The historic development of constitutional types in Homoeopathy began with a change in Hahnemann’s own pattern of thinking. Hahnemann (1810) initially advocated similarity of symptoms as the sole basis to select the most suitable curative remedy. Some years later (1816-17) he became convinced that this was not adequate for treating chronic diseases.
It became obvious to him that in chronic diseases the presenting transitory symptomatic picture was only one facet of the deep lying original evil. Thus basing a prescription only on this presenting data often meets with failure.
He attributed origin of all sorts of chronic diseases to three fundamental causes or chronic miasms named as Psora, Sycosis and Syphilis.
Apart from presenting symptomatology, evaluation of fundamental causes required investigation of seven special areas such as ascertainable physical constitution of the patient, his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age and sexual functions etc. (Vide aphorism 5,0rganon of Medicine 5th edition).
The paragraph puts sufficient light on the importance of assessment of constitution of the patient in the treatment of chronic diseases.
Constitution forms an important part of the prescribing totality. We know from Samuel Hahnemann’s Paris case books that the Founder studied Hippocratic temperaments and has used terms ‘sanguine’, ‘choleric” in his case records.
Hahnemann’s Materia Medica Pura is the first homoeopathic work to give a full constitutional picture in a medical work.
On studying Constitution and temperament closely one can see that particular type of temperament is predisposed to certain forms of disease. It makes the study of Materia Medica interesting and its application easier.
Hints about temperament are found scattered throughout the writings of Hering, Teste, J. H. Allen, H. C. Allen, C. B. Knerr, H. Roberts, J. H. Clarke etc but detailed descriptions of their Physiognomy, Psychology or Physiology are partly or entirely missing.
In order to understand the usage of the constitutional temperaments it is important to understand the classical traditions introduced by Pythagoras, Hippocrates and the early Greek naturalists and this requires thorough study of Greek philosophy with the use of the original sources and probably because of it the proper use of temperament and constitution has gradually come into disuse.
Von Grauvogl a German Homoeopath of Nuremberg in 19th century tried to reach Hahnemann’s concept of miasm and predispositions through another basis of body chemistry grouping types as Hydrogenoid, Oxygenoid and Carbo-nitrogenoid.
The Hydrogenoid constitution characterised by an excess of Hydrogen corresponds closely with Hahnemann’s Sycosis.
Oxygenoid characterized by an excess of Oxygen corresponds with Syphilis.
And Carbo-nitrogenoid constitution characterized by an excess of carbon and nitrogen corresponds with Hahnemann’s Psora.
Succeeding physicians knowing the importance of symptoms related to seven special areas in the treatment of chronic diseases coined the term of constitutional prescribing and went into broad generalization and three fundamental miasms of chronic diseases formed the basis of another classification of constitutional types into Psora, Sycosis and Syphilis. Later on Tubercular constitution has also been added into the list. The identification of constitutional types has now been made comparatively easy.
Kent however did not approve of the use of the Hippocratic constitutional types in homoeopathy. He questions the nature of such information in his Lesser Writings and criticizes Hering for introducing into homoeopathy the use of temperaments in the Materia Medica.
He complained that the idea of the constitutional types was outdated and too closely related to astrology and other forms of the “pseudo-sciences” to be of no practical use to a homoeopath. But Hahnemann’s ideas related to miasmatic constitutions were very well accepted and promoted by Kent.
Boger Boenninghausen’s repertory mentions nine rubrics related to constitutional types as Carbonitrogenous, Dyscratic, Hydrogenoid, Lithaemic/acidosis, Neuropathic, Oxygenoid, Psoric, Sycotic and Syphilitic. It covers concept of Hahnemann, Grauvogl and his own.
The case is taken in the usual way including all the information available. The information is subsequently repertorised mainly using Boger Boenninghausen’s Repertory but when some rubrics are not found they are taken to other repertories like Boericke and Complete repertory. If the case fitted into one of the nine constitutional types mentioned in BBR, the same was also taken as the deciding rubric.
The importance of knowing the constitution of an individual especially in the treatment of chronic disease is unquestionable and BBR rubrics related to constitutional types offer a great help in deciding the selection of similimum particularly among the polychrest remedies occupying higher rank in repertorial analysis.
The remedies listed under constitutional types have greater depth of action and provide confidence to the prescriber in the selection of the remedy, which can be depended upon. There is a need to add more remedies and rubrics under various constitutional types to make its use more useful.
(Poster Presentation at International Conference “Improving the success of Homeopathy: Reuniting Art with science on 22-23 February 2001 at London)