the body and soul that make up the Gestalt of the disease (§6). The disease-Gestalt is composed of the symptoms that mark the progression from the state of health to the state of disease. The essence is the individualized nature of the complete experience of suffering (§6, 91, 92 & 175). In this study Hahnemann included changes in the innate constitution and personality as well as the negative states brought on by the disease.
One cannot separate the susceptibility and predispositions of the mind/body complex from the disease suffered by the patient. They form an inseparable whole because the innate constitution and temperament are the major conditioning factors in the experience of suffering. The mechanists tried to reduce the entire disease state down to a single cause or disease name. As Hahnemann said, one symptom is no more the disease than one foot is an entire human being.
What is it that is altered when a person suffers a disease? It is the condition of the body and soul (Gr. Leibes und Seelenbeschaffenheit). How is this alteration known? It is known by the essential nature of the totality of the objective signs, coincidental befallments and subjective symptoms. What is at the root of these disease phenomena? Vide aphorism 7 of the Organon.
"The totality of these symptoms is the outwardly reflected image of the inner wesen [essence, nature, being - DL] of the disease, that is, of the suffering of the life force."
The inner essence of a disease (the suffering vital force) is invisible but the disease-Gestalt can be witnessed through the signs, befallments and symptoms. In this way, one can know the essential nature of the mistuning of the vital force and find appropriate medicine. This is the Esse in Hahnemannian Homoeopathy.
Hahnemann was the first physician to fully integrate into medicine the innate constitution, the spiritual, mental and emotional temperament, the instinctive vital force, inheritance, predispositions, single and multiple causations, susceptibility, infection, acute and chronic miasms as well as the complete objective signs, coincidental befallments and subjective symptoms. Hippocrates is normally thought of as the father of constitutional medicine but Hahnemann brought this study to its perfection in Homoeopathy.
The healthy state represents a harmonious tuning of all vital operations (§9). Disease is the mistuning of this harmonious tone by a dissonant dynamic influence (§11). It is the disease-tuned life force that manifests as the essence of the disease-Gestalt through the totality of the symptoms (§12). Homoeopathic remedies cure through their power to similarly alter the tuning of the human condition (§19). The primary action of a homoeopathic remedy over-tunes the disease and elicits a secondary healing response that retunes to the state of harmonious health. This is the Esse of Hahnemann’s treatment method.
The Spiritual-Bodily Organism
Throughout Hahnemann's writings he uses the phrases, the unity of life, the complete whole, laws of the organic constitution, our living human organism, the bodily constitution, temperament, the make-up of the body & soul, the spiritual-bodily organism, etc. What is this whole the Hofrath is speaking of? Vide Organon.
"It was next to impossible for the them [the materialists] to acknowledge the nature of the spiritual-body organism as a highly potentized wesen, to acknowledge that the changes of its life in feeling and function, which one calls disease, had to be determined and produced mainly (in fact almost solely) through dynamic (spirit-like) impingements and could not be produced differently. [Bold by DL]"
(Organon of the Medical Art, O'Reilly edition, Introduction, page 12.)
In the German text Hahnemann used the term, beschaffenheit (make up), which is usually translated into English as the word "constitution". This, however, does not reflect all the usages of the German term. This term can be used in a variety of ways that have nothing to do with the human constitution. The root word "schaffen" means "to do, to make, to work". Beschaffen is a verb that means, "to procure, make something available", and as an adjective it means, "constituted".
The English word, constitution, comes from the Latin root, constituere, which means constitutes: to set up, to establish, to form or make up, to appoint to give being to. Beschaffenheit is usually translated as constitution in relationship to the Latin root "constiture" in homoeopathic works. Chambers Dictionary defines constitution as: the natural condition of the body or mind; disposition. In this sense constitutional means; inherent in the natural frame, or inherent nature.
The W. Turner’s Dictionary, published in Leipzig in the 1830s, defines the German term, Beschaffenheit, as nature, quality, temper, condition, constitution, disposition and circumstance. Therefore, the term Beschaffenheit may include any circumstance, condition or quality related to the physical constitution and mental temperament as well as dispositions. This shows how the term was used in Hahnemann's lifetime. Modern German may not clearly convey this meaning. The homeopathic usage is related directly to the practice of medicine not the common usage of a layperson on the street. The term constitution is used at least 16 times in The Chronic Diseases. Pages 30, 34, 35, 48, 75, 90, 98, 99, 101, 103, 142, 143, 145, 181, 242, 243, etc. The term "beschaffenheit" may have the following meanings in German.
1. A quality of someone or something that is inherent or a characteristic trait that serves to define or describe its possessor.
2. The make-up or way something is composed or arranged, its constitution, composition, construction or nature.
3. A medical term for inherent traits and qualities of the human being [constitution; make-up and qualities of the body and/or soul].
The meaning of Beschaffenheit in English depends the context in which it is used. For example, in aphorism 5 we find the term "die erkennbare Leibes-Beschaffenheit", which means ascertainable or recognizable bodily make-up. This term "Leib" is not commonly used in modern German but in older times it meant the body with special emphasis on the abdomen. This area is a key center for storage of vitality in the organism. The vitalists and Mesmerists considered the vital energy to have two major centers of force. These are the energy of the spirit in the brain and pineal gland and the reserves of vital power stored in the abdomen. This reference to the objective make-up of the 'center of the body' refers to the nature of physical constitution and vitality of the individual that is being investigated.
Diathetic Constitutions
In Aphorism 81 of the German Organon Hahnemann uses the term "angebornen Koerper-Constitutionen", which means the congenital bodily constitution. The genetic constitution represents the essence of the paternal and maternal lineages. This represents the inherited diathetic constitution and temperament including all its predispositions. The interdependence of the mind/body constitution is as inseparable as the link between the essential nature (Gr. wesen) and the instinctive vital force (Gr. Lebenskraft). One does not appear without the other. Such relationships are called functional polarities and complementary opposites. This bipolar phenomenon is innate in nature.
Hahnemann saw the unity of the organic whole while the orthodox school fell under the sway of reductionist pathology and disease names. The Founder pointed out that the mechanist looks at the products of disease and mistakes them for the cause of the disease and the disease itself. 'Tolle Causum' they cry yet they do not yet realize that the cause of an event can never be at the same time, the event itself. Even in early Homoeopathy the constitutional view of the human organism was clearly defined and the local basis of disease refuted. Vide § 42 of the 1st Organon (1810).
"But the human organism in its living state is a complete whole, a unity. Every sensation, every manifestation of power, every affinity of the component parts of one part is intimately associated with the sensation, the functions and the affinities of the component part of all other parts. No part can suffer without all other parts. No part can suffer without all other parts sympathizing and simultaneously undergoing more or less change."
(Organon of Medicine 5th & 6th edition, Dudgeon and Boericke, Appendix, page 194, B. Jain, Delhi, India
What is the "human organism"? Let’s look at the definition of "organism" in O'Reilly's glossary to her edition of The Organon of the Medical Art.
"Organism: An organized or organic system; a whole which consists of dependent and interdependent parts. The human organism is more than just a body's accomplishments (e.g., Fending off malignities) and developmental capacity (e.g., the ability to become more seasoned through provings). The human organism houses the mental, emotional and bodily faculties, that is, it comprises of the body, the Geist (spirit) and Gemuet (emotional mind). (§ 9, 11, 26)"
Homoeopathy views the spiritual-bodily organism as a highly potentized essential being with spirit, mind, vital force and body. This synergy of natural forces composes a whole human being, which is more than the sum of its parts. Hahnemann integrated the ancient Hippocratic teachings on temperaments, physis, diathetic constitutions and miasms into Homeopathy and brought them up to date for his time. References to this subject can be found throughout Hahnemann’s writings and the Paris casebooks.
Although modern Homoeopathy has greatly expanded the psychological aspects of our materia medica few persons understand how Hahnemann used the terms constitution and temperament and their practical ramifications in the clinic. To appreciate this material the homoeopath must be familiar with the medical history of the vitalist lineage and its greatest practitioners as well as Hahnemann's original works. This dynamic view of mind/body constitution has its roots in Pythagoras, its trunk in Hippocrates, its branches in Paracelsus, and its fruit in Hahnemann. This fruit carries the seeds for a new generation of healers and will be part of De Medicina Futura.
Hippocratic Temperaments
Samuel Hahnemann used temperamental portraits that include both positive natural qualities during the time of health compared with the negative changes brought on by diseases. He utilized such constitutional information within the totality of symptoms when prescribing his homoeopathic remedies. The Hofrath gives a complete portrait of Pulsatilla in the *Materia Medica Pura, 3rd edition, 1833, page 345. This example includes the use of classical temperaments.
"The employment of this, as of all other medicines, is most suitable when not only the corporeal affections of the medicine correspond in similarity to the corporal symptoms of the disease, but also when the mental and emotional alterations peculiar to the drug encounter similar states in the disease states to be cured, or at least in the temperament of the subject of treatment.
Hence the medicinal employment of Pulsatilla will be all the more efficacious when, in affections for which this plant is suitable in respect to the corporeal symptoms, there is at the same time in the patient a timid lachrymose disposition, with a tendency to inward grief and silent peevishness, or at all events a mild and yielding disposition, especially when the patient in his normal state of health was good tempered and mild (or even frivolous and good humouredly waggish) It is therefore especially adapted for slow phlegmatic temperaments; on the other hand it is but little suitable for persons who form their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered. [Bolds by DL]"
The above quote is a constitutional portrait. Hahnemann's picture includes attributes of the natural constitution (timid lachrymose disposition, slow phlegmatic temperament), positive natural traits during a time of health and happiness (good tempered, mild, good humouredly waggish) and negative emotions brought on by disease (inward grief, silent peevishness). This portrait includes natural, positive and negative qualities. As one can see from the above quotes this information was included within the totality of the symptoms.
Pulsatilla is "adapted for slow phlegmatic temperaments", while on the other hand it is less suitable for those who "form resolutions with rapidity' and are "quick in their movements". Such data establishes constitutional portraits as well as the use of temperamental counter indications as elimination rubrics. Pulsatilla is rarely indicated in those constitutions that make quick resolutions or move rapidly because this remedy does not normally suit that type of patient. This temperamental picture demonstrates several of the essential elements of the Pulsatilla proving. This demonstrates that Hahnemann was the first to open the field of investigation into constitution and temperament in Homoeopathy.
Hahnemann's Paris casebooks show that the Founder used Hippocratic terminology. Rima Handley noted in her Later Hahnemann that the Founder wrote in his casebooks that Mme del a Nois was "sanguine" and Eugene Perry was "choleric" Hahnemann also occasionally used the diathetic terms. For example, he wrote that Claire Christallo (DF-5) was "disposed to scrofula" and called another patient "lymphatic". Ms. Handley wrote that Hahnemann did not seem to use constitution, temperament or diathesis in his prescribing. While it is true that Hahnemann did not give remedies because a person was "sanguine", this is not the complete picture. Negative changes in a formerly healthy constitution and temperament are part of the totality of the symptoms.
Boenninghausen made it very clear in his writing that it was important to assess the physical constitution, mental temperament and predispositions during case taking. He felt it was important enough to include in his case taking directions. In Judgment of the Characteristic Value of Symptoms (Lesser Writings) Boenninghausen wrote the following under the title Quis, which means "who":
"Quis? As a matter of course the personality, the individuality of the patient must stand at the head of the image of the disease, for the natural disposition rests on it.
To this belongs first of all the sex and the age; then the bodily constitution and the temperament; both if possible, separated according to his sick and his well days i.e., in so far as an appreciable difference has appeared in them. In all these peculiarities whatever differs little or not at all from the usual natural state needs little attention; but everything that differs in a striking or rare way therefrom deserves a proportionate notice. The greatest and most important variations are here found mostly in the states of the mind and spirit, which must be scanned all the more carefully, if they are not only sharply distinct, but also of rare occurrence and, therefore, correspond to only few remedies."
Boenninghausen made it extremely clear how to use this information in case taking and remedy selection. He wrote that those things that "differs little or not at all" from the healthy natural state require little attention but "everything that differs in a striking or rare way there from deserves a proportionate notice". This means that the homoeopath is to assess the changes from the state of health that are produced by disease. Therefore, the healthy state of the constitution is of little or no use while the changes from the healthy state to the state of illness are important. The more striking or rare these negative changes are in the constitution and temperament - the proportionately more important they are to the selection of the remedy. For example, if a formerly obese, jovial person becomes thin, emaciated and depressed these symptoms are striking and rare for that patient. Therefore, these symptoms can be used in the case and may help in finding or confirming a remedy.
It is easy to see that Boenninghausen’s statements are intimately connected to aphorism 5 of the Organon and Hahnemann’s portrait of Pulsatilla in the Materia Medica Pura. To really understand this material the homoeopath must be somewhat familiar with the medical history of the vitalist lineage. Rima Handley also wrote that Hahnemann had no idea of the modern usage of constitution or essence. This is most certainly true in the sense of "essence constitutional prescribing" advocated by a few Neo-Kentian practitioners in the 1970s. Although Hahnemann did not use their method of so-called "essence prescribing", he most certainly did introduce the idea of the Wesen (essence, nature and genius) in The Organon. Hahnemann’s essence is the Gestalt of a disease as expressed by the characteristic symptoms of the mistuning of the vital force. This Esse contains the essential nature of the totality of the characteristic symptoms that leads to the most suitable homoeopathic remedy. This is the true Esse.
Hahnemann included the observations of Ludwig Christian Junker in the main body of text of The Chronic Diseases. This quote shows how the four classical temperaments and various diathetic constitutions condition the signs and symptoms produced by the suppression of psora. Vide The Chronic Diseases, Volume I, page 17.
"A brief survey of the manifold misfortunes resulting thence is given by the experienced and honest LUDWIG CHRISTIAN JUNCKER in his Dissertalio de Damno ex Scabie Repulsa, Halle, 1750, p. 15-18. He observed that with young people of a sanguine temperament the suppression of itch is followed by phthisis, and with persons in general who are of a sanguine temperament it is followed by piles, hemorrhoidal colic and renal gravel; with persons of sanguino-choleric temperament by swellings of the inguinal glands, stiffening of the joints and malignant ulcers (called in German Todenbruche); with fat persons by a suffocating catarrh and mucous consumption; also by inflammatory fever, acute pleurisy and inflammation of the lungs. He further states that in autopsies the lungs have been found indurated and full of cysts containing pus; also other indurations, swellings of the bones and ulcers have been seen to follow the suppression of an eruption. Phlegmatic persons in consequence of such suppressions suffered chiefly from dropsy; the menses were delayed, and when the itch was driven away during their flow, they were changed into a monthly haemoptysis. Persons inclined to melancholy were sometimes made insane by such repression; if they were pregnant the foetus was usually killed. Sometimes the suppression of the itch causes sterility, in nursing women the milk is generally lacking, the menses disappear prematurely; in older women the uterus becomes ulcerated, attended with deep, burning pains, with wasting away (cancer of the womb). [Bolds by DL]"
This quote clearly shows that constitution and temperament are primary factors in conditioning the nature of the symptoms developed after the suppression of the psora. This same is true with sycosis, pseudopsora, syphilis and any other chronic miasm. Junker noted that the suppression of the itch miasma tended to produce phthisis in young sanguine persons, dropsy in the phlegmatic temperament, and insanity in the melancholic temperament. He noted in the obese there was a tendency to produce suffocating catarrh and mucous consumption. Junker makes a direct link between suppression and the development of pseudopsora TB symptoms like consumption and phthisis. Each innate constitutional temperament has its own unique reactions to stimuli. For this reasons the same pathogen will affect the 4 temperaments and their 12 mixtures in a different manner.
For example, the phlegmatic (water-wet and cold) and melancholic temperaments (air-cool and dry) are usually aggravated by cold while the choleric (earth-dry and warm) and sanguine temperament (fire-hot and moist) are usually ameliorated by cold. If this is not the case, these symptoms become more strange, rare and peculiar. In each of the 4 major biological constitutions the environmental and situational circumstances are modified by the nature of their innate temperament. That Hahnemann understood how the mind/body temperament conditioned the signs and symptoms is shown by his inclusion of Junker’s observations in the main text of The Chronic Diseases.
Physiognomy and Temperaments
The use of Hippocratic temperaments (choleric, phlegmatic, sanguine and melancholic) expands the study of constitution in Homoeopathy because it includes physiognomy and the natural groupings of human beings into four major and twelve minor mind-body types. This 2, 500 year old system is the oldest living tradition in western medicine. These classical methods offer much insight into the nature of the innate constitution and temperament as well as potential diathesis toward particular signs, befallments and symptoms. Physiognomy is defined as:
"Physiognomy, the art of judging character from the appearance, esp., from the face; general appearance of anything; character, aspect-Greek- physiognomy, a shortened form of physiognomoni-physis, nature, gnomon-onos, an interpreter."
A homoeopathic physiognomist is an interpreter of natural temperament, heredity, predisposition, miasms and constitutional diathesis, as well as the present state of the spirit, mind and body. Let us look at the definition of the key terms, temperament, and constitution. What does temperament mean? The word temperament has different levels of meaning depending on usage.
Temperament from Latin, temperare; to temper, restrain, compound, moderate.
Temperament means a state with respect to a predominance of qualities; an internal constitutional state; a natural disposition; a proportioned mixture of qualities. Specifically it refers to the Hippocratic temperaments, the choleric or bilious, phlegmatic, sanguine and melancholy constitutions.
Temper-noun; a mixture or balance of contrary qualities; the constitution of the body and/or mind; a natural temperament; an innate or acquired disposition; a frame of mind; a mood; composure; to exert self control; to be uncontrolled, a fit of anger.
Temperament is also a musical term for a system of compromise in tuning. An equal temperament is a system of tuning by which the octave is divided into twelve equal intervals. The octave is a system of eight notes that make up the major or minor scale. The twelve note series of tones is called the chromatic scale.
Constitution, temperament, the spiritual body organism, the make up of the soul and body are synonyms for the living whole represented by a complete living human being. It is interesting to see that these major terms also have musical definitions. Even the word 'organism' is an archaic name for a musical instrument. The organism (musical instruments) supports the temperament (division of 12 notes of the chromatic scale-natural qualities), which is tuned (German-stimmung-tuning, voice, pitch and mood) by the vital force.
Disease is the mistunement (verstimmung) of the life force that causes disharmony in the temperament (the scale of notes -the natural qualities) of the organism (the instrument). Is this the Odes of Pythagoras and the theory of life as music? After all, Pythagoras introduced the 7 note major scale (diatonic scale), the five elements (ether, air, fire, water, earth) and the Mappa Mundi (geometric map of the macro & microcosm)) into western culture. These hold the keys to understanding the complete system.
The four major constitutions are called the choleric, phlegmatic, sanguine and melancholic or nervous temperaments. The twelve minor types are mixtures of the major type. They are the cholero-phlegmatic, the sangino-phlegmatic, the nervo-phlegmatic, the phlegmo-choleric, the sanguino- choleric, nervo- choleric, the cholero-sanguine, the phlegmo-sanguine, and the nervo-sanguine, the cholero-nervous, phlegmo-nervous and sanguino-nervous. Each of these temperaments represents a natural grouping of constitutional types that have similar mental and physical qualities.
Hering's Contribution
When temperament is used in a general way it means the mental and emotional disposition, state, mood, composure, etc. There are other references to disposition and temperament in Hahnemann’s writings. Vide Materia Medica Pura, lecture on Nux Vomica, page 223.
"Some practical instructions may be of use, deduced from the results of the careful experience of many years. Among these may be mentioned, that is more frequently required by those persons who are of an anxious, zealous, fiery, hot temperament, or of a malicious, wicked irascible disposition."
When temperament is used specifically it means the Hippocratic constitutional temperaments, the choleric, phlegmatic, sanguine and nervous melancholic. Hering expanded this temperamental portrait by adding the names of the Hippocratic temperaments and physical descriptions of the patient in the portrait. The source of this information is the observation of the Hippocratic temperaments during the provings and recording which constitutions developed the most characteristic symptoms. This was then combined with clinical confirmations in patients under treatment. Hering created a separate section for constitution and temperament in his materia medica called Stages of Life and Constitution. Vide Guiding Symptoms, Volume VIII, Nux Vomica, page 168.
"II. For very particular, zealous persons, inclined to get angry or excited, or of a spiteful, malicious disposition. II. Ardent character or a disposition disposed to anger, spite or deception; always irritable and impatient. II. Nervous, melancholic people, troubled with indigestion; venous constitution, with tendency to hemorrhoids. II. Suits thin, irritable, choleric persons with dark hair, who make great mental exertion or lead a sedentary life. I. Bilious temperaments. (hepatic affections) I. Patients addicted to use of much wine or coffee and to those of sedentary habits combined with considerable mental exertion. II. Debauches, thin, of an irritable, nervous disposition. II. Drug subjects."
In Hering's 5-point system of grading remedies II (5) is the highest grade, I (4) is the second grade. We find similar rubrics in Allen's Keynotes under the title "adapted to". Allen includes temperaments, miasmic tendencies, diathetic constitutions and symptoms in these rubrics. These are all constitutional general rubrics.
The above rubrics are an extension of Hahnemann's original portrait of Nux Vomica. This temperamental portrait includes natural temperament (bilious, choleric, melancholic, nervous dispositions with their traits), diathetic constitutions (melancholic with venous constitution), mental rubrics (angry, spiteful, impatient, etc), physical descriptions (thin, dark hair), lifestyle (sedentary or great mental exertion), habits, (addicted to wine, coffee, drugs), as well as predispositions to regional symptoms (tendency to hemorrhoids, indigestion, hepatic affections). On this constitutional basis the signs, befallments and symptoms are further investigated for those rubrics that are strange, rare and peculiar to the individual organism (Org. §5.6.7). To utilize this method completely one must understand the teachings of Hippocrates as well as Hahnemann, Boenninghausen and Hering.
Hering's proving collection and his clinical confirmations are the source of constitutional characteristics such as: Nux Vomica is well adapted to angry, irritable, dark, thin, dry, bilious, choleric persons; Pulsatilla is well adapted to gentle, blond haired, blue eyed phlegmatic temperaments; Phosphorus is well adapted to tall slender persons of sanguine temperament, fair skin, delicate eyelashes, fine, blond or red hair, with quick perceptions, and very sensitive nature; Arsenicum is well adapted to the over anxious, chilly, nervous anxious temperaments. Such symptoms do not automatically lead to remedies by themselves, as they are only part of the totality of the symptoms.
One might ask, what is a phlegmatic temperament? How does Hahnemann’s statement that Pulsatilla is "especially adapted to slow phlegmatic temperaments" fit into the overall picture? The next chapter in our study contains a review of the essential rubrics of the phlegmatic constitutional temperament. This should help to put Hahnemann’s statements into perspective.

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