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You are viewing History & Basis Level 2 - Hierarchy of Symptoms
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to History & Basis - Level 1

The Hierarchy of Symptoms
by Ellen Kramer
College of Practical Homeopathy

Classical Homeopathy, also termed Kentian Homeopathy; Constitutional homeopathy; central prescribing; Essence prescribing, involves taking "the whole person into account not only on the physical level but more importantly on the mental, emotional and spiritual levels. The classical homeopathy approach owes a lot to the work of both Hahnemann and that of Kent (who can be seen as the Freud and Jung of the science (and art) of homeopathy). It can be further divided into a number of methods but the common thread is the principle of treating the whole rather than the parts, the patient rather than the disease. This method operates from the philosophy that the disease process flows from the innermost regions of a human being, spiritual or mental/emotional level first and then proceeds to the outer most levels of the physical plain.

The key elements for this method are:

"The Hierarchy of Symptoms". This means that once all the factors in the case have been collected i.e. spiritual essences, emotional, mental, and physical symptoms, they are graded in importance.
Mental/emotional symptoms being of primary importance.
Physical generals symptoms being of secondary importance.
Physical particulars (disease symptoms) being of least importance.

Thus disease symptoms are seen as the end result of disorder on the higher levels. Therefore in order to cure disease, treatment has to proceed in the same direction - "treat the person, not the disease".

Prescriptions take the form of a single remedy, in a single dose, in a predominantly high potency 30c to-CMs. The prescriber waits for a response in prescription to cease before repeating or re-prescribing.

Some Homoeopaths will tell you that Homoeopathy can only be done in one way - with a single remedy given once and followed by a long wait. (They also say that any other way of practicing is not just wrong but is almost evil. This is the most classical point of view. It is false and limited).

Some patients will do really well on the strategy of one remedy and wait a long time. Some will not. The classical problem is what to do about the patients who do not quite fit the perfect profile and do not produce the perfect response. These classically unresponsive patients require a different kind of strategy in order to be cured using Homoeopath.

It is never a matter of right and wrong. It is simply a matter of what way of using Homoeopathy gets the patient better the fastest, easiest and least distressing way.

At CPH the Classical approach is taught as one of the methods ( prescribing tools) that a Homeopath can use. To find out about other methods taught why not attend one of our Discovery Days?

In this method it is seen as inappropriate to prescribe on local symptoms like acute diseases or advanced pathology like cancer or disease in the physical organs as it would be considered a suppression i.e.

detrimental to the patient as a whole. Wherever possible, the remedy prescribed must bear similarity to the
mental/emotional state, as this is perceived as being fundamentally causative.
In the absence of clear mental/emotional symptoms, the physical general
symptoms are given precedence in the hierarchy.

This method is best used in cases of functional disorders and where there is a:

clear emotional/mental cause i.e. grief, anger, humiliation etc. . .
Where there is no pathology i.e. hay fever, menstrual cramps, headaches etc. .
Where there are strong mental/emotional symptoms with no real physical
symptoms i.e. psychosomatic illnesses, depression, schizophrenia etc. . .

The key issue when discussing this method once the above steps have been applied to the case, is how the practitioner accesses the case in order to assess what the relevant "totality of symptoms" are that will lead the practitioner to
the similar remedy. The Classical method although purporting to take account of the patient as a whole, pays lip service to the disease state; places it in a place of least importance and may ignore its vital message. This effectively limits the practitioner's "high and only mission to restore the sick to health". There are only a limited range of people who fall into this category "upper class/well of functionally disordered people" Robin Murphy.

This was not Hahnemanns aim when he developed this system. In p7 (6th organon) "It must be the symptoms alone by which the disease demands and points to the remedy suited to relieve it - and moreover, the totality of these symptoms (of this outwardly reflected picture of the internal essence of the diseases, that is, of the affection of the vital force) must be the principal or sole means, whereby the disease can make known what remedy is required.

A basic understanding of the above paragraph is this: When disease manifests itself in the physical tissue as cancers, tumours, cysts, arthritis, the patient is so unaware of what is going on, on the mental/emotional plain that the vital force
benevolently expresses that state for them in the physical plain in order to keep them alive. Therefore the more divorced the patient is from the deep mental/emotional issues the deeper the pathology. This method is limited to accessing those patients who have some awareness of their mental/emotional state. Here the vital force gently nudges them to pay attention to the mental/emotional issue by producing functional less limiting disorders. All of which if suppressed and ignored, filter into deeper pathology.

Within this method, there is the limited practice of prescribing a single remedy, in a single dose, in a predominantly high potency (30 - CMs) and then waiting until the response to the remedy has ceased before repeating or re-prescribing. The patient is left to deal with any acute disease that may come up as a result of "The Remedy", if prescribed on, it is seen as suppression and interference in the workings of "This Remedy". Thus ignoring one of the basic principles The high and only mission is to restore the sick to health.

There is also a myth that predominantly high potencies (30 - cm) treat the emotions. This assumption often ignores the vitality of the patient and what the vital force is trying to express. It also ignores the intensity of the diseases state which may require an incredible amount of vital energy to maintain itself like cancerous tumours. Thus one of the main pre-occupations of the practitioner is how to avoid "The homeopathic aggravation". Hahnemann by the 6th organon , p. 161.had abandoned this rule of high potencies in favour of frequent repeated doses in water potencies. This method ignores another of the principles of homeopathy - "removal and annihilation of the disease in its whole extent, in the shortest most reliable, and most harmless way." 6th organon p.2.

Within this method there is no paradigm to distinguish what the signs and symptoms of good health and normality, that are neither pathological nor curable and what is the derangement from this . Therefore the practitioner may use symptoms to access the case that are in fact healthy states that the person was born with. Robin Murphy states in his U.K. Cancer Seminar 1993 that he has never in 20 years of prescribing seen a Nat-Mur Constitution and that it is an acquired state and so the Classical concept of Constitution is often misleading and has more in common with the theories of Pythagoras and the theories of bodily humours.

These physicians did not concentrate on the type of disease, but on the type of patient (Humours were blood, phlegm, yellow bile and black bile). The patients physical and personality traits indicated what sort of imbalance was causing problems and the doctor had merely to restore balance. The humour theory later became associated with personality types in the same way that classical homeopathy is associated with remedy pictures. Nor does it seem to place any emphasis on the Miasmatic, thread running through a patients life. One of the conclusion of this method is that the shift into mental/emotional plain can often lose the prescriber in a quagmire of prejudice and assumptions about the mental/emotional state of the patient. It ignores the principles of vital force which is central to every thing; giving the practitioner information about potency, remedy and reparation. The high potency single dose has a fragile foundation of being susceptible to being anti-doted. Thus the practitioner never knows whether the remedy didn't work because it was antidoted or whether it just wasn't indicated. In a society where 60-70% of the population use drugs and stimulants like tea, coffee and tobacco to get through the day there is a 70% chance of the remedy being anti-doted. Hahnemann in the 6th organon p.4. states quite clearly that we find the remedy by accessing the totality of the disease not the person.

Constitutional prescribing (Also termed Kentian Homeopathy; Classical homeopathy; Central prescribing; Essence prescribing). This involves taking "the whole person into account not only on the physical level but more importantly on the mental, emotional and spiritual levels. This approach owes a lot to the work of both Hahnemann and that of Kent who can be justly seen as the Freud and Jung of the science (and art) of homeopathy. It can be further divided into a number of methods but the common thread is the principle of treating the whole rather than the parts, the patient rather than the
disease.

One of the key elements for understanding this method is what is called 'the hierarchy of symptoms' - this means that when all the factors, i.e. spiritual essence, emotional and mental and physical symptoms, have been taken they are graded in importance With the mental and emotional symptoms being seen as prime factors' the physical symptoms as secondary and the disease symptoms as the least'' important for initial prescribing purposes.

In my own experience I have only met one person who has clearly indicated a need to use this method. A had suffered from Psoriasis for 20 years. I felt the aetiology for her case was grief and the very essence of her being indicated the same remedy. Her mental/emotional symptoms concurred. I prescribed Nat.mur which has worked beautifully and there has been a dramatic improvement. I suspect that this method has not worked well in my other cases because there has been no clear remedy picture running like a thread through from the essence to the periphery of the client.

Kent:
The assumption is that human beings are graded in levels from material to spirit. This is hierarchical, spirit assumed to be the most causative. Another way of looking at it is "from periphery or circumference to the centre - the prescription is made on symptoms closest to the centre, these being the most important for defining the remedy. Only a single remedy at long intervals can be applied. This method is also called "classical" and sometimes "Hahnemannian". Hierarchy is Mentals -> Generals -> Particulars. 

,http://college-of-practical-homeopathy.com/classical.htm

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