Much of what follows is a summary of the more detailed exposition set out in my book, Homeopathy Renewed: The Cure and Prevention of Chronic Illness.

What is Disease?

Dis-ease, as the name suggests, is first and foremost an energy disturbance, a derangement of the vital force's normal harmonious vibratory frequency. Something must cause this derangement. The true origins of chronic illness, as identified by Hahnemann, lie in two factors. The first factor is the miasms, which constitute the fundamental cause of a state of dis-ease (in that they represent a kind of genetically acquired weakness or over-susceptibility to pathogenic forces). The second factor is the various shocks the vital force may receive during one's lifetime (which can be accidents, viral infections, drugs, or mental/emotional stresses). This perspective on the origins of chronic illness is set out in Hahnemann's Chronic Diseases and is generally agreed among homeopaths.

The point of contention arises when the concept of cause is applied to a system of treatment that is ostensibly based on the reading of the presenting symptoms. Hahnemann makes clear in the latest edition of the Organon that the physician must take into account the life history and the miasms in order to cure. He is less clear on how this is to be done. If the symptoms reflect disturbances in the vital force, then each particular incident of disturbance will contribute to the symptom picture to the extent that the vital force is unable to re-establish balance afterward. Miasms are like weak radio signals that can fade in and out, and the various shocks to our vital force during our lifetime are like static that interferes with the healthful signals necessary to our organism's functioning.

The totality of symptoms, then, usually consists of a mix of symptoms developed over time. Some symptoms will be recent, others will relate to different stages in a person's life. Some symptoms will be virtually a synthesis of previous individual symptoms. Some symptoms will have been suppressed in the past by drugs, other palliative treatment, or conscious or unconscious suppression of unpleasant emotional shocks.

By and large, the foundation of the current homeopathic approach is predominantly to try to identify a remedy that covers the totality of symptoms (the well-indicated remedy). David Little reminds us, in his article on miasms in the last issue, that Hahnemann intended this totality to include cause and lifestyle. However, this is still primarily taken to mean their use in better understanding the presenting symptoms and as auxiliary guides to the choice of the remedy based mainly on symptomatology. This is what I would call the symptom-centred approach. Hahnemann himself generally followed this approach, and developed new remedies that could encompass the new symptom totality (the anti-psorics).

However, the very reintroduction of cause into homeopathy raises the question whether a prescription that is primarily symptom-based can and will fully address (remove) the cause. To remove the cause — not just the symptoms — is the goal of all true systems of healing, including homeopathy. Initially, Hahnemann taught that removing the symptoms through the application of the well-indicated remedy was synonymous with eradicating the disease (cause of the symptoms). Yet this was not the case, because the underlying condition often deteriorated despite the often brilliant removal of the presenting symptoms. With the formulation of the theory of chronic disease, it was no longer certain that the removal of the symptoms with the well-indicated remedy meant the cause had also been removed. Hahnemann generally maintained the official view that a remedy that matched the symptom totality and removed those symptoms also removed the cause. However, his experimentation in his last years with two remedies at a time, with the nosode Psorinum, and the routine prescribing of Sulphur indicates that he was not necessarily content with this official line.

As Hahnemann also revealed, it was also no longer clear that the well-indicated remedy would work in the face of significant causes which acted as blockages to cure. Hahnemann identified things which interfered with the action of the well-indicated remedy, which is designed more to treat natural disease states. In particular, he was quite pessimistic about the possibility of treating people with artificial disease states caused by allopathic drugs and suppression, but he also highlighted the importance of mental and emotional stress in complicating illness.

Thus, it could no longer be asserted with the same confidence that a remedy prescribed on the basis of the presenting symptom picture would remove the cause. If the symptoms are removed, we now need to be certain that the underlying state is also improved over time, otherwise we have simply strengthened the vital force to the point that the underlying state is latent and producing no symptoms at the present time, but with significant stress, the original disease situation is likely to return, with the same symptoms or with a different symptom picture.

Integrating Cause into a Symptom Universe

The symptom-based approach has attempted to integrate the reality of causation into prescribing in a number of ways (see previous article). This is generally done by using cause as a weighting for symptoms and using remedies where there is an established (usually clinical) relationship to treating certain causes. This is reflected in the materia medica (see Clarke, for example).

This reveals another aspect of the concept of cause, that of seeing remedies as linked to cause. This viewpoint has led to the development of various remedies, called nosodes or isodes, which are made from substances associated with the disease-state itself. Psorinum was the first. Others followed. Provings may or may not have been conducted for these remedies, and their selection for development is based on cause, not necessarily symptom similarity.

In cases where the well-indicated remedy does not work, a remedy must be prescribed on the basis of knowledge of cause alone. For example, homeopaths give Tuberculinum or Carcinosin on the basis of tuberculosis or cancer in the family tree, Arnica for an old injury, or Nux vomica to clear the effect of drugs. Isodes made from vaccines are given where the patient has "never been well since" a particular vaccination (or even where a vaccination blockage is suspected). All of this is in the traditional and current literature. However, the problem is that the recourse to prescribing on causation is seen as a second-best choice, to be used only when the well-indicated remedy — the symptom-based approach — doesn't work. This approach is neither logically consistent, nor fully effective.

What is needed to give homeopathy the full power of Hahnemann's insights into chronic disease is to take causation as the central basis of prescribing in chronic cases, with auxiliary reference to the symptomatology. Chronic disease is an etiologically-centred universe. In such an approach, all suspected causes should be treated for in the reverse order of their occurrence, in accordance with Hering's third direction of cure, using remedies that have been clinically identified with a particular cause. It is not logical to treat only for the straw that breaks the proverbial camel's back, or for the one drop that causes the cup to run over. Dr. Compton-Burnett, a 19th century British homeopath who pioneered the use of nosodes, was once asked by a student which of the several remedies that he had used in a case had cured. He replied by asking the student to take a ladder and when he reached the roof to tell him which of the rungs had taken him there.

The vital force, once stimulated, begins a process of chronological retracing. Hering's Law of Cure tells us this, and it is observed in practice daily. We know that the vital force can encounter blockages on its way, and the more severe the case and the more severe the traumas, the more likely this will be the case. We also know that these blockages must be cleared for the process of cure to proceed. It is logical then, and would indeed seem necessary, to treat the blockages in the order in which the vital force will encounter them.