Hering and the Chronic Intercurrent Group
The following chapter brings up the subject of Hering's chronic intercurrents and their role in constitutional treatment. An experienced colleague on the Homeolist, the email group of the WWW. Homoeopathic Webpage, inspired a discussion which elucidates the case management strategies related to chronic intercurrent remedies.
Much of Hering's original contribution has been lost in the same way as Father Hahnemann's. We only find references to his more exotic experiments with nosodes, sarcodes, and isodes in our older works. For example, Dudgeon gave his famous Lectures on Theory & Practice at the Hahnemann Hospital, London, England between 1852-1853 only 10 years after Hahnemann left for his Heavenly Abode*. Hering was still teaching and practicing in the USA until he passed away in 1880. The more conservative Dudgeon's incredulous reactions to Hering's more progressive experiments is one of the only remaining documents from the time period. One of our mission goals is to find as much of Hering's original material and make it available in the public domain. This will help the worldwide homoeopathic community to begin research in many of these little known areas of Homoeopathy.
*Lectures on the Theory and Practice of Homoeopathy, Dudgeon, Lecture VI, Isopathy, page 141.
Questions:
Dear David,
Thank you for the very interesting post. It presented for me a new viewpoint on the case management in classical Homoeopathy. At the same time it created some additional questions.
You wrote:
The use of idem as an intercurrent, IF AND WHEN NECESSARY, is one of the methods of Classical Homoeopathy if the maxim of the single remedy and the minimal dose is respected. The use of a nosode, drug or vaccine by idem is part of Homoeopathy when integrated into proper constitutional case management.
My questions are:
1. Would you be able to explain more about indications for "the use of idem as an intercurrent, IF AND WHEN NECESSARY"?
Answer:
First of all, we must deal with IF NECESSARY! A homoeopath studies all the data related to the constitution, temperament, aetiology, miasms, suppressions and their signs and symptoms in the chronological order of development (aph 5.6.7.8). All the probable causes, befallments, miasms, suppressions, drugs, immunizations, traumas and their symptoms are reviewed in the order of their appearance. This information is needed to study the phenomena associated with the laws of cure as expressed by Hahnemann and Hering. If the totality of the characteristic symptoms points clearly to a well proven remedy it is imperative to give the simillimum at once.
The very fact that the vital force can express the disease state through constitutional symptoms shows that no one aetiological layer demands individual attention. To give a remedy that has an idem relationship with any one supposed causation is counterproductive and potentially disruptive to the natural symptom pattern. In such a condition an intercurrent is NOT NECESSARY, and therefore, contraindicated. The half homoeopaths often ignore this prime directive because they do not understand the relationship between causation, constitution and symptomatology.
Questions:
2. How would a homoeopath make a decision in case management to use an intercurrent remedy? When would such usage would be recommended to start?
Answer:
The subject of nosodes is quite misunderstood in modern Homoeopathy. On the one hand, we have those who would only use a nosode as a fully proven constitutional remedy, and on the other, we have those who give them routinely by the name of a miasm without any symptomatology. Surely there must be a middle ground between these two divergent approaches? We know that in The Chronic Diseases Hahnemann suggested the use of acute intercurrent remedies when constitutional treatment was interrupted by an acute crisis.* Acute intercurrents are chosen by the exciting cause and active symptoms of the acute crisis so that they do not disrupt chronic treatment. Is there a relationship between the usage of acute and chronic intercurrents for disruptions of the curative process during constitutional treatment? What is the special role of nosodes as chronic intercurrent remedies?
In 1833 Hering stated that:
"All these isopathic preparations can not be regarded as absolute specifics, but only as chronic intermediate remedies, which serve to stir up the diseases, and render the reaction to the subsequently administered homoeopathic remedy more permanent."*
In 1836 Hering gave a perfect example of the proper use of idem in a case of suppressed syphilis which would not respond to anti syphilitic remedies like Mercury so he used Syphiline (his syphilinium) as an intercurrent nosode.** This brought out the cutaneous eruption and chancre which was then perfectly cured by Mercury followed by Lachesis. Constantine Hering is the originator of the use of nosodes as miasmic intercurrents.
*The Chronic Diseases (Theoretical Part), Hahnemann, B.Jain, page 224-230.
**Lectures on The Theory & Practice of Homoeopathy, Dudgeon, B. Jain, page 146.
Characteristics of the Intercurrent Group
Hering noticed that certain characteristic symptoms are associated with the indications of miasmic intercurrents. Just as the homoeopath who works with families of remedies recognizes the nature of a plant group, mineral group and animal group, Hering also recognized the characteristic of the nosodes group picture. These characteristics includes indications of the miasms concomitant to lack of vital reaction to well chosen remedies, constant changing of symptoms, fragmented pictures of constitutional remedies and one-sided miasmic signs with few characteristic symptoms
Such individuals often have a sense of being tainted, guilty, dirty or feel as if life is a burden, they never feel comfortable or satisfied in any environment, they have discolored complexions and a look of suffering in the face when relaxed, and they are prone to self destructive impulses, cravings and habits. A differential analysis of the rest of the mental and general symptoms will immediately uncover which chronic miasm and therapeutic nosode is at the root of the picture.
Making a comparative study of the plant, mineral, animal and nosode group symptoms is very helpful. The symptoms of the nosode group are indications to study the case from the miasmic point of view. From a study of the totality of the available symptoms one can uncover which miasm is active or which nosode the vital force is calling to one's attention. At such a time an intercurrent may be useful in removing obstructions to the cure or bringing out a clearer picture. All miasmic intercurrents should be complemented by constitutional remedies at the appropriate time to complete the cure.
The following are some of the more characteristic rubrics associated with the use of the nosode group as a chronic intercurrent remedy.
1. WHEN WELL CHOSEN REMEDIES DO NOT ACT, HOLD OR JUST CHANGE THE SYMPTOMS. This is often caused by the suppression of the chronic miasms, psora, sycosis, pseudo-psora, and syphilis. This is one of the reasons it is important to know what miasms are in the background of a constitutional syndrome. Otherwise the prescriber may think they are choosing the wrong remedies and further confuse the situation by picking more and more new ones. An example of this usage of a nosode is Psorinum's keynote, Lack of reaction, when well-chosen remedies fail to act, especially in those who are extremely sensitive to cold, suffer from profuse sweating, filthy smell, dirty looking skin, who tend to be very pessimistic about their recovery, etc..
Another example of this rubric is Tuberculinum's characteristic, when symptoms are constantly changing and well-selected remedies do not improve, especially in those who have light complexion, narrow chest, lax fiber, low recuperative powers and constantly catch cold. There may also be fear of cats, dogs, and animals in general, a desire to travel, and a deep discontented state with a tendency to curse, swear, and a desire to break things, etc.. All of the nosodes have these symptoms but each characterizes it in their own way. This helps with the differential analysis.
2. WHEN PROGRESS UNDER A CONSTITUTIONAL REMEDY CEASES DUE TO A MIASMIC LAYER. This is a time when the use of a miasmic intercurrent may be necessary. A client's symptoms point to an inherited pseudo-psoric miasm and her symptoms fit Pulsatilla perfectly. Pulsatilla is a strongly anti-tuberculin medicine as well as the individual's constitutional remedy. After several months of solid improvement the patient begins to relapse with the same symptoms, and to one's great surprise, adjusting the dose of Pulsatilla no longer works. Although there is no change of symptoms calling for a new remedy, the previous remedy has become completely ineffective. If the symptomatology shows an active tubercular miasm in the background the homoeopath is led to the study of the tubercular nosode group.
The nosode may either move the case forward or set the stage for the reintroduction of the Pulsatilla. If the case improves on the nosode the remedy should not be changed. If the patient shows little change on the nosode, one should retake the case, and if still indicated, give the formerly used constitutional remedy. The nosodes are known for resensitizing the vital force to a constitutional remedy making it act just as dramatically as it did the first time it was given. This effect has been witnessed by experienced homoeopaths over and over again. The miasmic intercurrent may not radically improve the case other than to make the former remedy act anew. There are times when this technique is very useful.
3. "THE NEVER WELL SINCE SYNDROME" (NWS). Sometimes a person never fully recovers from an acute or chronic miasmic episode. The new miasmic layer changes their mentals and physical generals and represses the innate constitutional picture. For example, one may use Medorrhinum in a person who has a history of sycosis from which they have never recovered. Once they may have been of sharp intellect, clear memory, and of a calm nature, but all that has changed for the worse. Now they have become very hurried as if time passes too slowly, they can't follow the thread of a conversation because they are losing their memory, and they've become fearful of the dark, superstitious, and suffer from delusions that someone or something is always behind them. This last symptom is very indicative of the paranoid suspicious state of sycosis as it represents a subconscious delusion that something is going on "behind their back" and is about to "get them". This can be an indication that a miasmic intercurrent is needed.
The never well since syndrome (NWS) can also be applied to acute miasms. There are times when a person has never fully recovered from an acute illness and constitutional symptoms result. The affects of this acute miasm remain in the vital force and form a layer of disruption within the defense system. If this imbalance is strong it will become the dominant layer and repress the weaker older symptoms. At other times, the symptoms mimic the complications of the acute miasm in a subacute or chronic-like form. Examples of potential causative agents are acute miasms like influenza, diphtheria, measles, mononucleosis and whooping cough from which the patient never really recovered. A study of the potential disease states and complications combined the symptoms collected from the individual can lead to the symptoms of Influenzinum, Diphtherinum, Morbillinum, Pertussin, etc.
To never feel well since an acute episode can also be another indication of the chronic nosode group as the true susceptibility lies in the constitution. Knowledge of constitution, temperament, aetiology and the signs and symptoms must be included in case taking. If the constitution is healthy enough it will produce characteristic symptoms that will dominate the vital force. This will lead to a constitutional remedy which acts holographically and can affect any number of mixed susceptibilities and complete the cure. A homoeopath does not give a nosode just because a person has suffered from a miasms. The characteristics of the miasms and the genus nosode remedies must be present.
4. THE LACK OF SYMPTOMS. There are times when there are very few symptoms by which to prescribe. These are often one-sided cases where a strong layer has repressed the ability of the constitution to show symptoms. Other than the signs related to the pathology and the miasm characteristics there is little on which to base a constitutional prescription. This state may be caused by a combination of trauma, miasms, suppression and drug side-effects. The underlying diathesis can also be connected to inherited constitutional factors and miasms. The miasmic nosode is sometimes used in one-sided cases with a limited symptom picture (a prime characteristic symptom of the nosode group) if there is a clear aetiological factor and nosode group characteristics.
Vide the discussion of the remedy, Tuberculinum, from Kent's Lectures, "It seems from looking over the record of many cures that this remedy has been given many times for just that state on a paucity of symptoms, and if the records can be believed, it has many times balanced up to the constitution in that anemic state, where the inheritance has been phthisis. It is not the best indication for Tuberc., but where the symptoms agree in addition to that inheritance, then you may have indication for the remedy.".
There are two things that may happen after the ingestion of a nosode for such conditions. Sometimes the symptoms improve, the vitality increases and the constitution moves toward the state of health. At other times the symptoms of the patient may become more plentiful as the suspended layers within the constitution become active. This should then allow the homoeopathic practitioner to prescribe a constitutional remedy based on the newly arising syndrome and advance the case forward. The first new characteristic symptom which arises is the key to the rubrics of the new remedy.
5. WHEN PARTIAL PICTURES OF THE CONSTITUTIONAL REMEDIES MANIFEST YET NO ONE REMEDY COMPLETELY FITS THE CASE. Such cases seem to be fragmented and disorganized, but in actuality, this pattern is characteristic of the miasms and nosode group. An investigation of the miasms behind the fragmented picture may reveal the symptoms of the nosode group. Differential analysis will quickly show which nosode and miasm is involved. Such an intercurrent often improves the state of health and regularizes the natural symptoms pattern. After the nosode has done all it can do the symptoms will point more clearly toward a constitutional remedy. In this way a nosode can bring order out of chaos and clarity from confusion.
The nosode group characteristics are a signal to investigate the chronic miasms and map their signs and symptoms as well as looking closely for the symptoms of the major nosodes and anti miasmic remedies. There are always objective signs and subjective symptoms which will individualize the remedy if it is indicated. Over the years the use of nosodes as intercurrents have proved useful assistants to constitutional treatment if used correctly.
I would advise students of Homoeopathy to study constitutional Homoeopathy deeply and integrate the use of intercurrent remedies carefully into practice when needed to assist the cure. The isopathic concept is so easy (use the same against the same) that many star-struck beginners think they have found a short-cut way to do Homoeopathy. They do not have enough experience in constitutional Homoeopathy to understand those special moments when intercurrents are complementary to constitutional treatment. Others are prone to falling into old allopathic thinking combined with new age homoeopathic thinking. This leads to the abuse of idem in potency and disruption of the natural symptom pattern and constitutional state. In the name of treating layers, or removing drugs and blockages, the half homoeopaths give more and more remedies by idem and look less and less at the symptoms.
Posology Questions and Answers
Our homoeopathic colleagues asked two important questions:
1. "What would be posology recommendations for such intercurrent remedy?"
David answered:
Questions of posology must always be individualized. There are no hard and fast rules. Our strategy should be guided by the principles of the 4th, 5th and 6th Organon. If the nature of the situation and signs and symptoms point to the use of an intercurrent remedy it should be given in a single test dose. Remember, the idem remedy often stirs things up and gets the symptoms moving so it is imperative to wait and watch. It is quite foolish to rush into a series of doses at such a critical juncture in the case. It is the role of the intercurrent to reorganize the symptom pattern in such a manner that the signs and symptoms become clearer. If the intercurrent starts a progressive improvement the single remedy should be allowed to act alone. If there is slow progressive improvement the intercurrent can be repeated at suitable intervals in the liquid split-dose to speed the cure (5th and 6th Org). Only when the symptoms change should the case be retaken and a complementary remedy given.
Do not repeat the nosodes without good reasons. By their very nature the miasms and nosode group demands prudence and patience. Often an chronic intercurrent brings out the symptom pattern so it is best to wait until the symptoms have completely expressed themselves then retake the case by the totality. The vital force will naturally show which constitutional remedy it needs to complement the chronic intercurrent. In this way miasms can be cured and obstructions to the action of remedies can be removed.
2. What are the indications to stop using an intercurrent remedy?
As we have seen the symptoms of the nosode group appear when the normal symptom pattern of the constitutional remedies is disturbed*. There is usually lack of reaction, constant changes in the symptoms, fragmented symptom pictures or one-side symptoms combined with the signs of the classical miasms. What is normally considered a confusing jumble of symptoms and pathology are actually characteristic rubrics of the miasms and nosodes to one who understand the system. Thus knowledge brings order out of chaos.
There are certain conditions which point to the conclusion of the nosode's beneficial activity. If the first dose causes a striking improvement wait until there are signs of relapse and begin to chart the nature of the symptoms as they present themselves. If they are the "same" symptoms continue to reintroduce the liquid dose. If a new symptom pattern appears retake the case until you can find the complementary constitutional remedy. It is important to wait and watch the symptoms develop and be careful with the second prescription.
If the case progresses slowly but surely repeat the remedy at suitable intervals (only in medicinal solutions of Centesimal and LM potencies) as long as there is improvement and there are no new symptoms or aggravation of old befallments. The "wait and watch philosophy" must be the guide when the chronic intercurrent is being carefully repeated. If old diseases appear from the past then suspend the dose and wait and see how the symptom pattern develops. If they pass off without difficulty continue repeating the well adjusted dose at longer and longer intervals. Perhaps the nosode intercurrent was really the true simillimum and will lead to a complete cure.
If there is a change of symptoms under the influence of the remedy it is best to stop and see how the new symptom pattern develops. Wait and see what the vital force is trying to show the homoeopath. Remember, you are directly working with the chronic miasms when you use a miasmic intercurrent so caution is advised. Keep retaking the case until the new picture points clearly to the next remedy. A study of the new symptoms will often lead clearly to a simillimum and the case will move toward cure. This has been an area of research in Homoeopathy for 160 years.
The use of potentized drugs by idem (isodes) is much more experimental in nature. They are useful as intercurrent remedies to remove iatrogenic and toxic obstructions. The routine use of such unproven drugs is normally unnecessary because constitutional treatment often removes such toxins in the course of constitutional treatment. There may be cases, however, where the use of isodes may be of benefit as an intercurrent remedy. If we are to use the most offending drugs in such method a deep study of the side-effects and overdose symptoms should be collected. On top of this information provings of the most common drugs should be untaken. This will complete their therapeutic image.
One can see that to make a long list of drugs, suppressions, immunizations, miasms and traumas along the timeline, and try to treat them one by one by idem and specifics, is a counterproductive approach. On the one side, we have the "classical purists" who ignore Hahnemann's miasmic doctrine and Hering's intercurrents, and on the other, the isopaths who give everything by a one-sided concept of aetiology. Some claim they are practicing "Homoeopathy renewed' but in reality it is allopathicoid thinking combined with hubris. We few Hahnemannians are right in the middle working to reconstruct the original research of the great masters and integrate it into contemporary practice.
Hering's contribution to the Homoeopathic Materia Medica is mythic in its proportions. We must collect all his original material on these arcane subjects and learn the signs and symptoms associated with the nosode group and miasms. Those most qualified to do this research are experienced traditional homoeopaths who have a deep understanding of the totality of the symptoms and the nature of disease signs. It is time to put our full classical legacy through a complete review and bring those techniques which are useful up to date. It is for the homoeopathic community to do the hard work like the Founders did in their time.
Ars Longa-Vita Brevis |
