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Classification of Disease in Homeopathy

From an Emergency Perspective

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In Table 1 (Sarkar 2004), we see based on the Organon (1921), that Hahnemann divided diseases into Pseudochronic Disease or Indisposition (Aph 77) and DYNAMIC Disease (Aph 78). Please refer to this table during the discussion below for better conceptual clarity.

Pseudochronic Disease, discussed again later, is not within our focus of discussion, but one needs to recognize, during emergency triage, whether the presenting condition is one of true dynamic disease or pseudo-chronic disease, as the latter simply requires alterations in diet, habits or lifestyle.

DYNAMIC disease is further subdivided into ACUTE and CHRONIC Disease that should be perceived by a trained physician.:

Acute Disease is perceived in 3 categories (Aph 73)

Individual – An acute exacerbation of latent Psora. Eg: recurrent fevers, recurrent asthmatic attacks, recurrent middle ear infections, etc. Sporadic – Due to individual susceptibility to external influences Eg: Conjunctivitis, typhoid, respiratory tract infections, rheumatic fever, etc. Epidemic – Due to acute miasm (non-immunizing and fixed/immunizing) affecting a large number of people at the same time. E.g. Non-immunizing: cholera, plague, diphtheria; Fixed/immunizing: scarlet fever, measles, small pox, rubella, etc.:

All these three conditions may present as emergencies (categories I, II, III of Triage) depending on the gravity (intensity and morbidity) of the disease, the underlying miasm of the individual and his susceptibility. Management of each of them in an emergency can differ slightly, based on the perception of expression. E.g. Psoric miasm responds to treatment more easily; sycotic expression tends to require longer management, repeated doses, with constitutional support; syphilitic miasmatic expression requires the syphilitic group of remedies, as a non-syphillitic remedy will only palliate and there is a high possibility of complications occurring.

Chronic Diseases express in two ways depending on the amount of suppression that has occurred in the past history of the individual. One expression is of FULLY DEVELOPED SYMPTOMS, where symptoms are complete in components (location, sensation, modality and concomitant) and also present adequate characteristics to indicate an accurate prescription.:

These are further perceived to be either miasmatic in origin or non-miasmatic in origin. Those with a simple expression of miasm as fundamental cause (Hahnemann, 1896) can be clinically classified into Psora (Aph 80-82), Syphilis and Sycosis (Aph 79). Otherwise they may express as complex disease, i.e. as a combination of two or more miasms. These are psoro-sycotic, psoro-syphilitic (tubercular), syco-syphilitic, psoro-syco-syphilitic. The latter complicate the management of emergencies as these are the cases that tend to develop complications with further suppressive or palliative treatment. Following up with intercurrent antimiasmatic remedies (Sulphur, Tuberculinum, Syphilinum, Medorrhinum, etc) or constitutional remedies may be needed either during or post-emergency management:

Non-miasmatic expression of disease refers to chronic indisposition; artificial diseases (drug induced) or pseudo-chronic diseases (Aph 77). In this category are included cases that resolve following changes in diet and lifestyle, correction of bad habits, or removal of offending drugs or environmental influences. In these situations, the underlying miasm is not necessarily affected and often an acute/ palliative remedy is all that is required to set things right.

The other expression of chronic disease is DISEASE WITH FEW SYMPTOMS or ONE SIDED DISEASE. (Aph 172). The susceptibility in these cases has been blunted by suppression or palliation with either modern medicine or homeopathic acute remedies, over a long period of time resulting in poor disease expression. These symptoms expressions are either INTERNAL or EXTERNAL, but with very few symptoms available specific to the chief complaint.

INTERNAL disease with paucity of symptoms can be expressed as either mental disease or physical disease. The expression is completely restricted to an isolated expression of disease in any one particular area. Some of these especially if acute pain manifests, will present in the emergency room as sudden onset of pain with no other evident picture of symptoms. These could present in any category of Triage.

In the physical category (Aph 173) are expressions like chronic headaches or diarrhea or recurrent cardialgia. The aid to finding the accurate constitutional remedy are a keen observation of accessory symptoms (Aph 180, 181) like warts, perspiration - types, location; cravings/aversions to food; sleep and dreams, etc.:

In the mental category (Aph 210, 216) are disease expressions that result from suppressed corporeal disease, or from (Aph 224) bad habits or morals, sudden anger, fears, anxiety, grief (Aph 225). These are cases that come to the emergency room as acute mania or rage and may belong to category II of Triage, that require immediate treatment guided by the acute characteristics for a palliative homeopathic remedy, followed by chronic, long-term treatment by the constitutional/antimiasmatic remedy dealing with the suppressed miasm prescribed during the latent period.

Hahnemann perceived EXTERNAL disease also as LOCAL disease. (Aph 185, 186) These diseases are signified by changes that are observed on external parts of the body only, solely as external lesions with no obvious internal expressions. Hahnemann surmised that the local restriction was because the ailment was trivial enough that it did not require the whole organism ‘sympathizing’ in response. These are a major group of emergency conditions that can be managed with homeopathic injury remedies in collaboration with surgical skill in a hospital setting. These could belong to Category I, II or III of Triage, and include various accidents, trauma following natural (earthquake, flood, tsunami) calamities, included in WHO’s disaster triage protocol. In this category (pure surgical), he considered surgery to have an helpful scope as a mechanical aid to remove external obstacles to cure. Hahnemann gives examples in Aph 186: e.g.: reduction of dislocations, stitching of wounds, mechanical pressure to stem bleeding from blood vessels, extraction of foreign bodies, removal of fluid collections, apposition of fractured bones.:

Included in this group would be conditions of ‘suspended animation’ (Aph. 67 footnote) that occur in previously healthy individuals and belong to Category I of Triage. The best management in these emergency situations is antipathic treatment or palliation as a preliminary measure. The conditions Hahnemann lists are, asphyxia and suspended animation from suffocation, freezing, drowning; i.e. where vital signs are grossly abnormal. Antidotes to poisonings are also in this category which can be managed homeopathically.

The second group in the local disease category (Aph 186), (partial surgical) is those conditions where the whole organism is involved in response, due to severity of the local affection. Here a sympathetic involvement of the whole organism is required for healing, and often general symptoms and complications develop like fevers, distant infection, or involvement of other organs following injuries or other external trauma; persisting pain of trauma both mental and physical.

These conditions require immediate treatment with specific internal dynamic remedies as well as surgical action and form an important part of emergency management (Category II and III of Triage). Understanding the miasmatic background of the individual is often very helpful both in the choice of the remedy and the prognosis of healing response.:

E.g.: An active psoric miasm will show a healing response much more quickly. But an active syphilitic miasm will cause delayed healing and often unexpected complications if the miasmatic background is not taken into consideration. In this group are congenital abnormalities which are syphilitic in background ranging from more morbid conditions like a patent ductus ateriosus (PDA), or ventricular septal defect (VSD) to less serious problems like a cleft palate or aterio-venous (AV) anastamosis in non-vital areas. All these require surgery, but need to be followed up by dynamic treatment/remedies for healing and to improve/correct physiological and anatomical function post-surgery.

Pseudosurgical disease (Aph 187) is another expression of local disease where the disease expression is on isolated external areas, but there exists dynamic disease (miasmatic) within that gives rise to these local expressions. Surgery here is palliative or suppressive as the problems are only going to recur if dynamic curative medication is not given. E.g. warts, ulcers, corns, tumours in various organs: internal or external, etc. These may only sometimes present as emergencies and belong to Category IV of Triage.:

It is necessary to be aware that inspite of the suggested classification as made above there exist no watertight compartments in classifying disease in an emergency neither from the homeopathic perspective, nor in Triage. Classification of the emergency presentation remains a clinical decision at that point of time, made from both the medical standpoint and the homeopathic. As we saw in the clinical overview above, medical triage and re-traige is the first step in classification of an emergency. The second step is a classification on clinical grounds from the homeopathic standpoint based on the guidelines above, which will help make homeopathic remedy choice and management more accurate. It is the basis of successful homeopathic protocol.

References

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Hahnemann, S (1921) Organon of Medicine, 6th Edition; Translated by William Boericke, MD, BJain Publishers Ltd, Reprint edition 1986.

Hahnemann, S (1896); The Chronic Diseases: Their Peculiar Nature and their Homeopathic Cure, Volume 1; Translation by Tafel, LH; BJain Publishers.

Hahnemann, S (1994); Materia Medica Pura; II Volumes; Translated by R.E. Dudgeon; B. Jain Publishers reprint edition 1994.

Sarkar, B.K (2004); Hahnemann’s Organon of Medicine; 9th Edition; Birla Publishers, Delhi