Cause

Cause has always played a role in homeopathy since Hahnemann propounded his theory of chronic disease. Causation exists in the materia medica and is reflected in the repertories under "ailments from." Not uncommonly, remedies are given based almost solely on cause, for example, vaccinations, blows to the head, unresolved past grief, family history of tuberculosis or cancer. Causation, as David Little points out, is a valid factor to consider in the "totality of symptoms."

If there is anything new here, it is the emphasis given to cause as the basis for prescribing, and to time as a guide in treatment. If chronic disease is a causal world of miasms and shocks to the vital force, then the remedies chosen must have a relationship to the causes being considered. And the question is raised as to which shocks and miasms to address in treatment. In more traditional homeopathy, cause is taken into account as a factor, but because the prevailing perspective is symptom-based, not causal, it is generally considered as secondary. In traditional homeopathy, cause is usually only dealt with where it is obvious ("never been well since," or "ailments from"), active in the symptomatology, or suspected as a blockage to the action of the well-indicated remedy.

Cause is generally ignored if it is hidden or latent and only shows up during repertorisation in a minor way, if at all. Why should we restrict our treatment to the active or immediate causes? Why not address latent miasms in treatment? Why not treat all the shocks to the vital force? Clinical experience suggests that we all have each of the five main miasms to varying degrees, and that our current disease state has been caused by a series of shocks, not just the most obvious.

The sequential causal approach argues that, consistent with Hahnemann's insights, we should treat all probable and suspected causes. Only by removing all the possible causes can we fully remove the underlying chronic layer that leads to disease, thereby fully restoring health. The wisdom of this is borne out by clinical experience. The sequential causal approach further argues, consistent with Hering's Law of Cure, that we should treat the identified causes in the reverse of their chronological order, because that is the direction in which the vital force is trying to go in its efforts to heal. To consider cause is to consider time. Homeopathy traditionally takes account of the medical history of the patient, and is aware of the direction of cure, but time seems to be the missing dimension in terms of treatment. The medical history is generally used to try to understand the symptom picture and to choose a remedy based primarily on symptomatology, or to identify obvious and possible blockages to cure. By contrast, the sequential approach treats the medical history as the very map of the disease state and the guide to the treatment process required.

Nosodes/Isodes

The use of nosodes and isodes came later, but was the direct result of a more etiological perspective on disease. The distinction between a nosode and isode is not clear-cut. Nosodes are supposedly made from diseased tissue or discharges of disease. Isodes seem to be made from drugs, vaccines, or chemicals. However, remedies made from viral material can be considered as belonging to either category. Both derive more from thinking of disease as causal and not pure symptomatology. The energy state of the disease product represents the most similar remedy to the patient's disease state. Hahnemann initially felt that nosodes/isodes were similars because they underwent the process of potentisation and were not from the disease state of the patient being treated, but some other person. Later he became nervous about the use of nosodes/isodes, in particular by the efforts of one of his followers, Lux, to set up the concept of identity as the true basis for treatment, which seemed to threaten the concept of similars.

The debate was really a tempest in a teapot, as both were trying to find the most similar remedy. It did not prevent Hering and others from developing greater use of such remedies based more on identity to the disease state than the full symptom picture of the patient. The use of nosodes as treatment for miasms is now quite common. Margaret Tyler in England (a pupil of Kent), and others since, have made frequent use of the isodes of vaccines (Diptherinum, Morbillinum, Varicellinum) to treat for past traumas. Again, this was either done routinely based on experience, or specifically on the basis of a clear "never been well since" aetiology, or even just a suspected blockage to the action of the remedy that was indicated on the basis of the symptomatology. However, some opprobrium is still attached to the nosodes and isodes, and this is related to the confusion as to how their use really fits into the symptom universe.

The sequential approach is little different from more traditional homeopathy in the use made of such remedies. They are used based on previous experience confirmed by on-going clinical experience. The use of nosodes/isodes varies throughout the world of homeopathy and I see little difference in the sequential approach on this point.

Potency

The use of ascending potencies over a short period of time is not new, if not necessarily widely practised. Margaret Tyler was one to use common potencies (30, 200, 1M, 10M) over several days, or even only a few hours apart. The regular repetition of potencies is not new, being found in the 5th and 6th editions of the Organon. The concept of the need for ascending potencies to treat ever deeper, higher levels of the vital force is also not new.

Where the sequential approach differs is in the more systematic usage of ascending potency scales over short periods of time. This is based on the theory, validated by experience, that the ascending scale is necessary to remove the traumas completely from the deeper reaches of the vital force. As a simple example, someone who used Arnica and Nux vomica 30C for a dental intervention still reacted when Arnica and Nux vomica 200 and 1M were given on two consecutive days, and they saw an improvement in health. Someone who had used the higher potencies at the time of a similar dental intervention had no reaction to the repetition of the remedies and potencies and no change in the state of health.

The use of a series of ascending potencies is based also on the need to prepare the vital force for the power of the highest potency and on the need to directly address the blockage, much like the concentration of light on a specific point which gives lasers their power. The theory is not that critical. What counts is that it works well in practice. Account is taken of sensitivities, state of vitality, etc. in deciding what level to start with and whether to give higher potencies sooner rather than later.

Remedies

The use of the same remedy in certain similar situations is not new. Arnica is commonly given for any physical trauma, Tuberculinum for the tubercular miasm, Pertussin for whooping cough. The fact that the group of remedies for past, unresolved traumas is smaller than that for the acute, immediate reaction, is evident on reading the materia medica and repertories. Clinical experience also suggests that some remedies are more usefully prescribed in certain situations than others that could be considered. In the absence of clear indications to the contrary, these "percentage" remedies (mostly polychrests) are then prescribed. Hahnemann himself experimented with giving Sulphur to all patients at the start on the basis that they all had the psoric miasm. The sequential causal approach further supports such findings and experience.

The use of more than one remedy at a time is a controversial one. The single-remedy prescription was the foundation for homeopathy from its inception. It was necessary in the beginning in order to link the symptom picture to the remedy needed on the basis of provings. Hahnemann also had a particular bias against the polypharmacy of his day which mixed toxic drugs in cocktails of limited usefulness. Later in life, Hahnemann did experiment with giving two remedies at a time. He also gave more than one remedy in a short space of time. However, he never dropped his official proscription against the use of more than one remedy at a time, most likely because of his lingering bias. As Michael Tomlinson's column in the first issue of Homeopathy Online rightly argues, there is a case that can be made for giving more than one remedy at a time where there are reasons. This is different from simply giving several remedies in the belief that one may be indicated and work.

Prescribers using the sequential causal approach may give more than one remedy at a time, but this is based on the existence of more than one trauma at a time. Each remedy given is given for a reason related to the traumas experienced. Clinical experience again bears out that this approach is highly effective. For example, where there are severe emotional traumas, the person will likely have experienced a range of emotions at the time covering several remedies (grief, anger, anxiety for example). If only one of the remedies is given, it either doesn't seem to work or can lead to an apparent aggravation which is really the symptoms of the vital force unsuccessfully tackling the remaining traumas not yet treated. If the needed remedy is given based on the knowledge of the aetiology (confirmed often by the symptom picture), the aggravation is resolved and better health ensues. If all the needed remedies are given at the start, the aggravation can be avoided.

Symptomatology

In the causally-centred universe, symptomatology still plays a role, but the roles of the two factors are, in effect, reversed. In a symptom-based universe, cause is only a confirmatory factor, or where striking, an overriding factor; while in a causal universe symptomatology is a confirmatory factor that is only taken more fully into account when the symptoms are striking.

All of the remedies given in the causal sequential approach can be found in the classic repertorisation, although they will not necessarily be found in the top five or ten indicated. It is the knowledge of the cause and of the remedy-cause relationship that is the prime basis for prescribing.

Use of Constitutional Remedies

Constitution is one factor in homeopathic treatment, not the only one. A sequential causal approach treats the constitution once the causes have been treated, as this is what is left. The constitutional remedy is given during treatment sometimes to boost the vital force through healing reactions. Cases are not uncommonly begun with constitutional treatment to boost the vital force to a point that it can undertake a deeper healing process.

Palliation and Acutes