An approach to undertake chronic disease

Today morning I am glad to share again an impressive article on ” Chronic Diseases ” by Dr. YINGLING, M.D., which is not only relevant today but also a source of inspiration in the days to come to explore legitimate application of the law of similia in successful management of Chronic cases with a panel discussion of the Stalwarts of Twentieth Century.

Courtesy ;Ramakrishna Mission Charitable Dispensary, Bankura, West Bengal, India.

——– Dr.Nirmal Kumar Maity

CHRONIC DISEASES W. A. YINGLING, M. D.Chronic diseases are variable as are all other sicknesses. All kinds of disease are curable, but all cases are not amenable to any known remedy, nor are they get-at-able because of paucity of symptoms, the absence of the family history, the masking of symptoms and conditions and various other causes. It requires a philosophical mind to practice homeopathy successfully, especially in chronic diseases. Some physicians are quite successful with acute sickness, but fail dismally with chronics because they do not grasp the philosophy of this system of cure. They depend entirely on the symptoms and do not look into the causes, the hereditary influences, previous poorly treated sicknesses, suppress sion of symptoms and diseases, and the like. The condition of many years ago may be the key to the whole present state. Undeveloped acute troubles may be the cause of the present condition. A simple remedy that should have been given in an acute sickness ten, twenty or more years ago may make a remarkable cure and prolong life. Nearly forty years ago a man was said to be near the grave and that nothing could possibly relieve him. After a long line of questioning he said every morning he had a “miser able measly taste”. It came out that ten or twelve years before he tried to have the measles, but failed. The attending doctor ap plied five different large blisters, each covering the entire chest, without any benefit. His symptoms pointed to Rhus tox. After about ten days he had the measles in good shape, all over thick, and on palms of hand and soles of feet. He made a rapid cure and is alive and well today, and has been well all these years. Perhaps it may be of interest to state that while he had several children who never had the measles that not one of them took the measles from him.Another case: A little girl had scarlet redness of the neck and upper chest which came and went. I at once asked if the child ever had the scarlet fever. The father said she tried to have it, but the doctors could not bring it out. As the symptoms of the original sickness pointed to Belladonna she received it and was speedily cured, but she did not have the scarlet fever again.*Read at the I. H. A., Bureau of Homeopathic Philosophy, June 1930.


This same idea applies to the suppression of eruptions, dis charges, and all other conditions. Again, as with the suppression of a sickness, discharges, etc.,the cause may be the key to the course of treatment, so the cause may have to be studied. With a bad cold, headache, etc., a woman knew of no reason for the cold unless it was washing the head. Belladonna soon cured. Another patient ached all over, felt miserable and sick. He was caught in a rain storm when over heated hurrying to get home. Rhus tox. soon put him in a happy frame of mind. These might easily have resulted in serious sickness or have lapsed into chronic conditions. Every one knows, or should know, the happy effects of Nux vom. when a patient has been extensively dosed with drastic drugs. Often nothing further is re quired. Without the Nux vom, there would have been a progres sive sickness.Some physicians lay great stress on the temperaments, complexion or general build of a patient. I do not, for these are only one feature of the case, and unless very marked, peculiar and prominent, do not help one in finding the curative remedy; and even then they usually require corroborating symptoms or conditions to be of great help.Time is often an important factor in a case. Why one case has the same suffering condition at one hour, and another at some other hour no one can tell, but it is an observable fact which is often deciding. Some chronics suffer at night, others only dur ing the day. It may be morning, forenoon, noon, afternoon, or only in the evening, or at some particular hour. It may be during any one of the seasons, the hot season or the cold season, or from dampness, before or during storms, etc. No one can tell why some have asthma only about midnight, others at 3 a. m. and still others at a different hour. These facts must all be carefully noted and considered, as the deciding factor may be found thereby. Some chronics are much better while eating and for 2 or 3 hours after, while others are worse as soon as they swallow food or for 3 or 4 hours after. Other cases are worse only after one of the meals, and can eat at other meals without suffering. One person will have great trepidation before some particular ordeal, such as going into company or making a speech, and may even become quite sick or have diarrhoea. Another person will be quite elated and feel that he is a great mogul and worthy to be honored. Per sons are different and these differences are important in pre scribing.One person will like company and seek it, while another will seek solitude and wants to get away from everybody. Why this is so I do not know and I do not think anybody else knows, though some may attempt to give a full explanation. Human rea son cannot penetrate these intricacies, and personal opinion does not amount to much. These are facts and must be accepted as facts by the wise physician. Facts are facts and count for about everything in prescribing on the homeopathic line. Homeopathy is based exclusively on FACTS. Facts reign supreme.The modalities are very important and in some cases are most important. Why motion aggravates one case and ameliorates another of the same disease cannot be explained satisfactory ly, but it is a fact which the wise physician recognizes and stresses. While Bryonia is the remedy in the highest degree in aggravation from motion, it must not be overlooked that Rhus tox, is just as high, even more important when the aggravation is at the beginning of motion. Too much motion will also aggra vate the Rhus patient. Sepia “walks rapidly without feeling any dyspnoea, but if he is stopped gets so short of breath that he can not speak and is seized with a feeling of deathly anxiety which disappears when he resumes his walk”. “Dancing and running cause no shortness of breath.” Pulsatilla likes slow motion and such motion relieves discomfort of the whole body. In other conditions motion aggravates. Iodium must keep in motion day and night.

This seems to compete with Rhus, but does not, for Rhus is worse from too much motion. The conditions and symptoms differentiate and must be carefully pondered.Sitting or lying will ameliorate certain states, but aggravate others in the same remedy. Aggravation from jarring is often very important, as in Belladonna and other remedies. Light pressure will aggravate while hard pressure ameliorates in some remedies.This will be enough to show the essential need of discrimi nation when selecting a remedy and studying the modalities. This variation is seen in patients as well as remedies. The mind must 658THE HOMEOPATHIC RECORDERbe free of bias and preconceived notions.

The successful pre scriber must have an open mind. The consultation of the repertory and materia medica becomes essential, especially with the young physician. There are many remedies with aggravation from motion (and other mo dalities) and these must be compared and carefully selected. The modality is not a sufficient basis for the selection of a remedy and in some cases may have but little value. But when the modality is prominent, peculiar and uncommon it advances to first place, and possibly may be the deciding feature of the selection. All this is probably confusing to the novice or the inexperienced prescriber, but by careful use of the repertory and intelligent study the selection of the proper remedy becomes easy and rapid in a not too long time. Experience qualifies for rapid work, provided there is honest effort and patience during the first year or two of active practice. It will do the patient no harm, except of course in emergency cases like profuse hemorrhage, to give Placebo, look wise and go to hard study and comparison of pos sible remedies. Every wrong prescription may do harm, so it is better to give nothing than to give the wrong remedy. Caution shows more ability than hasty prescribing.There are many other modalities of great interest and use fulness: The location and direction of the symptoms may loom up into great value; the right or left side, upper left and lower right, or vice versa, the shifting from side to side as in Lac can., etc. The location of the appendix has been in the limelight for some years and is used as a money maker. In most of these cases, called appendicitis, the trouble is in the ilio-caecal region, typhli tis, the appendix being very slightly or not at all involved. In these cases I find Rhus tox. to be the curative remedy eight times out of ten. Where an abscess actually forms surgery is necessary, as it is too dangerous to wait.Thus many things are to be kept in mind and carefully con sidered in the treatment of chronic diseases. Hahnemann gives the three miasms, psoric, sycotic and syphilitic, as the basis of the majority of chronic troubles. These may be mixed which makes the cure all the harder. In many, possibly the most of these cases, it is impossible to get the family history with sufficient reliability to be of any value in remedy selection. Various remedies are to be considered, compared and the selection based on the totality of symptoms. In many cases the proper nosode, Psori num, Medorrhinum or Luessinum, acts wonderfully in curing or clearing up these chronics or in opening the way to the similli mm. The family history and history of skin diseases of child hood or later, are to be secured as far as possible and intelligently considered.The successful treatment of chronic complaints is many sided and requires diligence, work and due preparation. It is necessary to cover the symptoms of the individual case and not the remedy.

That is, the symptoms of the patient should be, and must be where known, covered by the remedy. All the symptoms of the remedy need not be in the patient and seldom are. The remedy is to cover the symptoms of the patient and not the pa tient’s symptoms cover the entire remedy.And it is not necessary to cover all the symptoms of the case. The incomplete, undefined and vague symptoms only con fuse. The 153rd section of Hahnemann’s Organon (Dudgeon’s translation) is the guide. Hahnemann says: “*** the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and almost ex clusively to be kept in view; for it is more particularly these that very similar ones in the list of symptoms of the selected remedy must correspond to. *** The more general and unde fined symptoms** demand but little attention when of that vague and undefined character”.Wesselhoeft uses the words prominent, uncommon and pe culiar: these may be more suggestive to the reader. Read a few more paragraphs before and after the 153rd section. It will re fresh the mind and do you good.To be complete every symptom must have its location, sen sation and modality. Wells believes the “totality” refers to this completion of the symptom. If the patient says he has the head ache and nothing more, it would be mere guess work, one guess out of fifty or more, to give a remedy. But if he adds, “it is a pressing pain on the vertex”, you are nearer the prescribing point, but it would still be a guess. If he adds further that “it is much better by hard pressure”, you can easily decide, especially if there are one or more concomitants to verify the choice. When the remedy is selected for the chronic ailment howshall it be administered? In what potency? An answer to these questions alone would more than make an article. Suffice it to say any potency applied homeopathically will act curatively. Each prescriber must decide from his own experience and ob servation. I prefer the higher potencies, from the 200th up, be cause they act more quickly, more efficiently, more deeply.

The only way to decide is to put away prejudice and bias and care. fully test the various potencies. This must be done with care and honesty, not haphazardly. Make sure you have the right remedy and administer it alone. Watch results. Don’t interfere by ad. juvants, local treatment, perfumes, etc. Don’t forget that Cam phor is an antidote to nearly all our remedies.The repetition of the remedy is important. Some excellent prescribers emphasize the single dose. This is the ideal prescription when the simillimum can be found, and should be adhered to, but it cannot apply in all cases, especially where the similar remedy is used. No one can always find the simillimum, the one remedy covering the totality and fitting the case like a glove. Some prescribers think they are giving a single dose by dissolv ing a powder in eight or ten spoons of water and administering a spoonful every night and morning. It is impossible to give a divided or broken dose of the homoeopathic remedy, for every spoonful is as strong as the original powder, or stronger, and each spoonful is a homoeopathic dose. The rule is the single remedy, the similar remedy, and the minimum dose. One dose will often cure a bad case, sometimes better results may be had by admin istering two to four doses at first. This must be left to the indi vidual prescriber as judge.

The further you get from the true simillimum the more frequent must the remedy be repeated.Dr. Burridge, of London, even gave Lachesis in the mil lionth potency night and morning for a week, and cured his pa tient. He said he thus repeated because the remedy was only a similar. Some of the best and truest prescribers give three or four doses at the beginning and wait. I believe this is the pre vailing practice unless the one simillimum can be found, and then only one dose is administered. Who can find the true simil limum in every case? It can not always be done, even by the best prescriber and most loyal homeopath. The materia medica is not complete enough for this. Symptoms are too much masked and too obscure. We can only do the best we can and be honest about. it. The rule is to repeat as little as possible for the best results. Placebo is essential and shows proficiency.I am inclined to think, notice this is not final, that one dose followed in six or eight weeks with another dose of the same remedy, especially if in a higher potency, will do more harm if amelioration progresses, than the repetition every three to twelve hours for two or three days at the beginning of treatment. After the remedy has had time to dig in and take strong hold of the vital force to interrupt it will cause that vital force to rebel and refuse to act or respond. The repetition at the beginning is very like one impression of remedy on the vital force. Of course this refers to chronic cases. I have seen the indicated remedy in acute cases act like a streak of lightning. You touch the button and, presto, the light is there; you turn the dial of your radio and you hop from Cincinnati to Denver instantly. It is wonderful, never theless absolutely true, and all in accordance with law.The change of the remedy is as important as the repetition of the dose, and in some cases more important. Dr. Kent once said if he had given two or three remedies and failed he would give no more, but depend on the vital force to cure. The best. men may have fads. When we consider the drastic dosing of the alloeopathic prescriber, the frequent change of remedies by the poor homeopathic prescriber, and the frequent change of doctors, often all good prescribers, we can easily see the case is not so readily ruined by the repetition and change of remedies. The rule is not to change as long as there is progressive improvement, and this rule should be followed. I had one case where there was an in jury above the right breast with stinging pains shooting out from the lump, a drawing feeling, and umbilicated on examination. With the average doctor surgery only would be thought of. I gave Sulphur, a single dose of the five millionth potency, and re peated only when the drawing and stinging began to return. This was followed by Calcarea carb. 5CM with steady change for the better. The shooting pain and drawing ceased, the size reduced and the umbilication lessened. Repetition and change of remedy only when amelioration ceased. To wind up the case Conium c was given. I diagnosed not cancer but enchondroma, a semi-ma lignant tumor, caused by the injury. The patient is nearly well and forgets all about the lump, a fragmentary thickening of the skin.Cases are not as easily spoiled as some suppose. If they were we might as well stop treating chronics. This is not a license to be careless in these chronics, but to give encouragement to the young practitioner. Follow the rules as announced by Hahnemann and the best and most experienced prescribers. Skill will come in due time by patient digging, grubbing and honest toil. There is no ex cellency, no proficiency, without labor. Labor ipse voluptas est to the true and honest homeopath.Of course there is such a thing as spoiling the case by the improper repetition of the selected remedy or the change of remedy when there is progressive improvement. We must be care ful and not too hasty in our decision. Sac. lac. is a real remedy. and is safe when in doubt.Space prevents a discussion of diagnosis. Usually it is not essential and may really be a detriment and prevent a proper treatment of the case. If the diagnosis is cancer one is apt to seek a remedy to cure cancer instead of the patient. It requires an experienced and proficient prescriber to see the patient and not the name of the diagnosed condition. When the remedy is diagnosed the disease can then be. This does not apply so much to acute disease as to chronic. Our alloeopathic friends put their stress on diagnosis and are mistaken in a very large per cent of their cases. It is proverbial how doctors disagree. I had one case where six doctors diagnosed cancer of the liver, the seventh said he did not know what the trouble was, but whatever it was it was just as bad as cancer. All agreed that there was no cure for the man. I did not try to decide the diagnosis, but decided Lycopodium was the remedy, and the man rapidly improved and lived for many years. This is often the case. The more diagnostic the symptom the less value, usually, in determining the remedy. Finally, a complete record must be kept of the whole case. No one can remember the symptoms, the change of remedies, or the potency used, etc. The first record should be very complete with the undefined as well as with the defined symptoms, for those undefined symptoms may develop and become valuable. Succeeding records should note all changes, variations, new symptoms, return of old symptoms, as well as the general condi tion of the patient. The case well taken and recorded is half of the battle.EMPORIA, KANSAS.DISCUSSION.DR. L. WRIGHT: To open that discussion may I ask for the opinion of those present as to whether it is dangerous to repeat the single chronic dose in six to eight weeks, as I understand Dr. Yingling to suggest. CHAIRMAN J. W. WAFFENSMITH: I can’t answer that question. You have heard the paper. Does anyone wish to venture an answer? DR. J. W. KRICHBAUM: We all see things differently. Unfortunately, I havebecome a little confused, and if they would kindly suppress measles and then have all the ailments follow it, it would be easier. I have had one or two cases. I had an old soldier who had measles during the war, and he was sick ever after. He really went through a typical case of measles and recovered.I do not agree with the paper that the temperament and general appearance are not of great importance. To me (and of course this is entirely a personal opinion) those things are of the utmost importance. Half the time I think I get more by looking at my patient than I do out of what he tells me.I usually try to make them laugh or cry, as the occasion may demand, so that they will become relaxed and become natural.We are not all built on the same pattern and we do not approach these things from the same angle. So, to me, the thing that is of great importance is what I can see by looking at the patient and watching him, watching his reaction while I am talking to him. DR. G. ROYAL: Mr. President, I want to say just a few words more, per haps, because of my respect for the writer than for any other reason. We were out in the wild and wooly west, and we have been for years, and I always.admired what I called his “yardstick” to help measure symptoms.And now I want to emphasize what has just been said about appearance. I spoke of this last year. I mention it in my last book. I have my office ar ranged purposely so that as the patient comes in I get the walk, the look, and everything about that patient. I showed you the difference in appearances last year, especially in the case of Platinum when the patient walks in with a haughty look; then the other one who comes in with that look which says, “Are we all alone”? It is quite unnecessary to take another symptom.There is another thing that I want to emphasize. I don’t want anything between me and my patient. As he gives his symptoms and responds to the questions that I ask him I want to see the actions he goes through. So I con sider of first importance the expression as he comes into There is another point I would like to talk about but I am going to take it up in my paper later on, and that is what has been said about diagnosn DR. C. L. OLDS: In regard to the appearance of the patient, I think we should not always consider this as a symptom. That is to say, if you have-a patient come into the office who has red hair, and blue eyes, those are not symptoms. Those are natural conditions. The natural appearance of the pa tient may suggest some remedy to use, but let us not consider appearances generally as symptoms. When there are any unnatural appearances, however, of course they should be considered as symptoms. As regards the repetition of the remedy I think that is a very large question. As was suggested in the paper many of the very best prescribers start in and give several doses, and then stop. Others give one dose and let it go at that. Others repeat constantly. I have always been afraid in chronic cases to do anything but give the one dose. But I can see that in cases where the remedy is only partially similar you might get results by a repetition where you will not with the single dose.In regard to suppressed diseases, suppressed eruptions, some years ago 1 had a young lady who came to me occasionally, for terrific headaches 1 couldn’t get much of a picture of her condition. There are some patients Ir whom it is very difficult to get anything except the thing that is bothering them. Finally I did get a picture of Sulphur. I gave her Sulphur probably in the 10% dose and in about a week’s time she got a very nice eruption resembling itch. I then found out that seven years before she had had sulphur oint ment. She had had itch and it had been suppressed by sulphur ointment. This dose of medicine was all that was necessary. Her terrible headaches left and she had no more.I think this is an exceedingly fine paper, something particularly for the younger members of the profession, something for them to read and study, and it won’t do the older members any harm to read it and study it also. DR. G. ROYAL: Would you give us the distinction between the words nat ural and normal? You speak about natural conditions, naturally red hair, naturally hot temper.DR. C. L. OLDS: It is perhaps a little difficult. An abnormal thing is some thing that has been taken on through accident or disease. DR. G. ROYAL: Different from the natural patients? DR. C. L. OLDS: Yes, different from the natural patient.DR. C. M. BOGER: Mr. Chairman, if this paper is an indication of what wel are going to hear at this meeting, we will all have to sit up and take notice because it is a paper of the highest value possible. There were a few points which struck me forcibly. One of them is that it brings home to us the fact that we haven’t been taught enough philosophy at school. And when the universities did away with the chair of philosophy in medicine, which they did a long time ago, long before you and I were born, they made a tremendous mistake. You can’t get along without philosophy in homeopathy and nearly all of these questions that are asked and suggested in this paper can be answered from the standpoint of philosophy. I have gradually come to the conclusion that I don’t know very much about materia medica. Perhaps that is the beginning of wisdom. But it involves so much digeing in and so much hard work that maybe I will conclude after awhile, as T. F. Allen did, that a man is not justified in taking more than four or five or six new cases a day; he cannot do the work. You will wear yourself out and your textbooks, too. if you do more than that.Dr. Wright raised the question about giving a dose of medicine every six weeks, and whether that helped or hindered the case. No such arbitrary rule can be made. It depends entirely upon the reaction. Some cases start to react and keep on reacting and reacting and reacting for months and years, and other cases can’t be started until they have had a number of doses. I know of one case of Magnesium carb, that has gotten a dose of Mag mium carb. every month or two, sometimes every three or four months, for several years and still occasionally needs a dose. The reaction is coming more and more. You must be careful about it and see what is going on.DR. J. HUTCHINSON: I think we greatly neglect the different periods of life. In our philosophy we talk very little about age, and it seems to me that it is very important, in taking a case and working out the prescription, that we take into consideration the habits of life, the number of years the person has lived, the temperament, but particularly the age, in respect, not only to years, but development. I should like to hear more from our scholars in homero pathic philosophy on that particular item, which I think is neglected.There is another point, a very simple one. We speak about Bryonia and Rhus tox as being very easily differentiated. I think that is a mistake. It is very lucky that they are complementary remedies because it is very difficult many times to decide just which to give. I will try to illustrate. For instance, we will say an arthritis case is quiet, and doesn’t move about much, and on starting to move has a great deal of pain, but on moving about gets relief. Rhus tox, as described might seem to be the remedy to cover the case but it doesn’t at all. Dr. Boericke last year gave a very wise rule, I think. He said, Rhus tox. is arrested Bryonia”, which to me contains the whole wisdom of the thing. If we have a case that seems ameliorated on motion but it doesn’t want to move-it is perfectly content to lie in bed that is a Bryonia case. DR. A. PULFORD: I should like to testify to the fact that this is a most excellent paper, and while I was listening to these discussions I was thinking if the universe was run with as little judgment, as haphazardly, and as erratical ly as we prescribe, we would be in chaos all the time.There is a misapprehension on the part of many regarding the exhibition of the single dose. Some suppose it to mean that each individual patient is to receive one, and only one dose of the given remedy, and no more. This is erroneous. The single dose does not apply to the case alone, but directly to the pre scription. Each prescription is to be of a single dose, unless there are very strong reasons for a repetition arising out of the nature of the acute case, or the similarity of the remedy, which will be but seldom with careful prescribers, and then only until the drug shows an action. If a well-selected drug does not show an action within a reasonable time, reason tells us to repeat it. W. A. YINGLING, M. D., 1895.

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