Hering’s Law of Direction of Cure – A Reliable Tool in
Homeopathic Therapeutics
:
Recently, some colleagues (Saine, 14), have doubted the
veracity of terming Dr. Constantine Hering’s observations a law, when they do
not observe every aspect fulfilled in a case. This paper seeks to restore faith
in this law as an indispensable clinical tool, with the help of reliable
perspectives from homeopaths of great capability. Dr. Hering described his
observations as a “law of order” (of
symptom expression) in his Preface (12, Appendix 1) to the 1845 American edition of The Chronic Diseases
by Samuel Hahnemann. (9, Appendix 2)
Nearly a hundred years ago, master homeopaths: JT Kent, HC Allen,
JH Allen, PC Muzumdar and others, understood the application of Hahnemann’s
theory of miasms in clinical case management in addition to Hering’s Law of Direction of Cure. They regarded this
law on par with the Law of Similars and were tremendously successful.
Essential to observing and accurately applying the law is to
first thoroughly understand the expression and progress of disease in an
individual case. Second, perceive the conceptual details of the law accurately
interpreted in that case, aptly supported by miasmatic interpretation of the phenomenology
that develops.
Dr. Praful Vijaykar, (7, 15, 16) a contemporary homeopath, has
correlated the “law of order” observed by Hering, with the embryological
development of a fetus. He also uses this explain the concept of ‘suppression’
in homeopathy; recognizing a pattern of deteriorating disease opposite to the
direction of cure, individual to every case (15).
A homeopath must seriously consider anomalies i.e. counterfactuals
(2, 13)
to this natural law and appropriately interpret this for clinical management.
Introduction:
In recent past, an esteemed colleague (Saine, 15) had doubted the
veracity of terming the direction of cure a law, since he could not observe
every aspect fulfilled. His wide influence on other homeopaths through his
article is regrettable. He states (Saine, 15) “It is reasonable to assume that
This paper seeks to restore faith in this law as an
indispensable clinical tool with the help of reliable perspectives from
homeopaths of great capability. Dr. C. Hering described this “law of order” in his Preface (12, Appendix 1) to the 1845 American edition of The Chronic Diseases
(9, Appendix 2, 2.1) by
Samuel Hahnemann.
The Law:
The 5 directions of cure Dr. Hering observed were from above,
downwards; within, outwards; center to periphery; from more important to less
important organs, in the chronologically reverse order of disease development (Appendix 1).
A Law speaks of a recurrent pattern that exists in Nature. With
a thorough conceptual understanding of these patterns and conditions necessary
to fulfill or violate them, one uses the law with hindsight in the various clinical
decisions of remedy choice or change, as well as posology. Often this is not a
conscious application, but an intuitive guide after achieving adequate conceptual
training of the patterns of cure, supported by clinical experience.
Dr. ML Dhawle, MD, FAMS, (5,6) a pioneering homeopath and founder of
the Institute of Clinical Research, Mumbai, that today runs over 6 successful
homeopathic hospitals (apart from clinics) in and around Mumbai (Pavaskar,13),
wrote in his article on Experimental
design for Clinical Research in Homeopathy (Dhawle, 6):
“Homeopathy
is scientific in that it is governed by two laws:
1.
The Law of Similars: The fundamental law of selection of the similar dynamic force which
demands a total understanding of the concept of the Hahnemanian totality, the
ability to perceive it in the area of disease (drug as well as natural) and the
capacity to achieve its establishment on the similar plane through the adoption
of suitable techniques and the application of the right clinical judgment.
2.
The Law of Direction of Cure (Hering): The law of verification that gives us the requisite
feedback in respect of the accuracy we have achieved in respect of the correct
application of the Law of Similars.
And we
must ever remember that Law does not recognize exceptions.”
If such an intelligent, medically trained, scientific homeopath,
with clinical experience spanning over 50 years had little reason to doubt the
clinical veracity of Hering’s Law of Cure, we must think seriously before we
trivialize the law.
An Embryological Perspective
of the Law:
Dr. Praful Vijaykar, (8, 16, 17) an extremely successful
homeopath from Mumbai, developed a reliable correlation of Hering’s Law based
on an irrefutable pattern in nature – the in-utero development process of an
embryo. His book, The Theory of
Suppression (16) states, (quoted
for brevity)
“The (fertilized)
human egg, like that of any chordate egg differentiates into various organs and
systems. Before it differentiates…., it gives rise to 3 germinal layers:
a)
Ectoderm
b)
Endoderm
c)
Mesoderm
The
fourth is a specialized ectoderm called the neuroderm or neuro-ectoderm.
Ectoderm:
Gives rise to all the organs which are in connection or exposed to the external
environment (skin). It is of least importance, …our first layer.
Endoderm: Forms
the respiratory tube lining, gastro-intestinal tube lining and urinary tract
lining. This is also … exposed to the external environment. … forms our 2nd
layer.
Mesoderm:
Gives rise to the viscera (lungs, heart, kidneys) or parenchyma of viscera.
These organs arise out of mesothelium
of mesoderm. (4th layer)
Connective tissue: …connection between endoderm derivatives and mesoderm derivatives …is
established by tissues arising out of the mesenchyme
of the medoserm…. the connective tissue includes blood, lymph, bones,
cartilages, muscles, dermis and fascias, and coverings of organs. (3rd
layer)
The neuro endocrine glands are externally
derived from ectoderm, endoderm or even mesoderm, But the functional part of
it, i.e. the secretary cells are of either neural crest in origin or
neuroectodermal in origin. (5th Layer)
The nervous
system, whether it is central or peripheral and the brain are derived from the
neuroectoderm which is a specialized ectoderm. (6th layer)
….As the
embryo grows, the nutrition is supplied from the first formed organ which acts
as the chief source.
*The
first to form is the Precordial plate which represents the head part. In the
cure axis, the head or brain or upper part is more important than other parts
which are formed later.
* The cephalo-caudal
axis so formed denotes the higher to lower level importance
* The
spread of mesoderm paraxially from inside out
* and from dorsal to ventral region also
denotes the importance of that direction.
All these indicate the 4 directions of cure:
a) More important to less important
b) Above downwards
c) Inside out and
d) Centre to periphery
Ecoderm
is least important when it forms skin and most important when it forms brain
and neural tissue. The Endoderm and Mesoderm give rise to organs which are in
between. How beautifully the circle becomes complete! From ectoderm – to
endoderm – to mesoderm – to neuro-ectoderm – to ectoderm once again.”
Explanatory details can be read in
my article (D’souza,
8). Embryological development involves serious study, but worth the
investment. One develops a conceptual idea of natural patterns in this process
which is a sophisticated explanation
of Hering’s Law of Cure. Dr. Vijaykar’s insight into embryology, maps
suppression (in 7 layers) and miasmatic deterioration therapeutically, and is
brilliant and clinically reliable.
Clinical Perspective of the
Law:
Science today has realized the necessity of natural laws;
universal patterns in nature, though these rely on inductive logic based on a priori premises. We could add to our conditions on laws, that in addition to being
universal in form, they support counterfactual
conditions. It is crucial to bear in mind that this is a symptom of their
being laws, not an explanation of it (
Hence it’s possible to detect an anomaly in natural law, as
a clash with observation or experiment, without rejecting the law. What makes a
mere generalization a law, is the necessity of linking cause with effect as seen
in applications of Hering’s Law. It is expected that universal laws continue to
be modified over time, as conditions are added to it and anomalies further
explained. Straightforward cases and
acute clinical conditions always support the law of cure. One counterfactual condition for observed
anomalies of the law in complicated clinical cases is Hahnemann’s theory of miasms.
Groups of homeopaths who perceived miasmatic expression in
individual disease evolution, also successfully in applied Hering’s Law. Among
contemporary groups, listed in ‘References’ are Dr. ML Dhawle’s ICR, Mumbai (5, 6, 13);
Dr. Praful Vijaykar (8, 16, 17), Mumbai; David Little (12)
www.simillimum.com . Among master
homeopaths that had effectively done so, were JT Kent MD, JF Allen MD and HC
Allen MD, Stuart Close MD, PC Muzumdar. These homeopaths also correlated the
philosophy of miasms parallel to their spiritual backgrounds.
JH Allen MD, reflects the necessity of combining Hering’s Law
with miasms, in The Chronic Miasms Vol 1 (1), pg.106-108
“We can only understand the forces of nature
by and through law; because law is the relater of all things, as it is only
through it the unknown principle (the miasm) is clearly revealed to us with all
its attending phenomena. It is also true that we can only see through law the
mystery of suppression, for suppression itself is a retrograde process or a
deflection of law, or it is a physiological law opposed. The physician who
suppresses any miasmatic state, or disease process if you wish, is an enemy of
law or at least there is not mutual understanding between him and law. We must
first law rules not alone the visible things, but all invisible as well…… Why? Because both the life and the disease (and
you know disease is perverted life) work from within outward and form above downward
and not from without inward; even the very unit of live (the cell) works from
within outward or from its nucleus. The life is within, not without; the
disease is within, not upon the surface. It is only an expression of it that
you see. You can never see disease any more that you can see life itself. ……
….Therapeutically
speaking then, we must enter into correspondence with it (life), we must deal
with that which animates the organism and gives it its being, the life. Nature
is the complement of life; but we must assist nature through its right channels
and by the way of law. Disease appears through the medium of the same law that
governs life, and we must work with it along these lines.
The
miasm is the opposing force to the life force; therefore the forces we being
against it must be in true opposition to the miasm and not alone against the
life itself or we disturb it more. It must go with the life (force) and work
through the life (force) and be in co-operation with life (force). Any other
procedure endangers suppression or a greater deflection of the perverted life
force.”
When is the Law not
clinically obvious?
In my clinical experience, some reasons why Hering’s Law may
not be obvious in certain instances are:
1. Lack
of proper conceptual understanding of the patterns described in this natural
law: Without a conceptual idea of observing these patterns in various
disease conditions, and knowledge of how differently various diseases manifest,
a homeopath can make inappropriate observations of clinical processes and
symptom expressions. A lot of this application is learnt over a lifetime, following
adequate exposure to the myriad of clinical manifestations of diseases. With a
sincere motivation to learn and an open mind, affordable training is available (4, 5).
2. Lack
of adequate correlation of clinical response with the miasmatic evolution of
disease in every individual case: Most homeopaths have not been taught to
observe Hering’s Law and maismatic evolution from the phenomenological standpoint.(D’Souza, 7) For example, in the process of
cure in a clinical case, a disease condition will manifest with an expression
of inherited miasmatic traits, contrary in direction to dominant miasm. I
referred to this as a “counterfactual
condition” to Hering’s Law. A manifestation of disease comes up during cure
contrary to expected pattern. This is often related to an ‘old’ symptom in the
individual’s life caused by inherited diathesis, whose expression was partially
suppressed in favour of the individual’s own active, acquired miasm. The remedy
indicated in this stage is an anti miasmatic remedy that covers the inherited miasmatic totality (Appendix 2,
2.3). When this ‘block’ is overcome, the constitutional remedy will
be indicated again and cure will proceed as per the law.
Dr. JH Allen states; The Chronic Miasms Vol 2, pg. 109,
“The
cases of chronic trouble that do not receive the basic miasmatic remedy
sometime in the course of their treatment are either palliated, or as Hahnemann
says, ‘suspended for a time, only to return more grievous than before’. Again
the basic miasmic remedy fulfills all the requirements of the law, indeed the
law is only satisfied or brought to its height of action against the contending
forces of disease by an anti-miasmatic selection.
3. Inveterate
Diseases as described by Hahnemann explained in the Organon (10) Aph.51, 206 and in The Chronic Diseases (9, Appendix 2: 2.2): These cases may have
combined miasms, both inherited and acquired that have been subject to
suppressive treatments and surgical intervention. Some of these suppressive
treatments include: Steriods; anti-allergic drugs; long term symptomatic
allopathic treatment for a particular long term ailment like diabetes,
hypertension; long term painkillers; un-indicated antibiotics; hormonal treatments
and contraceptives; gold salts; etc.
The similimum remedy will certainly work
in most of these situations, but will it cure??
First, these drugs produce DRUG disease, Hahnemann explains in Aphorism 74,
(10).
Second, a specifically indicated remedy may be needed, different to the
constitutional remedy. Third, continued allopathic medications produce masking
symptoms and proving symptoms (artifacts) that interfere with the prescriptive
totality, making it difficult to perceive the similimum and appropriately
interpret remedy-response. Fourth, Hering’s Law becomes unclear or manifests
partially due to these ‘artifacts’. Managing such cases (Case Examples, Barvalia, 3)
is an art of anti-miasmatic prescribing, requiring training, (4, 5)
experience with (quite) a few failed attempts. If the vital force remains
strong, and not over ridden by these external assaults, there is hope for long
term cure – but the ride ahead is bumpy.
4. Dr. Vijaykar points out some instances
where disease expression and its cure may be apparently contrary to Hering’s
law: (16,
pgs 44-49).
a) Chicken pox, small pox, measles, herpes, eruptions have a direction of
expression opposite to that of common ectodermal diseases. These viral diseases
have enanthema followed by exanthema to release of toxins. These are neuro-ectodermal diseases
which throw out toxins from the centre to the periphery, from above downward.
Hence when they resolve, the direction is from periphery to centre and from
below upward! Suppression of these diseases in miasmatically vulnerable
individuals causes neurological complications like encephalitis, etc.
b) In incurable diseases, (7th Layer, diseases of the genetic code),
compensatory cure takes place, with a
restoration to almost normal function. The constitutional similimum brings
about as much cure possible, given structural genetic abnormalities. These
compensatory cures do not manifest Hering’s directions of cure.
Clinical Steps when Hering’s
Law isn’t perceived:
Presuming we have accurately obtained information in a case,
to analyze the evolution of disease with miasmatic interpretation, we need to
be critical of our remedy choice and case management when the case appears to
move contrary to Hering’s Law. A cursory approach towards observing Hering’s
law could amount to homeopathic medical negligence.
Questions to ask when the movement of symptom expression is
contrary to the law:
1) Is the remedy truly similimum? Is it a partial similimum? Is it palliating
the case? Do I need to review for an appropriate similimum?
Remedies prescribed on mental
state only or on a core delusion that is not correlated with physical generals
and characteristics are often partial remedies or palliatives. These remedies
may cause a feeling of ‘well being’ but in cases of sycotic or syphilitic
miasmatic backgrounds, the disease process continues unabated, with superficial
ammelioration. Others, who prescribe on specific physical symptoms and keynotes,
with no concern for the mental state, cause similar palliation.
Dr. Vijaykar, admitting his
mistakes in early practice, perceived the need to prescribe the accurate “genetic constitutional similimum”, where
Hering’s Law was fulfilled for true cure. (16, pgs. 59-64) His point: if remedy choice
is truly similar, it has to be balanced, covering both mental and physical
characteristics according to the merits of the case. Perceive the case in
totality of what is characteristic in both the mind and the body.
2) If the remedy is truly similar, partially curing but not following Hering’s
law; evaluate the miasmatic expression; Aph.206 (10).
Is there a miasmatic block
requiring an anti-miasmatic remedy? Eg:
3) If no miasmatic block seen, investigate the patient’s past history for
suppressive intervention around the presenting symptoms; Aph.207, (10).
a) Is this a picture of an old
acute condition suppressed by antipathy, allopathy, wrong homeopathic remedies,
surgery? An acute similimum is required which may be alternated with or
supported by the constitutional remedy, based on change/alternation of symptom
picture; Aph.232-234, (10).
b) Is there an incurable
pathological or structural change? The case requires palliation. A
constitutional remedy palliates when the vital power and susceptibility are
good. But in patients with poor susceptibility e.g. close to death, the
specifically indicated (partial) remedy or acute remedy is a better choice.
c) Is this a new picture of a true
acute condition? It is possibly an acute and strong onslaught (infection) from
the environment (acute miasm), as in epidemics, and requires the genus epidemicus
or an acute similimum, followed by chronic similimum.
4) All 5 directions of cure do not have to manifest at every instance in
disease development in a case. The direction of cure in time (chronology),
takes precedence over the other 4 directions at any point in time. The
intelligent perception and experience of the homeopath is vital for this
intuitive interpretation. Embryological correlation further clarifies this.
Conclusion:
Important to training in clinical observation is the phenomenological approach to disease evolution
and miasmatic management (7) that supports and is complementary to
concepts in Hering’s Law of Cure. The phenomenological approach of miasmatic
evolution is one major contribution from ML Dhawle’s ICR (5). Unfortunately, published
clinical cases explaining the law are few (18) and this should be remedied in the
future.
One must perceive the depth of homeopathic philosophy in
health and disease, to successfully interpret the Law of Cure clinically. Often
this is a lifelong learning process, as with everything else in homeopathy.
Each case evolves differently and individually, and has to be investigated with
its individuality of evolution in miasm and suppression. Then, Hering’s Law can
be successfully applied to guide healing with appropriately prescribed
similimums. Dr. Vijaykars’ ‘levels of disease’ is a reliable correlation to
understanding this application, seek to study it. (8,16, 17)
I
suggest that counterfactual to
anomalies in Hering’s Law of Cure, is the theory of miasms as Hahnemann taught.
I quote a renowned professor and successful clinician Dr. PM Barvalia, MD, on
the importance of understanding miasmatic correlation, (Barvalia, 3)
“An integration of
the miasmatic totality is crucial in the Anamnesis of cases with genetic
disorders (and diseases where Hering’s Law isn’t clear - Leela)
Revisiting this area of
disease from the Homoeopathic perspective will be immensely
helpful to the entire homeopathic medical fraternity, enabling us to
handle many serious genetic disorders where very little can be done by Modern
Medicine. NOSODES are the most potent, deeper forces of
our remedy armamentarium that can play decisive role in the cure of these
diseases. This will demand a whole hearted acceptance of Hahnemann's miasmatic
doctrine in the Theory of Chronic Diseases, while keeping our analytical faculty open, agile and active. Any
ambivalence to our own philosophy will be disastrous and self-destructive.”
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