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-miasmaticmedicine
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.