Prescribing on the basis of Direction of Cure

By Dr. Pierre Schmidt

Dr. Hering discovered the Law of Direction of Cure on the basis of his experience during treatment of chronic cases. The direction of cure takes place:

1. From above down;
2. From within out;
3. In the reverse order of their coming.

It follows that if the patient is given several remedies, either concurrently, or within a day or two of each other, you will never know to which should be ascribed the paternity for the reaction which is observed or even the cure and under such conditions there is little chance of being able to observe the action of the Law of Cure of Hering.

Of the three aspects, the two, which are, without doubt, the most important, are the return of the symptoms in the reverse order of their coming and their evolution from within out. The third, concerning their direction from above down, is rarely observed alone, but here is an interesting, case to illustrate such an instance. To illustrate the following are the few cases of Dr. Casez of France.

Case I

A forester of about 40 years of age went for a consultation because he was suffering from a high left lumbarischias with painful irradiations, which had begun some six months previously. The condition, which had worsened in spite of the recent administration of some very active anti-inflammatory and anti-neuralgic allopathic medication, had reached the point where the pain was unbearable.

Neither examinations nor X-rays revealed an osteo-articular lesion and locally there was such a severe and painful contracture that vertebral manipulation and reposition were out of the question.

All of the patient's symptoms were crying out for Rhus Tox so that no doubt could be entertained as to the choice of remedy. He was given a single dose of Rhus Tox. XM to the exclusion of any other therapeutic treatment.

Eight days later, alas! He was still suffering, but with a certain change. "My back is alright ", he said, "but you have displaced my trouble and I am now suffering with pain in the calf of my leg so that 1 am unable to walk."

The characteristics were still the same and again he was given Rhus Tox.

The following week he came back again, with a big smile, saying: "If you will please give me a few more of those pills I think I shall be cured. I have no more pain in the calf but it has gone down to my ankle."

And; true enough, one more dose of the remedy had the desired result, the pains disappeared completely, so that in no time he was able to make his rounds through the forest unimpeded.

This was a 'typical example of the evolution of the pain from above down. Already at the time of the second consultation it was possible to predict the favorable course of the treatment and the cure, which was to follow. 

However, as a rule this aspect of the Law of Hering, from above down is usually observed in conjunction with the other two.

Case II

Dr. Casez was treating a lady who was suffering from chronic headaches, which had begun with cervicalgia, with stiffness of the nape of the neck. Then contractions of' the neck muscles with pains soon extended towards the vertex, the forehead and the supra-orbital region.

This case was really a puzzle to the doctor since; in spite of his most painstaking symptomatic research and every effort to help the patient, who co-operated fully, the results were most discouraging.

At last she had had to resort to anti-neuralgic drugs to deaden the pain (which, after two years, had in fact become permanent) and Dr. Casez was most concerned about the Toxic manifestations, which such drugging would provoke.

The patient underwent every possible examination. Numerous local treatments of the cervical column were carried out including locally applied fango, manipulations, repositions and physiotherapy, but all to no avail.

Some months ago, after failure of the homoeopathic treatment, which had been applied, to this chronic condition for over two years, he decided to retake the case completely, just as though he had never seen the patient before.

After pondering at great length over the anamnesis and studying most carefully the results of the minute symptomatologic research which he had carried out, he decided to follow the excellent advice of Sir John Weir of London: "To find the minimum symptoms of optimum value".

These were:

1.  Abnormal susceptibility ("offended easily" in the Repertory p. 69).
2.  Retropulsive vertigo (p. 99-Fall, tendency to, backward).
3.  A typical night diarrhea at varying hours, but always after midnight (p. 610).

The patient was given a remedy, in the 200th potency, which best covered, these three symptoms and which truly represented the minimum and most characteristic symptoms of the patient, i.e.

• One mental symptom.
• One subjective symptom.
• One peculiar objective symptom colored by the modality of time.

After several hours of typical aggravation of the neck and head pains, followed by a night diarrhea much more copious than usual, she was entirely freed from both the pains and the night evacuations.

But then, several days later, the doctor was called by the patient who was suffering from pains in the lower part of the back and was unable to straighten it without great suffering. He then asked himself whether this was an illustration, in accordance with Hering's law, of the- disappearance of the symptoms "from above down" when the lady remarked "You know, doctor, these were exactly the same pains which I used to suffer from before I started having the trouble in my neck and head"!

Thereafter every aspect of her sufferings disappeared and she was able to leave her tablets and suppositories in the drawer of her beside table:

Here we witness a double expression of the same process of cure with a centrifugal direction; it is an association of Hering's law regarding the return of symptoms "in the reverse order of their coming" and evolution "from above down".

The three remedies responding to this special symptomatology were, in order of importance:

1. Nux Vomica
2. Sulphur lod, and China off.

Nux was given although considered as a typical remedy for constipation.

I believe that if we avoid all prejudice, either in favour of, or against a particular remedy, we shall have no reason to regret it!

From these different cases we may conclude that the pathological lesions progress and become worse continually. This process is hastened when camouflaged by palliatives and then we clearly see the direction "from outward within". It is often through the skin th3t they manifest themselves and then the centers themselves are affected. Here the aggravation goes: "from the periphery to the center".

Inversely an amelioration of the center (the most recent manifestation) towards the periphery (of much longer standing) would imply an unrolling of the symptoms "in the reverse order of their coming".

These few examples, ladies and gentlemen, are surely an eloquent justification of the unicist Hahnemann Homoeopathic prescription. And to guide us through the darkness which so often besets us and we have a wonderful compass in the Law of Hering.

Case III

By Dr. A.U. Sriram M.B., B.S., M.F. Hom.

Patient M. came with pain in abdomen of about 5 years' duration. Pain starts at 5 p.m. lasting till 7 or 8 pm.Vomiting a few minutes after eating. Vomiting ameliorates pain. Visible peristalsis present. Warm food ameliorates pain.

• Ghee agg.
• Desires Salt, Milk++,
• Constipation,
• Mental make up: Irritable; Fear of high places+ +
• Not fastidious; no anticipation

17.7.58: Sulphur 200

13.8.58: Pain not as severe as before. Placebo.

8.10.58: Patient very much depressed. Attempted to commit suicide in august: Nat Sulph 200

21.10.58: Patient free from pain now. On some days he has eructations. An ulcer of the size of half inch in diameter has developed on the external aspect of right leg since the l4th. Generally feels much better. Placebo. Advised no external medication for the ulcer on the leg.

5.11.58: Ulcer on the leg now has grown big (1 inch in diameter), painful of late, but no gastric trouble. Patient given placebo. No interference since the ulcer on the' leg is the result of exteriorization.

6.12.58: Ulcer on the leg almost healed up, but the patient again has the old trouble of evening aches in the tummy. On enquiry it was learnt that the patient had consulted another doctor who had prescribed something for the topical application and had given two injections of penicillin. Though the patient was thankful for being enabled to walk without any pain in the leg; he was not as cheerful as on 5.11.58. The depression is marked this time. Natrum Sulph 10 M was given.

16.1.59: Abdominal pain gone. But the ulcer on the leg has again begun to spread, much to the dismay of the patient. This time he was advised that all the needed in-patient waiting for the ulcer to heal and no suppression should be attempted.

3.2.59: The ulcer on the leg healed up. No pain in abdomen.

13.3.59: Patient reported having had no trouble ever since.

This is an instance how the ulcer on the leg was the external manifestation of the internal gastric ulcer. It proved the Hering law of the direction of cure which occurs from within out.

Let me close by quoting, word for word, from the epilogue of Hering's publication:

"But alas! The rules, which the experienced founder of Homoeopathy lays down in the subsequent work (Chronic diseases) with so much emphasis, are not always practiced, and therefore, cannot be appreciated. Many oppose them; cures which otherwise might be speedy and certain, are delayed; much injury is being done by the wiseacres who intrude themselves into our literature and mix with it as chaff with the wheat. On all this we may console ourselves with the expectation that also in the history of Science there will be those great days of harvest, when the tares shall be gathered in bundles and thrown into the fire."

And now Hering again says:

"It is the duty of all of us to go farther in the theory and practice of Homoeopathy than Hahnemann has done. We ought to seek the truth, which is before us, and forsake the errors of the past. But woe unto him who, on that account, should personally attack the author of our doctrine; he would burden himself with infamy. Hahnemann was a great savant, inquirer, and discoverer; he was as true a man, without falsity, candid and open as a child, and inspired with pure benevolence and with a holy zeal for science.

"When at last the fatal hour had struck for the sublime old man who had preserved his vigor almost to his last moments, then it was that the heart of his consort who had made his last years the brightest of his life, was on the point of breaking. Many of us, seeing those who are dearest to us engaged in the death-struggle, would 'exclaim why shouldn't thou suffer so much! So too exclaimed Hahnemann's consort: "Why shouldn't thou who hast alleviated so much suffering, suffer in thy last hour? This is unjust. Providence should have allotted to thee a painless death".

"Then he raised his voice as he had often done when he exhorted his disciples to hold fast to the great principles of Homoeopathy, "Why should I have been thus distinguished? Each of us should here attend to the duties, which God has imposed upon him. Although men may distinguish a more or less, yet no one has any merit. God owes nothing to me I to him all."

"With these words he took leave of the world, of his friends, and his foes. And here we take leave of you, reader, whether our friend or our opponent."

"To him who believes that there may yet be truths which he does riot know and which he desires to know, will be pointed out such paths as will lead him to the light he needs. If he who has sincere benevolence and wishes to work for the benefit of all, be considered by Providence a fit instrument for the accomplishment of the divine will, he will be called upon to fulfill his mission and will be led to truth evermore.

It is the spirit of Truth that tries to unite us all but the father of Lies keeps us separate and divided." -Dr. C. Hering Philadelphia, April 22; 1845.

Updated on: 01 Feb 2010