By Dr. André Saine, D.C., N.D., F.C.A.H.
Presented at the Second Annual Session of the Homeopathic Academy of Naturopathic Physicians in Seattle, Washington, April 16-17, 1988.
In homeopathy today, Hering's law is widely recognized as the second law of cure, the first law of cure being similia similibus curantur, or like cures like. Hering's law pertains to the direction in which the symptoms of the patient will disappear during a cure under homeopathic treatment.
In his second lecture on homeopathic philosophy given in 1900 to the Post-Graduate School of Homœopathics, Kent said:
Here Kent does not differentiate between acute and chronic disease in the application of the law. It is reasonable to assume, because of the lack of precision, that he meant all diseases, acute and chronic of venereal and non-venereal origin, would disappear in the direction described above.
When first studying homeopathy, I listened to the teachers and read the “classic” modern works, and assumed, like my fellow colleagues, that Hering's law had been an irrefutable fact recognized by Hering and the many succeeding generations of homeopaths, and that all patients, (All italics used throughout this paper indicate my own emphasis of pertinent points.) acute and chronic, without an exception, would, at all times, be cured in the afore-mentioned direction under careful homeopathic treatment.
Later as a practitioner, I carefully applied myself to put the general homeopathic training I had received to the test. Since then, I have been able to substantiate most but not all of the rules, principles and laws contained in the homeopathic doctrine promulgated by several generations of homeopaths.
So far, however, I have been unable to substantiate Hering's law. Indeed, very rarely do I see, for instance, in a patient with chronic polyarthritis, the symptoms disappearing from the head first and then to the hands and feet. More often, the pain and other joint symptoms disappear in the reverse order of their appearance, even if it is from below upwards. In other words, if the arthritis manifested itself, as it happens at times, first in the knees and then in the ankles, the ankles would get better before the knees.
Or in a patient affected by a complex of essentially functional complaints such as fatigue, anxiety, irritability, difficult digestion, joint pain and acne, rarely would I see the disappearance of the emotional disturbance first, then the poor digestion followed by the joint pain and lastly the acne. With thesimillimum most symptoms begin to improve simultaneously and disappear in the reverse order of their appearance, and not necessarily from above downwards and from inside outwards. In fact it is not uncommon that in such cases the acne, the last to have appeared, would disappear readily and the emotional state (the oldest symptom) would be the last to completely disappear.
While treating a patient with an acute febrile disease that had progressed in the first stage from chills to fever, then to perspiration and lastly to weakness, I would observe a rapid and gentle recovery but without the patient re-experiencing the perspiration, then the fever and lastly the chills. While recovering from acute diseases under homeopathic treatment, the patient does not re-experience the original symptoms one by one in the reverse order of their appearance. Many more troublesome exceptions similar to the above could be cited.
According to Webster's dictionary, a law is defined as a sequence of events that occurs with unvarying uniformity, whereas a rule permits exceptions, and a dogma rests on opinion. Was this lack of confirmation of the said law due to “suppressive” homeopathic treatment, as suggested by a number of theoretical and perhaps dogmatic homeopaths? If so, why have these so called “purists” not stood up and proven that all their cured cases followed the said law? To my knowledge, this proof has not been forthcoming.
I questioned teachers and colleagues, some with many years of experience. Few could answer my questions, and none has been able to substantiate from their own experience without the shadow of a doubt that Hering's law was a true law of nature. It seems that most were in the same situation as me, even the supposed authorities would discuss the matter, but in private with the author. It seems that we all had classic cases of cure from above downwards, from within outwards, from more to less important organs and in the reverse order of appearance of symptoms. But these absolutely “perfect” cases were only occasional. The majority of cured cases did not fulfill all the four cited criteria.
On one hand, neither Kent, in his Lectures on Homœopathic Philosophy of 1900, nor Stuart Close, in The Genius of Homœopathy of 1924, nor Herbert Roberts, in The Principles and Art of Cure by Homœopathy of 1936, while discussing the above law, refer to it as Hering's law. (1-3) None of these three authors makes any reference to Hering in their lectures on the law of direction of cure. On the other hand, Garth Boericke, in A Compendium of the Principles of Homœopathy of 1929, refers to it as Hering's rule, but not as a law. 2) Confusing, isn't it? Did Hering ever formulate a law on the direction of cure? If he did, why was his name not clearly associated with the law, and was it as a law or a rule? Why was the literature so ambiguous?
At this point, I realized that the sources had to be explored further. The answers would all have to be within the literature of the nineteenth century. After a thorough examination of this literature, I have so far been unable to find any of Hering's famous contemporaries and close colleagues discussing or making any reference to a law of direction of cure. Writings of Boenninghausen, Jahr, Joslin, P.P. Wells, Lippe, H.N.Guernsey, Dunham, E.A. Farrington, H.C. Allen, Nash, etc., were all silent.
When Hering died in 1880, colleagues all over the world assembled to pay tribute to the great homeopath. His many accomplishments were recalled. Strangely, none made any mention of a law of direction of cure promulgated by Hering. 3) Arthur Eastman, a student who was close to Hering during the last three years of the venerable homeopath, published in 1917 Life and Reminiscences of Dr. Constantine Hering, also without mentioning a law pertaining to direction of cure. 4) Calvin Knerr, Hering's son-in-law, published in 1940, 60 years after Hering's death, the Life of Hering, a compilation of biographical notes. 5) Again no mention is made of the famous law. Not only confusing, but also puzzling.
Obviously, the sources had to be further explored. Here are the fruits of this exploration.
1. Hahnemann - 1811
With the first publication of his Materia Medica Pura in 1811, Hahnemann inaugurated a new arrangement of the symptoms: from above downwards, from inside outwards, but also from the parts to the generals.
2. Hahnemann - 1828
In 1828, Hahnemann published his first observations and theories on chronic diseases. 6) I summarize here the points most pertinent to the present discussion:
3. Hahnemann - 1833-43
In paragraphs 161 and 248 of the fifth and sixth edition of the Organon of Medicine of 1833 and 1843 respectively, Hahnemann says that in the treatment of old and very old chronic disease, aggravation of the original disease does not appear if the remedy is accurately chosen and given in the appropriate small doses, which are only gradually increased. “When this is done, these exacerbations of the original symptoms of the chronic disease can appear only at the end of the treatment, when the cure is complete or nearly complete.” The original symptoms of a chronic disease should be the last to aggravate or become more prominent before disappearing. 8)
In paragraph 253 of the same work, the author states that in all diseases, especially in quickly arising (acute) ones, of all the signs that indicate a small beginning of improvement (or aggravation) that is not visible to everybody, the psychic condition of the patient and his general demeanor are the most certain and revealing.
In paragraph 225, Hahnemann states that some psychic diseases are not the extension of physical disease but, “instead, with only slight physical illness, they arise and proceed from the psyche, from persistent grief, resentment, anger, humiliation and repeated exposure to fear and fright. In time such psychic diseases often greatly harm the physical health.” In other words, Hahnemann had recognized the existence of psychosomatic diseases, those diseases which progress from within outwards and from above downwards.
This is the background that now leads us to Hering, who, among all Hahnemann's students, was most similar to him. Like Hahnemann, Hering was a true scientist who totally adopted the inductive method in his scientific pursuits.
4. Hering - 1845
In 1845, Hering published in the preface of the first American edition of Hahnemann's Chronic Diseases an extract of an essay which was never published elsewhere, called “Guide to the Progressive Development of Homœopathy”.
In this essay, Hering writes:
Here Hering assumes that all chronic diseases (it is likely that he is referring here to diseases of psoric origin, i.e., non-venereal) progress from less to more important organs and disappear in the reverse order. This is compatible with Hahnemann's theory that all chronic diseases of non-venereal origin manifest themselves first on the skin then internally. (Concerning the theories of Hahnemann, Hering wrote in 1836 in the first American edition of the Organon of Medicine: Whether the theories of Hahnemann are destined to endure a longer or a shorter space, whether they be the best or not, time only can determine; be it as it may however, it is a matter of minor importance. For myself, I am generally considered as a disciple and adherent of Hahnemann, and I do indeed declare, that I am one among the most enthusiastic in doing homage to his greatness; but nevertheless I declare also, that since my first acquaintance with homeopathy, (in the year 1821), down to the present day, I hve never yet accepted a single theory in the Organon as it is promulgated. I feel no aversion to acknowledge this even to the venerable sage himself. It is the genuine Hahnemannean spirit totally to disregard all theories, even those of one's own fabrication, when they are in opposition to the results of pure experience. All thoeries and hypotheses have no positive weight whatever, only so far as they lead to new experiments, and afford a better survey of the results of those already made. (page 17) 10)
5. Hering - 1865
It seems that Hering did not further elaborate on this subject, at least in the American literature, until 20 years later. In 1865, he published an article in the first volume of The Hahnemannian Monthly called “Hahnemann's three rules concerning the rank of symptoms”. Hering states in this article that:
It is very clear here that Hering makes no mention of a law but rather of a rule, that the symptoms ought to disappear in the reverse order of their appearance during the homeopathic treatment of patients with chronic disease of psoric origin, the ones that progress from without inwardly, from less important to more important organs and generally from below upwards.
6. Hering - 1875
In 1875, Hering published the first volume of Analytical Therapeutics of the Mind, in which he stated that ”only such patients remain well and are really cured, who have been rid of their symptoms in the reverse order of their development”. (page 24) 12) Here Hering makes no mention of the three other propositions regarding the direction of cure: from above downwards, from within outwards and from the more important to the less important organs. Why? Were they not considered as important to evaluate the direction of cure as stated in previous years?
In the same work, Hering also explains that he adopted Hahnemann's arrangement of the materia medica: “First inner symptoms, then outer ones. This order we have now uniformly preserved throughout the whole work.” (page 21) In explaining why he adopted this arrangement, he says: “The arrangement as well as the style of printing, has the one object especially in view, viz.: to make it as easy as possible for the eye, and through the eye, for the mind to find what is looked for.” He makes no mention of this arrangement corresponding to a direction of cure, as it has been suggested by some well wishing homeopaths.
Where does the term “Hering's law” come from as it seems never to have been mentioned in the literature during Hering's time? The earliest mention I have been able to find in the homeopathic literature dates from 1911, in an article published by Kent in the first volume of the Transactions of the Society of Homœopathicians called “Correspondence of Organs, and the Direction of Cure”. Kent writes:
It is reasonable to assume that Kent was the one that officialized the term “Hering's law” and so inadvertently popularized the concept of the existence of a clear and precise law of direction of cure. (At least up till 1899, at Kent's Post-Graduate School of Homeopathics, the directions of cure were still called “the Three Directions of cure [given by Hahnemann].) 14) By using the name of Hering it is reasonable to say that Kent thus created false and misleading historical assumptions. Since H.C. Allen had died two years previously (1909), the profession, at least in North America, had no other leaders capable to refute Kent and defend the classic Hahnemannian tradition. (It is to be remembered that in 1908 H.C. Allen had severely criticized the materia medica of the new synthetic remedies that Kent had been publishing since 1904 in The Critique. Kent was at the time the associate editor of this journal in which, almost monthly, he had been publishing the materia medica of a new synthetic remedy, each of very questionable value. During an open session at the annual meeting of the International Hahnemannian Association, Allen and G.P. Waring accused Kent of publishing materia medica that was “without proving or any clinical experience”, which would have been completely contrary to the strict inductive method intrinsic to homeopathy. 15)
Kent then stopped permanently the publication of these synthetic remedies, even the ones that he had previously promised for upcoming publication in The Critique. 16) Although Kent continued to publish regularly in The Critique until 1911 he restricted his articles to reporting clinical cases rather than materia medica. Never was a synthetic remedy ever published by Kent after the initial criticism of Allen even in his own journal, The Homœopathician, that he founded in 1912. Furthermore, when Kent published the second edition of his Lectures on Homœopathic Materia Medica in 1912 [the first edition was in 1904], all the synthetic remedies published between 1904 and 1908 were omitted.)
In this same article, Kent says that in the course of treatment of a patient suffering with a psychic disease of the will (problems of affections, grief, anger, jealousy, etc), the heart or liver will be affected as the treatment progresses.
While in a patient suffering from a mental disease (problems of the intellect), the stomach or the kidney will be affected during appropriate homeopathic treatment. Were these comments on the direction of cure and correspondence of organs based on Kent's impeccable and meticulous observations or was he rather formulating hypotheses? He does not explain further but he does mention later in the same paper that “through familiarity with Swedenborg, I have found the correspondences wrought out from the Word of God harmonious with all I have learned in the past thirty years. Familiarity with them aids in determining the effect of prescriptions.” (15)
Nowhere was I able to find in the writings of Kent, including in a collection of not yet republished lesser writings, any other mention of Hering's law as to the direction of cure.
First let us briefly review the highlights of what has been so far demonstrated:
Now, with Kent's powerful influence, most modern works and presentations on homeopathy began to declare Hering's law as an established fact and seemingly assumed that it has been thoroughly verified since the beginning of homeopathy, although no author, to my knowledge, has so far been able to substantiate what each is repeating from the other. Here is one clear sign which indicates how profoundly the homeopathic profession of today has been cut off from its original and most essential sources. During the years of its decline in the U.S. the profession experienced a gradual discontinuity from its original foundation and started to rely more and more on a neo-foundation dating back to the turn of the present century. Each new generation of homeopaths has readily accepted Hering's law as a perfect law of cure and so unintentionally perpetuated a misleading assumption. For students it is an attractive concept but we clinicians must stand up and report our observations even if they are contrary to the teaching we have received.
From reviewing the literature, it seems unlikely that the law formulated by Kent in 1911 is a fair represention of Hering's overall understanding of a direction of cure and that neither Kent nor anyone else has been able thus far to clinically demonstrate that the original observations of Hahnemann constituted in fact a perfect law of nature. But if we assume, for a moment, that the law formulated by Kent is true, would all symptoms then have to disappear, not only in the reverse order of their appearance, but also from above downwards, from within outwards and from more important to less important organs?
To comply with this law it would mean that all diseases to be curable must proceed from outside inwards, from below upwards and from less important to more important organs. Many acute diseases and a whole list of chronic diseases such as psychosomatic diseases and others that develop from within outwards (for example cases of arthritis followed by psoriasis), or diseases that develop from above downwards, as in certain cases of polyarthritis, would then be theoritically incurable. Or (since we know this not to be the case) they are curable, but represent notable exceptions to Kent's formulation of a law of direction of cure.
In many cases of chronic disease the direction of disappearance of symptoms will contradict at least one of the four propositions. I assume that we all agree that the enunciation of a law must be based on impeccable observations. A law, if it is to be called a law, must explain all observable phenomena of direction of cure. It is unacceptable to use limited or even selected clinical phenomena to confirm a supposed law.
This situation appears to exist when certain homeopaths in their attempts to defend “pure” homeopathy subscribe to the position that what is observed as contrary to Hering's law, as formulated by Kent, is only due to poor prescribing, suppressive at times, palliative at best but surely not curative. For them what is wrong, is not the law but the prescription: “the simillimum was not given.”
Personally I use and can daily confirm the original observations of Hahnemann concerning the direction of cure and have found them extremely helpful to evaluate the evolution of diseases or of cure but I have not been able to substantiate these observations as a law and have not yet found a colleague with such substantiation. I use them as plain practical rules.
Probably by the end of my career, homeopathy will have become widely accepted. I would then resent it if a group of objective scientists clinically investigate the principles of homeopathy, and find numerous exceptions not abiding to our idealistic or dogmatic conception of Hering's law; thus rendering it only ”a plain, practical rule”. I would similarly resent having a group of scientists saying that for the last hundred or more years the homeopathic profession has been blindly erring in assuming that Hering's law was an irrefutable fact.
Five of the many plagues that have hindered the growth of homeopathy are ignorance, egotism, dogmatism, idolatry and the diversion from the inductive method. In his last address to the profession in an article published in the August 1880 (Hering died on July 23, 1880.) issue of the North American Journal of Homœopathy, Hering warned us that “if our school ever gives up the strict inductive method of Hahnemann we are lost, and deserve to be mentioned only as a caricature in the history of medicine.” 17) Indeed, since its early beginning the tendency to rationalize the practice of medicine has also constantly threatened homeopathy. Hahnemann, who had a thorough understanding of the history of medicine, knew that the only sure way was based on the experimental method. Hering demonstrated the same rigor. Unfortunatively, we can not say the same of Kent. Let us now start carefully observing and reporting any facts that would help to perfect Hahnemann's original observations. If a direction of cure can be expressed within the context of a law, then so be it. But until demonstrated otherwise, it should remain “a plain, practical rule”. The law that we suspect still needs to be rightly formulated.
At present it seems appropriate to refer to these observations as the rules of the direction of cure. To refer to these as Hahnemann's or Hering's rules may further prolong the confusion. From my personal experience, it appears that the four rules are not applicable to all cases and that there is a hierarchy among them, i.e., they do not have equal value. The first indication that a disease is being cured under homeopathic treatment is that the presenting and reversible (Many symptoms related to irreversible lesions can not be expected to totally disappear; consequently the more a symptom is related to organic changes, the less likely, or more slowly it will disappear. The greater the irreversibility of the pathology the greater the symptoms will linger. The practitioner can easily be confused by these important exceptions, which are often not well perceived. Therefore this rule [of symptoms disappearing in the reverse order of appearance] is generally less applicable to symptoms deriving from organic lesions.) symptoms of the disease will disappear in the reverse order of their appearance.
This confirms the observations as pointed out originally and plainly by Hahnemann in The Chronic Diseases and later by Hering in 1865 and 1875. This means that during the treatment of patients suffering with chronic diseases of non-venereal origin and also at times with acute diseases, the presenting symptoms of the patient's chronic dynamic disease (as opposed to the symptoms resulting essentially from gross error of living) will disappear in the reverse order of their appearance. So the presenting symptoms that have developed in the order of A B C D E seem to consistently disappear in the order of E D C B A. This rule seems to have supremacy over the other three rules: from more important to the less important organs, from within outwards and from above downwards.
The word “presenting” is here emphasized in order to state perfectly clearly that the symptoms that will disappear in the reverse order of the their appearance are only the presenting symptoms, and that it is not at all expected that every ailment experienced by the patient in his past will again be re-experienced under homeopathic treatment. In fact only a few of these old symptoms and conditions will reappear during a homeopathic treatment, usually the ones that have unmistakably been suppressed by whatever influences. Beside antipathic treatment that will suppress symptoms and normal functions of the organism (perspiration or menses) there are other measures which will cause suppression of symptoms, first, dissimilar diseases, natural or artificial; second, external influences such as exposure to cold temperature, (i.e., suppressed menses from getting the feet wet); and lastly, internal influences that cause the person to suppress emotions such as anger or grief. This rule concerning cure in the reverse order of appearance of the presenting and reversible symptoms of the disease is the most important of the four as it is observable in almost all cases. The importance of this rule is well emphasized by Hering in 1865 when he mentioned:
The second most important (applicable) rule in the hierarchy is that cure will proceed from more important to less important organs. Third in importance is the rule that cure will proceed from within outwards. Fourth, least important and least often observable, the cure will proceed from above downwards. Hahnemann's observation thatof all the signs that indicate a small beginning of improvement, the psychic condition of the patient and his general demeanor are the most certain and revealing is seen as the source of the last three rules. “The very beginning of improvement is indicated by a sense of greater ease, composure, mental freedom, higher spirits, and returning naturalness.” (paragraph 253) 10 This original observation of Hahnemann, which is verified daily, does not contradict the first rule in any case because the first sign of improvement can be and is often different than the symptom that would first disappear.
Consequent to Hahnemann's theory, (that all diseases, acute and chronic of non-venereal origin, come from the original malady called psora and its first manifestation is a skin eruption) all cases of chronic disease of dynamic origin must develop a skin eruption to be totally cured. As it seems unfeasible to demonstrate, it should at best be used as a working hypothesis and not as a law. For a law to exist it must be demonstrable without exception. Hahnemann had a clear opinion about the role of the physician as theorist when he wrote in the preface to the fourth volume of The Chronic Diseases:
To end this thesis, I would like to leave you with the spirit of some pertinent thoughts of Constantine Hering. In 1879, in the last two paragraphs to the preface of his last work, The Guiding Symptoms of our Materia Medica, he writes:
And finally he wrote in 1845 in the preface of Hahnemann's Chronic Diseases: