Using Acute Intercurrent or Intermediate Remedies in Chronic Diseases

-- Luc De Schepper, M.D., Ph.D., Lic.Ac., C.Hom

Proceeding with Treatment After Using an Acute Intercurrent

Again Hahnemann guides us very clearly in Chronic Diseases.

CD The intelligent homeopathic physician will soon note the point of time when his remedies have completed the cure of the epidemic intermediate disease (usually they appear in the form of a fever) and when the peculiar course of the chronic (psoric) malady is continued. The symptoms of the original chronic disease will, however, always be found somewhat varied (altered) after the cure of such a prevailing intermediate disease. ... The homeopathic physician will then choose his antipsoric remedy according to the totality of the remaining symptoms, and not simply give the one he intended to give before the intermediate disease appeared (1997, p. 132-133). (Author’s emphasis and words added.)

Therefore, after the acute event (a strong one, that is), one must retake the case with special emphasis on any newly appeared symptoms. The most recent and permanent symptoms point to the next remedy. Some of the chronic symptoms also persist during an acute crisis and thus obtain a higher value for the selection of the simillimum. If the same remedy that was serviceable before the acute crisis is indicated, it may be repeated. If the symptom picture has changed, the new symptoms must be investigated in relationship to all the data associated with the chronic strategies used before. This tells you how disruptive it is to continue administering the chronic remedy during acute crises! It is also wise, after the acute episode, to see whether the constitutional state improves greatly without the administration of any remedy. Better to wait and watch and give a placebo to please the patient until the VF has been able to produce all the symptoms you must prescribe on.

Hahnemann further reminds us in Chronic Diseases to pay attention to another event, which can occur at this point, after treating the acute event, even when the acute has been properly treated:

CD Here is a fitting opportunity to note that the great epidemic diseases ... when they complete their course especially without a judicious homeopathic treatment, leave the organism so shaken and irritated, that with many who seem restored, the psora, which was before slumbering (dormant) and latent now awakes quickly, either into itch-like eruptions or into chronic disorders, which then reach a high degree in a short time, if they are not treated properly in an antipsoric manner. ... The allopathic physician, when such a patient ... dies after all his unsuitable treatment, declares that he has died from the sequelae of whooping cough, measles, etc.

These sequelae are, however, the innumerable chronic diseases in numberless forms of developed psora which (were) unknown and consequently remained uncured (1997, pp. 133-134). (Author’s words added.)

How often do we see a patient in the clinic who comes to us and says, “I had this simple cough (or flu, or small trauma, or small upset), and I have never been well since then.” These statements are explained by the above quote: this “innocent-appearing event” has activated the dormant, often psoric miasm, leaving the patient in a state worse than he ever was before. This is incomprehensible to the patient and his allopathic physician, but easily managed by a well-trained homeopath.

Allopathic Recourse

In a footnote to Aphorism 67, Hahnemann elaborates on situations where allopathic intervention is justified.

A67 Only in the most urgent cases, where danger to life and imminent death do not allow time for a homeopathic remedy to act – neither hours, nor often quarter hours, nor even minutes – in sudden accidents to healthy individuals, such as asphyxiation, apparent death from lightning, choking, freezing, drowning, etc., only in such cases may we and should we as a first measure at least bring back irritability and sensitivity (physical life) by using a palliative …

Apart from the previous examples, if an acute situation becomes dangerously uncontrollable, we can use allopathic palliative treatment to give us a second chance to find the curative homeopathic treatment. This situation is an exception – for example, severe bleeding spells in a patient with chronic ulcerative colitis – and not at all the same as preferring to give your patients OTC drugs or antibiotics as acute interventions, for fear of disrupting the chronic treatment. Obviously those homeopaths do not know the basic principles of homeopathy. They should know that OTC drugs (just like other allopathic drugs) cause a dissimilar disease, thus creating a more complex disease, which is more difficult to treat. They do a disservice to the patient as well as to other homeopaths who inherit such cases. And of course, they have passed up a chance to show how well homeopathy works on acute diseases. The use of allopathic drugs might be an easy way out for the incompetent or lazy homeopath, but it will make the management of that patient’s case a lot more difficult. Antibiotics, for example, may overcome an acute infection, but they do not help the organism overcome future infections. After antibiotics, the person is, to a certain degree, even more susceptible to microorganisms. Some side effects of antibiotics include yeast overgrowth and destruction of the normal flora. Besides, homeopathy is superior to any other treatment that exists for infectious diseases.

What Acute Events Need an Intercurrent Remedy?

Not treating a serious acute event at all is a mistake. Due to its nature, an acute disease evolves in four possible directions. The patient can succumb to it; it will suspend the chronic disease and can become an independent chronic state; or it will combine with the existing chronic disease and create a complex chronic disease, which will be much more difficult to treat. The best outcome is that the strong VF might overcome this acute miasm without causing further sequela. “The physician amuses the patient while Nature cures,” Voltaire said –but this is not a reason to refrain from treating acutes!

Margaret Tyler wrote in her book Homeopathic Drug Pictures (in the lecture on Natrum muriaticum (Nat-m.) about a crisis situation where she treated a chronic Nat-m. patient with a severe acute headache. She advises against the use of the chronic constitutional remedy at this time because it may produce severe aggravations. Instead, she suggests using the acute of Nat-m., Bryonia, to deal with the acute crisis. Afterwards she resumes the chronic remedy to remove the underlying cause. This advice comes from years of clinical experience and should not be ignored. It also means that you do not continue Bryonia once the acute stage is over, as I have seen some homeopaths do!

Which acute crisis needs an acute intercurrent remedy rather than a continuation with the chronic constitutional remedy? As usual, Hahnemann gives us definite guidelines. In Aphorism 73 of the 6^th edition Organon, Hahnemann describes three kinds of acute diseases. Group One combines those relating to lifestyle/diet and miasmatic predisposition; Group Two includes epidemic and acutes belonging to idiosyncrasy; and Group Three includes acute miasms such as those belonging to childhood diseases.

Group One acute diseases

Group One is subdivided into three different categories.

A.    Acute situations caused by lifestyle or dietary mistakes

A73 ... Exciting causes of such acute febrile conditions are: excesses or privation in eating, traumatisms, chilling or overheating, fatigue (from poor lifestyle choices), strains from lifting, etc., or else psychic agitation and upsets (our modern TV, video games, magazines, and now Internet exposure). (Author’s notes added.)

These issues are also discussed in Aphorism 77

A77 Diseases engendered by prolonged exposure to avoidable noxious influences should not be called chronic. The include diseases brought about by:

·         the habitual indulgence in harmful food or drink;

·         all kinds of excesses that undermine health;

·         prolonged deprivation of things necessary to life;

·         unhealthy places, especially swampy regions;

·         dwelling only in cellars, damp workplaces, or other closed quarters;

·         lack of exercise or fresh air;

·         physical or mental overexertion;

·        continuing emotional stress; etc. ...

Hahnemann refers to these situations also as “false chronic diseases,” since they can become chronic through continued abuse, but all they will require to be cured is a sensible change to diet and/or lifestyle. He continues:

A77 These self-inflicted disturbances go away on their own with improved living conditions if no chronic miasm is present, and they cannot be called chronic diseases.

In all these cases no remedy is required except placebo (if called for) to temper the demands of the drug-oriented or hypochondriac patient. The best treatment is rest, sleep, appropriate diet, and TLC.

B.    Acute situations with a clear exciting factor and strong symptoms

If the exacerbation is moderate to strong, and a clear causality is manifested, an intercurrent remedy, which acts superficially on the chronic miasm, may be chosen according to the VB method, rather than giving a deep-acting polychrest. This will calm the symptoms for the moment without acting too deeply on the case. After the crisis has subsided, complementary constitutional treatment is needed to remove the underlying cause.

Examples of causality include:

·        Acute physical trauma – In these cases the etiology and the organ or tissue affected will help you identify the remedy. In other words, if the injury is a puncture wound compared to a blow (e.g., to the eye), it will correspond to a different remedy  (Ledum and Hypericum versus Arnica and Ruta).

·        Emotional trauma – You must look at the kind of trauma as well as the patient’s reaction to the trauma, which will be determined by the patient’s active miasmatic state. Remember, the trauma can wake up the miasm! The “Mind” section of Kent’s repertory gives many examples of emotional causalities. The patient’s miasmatic reaction to these triggers will help you select the appropriate remedy. For example, we have the tubercular jealousy of Pulsatilla, the psoric one of Nux vomica, the syphilitic one of Hyoscyamus, and the sycotic one of Lachesis.

·        Poisons and vaccinations – These include cases of street drug use, allopathic drug use, food poisoning, etc. The best antidote is not the same or isopathic substance but the most similar remedy. Sometimes you find effects of poisoning when you look into the “relationship of remedies” and when you look at what antidotes that remedy. This information will narrow the group of remedies you need to investigate.

C.    Acute exacerbation of a chronic miasm

For example, in this situation the patient may have contracted the flu after losing sleep or partying too much. In this case we do not always want to interrupt the action of the constitutional remedy with an intercurrent remedy. If there is no obvious exciting cause, it may be a healing crisis brought on by the constitutional chronic remedy. Rest, massage, and hot and cold water treatments (hydrotherapy) might be sufficient to render the patient comfortable until this acute exacerbation subsides.

In Third World countries like Kenya, I have found myself exposed to situations like those European and American homeopaths faced at the turn of the 20^th century. Many people came to us in an “acute” stage, excited by physical strain (all the women in the village where I worked in Kenya had at least four children and eight was not uncommon), by becoming chilled or overheated, by eating unsuitable food, mental stress, etc. How many of these cases are really acute?

As you can see in Aphorism 73, Hahnemann suggests, and experience confirms, that most of these cases are acute exacerbations of fundamental chronic states and miasms, activated by exciting causes. When the symptoms do not represent an extreme crisis, the simillimum, which suits their constitutional nature, often clears the acute exacerbations and then addresses the fundamental chronic states. That is the majesty of the grand simillimum. This may account for statements by homeopaths such as Massimo Manglialavori who state that it is possible to find a single remedy to successfully treat both chronic and acute situations. However, when the same author claims that “he does not believe in miasms and knows nothing about them,” I wonder about the veracity of his statement. Don’t we all owe it to our patients to investigate before we reject the concept of miasms – or worse still, we fail to investigate at all because of our knee-jerk negative feelings about miasms? Let’s not fall into allopathic reasoning, which borders on fear of and hostility towards one of the greatest discoveries of homeopathy.

Hahnemann says:

A73, In reality most of these acute diseases are only passing flare-ups of latent psora, which returns by itself to a dormant state if the flare-ups are not too violent and if they are quickly eliminated.

 Only if the exacerbation is moderate to severe do we want to intervene with intercurrent remedies as an emergency measure. Again, the VB method will help you choose the intercurrent remedy.

In his Lesser Writings, Kent expresses the same scenario:

 The acute expressions of a chronic disease have a different management from the acute diseases, e.g., a child suffers from bronchitis at every change of weather. It may grow worse if treated with the remedy for the acute symptoms. The miasm that predisposes the child to recurrent attacks must be considered (Kent, 1994, p. 419). (Author’s emphasis added.)

Group two acute diseases

A73 Then there are sporadic acute diseases, which affect a few individuals at a time here and there, acute diseases brought on by harmful meteorological or telluric influences to which only a few people are susceptible at any one time.

This was long recognized in Traditional Chinese Medicine: certain climate factors are known to influence specific organs which have an affinity for those conditions, e.g., cold to kidneys or dampness to spleen-stomach, though only certain people seem to have a high susceptibility to that particular climate factor. Sometimes, but not always, these diseases form acute layers, which repress the constitutional picture until they have run their course or are removed by homeopathic remedies. These acute disorders are so closely linked to the patient’s chronic susceptibility that they can often be treated with their constitutional simillimum. It is only in emergencies such as sunstroke, dehydration, severe exposure to cold, anaphylactic reactions, poisoning, and severe physical or mental trauma that these cases are truly an acute crisis. In such an exigency, the symptoms will indicate a crisis remedy. Acute miasms present a different situation from sporadic diseases because they involve infectious etiologies.

Hahnemann discusses a second type of sporadic diseases.

A73 Bordering on these are the epidemic diseases, in which many individuals are affected very similarly from a similar cause. In crowded areas they tend to become contagious. These epidemics cause fevers, each with its own characteristics; and because each case of disease in the same epidemic has the same origin, those affected manifest a similar disease process, which, left to itself, ends either in death or in recovery within a limited time. War, floods, and famine are often the exciting causes or the breeders of such diseases.

In acute miasms, the susceptibility factor is closely related to acquired and inherited miasms and family disorders. For this reason, the remedy for the acute miasm may also be the remedy for the patient’s constitutional condition. This is especially common to acute miasms that run a non-threatening natural course with few or no complications. This may not be the case, however, when the acute disease is of a very virulent nature. Because of their intensity, these acute diseases will suspend the chronic disease and an intercurrent acute remedy is needed to deal with this new acute natural disease. It will display a new symptom image that will either run its course or be removed by homeopathic remedies.

In these circumstances an acute intercurrent is the remedy of choice. We’ve all seen patients who have been never well since (NWS) a certain illness.  The NWS acute disease has now become a chronic disease, stronger and dissimilar to the previously treated chronic disease, which is now suspended.  SARS is a good example.

Deep-acting complementary remedies (constitutional and anti-miasmatic treatment) must remove the chronic underlying causes after the acute crisis is ameliorated. Let the constitutional factors, the nature of the disease, and the totality of the symptoms (Organon, Aphorisms 5, 6 and 7) be your guide to the homeopathic remedy, and you will have success. Follow the revelations of the VF and it will demonstrate, through causation, signs and symptoms, which remedy it needs. Trust your recuperated VF to tell you what to do!

Group Three acute diseases

Hahnemann also alludes to the third kind of acute diseases.

A73 Then there are those acute miasms that always recur in their own particular form, which is why they are known by an established name. Some of them are contracted only once in a lifetime, like smallpox, measles, whooping cough, ... scarlatina ... mumps, etc., while others recur frequently in fairly similar ways, like ... the yellow fever of coastal regions, Asiatic cholera, etc.

We see the same in modern times: bubonic plague in India; tuberculosis (TB) and cholera epidemics in South Africa; malaria and TB in Kenya; epidemics during the war between the Tutsi and Hutu in Rwanda and Burundi or the civil wars in Zaire; flu epidemics worldwide, etc. These acute miasms are caused by microorganisms and are self-limiting but tend to form a quick crisis and end either with complications, perhaps even death, or convalescence (a person can fall prey to these illnesses more than once). By contrast, the once-in-a-lifetime illnesses provide permanent immunity after only one attack.

All these acute diseases should be treated with remedies reflecting the picture of the acute miasmatic state alone – the acute genus epidemicus. A follow-up with constitutional and anti-miasmatic remedies to remove the underlying susceptibility is then necessary.

Hahnemann warns us to not pay attention to the name attached to the epidemic disease, like the yearly flu in modern times.

A100 In investigating the totality of symptoms of epidemics and sporadic diseases, it makes no difference at all whether something similar, by the same or a different name, has ever appeared in the world before.

Whether or not such an epidemic is new or unusual makes no difference either in the examination or in the cure, since in any case the physician must presume the true picture of every epidemic to be new and unknown and must thoroughly examine it as it is in all of its details if he wants to be a true and thorough physician who never replaces observation with guesswork, who never lets himself assume that the treatment of any given case in his care is wholly or partly known in advance and that he need not carefully seek out all its expressions.

This is all the more necessary because every epidemic is in many ways unique and upon careful examination is found to be very different from all previous ones falsely bearing the same name, the only exceptions being those caused by the same unvarying infectious agent, such as smallpox, measles, etc.

What a scathing condemnation of present allopathic practices where the severe flu strain of this year was treated, of course unsuccessfully, with a vaccination of the previous flu variety! 

Conclusion

We can emphasize that the proper use of an acute intercurrent in the treatment of a patient is essential for a speedy cure of a chronic illness. When and where to use these acute remedies are equally important issues as when to continue the chronic treatment, especially when the homeopath should recognize where the acute manifestation is nothing more than an expression of a chronic miasmatic state. Homeopaths throwing one acute remedy after another to the unsuspecting patient for trifling matters, are just as guilty of misconduct as those homeopaths who refuse to use acute intercurrents under any circumstances. Knowledge of Hahnemann’s teachings is the only guide!

Bibliography-References

1. Hahnemann, S. 1997. The Chronic Diseases: Their Peculiar Nature and Their Homeopathic Cure. Translated by L. Tafel, edited by P. Dudley. New Delhi: B. Jain Publishers Pvt. Ltd.

2. Hahnemann, S. 1982. Organon of Medicine. Sixth Edition. Translated by J. Kűnzli, A. Naudé and P. Pendleton. Washington: Cooper Publishing.

3. Kent, J.T. 1979. Lectures on Homeopathic Philosophy. California: North Atlantic Books.

4. Kent, J.T., 1994. New Remedies, Clinical Cases, Lesser Writings, Aphorisms & Precepts. New Delhi: B. Jain Publishers Pvt.Ltd.

5. von Boenninghausen, C.M.F. 1991. Lesser Writings. New Delhi: B. Jain Publishers Pvt. Ltd.

This article is an excerpt of the new book of Dr Luc, “Achieving and Maintaining the Simillimum: Strategic Case Management for Successful Homeopathic Prescribing.” Full of Life Publishing, PO Box 31025, Santa Fe, NM 87594, USA. Dr Luc is the founder and sole teacher of the Renaissance Institute of Classical Homeopathy since 1993, with schools in Boston, MA, Secaucus, NJ and Las Vegas, NV. For more info: write drluc@cybermesa.com and see www.drluc.com

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