Hahnemann Revisited

Review

This book review is reprinted with the permission of the National Center for Homeopathy

Reviewed by Julian Winston

Dr. Luc De Schepper received his medical degree in Belgium in 1971. He began studying homeopathy as part of a PhD program in acupuncture. He moved to the U.S. in 1981 and has been using homeopathy exclusively since 1991. He is in private practice in San Diego, CA.

When Dr. De Schepper titles this 576-page book A Textbook of Classical Homeopathy for the Professional he is very serious. This is a book for practitioners. It is not for beginners. Many of the concepts discussed within it could easily be misunderstood by them, or worse, misused.

The author says, "I believe he [Hahnemann] has answers and guidance highly relevant for us today, although sometimes inaccessible because they are couched in old-fashioned language." Cautioning that the book is designed for the practicing professional, the author describes it as an "exposition" of Hahnemann's system.

The book is divided into four parts: The Foundation, The Healing Process, The Chronic Miasms, and the Appendices.

Basic principles

Part One, The Foundation, discusses the basic principles of the system. There is a good discussion about provings. "Hering's Law" is discussed, although there is confusion here about the details of when Hering's Law was first published.

There is a discussion about what makes a remedy homeopathic, and the author says it must be based on the totality of symptoms- mental, emotional, and physical; it must be a single remedy; and it can never have a "material substantial dose." This is not actually what Hahnemann says. Hahnemann speaks of considering the totality of the characteristic symptoms of the disease. Mental, emotional, and physical indications may be used if they are characteristic.

Considering that Hahnemann, Gram and others did good homeopathy with drop doses of tincture, I wonder about the inclusion of "never have a material substantial dose" without further qualification as to what "substantial dose" means.

There is a good discussion about the place of pathology in homeopathy with quotes from Grimmer, Hering, Farrington, and Nash, and there is a good exposition of the development of potencies-including the LMs.

There is a listing of recommended usages for some common potencies, based on writings from "old masters" and, says De Schepper, "confirmed by my own experience." This is followed by specific variations such as, "In sports injuries to a basically healthy person, 30C, then four hours later a 200, then four hours later a 1M, in each case 3 pellets dry"-a posology used by the late Pierre Schmidt.

Following that is a discussion about frequency of administration, specific application of centesimal potencies (acute cases, chronic cases, constitutional remedies, nosodes, epidemic prescribing), adjusting the remedy, adjusting the potency, the distinction between dose and potency, and 13 pages about LM potencies.

In describing the process of case taking, De Schepper lapses into "homeopathic shorthand" and gives hints that are, to my thinking, exactly what Hahnemann cautions against when he talks of "freedom of prejudice" in Paragraph 83 of The Organon. De Schepper says: "When you meet the patient in the waiting room, one patient will be calmly waiting for you, reading a book or knitting some socks for Christmas (Calcarea). Another one will be fuming at you for being five minutes late, telling you in no uncertain terms that you are wasting his precious time (Sulphuric acid the 'time is money' guy)..."

These judgments continue throughout the chapter-the "dogmatic and rigid Kali carb person," the "know it all" Sulphur the "non-trusting" Lachesis, "the elegant and subtle colors [of clothing] of Carcinosin, the black, white or purple of Nat mur" He describes patients who were so environmentally sensitive that they came to the office wearing masks: "I immediately knew what remedy to prescribe (Phosphorus or Arsenicum) ... " Says De Schepper, "What jewels for your prescription. You have hardly asked the first question and you have an abundance of information ... "

Yes. But this information can easily be misused by someone beginning in homeopathy. I wish the author had expressed more qualification about this kind of thinking (e.g., "these are hints I have found through my years of practice") rather than putting it out with such unfailing certainty I know of two cases of environmental sensitivity that responded to Sepia-based upon the unique symptoms of the case. Had the prescribers immediately "known what to prescribe" they would have missed the remedy that was curative.

De Schepper suggests the use of a written intake form (which is described in full in the appendix). He gives brief mention to the practice of "underlining" (as taught by Vithoulkas) without describing it fully. He encourages the physical exam specifically looking at the tongue and examining the skin in eczema cases.

When taking an acute case, he suggests the use of Boenninghausen's seven levels of case-taking: quis (who-the details of the patient), quid (what-the etiology), ubi (where-the location of the complaint), quibus auxiliis (with what-concomitant symptoms), cur (why-modalities), quomodo (how-how did it manifest?), quando (when-time modalities).

In discussing pediatric case taking, De Schepper discusses questions to ask the parent, for example: How is the child with affection? What is the child's reaction to music? What are the food cravings and aversions? He again makes the leap of describing remedies for behaviors ..."Does the child watch every gesture you make (Calcarea)? Does the child jump around and destroy things (Tuberculinum)?"

Chapter eight, "Constitution, timeline, and temperament," contains some interesting ideas. He uses the word "constitution" to mean the innate "stuff" of which the person is made and not necessarily the curative remedy for the persn's chronic condition. This is very like the thinking of Argentinean homeopath Francisco Eizayaga. According to De Schepper there are only seven possible innate constitutions-Sulphur, Phosphorus, Calcarea, Calc phos, Silica, Lycopodium, and Baryta carbonicum. The case usually consists of the building of further layers on top of the constitution, and this can be understood by viewing a time-line of the patient.

An interesting diagram on page 150 shows "the road not traveled"-a constitutional Phosphorus has a detour through a "Natrum muriaticum" event (loss of parent, move, etc) and through the childhood years exists in a Nat mur state, moving to a young adulthood characterized by unsuitable partners and heartbreak. This leads to a Sepia state of indifference to loved ones, unhappy relationships, and infertility. In later life the person becomes a "crusader"-the Phosphorus constitution with the Natrum mur personality.

The chapter is followed by an 11-page discussion of the Hippocratic temperaments (Sanguine, Choleric, Phlegmatic, Melancholic) and how they relate to both Chinese medicine and homeopathy.

Prescribing

Part Two, The Healing Process, is about the process of prescribing. De Schepper presents his own clinical method based on the selection of ten rubrics. He says that, given this method, the homeopath will have "a consistent chance of finding the curative remedy," and that when he uses this method with his homeopathy classes, the students can select the correct remedy. These are "solid principles for finding the simillimum in a logical, orderly way," and "derive from the works of the old masters, starting with Hahnemann."

After a brief discussion of the difference between the simile (the almost correct remedy) and the simillimum, he presents his methodology which begins with the prioritizing of the symptoms, in this order of importance:

1. Strange, Rare, or Peculiar symptoms (including delusions and strong keynotes)
2. Never well since
3. Mental/emotional
4. Generalities
5. Food cravings and aversions
6. Sleep and sexuality
7 The chief complaint with location, sensation, modalities, and concomitants.

De Schepper presents an example grid to fill in, but I found the instructions, without an example, to be confusing and hard to follow. Examples, however, do exist in the appendix, but only result, to me, in many unanswered questions. In the first case there were 28 possible selected rubrics. To fit them into the schema, 10 rubrics are to be selected. Although De Schepper offers the guideline that one should choose "medium sized" rubrics, the 10 he selects for the case are described as "my 10 favorite rubrics." Should one have "favorites"? Or should the rubric selection be based on some understandable criteria? What are the criteria for selection? What does he know that he is not stating clearly?

The second sample case contains 55 possible rubrics. The 10 rubrics used are seemingly selected by looking at the "essence" of the case and drawing conclusions about the patient's personality There is a discussion of the possible remedies that might be of use. De Schepper says, "Let's see where these remedies are in our repertorizing. With so many rubrics available, we want to choose the ones that reflect this patient the best." This sounds like the remedy is being decided first and rubrics that support that choice are there selected.

If that is the feeling I get from this section, then the process of selection has not been well explained.

After discussing "Golden Rules and Special Forms of Prescribing," which include a list of remedies in series (gleaned from old literature) and a list of acute and chronic relationships, De Schepper urges one to "start with a polychrest remedy" Saying that he has been to many conferences where the presenter "tries to impress the participants with a small remedy that matches the case in only a few specific symptoms," he suggests the use of the larger remedies. "I would advise in 99% of cases starting with a polychrest." He then outlines a series of exceptions to the rule.

He urges prescribing by symptom, not by symbolism (e.g., he quotes a case where Lac leoninum [lion's milk] was prescribed because a cat came to the prescriber's door when she was puzzling over the case) and decries this type of practice-reminding us of Hahnemann's exhortation against "supersensible speculations which are not borne out by experience."

There is a whole chapter discussing how delusions manifest some remedies. It includes lists of some of the delusions De Schepper has seen in practice and how they were manifested in the case.

After discussing aggravation, healing crisis, suppression, and obstacles to cure, De Schepper presents 12 possible scenarios of reactions to the first prescription (similar to those which Vithoulkas presented in The Science of Homeopathy), and some management tips from the old masters. He also discusses the second prescription, that is, when and how to change the remedy or potency This is followed by advice about palliation and incurable diseases, remedies for the dying patient, and a discussion of the nosodes and indications for use, including a full discussion of the bowel nosodes of Bach and Wheeler.

Miasms

Part Three discusses the "chronic miasms" including the tubercular and cancer miasms. De Schepper discusses the "central idea" of each-a construct of the mental symptoms that are obviously valuable to him in his prescribing.

The final chapter is a discussion of the treatment of cancer with homeopathy and includes a number of cases from homeopathic literature.

More

Part Four, the appendices includes the "intake forms," a listing of remedies "Never Well Since" and "Ailments From," a 24-page listing of symptoms and their miasms, and the solutions to several of the cases within the text. Included are cases from the "Cancer" chapter, three of which were taken from the experience of Edmund Carleton, MD, who practiced at the turn of the century Since Carleton only spoke of the remedies he prescribed, the repertorizations and reasonings for his choices are retrospective as interpreted by De Schepper. The fourth case is described in the text as one which "shows how to prescribe for advanced pathology for the one-sided disease that has over-powered the vital force." But when the case is looked at in the appendix, there is only the suggestion that "No doubt a dose of Arsenicum album is required... Aurum may be the next remedy coming up..." but no remedy is given and no follow up reported.

The fifth appendix is a 16-page discussion of the similarities between homeopathy and traditional Chinese medicine.

In summary

This is a book intended to be of help to the practicing homeopath. The format is full letter size (8 1/2 by 11 inches). It is well bound and has a number of excellent diagrams that are useful to those who are visually rather than verbally oriented. I had a problem reading the text because of a consistent lack of the use of a space between a comma/period and the next letter-causing all the sentences to seemingly "run-on."

There are a few strange typos like Hippocrates being Hippolates and "next" being "neai." On page 213 (food desires and aversions), the last few words on the page are "Ask a question like,'if you didn't have to think..'" and there is no continuation on the next page which starts the section "Breastfeeding and infants."

In the Cancer chapter, one case is footnoted in the text as "16," but the footnotes for the chapter end at "15."

While discussing the Genus Epidemicus, there is mention that the Spanish Flu of 1918 responded mainly to Baptisia. I am curious as to the source of this information, since there is no reference given in the bibliography. In all the reading I have done about the Flu of 1918, the prime remedies were Gelsemium and Bryonia.

My reservations about the work have been outlined above. While the book contains a plethora of information, much of never before found in one place, the information on "the method" is very thin and, in my opinion, poorly justified. De Schepper writes with a certainty about things that are not so black and white in my observation.

I am sure that most practitioners with a few years under their belt would find useful information within these pages the "Aha! I never looked at it like that." But much of the advice is, for me, too pat and too cut and dry While the author decries prescribing on "symbolism," a number of his suggestions found in the case taking chapter are, in my opinion, very close to that edge, and run the risk of having one who is a novice fall into the "clammy handshake equals Calcarea" syndrome, without looking further afield. These ideas are based on the experience of the author and should have been clearly identified as such rather than presented as "the way"-as they differ from the experiences in practice of other homeopaths I know.

HOMEOPATHY TODAY
Volume 20, Number 4
April 2000

This book review is reprinted with the permission of the Homeopathic Academy of Naturopathic Physicians
Reviewed by Peter Morrell

Hahnemann Revisite& A Textbook of Classical Homeopathy for the Profes-
sional. Full of Life Publications, Santa Fe, New Mexico.

This new, large-format textbook is composed of three sections: "The Foundations," "The Healing Process," and "The Chronic Miasms," divided into 25 chapters and four appendices. It also contains 44 diagrams.  This is undoubtedly an important new textbook that is comprehensive, de-
tailed and authoritative. It provides the reader with a sound introductory grounding in every aspect of homeopathy, apart from materia medica, although it does give some brief guidance on that too. It is supplemented by detailed information on case analysis [replete with numerous examples],
miasms, nosodes and the LM potencies. It is rounded off with a useful bibliography and a "further reading" section.

This book gives a very clear and detailed exposition of some topics only previously explored superficially, if at all, by other authors. It therefore fills a much-needed gap in the literature. It is especially valuable in its detailed treatment of the LM potencies, which will be welcomed by
all students. Though a much neglected area, considerable helpful advice is given to the reader by Dr. Schepper, which draws on his extensive clinical experience with this approach. It also has good sections on homeopathy and cancer [chapter 24]; sample cases reviewed in depth [appendix 4]; homeopathy and Traditional Chinese Medicine [appendix 5]; miasms (chapters 19-25]; bowel nosodes [chapter 18]; suppression [chapter 13]; how to learn materia medica [chapters 10 and 11].

By its sheer scope and detail, the text recommends itself as one of the best modern textbooks on the subject that is currently available. It is written with great clarity and might be seen to comprise a modem version of Kent's Lectures, Close's Lectures and Vithoulkas's Science of Homeopathy, all rolled into one. Such a claim is not very far wide of the mark.  Indeed, if a student only purchased this book, a materia medica and a good repertory, it is hard to see how they could not soon become an excellent practitioner. Above all, it guides the reader to become an effective and
diligent practitioner.

Detailed study of the text provides the student with an excellent grounding in how to practice homeopathy and how to become a skilled and successful practitioner.

It is definitive, authoritative and comprehensive in scope, content, and detail, providing also in places some sound historical perspectives, against which to view certain aspects of the subject, for example, miasms and nosodes. It is hard to find words to convey the richness, usefulness and
clarity of the text.

Whichever other general text one compares it with, this book comes out very favorably. I therefore, recommend it most highly as an extremely valuable addition to the literature, for students and established practitioners alike. People at every level of understanding can read this book and derive some benefit from it. Regardless of one's level of experience, some profit can be acquired from reading this book. It enriches one's understanding and one's expertise. In some cases this enrichment will be very great. In particular, the outstanding sections on miasms, nosodes, constitutions and the L*M potencies, are extremely useful additions to the literature, simply
because the information is not available elsewhere, and certainly not in such a clear and detailed format. Complex and difficult topics are addressed with clarity and energy. It is beautifully laid out and presented.

Along with established texts by such greats as Kent, Close and Roberts, it seems certain that this book will quickly and easily establish itself as a popular general textbook on homeopathy. It seems destined to become a favorite in the colleges and to become a classic text in the field for
many years to come. Its detailed appraisal of many subjects is much better than that found in some smaller texts.

 We now come to some quotation material, which hopefully conveys the way each topic is examined in a new, original and elegant manner; the way little gems and insights are littered throughout the text; the way it is lavishly filled with examples at every turn, drawn from the author's personal experience; the way it is written, with great clarity, energy and detail, emphasizing key points in diagrammatic form or by use of bullet indents to summarize a topic.

"Virchow, the celebrated German anatomist and physiologist, said, 'If I could live my life over again, I would devote it to proving that germs seek their natural habitat - unhealthy tissue - rather than being the cause of unhealthy tissue."' [p. 18]

"Allopathic medicine has never tested remedies on healthy persons... before prescribing them for the sick. This is where Hahnemann's approach was revolutionary." [p. 32]

"Hahnemann took his discovery one step further... Mercury and Quinine... were found to have even greater healing powers when potentised.. the curative power of a remedy... is in inverse proportion to their material quantity; and that their medicinal power can be enhanced [or developed in
an inert substance] by dilution and succussion or trituration." [pp. 33-4]

"It is well known that many homeopaths oppose vaccination across the board... Land]... that these diseases had already declined, due to improvements in sanitation and public health, at the same rate in countries which never had mandatory vaccinations and those that have." [p. 46]

"Remedies such as Carcinosin and Staphysagria [which complement each other] should always be in the differential diagnosis for children with emotional or physical symptoms due to authoritarian and domineering
parents." [p. 135]

A superb diagram on page 148 shows how a typical Calcarea carbonica child can change at age two to become a Lycopodium, Phosphorus or Sulphur type and then at puberty to change again. This is a very useful and insightful approach to materia medica and viewing the case, as well as the diagram being a good way to illustrate this idea.

The whole chapter on constitutions is superb and not only diseases, constitutional types, layers of remedies, but also a rare modem discussion of the "Hippocratic Temperaments" is given, which is a treat. It also gives remedy links for the temperaments, and links them also to the five elements of TCM and the acupuncture meridians. This is original and enlightening material.

"While the humors literally represented fluids thought to circulate in the body, metaphorically each became associated with a prevailing emotion: blood with joy, called the sanguine temperament [from the Latin sanguis, blood]; phlegm with worry and contemplative calm, the phlegmatic
temperament; yellow bile with anger, called the bilious temperament; and black bile with sadness, called the melancholic temperament ... equilibrium of the humors and moods was necessary for health..." LP. 156]

"Unlike allopathic drugs, which must be given with extreme caution during pregnancy, remedies are ideal treatments for the pregnant woman." [p. 202]

Regarding suppression, we read: "The stronger the suppressive treatments, the more the internal symptoms will be aroused. This should be a lesson to the practitioner and patient alike not to mix allopathic and homcopathic prescriptions." [p. 2521

"Surgical removal of polyps, hemorrhoids, fistulae, and inflamed tonsils, adenoids and appendixes should be postponed until homeopathy has been given a chance to heal them, which it often does." [p. 2561

"Since allopathic medicine and homeopathy are based on opposite laws, the homeopath's task is made more difficult [not impossible] through continued drug suppression. The homeopath has to battle constantly against heavy odds to demonstrate the superiority of homeopathy." [p. 271]

"...homeopathy is superior to allopathy because the material doses of allopathic drugs have a pathogenic action. They produce new symptoms, euphemistically called side-effects ... they compel a defensive or eliminative reaction which exhausts the already weakened Vital Force. The ma-
terial dose is a toxic dose." [pp. 309-1 01

The book contains many insights about nosodes and miasms: "The Medorrhinum person, for example, loves parties, 'sex, drugs and rock'n'roll,' and staying out late at night in the darkness."   [p. 321 ]

"Tuberculinum also has a particular indication which the other nosodes do not share: when symptoms are constantly changing and well-selected remedies do not help..." [p. 321 ]

An excellent "spider diagram" on page 326 summarizes the general approach to use of nosodes, where lack of symptoms, family history or "never well since" conspire to spoil a case from the traditional angle or where well-indicated remedies fail to act for long. He also has some useful
comments to make about the Bowel Nosodes, used so often in English homeopathy.

"...bowel nosodes can produce miracles in tenacious, difficult cases.  But always use the similar remedy first unless you absolutely cannot find it.... using a bowel nosode ... [really I has moved these cases along. I have found them most helpful for eczema, asthma, enuresis, and anticipation
anxiety, in that order." [p. 345]

"Hahnemann also mentions that pregnancy is an ideal time to treat the mother with an antipsoric remedy, because the woman's increased sensitivity makes her internal psora manifest more plainly." [p. 375]

"Tbe sycotic infant, if hom full term, may have a fleshy appearance, but instead of the natural bright flesh colour, the skin has a pale yellow cast... its extremities are thin and weak, and the abdomen may be enlarged. These babies have a great tendency to nasal and intestinal catarrh."
[p. 394]

... homeopaths avoid tonsillectomies through careful prescribing, to avoid depriving the child of these valuable immune-system glands. Homeopaths would also rather see the child catching all the childhood diseases instead of having a multiplicity of vaccinations, in which foreign substances are injected into the bloodstream. Childhood illnesses boost the Vital Force rather than lowering it." [p. 438]

"The following remedies have been found so effective for cancers in specific areas that they can almost be prescribed by the location of the tumor: Graphites for cancer in cicatrices; Phosphorus for hepatic and pancreatic cancer; Omithogalum [Star of Bethlehem] for cancer of stomach and cecum; center of action is the pylorus." [p. 444]

The only criticism I can make of the entire text is that it lacks an index, which is probably made up for by the excellent table of contents at the front. This probably gives sufficient detail for most users to find a topic.

Simillimum
Volme XIII Issue 2
Fall 2000