THE HISTORY RELATED TO THE FORMULATION OF HERING'S LAW
- Hahnemann - 1811
With the first publication of his Materia Medica Pura in 1811, Hahnemann inaugurated a new arrangement of the symptoms: from above downwards, from inside outwards, but also from the parts to the generals.
- Hahnemann - 1828
In 1828, Hahnemann published his first observations and theories on chronic diseases. (8) I summarize here the points most pertinent to the present discussion:
- "All diseases, acute and chronic of non-venereal origin, come from the original malady, called psora. (page 7)
- "A skin eruption is the first manifestation of psora. (page 38)
- "The skin eruption acts as a substitute for the internal psora (page 11) and prevents the breaking out of the internal disease. (page 13)
- "The more the skin eruption spreads the more it keeps the internal manifestations of psora latent. (page 40)
- "But when the skin eruption is suppressed with an external application or other influences the latent psora goes unnoticed and its internal manifestation increases. Then "it originates a legion of chronic diseases." (page 12) Incidently, for Hahnemann, a suppressed skin eruption is not driven into the body as it was popularly thought in his time, and even today by most homeopaths, but rather the vital force is compelled "to effect a transference of a worse form of morbid action to other and more important parts." (Introduction of the Organon of Medicine page 62) (9)
- "Latent psora, an abnormal susceptibility to disease, will manifest itself as severe diseases after exposure to stress (or as he calls it, unfavorable conditions of life) acute infections, trauma and injuries, exhaustion from overworking, lack of fresh air or exercise, frustration, grief, poor nutrition, etc, and by "incorrect and weakening allopathic treatment". (page 48)
- "During the treatment of chronic diseases of non-venereal origin with antipsoric remedies, the last symptoms are always the first to disappear, "but the oldest ailments and those which have been most constant and unchanged, among which are the local ailments, are the last to give way." (page 135)
- "If old symptoms return during an antipsoric treatment, it means that the remedy is affecting psora at its roots and will do much for its thorough cure (page 135). If a skin eruption appears during the treatment while all other symptoms have so far improved the end of the treatment is close."
- Hahnemann - 1833-43
In paragraphs 161 and 248 of the fifth and sixth edition of the Organon of Medicine of 1833 and 1843 respectively, Hahnemann says that in the treatment of old and very old chronic disease, aggravation of the original disease does not appear if the remedy is accurately chosen and given in the appropriate small doses, which are only gradually increased. "When this is done, these exacerbations of the original symptoms of the chronic disease can appear only at the end of the treatment, when the cure is complete or nearly complete." The original symptoms of a chronic disease should be the last to aggravate or become more prominent before disappearing. (10)
In paragraph 253 of the same work, the author states that in all diseases, especially in quickly arising (acute) ones, of all the signs that indicate a small beginning of improvement (or aggravation) that is not visible to everybody, the psychic condition of the patient and his general demeanor are the most certain and revealing.
In paragraph 225, Hahnemann states that some psychic diseases are not the extension of physical disease but, "instead, with only slight physical illness, they arise and proceed from the psyche, from persistent grief, resentment, anger, humiliation and repeated exposure to fear and fright. In time such psychic diseases often greatly harm the physical health." In other words, Hahnemann had recognized the existence of psychosomatic diseases, those diseases which progress from within outwards and from above downwards.
This is the background that now leads us to Hering, who, among all Hahnemann's students, was most similar to him. Like Hahnemann, Hering was a true scientist who totally adopted the inductive method in his scientific pursuits.
- Hering - 1845
In 1845, Hering published in the preface of the first American edition of Hahnemann's Chronic Diseases an extract of an essay which was never published elsewhere, called "Guide to the Progressive Development of Homœopathy".
In this essay, Hering writes:
- "Every homœopathic physician must have observed that the improvement in pain takes place from above downward; and in diseases, from within outward. This is the reason why chronic diseases, if they are thoroughly cured, always terminate in some cutaneous eruption, which differs according to the different constitutions of the patients.
- "The thorough cure of a widely ramified chronic disease in the organism is indicated by the most important organs being first relieved; the affection passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last. (page 7)
- "Even the superficial observer will not fail in recognising this law of order.
- "This law of order which we have pointed out above, accounts for numerous cutaneous eruptions consequent upon homœopathic treatment, even where they never had been seen before; it accounts for the obstinacy with which many kinds of herpes and ulcers remain upon the skin, whereas others are dissipated like snow. Those which remain, do remain because the internal disease is yet existing... It lastly accounts for one cutaneous affection being substituted for another." (11) (page 8)
Here Hering assumes that all chronic diseases (it is likely that he is referring here to diseases of psoric origin, i.e., non-venereal) progress from less to more important organs and disappear in the reverse order. This is compatible with Hahnemann's theory that all chronic diseases of non-venereal origin manifest themselves first on the skin then internally. (Concerning the theories of Hahnemann, Hering wrote in 1836 in the first American edition of the Organon of Medicine: Whether the theories of Hahnemann are destined to endure a longer or a shorter space, whether they be the best or not, time only can determine; be it as it may however, it is a matter of minor importance. For myself, I am generally considered as a disciple and adherent of Hahnemann, and I do indeed declare, that I am one among the most enthusiastic in doing homage to his greatness; but nevertheless I declare also, that since my first acquaintance with homeopathy, (in the year 1821), down to the present day, I hve never yet accepted a single theory in the Organon as it is promulgated. I feel no aversion to acknowledge this even to the venerable sage himself. It is the genuine Hahnemannean spirit totally to disregard all theories, even those of one's own fabrication, when they are in opposition to the results of pure experience. All thoeries and hypotheses have no positive weight whatever, only so far as they lead to new experiments, and afford a better survey of the results of those already made. (page 17) (12)
- Hering - 1865
It seems that Hering did not further elaborate on this subject, at least in the American literature, until 20 years later. In 1865, he published an article in the first volume of The Hahnemannian Monthly called "Hahnemann's three rules concerning the rank of symptoms". Hering states in this article that:
- "The quintessence of Hahnemann's doctrine is, to give in all chronic diseases, i.e., such as progress from without inwardly, from the less essential parts of our body to the more essential, from the periphery to the central organs, generally from below upwards - to give in all such cases, by preference, such drugs as are opposite in their direction, or way of action, such as act from within outward, from up downward, from the most essential organs to the less essential, from the brain and the nerves outward and down to the most outward and the lowest of all organs, to the skin... All the antipsoric drugs of Hahnemann have this peculiarity as the most characteristic; the evolution of their effects from within towards without. (page 6-7)
- "Hahnemann states, in his treatise on Chronic Diseases, American translation p.171: Symptoms recently developed are the first to yield. Older symptoms disappear last. Here we have one of Hahnemann's general observations, which like all of them, is of endless value, a plain, practical rule and of immense importance.
- "The above rule might also be expressed in the following words: In diseases of long standing, where the symptoms or groups of symptoms have befallen the sick in a certain order, succeeding each other, more and more being added from time to time to those already existing, in such cases this order should be reversed during the cure; the last ought to disappear first and the first last." (page 7-8) (13)
It is very clear here that Hering makes no mention of a law but rather of a rule, that the symptoms ought to disappear in the reverse order of their appearance during the homeopathic treatment of patients with chronic disease of psoric origin, the ones that progress from without inwardly, from less important to more important organs and generally from below upwards.
- Hering - 1875
In 1875, Hering published the first volume of Analytical Therapeutics of the Mind in which he stated that "only such patients remain well and are really cured, who have been rid of their symptoms in the reverse order of their development". (page 24) (14) Here Hering makes no mention of the three other propositions regarding the direction of cure: from above downwards, from within outwards and from the more important to the less important organs. Why? Were they not considered as important to evaluate the direction of cure as stated in previous years?
In the same work, Hering also explains that he adopted Hahnemann's arrangement of the materia medica: "First inner symptoms, then outer ones. This order we have now uniformly preserved throughout the whole work." (page 21) In explaining why he adopted this arrangement he says: "The arrangement as well as the style of printing, has the one object especially in view, viz.: to make it as easy as possible for the eye, and through the eye, for the mind to find what is looked for." He makes no mention of this arrangement corresponding to a direction of cure, as it has been suggested by some well wishing homeopaths.
The origin of the term "Hering's law"
Where does the term "Hering's law" come from as it seems never to have been mentioned in the literature during Hering's time? The earliest mention I have been able to find in the homeopathic literature dates from 1911, in an article published by Kent in the first volume of the Transactions of the Society of Homœopathicians called "Correspondence of Organs, and the Direction of Cure". Kent writes:
- "Hering first introduced the law of direction of symptoms: from within out, from above downward, in reverse order of their appearance. It does not occur in Hahnemann's writings. It is spoken of as Hering's law. There is scarcely anything of this law in the literature of homœopathy, except the observation of symptoms going from above to the extremities, eruptions appearing on the skin and discharges from the mucous membranes or ulcers appearing upon the legs as internal symptoms disappear.
- "There is non-specific assertion in the literature except as given in the lectures on philosophy at the Post- Graduate School." (15)
It is reasonable to assume that Kent was the one that officialized the term "Hering's law" and so inadvertently popularized the concept of the existence of a clear and precise law of direction of cure. (At least up till 1899, at Kent's Post-Graduate School of Homeopathics, the directions of cure were still called "the Three Directions of cure [given by Hahnemann].) (16) By using the name of Hering it is reasonable to say that Kent thus created false and misleading historical assumptions. Since H.C. Allen had died two years previously (1909), the profession, at least in North America, had no other leaders capable to refute Kent and defend the classic Hahnemannian tradition. (It is to be remembered that in 1908 H.C. Allen had severely criticized the materia medica of the new synthetic remedies that Kent had been publishing since 1904 in The Critique. Kent was at the time the associate editor of this journal in which, almost monthly, he had been publishing the materia medica of a new synthetic remedy, each of very questionable value. During an open session at the annual meeting of the International Hahnemannian Association, Allen and G.P. Waring accused Kent of publishing materia medica that was "without proving or any clinical experience", which would have been completely contrary to the strict inductive method intrinsic to homeopathy. (17)
Kent then stopped permanently the publication of these synthetic remedies, even the ones that he had previously promised for upcoming publication in The Critique. (18) Although Kent continued to publish regularly in The Critique until 1911 he restricted his articles to reporting clinical cases rather than materia medica. Never was a synthetic remedy ever published by Kent after the initial criticism of Allen even in his own journal, The Homœopathician, that he founded in 1912. Furthermore, when Kent published the second edition of his Lectures on Homœopathic Materia Medica in 1912 [the first edition was in 1904], all the synthetic remedies published between 1904 and 1908 were omitted.)
In this same article, Kent says that in the course of treatment of a patient suffering with a psychic disease of the will (problems of affections, grief, anger, jealousy, etc), the heart or liver will be affected as the treatment progresses.
While in a patient suffering from a mental disease (problems of the intellect), the stomach or the kidney will be affected during appropriate homeopathic treatment. Were these comments on the direction of cure and correspondence of organs based on Kent's impeccable and meticulous observations or was he rather formulating hypotheses? He does not explain further but he does mention later in the same paper that "through familiarity with Swedenborg, I have found the correspondences wrought out from the Word of God harmonious with all I have learned in the past thirty years. Familiarity with them aids in determining the effect of prescriptions." (15)
Nowhere was I able to find in the writings of Kent, including in a collection of not yet republished lesser writings, any other mention of Hering's law as to the direction of cure.
Discussion and Conclusion
First let us briefly review the highlights of what has been so far demonstrated:
- Between 1828 and 1843, Hahnemann enunciated his theories of chronic diseases and described his observations and rules about the progression and resolution of these chronic diseases. One key point of his theory is that a skin eruption is the first manifestation of psora, which is the source of all chronic diseases of non-venereal origin. In chronic disease the presenting symptoms of the patient ("those ailments which have been most constant and unchanged") may aggravate and will disappear in the reverse order of their appearance with the correct antipsoric remedies in the correct posology. Possibly, old symptoms may return during an antipsoric treatment. In all diseases, if after a homeopathic remedy the psychic symptoms are the first to improve or aggravate it is a most certain sign of curative change. For Hahnemann this inside outward improvement was not a law but rather a most certain sign of curative change. Finally not all diseases progress from outside inwards but certain diseases (psychosomatic diseases) can progress from within outwards.
- In 1845, Hering enunciated the original observations of Hahnemann as a law of order in a work never to be published. In this law he mentions essentially four points, that "the improvement in pain takes place from above downward; and in diseases, from within outward... Chronic diseases if thoroughly cured, always terminate in some cutaneous eruption" and lastly "the thorough cure of a widely ramified chronic disease in the organism is indicated by the most important organs being first relieved; the affection passes off in the order in which the organs had been affected, the most important being relieved first, the less important next, and the skin last". As a reader I do not clearly sense that Hering is officially proclaiming the original observations of Hahnemann as an absolute law but rather that there is a "law of order" during a curative process. Also I was unable to find Hering or any of his contemporaries referring further to this unpublished work or to a law of direction of cure.
- In 1865, Hering described these observations not as a law but as Hahnemann's general observations or as plain practical rules. Essentially he emphasizes the proposition that the symptoms should disappear in the reverse order of their appearance during the treatment of patients with chronic psoric diseases.
- In 1875, Hering now discussed only one proposition, that the symptoms will disappear in the reverse order of their appearance. The three other propositions are now not mentioned at all.
- All the illustrious contemporaries of Hering seems to remain silent on this point, at least from my review of the literature.
- In 1911, Kent, almost arbitrarily, calls the original observations of Hahnemann "Hering's law".
Now, with Kent's powerful influence, most modern works and presentations on homeopathy began to declare Hering's law as an established fact and seemingly assumed that it has been thoroughly verified since the beginning of homeopathy, although no author, to my knowledge, has so far been able to substantiate what each is repeating from the other. Here is one clear sign which indicates how profoundly the homeopathic profession of today has been cut off from its original and most essential sources. During the years of its decline in the U.S. the profession experienced a gradual discontinuity from its original foundation and started to rely more and more on a neo-foundation dating back to the turn of the present century. Each new generation of homeopaths has readily accepted Hering's law as a perfect law of cure and so unintentionally perpetuated a misleading assumption. For students it is an attractive concept but we clinicians must stand up and report our observations even if they are contrary to the teaching we have received.
From reviewing the literature, it seems unlikely that the law formulated by Kent in 1911 is a fair represention of Hering's overall understanding of a direction of cure and that neither Kent nor anyone else has been able thus far to clinically demonstrate that the original observations of Hahnemann constituted in fact a perfect law of nature. But if we assume, for a moment, that the law formulated by Kent is true, would all symptoms then have to disappear, not only in the reverse order of their appearance, but also from above downwards, from within outwards and from more important to less important organs?
To comply with this law it would mean that all diseases to be curable must proceed from outside inwards, from below upwards and from less important to more important organs. Many acute diseases and a whole list of chronic diseases such as psychosomatic diseases and others that develop from within outwards (for example cases of arthritis followed by psoriasis), or diseases that develop from above downwards, as in certain cases of polyarthritis, would then be theoritically incurable. Or (since we know this not to be the case) they are curable, but represent notable exceptions to Kent's formulation of a law of direction of cure.
In many cases of chronic disease the direction of disappearance of symptoms will contradict at least one of the four propositions. I assume that we all agree that the enunciation of a law must be based on impeccable observations. A law, if it is to be called a law, must explain all observable phenomena of direction of cure. It is unacceptable to use limited or even selected clinical phenomena to confirm a supposed law.
This situation appears to exist when certain homeopaths in their attempts to defend "pure" homeopathy subscribe to the position that what is observed as contrary to Hering's law, as formulated by Kent, is only due to poor prescribing, suppressive at times, palliative at best but surely not curative. For them what is wrong, is not the law but the prescription: "the simillimum was not given."
Personally I use and can daily confirm the original observations of Hahnemann concerning the direction of cure and have found them extremely helpful to evaluate the evolution of diseases or of cure but I have not been able to substantiate these observations as a law and have not yet found a colleague with such substantiation. I use them as plain practical rules.
Probably by the end of my career, homeopathy will have become widely accepted. I would then resent it if a group of objective scientists clinically investigate the principles of homeopathy, and find numerous exceptions not abiding to our idealistic or dogmatic conception of Hering's law; thus renderiing it only "a plain, practical rule". I would similarly resent having a group of scientists saying that for the last hundred or more years the homeopathic profession has been blindly erring in assuming that Hering's law was an irrefutable fact.
Five of the many plagues that have hindered the growth of homeopathy are ignorance, egotism, dogmatism, idolatry and the diversion from the inductive method. In his last address to the profession in an article published in the August 1880 (Hering died on July 23, 1880.) issue of the North American Journal of Homœopathy, Hering warned us that "if our school ever gives up the strict inductive method of Hahnemann we are lost, and deserve to be mentioned only as a caricature in the history of medicine." (19) Indeed, since its early beginning the tendency to rationalize the practice of medicine has also constantly threatened homeopathy. Hahnemann, who had a thorough understanding of the history of medicine, knew that the only sure way was based on the experimental method. Hering demonstrated the same rigor. Unfortunatively, we can not say the same of Kent. Let us now start carefully observing and reporting any facts that would help to perfect Hahnemann's original observations. If a direction of cure can be expressed within the context of a law, then so be it. But until demonstrated otherwise, it should remain "a plain, practical rule". The law that we suspect still needs to be rightly formulated.
At present it seems appropriate to refer to these observations as the rules of the direction of cure. To refer to these as Hahnemann's or Hering's rules may further prolong the confusion. From my personal experience, it appears that the four rules are not applicable to all cases and that there is a hierarchy among them, i.e., they do not have equal value. The first indication that a disease is being cured under homeopathic treatment is that the presenting and reversible (Many symptoms related to irreversible lesions can not be expected to totally disappear; consequently the more a symptom is related to organic changes, the less likely, or more slowly it will disappear. The greater the irreversibility of the pathology the greater the symptoms will linger. The practitioner can easily be confused by these important exceptions, which are often not well perceived. Therefore this rule [of symptoms disappearing in the reverse order of appearance] is generally less applicable to symptoms deriving from organic lesions.) symptoms of the disease will disappear in the reverse order of their appearance.
This confirms the observations as pointed out originally and plainly by Hahnemann in The Chronic Diseases and later by Hering in 1865 and 1875. This means that during the treatment of patients suffering with chronic diseases of non-venereal origin and also at times with acute diseases, the presenting symptoms of the patient's chronic dynamic disease (as opposed to the symptoms resulting essentially from gross error of living) will disappear in the reverse order of their appearance. So the presenting symptoms that have developed in the order of A B C D E seem to consistently disappear in the order of E D C B A. This rule seems to have supremacy over the other three rules: from more important to the less important organs, from within outwards and from above downwards.
The word "presenting" is here emphasized in order to state perfectly clearly that the symptoms that will disappear in the reverse order of the their appearance are only the presenting symptoms, and that it is not at all expected that every ailment experienced by the patient in his past will again be re-experienced under homeopathic treatment. In fact only a few of these old symptoms and conditions will reappear during a homeopathic treatment, usually the ones that have unmistakably been suppressed by whatever influences. Beside antipathic treatment that will suppress symptoms and normal functions of the organism (perspiration or menses) there are other measures which will cause suppression of symptoms, first, dissimilar diseases, natural or artificial; second, external influences such as exposure to cold temperature, (i.e., suppressed menses from getting the feet wet); and lastly, internal influences that cause the person to suppress emotions such as anger or grief. This rule concerning cure in the reverse order of appearance of the presenting and reversible symptoms of the disease is the most important of the four as it is observable in almost all cases. The importance of this rule is well emphasized by Hering in 1865 when he mentioned:
- "This rule enables the Hahnemannian artist not only to cure the most obstinate chronic diseases, but also to make a certain prognosis when discharging a cases, whether the patient will remain cured or whether the disease will return, like a half-paid creditor, at the first opportunity." (12)
The second most important (applicable) rule in the hierarchy is that cure will proceed from more important to less important organs. Third in importance is the rule that cure will proceed from within outwards. Fourth, least important and least often observable, the cure will proceed from above downwards. Hahnemann's observation thatof all the signs that indicate a small beginning of improvement, the psychic condition of the patient and his general demeanor are the most certain and revealing is seen as the source of the last three rules. "The very beginning of improvement is indicated by a sense of greater ease, composure, mental freedom, higher spirits, and returning naturalness." (paragraph 253) 10 This original observation of Hahnemann, which is verified daily, does not contradict the first rule in any case because the first sign of improvement can be and is often different than the symptom that would first disappear.
Consequent to Hahnemann's theory, (that all diseases, acute and chronic of non-venereal origin, come from the original malady called psora and its first manifestation is a skin eruption) all cases of chronic disease of dynamic origin must develop a skin eruption to be totally cured. As it seems unfeasible to demonstrate, it should at best be used as a working hypothesis and not as a law. For a law to exist it must be demonstrable without exception. Hahnemann had a clear opinion about the role of the physician as theorist when he wrote in the preface to the fourth volume of The Chronic Diseases:
- "I furnished, indeed, a conjecture about it [on how the cure of diseases is effected], but I did not desire tocall it an explanation, i.e., a definite explanation of the modus operandi. Nor was this at all necessary, for it is only incumbent upon us to cure similar symptoms correctly and successfully, according to a law of nature [similia similibus curantur] which is being constantly confirmed; but not to boast with abstract explanations, while we leave the patients uncured; for that is all which so-called physicians have hitherto accomplished." (8)
To end this thesis, I would like to leave you with the spirit of some pertinent thoughts of Constantine Hering. In 1879, in the last two paragraphs to the preface of his last work, The Guiding Symptoms of our Materia Medica, he writes:
- "It has been my rule through life never to accept anything as true, unless it came as near mathematical proof as possible in its domain of science; and, in the other hand, never to reject anything as false, unless there was stronger proof of its falsity.
- "Some will say, "but so many things - a majority of all observations - will thus remain between the two undecided." So they will; and can it be helped? It can, but only by accumulating most careful observations and contributing them to the general fund of knowledge." (20)
And finally he wrote in 1845 in the preface of Hahnemann's Chronic Diseases:
- "It is the duty of all of us to go farther in the theory and practice of Homœopathy than Hahnemann has done. We ought to seek the truth which is before us and forsake the errors of the past." (page 9) (11)
References
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