Utility of Constitution chapter in Medical Repertory by Murphy

Book review by Dr Sudheera A

This book was designed to be a modern, practical and easy to use reference guide to the vast Homoeopathic and herbal Materia Medica. To achieve these goals a completely new repertory has to be created. The alphabetic format was chosen as the most natural method to organize large amounts of informations, thus bringing the repertory in line with all the large Homoeopathic Materia Medicas which are also alphabetically arranged. Kent’s repertory and Knerr’s repertory were used as the foundation for building the new repertory. Seventy different chapters were created and arranged in alphabetic order from the original 67 chapters. Next all the rubrics and subrubrics within each chapter were sorted in to an alphabetical format. Thus simplifying Kent’s complicated system of arranging rubrics and subrubrics(STME etc.)

Grading :
Bold capitals -3 marks
Italics -2 marks.
Plain type -1 mark

If a remedy cured a symptom or condition more than 3 times and it has been confirmed by more than 3 Homoeopaths-Lowest grade
If a remedy has cured more than 6 times and likewise confirmed by 3 others- second grade
12 cases + confirmation by 3 or more practitioner – Top grade 

First edition of Homoeopathic Medical Repertory contained 67 chapters .In the second edition 3 new chapters(Diseases,constitution and headaches) were created from the original 67 chapters and new additions from Hering’s guiding symptom and Allen’s Symptom Index Of The Encyclopedia Of Pure Materia Medica, Jeremy Sherr’s Provings and Clinical Observations On The Homoeopathic Uses of Chocolate, Hydrogen. Scorpion are included in this edition. Works of 56 authors considered to prepare this book.

Constitution chapter contains all the genetic,dispositions and body types from the generals chapter. Extensive additions were gathered from Hering’s Guiding symptoms. The constitutions chapter contains constitutions, temperaments,body type, body size, hair in general, complexions, age,growth,gender,habits, defects,miasms, infants,inheritance, children, boys, girls, elderly people, men,occupations, women, young people.

Kent’s repertory is based on the assumption that all cases should be analysed from the general to the particulars. Kent saw his cases from one perspective only, therefore he was prejudiced observer even before he took a case. It is a common myth in modern Homoeopathy that mental symptoms are more important than physical symptoms. The particular symptoms tumors, disease organs or wounds can literary kill a person, which makes local symptoms the most important in many cases.

According to Murphy, natural hierarchy used for case analysis has to be based on (1)what is most life threatening to the patient
(2) causative factor in the case
(3) most severe or presenting symptom

Hahnemann states throughout the organon, that every homoeopath must clearly perceive what has to be cured in disease and to perceive the totality of symptoms of the disease. He also refers to acute disease, chronic disease, epidemic disease, iatrogenic disease, infectious disease, mental disease, miasmatic disease physical disease traumatic disease etc. Hence Homoeopathic repertories must include more clinical rubrics especially ones that reflect the new diseases condition of our modern chemical industrial society and those caused by allopathic drugs, radiation, chemotherapy, surgery,vaccination etc.

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.

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 way in which the new born is received on its arrival in this world and its consequent exposure to radically different environment .More specifically 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 and parcel of its behavioural 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. A person constantly reacts and thereby tries to strike a balance..The state of balance assures to a person to enjoy the environment without giving rise to 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. Since the sickness represents the reaction of a person to his unfavourable 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 afflicted person. Though the nosological diagnosis may be the same in several persons, the symptoms of the suffering are not the same in all the cases. No two persons are alike and each maintains his or her characteristics during different stages of life. Each person maintains his unique features both in health and sickness. This Universal law that the individuals always differ from one another has given to the concept of individualization in Homoeopathy.

The concept of individualization states that every individual is unique and thus needs unique treatment when he is sick. In Homoeopathy, it is possible to handle every case according to its individual presentation because of special nature of Materia Medica and its therapeutic application based on the law of similars

The medicines in Homoeopathic systems are proved in healthy human beings of different ages and of both sexes. This is done by administering a medicine in minimum doses to a group of healthy persons and recording changes in sensation and functions.This record forms the basis of Homoeopathic Materia Medica. It has been noticed by the physician who supervised and conducted drug proving that certain provers do not react easily to the administered medicine while others prove it easily and express symptoms in abundance both on the mental and physical plane. This fact has helped us to come to the conclusion that certain persons are prone to react faster to certain stimuli while others are not. The type of person, therefore is an important factor in drug proving. The factor has been discussed, explained and described at length by the masters of Materia Medica.Thus Homoeopathic Materia Medica is not only rich with information regarding changes in functions and sensations but also it tells the physical and mental make up of a person who readily proves a particular medicine. This gave rise to the concept of individual types or constitutions of study of Homoeopathic Materia medica. All individuals do not fall sick inspite of being exposed to a common adverse environment.This indicates that the origin and development of a disease depends on individual factor This factor known a susceptibility, governs all the reactions of an individual to the environment.

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.

The constitution of a medicine is known by studying various Materia Medica books from different angles. To understand the constitution of a person, a physician must know the person’s physical make up, namely, his build,desires, aversions, and disaggrement with foods, characteristics of his discharges and eliminations, information related, and his thermal reactions.It is also important to know mental attributes, namely, emotional and intellectual reactions and performances.The pattern of reactions to be environment also tells us the quality of susceptibility of the constitution. The study of the quality of susceptibility, in turn, points out the quality of the constitution. Various concominants 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.

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 behavioural pattern and the underlying miasms.

Constitutional medicine is a potential force and it should not be misused in the course of treatment. It should be noted that 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. Acute totality means the totality of characteristic symptoms expressed at the level of parts or system and the characteristics expressed at the level of generals. These general symptoms expressed prior to or during the acute disease are also called fixed generals since they comparatively stable in relation to fast changing particular symptoms. Therefore, acute totality is the sum total of characteristic particulars and fixed generals.

Constitutional medicine should be prescribed only after the acute crisis which is overcome with the help of acute medicine in order to facilitate the individual to have a quick and uneventful convalescence. It also effectively checks the tendency to relaps. All these are achieved not by direct action on the causative e organism if any, but by conservation and stimulation of natural defence mechanism of the person. Thus an artistic,, Homoeopathic prescriber successfully evolves an undistorted, accurate, conceptual image of the person during acute and chronic illnesses and uses his discretions to find their exact replica in Homoeopathic Materia Medica, ie., either acute medicine or constitutional medicine, in order to achieve the highest and the only mission that is to restore the sick to health.

No knowledge is perfect unless it includes an understanding of the origin- ie; the beginning and as all men’s disease originate in his constitution, it is necessary that his constitution should be known if we wish to know his disease- Paracelsus.

Many observers in all schools have noticed certain tendencies particular disease manifestation in certain types of individuals and among those who have succeeded in reducing the different forms to specific types there is a fairly unanimous selection of the three.

After years of patient observation Hahnemann saw that a superficial symptom resemblance between drug symptom and disease symptom was sometimes insufficient to show the specific correspondence. Eventually he reached to three miasms, named as Syphilis, Sycosis, Psora and the 3 typical remedies indicated in the 3 dyscrasias were (1)Mercury (2)Thuja (3) Sulphur.

Bazin again reduces all chronic disease in to 3 forms – Scrofula,Gout and Syphilis from which he thinks that all other pathologic forms originate.

Rademacher also found 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.

Grauvogl who did not deny the value of these 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 differently under these different conditions and he traced them down in the first palce 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‘.

“If a patient who has been for a long time annoyed by this circumstance that every draught of air effects him unpleasantly ,he is not cured even if, for instance many years have elapsed since he recovered from his last pneumonia. As long as the disposition to take cold is not removed from him, every relapse to which he is exposed under such circumstances he is proof of the still present conditions for the same or a similar disease, and hence a proof that he is not wholly cured.

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

No further elaboration is needed in order to show how the mind of Von Grauvogl worked to map out the generals and to fine the basic remedies for the constitutions out of which arose such a multiplicity of apparently different diseases. But really only different manifestations of one and the same disease

Grauvogl has classified morbid constitutions according to excess or deficiency of certain elements in the tissues and blood. Though the concept of morbid constitution is old, its rational basis is yet to be understood. The concept broadly classifies the type and nature of the physical make up which is prone to certain ailments in given situations.

The 3 constitutions of Grauvogl are;

The hydrogenoid constitution:
This is characterized by an excess of hydrogen and consequently of water in the blood and tissues. 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. The vaccinosis too comes under this constitution.

Under this constitution, the symptoms appear and get worse in cold or damp weather and in rain. The symptoms are aggravated by any kind of exposure to both water and water products. For example, bath, fishes, plants and fruits grown in water can increase the complaints.
All diseases under such constitutions are aggravated by cold weather and also by cold food and drinks, sour, milk, hard eggs, cucumbers and mushrooms.The diseases get specially aggravated by living in the proximity of ponds, rivers and sea, as well as stagnant water. The complaints which are aggravated by electric disturbance find a special place under this constitution. There is a marked periodicity of complaints. Medicines which have similar features and are curative for such a constitution are Nat.sulph,Thuja, Ant.tart,ipecac etc.

The oxygenoid constitution:
This is characterized by an excess of Oxygen or atleast by exagerrated
Influence of Oxygen on the organism. 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. They like fats and have aversion of carbohydrates. They are 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. Oxygenoid constitution corresponds to Hahnemann’s Syphilis. Medicines closer to this constitution are Kali.iod,ferrum and the carbon group.

The Carbon- Nitrogenoid Constitution:

This characterized by an excess of carbon and nitrogen or insufficient
Oxygenation and the complaints are caused by retarded nutrition.
This constitution is marked by obesity, which is followed by emaciation in due course. The respiration is faster and shallow. Other marked features are short breath, rapid pulse, constipation followed by diarrhoea, flatulence, urinary troubles, dullness, yawning, irritability and impatience. They are mostly tired individuals and do not like to take any active work. They have unhealthy smell, offensive and irritating perspiration, boils etc.

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 cioresponds to Hahnemann’s Psora. Medicines like Lyco, Phos.Sulph., comes very closer to this morbid constitution.

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. If he learned that a patient has never been the same since an attack of influenza either of recent or ancient date, he is fairly certain that a course of the Tuberculinum of Koch will be required. If again there is history of vaccination, successful or otherwise, in the case, Thuja, Vaccininum and variolinum are at once visible in the field. So that there many other constitutional indications to be found independently of those supplied by Grauvogl. These every practitioner will be able to find for himself.

“Constitution” chapter in the Homoeopathic Medical Repertory several types of constitutions other than what is mentioned by Grauvogl. Many of the rubrics are useful in our clinics. The rubric -Occupation with some subrubrics are not seen in other repertories.

Some important rubrics:
Adipose tissue increased
Alcoholic constitution
Atony body
Constitutional types
Fibre, lax
Gouty constitution
Growing pain
Growth disorders

Inheritance, bad, defective
Large fat people
Lean thin people
Lymphatic constitution
Men general
Occupations, actors
Bookworms etc.
Old age premature
Paralytic constitution

Plethora of body
Puberty, ailments in
Reaction lack of
Sluggishness of body
Stoop shouldered

Tall lean slender
Tremulous and weak bodies
Tuberculosis constitution
Venous constitution
Weakly sickly constitution
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

1) Homoeopathic Medical Repertory- Dr. Robin Murphy
2) Constitutional Medicine by John. H. Clarke

Dr Sudheera A.P  BHMS,MD(Hom)
Calicut. Kerala

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