Now we should see the errors that we should avoid when treating patients.
While treating this subject we will often be forced to come to some general considerations. The first is the most important. It is that there must be a close relation between the clinic and the therapeutic. We must always keep in mind that in homoeopathy we must make triple diagnosis :
1. Diagnosis of the disease.
2. Diagnosis of the patient.
3. Diagnosis of the remedy or remedies.
If we apply the law of similars directly without taking into consideration the patient on the one hand and the disease on the other, we will end very often only in partial or ephemeral ameliorations. Therefore it is necessary to practise an etiologic therapeutics and this cannot be realised without good diagnosis.
I will speak here only regarding some diseases for which this principle has much more importance.
DISEASES OF THE HEART AND OF THE BLOOD VESSELS
I take for example the diseases of the heart and of the circulatory apparatus in general. The modern methods of investigation, particularly electrocardiogram, may help us in certain cases to eliminate some homoeopathic medicines of which the patients have all the symptoms, but the application of which might be dangerous or useless according to a given diagnosis.
This is true for some cases of myocarditis. You have to deal with a patient who has fever, an intense precordial pain, and a sudden fall of the blood pressure. Before the era of cardiogram, or even when it was not possible to arrive at a proper diagnosis clinically of the infarcts of myocardia, one was tempted to apply homoeopathy to these patients on symptomatic basis, without knowing how they got the lesions, In such cases, one could not get the desired results that are now obtained. We know now that it is necessary to abstain in these cases from the tonicardiacs in high dilutions. We know that if in these cases we apply medicines to act on the fever we shall arrive at nothing, and remedies like, Naja, Bothrops, Arnica, Arsenicum, are specially indicated to us because we have the physiopathologic knowledge of that disease, an idea which we wanted totally until clinically on the one hand and by electro- cardiogram on the other we learn what happens at the moment of a myocardiac infractus.
Therefore in a general way we must keep in mind that the diagnosis of the disease has an importance, and an importance on which one cannot have the slightest doubt, not only from the point of view of the prognosis as it is believed by the unicists, but from the point of view of the therapeutics, because it may have all sorts of extremely important consequences. The kentian homoeopaths have the habit of saying that practice must be based purely on symptoms and that the diagnosis of the disease has no importance for the treatment; and that it is important only from the point of view of prognosis. This idea is absolutely erroneous and we will find other important examples of
TONICARDIACS AND HOMOEOPATHY
Now I must speak on the question of the relation between the toni-cardiacs and symptomatic and etiologic homoeopathic treatment.
This is important as regards asystole. There are cases where we are forced to apply some toni-cardiacs. In a general way we may use them in minimum doses. We agree with the official school in these cases but rather with the minimalists than with the maximalists and by so doing we will have good results keeping a good relation with our therapeutics. Let us not trust Oubain given intravenously repeated daily for ten days, which does not agree well with Homoeopathy. Oubain for example is good for acute heart weakness. It is a marvellous remedy in this case. But in chronic cases this medicine is used in intravenous injections and in repeated doses. I have often observed that it does not succeed well. By this kind of application of medicine, we get only a momentary amelioration after which there is established a kind of obstruction. We may say that the heart having made its last attempt has become completely tired.
In cardiac weakness, Oubain is a marvellous remedy no doubt, but it is a remedy to which one becomes habituated; one cannot make himself free from its power.
Digitalis in massive doses is also extremely dangerous in weakness of the heart. There are cases of suicides caused by taking digitalis. Digitalis causes tachyarythmia.
As regards the toni-cardiacs there is now a tendency to react against their being used for a long time and in massive doses.
They are now replaced by bromohydrates of quinine and also quinidine.
For the homoeopaths it is a great problem, the question of toni-cardiacs. We are sometimes obliged to apply to these patients in certain cases some toni-cardiacs but they hamper the action of the homoeopathic ground remedies.
I had two very curious cases. A case which I treated a long time ago. The patient was suffering from mitral disease. A young patient having hyposystole, with periodic asystole. He used for a long time Digitalis. When we treated him we applied a dose of Arsenicum Album M or 30 to be followed by a maceration of Digitalis. He took Arsenicum but he did not take the maceration. The urine augmented from 400 grammes to one litre and a half after the use of Arsenicum.
On the other hand we often see that Phosphorus augments the diuresis in astonishing manner in old asystolic patients.
How can the tonicardiacs act in a general way?
(A medicine like Naja act in rheumatic pancarditis. there is no doubt about it, and there is always infection of the muscular fibres).
Naja sometimes causes the systolic rhythm to disappear in few hours.
(Can we treat with oil of Camphor along with homoeopathy).
Yes, that does not prevent the Homoeopathic remedies to act.
In conclusion we may say that we require some homoeopath cardiologists who understand well their clinical diagnosis as well as homoeopathy.
ACUTE AND CHRONIC DISEASE
It is evident that in acute cases of heart, such as endocarditis, rheumatic endocarditis, pericarditis, the application of homoeopathy according to the symptoms will give interesting results. But when it is the question of a chronic disease, the case becomes completely different. Take for example a case of endocarditis who has a lesion of the endocardium. In such a case, the endocarditis will not settle the prognosis. It is myocardia, and the general condition which will settle the prognosis. We will have to treat the patient according to his constitution. We will have to give him some diluted tuberculines. We will have to treat the patient a long time before we come to the disease. And the most important and general rule in homoeopathy is: In epidemics of acute diseases it is often necessary to treat the disease first. In the epidemics there is a kind of epidemic Genus, so that all the patient require the same medicine. In certain epidemics of typhoid, Baptisia will be the only remedy, in others the remedy will be Arsenicum. During the epidemic of `flu’ called “Spanish”, in 1918 all the homoeopaths of Europe and of the United States cured the disease with Eupatorium perf.; the homoeopaths of Brazil used Gelsemium. The patients of Brazil had the symptoms of Gelsemium, while Gelsemium is a remedy of acute diseases in a hot countries.
Then in acute epidemics, the diagnosis of the disease leads directly to the homoeopathic remedy, indicated by the symptoms, while in chronic cases, it is the diagnosis of the patient himself which is of the first importance, his temperament, his constitution, his morphology, etiology of his troubles etc….
I believe that there we have to avoid many errors. The first is that we must not base our treatment purely on symptoms. The second is that inversely we should apply only the medicine having a far away action in relation to the lesions in question. And this brings us to another consideration which will be much more apparent as regards the diseases of other organs: which is that there is very often in the local organism a kind of antagonism between the local interest and the General interest of the patient and very often we are forced in homoeopathy to watch and treat the patient in such a way that we do not aggravate the lesions or the local troubles or inversely by respecting the general condition.
In a general way we may say that the allopathic medicine has always the tendency to consider the disease locally; the homoeopaths practise a therapeutic, which is quite different and has the tendency to make a general treatment and does not occupy itself with the local lesion. But the local lesion has also its importance. Some homoeopaths were right to make us wise in this regard. You know that Sulphur for example of which the child has all the symptoms, will ameliorate the general health but it may aggravate the otitis. We cannot, however aggravate a suppuration which will cause some local disorders only because it is the best remedy of the general health.
There is another consideration which is the following :
Very often in chronic cases, the most evident symptoms are of an organ or of a system which suffers, while it is another organ or another system which was really or primarily affected.
DISEASES OF STOMACH AND OF INTESTINES
I will at first give you the example of aerophagia. In all aerophagias there is a vago-sympathetic syndrome and a hepatic syndrome. We can cure aerophagia marvellously by the help of homoeopathy, but we can ameliorate more surely with triturations of the liver and of the parathyroid, than by Carbo vegetabilis. If we follow directly the homoeopathic therapeutics, and if we try to search for the similimum then we will find that China will suit to aerocolia, Carbo vegetabilis in aerogastria, and Abies canadensis in aerogastria which causes heart troubles. Then we will not think of the liver which is really the cause of the disease. Here the suffering organ is the liver, and it is a dumb organ, and the organ which cries for the pain is the stomach but the latter is not really the cause of the disease.
This is therefore a case in which the homoeopathic therapeutics should really be etiologic and should be applied on the basis, not only of the etiology but on the pathogenesis. We will cure aerophagia with Thuya, Ignatia, remedies of spasms, Kali carbonicum extracts of liver and of parathyroid in small homoeopathic or imponderable doses, while very frequently Carbo vegetabilis and Graphites will be but medicines of secondary importance.
Let us take another case : The ulcer of the stomach, with hyperchlorhydria, syndrome of Reichmann, rather a pyloric ulcer. According to the law of similars there is no other remedy but Robinia which is the best indicated by symptoms. Robinia will cause amelioration no doubt because it will act on hyperchlorhydria. Besides, Sulphuric acid will be indicated, or another remedy of the same type but these remedies will have only momentary effect. Anacardium, may also have a deep action if it is used according to the modality painful hunger, amelioration by eating.
Kent had already shown that very from the homoeopathic point of view the symptom itself was not so important, but it is the modalities by which the syndrome is established, which are much more important. It is for this reason we give so much importance to the modalities which translate the temperament and the reaction of the organism, while reaction of the organism is nothing but the pathogenesis itself.
Thus in order to cure ulcer of the stomach we apply on the one hand some antispasmodics and on the other hand some medicines, having special action on the liver, such as Lycopodium. We also apply a remedy having local action because we are obliged, it may be said, to act on a particular point according to its similimum. It is important to use the medicines of hyperchlorhydria i.e., to say of the pain of the patient, but these remedies will be of secondary importance.
This is the reason why in the whole homoeopathic treatment of chronic disease, in order to avoid this kind of antagonism between the superficial and evident symptoms on the one hand and the general symptoms on the other, Dr. Nebel has rendered a great service by first modifying the rules of the Drainage and Canalisation. He has built the bridge between these two types of phenomena.
I am giving you some examples in order to make you understand this point of view and to show you the errors that should be avoided. It is very curious to see how in a general way we get an action much more deep with the diluted and dynamised medicines given according to the law of similars on the hollow organs, having some autonomous movement. And this is rather true as regards the digestive apparatus. It is on the digestive system that we can act better, while apparently it is the question of some phenomena which seem material, visible, energetic and palpable and which are before all due to s question of energy, to the sympathetic action on the nervous system, on these hollow organs that can be contracted at will.
Well, there again, when we speak of Nux vomica as a canaliser of the small intestines, when we speaks of Aloe, the canaliser of the large intestines, and the rectum, we have in view some medicines that act on the sympathetic system and which have no direct action, either mechanical or physiological on the intestines and on the rectum. Our medicines act because we treat according to the pathogenesis of the observed troubles.
While treating the acute and the chronic intestinal troubles sometimes some interesting facts are observed. A patient told me this: when I work or when I become nervous and fretful, I have soft and fetid stool. When I am at rest stools are formed and have no odor. Try to understand the story. You will understand that his nervousness augments the velocity of his intestinal transit because of the sympathetic action on the peristalsis. Thus you understand why sometimes he has soft and why he has formed stools when he is at rest. But at the first thought you will not be able to understand why in certain cases the stools are fetid and why in certain cases the stools are not fetid. If you think a bit you will understand the reason. When the intestinal transit is very rapid the bile flow is not sufficiently abundant and cannot act well enough to check the intestinal putrefaction. And very often when the stools are fetid the medicines like Podophyllum or Arsenicum will act better than Benzo naphtha or other allopathic medicines capable of deodorising the stools. We must come to the sympathetic system if we want to know what really happens, Arsenicum album will be the important remedy for intestinal putrefaction.
(And if the rest of the individual is not Arsenicum Album, is there no risk of aggravation by Arsenicum album?)
I have never experienced. Arsenicum album is a remedy difficult to apply in chronic cases. It does not act according to expectation. In acute cases it is a marvellous remedy. It is extra-ordinary from the point of view of the digestive system.
(But the patient may be of Arsenicum album from the point of view of the cardio-vascular system or of the skin and if Arsenicum is given to him, is there no risk of aggravation?)
I do not believe it because you know the antagonism described by Hahnemann between the acute and the chronic disease. The acute disease acts as a drainer of the chronic one. You know that an acute disease ameliorates the chronic one temporarily. The chronic disease will appear again but not in aggravated form.
I speak of Arsenicum album so that you may not confuse it with Podophyllum which will act on stools which is less coloured. Arsenicum has back stool. The stools Podophyllum contain no bile, or in which the action of the bile is much less. The stool is not deodorised by bile.