The basis of a sequential causal approach to chronic illness is contained within traditional homeopathy itself, but to my knowledge the full implications of such an approach were not advanced until relatively recently. Like progress in science generally, there are often multiple streams of thought heading in the same direction, but one person unites them into a more powerful and directed system. Five years ago, by chance in a Geneva bookstore, I came upon a book that changed my life. It is called La Medicine Retrouvee (Medicine Rediscovered), and I believe it holds the key to completing the revolution in homeopathy. The writer, a Swiss homeopath called Dr. Elmiger, outlines the basis for a new, causally-based view and treatment of chronic illness within homeopathy. He has been using his approach for over twenty years.

Elmiger called his new approach Sequential Therapy, a name is intended to draw attention to the fact that a shift in perspective and with it a change in certain rules is being put forth within homeopathy.

Dr. Elmiger trained with classical teachers in Europe (called "unicists" for their insistence on the use of the single dose and single remedy, in contrast to the other European tradition of using many remedies at once). While filling in for his mentor one summer, Elmiger discovered that many patients were only being maintained in their state of health, sometimes over 10, 15 or 20 years, by the well-indicated remedy. He felt that this was not a true cure according to Hahnemann's directives. Not satisfied with the partial and often confusing answers being given by his mentors and in the traditional literature, he had many questions about how the miasms and blockages to cure identified by Hahnemann were being, or more precisely not being, addressed in treatment.

By a process of careful observation and experimentation in the Hahnemannian tradition, Dr. Elmiger came to the conclusion that to cure, one had to address the cause, and that this could only be done by treating each cause in the reverse order of their occurrence. He also discovered that as an event receded into the past, it lost much of its individuality. Thus, there was a large group of remedies to treat an acute state, but a much smaller group to treat a past shock (chronic state), such as grief for example. He went back into the materia medica to identify those remedies that were known to address causation. He experimented with the main ones and found that in most cases, they worked regardless of the individual case. Cause, it seems, is common to us all; it is the expression in symptoms that will vary. A causal approach is driven by remedies specific to the cause, and employs little individualisation; a symptom-based one is driven by individuality and uses remedies specific to the individual.

An article by an American psychologist, published in the journal Science in 1992, sheds some light on why this might be so. Dr. Michael Fanselow discovered that fear is initially stored in a particular part of the brain, but after some time, the memories of a fearful incident migrate into other parts of the brain. They then become increasingly integrated into other thoughts and neural pathways. Fear increases over time even if there are no new memories. This spreading also suggests that a trauma becomes more systemic and less individual over time. Fanselow's research suggests that we don't erase anything, but simply add new memories in layers, each reinforcing the effect of the previous ones. The old memories are spread all over the brain and the homeopath needs to treat all of them.

Using a Sequential Approach

Like Hahnemann's formulation of homeopathy as a system of medicine, Dr. Elmiger's approach to treating chronic disease is really a systematic application of existing concepts and experience in a way that makes them therapeutically more understandable and effective. He brings out more explicitly the threads of thought that have existed in homeopathic philosophy, giving us a better understanding of what we are treating and providing a systematic and easily mastered protocol for the treatment of cause.

I began to apply the approach almost immediately to cases which were not responding to the more traditional approach, or which seemed stalled in terms of cure. The results were sometimes astounding and always better than expected. I also felt more confident in tackling complex cases and in anticipating what would happen next. I now had a better map through the swamp of chronic illness. I became convinced, both logically and on the basis of experience, that the approach should be applied to all cases in order to directly and more deeply address the underlying cause of disease in any given patient, even where the cause was latent or hidden.

Dr. Elmiger's sequential causal approach to homeopathic treatment is, in my view, fully consistent with the homeopathic principles and directions given by Hahnemann and practised by others. It establishes a clearer view of the separate universe of chronic disease revealed by Hahnemann and takes homeopathy further in its therapeutic effectiveness. This chronic universe and its treatment protocols are based on three principles. Firstly all causes must be treated, but in the reverse order of their occurrence (the principle of causal treatment). Secondly, each cause requires a particular remedy, and, thus, multiple shocks (causes) occurring at the same time require multiple remedies (the principle of the causal remedy). Lastly, the deeper a shock has penetrated the energy field of the vital force, the higher the potency needed to remove the disturbance caused (the principle of ascending potency).

The causes can be multiple in theory, but experience has identified a list of the most common and likely ones. These are mainly related to accidents, drug use, surgical interventions, vaccinations, severe viral infections, and mental/emotional shocks. The degree to which any of the identified shocks is relevant in any individual case depends on the interrelationship between the strength of the shock and the susceptibility of the recipient (determined by the constitution, the state of health at the time of the shock and the level of the miasms).

The consultation I undertake is much like a traditional one, with a recording of the chief complaints and medical history, including parents, grandparents etc. A constitutional case-taking is also usually done, as this remedy can be useful later in palliating strong healing reactions and is used to treat the person at the end of the sequential treatment. The difference, if there is one, is the emphasis given to identifying all the possible and probable causes of dis-ease. Once these are identified, the patient's time-line is written. The time-line is the list of shocks and traumas of that particular person listed in chronological order. The time-line provides, in effect, a map of the dis-ease as well as a map of the process of cure. It locates the blockages that the vital force will attempt to remove if it is stimulated to cure. The time-line is individual to the person.

In essence, the disease really represents the efforts of the vital force to re-establish order in the system. Chronic disease exists when the vital force is unable to overcome the disturbance, and is struggling against one or more blockages. Whatever you may use to start the process of cure, the effect is to stimulate and strengthen the vital force. If the etiological factors are not too critical, the process proceeds with little trouble. However, if the blockages are severe enough, experience shows that the symptom-based remedy is not necessarily able to resolve the problem on its own. This suggests, and experience confirms, that a remedy which is not causally related to a trauma will not remove it, but instead render it latent or invisible. It remains to impair the patient's underlying health and produce dis-ease states later in life.

Let me give a simple example. A teenager developed a severe sore throat and swollen glands, and was treated with a high potency of Sulphur, his constitutional remedy. After several months all the symptoms had disappeared, but they returned unchanged after a year, at which point the Sulphur no longer worked in any potency. Tuberculinum was given, and again the well-indicated remedy, but to no avail. The family were told the case was incurable. The parents then resorted to herbs and combination remedies on their own, again unsuccessfully. When they came to see me, the teenager was back where he started. The parents were desperate. I explained that the earlier symptoms and the current ones represented unsuccessful attempts by the vital force to heal the disturbance it was suffering from, starting with the first, most recent trauma. The constitutional remedy had strengthened the vital force and stimulated this healing process, temporarily removing the symptoms, but the vital force then returned to its efforts to remove the blockages, starting with the most recent. Now a remedy matching that cause needed to be given. When the most recent trauma was treated with a causally-based remedy, the state of health improved significantly and the family were able to take a long-planned holiday without incident. We then proceeded to address the remaining traumas, seeing the state of health improve progressively at each stage.

Another example will illustrate how a remedy based on symptomatology will assist the vital force and improve the overall state, without necessarily touching the underlying trauma. A patient was treated by an eminent homeopath for a severe emotional state resulting from a trauma. The remedy had helped for the acute state, but it was clear that the trauma that had given rise to the emotional state was unhealed and a substantial disturbance and state of dis-ease remained. The trauma concerned involved grief and anger according to the patient. When the remedies for these shocks were given, there was an improvement followed by a healing reaction and a resolution of the most recent emotional trauma in the patient's mind. The state of health improved further with each trauma treated.

It is not possible to know in advance whether a particular event has left a mark on the vital force; however, experience provides a guide to the likely events that one should address in treatment. If there is no remaining trauma, then there is no response to the remedy. Also, the vital force contains a memory of each trauma and will bring it to the surface to be treated at the appropriate point in the timeline. What is interesting in the case cited immediately above is that the patient called up in alarm several weeks after taking the remedies for grief, because a new symptom state involving a lot of fear and anxiety had emerged. When the causal remedy for unresolved fear was given, the new "crisis" resolved itself and a better state of health ensued. The vital force typically will bring to the surface traumas that are there but not remembered.

The stronger the disturbance of the vital force left by a trauma, the greater is the likelihood of a healing reaction (return of old symptoms and an aggravation of existing symptoms). Because the practitioner starts with the most recent trauma and works back in time, it is not necessary to know the patient's complete time-line to start treatment . Events the patient could not remember return to the awareness as the vital force strengthens (often there is a reason for the loss of memory). If this does not happen, then the struggle of the vital force with the blockage left by the trauma will throw up a symptom picture that will suggest its existence. The body-mind retains a memory of the trauma even if the conscious mind has "forgotten."

The treatment of miasms comes after the treatment of all the life traumas. Miasms pre-date conception. We all have them to a greater or lesser degree. They may be active or latent, but they should all be addressed in treatment. It is not important to know the family health history, although this can provide useful clues as to the depth of any given miasm. Each person is treated for the five "classic" miasms: Psora, Tuberculosis, Sycosis, Cancer, Syphilis. The miasms are treated in the order listed here, and the treatment is based on Hahnemann's own directions as well as Dr. Elmiger's clinical experience.

Potencies used are the centesimal scale (centesimal-scale remedies are sequentially diluted and succussed at the ratio of one part remedy to 99 parts of the dilutant). The protocol is to give remedies in ascending potency, usually 30-200-1M and 10M, at intervals of 24 hours. In most cases of physical trauma, 10M is sufficient to clear the trauma from the vital force. In emotional shocks, 50M, and sometimes CM must be resorted to. This reflects the fact that emotional traumas penetrate more deeply into the vital force and are the greatest cause of chronic disease in Western societies. Civilisation means the suppression of base emotions. The highest potencies, 10M and above, seem to have the power to jump the time queue as it were, and are only used when one is at the origin of a type of trauma in a time-line. If a child has had antibiotics several times over several years, then the 10M of Penicillin or the isode of the particular type of antibiotic is only used when the retracing process during treatment reaches the initial taking of antibiotics.

It is usually sufficient to go to 10M in treating the miasms, but the deeper the miasms (ascertained through the family history, the severity of the illness and the reaction to the initial nosodes), the higher the potencies needed. In such cases, the patient goes back through the cycle of the miasms in the prescribed order at the next potency level (50M and even CM). This would be required in AIDS cases, for example.