Constitution,temperament & diathesis with relation to Knerr repertoty, Kent repertory, BBCR & Allen’s key note

Dr Debika Biswas  

CONSTITUTION

INTRODUCTION:-

• “No knowledge is perfect unless it includes an understanding of the origin –that is, the beginning ;and as all man’s diseases originate in his constitution should be known if we wish to know his diseases.”——PARACELSUS.
• Constitution is defined as the structure, composition, physical make up or nature of a person, comprising inherited qualities and modified by the environment.
• English word constitution comes from Latin word “Constituere”, which means constitutes: to set up, to establish, to form or make up, to appoint to give being to.
• Hippocrates was the first person to write of the constitutional nature of human organism.
• Dr. Hahnemann gives a fair idea on the importance of constitution on aphorism 5 of Organon of Medicine , where he states “Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease  , as also the most probable exciting cause of the acute disease , as also most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause , which is generally due to a chronic miasm, the ascertainable physical constitution of the patient and intellectual character, his occupation etc….taken into consideration. Thereafter, in many places he mentioned about the constitutions in different context. He mainly refers constitution to the inherent in the natural frame , or inherent nature of the individual.
• Stuart close says Constitution is that aggregate of hereditary characters, influenced more or less by environment, which determines the individual’s reaction, successful or unsuccessful, to the stress of environment.
• Dr. J.T.Kent says in his lesser writings that “there are no fixed types of constitutions. They vary according to the combinations of characteristic general and characteristic particular symptoms of the sick individual. General symptoms are the most valuable symptoms because they pertain to the patient as a whole.”
• Dr.J.H.Clarke in his book Constitutional Medicine says that “The importance of observing the conditions under which a symptom occurs or is or better; also the time of recurrence and disappearance, and the concomitant symptoms with which it is associated. These particulars, which in general arise from the constitution of the patient and not from the disease form which he is suffering, are often of greater importance than the actual symptoms which they characterise.

CLASSIFICATION OF CONSTITUTION:

• Chinese concept : YANG & YIN
• Ayurvedic concept : VATHA, PITHA & KAPHA
• Hippocratic concept: SHORT and THICK & LONG and THIN. According to him first type is prone to apoplectic conditions and the second type is prone to tubercular affection.
• BAZIN Concept: SCROFOLOUS, GOUTY & SYPHILITIC.
• Leo Vannier’s & Zissus concept: Carbonic constitution, Phosphoric constitution, Fluoric constitution.
• Von Grauvogl concept: Hydrogenoid constitution, Oxygenoid constitution, Carbo-nitrogenoid constitution.
• Ernst Kretschner concept : ASTHENIC, ATHLETIC, PYKNIC, DYSPLASTIC

CARBONIC TYPE

• PHYSICAL MAKEUP :

• Body short-limbed, thickest, squire or spheric. Developed in width. Thick skeleton. Rigid articulation.
• Movement rigid, regular, condensed, walks on heel.
• Gestures sober, precise, utilitarian.
• Well defined jaw. Teeth squire, white, caries rare. Roots are divergent.

• MENTALMAKEUP :

• Guided by reason and sense of responsibility.
• Stubborn, straight.
• Speaks very little and only about what he knows.
• Loyal person does not take things lightly.

Respects order in society and in manner. 

 PHOSPHORIC TYPE:

• PHYSICAL MAKEUP :

• Body long-limbed. Prominence of cranium. Thorax long and flat, forward from behind.
• Tall, slim and slender with elegant movement, attitude supple, gracious.
• They are also prone to fatigue with low resistance of infections, particularly ear, nose and throat.
• Fingers grapious and tapered. Nail fine, rosy, long or almond shaped.
• Teeth rectangle, vertical. Easily caries. Becomes yellow.

Should avoid too much sun and stormy atmosphere

• MENTAL MAKEUP :

• Nervous, sensitive, easily excited and soon depressed.
• Love of beautiful things.
• Care of elegance.
• Artistic. Imaginative persons.
• Horror of reality, of facts.
• Easy vanity of dominating.

Feels well by the sea side or in medium altitude

FLUORIC TYPE:

• PHYSICAL MAKEUP:

• Body lean, asymmetric, attitude unbalanced. Walk irregular, easy sprain.
• Skin dry and cracked.
• Teeth triangular, greyish. Malposition of teeth. Tendency to caries and pyorrhoea.
• There may be a tendency to bone and ligament troubles & predisposed to diseases of nervous system. 

• MENTAL MAKEUP :

• Unstable, can not take any decision.
• Restless, intuitive.
• Unforeseen & lively reaction but not durable.
• Capricious
• Versatile
• Easily vulgar.
• Brilliant but unstable.

• MENTAL MAKEUP :

• Unstable, can not take any decision.
• Restless, intuitive.
• Unforeseen & lively reaction but not durable.
• Capricious
• Versatile
• Easily vulgar.
• Brilliant but unstable.
• Cunning and Unreliable

GRAUVOGL’S  CONSTITUTION:

• Human body three-fourths are made up of water—that is of oxygen & hydrogen. Carbon & Nitrogen account for most of the remainder. Constant & regular inter change between the tissues & the gasses effected by the blood the health of the body depends. On any constant plus or minus of any of these elements in the blood and tissues depend the basic differences in the constitutions of the individuals so affected. And in these differences revealed in their symptoms.

HYDROGENOID   CONSTITUTION:

• A constitution in which the subject can’t tolerate moisture. It is characterised by an excess of hydrogen & consequently water in the blood and tissues. They belong from Sycotic  background

• Always worse in cold or damp weather and in the rain.
• All diseases in such constitution are increased by cold and cooling food & drinks(sour milk, hard eggs, cucumber, mushrooms).
• Slow intake of nutrition.
• Puffiness, retention of water in tissues.
• All of its disordered have a periodicity.
• Slow, fatigue, heavy.
• They are aggravated by moisture and humidity, prone to dropsy & anasarca, & suffers from tissue growth of benign type.

OXYGENOID  CONSTITUTION:

• Oxygenoid constitution is characterised by the accumulation of excess oxygen and consequently exaggerates breaking down of hydro-carbons, nitrogenoids, & albuminous tissues & bones –destructions of tissues. They are mainly Syphilitic background.

• Person is thin with complain of weight loss in spite of having food, appetite and eating well.
• They are nervous individual & they have increase physical & mental activities.
• Bad effect on change of season.
• They refuse to fatty food & animal food.
• They are prone to have ulcers and self destruction.
• Prominent glands & weak bones.
• White spot on nails.

CARBO-NITROGENOID  CONSTITUTION

• This constitution is characterised by excess of Carbon and Nitrogen and by insufficient oxygenation and the diseases it produces are called retarded nutrition. This makes for increased liability to diseases and perverted nutrition. They have disease of body & mind ,with irregular working of heart, lungs, kidneys, liver and spleen. They are mainly Psoric nature.

• Short breath
• Frequent pulse
• Gouty pain in head, gouty swellings.
• Irritability. Extra-ordinary impatience.
• Dullness of head, day sleep.
• Somnolence
• Hypochondriasis
• Yawning
• Copious uric acid and oxalate in urine.
• They also suffer from epistaxis, haemorrhoids.
• Unhealthy skin with boils, eczema and urticarea.

It is related to Psoric miasm of Hahnemann

• ASTHENIC CONSTITUTION

• Average or less height
• Thin individual
• Lean narrow built with poor skin, narrow shoulder, muscles
• Delicate bones
• Narrow flat chest
• Thin stomach

• ATHLETIC  CONSTITUTION

• Strong development of the skeleton, muscles and skin
• Middle sized person
• Projecting shoulders
• Superb chest 
• Firm stomach
• Magnificent leg

• PYKNIC CONSTITUTION:

• Fat person
• Refers to plump physique

• DYSPLASTIC  CONSTITUTION:

• Irregular

• DIFFERENT CONSTITUTION TEMPERAMENT & DIATHESIS PRESENT IN KNERR REPERTORY, KENT REPERTORY AND BBCR

• KNERR REPERTORY : Dr.Calvin B Knerr His repertory, ‘The Repertory of Hering Guiding Symptoms of our Materia Medica’ the rubrics related to constitution, temperament and diathesis especially present in ‘Stages of  Life and Constitution’ chapter and also scatterdly present in different chapters of this repertory. Knerr repertory is a concordant repertory in which rubrics are direct expressions of symptoms without much change, which gives unique expressions of patients or proving’s as it is. Study of these traits helps in understanding the constitution of medicine as well as patient.
• KENT REPERTORY : Dr.J.T. Kent his repertory, ‘Repertory of the homoeopathic materia medica’ the rubrics related to constitutions especially present in Generalities chapter and some of  in Mind chapter.
• BBCR : In BBCR Constitution, Temperament and diathesis related rubric especially present in Sensation and complaints in General chapter.

SOME CONSTITUTIONS FROM KNERR REPERTORY

• ANAEMIC  CONSTITUTION:
• ASTHAMATIC CONSTITUTION : 
• BILIOUS  CONSTITUTION : This is recognised by a dark or yellow skin, by predisposition to derangements or irregularities of the digestive functions and tendency to constipation, piles etc.
• CACHECTIC  CONSTITUTION : A profound and marked state of constitutional disorder, general ill-health and nutrition.
• CANCEROUS CONSTITUTION : General ill-health due to cancerous diathesis.
• CARBO-NITROGENOID CONSTITUTION : Discuss in before.
• CATARRHAL CONSTITUTION : A lack of vitality of the skin and mucous membranes which are easily affected by external circumstances or etiological influences.
• DWARFISH CONSTITUTION : A condition originating in foetal life or early infancy, due to some systemic diseases of mother or some hormonal disbalance of infant , characterised by stunting of physical and mental development.
• DYSPEPTIC CONSTITUTION : Impairment of the power or function of digestion.
• FIBER CONSTITUTION : 
• RELAXED CONSTITUTION :
• GOUTY CONSTITUTION :  A constitutional hereditary condition of uric acid metabolism, associated with high blood level and

• Decreased  urinary excretion of uric acid. There are sudden attacks of acute painful arthritis which may last for few days to a few weeks, recurring at irregular intervals with complete remission between the attacks.

• HAEMORRHAGIC  CONSTITUTION : Tendency to easy and prolonged bleeding , often hereditary.
• HAEMORRHOIDAL  CONSTITUTION : Tendency to piles.
• LYMPHATIC  CONSTITUTION :  This constitution recognised by

• Light complexion, a full and rounded frame but flesh soft and flaccid and muscular fibre yielding and relaxed.
• Circulation is sluggish, pulse is slow.
• Sensitiveness to cold.
• Affections to catarrhal diseases , abscesses, accumulation of water in various organs.

• PHTHISICAL  CONSTITUTION : Patient peculiarly liable to affections of lungs. This constitutional patient can be recognised by—

• A clear, transparent skin, often with bright spot on cheek.
• Flatness of the chest
• Long and spare neck
• Rapid growth
• Quick and small pulse
• Long slender fingers with large joints.

• PLETHORIC CONSTITUTION : This constitution characterised by florid complexion, a full and robust frame, activity of strength of body and strong full pulse. There is an activity in calculative system and a predisposition to local or general congestion.
• PSORIC  CONSTITUTION : Same as the Carbonitrogenoid constitution of Grauvogl.
• RACHITIC  CONSTITUTION : Tendency to rickets in infants and children in the growing period.
• RHEUMATIC CONSTITUTION : A disease marked by inflammation of the body, especially the muscles and joints, by pain in those parts, bi- vegetation on the valves of heart and the presence of Aschoff’s bodies in the myocardium and skin. (Dorland)
• SCORBUTIC  CONSTITUTION : Tendency to scurvy.
• SCROFULOUS  CONSTITUTION : It is characterised by a tendency to ulcerative sores, particularly in glands, unhealthy secretions from the skin and various forms of eruptions.

NAME OF THE CONSTITUTION	KNEER REPERTORY	KENT REPERTORY	BBCR
Haemorrhagic constitution/ diathesis	Stages of life and constitution	Generalities- Haemorrhage	sensation & complaints in General- Haemorrhage, tendency to
Scorbutic constitution	,,	GEN-SCURVY, scorbutus	Sensation & complaints in General-SCURVY, scorbutics symptoms
Syphilitic constitution	,,	GEN-SYPHILITIC	Sensation & complaints in General-CONSTITUTION, syphilitic
Plethoric constitution	,,	GEN-PLETHORA
Cancerous constitution	,,	GEN- CANCEROUS AFFECTION	SENSATION & COMPLAINTS IN GENERAL-CANCEROUS cachexia
Dwarfish constitution	,,	GEN-DWARFISHNESS	SENSATION & COMPLAINTS IN GENERAL-GROWTH AFFECTED
Sycotic constitution	,,	GEN-SYCOTIC	SENSATION & COMPLAINTS IN GENERAL-CONSTITUTION, Sycotic
Relaxed constitution	,,	GEN-RELAXATION	SENSATION & COMPLAINTS IN GENERAL-MUSCLES, relaxed, flabby, weak
Weakly constitution	,,	GEN-WEAKNESS	SENSATION & COMPLAINTS IN GENERAL-WEAKNESS,exhaustion, prostration, infirmity
Cachectic constitution	,,	GEN-EMACIATION	SENSETION & COMPLAINTS IN GENERAL-Emaciation, atrophy in general
Scrofolous constitution	,,		SENSETION & COMPLAINTS IN GENERAL-SCOROFULA
Venous constitution	,,	GEN-VARICOSE VEINS
Carbo-nitrogenoid constitution	,,		SENSETION & COMPLAINTS IN GENERAL-CONSTITUTION, Carbogenoid
Hydrogenoid constitution	,,		SENSETION & COMPLAINTS IN GENERAL-CONSTITUTION, Hydrogenoid
Oxygenoid constitution	,,		SENSETION & COMPLAINTS IN GENERAL- Oxigenoid
Psoric constitution	,,		SENSETION & COMPLAINTS IN GENERAL-CONSTITUTION, psoric, scrofulo- lymphatic
Rheumatic/Gouty/Lithaemic diathesis	,,		SENSETION & COMPLAINTS IN GENERAL-CONSTITUTION, Lithaemic,acidosis
Dyscratic diathesis	,,		SENSETION & COMPLAINTS IN GENERAL-CONSTITUTION, Dyscratic

SOME EXAMPLES FROM H. C. ALLEN’S KEYNOTES TO MATERIA MEDICA :

• Tuberculinum : adapted to persons of light complexion ; blue eyes , blond in preference to brunette; tall , slim , flat, narrow chest; active and precocious mentally, weak physically; the tubercular diathesis.
• Sarsparilla : for dark haired persons lithic or sycotic diathesis.
• Kreosote : haemorrhage diathesis: small wounds bleed profusely.
• Bryonia alba : it is best adapted to persons of a gouty or rheumatic diathesis.
• Calcarea carbonica : leucophlegmatic, brown, light-complexion, blue eyes , fair skin, tendency to obesity in youth.
• Chamomilla : persons especially children with light brown hair, nervous, excitable temperament.
• Cofea cruda : tall, lean , stooping persons, dark complexion, sanguine choleric temperament.
• Conium maculatum : cancerous and scrofulous persons with enlarged glands.
• Cyclamen : best suited for leuco-phlegmatic persons with anaemic or chlorotic conditions.
• Diphtherinum : especially adapted to the strumous diathesis
• GELSEMIUM : For children , young people, especially women of nervous hysterical temperament.
• GLONOINE : Nervous temperament, florid , sensitive woman; persons readily affected.
• KALI CARBONICA : For diathesis of old people , dropsy and paralysis; with dark hair , lax fibre, inclined to obesity.

• KREOSOTE : Haemorrhage diathesis: small wounds bleed profusely.

• LACHESIS : Persons of less melancholy temperament; women of chloeric temperament with freckles and red hair.

• NITRIC ACID : Especially suited to thin persons of rigid fibre , nervous temperament.
• NUX VOMICA : Adapted to thin, irritable, careful, zealous persons with dark hair and bilious or sanguine temperament.
• PODOPHYLLUM : Adapted to persons of bilious temperament who suffer from gastrointestinal derangement, especially after abuse of mercury.
• PSORINUM : Especially adapted to the psoric constitution.
• SARSPARILLA : For dark haired persons lithic or sycotic diathesis.
• THUJA OCCIDENTALIS: Adapted to hydrogenoid constitution of Grauvogl.
• TUBERCULINUM : Adapted to persons of light complexion ; blue eyes , blond in preference to brunette; tall , slim , flat, narrow chest; active and precocious mentally, weak physically; the tubercular diathesis.

  TEMPERAMENT   

• According to Dorland’s dictionary….Temperament is peculiar physical character and mental cast of an individual.
• Temperament means the internal constitution or state, disposition, type of physical constitution and internal organisation.

It is the dynamic physiopathological, and characteristic expression of the individual. It is partly determined by heredity but, above all modelled by the internal and external stimuli

 Temperament theory originated in ancient Egypt or Mesopotamia but Hippocrates(460-370 BC) developed it into a medical theory. He believed certain human moods emotions were caused by body fluids( called “humors”) blood, yellow bile, black bile and phlegm

 Galen proposed a temperament theory built on Hippocrates observation around 149B.C . According to Galen, there are 4 basic human temperaments– SANGUINE, CHOLERIC, MELANCHOLIC  &  PHLEGMATIC.

 According to Dr.H.A.Roberts….”Temperaments are to a very large extent physiological but besides the stature of the patient the matter of temperaments implies colouring, functional tendencies of circulation, elimination, respiration and so on; and at the same mental and emotional tendencies in reaction to environment and circumstances”. 

According to Roberts….there are four classical temperaments : Nervous, Bilious, Sanguineous, Phlegmatic.

NERVOUS TEMPERAMENT:

• PHYSICAL  ASPECT:

• Excessive alterness with quick action leads to fatigue with exhaustion.
• Scared  look with flushed face due to nervousness—may be with excess sweating or trembling.
• Easily startled, have a tendency to neural disorder.
• Rapid pulse,

• MENTAL  ASPECT:

• Anxious , undisciplined & forgetful.
• Due to loss of confidence taking a lot of undue stress.
• Hastiness, fearful, timid, unpredictable mood.
• Introvert and pessimistic.

CHOLERIC  TEMPERAMENT:-

• PHYSICAL  ASPECT :

• Muscular well built with yellowish pale skin.
• Prone to suffer from liver and GI problems.

• MENTAL  ASPECT:

• Irritable, high-strung type, dominating, extrovert.
• Aggressive, unemotional, strong-willed persons with little need for friends and attachments with family.
• Optimistic, have a lot of confidence, full of vitality.
• Self sufficient in nature.
• Always aiming and achieving the success by firm determination.
• Can’t tolerate contradiction

SANGUINOUS TEMPERAMENT:-

• PHYSICAL  ASPECT:

• Plethoric with flushed face, full pulse, light and delicate skin.

• MENTAL ASPECT :

• Extremely energetic, enthusiastic with optimistic outlook and full of vitality.
• They are vivacious, love of lough, making friend and always be with people.
• They have good sense of humour with a beautiful expressive capacity. They are good storytellers, so people are too much attracted towards them.
• Extrovert in nature.

PHLEGMATIC TEMPERAMENT:-

• PHYSICAL  ASPECT:

• Fatty or dropsical, slow, sluggish, pale and puffy skin, soft emotional expression on face.
• Tendency to catch cold easily and venous stasis.

• MENTAL  ASPECT :

• Introvert with low vitality, apathetic, unexcitable.
• They are friendly, peaceful, calm, family oriented people.
• They have aversion to work with timidity & lack of confidence.
• Consistent with life and avoid conflicts.
• They are well balanced and good listener.
• They don’t mind at trifles and give less importance even to serious matter also.

SOME TEMPERAMENTS FOUND IN DIFFERENT LITARATURES OF HOMOEOPATHY:

• MELANCHOLIC  TEMPERAMENT :

• PHYSICAL  ASPECT :

• Anorexia, generally weight loss.

• MENTAL  ASPECT :

• They are sentimental, introvert, sympathetic, soft spoken.
• Pessimistic and too much emotional.
• They are talented, deep and thoughtful, perfect and organised at work, creative with enough discriminative intellect and conscientious.
• They have deep feelings for others, compassionate, friendly, self sacrificing, idealistic and philosophical. Long continued grief or sentimental mood leads to depression and suicidal tendencies.

• LEUCOPHLEGMATIC TEMPERAMENT : This term is frequently found in homoeopathic literature, but there is no clear definition is found anywhere.

• According to Dr.J.N.Kanjilal….It is nothing but a Phlegmatic temperament in a fair-complexioned individual. The fair complexion is not so much due to fairness of the skin as due to different degrees of pallor or anaemia.

• LYMPHATIC  TEMPERAMENT :

• Lymphatic temperament is characterised by a fair but not ruddy complexion, light hair and a general softness or laxity of the tissues. 
• According to old pathologist….from the predominance of lymph or phlegma in the system

• BILIOUS  TEMPERAMENT : This is similar to choleric temperament.

• APPLIED RUBRICS : FROM KENT REPERTORY:

• SANGUINE TEMPERAMENT:

• MIND-EXCITEMENT-Emotional , ailments from
• MIND-LOQUACITY
• MIND-VIVACIOUS
• MIND-CHEERFUL
• MIND-COMPANY , desires for
• MIND-FORGETFUL
• MIND-CARELESS
• MIND-THEORIZING

• BILIOUS TEMPERAMENT:

• MIND-ANGER , Vexation
• MIND-INDUSTRIOUS
• MIND-CENSORIOUS
• MIND-CONTRADICTION, is intolerant of
• MIND-IMPATIENCE
• MIND-FEARS
• MIND-TIMIDITY
• MIND-RESTLESS

• TEMPERAMENT  PRESENT  IN  DIFFERENT CHAPTERS  IN  KNEER  REPERTORY:-

• Headache, in hysteria; in people of nervous or sanguine temperament, I  coff ( chapter – inner head)
• Headache, nervous; nervous or sanguine temperament, I coff ( chapter – inner head)
• Headache, nervous; and sensitive temperament, I coff ( chapter – inner head)
• CONJUNCTIVA, blennorrhoea; malignant, leucophlegmatic temperament, I Thuja ( chapter – eyes)
• Opthalmia menstrualis; in patient of a sanguine temperament, subject to attacks of       congestion and inclination to hysterical spasms, croc (chapter – eyes, pg no -214
• Stomach, cramp; with tendency to constipation, especially those of lymphatic temperament, I ( chapter – scrobiculum and stomach, pg no -458)
• Stomach, oppression ; in hysterical women, with nausea, pale face, weakness, phlegmatic temperament, I ( chapter- scrobiculum and stomach, pg no -466)
• Constipation, stomach; gastralgia, in those of lymphatic temperament, I  (chapter – stool and rectum,, pg. no -537)
• Gonorrhoea, constitution in blonde men of light temperament, I ( chapter – male sexual organs, pg no -619)
• Menses , bright red ; females of sanguine temperament, I Kali carb ( chapter- Female sexual organs, pg no- 649)
• Menses , profuse ( menorrhagia); in sanguine temperament, I Kali c (chapter- Female sexual organs, pg no- 653)
• Menses, protracted ( lasting too long); in sanguine temperaments, II Kali c (chapter- Female sexual organs, pg no- 653)
• Menses, suppressed ; in women of full habits, leucophlegmatic temperament, I Calc (chapter- Female sexual organs, pg no 655)
• During menses, pain ( colic, dysmenorrhoea); in women of spare habit, and of a delicate, nervous temperament, II (chapter- Female sexual organs, pg no- 664) 
• Sexual excitement ; suddenly, in a women at 40 , of phlegmatic temperament, and without the least sexual inclination, II (chapter- Female sexual organs, pg no- 672)
• Lungs, haemorrhage ( haemoptysis); sanguine temperament, I (chapter-  inner chest and lungs, pg no- 681)

 DIATHESIS

• DIATHESIS—derived from a Greek word  DIATITHENANI  means… to constitutional predisposition to certain disease condition.
• The word “Diathesis” can be explained as a borderline state between disposition and expression, or it can be defined as a borderline state between normal susceptibility and expression of the disease.
• Compton J Burnett was the first person to describe this state. He called it “consumptiveness” .
• Dr.Hahnemann never used the term Diathesis. He used predisposing factor rather than diathesis.
• According to Dr.M.L.Dhawale…”Diathesis represents certain deviations in susceptibility which are not sufficiently marked to merit the label disease and in which the responses to environmental stimuli tend to be exaggerated or erratic.”

TYPES OF DIATHESIS:- 

• Tubercular diathesis
• Scrofulous diathesis
• Haemorrhagic  diathesis
• Lymphatic  diathesis
• Uric acid or Lithaemic or Rheumatic or Gouty diathesis.
• Dyscratic  diathesis

TUBERCULAR DIATHESIS:-

• The French called it “elat tuberculinique”. This diathesis is found in offsprings of those who had suffered from tuberculosis. It may also be observed in some individuals who do not respond to anti-tubercular treatment.
• Lean and thin constitution. Fatty constitution with extreme sickness. Emaciation in spite of taking proper food and drink. Eats much but loses flesh rapidly.
• Tendency to easily catches cold.
• Hair thin, dry, matted .Nails thin and white spot.
• Mentally keen but physically weak. Cosmopolitan mentally and physically.
• Symptoms are ever-changing. Rapid response to any stimulus

SCROFULOUS  DIATHESIS:-

• Scrofula owes its origin to that malignant combination of psora and syphilis.It is arising from a psoric constitution yet it is generally understood that in psora we have no involvement of the lymphatics ,whatever, which is so characteristic of scrofula.
• The development of the Scrofulous diathesis is largely due, not only to syphilis and psora combined but to the suppressive measures and crude drugging used in the treatment of syphilis  in allopathic school

HAEMORRHAGIC  DIATHESIS:

• An inherited predisposition characterised by excessive bleeding.
• It comes in the syphilitic diseases, where ulceration and bleeding is well marked.

LYMPHATIC DIATHESIS :

• Psoric factors lead to the development of lymphatic diathesis.
• It develops the way—-involving first the skin, then the mucosa and finally internal organs and systems. Milk crust, dermatitis, intertrigo, weeping eczema are often present during the first weeks of life, they are followed by coryza, bronchitis, repeated colds. Development tends to reterded, and the child is late in learning to talk and walk. Tendency to rickets and spasmophilia .Lymphoid tissues—even normally very active in childhood—grow hypertrohic and prone to diseases.

• Nose blocked by lymphoid tissue and mucosal swelling. Prone to develop sinusitis. Snotty nose.
• Abdominal lymph nodes enlarged, sometimes palpable. Attacks of colic in infants.
• Exudative process in infancy, later rough skin, poor healing tendency, enlarged lymph nodes in neck, axilla, inner aspect of elbow and inguinal region.

URIC ACID DIATHESIS or RHEUMATIC or GOUTY or LITHAEMIC DIATHESIS :

• Within the sycotic range of constitutional disorders one often comes across this diathesis.
• Rheumatic affections affecting joints, muscles, tendons, nerves.
• Gouty deposits in joint, tendons.
• Concretions in the urogenital system, inflammetory conditions in the urogenital region.
• Liver and gall bladder diseases, concretions in bile duct.
• Metabolic disorders with hyperuricaemia, hypercholesterolemia,  hyperlipidaemia consequently increased risk of arteriosclerois and cardiovascular diseases.
• Benign tumours  ranging from warts to fibroids, ademonas (prostate) and uterine myomas.
• Symptoms are usually worse in cold damp weather, humid climate, sequelae

DYSCRATIC  DIATHESIS :

• The dyscratic diathesis belongs the syphilitic range of constitutional disorders. In human pathology the term DYSCRASIA was used to define a depraved states of the humours, a state of imbalance.
• It relates the end state of processes arising through psoric, sycotic and tuberculunic  traint. It provides the background for the development of carcinomas and other malignant tumors and malignant blood diseases. Degenerative diseases of the nervous system also included.

DIATHESIS PRESENT IN DIFFERENT CHAPTERS OF KNEER  REPERTORY:

• Headache, drawing; intermittent, in rheumatic, gouty or nervous diathesis
  • , I ( chapter – inner head pg no-125)
• Headache, neuralgic; intermittent, in rheumatic, gouty or nervous diathesis, I ( Chapter – inner head pg no – 132)
• Headache, tearing; intermittent in those of rheumatic, gouty or nervous diathesis, I ( chapter – inner head pg no – 143)
• Cornea, inflammation ( keratitis); superficial, involving epithelial layers, caused by injuries, colds or in scrofulous diathesis, I( chapter – eyes, pg no- 178)
• Cornea, pannus , in patients of strumous diathesis, I ( chapter-eyes, pg no 179)
• Vomiting, at night sudden attack, gouty diathesis( acute inflammation of pancreas) I ( chapter – hiccough, belching, nausea and vomiting, pg no -445)
• Vomiting, saliva; without admixture, gouty diathesis(acute inflammation of pancreas) I ( chapter – hiccough, belching, nausea and vomiting, pg no -445)
• Liver, scrofulous diathesis: I( chapter- Hypochondria, pg no-481)
• Constipation, eruption; in subjects of herpetic diathesis, I( chapter- stool and rectum, pg no -535)
• Diarrhoea, at night; sudden attack, gouty diathesis( acute inflammation of pancreas), I (chapter- stool and rectum, pg no- 543) 
• Rectum, tenesmus( involuntary straining); irritability of bladder, depending upon gouty diathesis, I( chapter- stool and rectum, pg no- 554)
• Bladder, irritability; gouty diathesis, I ( chapter- urinary organs, pg no – 584)
• Bladder, irritability;  with tenusmus,  depending  upon gouty diathesis, I ( chapter- urinary organs, pg no – 584)
• Urine, aluminous; rheumatic  diathesis, sal. Ac (( chapter- urinary organs, pg no – 604)
• Urine, diabetes mellitus, with gouty diathesis, I (( chapter- urinary organs, pg no – 607)
• Urine, sediment; with calculous diathesis, I (( chapter- urinary organs, pg no – 613)
• Urine, sediment; with gouty diathesis, I(( chapter- urinary organs, pg no – 613)

• IMPORTANCE OF COSTITUTION, DIATHESIS  & TEMPERAMENT:-

• Prescribing on Types or temperaments, is at best a slack method of using the blessings of homoeopathy. It is really keynote prescribing,& then not on any morbific symptoms, but on a general stature that is present from birth. Keynotes may often give us a clue to the indicated remedy, but this clue must not be allowed to overbalance our judgement in weighing the whole symptom picture.(Robert)
• The morbific influences that are attracted to temperamental tendencies are amenable to treatment and can be removed by the homoeopathic remedy; this in itself greatly preventive of the dangers arising from temperamental weakness.(Robert
• Susceptibility is modified by constitution and temperament—the higher potencies are best adapted to sensitive persons of the nervous, sanguine or choleric temperament.
• Lower potencies and larger and more frequent doses correspond better to torpid and phlegmatic individuals. (Stuart Close)
• Natural physical makeup of certain people predispose them to certain reactions under certain circumstances makes them particularly susceptible to certain disease influences are natural (created by themselves or their environment) or artificial (created by homoeopathic provings). (Robert)
• Temperament cannot well be left out of any case in making up our anamnesis, for as we see that peculiar temperament is predisposed to certain form of disease. In this we see a fixed law, or principle, involved. As illustration of this we might take for example- the bilious temperament so characteristic of Nux vomica patient. (J.H.AlleN)
• Prescribing for a patient his constitution often counts  for more than the particular complaint in which it manifests itself. Once constitution is known and cured, all the rest of the symptoms clear up. (J.H.Clarke)

BIBLIOGRAPHY:- 

• Calvin B.Kerr; Repertory of Hering Guiding Symptoms of our Materia Medica; B.Jain Publishers (p), New Delhi.
• Cyrus Maxwel Bogar ; Bogar Boenninghausen Characterstic Repertory ; B.Jain Publishers (p) ; New Delhi.
• Dr.M.L.Dhawale; Principles & practice of homoeopathy; B.Jain Publishers (p); New Delhi.
• Herbert A.Roberts ; The Princilples and Art of Cure by Homoeopathy; 3^rd edition; B.Jain Publishers (p), New Delhi.
• J. Henry Allen ; The Chronic Miasms with Repertory ; Revised edition ; B.Jain Pulishers (p), New Delhi.
• John H. Clarke ; Constitutioal medicine ; B.Jain Publishers (p)
• J.T.Kent ;Lesser Writtings ; B.Jain Publishers (p); New Delhi
• J.T.Kent ; Repertory of homoeopathic materia medica; B.Jain Publishers (p); New Delhi.
• Samuel Hahnemann; Organon of Medicine; 5^th & 6^th edition; IBPP.
• Stuart Close ; The Genious of Homoeopathy ; B.Jain Publishers (p); New Delhi
• Tapan Chandra Mondol ; Organon of Medicine, ready reference encyclopedia ; NCVA publications.

Dr Debika Biswas 
UNDER GUIDANCE OF Dr. Ardhendu Sekhar Charkraborty
MBHMC&H (GOVT.OF WB)