Role of Constitution in Homeopathy

Dr Beenadas

“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, it is necessary that his constitution should be known if we wish to know his diseases.”    –   Paracelsus.

Constitution is defined as a person’s physical and mental make up which  is revealed  through  his physical  built,  his characteristic  desires, aversions and reactions as well as emotional and intellectual attributes.

• Physical make-up of the individual illumines many aspects of   personality and many of the behavioral patterns.
• Physical characteristics are linked closely to the genetic set-up and this suggests that the physical and psychic characters are intimately related.
• The term constitution emphasize physical structure as well as the biological function, comprising inherited qualities modified by the environment.

Every person is born with a certain part of organization which is determined by the genes and the environmental influences . During intrauterine life, the embryo is liable to receive the effect of various physical and emotional factors on mother .It develops certain attributes during this stage of life. After nine months of intrauterine life it comes out with certain attributes and enters the world which has altogether different environment. The first reception as well as the new environment will have a great impact on his constitution.

In the course of its growth, it comes across different environment and accordingly modifies its reaction by learning through experiences. It develops certain likes and dislikes, certain positive and negative attitudes which, in due course , become a part of its behavioral pattern. Through out his life, a person learn through his personal experiences , but the impact of early environment plays a great role in the making of his constitution. Thus the constitution of a person is the sum total of the result of the influences of early environment on hereditary characteristics

A person inherits a definite organizational plan , tendencies, attributes and the miasm which decide his pattern of reactions or susceptibility to the environment. He constantly reacts and thereby tries a state of balance to enjoy the environment without giving rise any discomfort. The imbalance causes sickness which give rise to discomfort, disharmony, disruption of the equilibrium in the functioning of the individual. The imbalance is expressed through the signs and symptoms,  the reaction  to his unfavorable environment. The pattern of this reaction is determined not only by the factors which have caused the influence but also by the constitution of the person.

The constitution of an individual plays an important role in the drug proving and also in the occurrence of natural diseases. Hence the role of constitution is crucial in treatment and achieving a cure. The Knowledge of constitution of a medicine and constitution of a person on the part of a physician helps to arrive at a greater level of similarity between the person and the medicine.

To understand the constitution of a person, a physician must know the person’s physical make up, namely, his build, desires, aversions, and disagreement with foods, characteristics of his discharges and eliminations, and his thermal reactions. Also mental attributes, namely, emotional and intellectual reactions and performances. Various concomitants expressed in relation to the stressful situations like dentition in a child, menstruation, pregnancy and menopause in a female are important expressions which reveal the quality of a constitution.

A constitutional prescription should be based on the totality of the mental and physical reactions. It should be able to cover the level of susceptibility, the tendencies, the behavioral pattern and the underlying miasms.

Administration of constitutional medicine during acute stage of a disease might prove hazardous. In acute stage of a disease an acute remedy should be selected only on the basis of acute totality. Constitutional medicine should be prescribed only after the acute crisis. It  help the individual to have a quick and uneventful convalescence, also effectively checks the tendency to relapse.

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 –  classified constitution into 3 types – SCROFULOUS,  GOUTY & SYPHILLITIC
• VANNIER’S & ZISSUS Concept  – CARBONIC CONSTITUTION,  PHOSPHORIC CONSTITUTION & FLUORIC CONSTITUTION

The characteristics of carbonic constitution are mentally and physically upright persons, having square white regular teeth, slight acute angle between Ibre-arm and upper-arm, orderly, undemonstrative, responsible and capable. They are Psoric. Cal carb, kali carb, mag carb, nat carb, graph, carbo veg, carbo anim are the drugs having this constitution.

Phosphoric constitution have scrofulous or tubercular diathesis. Tall , thin delicate, easily tired persons with long yellow teeth but well fitted. Arm forms perfect straight line when stretched. Dislike hard work but orderly and studious. Usually sychotic. Calc phos, phos acid, kali phos, phos, mag phos are the main drugs.

Flouric constitution is characterized by unbalanced irregular body formation with obtuse angle of outstretched arm, teeth irregular and ill fitted, untidy, cunning and unreliable. Capable of heroism, sanctity and wickedness. Predisposed to diseases of nervous system, dislocation of the joints and suicide. Mainly Syphillitic. Flouric acid, calc flous are the main drugs.

ERNST KRETSCHNER (1921)  – ASTHENIC, ATHLETIC,  DYSPLASTIC  &  PYKNIC
By taking a limited number of physical characteristics Kretschner classified constitution into asthenic, athletic and pyknic — with an additional one — dysplastic.

Asthenic refers to frail, linear physique. A deficiency in thickness combined with an average unlessened length. Lean narrow built with a skin poor in secretion, narrow shoulders, muscles, delicately bones limbs, narrow flat chest, sharp rib angle, and thin stomach.

Athletic constitution is characterized by strong development of the skeleton, musculature and skin, a middle sized man with projecting shoulders, super chest, firm stomach and trunk tapers in its lower edge so that the pelvis and the magnificent leg seem almost graceful compared with the size of the upper limb and particularly hypertrophied shoulder.

Pyknic refers to plump physique.

RADEMACHER – a 3 fold division, division according to aetiology. According to him in some epidemics one type would rule and the remedy for that type would be Copper. At another season a some what different type would prevail and for that Iron would be needed. For a third type Natrum nitricum would be the remedy each of these remedies had allied remedies of its own type.

VON GRAUVOGL – HYDROGENOID,  OXYGENOID   &  CARBO-NITROGENOID
Grauvogl who did not deny the value of above said other classification, did not find that any of them went deep enough. So he restated them in terms of the tissue themselves and widened their borders. It was through Hahnemann’s insistence on the necessity of observing concomitant circumstances in relation to symptoms that Grauvogl was led to make his great generalization. In the practice of Homoeopathy it makes all difference whether a symptom is worse or better in hot weather or cold, wet or dry, summer or winter. Grauvogl with his critical and analytical instincts asked himself what these condition meant in the organism. Being well versed in Chemistry he asked himself what change in the organism took place under these different conditions and he traced them down to the change that take place in the blood in respiration.

According to him respiration is a function which is not confined to the lungs, all parts of the body respire and  consequently  oxygen is found  in all organs and tissue, sometimes as ozone (neutral), and sometimes as antozone (positive). The  air we  breath  is composed of  Oxygen , Carbon, Hydrogen, and Nitrogen of which the whole Organism is composed and which are even contained  free in the  blood. Thus  changes of  the atmospheric constituents affect the constant whole of the organism.

It is in this conception as explaining Hahnemann’s observation of the effect of the various seasons and climatic conditions on patients and drug provers that Grauvogl’s arrangement of the constitutions is based. ‘The Homoeopath abstracts first from the symptoms the individuality of the patients in connection with the state of the outer world in which they have existed from their birth and out of which the bodily constitution is developed. The bodily constitution is hence the general cause’.

Grauvogl made the true observation that if the organism is not able to adapt itself to varying conditions there is something wrong with the organism. ‘If, for example, a patient with intermittent fever, even before his sickness, was always affected by damp weather, he is not cured, even though the last paroxysm occurred years ago, so long as he does not feel quite as well in damp as in dry weather.

“Such constitutional conditions which make themselves known by such accompanying circumstances, give us, the only right indications”.

Grauvogl’s arranged  the morbid constitutions  according to excess or deficiency of certain elements in the tissues and blood. For every organ and every tissue breathes, and if the lungs are the gate-way and the blood the carrier it to the tissues which are the ultimate recipients of the oxygen that is  breathed.

THE THREE CONSTITUTIONS OF GRAUVOGL :-   

1. The hydrogenoid constitution.
“If the patient states, that he feels worse in cold, or damp weather, and in the rain, then choose remedies which are similar to disease, such only as contain a greater percentage of a combination of O with C and H, consequently produce more heat and diminish the influence of the water. Hence the symptoms of a disease in this constitution of the body are aggravated by everything which in any way increases the atoms of water in the organism, for example by baths- mineral baths or simple water baths; eating of animals which have lived in the water, as fishes; by cold and cooling food and drinks- sour milk, hard eggs, cucumbers and mushrooms, but chiefly by living near water, and especially standing water. The complaints which are aggravated by electric disturbance find a special place under this constitution.

This is characterized by an excess of hydrogen and consequently of water in the blood and tissues. They are aggravated by moisture and humidity, prone to dropsy and anasarca, and suffers from tissue growth of benign type.  This constitutions corresponds closely to Hahnemann’s Sycosis, but it covers a much wider area and is not by any means confined to the acquired or inherited result of Gonorrhoeal infection. Intermittent-fevers and periodicity come within its sphere.

Vaccinosis, or the constitutional sufferings from cow-pox infection, should certainly be included under this heading. The antidotal relation to it of Thuja, which is one of Grauvogl’s principal remedies for Hydrogenoids is a clear indication that this is so.  Moreover, Burnett regarded Gout as belonging to the Sycotic diseases.

“Since in this constitution in which Hydrogen frequently seems to have usurped the place of Nitrogen the problem is not only to diminish the influence of the Hydrogen but, where it is possible, to preserve at the same time tissues rich in nitrogen, Nat. sul. recommends itself all the more as Prof. Seegen has given experimental proof that by its action the exchange of the nitrogenous tissue-elements is considerably curtailed, the animal body becomes richer in nitrogenous atoms, gelatine and albuminous bodies, and that during the use of Nat. sul. the elements of the body free from nitrogen, and especially the fatty tissues, are more freely exchanged.

“If we know, further, that the alkalis essentially promote the operation of oxygen by means of the respiratory process, it is clear that if we compare the various localisations of the pathological processes in these constitutions and their specific forms with the Homœopathic drug-provings, then even Nat. nitric., Nat. carb., Nat. acet., and Sal ammoniac (Ammonia muriatica) especially belong here.

“Moreover, in this series  mention  nutrition remedies – [Grauvogl divides remedies into functional and nutritional] – Calc. carb., Mag. carb., Mag. phos., and Silica.

“Then for other reasons adduced, Iodine, Bromine, Chlorine, Nitr. ac., Borax, Antimony, Alumen, Thuja, Carb. veg., Arnica, Aranea diadema, Pulsatilla, Nux vomica in alternation with Ipec., or with Arsen., Conium, Apis, Spigelia and animal food.” (§ 308).

Medicines which have similar features and are curative for such a constitution are Nat.sulph, Thuja, Ant.tart, ipecac etc.

“In cases where there is a combination of the hydrogenoid and carbo-nitrogenoid constitutions the Hydrogenoid must be cured first and then the Carbo-nitrogenoid. This corresponds with Hahnemann’s directions regarding Sycosis and Psora – Sycosis was to be dealt with first. [The same applies to Vaccinosis. – J. H. C.] Remedies – Ars, dulc, nat suiph, nitr acid phytolacca, rhustox, thuja, dig etc are the main drugs.

2. The oxygenoid constitution.
Oxygenoid constitution is characterized by the accumulation of excess of oxygen and consequently exaggerates breaking down of hydro-carbons, nitrogenoids and albuminous tissues and bones – destruction of tissues.

This constitution, whether inherited or acquired is of a grave character, says Grauvogl. The blood is a product of the organism and its elaboration is handed down from parents to children for generations. Immunity may also be inherited. A weakened power of resistance against the destructive energy of oxygen may be acquired by attacks of acute epidemic diseases and by syphilitic infection. The incubation periods required by these diseases between the original infection and the outbreak of symptoms is the period required for the increase of the poison up to the degree necessary to make it efficient. These poisons must therefore be living organisms, which induce the most intense processes of reduction, so changing the constitution of the body as to render it unable to resist an immediate influx of oxygen.

Oxidations are rapid though often incomplete. Consumption of tissue arrives more rapidly than in normal conditions of life. Hydrocarbons and albuminoids being rapidly burnt up leave the tissues defenseless against the burning power of oxygen. Oxygenoids are thin and weigh less than carbo-nitrogenoids of equal volume. This provokes the using up of protein materials and the cellular framework. Scrofula, rickets, infantile atrophy and various states called “anæmia” result from this.

The persons under this constitutions are thin and complain of weight loss inspite of having food, appetite and eating well. They have prominent glands, weak bones, and anaemia. Destructive, disorders involving the genitalia and diseases of central nervous system.  They like fats and have aversion of carbohydrates. They are ill on change of season –  worse when dryness is changing to humidity, before storms and before and during tempestuous winds. They are better when it begins to rain and snow. They are also worse in foggy weather. Oxygenoids are commonly called nervous individuals and are characterized by increased physical and mental activities. Body is prone to ulcerations and self— destruction. Oxygenoid constitution corresponds to Hahnemann’s Syphilis  and its analogue in medicine – Mercury.

Speaking generally on the remedies for the Oxygenoid constitution, Grauvogl says, that on account of too active an influence of Oxygen on the body this seeks its remedies mainly in the Carbon and Nitrogen series which prevent the oxidation of tissues.

Remedies for the Oxygenoid constitution are largely anti-syphilitic remedies as recognised in Homœopathy. And Grauvogl expressly states : “The law of similars must always decide the special indication.”

Oxygenoids feel better in an atmosphere saturated with nitrogen and carbon, in the midst of resinous, fatty or empyreumatic vapors.   They refuse easily oxidizable, animal foods, and seek for fats and hydrocarbons.

Electric attractions polarise atmospheric oxygen and transform it into ozone (oxygen polarised negatively) and antozone (oxygen polarised positively) ; it is after undergoing this modification that it becomes an effective and energetic oxidizer. Electric disturbances then act as hyperoxidants and this accounts for their aggravations. In brief, electric disturbances aggravate, and electric equilibrium relieves oxygenoids.

However, watery excess enables hydrogenoids to bear hyper-oxidation better, for it demands s till greater storage of heat. This is why rainy weather, charged with ozone, relieves hydrogenoids under certain circumstances whilst it aggravates oxygenoids.

 Other symptoms constantly found in oxygenoids are :

• Excessive elimination of urea and phosphates ;
• Plethora – great quantity of blood ;
• Much oxygen fixed on the hæmoglobin ;
• Excessive thinness.
• Animal heat, strong after meals and feeble in the intervals.
• Vigorous appetite which persists astonishingly during illnesses.
• Abstinence, on the contrary, is badly tolerated.
• Amel. by Rest and Food.
• Agg. by Cold, Sea-air, Low altitudes.

 Treatment.
Grauvogl puts in the first rank Kali iod. since it absorbs all the ozone. Rademacher gives the first place of Ferrum.  Among remedies having a direct action on oxygenoids are the Carbons and compounds rich in carbon, Graphites, Petrol., Benzin., Citric ac., Hydr. ac., Laurocerasus, and also, by inference, Antozonised water, which is probably equal to Iodosmised water (l’eau iodosmée) ; Nitr. ac. and a great number of bodies capable of checking the destructive process : Ars., Chi., Chi. sul., Chrom., Kali bichr.        The law of similars always decides special indications.

Remedies – CaIc phos, ferr phos, nat phos, phos, phos acid, iod, sit, calc, natr mur, hell, tuberc, syph, merc sol, are the main drugs. Medicines closer to this constitution are Kali.iod,ferrum and the carbon group.

3. Carbo-nitrogenoid constitution.
This characterized by an excess of carbon and nitrogen or insufficient oxygenation and the complaints are caused by retarded nutrition. This makes for increased liability to disease and perverted nutrition. They suffers from functional disorders of body and mind, marked by erratic working of the heart, lungs, kidneys, liver, spleen etc.

After a period of obesity, thinness follows. Albuminoids are decomposed like the hydrocarbons. There is pseudo-albuminuria, phosphaturia, acetonemia, rickets and osteo-malachia. General symptoms are great frequency of respirations with shallowness ; short breath, frequent pulse, blood charged with melanotic cellules. Constipation or diarrhœa, flatulence, urinary troubles, gouty pains in the head, gouty swellings, vertigo, ataxia, dullness of the head, somnolence, yawning, hypochondriasis, irritability, and extraordinary impatience.

Copious uric acid and oxalates in urine. – Epistaxis and hæmorrhoids. – Pruritus. – Precocious baldness with perspiration of the head. – Cerebral fatigue. – Unhealthy skin, fetid and acid perspiration, boils, eczema, urticaria.

Causes of aggravation.

1. Everything which hinders oxidation.
2. Everything which increases hydrocarbons and albuminoids.
3. Everything which diminishes the alkalinity of the humours.
Agg. Rest.
Agg. Non-ozonised mists.
Agg. Irritation of cerebro-spinal or sympathetic nervous system.
Agg. Sexual excesses.
Agg. Over-feeding.
Agg. Confined air.
Agg. Chagrin.
Agg. Respiratory insufficiency.
Agg. Loss of blood or blood-letting which diminishes the number of blood  globules and consequently oxidation.
Agg. Excess of Sodium salts, like sea salt, which hinders cellular osmosis and diminished the quantity of water in the tissues.

Treatment.
The Carbo-nitrogenoid lacks ozone and is rich in carbon and nitrogen. Consequently it finds its chief remedy in ozone and ozonated water.

Applicable also are all remedies which facilitate the splitting up of hydrocarbons and albuminoids and the discharging of oxygen chemically into the heart of the tissues. For example :  Cupr., Phos., Sulph., Camph., Hepar sulph., Aco., Merc., Aur., Argent., Plumb., Plat., Ol. tereb., Rhus., Dulc., Cham., Lyc., Bov., Bel., Nux 30 (alone – not alternated as for Hydrogenoids), Digit., Hyos., Apis., Lob. infl.

The factors which cause and aggravate complaints are overfeeding, exertion or anything which hinders the use of energy or which results in the wastage of energy.
This constitution corresponds to Hahnemann’s Psora. Medicines like Lyco, Phos.Sulph., comes very closer to this morbid constitution.

Remedies –   Ars, ars iod, calc phos, crbo veg, hep, iod, kali bich, lach, lyco, natr mur, sulph, zinc met, etc. are the main drugs.

Phlegmatic Bodily Constitution
Von Grauvogl called them the hydrogenoid type because of their tendency to hold water weight and to be < worse by damp cold atmospheres, watery foods, or living near bodies of water.

John.H.Clarke, put to his own patients the same questions that Grauvogl did, and this at once sorts them in to sections and narrows the choice of remedies. He also followed the Paracelsic maxim and find, if he can, the beginning.

Some important rubrics:

• Adipose tissue increased                 Alcoholic constitution
• Atony body                                      Constitutional types
• Complexion                                     Dwarfish
• Elderly                                             Emaciated
• Fibre, lax                                          Rigid
• Gouty constitution                           Growing pain
• Growth disorders                             Haemorhagic
• Haemorrhoidal                                 herpetic
• hydrogenoid                                     hypersensitive
• hysterical                                         Inheritance, bad, defective
• Infants                                             Large fat people
• Lean thin people                             Lymphatic constitution
• Melancholic                                    Men general
• Mild;      Nervous                            Obesity
• Occupations, actors                         Bookworms etc.
• Old age premature                           Paralytic constitution
• Phlegmatic;      Plethoric                 Plethora of body
• Psoric;    Puberty, ailments in         Reaction lack of
• Rachitic;       Rheumatic                  Sanguine
• Scorbutic;   scrofulous;                                 sedentary;    sensitive
• Sluggishness of body;  stoop shouldered;      syphilitic
• Tall lean slender; tremulous and weak bodies;  tuberculosis constitution
• Venous constitution;  weak;                             weakly sickly constitution
• Women;                     Young people
• But some rubrics are given with similar meaning and different group of drugs Eg; Plethoric
• Plethora of body
• Tremulous and weak bodies
• Weakly sickly constitution
• Weak

Reference:
Homoeopathic Medical Repertory- Dr. Robin Murphy
Constitutional Medicine by John. H. Clarke

Dr Beenadas
Govt. Homoeopathic Medical College. Calicut
Kerala