Ok folks, this is a big one!  I honestly have been putting this one off for a bit, because it’s just SO BIG.  But also quite vague.  So it’s difficult to truly understand what, specifically, he is asking us to do (for me anyway).  But I will go into some of the different interpretations here and you can decide what to take away from this aphorism.

Here’s the text (Kunzli, Naude and Pendleton translation):

First the easy stuff

Note how this aphorism is introduced:  “In addition, it will help the physician to bring about a cure if…” The aphorism clearly sets up a hierarchy, like in aphorism 3 and 4.  The things in this aphorism will help, but are not required in restoring someone to health. While I said that it’s hard to know exactly what he is telling us to do in this aphorism, we at least know that whatever he is talking about is not vital to practice. 

Exciting causes

Next, note that the first part of the aphorism makes a distinction between acute and chronic conditions, as well as exciting and fundamental causes.  With an acute, he asks us to pay attention to the exciting cause of the acute.  In practice, these are often our etiologies.  Etiologies can be seen as essentially very strong aggravations.  For example, a high fever after a cold, dry wind.  The cold wind is the etiology of the fever.  In other words, the wind caused the fever.  But you could also say that the person was made worse from the cold dry wind.  So when you are analyzing a case, know that these “causes” can be translated into the words “worse from”. 

The idea of an “exciting” cause I think is useful.  Because do cold, dry winds truly cause a fever?  No.  A cold, dry wind, has to meet a susceptible individual, and only then will it trigger a fever.  In other words, not everyone gets a fever after a cold, dry wind or after washing their hair in cold water, but for some people, that’s a trigger.  The wind is not a true “cause” of disease.  However, knowing these exciting causes can be useful in determining the correct remedy in practice, because these “worse from” symptoms are often the most helpful type of symptom in determining a remedy.

Fundamental causes and miasms:

This is where it gets a bit complicated, so buckle up. 

I have a post on the basic idea of miasms, because it’s a bit too much to go into here.  But the basic idea is that Hahnemann felt all chronic disease started with an infection.  The infectious agent stayed in your body for decades, making you worse and worse.  The infectious agent caused everything from asthma to cancer to arthritis to dementia. 

I know it can be a bit difficult to wrap your head around it.  But basically, he felt that we walked around, perfectly healthy, until we met with a certain infectious agent, which he called psora.  The psora would reproduce in the body and create an infection, the first symptom of which would be an eruption that looked like herpes, eczema, psoriasis, poison ivy, anything like that.  From then on, we would get one condition after another as the infection got worse and worse. 

When he says that in chronic disease, the phases will show you the fundamental cause, meaning a chronic miasm, he means, I believe, that the symptoms a person has will show if they have been infected with psora, syphilis, sycosis or a combination of the three.  In other words, you had genital warts (sycosis), a chancre (syphilis), or an eruption like eczema, herpes, cradle cap, or psoriasis (psora) in your history. 

So when he says the fundamental cause is a chronic miasm, he’s saying either psora, syphilis or sycosis is at play. 

Exciting Causes and Chronic Disease:

This is a slight digression from this aphorism, but know that there are “exciting” causes of chronic diseases, as well as acutes (this comes up more clearly in the footnote to aphorism 206). Think about fibromyalgia.  The common story is a relatively healthy person in their twenties goes through a stressful period, gets a flu and suddenly develops fibromyalgia.  Not everyone has this story, but it’s common for fibromyalgia.  Did the flu actually cause the disease?  Or did the stressful time actually cause the disease? I don’t think Hahnemann would have thought so.  In view of his chronic disease theory, the person with this story was infected with psora years before the flu or stressful event, and the flu/stress triggered the psora to become active and morph into what we call fibromyalgia.  So like with acutes, we can think of these triggers as aggravations or modalities in our case analysis. 

We actually know this phenomenon well with chicken pox.  You are 10, you get exposed to someone with chicken pox, a few days later you develop some red pox.  It goes away, but 10 years later you get stressed out studying for your college exams and suddenly you get shingles!  The virus has been living in your spinal column for 10 years, waiting for a trigger to break out and cause more mischief.  Understanding the triggers and what the shingles looks like, maybe even how the chicken pox presented years ago, will help with finding the correct remedy. 

Significant phases in Chronic Disease

If we look at his theory of chronic disease, where you have this moment in time where suddenly you are infected and then get issue after issue after issue, then you need to take the case of all (or many of) the different conditions that have come up.  This how I interpret the idea of significant phases.  There was an eczema phase, then the person got an asthma phase, but now they have a depression phase.  You need to understand the eczema, the asthma and the depression, not just the depression, because they all are part of the same disease process; they are unique phases of the same disease. 

“Attendant Circumstances”

At the end, he says a practitioner “should consider: the evident physical constitution of the patient (especially in chronic affections), his affective and intellectual character, his activities, his way of life, his habits, his social position, his family relationships, his age, his sexual life, etc.”  In later aphorisms, he will refer back to these as the “attendant circumstances” (see aphorism 7). 

But again, does he say why we should consider these?  No.  He just says to consider them.  There are a couple different ways to look at these attendant circumstances.

First, this might be from his chronic disease theory again.  In his book on the topic, he seems to believe that your constitution, living conditions, the way you comport yourself and your education, all impacted which chronic diseases you got after you were infected with Psora.  Look at the following excerpts from his book on chronic diseases:

So someone who values romantic relationships and gets infected with Psora may develop anxiety or hysteria (as they called it then) after a breakup, whereas someone who is largely driven by finances might develop an ulcer and become irritable if their financial security is threatened. These people both have Psora, but will need different homeopathic remedies and have different manifestations of Psora.  

The second way to look at this, is that different constitutions need different remedies in general. There are some books that will say a remedy is good for someone who is muscular, or someone who has dark hair or light eyes.  So perhaps he’s saying to pay attention to someone’s constitution, because it will help you determine the correct remedy.  But I tend not to believe those statements in books, to be honest.  Because you know who they tested remedies on?  Europeans.  So do you think there were a lot of dark people doing testing for homeopathic remedies? No.  And they never really define “dark” people anyway.  Is a brunette a dark haired person, or only someone with jet-black hair?  Unclear.  And I don’t necessarily think that just because you are a light colored Swede you need one remedy, and just because you are dark and descended from people in Ghana you need another remedy.  Racial issues in medicine are just too sticky.  I’d rather pay attention to clear, pathological, symptoms rather than hair color.  But that’s just me. Hahnemann may have thought differently.

The final way to look at these attendant circumstances is from a hygiene perspective.  Aphorism 4 and part of aphorism 3 are about hygiene remember.  Much later in the Organon, he says that these attendant circumstances should be looked at to see if they may be aggravating the person’s disease, or whether they may impede treatment (aph 208).  So he may be bringing up the person’s living conditions here as part of what you should investigate, in order to remove obstacles to cure.

The issue of its fuzziness

The reason I said that this is a vague aphorism, is that he doesn’t actually, explicitly say that these things I have talked about – getting etiologies and modalities in a case, taking the case of all the different conditions the person has had, are what we should do.  He just says to investigate the exciting causes, significant phases and attendant circumstances. But what do we do after we investigate them?  How is the investigation supposed to be useful?  He doesn’t say here. 

In aphorism 3 he tells us what is vital for a practitioner to know, but in aphorism 4 and 5, he tells us what is helpful for a practitioner to know.  He’s still speaking in vague, general terms, because he’s still setting the stage for the rest of the book.  We are only on aphorism 5 out of 291 – he’s just warming up right now! 

However, the difference between aphorism 4 and 5 is that aphorism 4 deals with something we all have a basic understanding of – hygiene – whereas aphorism 5 deals with things that are not clearly defined or part of our basic understanding to begin with.  In aphorism 5, exciting causes are not well defined, fundamental causes/miasms are not well defined (and his theory on miasms was unusual even at his time, so even when he wrote this it would not have been clear what he was referring to exactly), and the purpose of  attendant circumstances are not well defined.  In aphorism 4, he also clearly tells you why hygiene is important – you need to correct it if you want cure to be permanent.  In aphorism 5, he does not say why investigating these factors is helpful.  He only says that they will help bring about a cure. 

So again, I have tried to put together pieces from the rest of the Organon for you and some from Chronic Diseases to help you understand what I think he means, but he is not explicit here.  I have heard aphorism 5 used as “evidence” for one or another method of case taking/case analysis, and I think its vagueness is why seemingly contradictory schools of thought use it as “evidence” of their Hahnemannian-ness.

Conclusion

So there you have it.  Aphorism 5 tells you to pay attention to the exciting causes of disease, the significant phases of chronic diseases and a person’s physical, emotional and mental characteristics because all might help get you a good remedy.