THE MYSTERIUM OF PRESCRIBING
KARL KÖNIG, M. D. BHJ. LXV, 3/1976)
In opening this lecture may I express my grateful thanks to the Faculty of Homœopathy for giving me again the opportunity of addressing the Faculty and for the permission to speak on the “Mysterium of Prescribing”. This title has caused some of you to wonder what might be the content of my discourse. For many years I have occupied myself with the questions: what actually lies behind the mental process in man that, at times, enables us as physicians to find the true and proper remedy for some of our patients? How is it possible that by certain conscious and sub-conscious processes the proper remedy appears before our mental eye? What kind of inner answer can solve the complex question which a diseased person asks the doctor by way of the symptoms which he exhibits? For all the symptoms are to the doctor a question, and the remedy which he prescribes is the answer to this question. What, now, is really the mental process which makes it possible for the physician to find the answer to this question which the symptoms ask?
I do not claim to be myself a homœopathic physician. In spite of this statement I have sometimes been able to find the proper remedy and to stand in wonder before the result and the achievement. These occasions give rise to the question: “What lies behind this Mysterium of Prescribing?” This is the problem with which I have been occupied for many years, and it is for the first time today that I dare to speak about this problem. Therefore, although I know that it will be a first attempt, I hope that, in spite of its incompleteness and deficiencies, it may be a first step in opening up the problem which in my opinion, has been rather neglected in medical literature. I am aware that the complexity of this question is so great that only in the course of years or centuries will the proper answer be found: therefore only the first step can now be attempted.
To begin with, I should like to describe the facts which lead us to arrive at a diagnosis. A good deal of literature exists in this field, written by allopathic as well as homœopathic physicians; I shall first quote certain paragraphs from Dr. RYLE’s book on The Natural History of Disease (Oxford University Press, 1936). In the chapter on “The Study of Symptoms”, RYLE refers to the split within the whole field of medicine. There is on the one hand the way of scientific research; on the other hand the practical art of healing. RYLE now tries to discuss how it might be possible to bring the study of symptoms, which so far belongs to the subjective art of healing, into the objective field of scientific research. He writes: “It will, I think, be a very long time before symptoms can be studied experimentally on any considerable scale. Very few of them can be accurately reproduced. The majority of them as they occur in nature are transient. We have no practical method at present of measuring or photographing subjective phenomena. They express the behaviour of disordered or diseased tissues.” Please remember this very important statement! To the allopathic physician the symptoms express the behaviour of disordered or diseased tissues. Then RYLE continues: “Like the behaviour of plants and animals we are likely to learn more about them by constant and close observation, by careful recording, and by correlation of these observations with objective phenomena and existing physiological knowledge than by any other process of study.”
In this book, which is so delightfully and earnestly written, RYLE continues his study of the nature of symptoms, and states: “Symptoms, as has been stated, express a disturbance of function. Although they are often caused by organic disease, they do not express the disease but the disturbance of function which the organic change produces. The same symptoms may thus be produced by functional error or structural flaw. While not specific for diseases, symptoms are nevertheless specific for functional errors, and these errors, for the most part, depend upon an exaggeration, a depression, or an inhibition of normal reflex phenomena. The dyspnœa of great effort in health is physiologically similar to the dyspnœa of small effort in heart disease. The angina of anxiety or tobacco excess or anæmia has the same physiological basis as the angina of Coronary Sclerosis, although none of its gravity. Gastric and intestinal pain, as severe as the pain of gastric ulcer or intestinal obstruction, may occur in the absence of gastric or intestinal disease.”
Here, in these words, the case is clearly stated. In studying symptoms and the complexity of their order, the allopathic physician continuously thinks of the disordered function and the disordered function leads him to a concept of what he describes by the word “disease”.
The physician has then to ask himself what the symptoms mean in the whole household of nature, and RYLE states: “The function of symptoms is presumably protective. Dyspnœa denmands general rest for a local and general advantage. Pain in an injured limb compels localk rest and so permits repair. The pain of Angina Pectoris demands instant immobility and so spares the heart in jeopardy from anoxæmia and acute muscle failure.” Apart from these and many other examples, RYLE is, nevertheless, compelled to admit: “The protective significance of many other symptoms is obscure, but for the most part they are symptoms whose nature remains at present undetermined. In a more remote and less biological sense symptoms in man are protective in that they compel their victim to seek the advice and aid of others.”
This kind of statement is scientifically untenable. It is the same kind of thought which states that the good God has created the cork tree so that we are able to stopper our bottles of Wine. Dr. RYLE is therefore quite unable to arrive at a proper answer to the question: “What is actually a Symptom or a number of symptoms in a diseased person?”
If we now turn to the point of view of the homoœopathic physician, we find in KENT’s Lectures on Homœopathic Philosphy (Chicago, 1937) the following statement on the nature of symptoms: “Who is the sick man? The tissues could not become sick unless something prior to them had been deranged and so made all of his organs. Everything that we know by the senses belongs to physical man, everything that we can feel with the fingers and see with the eyes he leaves behind. The real sick man is prior to the sick body and we must conclude that the sick man must be somewhere in the portion which is not left behind. That which is carried away is primary and that which is left behind is ultimate.”
This statement is further substantiated when KENT continues: “We must, to be scientific homœopaths, recognize that the muscles, the nerves, the ligaments and other parts of man’s frame are a picture, and, manifest to the intelligent physician the internal man. Both the dead and the living body are to be considered, not from the body to the life, but from the life to the body.”
KENT, in the follwing lectures, describes very clearly how symptoms are actually nothing else but the expression of what he calls “the internal man”, the one who is not left behind when the physical body turns into a corpse. Only the living man can produce symptoms. This is a fundamentally new concept, and KENT states:”We also study disease from the symptoms of medicines that have caused disorder in the economy. Indeed, we can study the nature and quality of disease as much by studying the Materia Medica as by studying symptoms of disease … True knowledge consists of becoming acquainted with and understanding the nature and quality of a remedy.”
Therefore, to the true homœopathic physician, the symptoms do not only suggest disease, they suggest the remedy itself, and from this fundamental principle springs the whole idea of the drug-picture.
There are two ways of looking at this single phenomenon, the phenomenon of the diseased person. If the allopathic physician exasmines a diseased person he can find exactly the same order of symptoms, being thorough and painstaking in his examination, as the homœopathic Physician; but for the allopath, the various symptoms order themselves into a mental image which may fit into a picture of a known disease. For the homœpath, on the other hand, the order of the symptoms paints a mental picture which, to him, suggests a remedy. Therefore, when looking at a patient and his symptoms, two entirely different images arise in the minds of the homœopathic and the allopathic physician. In the one, it is a disease, in the other a drug-picture which comes to the fore.
No doubt to the trained allopath, behind the diagnosis of disease, a certain medicine will be suggested, and to the homœopath, in the background of the drug-picture, a certain disease will occur. Nevertheless the main issue lies in the fact that a bundle of symptoms can be suggestive of two entirely different things: the disease or the drug-picure.
We now have to ask ourselves how it happened that these two different schools of medical approach to the patient, based on two such different points of view, have occurred in the development of the history of medicine. The homœopathic way arose some one hundred and fifty years ago and the allopathic some two thousand four hundred years ago. Let us make an excursion into the history of medicine.
HIPPOCRATES, the great Greek physician who is called the Father of Medicine, lived from 460 to 377 B.C. on the island of Cos. If we ask ourselves from what source HIPPOCRATES gained his tremendous knowledge we find that he was the son of another HIPPOCRATES who also worked as a physician and that indeed there existed a whole family in which medical knowledge was handed down from generation to generation. All his forefathers however, were physicians who had never spoken publicly of their medical knowledge. HIPPOCRATES the Great was the first of them who dared to do so. I cannot withhold from you this statement: HIPPOCRATES did not know more than his father and grandfather he only made publicly known what he had learned. This is the reality behind the man HIPPOCRATES. He lived in a time when medical knowledge was still cloaked in mystery for ordinary men. Before the age of HIPPOCRATES, the mind of ordinary man was unable to grasp the knowledge which the family of the Hippocrateans held in their hands. The more the human mind developed from pictorial thinking to logical comprehension of ideas, the more all that was hidden knowledge was brought to the public notice. HIPPOCRATES revealed a knowledge which, until his time, was hidden in the depths of the mystery temples.
At the same time PLATO was forced to take a similar step, and his pupil ARISTOTLE, out of his knowledge, created the laws of logical thinking. These three great men committed treason for the good of mankind. They gave away the secrets of the mysteries into which they were initiated.
HIPPOCRATES emerged out of the temples and brought with him the secrets into which his forefathers were initiated. HIPPOCRATES threw this mysterious cloak away, stepped out from the shadow of the temples and took with him a certain number of remedies which he knew he could use and which, until then, were known only to the initiated physician. With this handful of remedies and with a completely different and new approach to the diseased person, describing the difference between organic and epidemic diseases, and the way in which to detect symptoms, he opened the doors of medical knowledge to mankind.
If we now ask ourselves what was the content of all that was hidden within the mysteries and which HIPPCRATES tried to reveal in part, we should not look for something mysterious. For HIPPOCRATES, although he opened the doors to the mystery-knowledge did not give away the magic source of its content. And the main content of the mystery-knowledge of olden times, in the sphere of temple medicine, was nothing other than what we know today as the various drug-pictures of our homœopathic remedies. These drug-pictures were taught in the temples to those who were chosen to become Physicians. This teaching was done in a different way. It was done in such a way that the imaginative powers of thinking were used and the drug-pictures then were real pictorial images. These images were not permitted to be disclosed to the uninitiated. But the true initiates among the ancient physicians knew in a different way the same truth which we know today: that the same remedy which can heal, is also able to create disease. Therefore these remedies are, if known, a potential danger in the hands of men, and for this reason, only those who were willing to heal and who had purified themselves to a certain extent, and of whom no misuse of knowledge was to be expected, were initated into the mysteries of the temples.
Through HIPPOCRATES who stepped out of the mysteries and closed the gate of the temple behind him, the pictorial images of the drug-pictures were lost to mankind. Man was no longer able to see the true picture of Apis, Belladonna, Calcarea carbonica or any other of the great remedies.
The trend of medical thinking had to move forward in a different direction. The physician had the task of gradually learning to study the symptoms in relation to the disease and not to the remedy, and more and more the body itself became the central subject of study in the realm of medicine. HIPPOCRATES turned the eye of the physician from the remedy to the human body and all the surrounding forces which influence it.
Most of the physicians followed the teachings of HIPPOCRATES, and only in a few remaining mystery temples were the old methods still carried on.
Parts of one of these mystery places are still preserved. In Epidauros we can see a huge amphitheatre, and among the ruins of the different temples and treasure-houses there exists a strange structure; beneath the earth a kind of spiral is built of stone, and from the inscriptions found in the temple of Epidauros it is known that the patient was led to this spiral in the evening and put to sleep there. During the night he dreamed of the God ASKLEPIOS, who appeared to him and held in his hand a plant or substance which, upon waking, the patient could remember. This plant or substance was subsequently used as his remedy. This type of instruction by way of dreams happened many times in the mysteries, and brought healing to thousands of people. It was in Epidauros that the patient himself, and not the physician, experienced in s supernatural way his own particular remedy.
This way of finding the right and proper remedy was gradually lost to mankind from the time of HIPPOCRATES. In HAHNEMANN, for the first time after two millennia, the foundation of a new medicine was again created. It was HAHNEMANN who resumed the search for the proper drug-pictures, but now in a new and scientific way. In the time between HIPPOCRATES and HAHNEMANN, the history of medicine followed a special direction. It was its task to discover the nature of disease and not the nature of the remedy. Only odd people, old shepherds and old women of the countryside, had some insight into the healing powers of certain remedies. In the herbal remedies of the Middle Ages this remedial knowledge was preserved, but it was traditional wisdom, not a scientific one. It was handed down like the old mystery knowledge from father to son and lived within the blood and hereditary forces of some families.
HAHNEMANN, in a precise and scientific way, had the great intuition to collect symptoms, not relating them to the disease but to the remedy. This was a tremendous step forward in the development of medicine. For it was HAHNEMANN who again opened the doors of the mysteries which had been closed since the time of HIPPOCRATES.
The history of medicine has two great pillars, the two great “H’s”, HIPPOCRATES and HAHNEMANN, the one who lived in Cos and the other who worked in Köthen; and we may rightly say that between Cos and Köthen the diagnosis of disease was the main element of medical knowledge. Before Cos and after Köthen, the diagnosis of the remedy was and will be the central theme of medicine.
Up to the time of HAHNEMANN, the Hippocratic tradition lived on in medical knowledge. In his book on Pathology, the great scientist ROKITANSKY of the Vienna School of Medicine still adhered to the four humours, the blood, the phlegm, the black and the yellow bile. His book was written at the beginning of the last century. After this time, with the dawn of modern medicine, the Hippocratic ideas disappear. Medicine changed from the art of finding the disease into a mixture of science and traditional rules of attending a patient. Apart from the pupils of HAHNEMANN, medicine has gone into the realm of science and disregarded the sick person. When Hippocratic ideas came to an end the new Hahnemannian way of healing started. What today is considered as Medicine in the medical books has in reality nothing to do with Medicine, but is Biology, Pathology and various other departments of scientific research which, instead of serving the physician’s work, have attained to a point where they dominate him.
I have now tried to show these two ways of Medicine. The search for the remedy and the search for the disease have their historical time. Both draw their knowledge from the study of Symptomatology. Symptoms in themselves, as we can read in KENT, are the reaction of the living man, not of his bodily tissues. How is it then possible that the same symptoms can evoke in one physician the picture of the remedy and in the other the picture of the disease?
We all know the experience that sometimes, when seeing a patient, suddenly we know, in an instant, the right remedy. We are struck by the image of Drosera or Antimony. We are convinced that this is the right drug and that it will fit the patient as a key fits its lock. How does this come about? It is not a matter of combined thought and impressions of outer symptoms, it is a sudden and immediate knowledge.
Would this be possible were it not that every man, in the deeper layers of his existence, in the wide realm of the unconscious, carried all the drug-pictures in him? Can one not imagine that all the various drug-pictures live in the deeper strata of man as potential powers, that we carry within us a complexity of forces which are Belladonna, Hyoscyamus, Calcarea carbonica, Sepia and Apis, etc.? In the patient these potential forces of the inner man create the symptoms. In the physician the same complexity of forces gives rise to the image of the drug-picture.
Suppose that Belladonna rises from the deeper layers of man to the surface, then these Belladonna forces create a complexity of symptoms which can appear, according to the patient’s condition, at one time as Pneumonia, at an other time as an inflammation of the eye, as a sudden rise in temperature only or as a fully developed Scarlet fever. If a physician with proper insight observes these symptoms, he will always recognize the same or a similar underlying combination of forces – the Belladonna type of symptoms – and immediately he will name the proper remedy.
Let us imagine that each one of our remedies is a melody; the symptoms which they produce are the score which they inscribe in the book of the body. If the physician is able to read the score, i.e. the symptoms, he will then discover the remedy, the right melody. Our Materia Medica is nothing but a collection of scores which we learn to read so that we may discern the right melody.
Outside in the world, there is the source of the melody : the plant Belladonna the substance Calcarea the metal Argentum, the bee for Apis. And now we discover that this melody, always the same in itself, has three different forms of appearance: the melody sounds in undisturbed and unmodified simplicity when outside in the world. It then appears as the plant, Atropa belladonna. Within the deeper layers of man the same melody is potentially existent and, when rising up to the surface, appears in many variations. These are the symptoms. All the variations are written down in our Materia Medica and the Physician has the task of discerning the variations, the simple undistorted melody. This is the Mysterium of Prescribing. But we will only be able to find the simple undistorted melody when, apart from studying it in its variations in the Materia Medica, we make a proper study of the pure melody in nature. We have a task before us to study Apis and Bellodona, Sepia and Sulphur, Gelsemium and Bufo, in their purity, as they appear in the world around us. This is the way of the true physician and PARACELSUS expressed it when he said: “The physician must go through the examination of Nature.”
If Homœopathy of today would start to work on this conception. I am convinced that it would be following the right path of development. The homœopathic Medica Medica is, today, very far from being comprehensible. To study it means a tremendous amount of work, of memorizing, of continuous exercising and training. In spite of this we often fail to find the right remedy. The reason is the almost complete neglect of the study of the pure “melody”, the substance as it appears in nature. Only this study, “the examination of Nature”, will add to the variations of the Materia Medica, the true melody, the archetypal picture of each remedy.
If, for instance, we start to study Apis, then we should not only learn the drug-picture as we find it in the Materia Medica. We should also try to study as intensively as possible the life of the bee and the beehive. The bees are insects and throughout the insect world there is one special instinct and underlying force of development and life; all insects are obsessed by their striving to reach the light. Every insect develops towards the light. Their eggs are laid in a dark place, for example in the bark of a tree, in a hole dug in the earth, in a specially folded leaf. Out of this egg the caterpillar or a further stage develops, and at last the image unfolds to live for a few hours or days in the radiant light of the summer. The drive of insects to seek a light during the night, the nuptial flight of the queen bee, the playing of the butterflies in the light of the sun, are all founded on the same instinct and desire. This instinct also underlies the life of all bees, especially the workers among the bees are those which possess the special Apis poison, and it is this substance which keeps them to their task. This substance clouds the desire for the light and makes the worker bee return to the hive. Let us imagine this strong desire to reach the light and the poison. Apis which counteracts this desire by its magic power, then many symptoms of the drug-picture of Apis will appear to us in a new light.
We may, for instance, remember the case which Dr. TYLER describes at the opening of her delightful account of Apis: a boy suffering from severe dropsy (ascites and hydrothorax). For many months this child was severely ill until an Indian woman suggested to the family the use of a bee. In a few weeks this child was cured; and KENT writes: “It is queer how old women knew, long before Apis was proved, that when the little new-born baby did not pass water they could find a cure by going out to the beehive and catching a few bees over which they poured hot water and of which they gave the baby a teaspoonful.” This all points, as we know, to the strong relation of Apis to the function of the kidneys. The kidneys regulate the whole of the water metabolism in the body and they work to /’;prevent our bodies from becoming too moist and watery. They remove continuously the waters rising in the body, and if they fail to function, the body is drowned from within.
These kidneys in us are filled with the same drive to the light which is inherent in all insects. Therefore, they have an intimate relation to our eyes and every disease of the retina. In fact, the eyes and kidneys can more and more be seen as two closely related organs. I would not hesitate to call the kidneys the eyes of our abdominal parts. If they fail to work, then this drive toward the light which is able to keep the rising waters of the body in check, is unable to act. Dropsy develops, in the eyes, in the skin, in the throat (diphtheria), actually on any of the serous membranes. The Apis patients is irritable and he is worse from heat. His skin is dry and hot and he develops high temperatures without thirst.
May we not feel in all these symptoms the hot summer days with the flying bees busily gathering the pollen and nectar and bringing it back to the hive? The Apis poison keeps the bees down to the ground and creates a balance between light and darkness. In our Apis patients this balance is broken, and therefore the waters rise and overwhelm the drive to the light.
By such an approach to the archetypal image of a remedy, studying its melody in nature and then returning to its variations in the Materia Medica, we can achieve a new but living understanding for the word “cure” in Homœopathy. In similar ways, we should have to study plants and minerals, but the time is now too short to go into further details. This way of approach, however, of learning through the “examination of Nature”, the true melody of our remedies is a necessity which we cannot forego. Only then will the true “Mysterium of Prescribing” gradually turn within us into a conscious act of healing.
Let us return to HAHNEMANN. He was born in 1755 and died in 1843. This makes him a contemporary of GOETHE who lived from 1749 to 1832. This man GOETHE, the greatest German poet, was also a great scientist. He started a new way of studying Nature, a way which is nowadays more and more recognized. It was for the “true melody” in Nature that GOETHE was searching and he conceived the idea of the archetypal plant. What HAHNEMANN did for the study of symptoms, for the finding of the new Materia Medica, GOETHE did for the realm of Nature. If Homœopathic Physicians would become earnest pupils of the Goethean way of nature study, then we should be able, in true Hahnemannian spirit, to celebrate this great physician’s bicentenary in a few years’ time. This path of approach was indicated by Rudolf STEINER, who fulfilled what GOETHE had begun.
We must learn to understand that drug pictures are not fleeting ideas and chance combinations, but that they are living entities, living forces, melodies which the physician can discern, which the patient can experience as his symptoms and which appear in their true form and melody around us in Nature. If this is gradually understood, then the doors of the temples which HIPPOCRATES closed behind him will be reopened and medicine will again turn into a true Art of Healing.