Causation vs. Symptomatology

One of the first premises of Sequential Therapy (ST) is that aetiology is superior to symptomatology. In a sense this is true, as if there is no causation (aetiology) there will be no effects (signs and symptoms). Nevertheless, to separate action (cause) and reaction (symptoms) in practice is not useful as they form two halves which make up a complete whole. Although the relationship between a specific aetiology and the symptoms may not always be apparent, in most cases the causation points to the symptoms and the symptoms point to the causation. Classical homeopathy reflects a perfect balance between three critical aspects, the constitution, aetiology and symptomatology.

One of the advantages of homeopathy over orthodox medicine is the fact that the aetiology does not always have to be known in order to treat a case. Of course, it is always better to understand the aetiology, as it gives much more insight, but true causation is not always that apparent. In some cases the aetiology is clear but the symptom picture is more confused. In such a circumstance, the aetiology must be given more consideration. With the variations seen in clinical practice, the homeopath needs a system of flexible response which can adapt to the nature of the information presented.

Hahnemannian homeopathy offers several methods of approaching the cure depending on what information is highlighted when taking the case history. The discerning homeopath can use constitution, psychology, causation or symptomatology as confirmatory symptoms when searching for the simillimum. A perfect totality, however, includes the exciting and fundamental causes, the characteristic signs and symptoms, and a clear analysis of constitutional factors. With these three vectors one can rest assured that one can remove both the cause and symptoms from the vital force thus restoring the true state of health.

The Routine Use of Specifics by Causation

Homeopathy pays special attention to causation when analyzing a case history. Nevertheless the routine use of remedies with a one-sided view of causation can be extremely limited in its scope. Without the careful individualization of the signs and symptoms, homeopathy is bound to fall into routinism in the name of simplicity of application. For example, the routine use of Natrum muraticum in ST as a specific remedy solely on the aetiology of "grief" is reductionist in its view compared to the traditional methods. Homeopathic psychology goes so much deeper than such elementary notions because it looks primarily at "who" is suffering from the grief and "how."

The rubric for "ailments from grief" contains so many other equally important remedies such as Aur., Carc., Caust., Coccus., Ign., Lach., Nux-v., Ph-ac., Phos., Staph., to mention only a few. The differentiating factors are made by the nature of the expression of the grief through constitutional signs and symptoms. All of these remedies manifest different reactions to the same causation because of uniqueness of the individual mind-body complex. A person who needs Aurum does not look, feel, nor act the same as a person who needs Natrum muraticum, Phosphoric acid or Lachesis. Each of the remedies has the specific causations and can remove the related complaints. A one-sided aetiological rubric is far too limited without the use of concomitant symptoms to complete the totality.

The routine use of remedies by aetiological rubrics as suggested in Sequential Therapy lacks a complete comprehension of the importance of balancing constitutional factors, aetiology and symptomatology in homeopathy. To believe that such symptoms are not available is to say that the individual has no mind, temperament, constitution, nor a vital force that reacts to the environment. The only person who lacks such things is dead. (The cause of this is mortality, for which, unfortunately, we have no remedy.) So in the final analysis ST does not place enough emphasis on the individualization of treatment nor on differentiating constitutional factors. Not everyone needs Natrum-muraticum for ailments caused by grief, Staphysagria for humiliation, nor Opium for fear, as suggested in ST.

Combination Remedies

This brings us to the next important difference between Homeopathy and Sequential Therapy, the use of polypharmacy by aetiology. In ST it is claimed that if there are multiple causations at the same time, the practitioner may use homeopathic remedies in combination. Those who use combination remedies often try to equate Hahnemann's alternation of remedies as proof he practiced polypharmacy. This view is certainly untrue, as Hahnemann always taught the use of only one single remedy at a time even though he sometimes alternated two remedies within a 24 hour period. That this somehow paves the way for the use of two, three, or four, or more remedies at the same time chosen by multiple aetiologies is unfounded. The approach of ST is not similar in theory or practice to the methods of traditional homeopathy, and therefore, must be assessed on its own merits.

Let's look at some of the suggested use of polypharmacy in ST. If a person has suffered an emotional trauma which involved fear, grief, and humiliation, the sequential therapist would give Opium, Natrum muraticum and Staphysagria all at the same time. This lacks homeopathic logic, as many remedies have all three of these mental components within their constitutional expressions. Some individuals have ten or more components involved in a trauma. Are we then to give ten remedies? To separate the components that make up a psychological trauma as if they are separate entities is very reductionist as the structure of the psyche is integrative in nature.

The claim by ST that a single remedy will not work or will only cause aggravation in a trauma with multiple emotions can not be supported by the facts. Homeopaths have thousands of cases where complex emotional states induced by a single trauma were completely removed rapidly and gently by a well chosen remedy that suited the totality of the case. It seems that in ST there is very little grasp of the sophisticated nature of the totality of the symptoms which includes both the cause and its effects. This is one of the weakest points raised by those who follow a one-sided view of the superiority of aetiology over symptomatology.

A therapist who uses combinations does not understand the reasons for the classical maxim; the single remedy. The exposure of the vital force to the primary action of one substance allows the constitution to focus its total energy potential in one grand secondary reaction. Combination medicines force the constitution to react to several primary actions simultaneously, thus spreading the vital energy in several different directions at once. This diffuses the dynamic response, and in some cases, confuses the vital force as many remedies have contrary medicinal effects. This confusion is heightened, for example, when a combination contains one remedy which is hot in nature and another which is cold.

To every primary action of a remedy there is an equal and opposite secondary reaction of the vital force. If a person's disease state produces warmth, and the homeopath gives a warm remedy, the secondary action of the vital force will produce coolness to bring homeostasis. This is the basis of the homeopathic laws of cure. If the constitution is suffering from heat, and it receives a primary impression of heat and coldness, the reaction of the vital force becomes confused as it cannot clearly oppose anything. What can the constitution do when it is given contradictory stimulations through several remedies that do not have similar symptoms? The outcome is often suppression, antagonistic secondary reactions and prolonged aggravations.

To understand the subject of how different medicinal influences affect the vital force, one should study the aphorisms of The Organon dealing with how remedies work (Aphorisms 25 to 30), the action of similar and dis-similar medicine (Aphorisms 31 to 60) and the nature of primary and secondary effects (Aphorisms 63 to 69). The are also several paragraphs in The Chronic Diseases that deal with similar subjects. The reader is referred to these works for a fuller explanation. These observations originally recorded by Hahnemann have been confirmed by several generations of carefully observing homeopaths over the last century and a half.

One of the greatest oversights in ST is the lack of understanding of the supremacy of the constitutional factors over both aetiology and symptoms. It is the individual's innate constitution and temperament that gives form to experience and produces full expression. This demonstrates to the careful homeopath which remedy reflects the personal experience of fear/grief/ humiliation and other such states. The same applies to physical causations such as drugs and medicinal procedures which is another area in which the practitioners of ST like to combine remedies. Individualization is superior to routinism because it always takes into account "who" is suffering from "what" and "how" whereas in ST they only look at "what."