Using Acute Intercurrent or Intermediate Remedies in Chronic Diseases - Homeopathic Philosophy & Organon of Medicine

KEY

A61: Organon Aphorism by Hahnemann Reference. This symbol represents the paragraph from Hahnemann’s Organon, specifically the Aphorism number from where the reference originated.

CD: Chronic Diseases by Hahnemann Reference. This symbol represents the thought taken from Hahnemann’s Chronic Diseases book.

Modern homeopaths no longer understand how to use an acute intercurrent remedy. These remedies have been called everything from drainage remedies and tandem remedies to support and lesional remedies. Too many so-called masters, who claim to be constitutional prescribers (homeopaths who say they do chronic “layer” prescribing), totally forbid the use of acute intercurrent remedies and misinform others by saying that the use of acute remedies during the administration of a chronic remedy is suppressive. These individuals always try to find one remedy that goes throughout the chronic case history, no matter what the patient’s present acute disease state may be. They use this “constitutional” remedy for everything, no matter what disease state arises! This limited view is too extreme for the general practitioner of homeopathic healing.

Why does this very rarely work? We only have to refer to Aphorisms 36-40 of the Organon on similar and dissimilar diseases. In Aphorism 38, Hahnemann tells us that the stronger and dissimilar acute disease will postpone or suspend the old chronic and weaker disease. Thus, administering the constitutional/chronic remedy during emergencies such as dangerous pathological crises, severe traumas, overexposure, serious injuries, and virulent acute miasms, is a serious mistake as it runs the risk of disrupting the natural symptom pattern and causing unproductive aggravations as well as accessory symptoms of the chronic remedy!

During an acute crisis the remedy of choice is the acute intercurrent! This acute illness shows a different clinical picture from the chronic natural disease. How could a dissimilar remedy correct this situation? That would fly in the face of our most sacred principle: Like cures like. A homeopath must have the tools to prevent and cure dangerous epidemic diseases, treat emergencies, crises, and acute virulent miasms. The acute remedy must be chosen according to the causal or exciting factor and its active symptoms (von Boenninghausen [VB] method), not according to the chronic case history! The desired middle path is the class of homeopaths who find a balance between those who treat in layers and those who use the grand constitutional remedy for everything. Turning this subject into absolutes will only help create opposing extremist views.

No doubt, the closer the remedy is to the simillimum the deeper and more all encompassing its action will be on the Vital Force (VF). This is a very subtle aspect of the single remedy and minimal dose and is a wonder to perceive. The goal is always to use the minimum number of remedies, the smallest amount of medicine, and the fewest repetitions. Since the simillimum addresses the soil on which acute and chronic diseases grow, it can sometimes cure both acute and chronic manifestations as well as acting as a prophylactic. Especially with the use of Hahnemann’s medicinal solutions (5^th and 6^th Edition of the Organon), we often find that the adjustment of the succussions or size of the dose will keep the remedy working.

The skillful use of intercurrents is an essential method in classical homeopathy, an aspect of complete case management. Acute intercurrent remedies are used during temporary disruptions of the chronic treatment. For example, “taking cold in the stomach by eating fruit, [cured] by smelling of Arsenicum” (Hahnemann's Chronic Diseases, 1997, p. 131). These remedies are chosen based on of the exciting cause and the active acute symptoms so that they do not disrupt the deeper layer associated with a different fundamental cause and with the constitution. These intercurrents mainly act superficially so that they will not interfere with the complementary constitutional treatment. They are specialized specifics, which deal with the disruption of the chronic treatment by occasional exciting causes that would delay the cure.

Because of the continued suppression of miasmatic chronic diseases in modern countries, we must know when to use acute intercurrents. If you read the old masters (see von Boenninghausen’s Lesser Writings), you will see that they dealt with horrendous acute situations, which are still present today. Nothing has really changed, except that we have some new acute diseases: SARS (Severe Acute Respiratory Syndrome), West Nile virus, the Four Corner’s disease (hantavirus), etc.

The reason some homeopaths speak about disrupting their chronic cases with acute remedies is that they do not know the strategy behind using acute intercurrents. As mentioned above, if you use the exciting cause and active symptoms of the acute syndrome as a basis for selecting a remedy (VB method), then the intercurrent will not disturb the chronic condition. But if, during an acute attack, the homeopath continues to administer a deeper-acting chronic remedy, which envelopes the previous deeper and often different fundamental causes, this may disrupt the natural layers of symptoms. Simply put, one-dimensional constitutional prescribers are afraid of treating acute diseases because they do not know how to do it.

What does Hahnemann have to say about acute intercurrents? He introduced the idea in 1828 by presenting the following examples in Chronic Diseases:

CD Among the mishaps which disturb the treatment only in a temporary way, I enumerate: overloading the stomach (this may be remedied by hunger ... ; disorder of the stomach from fat meat, especially from eating pork (to be cured by fasting and Pulsatilla); a disorder of the stomach which causes rising from the stomach after eating and especially nausea and inclination to vomit (by highly potentized Antimonium crudum); taking cold in the stomach by eating fruit (by smelling of Arsenicum); troubles from spirituous liquors (Nux vomica); ... when vexation is joined with fright, by Aconite; but if sadness is caused by fright give Ignatia seed; ... unhappy love with jealousy (Hyoscyamus); ... burning of the skin by Arsenicum; ... homesickness with redness of cheeks by Capsicum, etc. (1997, pp. 131-132).

After talking about this first class of acute illnesses, Hahnemann tells us not to continue (to suspend) the chronic antipsoric treatment in cases of epidemic diseases or intermediary diseases, so as not to mix the symptoms of the acute crisis with those of the chronic disease. If one needs to administer a first aid, crisis or genus epidemicus remedy, the constitutional chronic remedy should be withheld until after the crisis subsides.

CD But during the treatment of chronic diseases by antipsoric remedies we often need the other non-antipsoric store of medicines in cases where epidemic diseases or intermediate diseases (morbi intercurrentes) arising usually from meteoric and telluric causes attack our chronic patients, and so not only temporarily disturb the treatment, but even interrupt it for a longer time. Here the other homeopathic remedies will have to be used, wherefore I shall not enter upon this here, except to say that the antipsoric treatment will have for the time to be totally discontinued, so long as the treatment of the epidemic disease which has also seized our (chronic) patient may last, even if a few weeks in the worst cases may thus be lost. But here also, if the disease is not too severe, the above mentioned method of applying the medicine by smelling a moistened pellet (olfactory method) is often sufficient to help, and the cure of the acute disease may thus be extraordinarily shortened (1997, p. 132). (Author’s emphasis and words added.)

The same idea – not taking into account the active miasmatic state in acute events – is reflected in the Organon,

A221 If, however, insanity or mania (precipitated by fright, vexation, alcohol, etc.) suddenly bursts forth as an acute disease from the patient’s usually calm condition, although it almost always arises from internal psora (like a flame flaring up from it), at this initial, acute stage it should immediately be treated, not with antipsoric remedies, but with medicines such as Aconite, Belladonna, Stramonium, Hyoscyamus, Mercury, etc., chosen from the other group of proved remedies and given in highly potentized subtle homeopathic doses, so as to overcome it to the point where the psora returns for the time being to its former, almost latent condition, in which the patient appears to be well.

In such acute flare-ups, Hahnemann tells us to use those very specific acute remedies without taking into account the dominant miasmatic state as we would for chronic cases. This is one of the few exceptions – together with the one-sided diseases, which can be regarded as severe acute situations suspending the chronic miasmatic natural illness – in which we use the VB method. With this method you select the remedy according to modalities, location, sensation and concomitant symptoms. The VF needs an intercurrent remedy in high potency and subtle or minute dose, to subdue a threatening acute flare-up.

Kent continued this discussion in his Lectures on Homeopathic Philosophy in Lecture XXVI titled, The Examination of the Patient.

It is important to avoid getting confused by two disease images that may exist in the body at the same time (that does not mean both are equally active). A chronic patient, for instance, may be suffering from an acute disease and the physician on being called may think that it is necessary to take the totality of the symptoms; but if he should do that in an acute disease, mixing both chronic and acute symptoms together, he will become confused and will not find the right remedy. The two things must be separated. The group of symptoms that constitutes the image and appearance of the acute miasm must now be prescribed for. The chronic symptoms will not, of course, be present when the acute miasm is running, because the latter suppresses or suspends the chronic symptoms. ... This illustrates the doctrine of not prescribing for an acute and chronic trouble together. ... The acute disease is never complicated with the chronic; the acute suppresses the chronic and they never become complex. ... Prescribe first for the acute attack, and the symptoms that belong to it. It is well, however, for the physician to know all the symptoms that the patient has of a chronic character, that he may know what to expect, that he may look at the close of the acute attack for the coming out of the old manifestations of psora, although often an entirely new group of symptoms will appear (Kent, 1979, pp. 174-176). (Author’s note added.)

As you can see, here Kent follows Hahnemann and lays to rest those “modern myths” of not treating acutes while you are treating a chronic disorder. He speaks here of true virulent acute miasms, not sporadic befallments or non-threatening exacerbations of chronic miasms. After the acute crisis is over, the homeopath can resume the chronic treatment.

von Boenninghausen was another homeopath who talked about acute intercurrents in the first published homeopathic repertory (1832), A Systematic Alphabetical Repertory of Homeopathic Remedies. Within a sub-chapter titled Interruption of the Antipsoric Cure is the section, Intercurrent Remedies in Chronic Disease. This section includes a list of acute intercurrents and their symptoms in crisis during chronic treatments. These therapeutic hints are characteristic keynotes of the acute intercurrent remedies and the homeopath must refer to the materia medica for confirmation and differential diagnosis with other remedies. Some examples include:

Among the remedies listed by the Baron are non-miasmatic remedies like Aconite, Antimonium crudum, Arnica, Bryonia, Chamomilla, Coffea, Ignatia, Ipecacuanha, Rhus tox., etc. These are used for acute emotional crises, accidents, vomiting, diarrhea, weakness from loss of fluids, and acute miasms such as colds and flus.

Why would a deep-acting remedy such as Arsenicum be found among these acute intercurrents? It is in the acute list of Hahnemann and von Boenninghausen for use in an upset stomach – in other words an acute local complaint. If Arsenicum had a deeper relationship to the individual’s case history (anxiety, fear of death, fear of contamination, obsessive compulsive behavior, etc.), it should not be used during a serious acute crisis as it might interrupt the chronic treatment and delay the cure. Another more superficial simillimum must be chosen at that point. Most intercurrents are non-miasmatic remedies that have no relationship to the deeper aspects of the case. They are chosen according to the location, sensation, modalities, and concomitants (a complete von Boenninghausen case). These acute intercurrents act as superficial remedies that suit the acute layer of symptoms one wishes to remove, but are not directed toward the underlying miasm or constitution. This also means that we should choose these intercurrents only for serious acute events, only if the crisis needs special attention, and not for every trifling situation as often happens. A homeopath should treat strong acute miasms, painful exacerbations of chronic states, and dangerous crises whenever necessary, because it is preferable to administering allopathic dissimilar drugs.

As an example, let me tell you about choosing the right intercurrent for myself when I was plagued by an annoying, lingering cough and while I was taking a chronic constitutional remedy. After waiting for 14 days and finding that the cough was getting worse, I decided to take an intercurrent. The rubrics included:

Far stronger than the rest of the remedies which appeared were Phosphorus (first), and Cuprum (second). Because Phosphorus is a deep-working anti-miasmatic remedy, which would have interrupted my chronic treatment, I decided on Bryonia 200C, (the acute of Phosphorus), split dose in bottle, 12 succussions, 1 tsp. PRN. After one dose my cough was already much better, and it disappeared completely the next day. Later, chronic treatment was resumed.

I asked the following question: “What changes are important in acute diseases?”

ALL the symptoms that have changed since the onset of the cough belong to the cough – for example, being very thirsty now that the cough started when usually I am not thirsty. This becomes very important. It would not be important if I were always thirsty, even before the onset of this cough.

Another very important facet of change in acute diseases is the change in disposition and mental/emotional symptoms: the disposition during the acute disease as compared to the usual disposition will be a key factor. This absolutely must be investigated and plays an important role in finding the remedy. The more drastic this change is, the more important it is. The “feeling of wanted to be left alone” is very unusual for me, and Bryonia, the indicated remedy, certainly has this symptom as well as the great thirst. This resembles, of course, the VB method, where von Boenninghausen only takes into account the mental/emotional symptoms as a tool to differentiate between several remedies close to the case. Hahnemann also stresses the importance of emotional changes in acute diseases.

A213 Therefore one will never cure according to nature—that is, homeopathically—unless one considers the mental and emotional changes along with the other symptoms in all cases of disease, even acute ones, and unless for treatment one chooses from among the remedies a disease agent that can produce an emotional or mental state of its own similar to that of the disease as well as other symptoms similar to those of the disease. Thus Aconitum napellus will seldom or never cure either quickly or permanently if the disposition is calm and undisturbed; nor will Nux vomica if it is mild or phlegmatic; nor will Pulsatilla if it is glad, cheerful and willful; nor will Ignatia if it steady and without fearfulness or irritability.

A82 ... In this investigation one must distinguish between acute diseases of sudden onset and chronic diseases. In the former the principal symptoms become prominent and recognizable to the senses more quickly, so the taking of the case requires far less time and there are far fewer questions to ask, because most of the symptoms are self-evident; whereas in a chronic disease that has been evolving gradually for a number of years, it is far more troublesome to obtain the symptoms.

A99 On the whole it will be easier for the physician to take the case in diseases that are acute or that have arisen recently, because all the symptoms and deviations from the healthy condition, which was only recently lost, are to patient and relatives still fresh in memory, still new and striking.

The physician must of course know everything here also, but he needs to probe far less, because everything he needs to know is told to him, most of it spontaneously.