Temperament

 

[Christopher Hedley]

The best way to learn about humours is to try applying humoral theory in practice. This project is a first attempt to devise an approachable and practical solution to the problem of how to teach humoral medicine in a modern setting. Your feedback is important to the success of the project.

The Four Temperaments

In the body the four elements; EARTH, AIR, FIRE and WATER are known as the four Humours and give rise to the four Temperaments; Melancholic, Sanguine, Choleric and Phlegmatic respectively.

We are, everyone of us, composed of all four elements. We must have them all or we couldn't function or even 'be'. The interplay and relative dominance of each of the four humours within our bodies gives rise to our individual temperaments and bodily shapes. The system describes us as a whole - mental, physical and emotional characteristics.

(Only about 10% of people have one clearly dominant humour, most of us are complex mixtures. The purpose of this exercise is to help you gain a clear picture of your overall balance. Our humoral balance changes throughout our life so the exercise is worth repeating every decade or so).

1. Put a tick by every statement in the sheet called "What humour are you" that describes you. Don't worry if your ticks seem contradictory, people are contradictory!

2. Enter on the Record Sheet the number of ticks you gave to each humour.

3. In one sentence sum up your assessment of your humour:

For example; Fire 3, Air 2, Water 10, Earth 16 - this person is dominated by Water and Earth ie. they tend to be a bit muddy.

Notes for guidance: I have included a few signs of excess. Tick these only if you tend to have them regularly or persistently. You may need to take the pulses / see the urine of other people to help you assess yours. 'Dreams' concerns recurrent themes. The illustrations given are from 'Winnie the Pooh'.

4. Read through the following lists and decide on a regime for yourself, based on your assessment of your native humoral balance. Write down that regime and follow it, as best you can, for one month. (Most people will need a regime that is a mixture from the various lists).

5. Fill in the first page of the RECORD SHEET.

Which humour are you?

 

Fire (choleric)

Air (sanguine)

Water (phlegmatic)

Earth (melancholic)

Definition

FIRE is the easiest humour to see as it is the most 'active'. Fire is Hot and Dry & most active in adolescence and in summer. The CHOLERIC humour.

AIR is seen most easily as mobility. Air is Warm and Moist, light and mobile, most active in infancy and spring. The SANGUINE humour.

WATER is somewhat more hidden than the above two. Water is Cold and Moist, flowing and binding, most noticable in old people and winter. The PHLEGMATIC humour.

EARTH is most easily seen in the way it 'is'. Earth is Cold and Dry, solid and retaining, most noticable in middle age (especially if they have teenage children) and autumn. The MELANCHOLIC humour.

Build

___ Short and muscular.
___ Easily puts on muscle.

___ Slender and supple.
___ Of middling height or tall and well proportioned.

___ Short or middling.
___ Inclined to fat - pear shaped.

___ Solid bones and with little fat.
___ Medium height.

The wrist, from the hand halfway up the elbow

 

__ Medium wrists with clearly defined arm muscles

___ Thin wrists (light build)

___ Medium wrists with soft flesh and the muscles not clearly defined

___ Thick wrists (heavy, not swollen) (heavy bones)

Stance

___ Steady and firm.

___ Stands lightly.
___ Springy step, restless.

___ Tends to sag.
___ Gait soft & slow or dragging.

___ Firm but dragging.
___ Tends to hold head down.

Features

___ Well defined (eg a 'Roman' nose - Fire gives definition).

___ Mobile.
___ Nose straight.

___ Soft, indefinite & rounded.
___ Nose rounded.

___ Gaunt.

Skin

___ Dry or combination skin.
___ Rough and warm.
___ Prone to acne & hot rashes, especially during adolescence.

___ Soft, smooth & warm.
___ Large veins.
___ Light or reddish complexion.
___ Blushes easily, red face.
___ Freckles.

___ Cool & soft.
___ Smooth & pale.

___ Cold & dry.
___ Rough, hard and thick.
___ Dark or ashen, often lumpy.
___ Often itchy.

Eyes

___ Dark and sparkling.
___ Steady gaze.

___ Blue or grey blue.
___ Looks around a lot.

___ Pale and watery.
___ Looks away.

___ Dark.
___ Dull gaze.
___ Avoids eye contact.

Hair

___ Curly, dark or red.
___ Plenty of body hair.

___ Thick hair, brown or red (in white people).

___ Light colour, flaxen (in white people) & straight.
___ Lack of body hair.

___ Colour dark.
___ Lack of body hair.

Pulse

___ Strong and full.

___ Great and full.
___ Circulation can be erratic.

___ Hidden & deep.
___ Circulation poor, feels the cold.

___ Slow and steady.
___ Hard or irregular.
___ Tends to overheat in hot weather.

Appetite

___ Good - regards food as fuel.
___ Digestion strong can eat most things but may be prone to acidity or liverishness.
___ Stools generally soft.

___ Good.
___ Digestion good and quick.
___ Likes rich food and eating in company.

___ Cold, weak digestion.
___ Tends to bloating.
___ Prone to mucus.

___ Good but often better than their ability to digest.
___ Prone to liver congestion.

Urine

___ Yellow or dark yellow.

___ Thick and yellow.

___ Pale and thick.

___ Dense, can be pale or dark.

Mental set

___ Proud & ambitious.
___ Strong willed.
___ Blunt but can be charming and a flatterer.
___ Aggressive & quarrelsome or touchy.
___ Bold
___ Quick witted, grasps ideas quickly.
___ Strong emotions quickly expressed.
___ Can hold conflicting emotions at the same time.
___ Appreciates discipline.
___ Likes high adrenaline & competitive sports.
___ Likes few possessions, but must be of quality.

___ Sociable, good company.
___ Joyful & merry.
___ Generous, courteous & merciful.
___ Not easily offended.
___ Likes the company of the opposite sex.
___ Likes good wine and song.
___ Childlike, easily bored, easily changes opinions.
___ Selfish, fickle & restless.
___ Easily moved.
___ Likes new things, can be silly & foolish, self indulgent.
___ Tends to excessive thinking, anxiety & hypochondria.

___ Introverted & calm.
___ Sluggish or lazy.
___ Likes to sleep.
___ Dislikes exercise.
___ Passive.
___ Covertous, stingy & conservative.
___ Careful & dependable.
___ Feels emotions deeply but hides them.
___ Fearful.
___ Kind & friendly.
___ Practical.
___ Stubborn but good at disguising this.
___ Works well under pressure.

___ Introverted.
___ Sad or pessimistic.
___ Stubborn, obstinate.
___ Suspicious, retains anger, splenic.
___ Makes and keeps to judgements about others.
___ Easily offended.
___ Analytical, intellectual & studious.
___ Evaluates before action.
___ Thinks deeply about things.
___ Retentive memory.
___ Careful can be fearful.
___ Tight fisted.
___ Air of being worn out.
___ Suffers in silence. Poets and theorists are often melancholic.

Social

___ Extrovert.
___ Likes to be in charge.
___ Good initiator but won't follow through if goals take too long to achieve.
___ Acts quickly, good in emergencies.
___ Difficult to please.
___ Prefers stimulant to narcotic drugs.

___ Extrovert, very sociable.
___ A better lieutenant than leader.
___ Always says 'yes' to new things.

___ Likes things to run smoothly - good at facilitating groups and diffusing anger.
___ Good listeners.
___ Annoyed by active types - pours cold water on them.

___ Anti-social, likes their own company.
___ Self sacrificing.
___ Excellent at evaluation (but slow).

Clothes

___ Important to wear smart or well fitting clothes.

___ Likes to dress well (or fashionably) but comfortably.

___ Soft materials.
___ Loose and flowing.

___ Not bothered about appearances.

Dreams

___ Of fire, violence or quarrels.

___ Merry conceits, flying.

___ Of water.

___ Of sad and dark things, of stars falling to earth, of monstrous creatures (Avicena).

Sex

___ High sex drive but goes for quick satisfaction.
___ Important to have good looking partners.

___ Likes flirting & foreplay.
___ Good fertility.

___ Low sex drive.

___ Prefers to think about sex rather than take part in it.

Signs of excess

___ Acidity & Heartburn.
___ Biliousness with regurgitation, sour taste in mouth & abdominal discomfort.
___ Insomnia (with restlessness rather than with anxiety).
___ Any fevers tend to be high and short.
___ Heavy menstrual bleeding.

___ Head full of confused & unquiet thoughts.
___ Body feels heavy, wants to stretch and yawn a lot.
___ Mouth ulcers and boils.
___ Easily fatigued but easily distracted from fatigue.

___ Lethargy.
___ Indigestion with bloating.
___ Excess mucus, coughs, sinus congestion.
___ Pelvic congestion with painful periods.

___ Weariness.
___ Liver congestion with feelings of fulness or burning around the solar plexus.

Illustration

Tigger, "For of all the things which he had said Tiggers could do, the only one he felt really certain about suddenly was climbing trees".

Winnie the Pooh, "'Piglet', said Pooh solemnly, 'what shall we do?' And he began to eat Tigger's sandwiches".

Piglet, "are they stuck? Asked Piglet anxiously" (of Tigger and Roo up the tree).

Eeyore, "I'm not complaining, but There It Is".

Total

___

___

___

___

 

Maintaining humoral balance

People with one dominant humour tend to lead a life which builds on that humour. Firy people tend to do firy things, watery people watery things and so on. We play to our strongest hand but each humour has its own, necessary function and its own place. Illness arises when one humour (usually the dominant one) accumulates to excess, overflows its place and upsets the balance of the other 3.

People with a relative excess of ONE humour should avoid those things which feed that humour.

People with TWO, evenly dominant humours need to make sure that both are fed. One course is to cultivate different areas of life for different humours. For example, I often see Fire and Water disharmony in practice. Such people might cultivate fire in their work and water in their social life.

People with THREE dominant humours are best considered as having a relative deficiency of the fourth humour. They should do those things that cultivate that humour.

(Ideally we build a good relationship with all our humours so that we may access each of them according to need).

Regime for choleric people (fire)

AVOID; Fatty and spicy foods, fatty meat, salty and dry foods, stimulants, alcoholic spirits, excess wine and an excess of competitive sports - but forced inactivity will cause fire to burn out and lead to the 'Burnt Choler' type of depression. This can happen in retirement and I often see it in students who force themselves to sit still reading books - thus neglecting their preferred sporting activity.

TAKE; Fish and wild meats, beer and cider, soups with barley, summer fruits such as raspberries, sufficient water, regular exercise and vapour baths. Regular cleansing regimes such as short fasts or eating only light food for a few days. Cultivate respect for an authoritative figure and exercise self discipline. Choleric people appreciate discipline and make good soldiers. Always have a project on the go preferably one with clear aims that doesn't take too long.

USEFUL HERBS; Cooling and softening herbs such as Violets, Mallows and Plantains. Herbs that clear heat from the liver and digestive system such as Meadowsweet and Rhubarb root. Herbs that clear heat from the skin such as Burdock root and Yellow dock. Herbs that protect the heart from excess heat such as Motherwort and Lemon Balm. Choleric people often react badly to Valerian and cooling sedatives such as Wild Lettuce and Hops are usually more appropriate.

Regime for sanguine people (air)

AVOID; Excess of all kinds, especially rich food, alcohol and sex. Being too scattered - too many different things on the go. Damp and heating foods such as honey, wine and mead. Excess of concentrated foods such as dried fruit and sugar and garlic and onions in excess. Sanguine people have good digestion and don't need to worry too much about what they eat - only about eating too much.

TAKE; Beer and cider. Water and soups with barley. Vinegar and pickles. Wild meats, fish, salad and summer fruits. Regular exercise in company and co-operative sporting activity. Cultivate esteem and love for one person or find an enduring, central interest to life. Allow positive expression of excess air by singing, writing or expressing ideas. Eat regular meals and avoid eating between meals.

USEFUL HERBS; Calming and centring herbs such as Chamomile, Linden and Oats. Chamomile is almost obligatory for sanguine types. Valerian combined with Skullcap or Passion flower leaves for anxiety. Herbs to protect and balance the circulation such as Hawthorn berries and Bilberries.

Regime for phlegmatic people (water)

AVOID; Excess sleep and slothfulness, eating too much, fish (except with warming herbs), milk products, ice cream, sweet foods, salty foods, raw foods, salads (except with spicy or garlic dressings), pears and summer fruits. The traditional English diet included lots of warming spiced meat and astringent pickles. The traditional cooking of any country will be found to balance the excesses of that country's climate. Modern, fast food will, of course, be the death of us all.

TAKE; Warming foods such as onions and garlic and cooked foods. Astringent (dry) foods such as globe artichokes and cabbages. Warming wine and root vegetables. Fast at the change of seasons and get into the habit of adding gentle spices to foods. Regular, gentle exercise and co-operative ventures with your peers. Avoid getting caught up in emotional introspection - find creative ways of expressing deep emotions.

USEFUL HERBS; Gentle spices especially; Cinnamon, Cardamons, Coriander, Fennel and dried Ginger. Gentle astringents such as Agrimony and Elderflowers. Warm, dry herbs such as Thyme, Sage and Rosemary. Nettles are especially beneficial. Take Nettles and Clivers in the spring and warming herbs in the autumn.

Regime for melancholic people (earth)

AVOID; Excess food. Heavy foods such as beef. Drying foods such as lentils and an excess of astringent foods such as apples and quinces. Eating late in the day. Narcotics. Thinking too much and getting caught in introspection. Lack of physical activity.

TAKE; Light but nourishing foods such as light breads, soft cheeses, shellfish, eggs, lamb, olive oil, root vegetables and dried fruits. Cleansing foods such as asparagus, fennel and celery. Prolonged, gentle exercise such as long walks, hikes and gardening. 'Earthy' activity which has an end product such as pottery. Regular long baths with relaxing oils such as Lavender. Cultivate the friendship of a sanguine person and always have a big, long term project on the go - one which requires deep thought but also gets 'you out of yourself'.

USEFUL HERBS; Gently warm, moving and cleansing herbs such as Fennel, Angelica, Coriander leaves, Parsley and Juniper berries. Herbs for liver congestion such as Barberry bark and Dandelion root and leaf. Herbs to clear melancholy from the heart such as Borage and Motherwort. Comfrey cream for dry skin. Valerian combined with Linden for anxiety.

 

[David Little]

Part 1: Constitution, Temperament and Diathesis

Part 2: The Phlegmatic Temperament

Part 3: Constitution and Predisposition

Part 4: Mappa Mundi

 

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 occasionof 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. 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)

    2. mental and emotional character (character of the Geist and Gemuet)

    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 of the 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 (= 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. "

    (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 16x 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. H. 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.

 

Part 2: The Phlegmatic Temperament

What did Hahnemann mean by the "phlegmatic temperament"? To understand this one must study the teaching of Hippocrates and Hahnemann very closely. The data on the Hippocratic temperaments represent 2,500 years of continuous clinical observation. The homoeopaths of the 19th century were very familiar with the Hippocratic canon and most knew the constitutional temperaments. The archetypal images of the four temperaments and humours are still in use even in the modern English language. For instance, the word "temperamental" still means to be very sensitive or overly emotional. At the same time to be in "good" or "bad humor" denotes a happy or distressed state of mind. A person may also be "full of humor" or "humorless" depending on the nature of their personality or mood.

Somebody may be referred to as being in a "dark mood" or to be "melancholic" when he or she is depressed. The word, melancholic, is derived from the word "black" (melan) and the term "bile" which denotes a dark humour or inwardly sullen state of mind. We also say that some people have a "bitter temperament' or while others have a "sour disposition". To be bitter is defined as a state of intense antagonism or hostility whereas to be sour is defined as being austere, morose, or peevish. These states are associated with the choleric and melancholic humour. Terms like these have their roots in the tastes of the four humours i.e., bitter (bile), sweet (blood), salty (phlegm), and sour (atrabile). To be "jaundiced" not only means to turn yellow because of excess bile but also to be prejudiced, envious and resentful. To "turn white" is a common expression associated with a state of fear. To "see red" means to be violently enraged which is related to the term "sanguinary" which means to be ready to shed blood. To feel "blue" is defined as being depressed in spirits, dejected or melancholic. These terms are closely related to the colors of the four humours, yellow (bile), white (phlegm), red (blood), and atrabile (blue-black).

All of these terms are based on the doctrines of the ancient Greeks and the nature of instinctive, innate body language. The Hippocratic theory of temperaments is closely related to the psychological and the physiological functions of the psycho-neuro-endocrine system (PNE) and morphological structures. The intrinsic connection between constitutional development and the neuro-endocrine secretions are well known in modern medicine. Nevertheless, the 2500-year-old Hippocratic system is still much more advanced in its observations of human temperament. The following rubrics are part of a collection taken from traditional sources and a clinical study spanning more than a decade.

The Phlegmatic Temperament (Mental rubrics-Spirit and Emotional Character)

The water element is related to the emotional sensitivity and gives a person an ability to have deep feeling tones. This is why the phlegmatic temperament is psychic, sympathetic, mediumistic, and empathetic. When they are in "pleasant humour" they are imaginative, sensitive, artistic, romantic, sentimental and sympathetic. They are gentle, sweet, mild, and timid and have a receptive, yielding disposition with a tendency to try to please everyone. They like comfortable, safe situations and when they are with friends they come out and can be quite playful, frivolous, and jovial and like to tease.

Their strengths are that they are very sensitive, imaginative, sympathetic, adaptable, peaceful, tolerant, gentle, placid, soft, receptive, considerate and calm.

Their weaknesses are that they become easily attached and are prone to be sad, tearful, indecisive, vulnerable, unsure, fearful, timid, envious, hesitant, changeable, submissive, indifferent, silent, reticent, unforgiving, mournful, pitiable and stubborn.

Under stress phlegmatic types easily become tearful, fearful, sentimental and very moody. The phlegmatic type experiences changeable moods that come in waves and tides like an emotional ocean where one moment they seem happy and the next sad. Their emotional state changes like the phases of the moon. When their mental skies are cloudy they rain down a shower of tears that gives them a sense of relief and allows them to return to bright sunny clarity. They may cry for happy or sad reasons, and sometimes, for no reason at all! If they are under prolonged stress they become sad and withdrawn as if a dark cloud has settled over them and they become shy, inward and dreamy.

Phlegmatics make very strong emotional connections with their loved ones and sexual partners, and suffer greatly from loss if these relationships do not work out. They suffer deeply from a sense of abandonment if they feel they are not appreciated and are easily hurt.

< when exposed to too much excitement, over stimulating environments, and when forced to do things in a hurry. In their own private way they can be stubborn, irritable, and they easily suffer from inward grief with silent peevishness. They are prone to passive aggression.

As the individual breaks down under stress the phlegmatic temperament becomes more insecure, indecisive, cold, careless, listless, apathetic and suffers from nervous exhaustion. They may even become completely dull, blank, slow and stupid and appear like an idiot.

Phlegmatic Bodily Constitution (Generals)

In the Hippocratic tradition the seat of a phlegmatic's inner energy is in the cool moist fluids of the brain and pituitary gland and its influence spreads through the lymphatic channels and the veins and has its outer lower seat in the lower abdomen. The negative pole of the "natural forces" that governs the anabolic processes of nutritional transformations and the generative seed rules the phlegmatic constitution. They rule the lymphatic system level of the five-fold defense mechanism and often suffer from autointoxication due to imbalances of the toxin-antitoxin axis.

The body of the phlegmatic temperament is large boned, well rounded, and has soft tissue with flaccid muscles that tire easily.

They easily suffer from water retention that makes them look and feel heavy, fleshy and fat. They easily put on weight on the hips, sacrum and thighs.

The phlegmatic temperament moves with leisurely graceful motions and has difficulty doing things quickly because rapid motion makes them feel confused.

Under continual stress the phlegmatic constitution suffers alternating emotional states, and becomes tired, weak, slow, chilly, and prone to edema.

The phlegmatic constitution has a round face, soft features, and deep watery eyes that swim with emotion. The sclera and the iris of their eyes often have grayish white spots and the iris may show a white ring around its outer edge. This ring like effect is called a lymphatic rosary in iridology.

The face of a phlegmatic is round with soft, oval features and is often slightly bloated. Their skin is commonly cold, moist, whitish, pale, pasty and translucent with blue and green veins showing through.

< cold food and drinks.

The phlegmatic type may like open air because it stimulates them but they do not like cold wind. They have a tendency to cold clammy perspiration that may be < emotions.

All complaints < by cold, cloudy weather, winter and dampness, and > warmer, dry climates and warm influences. They also can be worse < cold and heat as their temperature control extremely unstable.

They suffer from skin diseases that are accompanied by swelling and clear discharges that may change from bland to more irritating clear or white secretions. They also have a tendency to form lesions with white scales.

A phlegmatic type usually feels cold easily and < by cold, damp environments and cold food and drink. Correspondingly, phlegmatic types are > warm drier environments and warm food and drinks.

The tongue of a phlegmatic is pale, swollen and may be watery or coated with a white coating.

The phlegmatic pulse is usually slow, soft, wide and slippery. It is strong in the first phases of an illness but it becomes weak and stagnates as a disease becomes chronic.

The hands of the phlegmatic temperament are cold, thick, soft, humid, swollen, and plump and their skin is white, pale and puffy.

Their fingers are often short with thick tips and the joints are reasonably lax. The nails of the phlegmatic are often wide, white, pale, and soft and the moons are not very predominant.

When they shake hands their palm feels soft, wet, and cold, and their grip is weak. Phlegmatic women tend to hug softly and often do not offer a kiss as a greeting. If they do kiss, it is usually on the cheek, which causes them to blush and look sideways.

Von Grauvogl called them the hydrogenoid type because of their tendency to hold water weight and to be < worse by damp cold atmospheres, watery foods, or living near bodies of water.

Physiognomists of the past have called the phlegmatic constitution such names as the venous, lymphatic, abdominal and thymus types.

Morphologically speaking, Sheldon considered these constitutions to be pure endomorphs because of their large organs and lack of somatic structures. For this reason he called them the viscerotonic persons.

In Danielopolu's system the phlegmatics are called vagotonic persons because they have overactive parasympathetic nervous systems that suppress the function of the sympathetic nervous system. This is related to many of their predispositions to hypofunction, coldness, slow metabolism, water retention, weight gain, etc.

Phlegmatic Predispositions (Diathesis and miasms)

The phlegmatic temperament is prone to water retention, cold stomachs, insufficient secretion of digestive juices (such as hydrochloric acid), poor assimilation, anemia, and flatulence.

The phlegmatic temperament is prone to poor circulation, lymphatic stagnation, non-inflammatory swollen glands, watery swelling, autointoxication, glandular swellings, increased mucus and serous secretions and watery discharges of clear or whitish color.

They have a tendency toward hypo-pituitary, hypothyroid, low blood pressure, slow metabolism, low temperature, and lack of energy.

The phlegmatic has a tendency to disorders of the genito-urinary system and their urine is frequent, pale and in larger quantities.

Their arthritic problems manifest with cold white swellings that are < cold and damp and often better > warm applications and dry weather.

They prone to taking cold with watery discharges and chilliness and flushes of heat. They easily accumulate water in the lungs and have much phlegm and mucus that produces complications.

Tendency toward urinary infections (acute miasms), NSU, frequent urination and yeast infections with watery milky discharges.

The sycotic miasm tends to produce an abundance of phlegmatic humours and the phlegmatic temperament.

Now we can see that the phlegmatic temperament represents a portrait of a group of individuals who share similar natural traits and reactions to environment as well as predispositions toward certain signs and symptoms. This system includes mentals and generals, thermals, desires, aversions, sensations, modalities and pathological generals as well as particular symptoms of the regions of the body. It also assesses the vitality of the life force as well as the inherited and acquired miasms, predispositions and diathesis.

One can see that this system of constitution and temperament is much more advanced than any modern constitutional concepts (glandular and morphological types which have few symptoms) as it employs similar data to Hahnemannian Homoeopathy. Thus the ancient wisdom of Pythagoras and Hippocrates has found its home in the medicine of the future, Homoeopathy.

Phlegmatic Remedies

The phlegmatic, leuco-phlegmatic temperament as well as the lymphatic and hydrogenoid constitution is ruled by the same element (water). These constitutions are reflected in a group of well-proven remedies. It is easy to see the similarities between this phlegmatic constitution and Pulsatilla. It is also similar to well known remedies:

Agn. Aloe, Aster. Am-c. Calc. Caps. Carb-v. Cycl. Dulc. Graph. Hep. Merc. Nat-c. Nat-m. Nat-s. Sep. Thuj.

The carbon group of mineral remedies are very similar to the phlegmatic temperament, leuco-phlegmatic and lymphatic constitutions. Such remedies include Am-c. Calc. Carb-v. Graph. Kali c. Nat-c. etc.. The Natrums also have a tendency to phlegmatic states Nat-c., Nat-chlr, Nat-m., Nat-s. The Ammoniums, and Antimoniums also are similar as demonstrated by Am-c., Am-m., and Ant-c., Ant-t., Animal remedies include Asterias Rubens, Calcarea, Sepia (water creatures) and Apis. Many anti-sycotic remedies also are similar as there is a connection between phlegmatic states and sycosis. Here you find Agnus Cast., Thuja, Asterias rubens, Natrum sulph., Calc carb., etc.. Plant remedies include Aloe, Dulcamara, Pulsatilla, Cyclamen, Thuja, etc. Here is a repertory rubric with sources for the phlegmatic temperament and lymphatic constitutions.

*Reputed Remedies for the Phlegmatic Temperament and Lymphatic constitution*. h=Hering, k=Knerr, l= Lilienthal, c=Clark, a= H.C. Allen, bk=Boericke, bh=Bhanja.

    agar., agn-c. (h), aloe. (h, a, k, bk), alum., am-c. (c), am-m. (a, k), anthr. (h), apis. (h), all-c. (bk), ant-c. (f), ant-t. (h, a, k), aran. (f), ars. (c), asaf. (h), ast-r. (a, h), bad., (f), bapt. (a, h), bar-c. (f), bell. (a, k, h), bov. (f), calad. (h, c, k, bh), calc-ars., Calc. (a, c, k, h), cann-i. (h), Caps. (a, c, h), carbo-an. (f), carbo-v. (f, l), cast. (c), caust. (h), chel. (h), chin. (k), cinnam. (h), clem. (k), cocc. (k, h), colch. (l), cycl. (h, c), cupr. (f), dig. (h), dros. (hm), Dulc. (k, a. c), ferr. (h), ferr-p. (h), graph. (f), hep. (h, k, a), hydr. (f), kali-bi. (k), kali-br., kali-c. (f), kali-chl. (f), kali-i (f), kali-n., (f), kalm., kreo. (k, c, bh), lach. (c, k), led. (k), lyc. (l, h), mag-m. (f), mag-s. (f), mang. (f), med. (f), merc. (k, l, h), Mez. (h, c, k), Murx., Nat-c. (c, k, bh), nat-chl. (bk), nat-m. (f, k), nat-n. (f), nat-s. (f), nit-ac. (f, l), nux-m., nux-v. (h), op. (k. h), petr. (f), phos. (l), Phos-ac. (h), Plat-met. (k, h), Puls. (h, k, a, c), rhus-t. (f, l), sabad. (j). sabin. (f, h), sars. (c), Sep. (c, k), seneg. (k, c, l, h), sil. (f), spig. (c), spong. (f), stann. (h), stront-c. (f), sul-ac. (k), sulph. (k, h), thuja. (a, f, k), tub. (f), ust. (c), vario, (f).

I have personally confirmed many of the above remedies in the clinic. Others are more experimental. The grades are based on the number of homoeopaths who offered references in materia medica and the clinical experience of the author (DL). Here are a few examples of the corresponding rubrics in the Homoeopathic Materia Medica.

1. Aloe

[H.C. Allen]

Adapted to indolent "weary' persons; averse to either mental or physical labor; mental labor fatigues. Old people, esp. women of relaxed, phlegmatic habit. Extreme prostration, with perspiration. (Hering) Phlegmatic, indolent; Women of relaxed phlegmatic habit. Prolapsus uteri.

2. Asterias rubens

[Phatak]

Disturbances of the circulation, with pulsations and congestion, in head, womb, chest etc. It has a decided action on female organs. Cancer; of mammae. Flabby lymphatic constitution. Left-sided symptoms. (Boericke) A remedy for the sycotic diathesis; flabby, lymphatic constitution, flabby with RED face. (Hering) Sycosis. Flabby, lymphatic constitution. [red starfish (red face)-lives at the bottom of the sea (lymphatic phlegmatic fluids), cancer of the mamma (water, cancer rules the breast).

3. Calcarea carbonate

[H. C. Allen]

Leuco-phlegmatic, blond hair, light complexion, blue eyes, fair skin; tendency to obesity in youth. Psoric constitutions; pale, weak, timid, easily tired when walking. Disposed to GROW FAT, corpulent, unwieldy. Children with red face, flabby muscles, who sweat easily and take cold readily in consequence.

[Hering]

Pale, leucophlegmatic, weakly timid persons. Scrofulous constitution, with pale face, rather fair complexion and disposition to corpulence. More frequently indicated with the young; cannot be often repeated with the old, unless higher potencies are used. Diseases of children, especially during dentition. Children and sucklings become thick and gross, as if fat, but are pale and unhealthy. Leucophlegmatic temperament in childhood. Dentition. Fair, plump children. Crusta lactea. Urticaria, etc. Children: self-willed; fair, plump; fat, flabby, with red face, sweat easily, and readily take cold; large heads and abdomens, open fontanelles and sutures, and crooked legs.

4. Dulcamara

[H. Allen]

Adapted to persons of phlegmatic scrofulous constitutions; restless; irritable. Catarrhal rheumatism or skin affections, brought on or aggravated by exposure to cold, damp, rainy weather, of sudden changes in hot weather. Increased secretion of mucous membranes; perspiration being suppressed from cold. These are all phlegmatic symptoms. (Hering) Phlegmatic, torpid, scrofulous patients, who are restless and irritable; take cold in cold damp changes. Dark hair: skin delicate, sensitive to cold; liable to eruptions from being exposed to cold.

5. Natrum carbonicum

[Hering]

Leucophlegmatic constitutions, with aversion to open air and dislike to exercise, physical or mental.

6. Pulsatilla

[Hering]

Persons of indecisive, slow, phlegmatic temperament; sandy hair, blue eyes, pale face, easily moved to laughter or tears; affectionate, mild, gentle timid, yielding disposition. Especially suitable for slow, phlegmatic, good-natured, timid people; for women, and especially during pregnancy. Sandy hair, blue, eyes, pale face, inclined to grief and submissiveness. Often indicated with women and children. Women inclined to be fleshy, with scanty menstruation.

7. Thuja

[H.C. Allen]

Adapted to the hydrogenoid constitution of Von Grauvogl, which is related to sycosis, as effect is to cause.

Thuja bears the same relation to the sycosis of Hahnemann-fig warts, condylomata and wart-like excrescences upon mucous and cutaneous surfaces that Sulphur does to psora or Mercury to syphilis. Acts well in lymphatic temperaments, in very fleshy persons, dark complexion, black hair unhealthy skin.

[Hering]

Hydrogenoid constitution; this constitution is distinguished from the oxygenoid and the carbo-nitrogenoid, in that it is more hygroscopic i.e., it possessed an increased capacity to contain water; hence, rain, cold, damp weather, baths, and food that increases the number of molecules of water in the system, aggravate the symptoms of the hydrogenoid constitution. Strumous and sycotic persons. Lax muscles; light hair; children.

Part 3: Constitution and Predisposition

Susceptibility and Predisposition

Hahnemann presents a complete system of constitution, temperament, heredity, disposition, idiosyncrasy and susceptibility in his writings. Aphorism 31 deals directly with the subject of the living organism and its disposition toward disease. Vide Organon.

    "The-partly psychical and partly physical-inimical potencies in life on earth (which we call disease malignities) do not possess an absolute power to morbidly mistune the human condition. We become diseased by them when our organism is just exactly and sufficiently disposed and laid open to be assailed by the cause of disease that is present and to be altered in its condition, mistuned and displaced into abnormal feelings and functions. Hence these inimical potencies do not make everyone sick every time."

This aphorism points out that the susceptibility of the human organism is partly psychological and partly physical. It has been well proven that physical and mental stress lowers the immunity and makes individuals and groups more susceptible to particular illnesses. Therefore, susceptibility is related to both constitution and temperament. To be susceptible the organism must be sufficiently disposed to specific inimical disease powers. Without this sympathetic relationship there will be no disease. This is why pathogenic agents do not affect every person nor the same person all of the time. The patient must be sufficiently susceptible according to the time and circumstances. Susceptibilities may be inherited as well as acquired.

In the Sacred Diseases Hippocrates opined that most diseases are based on hereditary predispositions. He noted that the diseases found in the mother and father are often found in the offspring. Lamarck, who is considered the founder of modern genetics, published his research on inheritance between the years 1809 and 1822. By 1828 Hahnemann was integrating information about inherited depositions in his dynamic healing system. He speaks of inheritance and predisposition in both the Organon and The Chronic Diseases. Vide aphorism §78 and its note 78.

    "The true, natural chronic diseases are those that arise from a chronic miasm. When left to themselves (without the use of remedies that are specific against them) these diseases go on increasing. Even with the best mental and bodily dietetic conduct, they mount until the end of life, tormenting the person with greater and greater sufferings."

    "In the most blooming years of youth and with the commencement of regular menstruation, coupled with a beneficial lifestyle for spirit, heart and body, these chronic diseases often remain indiscernible for several years. Those afflicted appear in the eyes of their relatives and acquaintances as if they were completely healthy and as if the disease, implanted in them through infection or heredity, were completely vanished. However, it inevitably comes to the fore again in later years and with adverse events and relationships in life. The more the life principle has been deranged through debilitating passions, grief and worry, and especially through inexpedient, medicinal treatment, the more rapidly the disease increases and the more onerous its character.

This establishes several important features in homoeopathic pathology and philosophy.

1st H. was the first to suggest a complete theory of susceptibility and infection. He makes it very clear that the miasms are infectious in their primary state. He also taught that the microscopic microorganisms he called "animalcule" were the infectious agents of the contagious miasms. He noted that the process of infection includes susceptibility, a moment of infection, incubation period, prodromal stage and primary, latent and secondary or tertiary symptoms. He classified miasms into three categories, the acute, half-acute and chronic and recorded the symptoms in individuals as well as groups affected by the same miasm. On this basis, he established a materia medica of anti-miasmatic remedies in the Chronic Diseases.

2nd H. stated that miasms are transmitted by infection or inheritance. Hahnemann notes three means of transmitting miasms, i.e., by contact with the infected host, congenitally through the mother's womb or by nursing and by heredity. Inherited miasms produce predispositions in the offspring to particular disease states associated with the miasms.

3rd H. records the effects of stress as an activator of inherited and acquired chronic miasms. He points out that mental and emotional stress greatly increases the damaging effects of the chronic miasms.

The effects of stress on the human constitution and susceptibility to disease have been discovered by modern medicine but Hahnemann recorded the entire syndrome in 1828 and integrated it into homoeopathic philosophy and treatment.

Hahnemann's view of the global effects of universal chronic miasms is closely linked with his theory of pathogenesis. In his writings he mentions three factors in the evolution of degenerative diseases.

1.      suppression of the symptoms of the miasms by allopathic means,

2.      the transmission of the miasms through the generations,

3.      the increase of stress caused by modern civilization. Who else has done such a deep study of factors related to the individual as well as to groups suffering from diseases of common cause and similar symptoms? Not only this, Hahnemann established a special section of the materia medica to treat these chronic illnesses!

 

H.´s writings demonstrate the important relationships between the congenital constitution, inheritance, predisposition and diathesis. The individual constitution and temperament is the most important feature in individualizing the symptoms of the chronic miasms. In the Chronic Diseases Hahnemann pointed out that the physical constitution, the mental temperament, hereditary dispositions, habits, lifestyle as well as environmental factors like diet are the most important conditioning factors in the symptoms of the miasms. This careful assessment of inheritance (nature) and environmental factors (nurture) is found in no other system of healing. Vide page 102 of the Chronic Diseases.

    "The awakening of the internal Psora which has hitherto slumbered and been latent, and, as it were kept bound by a good bodily constitution and favorable external circumstances, as well as its breaking out into more serious ailments and maladies, is announced by the increase of the symptoms given above as indicating the slumbering Psora, and also by a numberless multitude of various other signs and complaints. These are varied according to the difference in the bodily constitution of a man, his hereditary disposition, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc."

Hahnemann wrote that the same disease state (such as psoric miasm) is varied according to the differences in "bodily constitution" and "hereditary disposition" as well as the patient’s turn of mind, morals, diet, etc. This is because the human constitution and temperament (Nature) are the most important influences in the development of disease signs and symptoms. The next most important factors are environment, climate, diet and stress (nurture). For these reasons, a homoeopathic remedy should be similar to the negative changes found in the constitution and temperament as presented by the signs, befallments and symptoms. Hahnemann repeats a similar refrain in aphorism 81 of the Organon where he discusses the influence of the congenital bodily constitutions (angebornen Koerper-Constitutionen).

    " It is, to some extent, understandable how psora could now unfold itself in so many countless disease forms in all the human race since this age-old infectious tinder has gone, little by little, through many millions of human organisms over the course of hundreds of generations, thus attaining incredible proliferation. This is all the more understandable when we consider the multitude of circumstances that have tended to contribute to the formation of this great diversity of chronic diseases (secondary symptoms of psora), as well as the indescribable variety of human congenital bodily constitutions, which already, in and of themselves, deviate so greatly from one another."

The diversity of human constitutions and the environments in which human beings live are a major contributing factor in the development of the manifold symptoms of psora and the miasms. As the infectious agents of the miasms have been passed through millions of human beings over the course of hundreds of generations its symptoms have greatly mutated. For hundreds of thousands of years the infectious miasms have been present either in endemic pockets or as universal epidemics. The effects of the miasms have been found in the remains of the most ancient human beings and are found on every continent in every culture. It is no wonder that the symptoms produced by the universal miasms have been mistaken for manifold different diseases.

 

Diathesis, Inherited and Acquired Constitutions

The idea of a diathesis is very closely linked with the inherited constitutional predispositions to particular symptoms. What does Diathesis mean? The Greek term, diathesis, is very closely linked with the inherited and acquired miasms and constitutional predispositions to particular symptom syndromes.

1. A diathesis is an inherited or acquired condition of the organism which makes it susceptible to peculiar disease states; a constitutional predisposition toward certain disorders. From the Greek, diathesis, dia-asunder and tithenai-to place.

2. A constitutional state which mistunes the body, and/or mind.

3. Diathetic constitutions are a category of constitutional predisposition or susceptibility to certain disorders, i.e., lymphatic, venous, leuco-phlegmatic, scrofulous, psoric, sycotic, etc. A diathesis is a permanent (hereditary or acquired) condition of the body that renders it liable to certain special diseases or affections; a constitutional predisposition or tendency. This word comes from the Greek for disposition or state. Thus a diathesis is a constitutional state that can be physical and psychological as well as inherited or acquired. The concept of diathesis is closely linked to both predisposition and the inherited miasms in Homoeopathy. This material is very cryptic to most modern homoeopaths yet those who have put this system to work find it practical and indispensable to daily practice. Homoeopathic reference works have recorded a great amount of information on constitutional diathesis and dynamic remedies that reflect a similar state. Hering and Knerr recorded a large amount of material in their writings.

 

Knerr's Repertory to Hering's Guiding Symptoms includes the following rubric in the general section.

Constitution (Diathesis)

In this section Knerr gives rubrics of various diathetic constitutions and their remedies. The source of this information is Hering's Guiding Symptoms in the section called Stages of life and Constitutions. Here is a sample of the types of rubrics included and a few examples.

1. Rubrics related to constitutional diathesis include; Hysterical, constitutions; Hemorrhagic, constitutions; Lymphatic, constitutions; Venous, constitutions; Plethoric, constitutions; Rheumatic, constitutions; Scrofulous, constitution; Paralytic, constitutions; Gouty, constitutions; Tubercular, constitutions; Asthmatic constitutions; and their similar remedies.

Example:

    "Lymphatic, constitutions -am-c., Apis, arn, ars, aster, aur-m., bapt, BAR-C., Bar-m, BELL., CALC., calc-ar., Cann-i., Carb-v., Chin., dulc., FERR., GRAPH., Hep., kalm., Lyc., MERC., murx., Nat-m., nit-ac., Petr., phos., Puls., Rhus-t., Sep., Sil., Sulph., thuj."

2. Rubrics related to the bodily constitution include; Lean, thin people; Large fat, people, bloated; Emaciated constitutions; Fibre, lax, constitutions; Fibre rigid, constitutions; Tall lean, constitutions; Dwarfish, constitutions; and their similar remedies.

Example:

    "Fibre, lax., constitutions-agar., bar-c., bor., CALC., calc-p., Caps., cinnam., hep., KALI-C., MAG-C., MERC., OP., PHOS., SABAD., Sil., spong."

3. Rubrics related to the Hippocratic temperaments and humours include; Bilious, constitutions; Choleric, constitutions; Phlegmatic, constitutions; Sanguine constitutions; Melancholic, constitutions; Nervous, constitutions and their remedies.

Example:

    "Bilious, constitutions; acon., Aesc., ail., ambr., ant-c., ant-t., ars., Bell., berb., BRY., cann-i., CARD-M., Cham., CHEL., CHIN., chion., chol., Cocc., Ip., iris., Lach., lept., mag-m., Merc., nat-s.,

NUX V., Phos., plat., ptel., PSOS., Puls., sang., sep., Sulph."

 

Rubrics related to the miasms include; Psoric, constitutions; Sycotic constitutions; Tubercular, constitutions; Syphilitic, constitutions; Cancerous constitutions (mixed miasms).

Example:

    "SYPHILITIC, constitutions-Ars., aec-t., AUR., Benz-ac., Clem., Cor-r., Crot-h., cund., euph., ferr-i., Fl-ac., Guai., Kali-b., KALI-I., MERC., Merc-c., Merc-d., Merc-i-f., Mez., NIT-AC., Petr., Phos., Ph-ac., Phyt., Sars., Sil., Still., sulph., SYPH., Thuj."

There are literally 100's of rubrics on this subject in the old materia medicas and repertories. These are general symptoms of the constitution, temperament, diathetic states and miasms. A miasm can produce a number of diatheses depending on the constitution and temperament and conditioning factors. For example, pseudo-psora TB miasm tends to produces a hemorrhagic diathesis while sycosis tends to an arthritic rheumatic diathesis. If the individual is of a sanguine temperament and acquires the TB miasm the chance of dangerous hemorrhage is increased greatly. This is because the fiery sanguine temperament that rules the warm/moist blood humour and the TB miasm both have an easy tendency to bleed. Such knowledge forms the basis of the homoeopathic view of constitution, temperament, susceptibility, miasms and diathesis.

 

Constitution and Concomitants

Hahnemann paid close attention to the constitution in both acute and chronic diseases. Vide Sycosis, The Chronic Diseases, the footnote on page 150.

    "The miasm of the other common gonorrhoea seem not to penetrate the whole organism, but only to locally stimulate the urinary organs. They yield either to a dose of one drop of fresh parsley juice, when this is indicated by a frequent urgency to urinate, or a small dose of Cannabis, of Cantharides, or of the Copaiva balm, according to their different constitutions and other ailments attending it.

In this example Hahnemann suggests using the constitutional concomitant symptoms to help in the selection of a remedy. He expects homoeopaths to understand that the term "constitution" simply means the whole living organism. All chronic remedies are "constitutional" in this sense as they reflect the essential nature of the totality of the symptoms.

 

I think we have proved beyond a doubt that Hahnemann had a deep understanding of classical constitution, temperament, inheritance, susceptibility, diathesis and miasms. He also introduced temperamental pictures that included both the natural traits of the individual when healthy compared with the negative changes brought on by illness. Hahnemann’s writing and the Paris casebooks include Hippocratic terms like the choleric, phlegmatic, sanguine and nervous temperaments. Each of these temperaments is associated with positive and negative qualities and predispositions toward certain disease states, signs, befallments and symptoms. They are also prone to particular diathetic states such as the venous, lymphatic and leuco-phlegmatic constitutions. If one studies material of the first generation of homoeopaths they will find such references with their concomitant signs and symptoms.

 

Part 3: Constitution and Predisposition

Susceptibility and Predisposition

Hahnemann presents a complete system of constitution, temperament, heredity, disposition, idiosyncrasy and susceptibility in his writings. Aphorism 31 deals directly with the subject of the living organism and its disposition toward disease. Vide Organon.

    "The-partly psychical and partly physical-inimical potencies in life on earth (which we call disease malignities) do not possess an absolute power to morbidly mistune the human condition. We become diseased by them when our organism is just exactly and sufficiently disposed and laid open to be assailed by the cause of disease that is present and to be altered in its condition, mistuned and displaced into abnormal feelings and functions. Hence these inimical potencies do not make everyone sick every time."

This aphorism points out that the susceptibility of the human organism is partly psychological and partly physical. It has been well proven that physical and mental stress lowers the immunity and makes individuals and groups more susceptible to particular illnesses. Therefore, susceptibility is related to both constitution and temperament. To be susceptible the organism must be sufficiently disposed to specific inimical disease powers. Without this sympathetic relationship there will be no disease. This is why pathogenic agents do not affect every person nor the same person all of the time. The patient must be sufficiently susceptible according to the time and circumstances. Susceptibilities may be inherited as well as acquired.

In the Sacred Diseases Hippocrates opined that most diseases are based on hereditary predispositions. He noted that the diseases found in the mother and father are often found in the offspring. Lamarck, who is considered the founder of modern genetics, published his research on inheritance between the years 1809 and 1822. By 1828 Hahnemann was integrating information about inherited depositions in his dynamic healing system. He speaks of inheritance and predisposition in both the Organon and The Chronic Diseases. Vide aphorism §78 and its note 78.

    "The true, natural chronic diseases are those that arise from a chronic miasm. When left to themselves (without the use of remedies that are specific against them) these diseases go on increasing. Even with the best mental and bodily dietetic conduct, they mount until the end of life, tormenting the person with greater and greater sufferings."

Note 78.

    "In the most blooming years of youth and with the commencement of regular menstruation, coupled with a beneficial lifestyle for spirit, heart and body, these chronic diseases often remain indiscernible for several years. Those afflicted appear in the eyes of their relatives and acquaintances as if they were completely healthy and as if the disease, implanted in them through infection or heredity, were completely vanished. However, it inevitably comes to the fore again in later years and with adverse events and relationships in life. The more the life principle has been deranged through debilitating passions, grief and worry, and especially through inexpedient, medicinal treatment, the more rapidly the disease increases and the more onerous its character. [Bolds by DL]"

This establishes several important features in homoeopathic pathology and philosophy.

1st Hahnemann was the first to suggest a complete theory of susceptibility and infection. He makes it very clear that the miasms are infectious in their primary state. He also taught that the microscopic microorganisms he called "animalcule" were the infectious agents of the contagious miasms. He noted that the process of infection includes susceptibility, a moment of infection, incubation period, prodromal stage and primary, latent and secondary or tertiary symptoms. He classified miasms into three categories, the acute, half-acute and chronic and recorded the symptoms in individuals as well as groups affected by the same miasm. On this basis, he established a materia medica of anti-miasmatic remedies in the Chronic Diseases.

2nd Hahnemann stated that miasms are transmitted by infection or inheritance. Hahnemann notes three means of transmitting miasms, i.e., by contact with the infected host, congenitally through the mother's womb or by nursing and by heredity. Inherited miasms produce predispositions in the offspring to particular disease states associated with the miasms.

3rd Hahnemann records the effects of stress as an activator of inherited and acquired chronic miasms. He points out that mental and emotional stress greatly increases the damaging effects of the chronic miasms. The effects of stress on the human constitution and susceptibility to disease have been discovered by modern medicine but Hahnemann recorded the entire syndrome in 1828 and integrated it into homoeopathic philosophy and treatment.

Hahnemann's view of the global effects of universal chronic miasms is closely linked with his theory of pathogenesis. In his writings he mentions three factors in the evolution of degenerative diseases. These are the suppression of the symptoms of the miasms by allopathic means, the transmission of the miasms through the generations, and the increase of stress caused by modern civilization. Who else has done such a deep study of factors related to the individual as well as to groups suffering from diseases of common cause and similar symptoms? Not only this, Hahnemann established a special section of the materia medica to treat these chronic illnesses!

Hahnemann’s writings demonstrate the important relationships between the congenital constitution, inheritance, predisposition and diathesis. The individual constitution and temperament is the most important feature in individualizing the symptoms of the chronic miasms. In the Chronic Diseases Hahnemann pointed out that the physical constitution, the mental temperament, hereditary dispositions, habits, lifestyle as well as environmental factors like diet are the most important conditioning factors in the symptoms of the miasms. This careful assessment of inheritance (nature) and environmental factors (nurture) is found in no other system of healing. Vide page 102 of the Chronic Diseases.

    "The awakening of the internal Psora which has hitherto slumbered and been latent, and, as it were kept bound by a good bodily constitution and favorable external circumstances, as well as its breaking out into more serious ailments and maladies, is announced by the increase of the symptoms given above as indicating the slumbering Psora, and also by a numberless multitude of various other signs and complaints. These are varied according to the difference in the bodily constitution of a man, his hereditary disposition, the various errors in his education and habits, his manner of living and diet, his employment, his turn of mind, his morality, etc.

Hahnemann wrote that the same disease state (such as psoric miasm) is varied according to the differences in "bodily constitution" and "hereditary disposition" as well as the patient’s turn of mind, morals, diet, etc. This is because the human constitution and temperament (Nature) are the most important influences in the development of disease signs and symptoms. The next most important factors are environment, climate, diet and stress (nurture). For these reasons, a homoeopathic remedy should be similar to the negative changes found in the constitution and temperament as presented by the signs, befallments and symptoms. Hahnemann repeats a similar refrain in aphorism 81 of the Organon where he discusses the influence of the congenital bodily constitutions (angebornen Koerper-Constitutionen).

    " It is, to some extent, understandable how psora could now unfold itself in so many countless disease forms in all the human race since this age-old infectious tinder has gone, little by little, through many millions of human organisms over the course of hundreds of generations, thus attaining incredible proliferation. This is all the more understandable when we consider the multitude of circumstances that have tended to contribute to the formation of this great diversity of chronic diseases (secondary symptoms of psora), as well as the indescribable variety of human congenital bodily constitutions, which already, in and of themselves, deviate so greatly from one another. [Bolds by DL]"

The diversity of human constitutions and the environments in which human beings live are a major contributing factor in the development of the manifold symptoms of psora and the miasms. As the infectious agents of the miasms have been passed through millions of human beings over the course of hundreds of generations its symptoms have greatly mutated. For hundreds of thousands of years the infectious miasms have been present either in endemic pockets or as universal epidemics. The effects of the miasms have been found in the remains of the most ancient human beings and are found on every continent in every culture. It is no wonder that the symptoms produced by the universal miasms have been mistaken for manifold different diseases.

 

Diathesis, Inherited and Acquired Constitutions

The idea of a diathesis is very closely linked with the inherited constitutional predispositions to particular symptoms. What does Diathesis mean? The Greek term, diathesis, is very closely linked with the inherited and acquired miasms and constitutional predispositions to particular symptom syndromes.

1. A diathesis is an inherited or acquired condition of the organism which makes it susceptible to peculiar disease states; a constitutional predisposition toward certain disorders. From the Greek, diathesis, dia-asunder and tithenai-to place.

2. A constitutional state which mistunes the body, and/or mind.

3. Diathetic constitutions are a category of constitutional predisposition or susceptibility to certain disorders, i.e., lymphatic, venous, leuco-phlegmatic, scrofulous, psoric, sycotic, etc. A diathesis is a permanent (hereditary or acquired) condition of the body that renders it liable to certain special diseases or affections; a constitutional predisposition or tendency. This word comes from the Greek for disposition or state. Thus a diathesis is a constitutional state that can be physical and psychological as well as inherited or acquired. The concept of diathesis is closely linked to both predisposition and the inherited miasms in Homoeopathy. This material is very cryptic to most modern homoeopaths yet those who have put this system to work find it practical and indispensable to daily practice. Homoeopathic reference works have recorded a great amount of information on constitutional diathesis and dynamic remedies that reflect a similar state. Hering and Knerr recorded a large amount of material in their writings.

 

For example, Knerr's Repertory to Hering's Guiding Symptoms includes the following rubric in the general section.

Constitution (Diathesis)

In this section Knerr gives rubrics of various diathetic constitutions and their remedies. The source of this information is Hering's Guiding Symptoms in the section called Stages of life and Constitutions. Here is a sample of the types of rubrics included and a few examples.

1. Rubrics related to constitutional diathesis include; Hysterical, constitutions; Hemorrhagic, constitutions; Lymphatic, constitutions; Venous, constitutions; Plethoric, constitutions; Rheumatic, constitutions; Scrofulous, constitution; Paralytic, constitutions; Gouty, constitutions; Tubercular, constitutions; Asthmatic constitutions; and their similar remedies.

Example:

    "Lymphatic, constitutions -am-c., Apis, arn, ars, aster, aur-m., bapt, BAR-C., Bar-m, BELL., CALC., calc-ar., Cann-i., Carb-v., Chin., dulc., FERR., GRAPH., Hep., kalm., Lyc., MERC., murx., Nat-m., nit-ac., Petr., phos., Puls., Rhus-t., Sep., Sil., Sulph., thuj."

2. Rubrics related to the bodily constitution include; Lean, thin people; Large fat, people, bloated; Emaciated constitutions; Fibre, lax, constitutions; Fibre rigid, constitutions; Tall lean, constitutions; Dwarfish, constitutions; and their similar remedies.

Example:

    "Fibre, lax., constitutions-agar., bar-c., bor., CALC., calc-p., Caps., cinnam., hep., KALI-C., MAG-C., MERC., OP., PHOS., SABAD., Sil., spong."

 

3. Rubrics related to the Hippocratic temperaments and humours include; Bilious, constitutions; Choleric, constitutions; Phlegmatic, constitutions; Sanguine constitutions; Melancholic, constitutions; Nervous, constitutions and their remedies.

 

Example:

    "Bilious, constitutions; acon., Aesc., ail., ambr., ant-c., ant-t., ars., Bell., berb., BRY., cann-i., CARD-M., Cham., CHEL., CHIN., chion., chol., Cocc., Ip., iris., Lach., lept., mag-m., Merc., nat-s., NUX V., Phos., plat., ptel., PSOS., Puls., sang., sep., Sulph."

 

Rubrics related to the miasms include; Psoric, constitutions; Sycotic constitutions; Tubercular, constitutions; Syphilitic, constitutions; Cancerous constitutions (mixed miasms).

 

Example:

    "SYPHILITIC, constitutions-Ars., aec-t., AUR., Benz-ac., Clem., Cor-r., Crot-h., cund., euph., ferr-i., Fl-ac., Guai., Kali-b., KALI-I., MERC., Merc-c., Merc-d., Merc-i-f., Mez., NIT-AC., Petr., Phos., Ph-ac., Phyt., Sars., Sil., Still., sulph., SYPH., Thuj."

 

There are literally 100's of rubrics on this subject in the old materia medicas and repertories. These are general symptoms of the constitution, temperament, diathetic states and miasms. A miasm can produce a number of diatheses depending on the constitution and temperament and conditioning factors. For example, pseudo-psora TB miasm tends to produces a hemorrhagic diathesis while sycosis tends to an arthritic rheumatic diathesis. If the individual is of a sanguine temperament and acquires the TB miasm the chance of dangerous hemorrhage is increased greatly. This is because the fiery sanguine temperament that rules the warm/moist blood humour and the TB miasm both have an easy tendency to bleed. Such knowledge forms the basis of the homoeopathic view of constitution, temperament, susceptibility, miasms and diathesis.

 

Constitution and Concomitants

Hahnemann paid close attention to the constitution in both acute and chronic diseases. Vide Sycosis, The Chronic Diseases, the footnote on page 150.

    "The miasm of the other common gonorrhoea seem not to penetrate the whole organism, but only to locally stimulate the urinary organs. They yield either to a dose of one drop of fresh parsley juice, when this is indicated by a frequent urgency to urinate, or a small dose of Cannabis, of Cantharides, or of the Copaiva balm, according to their different constitutions and other ailments attending it.

In this example Hahnemann suggests using the constitutional concomitant symptoms to help in the selection of a remedy. He expects homoeopaths to understand that the term "constitution" simply means the whole living organism. All chronic remedies are "constitutional" in this sense as they reflect the essential nature of the totality of the symptoms.

I think we have proved beyond a doubt that Hahnemann had a deep understanding of classical constitution, temperament, inheritance, susceptibility, diathesis and miasms. He also introduced temperamental pictures that included both the natural traits of the individual when healthy compared with the negative changes brought on by illness. Hahnemann’s writing and the Paris casebooks include Hippocratic terms like the choleric, phlegmatic, sanguine and nervous temperaments. Each of these temperaments is associated with positive and negative qualities and predispositions toward certain disease states, signs, befallments and symptoms. They are also prone to particular diathetic states such as the venous, lymphatic and leuco-phlegmatic constitutions. If one studies material of the first generation of homoeopaths they will find such references with their concomitant signs and symptoms.

 

Part 4: Mappa Mundi

I have been asked by quite a few people to explain what the words choleric, phlegmatic, sanguine and melancholic mean. This is no easy task to do briefly but I will try to give some of the most basic images related to the Mappa Mundi. In the old Pythagorean works the entire universe is said to be revolving around a universal center of etheric fiery pneuma (The old Greek word pneuma and the Sanskrit word prana have similar roots). Due to the complimentary actions of attraction and aversion different concentrations of this primordial pneuma produced heat (fire), gases (air), fluids (water) and solids (earth), which are called the four root elements. It is a mixture of these elements that produced the galaxies, solar systems, planets and moons as well as all life on Earth Mother Gaia.

In the human organism the fire and air make up what the ancient Greeks called the vital force (pneuma zotikon). Due to the innate heat of the fire element stored in the heart, the outer air is drawn deeply into the lungs to cool the body. These complimentary opposites produce the energy cycle of the vital force that is circulated through the arteries (fire) and the nervous system (air). The water and earth element make up the natural force (pneuma physikon) which rules from its seat in the liver, the transformation of food (earth) and drink (water).

The combination of the vital force and the natural force distills the essences of the four elements which become the four humours of the body, the bile (earth), phlegm (water), blood (fire) and atrabile (air).The essence which is left over is distilled into the psychic force (pneuma psychikon) which is stored in the pineal gland and nourishes the spirit (Anima). The bilious humour is made up predominately of the dry earthy element but has a secondary part of fiery heat. The phlegmatic humour is made up predominately of the moist water element but has a secondary part of cool air. The hot sanguine blood humour is made up predominately of the fire element but has a secondary part of moist water. The atrabilious humour is made up predominately of the cold air element but has a secondary part of the dry earth element.

Each innate constitution has a different mixture of the four elements and four humours. When there is a predominance of the bilious humour this makes the dry and hot choleric temperament.

A predominance of the phlegmatic humour makes the moist and cold phlegmatic temperament. A predominance of the sanguine blood humor makes the hot and moist sanguine temperament.

A predominance of the atrabile makes the cold and dry melancholic temperament. Each of these four temperaments is associated with its own sphere of influence in the constitution. The choleric temperament is associated with the liver, gall bladder, digestive and eliminative systems; the phlegmatic temperament is associated with the brain fluids, lymph and genito-urinary system; the sanguine temperament relates to the heart, blood and arteries; and the melancholic temperament is associated with the nerves, lungs and spleen. This is why the choleric type is sometimes called the liver or gastric type; the phlegmatic is called the lymphatic or venous type; the sanguine is called the heart or blood type; and the melancholic is called the nervous or lung type.

Each of the four types are associated with certain emotions and body types. The choleric temperament (earth) usually has a warm, dry, rectangular or square body, tight connective tissue, yellowish complexion, and are practical and rational, yet prone to anger, irritability, and impatience. The phlegmatic temperament (water) usually has chilly, watery, round or oval body with a white complexion, lax soft tissue, and are sympathetic and sensitive, yet prone to fearfulness, tearfulness, and sadness. The sanguine temperament (fire) usually has a hot, moist, triangular or barrel chested body, muscular or fleshy tissue, a red complexion, and are optimistic and joyful, yet prone to pride, passion, and cruelty. The nervous melancholic temperament (air) usually has a cool, dry, thin, body with pipe stem bones, little flesh, a gray, ashy complexion, and are intelligent and sophisticated, yet prone to be pensiveness, restlessness or depression. With these correspondences in mind please look at the Mappa Mundi below and allow the images to take hold of your subconscious mind where they may draw on information from the collective unconscious.

 

                                                                                                                                                                                                                                                                                                                          

                                                                                                                                            Summer Solstice

                                                                                                                                            Full Moon

                                               Summer                                                                                                                                                                                         Spring

Adolesence                                                                                                                                                                                Youth

                                                                                                                                            Fire Element

                                                                                             Choleric                                                                                  Sanguine

                                                                                             Dry/Hot                                                                                  Hot/Moist

                                                                                             Earth in Earth                                                                         Fire in Fire

                                                                                             Angry and Intellektuell                                                   Emotional and Proud

Autumnal equinox                 Earth Element                                                                                                                                                                                Water Element          Vernal Equinox

(Last Quarter of the Moon)                                                                                                         Neutral Pole                                                                                                                         (First Quart of the Moon)

                                                                                             Melancholic                                                                                  Phlegmatic

                                                                                             More Cold/Dry                                                                   Moist/Cold

                                                                                             Air in Earth                                                                                  Water in Water

                                                                                             Depressed and Intellectual                                                         Sad and Emotional

                                                                                                                                            Air Element

                                                                                                                                           

Winter Solstice

                                                                                                                                            New Moon

 

The astrologers out there should have no trouble relating the temperaments to the four cardinal elements. Unfortunately, most medical astrology books that use the temperaments follow the Aristotelian-Galanic relationships rather than the Pythagorean-Hippocratic system. This is why most books based on the middle age version have the wrong elemental qualities and zodiacal rulerships. This corruption is found in most modern books that deal with the subject. Not only did Galen record the Pythagorean elements wrong, he also changed the ancient law of Likes Cure Likes to Opposites Cure Opposites. Only a study of the ancient pre-Socratic texts reveal the mistakes made by the Scholastic schools. As destiny would have it the homeopaths (Reeves, Norland and myself) have all fallen into the correct early version! I did my research independently of these two sources. A few years ago I saw a Tibetan Mandala like version of the mappa mundi from Misha Norland and was very happy to see we have agreed on the elements, humours and temperament. I presume this is the same tradition as Jeremy uses.

 

 

Vorwort/Suchen.                                Zeichen/Abkürzungen.                                   Impressum.