The whole truth about constitutional prescribing
The half truth about constitutional remedies
When we were first introducted to the Kentian constitutional approach, I realised that homeopathy was full of materia medica books for this approach with elaborate details of remedy pictures. Most of them leaned heavily towards the mental constitutional pictures and colourful descriptions of personalities. No doubt it made homeopathy appealing to me as a student.
I could spend days reading Catherine Coulter's personalities like an interesting novel in my first year. However as soon as I started the OPD with consultants using this approach for prescribing real life patients, I had a wake up call. Suddenly the pictures seemed to be a part of a fantasy character.I had imagined the characters of these books walking through the door but that seldom happened.
Suddenly I found homeopaths prescribing the same remedy for totally contrasting personalities. it seemed that everyone based their remedy understanding on their own experience.
Each expression in clinic seemed half the truth to me. Then I tried looking for some confirmations in the books again and I found the same contrasting examples.
Two sides of the same remedy
Let's look at the remedy Sulphur.
A Sulphur constitution is described in Lectures on Homoeopathic Materia Medica by Kent as follows -
Persons who lead sedentary lives, confined to their rooms in study, in meditation, in philosophical inquiry, and who take no exercise, soon find out that they must eat only the simplest foods, food not sufficient to nourish the body, and they end up by going into a philosophical mania.
The Sulphur scholar, the inventor, works day and night in threadbare clothes and battered hat; he has long, uncut hair and a dirty face; his study is uncleanly, it is untidy; books and leaves of books are piled up indiscriminately; there is no order.
You find the confirmatory rubrics in the repertories as -
Indifference about personal appearance.
This is indeed the most popular identity of a Sulphur constitution. However I found it extremely confusing as a beginner to find the exact opposite to be true in patients I observed. There were extremely successful businessmen who had done well on Sulphur. They were not just well dressed but extremely particular about themselves and their venture.
Interestingly even this facet of Sulphur is covered in the rubrics -
Fastidious appearance about personal
Fastidious work in
Ambitious money for
Business aptitude for.
I then realised that Kent has written about this contrasting picture as well -
The Sulphur patient is a lean, lank, hungry, dyspeptic fellow with stoop shoulders, yet many times it must be given to fat, rotund, well-fed people.
Finding the whole truth
So what exactly is the real constitution?
How do you get the whole picture of a remedy when descriptions can be poles apart?
I simply did not want to reinvent the wheel and wait for years before I had every personality of Sulphur walk in my clinic to know the real picture.
So I decided to find what were the experiences of other homeopaths. I went back and extracted all the old and new journals, books and every case I could find on cured cases of Sulphur using the well known constitutional approach. I wanted to find how both the traditional and contemporary homeopaths used this approach for finding the same remedy
And I had an Aha moment. I discovered that well proved remedies have always expressed these polarities in practice when you looked at the remedy superficially. But all these expressions seemed to be derived from a common center. This was underneath these superficial expressions. Some described it as a red thread running through the remedy, some called it the essence and some called it the soul. Some derived it exactly, some did not and chose to prescribe only on the expressions. But the beauty was that the common connecting center was constant for the remedy.
So I realised that the key in practice to make convincing prescriptions was to find this common connecting link between the these expressions in both the remedies and patients.
How do you derive and understand the common link in the remedies?
In well proved remedies it could be well confirmed through the provings and successful clinical cases of the remedy. This can be done by looking at the rubrics which represented the deeper feelings rather than the expressions.
In partly proved or newer remedies it can be reconfirmed through group analysis ie from other well proved remedies belonging to the same group.
No matter which way you reveal it, this underlying link or hinge remains constant.
For example one of common links around which the Sulphur personalities revolved was about having a strong sense of identity and ego. When this identity was lost at some stage (eg from being disgraced, scorned or embarrassed), it brought the strong expressions of Sulphur in a clinical situation.
This then aligned with every expression you may find ie the boastful philosopher who thought his rags were beautiful or it could be the ego centric businessman who had been scorned in the past striving to achieve that name and respect which he deserved etc.
This process opened up for me a whole new understanding of remedies.
How do you elicit the common link in case taking?
Although one may find a remedy based only on expressions they have known before, the key to remove the subjectivity when using the Constitutional approach is to take the case taking to confirm the common link.
Imagine the patient's core to be the center of four concentric circles. You are travelling from the outermost circle to the center during the whole case taking process.
There are various approaches in homeopathy which lead you to different circles at different depths
The constitutional approach takes you to the third circle which I consider at Stage 3.
Through years I have realised that when a patient is ready to go to Stage 3 and beyond, there is a specific step by step process which can subtely lead your patient to reveal these deeper common links no matter what specific approach you choose to use.
Its interesting how every step you take to the center improves the accuracy of understanding your case as well as the remedy and suddenly the success rate of your prescribtions increases remarkably.
Coming back to the constitutional approach, let me share with you an interesting clinical case which I had seen around 10 years back. This case is edited for brevity, however I want to share with you how the two expressions of a common remedy became clear once I understood the common hinge.
Your patients are your best teachers after all.
The whole idea for today's blog was to inspire you to look beyond the expressions in your own cases where your patient is ready to travel with you.
However I promise to share my experiences of using this integrated approach in much more detail and elaborate the exact steps to travel through the stages in my future communications so you can apply it in your own patients too and share the experiences.