In my extremely petite professional years, I have often heard the notion that in homoeopathic parlance, the sickness is basically the derangement of harmonious flow in the sensations of vital principle, whereby the disease producing micro-organisms and the likes of them are nothing- nihilist.
They are material instruments of pathogenesis and a homoeopathic physician needs to scuttle them out in perceiving the aetio-pathogenesis of sickness. Then are we, as rational physicians, stating that mycobacterium tuberculosis and its variants have no role in aetio- pathogenesis of Tuberculosis!!!!
Absurd that it may seem so, then what is our consideration, as practitioners of phenomenological medicine, of the notion of CAUSE, which has been the QUESTIO VEXATA of homoeopathic philosophy.
Every effect has underlying causation and appreciating the fundamental concept of causation is essential in the study of life sciences. Each and every stream of medical science dealing with therapeutic interventional approach has to be very unambiguous in its understanding of cause-effect axis. In fact, perception of the causes of disease is important in health ? not only for prevention, but also for diagnosis and the application of appropriate therapeutic regimen.
In homoeopathic system of therapeutics too, the same holds good. As highlighted above, there is a prevalent view that believes in perceiving totality of symptoms (i.e. EFFECT) and completely turns a blind eye towards the concept of causation.
However, this is a myopic perception of philosophy of the great philanthropist, Samuel Hahnemann who gave due consideration to the concept of causation, albeit in different light than the accepted allopathic norm. This can be deciphered from ?5 of his magnum opus work ?Organon of Art of Healing? where he precisely states that:
?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 whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm???? 1
Besides this, in aphorisms 93, 207 & 208; Hahnemann has extolled the significance of perceiving causations in a given case of sickness. In light of these facts, let us evolve our approach to the understanding of pathogenesis of sickness and its significance in prescribing.
To start with, let us glean through the two different models of causations:
MODELS OF DISEASE CAUSATION
NON LINEAR MODEL
LINEAR MODEL OF CAUSATION emphasizes upon the fact that cause produce effects in a known, discernible linear manner and the effect is proportional to cause.
NON LINEAR THEORY OF CAUSATION states that a minor change in the initial conditions can lead to a major deviation in the result and a major change may result in a minor deviation. In fact, the Non linear system of equations emphasizes that effects are not proportional to their causes. Aside from the complex abstraction of mathematics, the concept of a nonlinear relationship is often seen simply as a cycle, or feedback loop. 2
Since the linear model of disease causation believes in the fact that causes produce effects in a linear, known pattern; therefore the cause may be discernible from the known effects. It has been the application of this very concept that is the edifice of allopathic system of medicine where the symptoms of the patient demand hearing as long as they are directive towards some form of causation, which then becomes the central theme of treatment. For instance, a patient presenting with the symptoms of typhoid fever will be in accordance to the linear model lead on to the sole cause of salmonella typhi. This in turns becomes the core issue of treatment in the form of antibiotic. Now this may still hold good for directly traceable infectious diseases, yet how will this model work in the chronic disease of modern era ? NON COMMUNICABLE DISEASES or the LIFE STYLE DISORDERS. Let us glance through the model of causation in some of these:
Another instance that may be quoted is:
Compared to the simple “linear” causal chains of paradigmatic classical physics (a causes b causes c causes . . .), causal chains in the living systems tend to be complex graphs in which each effect has many causes, and each cause has many effects.
Since Rene Descartes, the “scientific method” has progressed under two related assumptions. A system could be broken down into its individual components so that each component could be analyzed as an independent entity, and the components could be added in a linear fashion to describe the totality of the system. On the other hand, philosophers like Von Bertalanffy have proposed that the living systems are characterized by the interactions of its components and the non-linearity of those interactions.
The non-linear model stresses upon the fact that interactions between psychosocial and biological factors in the etiology and progression of illness and disease are varied and form a web of causality. How an individual interprets and responds to the environment determines responses to stress, influences health behaviour, contributes to the neuro-endocrine and immune response, and may ultimately affect health outcomes.
In his landmark work on the dynamic, living phenomenon of our ecological system, ?The Web of Life?, the noted modern physicist, Fritjof Capra has stressed upon the non-linear theory of causation operational in living systems that has dramatically increased the understanding of the key characteristics of life.
Elaborating upon the principles of causality, Capra states that linear concept of causation focuses on causal explanations of functioning which may be appropriate for describing mechanical structures.
?In this model, there is a direct line of cause and effect, and a breakdown at one point can be traced back to its cause. However, humans are living systems and function in processual rather than structured ways. For example, medical science has illustrated the complexity of the human system in acknowledging that associating diseases with single linear cause is highly problematic?. 3
‘Besides this; ?the web of causality? functions at a very subtle level to produce effects that are beyond the realm of human understanding.? 4
In fact, it is important to comprehend that in spite of the great triumphs of molecular biology, biologists still know very little about how we breathe or how a wound heals or how an embryo develops into an organism. 5
The same concept reverberates in the work of Hans Driesch when he emphatically states that: ?The human behavior is seldom linear: it is processual, and there are many influences operating simultaneously ? some known and some unknown.? 6
James Gleick, well known New York Times science reporter, has encompassed these very concepts in his CHAOS THEORY when he reinforces the notion that anything is capable of affecting anything else. Besides this, in his wonderful work ?Fractals: Form, Chance and Dimension and the Fractal Geometry of Nature?; Benoit Mandelbrot has highlighted the importance of Butterfly Effect discovered by Edward Lorenz which, through computer modeling, has authentically shown that a flap of butterfly wing might, through a chain of weather events, create a storm on the other side of the globe. Mandelbrot clearly emphasizes that:
?The mechanistic world view has to give way to something far more haphazard and multi-dimensional; and it shows, too, that throughout the universe random elements emerge and self catalyse into discernible and coherent form that are characterized by orderliness.? 7
This concept is also beautifully highlighted in the works of Stuart Close when he talks of MULTI-FACTORIAL CAUSATION of sickness, where a complex network of causes, some known and some unknown are at work in non-linear pattern to produce multitude of effects, which are perceptible and capable of logical coherence.
It is the appreciation of this very concept that is central to our understanding of homoeopathic methodology of treatment. Let us acknowledge and accept that the diseases are mediated by numerous etiological factors such as environmental, bacteriological, socio-cultural, so and so forth and appropriately adopt remedial measures where they can be removed through the modification of accessory circumstances.
However, on account of inability of human reasoning to decipher the whole host of causations, let us rely on the effects, that encompass the cause, as the basis of logical prescription. To clarify this point further, let me quote the famous philosopher, Henri Bergson who said that: ?The present contains nothing more than the past, and what is found in the effect was already in the cause; it is just the matter what was perceptible and what was not.? 8
This does not any way demean the importance of taking causation in consideration but emphasizes that cause is important as along as it is perceptible and the effect produced by the cause (in the form of concomitant symptoms) provides logical basis of prescribing the similimum. The very fact that such a cause produced effect through subtle, non linear pattern and therefore its mechanism of action was inexplicable does not decry its connotation. In actuality, it had to be inexplicable due the very fact that the perceptible cause is just one of the causes involved in the web of causations.
Let me clarify this point further. Any case of illness tracing its origin to h/o grief (which was one of the causes yet the only one perceptible) does not automatically warrant a prescription of Ignatia or Nat. mur. but in case such a patient develops the concomitant symptom of involuntary sighing, the prescription of Ignatia becomes logical; irrespective of the lack of reasoning of this cause-effect axis.
It is for this reason that most faithful follower and ardent disciple of Hahnemann, Boenninghausen introduced a case taking schemata that included the seven aspects most important to the homoeopath when forming a complete symptom image in which ?CUR? or perceptible etiological aspect of illness was one of the chief factors. Yet the concept of ?cur? is handicapped without the crutches of concomitant symptoms taken into consideration.
Now, I would like to quote two cases from my clinical experience that would shed light on the fact as to how seemingly unrelated cause can assume significance when synchronized with the effect in form of concomitant symptom.
A gentleman about 40 years age had reported with the diagnosis of Myelo-dysplastic syndrome. The disease had resulted in pancytopenia with resultant weakness and tendency to infections in the form of recurrent pneumonias. His occupational history revealed that being in an hotelier line (he had been running his own restaurant which he had now closed down on account of his illness), he had an extremely exertive nature of job. Besides his other symptoms, the most striking feature that he involuntary disclosed was that in spite of the great weakness and prostration that he suffered from, he never wished to complain to his family members about his poor health and it was her daughters who used to take him forcibly to the consulting physician.
Keeping in mind, the h/o persistent physical exertion with the concomitance of MILDNESS, does not complain and the location of pathological changes ? i.e. blood; Arnica Montana in LM potencies was prescribed. The patient showed symptomatic relief and what was more important, in two months time his blood count level improved markedly.
In another case of renal colic, patient presented with among other symptoms the symptom of severe pain in region of loin accompanied by ineffectual urge to defecate although the flow of urine was normal. There were other symptoms in this given case but the beacon light was that whenever patient experienced pain, the concomitance of Nux vomica emerged; although the reasoning of this phenomenon was far fetched. This patient responded extremely well to Nux vomica 200, unit doses given infrequently and expelled 6.2 mm. calculi within a period of 2 months of starting treatment.
It is for this reason that Boenninghausen has described concomitant symptoms as ?unreasonable (in modern context, non-linear)* attendants of the case in hand?. 9
Before, I conclude this discussion, let me throw light on the following statement mentioned by H.R. Wulff in the much talked about journal of the present day ?Lancet?:
?This, then is my vision of what will happen to our scientific perception of disease during the next century: we shall realise the wisdom of the ancient Aristotelian approach to the study of nature, which means that we shall no longer regard disease as a ?mechanical fault in the human machine? but as a disturbed life process. We shall apply the theories of open systems and non-linear dynamics to medical problems, and we shall reach a fuller understanding of the development of disease.? 10
1. Hahnemann, Samuel, Organon of Medicine, 6th edition, New Delhi, B. Jain Publishers Pvt. Ltd., 1992, 31-32.
2. Benet, William Rose, The Reader?s Encyclopedia, 3rd edition, London, A & C Black Publications, 2000, 2: 112.
3. Capra, Fritjof, The Web of Life, London, Harper and Collins,1996.
4. Fritjof Capra, Uncommon wisdom, New York, Simon & Schuster, 1988, 36.
5. Carrel, Alexis , Man, the Unknown, Wilco Publishing House, 1959.
6. Hans Driesch, The Science and Philosophy of the Organism, 2nd edition, Aberdeen, Aberdeen University Press, 2001, 198.
7. Mandelbrot, B., Fractals: Form, Chance and Dimension and the Fractal Geometry of Nature, Paperback edition, London, Routledge, 1999, 167.
8. Matt R., Weiss C., Royal T, Stanford Encyclopedia of Philosophy, The Metaphysics Research Lab Stanford University, 1995, 1:209
9. Boenninghausen, C.M.F. von, Introduction by H.A. Roberts & Annie C. Wilson, Boenninghausen?s Therapeutic Pocket Book, Reprint edition, New Delhi, B. Jain Publishers Pvt. Ltd, 2000, 20.
10. Wulff H.R., The concept of disease: from Newton back to Aristotle, Lancet 1999; 354 (suppl):50.
1. Ludwig von Bertalanffy, General System theory, London, Allen Lane Publications, 1968.
2. Hahnemann, Samuel. Organon of Medicine, Translated from 5th edition with an appendix by R.E. Dudgeon; with Additions & Alterations as per Sixth edition translated by William Boericke, B. Jain Publishers Pvt. Ltd., New Delhi.
3. Close, Stuart. The Genius of Homoeopathy, New Delhi, Indian Books & Periodical Publishers,
4. Boenninghausen, C.M.F. von. The Lesser Writings of Boenninghausen, New Delhi, B. Jain Publishers Pvt. Ltd.
5. Boger, C.M., A Synoptic Key to the Materia Medica, New Delhi, B. Jain Publishers Pvt. Ltd.
Dr. Bipin Jethani
Medical Officer (Teaching), Deptt of Organon,
Nehru Homoeopathic Medical College & Hospital