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What is constitutional prescribing?
WHAT IS CONSTITUTIONAL PRESCRIBING?
(By Louise Barton Training Manager VCCH)
Constitutional prescribing is the foundation and basis of all chronic disease prescribing and yet what is it? How can we define constitutional prescribing - and are we all understanding it and practising it in the same way?
Constitutional prescribing is treatment based on the whole person – that is the mentals, generals and particulars. Some methods also include a miasmatic interpretation. In the case of Homeopathic Facial Analysis (HFA) the miasmatic dominance of both patient and remedy must match to include all aspects of totality. The miasm is interpreted from facial structure while the totality is taken from repertorisation of symptoms with emphasis on generals.
The way constitutional prescribing is applied throughout the profession can be sorted into various categories – essence is a broad term that implies the “heart” or totality of the person is being taken into account and is a subcategory of constitutional prescribing
While our college promotes the HFA method we also offer as much information as we can to support the profession in making up its own mind as to how they practice and why they practice the way they do. It is fundamental to any profession to understand its own principles and to question why such variation of principles exist at all and why a particular method is chosen. Consider the following -
- HFA method – totality with miasmatic base (Hahnemannian except the face indicates the miasm rather than pathology)
- Hahnemannian – totality with miasmatic base (miasm is based on pathology) – this approach is common in countries with higher numbers of patients such as India and is also the basis of homeopaths who call themselves Hahnemannian - although they often use an essence approach which is not Hahnemannian.
- Essence – developed via Kent, Tyler, Vithoulkas – a picture of the behaviour of the person combining their symptoms (no miasm) – the irony of this method is that Kent said himself it was a folly (in a letter to his niece Margaret Tyler) – she wrote Drug Pictures anyway – which is often a year 1 homeopathy book. The concept of essence was reignited in the 1980’s when brought to the US. Kent lectured with an emphasis on essence (it is more interesting for students) but in his clinical cases only used symptom totality and didn’t use the mental pictures at all. Hahnemann warned against using doctrine of signatures or essence early on in the development of homeopathy.
- Sensation method – uses an essence approach but builds upon the link between the mentals and the physicals – a red thread approach – also incorporates kingdom and a miasm filter – which is determined by how dominant that remedy is in the matching pathology in the rubrics – eg Baptisia = Typhoid rating of 3 = Typhoid miasm (however the rubric Typhoid has 150 remedies including Sul, Merc, Phos also rated 3 – all of which are allocated to other miasms).
- Periodic table method – uses an essence approach based on mentals and stages of life – very much a psychological model – physicals are added in (where they fit) but mostly interpretative – remedies often based on meditation provings or synthesized mixing of two elements. No miasm included.
- Keynote method – uses totality and pathology – partially like a Boenninghausen method – location, sensation, modality, concomitant – but the emphasis is on the pathology eg if a patient is < night, < heat and has skin issues they will get the remedy Sulphur. No miasm included. This method is popular in countries with a high patient turnover – some practitioners also attempt a layers model of miasms – where they throw in a nosode or a remedy that is “miasmatic” at certain times – to move the case along.
- Boenninghausen method – location, sensation, modality, concomitant – not taught or used much but a very sound starting point for most repertorisations. HFA repertorising is modelled on this approach but also adds mentals as a life theme – that is generalising the mentals and mostly removing emotions and replacing with circumstance where applicable. Boenninghausen did not use a miasmatic approach although he wrote letters to Hahnemann about miasms – questioning their validity.
- Polypharmacy – remedies high in rubrics for particular pathologies – put together in one prescription for that pathology.
- Machine testing/kinesiology – any one or more of the above approaches combined and then a machine or muscle testing making the final remedy decision.
These methodologies cover most of the world's prescribing methodology although there are more than one hundred methodologies within homeopathy many of them variations of the above. Such variety of interpretation and application points to a lack of standardisation within the Homeopathic profession. Standardisation is important for any profession which seeks to be validated and to provide consistent results to its patients.
At the Victorian College of Classical Homeopathy we have developed a standardised approach to all cases of chronic illness - Homeopathic Facial Analysis (HFA). Proven over ten years of research and clinical application HFA meets the criteria of a standardised approach to constitutional prescribing.