The constitutions in homeopathy: critical and reasoned revision

The Importance of Constitutions in Homeopathic Medicine

Homeopathic medicine is the therapeutic discipline that is based on the concept of “disease of the like”.

The term comes from the Greek: ómois = similar and pàthos = disease and indicates the medicine that fully responds to the principles of the Law of Similitude: “similia similibus curantur”, formulated by Hippocrates (460-370 a.c.), Greek physician recognized father of medicine, according to which any substance (vegetable, animal or mineral) that causes in a healthy individual, a series of symptoms when taken in weight doses, is able to cure those same symptoms when taken in diluted (or infinitesimal) doses by the sick individual. Classic examples are the administration of the Arnica montana plant that causes blood transfers, while the homeopathic remedy Arnica montana helps to treat hematomas and hemorrhagic extravasations; the same applies to bee venom that causes strong irritation of the skin, while Apis mellifica properly diluted homeopathic preparation is the remedy of choice for allergic manifestations.

It is due to the German physician Samuel Hahnemann (1755-1843), the father of Homeopathy, the rediscovery of this principle and the development of the techniques of preparation of homeopathic remedies, still adopted, which provide for the dilution of the substance in hydroalcoholic solution and the subsequent dynamization (or enhancement) of the preparation at each subsequent step.

In Homeopathic Medicine, the choice of the remedy that must take place on the basis of the similarity of the symptoms, both physical and psychological, with those of the patient is of fundamental importance, because the higher the similarity, the greater the therapeutic action of the remedy used. One will, therefore, have to research The homeopathic remedy as similar as possible to the patient and his symptomatology or simillimum, as theorized in the studies by Hahnemann himself.

This indicates a very important aspect of homeopathic practice and that is the personalization of care, which can also allow the use of remedies in high dilutions, with a systemic, deep and effective therapeutic action.

On the contrary, traditional or allopathic medicine is based on the opposite principle of “opposites“, that is, on the use of drugs that have an action opposed to the symptom to be treated, in order to eliminate or mitigate it, for this reason it is also called “allopathic medicine” or “allopathy” (the term coined by Hahnemann himself), from the Greek words allos = different and pàthos = disease, that is, disease of the different, of the opposite. It is therefore a medicine that identifies the disease in the symptoms of the disease itself and the goal of the treatment systems is to suppress the pathological symptomatology in progress.

As previously emphasized, the therapeutic approach of Homeopathic Medicine, compared to the allopathic one, is different: the disease is not considered, but the patient is considered and for a careful analysis the patient’s symptoms alone are not enough, but it is necessary to take into account all the other somatic and psychic aspects that make the subject unique compared to all other subjects affected by the same disease. It will therefore be the task of the homeopathic doctor to seek through the patient’s history and its pathological manifestations, the homeopathic remedy most “similar” to him, that is, the most suitable simillimum for the treatment of his disease, that is…”of that disease in that patient”. Each homeopathic remedy then presents its physical and psychological symptoms, which must “fit perfectly” with those of the patient, that is, those possessed by that particular patient at that particular moment.

Each remedy presents, thus, very important distinctive characteristics sometimes even of a caricatural type, which refer to the concept of sensitive typology, classic examples are: Arnica montana which is the remedy of sports subjects, Aconitum napellus of hyper-reactive people, Actaea racemosa is the remedy for the hysteria of the woman or the neurosis of the man, while Carbonic limestone it is suitable for obese, anxious and depressed adult and so on. In Homeopathy there is, in fact, no general purpose drug, but different drugs for different organisms that are affected by diseases.
As for the sensitive type, this should not be confused with the constitution of the subject, as it is a characteristic of the homeopathic remedy, which in part can correspond to a series of morphological and behavioral characteristics of the subjects most sensitive to that particular medicine during the pathogenetic experimentation.

This concept of sensitive typology integrates well with the Patient’s Constitution to better identify the therapy suitable for that subject at that time of the disease.

The disease in Homeopathic Medicine must always be integrated with the patient’s history and his biological characteristics: heredity, previous pathologies, somatic aspects, psychic and behavioral symptoms, habits, feelings, reactivity to environmental stimuli and so on in what is called the “process of individualization“.

By thus grouping individuals into classes on the basis of homogeneous characteristics, it is possible to obtain the so-called “biotypes“, which are … “the complex of morphological, physiological and psychological characteristics proper to each subject, due to the interaction of the genetic heritage with the environmental conditions in which he lives, which make him unique”.

The study of biotypes is a very ancient practice that finds its roots in India with Ayurveda medicine and also in the religious practices of Buddhism. From all this complex of notions and knowledge derives the importance of the Constitutions in Homeopathic Medicine. On closer inspection, Western or Hippocratic medicine also takes into consideration biotypes, which refer to the concept of “constitution“, in which the morphological, physiological and psychological components influence each other.

Historically, in fact, we can remember that it was Hippocrates in the fifth century BC.c. the author of a first biological analysis of a constitutional type that, referring to the thought of the medical schools of Magna Graecia a century before him, extended the doctrine of the four fundamental elements (Air, Fire, Earth and Water) to human nature by introducing the theory of the four humors, according to which it is the phlegmous, blood, black bile and yellow bile humors that govern the human body determining its state of health or disease. The predominance of one of these moods over the others, which he linked to the anatomical structures and functionality of the organs, determined four psychosomatic typesphlegmaticsanguine, melancholic and choleric.

Subsequently, many other authors and in particular Galen (129-199 d.C.), reworked these concepts without changing the fundamental principles, but it is necessary to get to more modern times, around the middle of the nineteenth century, to have a real Classification of Temperaments still recognized:

■ Lymphatic or phlegmatic temperament: corpulent individual, with a tendency to obesity, calm, slow, lazy. The nutrition function prevails.

■ Blood temperament: an individual of normal appearance, ruddy, cheerful, active and tendentially unstable. Reproduction function prevails.

■ Nervous or melancholic temperament: thin, weak, pale, sad individual with frequent inhibitions. The receptivity function prevails.

■ Bilious or choleric temperament : a ruddy individual, with precarious balance, short-tempered, touchy, strong, with a tendency to excitement. The reactivity function prevails.

More recently, in the second half of the last century, Homeopathic Medicine, led by the French school, began to feel the need to proceed towards a more in-depth constitutional analysis that, always starting from the morphological, physiological and psychological characteristics of the subject, could better identify the “constitutional terrain” on which the disease had the possibility of settling , in essence, the potential tendency of an individual to get sick, i.e. his pathological predisposition.

The most accepted and still used classification of constitutions is due precisely to the aforementioned Homeopathic School French led by the doctor Antoine Nebel (1870-1954) and his pupil Léon Vannier (1880-1963), as well as to the most recent contribution of the doctor Henri Bernard (1895-1980) author of a series of important writings on human constitutions that, at the turn of the forties and fifties, in his Doctrine homeopathique, he managed to correlate the deductions of previous authors in a complex and synthetic model in which Homeopathy enters in its own right.
Four Constitutions are thus identified, which are reflected in as many homeopathic remedies progenitors:

■ The CARBONIC CONSTITUTION: corresponds to the brachy type subject, who has shorter limbs than the trunk, squat and large hands, round face, square teeth, has muscle stiffness, tendency to retain fluids and obesity. He is tidy, tenacious, but slow, cold and greedy, he loves to eat. Morbid predispositions are characteristic of age: in the child we will have mainly inflammatory skin diseases such as eczema, itching, urticaria, respiratory system and digestive system such as enteritis and gastroenteritis; cystitis, vaginitis or vulvitis in the female and finally eye diseases (conjunctivitis and blepharitis). In adults, on the other hand, there is a predisposition to rheumatic-degenerative diseases: arthritis, arthrosis, as well as to sclerotic pathologies: arteriosclerosis, atherosclerosis or sclerosis affecting various organs. He may also suffer from thrombophlebitis, hypercholesterolemia, diabetes and obesity. It is associated with lymphatic temperamentThe progenitor homeopathic remedy is Calcarea carbonica and all remedies containing carbon: Magnesia carbonica, Kalium carbonicum, Ammonium carbonicum, Baryta carbonica, Natrum carbonicum, Carbo animalis, Carbo vegetabilis, Graphites, Sepia.

■ The SULFURIC CONSTITUTION: corresponds classically to the normotype, that is, to a subject with a harmonious build, medium height and weight, well-developed and toned muscles, proportionate hands and fingers. Also called “neutral sulfuric“, which is dynamic, active, sporty, creative and sociable, and sometimes even unstable and fickle. Equally characteristic is the tendency to self-detoxification by accumulation of toxins. Generally it enjoys good health even if the pathologies to which it is mainly subject are borne by the cardiovascular and respiratory system and by the skin such as dermatitis, dermatosis, urticaria, acne, etc., as it eliminates accumulated toxins through the skin. It is associated with the blood temperament. The parent homeopathic remedy is Sulphur and all the sulfur-containing remedies: Sulfuric calcarea, Sulfuric magnesia, Natrum sulphuricum, Kalium sulphuricum, Hepar sulphur, Petroleum, Psorinum. Several authors further divide this constitution into two biotypes: the “sulfuric fat“, which has a sulfuric constitution but with carbonic notes and the “sulfuric lean” or “muriatic“which is closer to the phosphoric constitution.

■ The PHOSPHORIC CONSTITUTION: corresponds to the longitype, that is, to a slender, tall subject with long limbs with hypotrophic musculature, slender chest, triangular, elongated and pale face. Basically cold, lacks vigor, gets tired easily, but recovers just as quickly. He suffers from low blood pressure, is an intellectual, hypersensitive, emotional, idealistic, aesthetically conscious, melancholic, depressed and hypochondriac. The morbid predispositions of this constitution are neurovegetative dystoniadiseases of the nervous system or affecting the respiratory system due to thoracic insufficiency (pharyngitis, bronchitis, asthma, whooping cough, etc.) and then again rheumatic diseasesscoliosis, flat feet, gastroenteric disorders (colitis and constipation). It may be associated with nervous temperament. The most suitable homeopathic remedies are those containing phosphorus and the progenitor remedy is Calcarea phosphorica followed by: Kalium phosphoricum, Magnesia fosforica, Natrum phosphoricum, Phosphorus, Chamomilla, Pulsatilla.

■ FLUORIC CONSTITUTION: corresponds to a lean subject with pronounced asymmetry and morphological irregularity of the physique: elongated and thin fingers, characteristic are the descaled skeleton, muscle hypotonia, fragility and laxity of the ligaments. He is compared to the acrobat, he is a very intelligent subject, but unstable is the classic “genialoid”.. Its morbid predispositions are psychic instability tending to paranoia, scoliosis, sclerosis, osteoporosis, dental caries, joint problems (sprains, dislocations), low back pain, ptosis of vai organs (stomach, kidney and uterus), congenital hernias, varicose veins, hemorrhoids. The most suitable homeopathic remedies are those containing fluoride as the progenitor remedy which is Fluoric Limestone. The other remedies are: Fluoricum acidum, Mercurius solubilis, Argentum nitricum, Aurum metallicum.

It should be noted that several authors do not include the Fluoric Constitution among the basic ones considering only three, as they consider it as a pathological expression of the phosphoric constitution, corresponding to the most asthenic longitype.
Each constitution presents, therefore, as we have seen, very precise and sometimes even caricatured characterizations of the subject / patient from the psycho-physiological point of view whose identification is extremely important for the treatment and prevention of the various pathologies in Homeopathy.

In fact, each constitution corresponds to one more organs or systems predisposed to develop pathologies, and or not to function properly, Homeopathic Medicine, which uses this knowledge of “constitutional terrain” and “similar remedy” is certainly the one that can allow to implement a targeted and not generic prevention, and at the same time presents the greatest chances of success.
It is however evident that the aforementioned classification of the human biotype in the four constitutions is schematic so much so that, in reality, it is difficult to find an individual who can be completely identified in a single constitution, but often we will talk about subjects with mixed characters crossed between the various constitutions.

Numerous studies, from the same period and the following years of the twentieth century, have proposed other interesting classifications that have further expanded and deepened the subject. Great merit is due, in this regard, to the Italian endocrinologist Nicola Pende (1880-1970) for having elaborated, taking up the doctrine of his teacher Giacinto Viola (1870-1943), an analysis of the constitutions in which the connection between the morphological, physiological, psychological characteristics and the endocrine functions of the human organism is highlighted, thus laying the foundations for the introduction of constitutional endocrinology .

In fact, he observed how the functioning of the endocrine glands could act on the physical appearance and psychology of the individual. According to Pende, in fact, the.. “constitution is the resulting morphological, physiological and psychological, variable from individual to individual, of the properties of all the cellular and humoral elements of the body,..”. determined by the laws of heredity and contact with the living environment. Evident in this thesis are the links between modern Hippocratic clinical medicine or the “medicine of the sick rather than of the disease” and The homeopathic medicine of Hahnemann aimed at the continuous search for the “individualization” of the patient, with the study of his psycho-somatic characteristics and pathological predispositions, aimed at choosing personalized therapy according to the Law of Similarity.

Pende’s model and endocrinological approach underlie his biotypological classification. The endocrine glands most affected are the Thyroid, the adrenal or adrenal gland consisting of the medullary and cortical part of the adrenal gland, as well as the sex glands or gonads: Ovaries and Testicles; their main characteristics are those of being endocrine glands or glands with internal secretion, that is, glands whose products hormones, are directly introduced into the bloodstream.The school of Pende therefore describes four endocrine frameworks corresponding to as many constitutions in which it is always possible to distinguish a “stenic” phase of active defense and an “asthenic” phase of failure, differently present in each biotype, so we will talk about:

  • Asthenic brevilineum, characterized by poor functioning of the thyroid (hypothyroidism), adrenal cortical and sex glands (hypogonadism). It corresponds to the carbonic biotype or lymphatic biotype.
  • Stenic brevilineum, characterized by increased functioning of the adrenal cortical. It corresponds to the fatty sulfur biotype or blood biotype.
  • Asthenic longilineum, characterized by increased functioning of the thyroid (hyperthyroidism) and adrenal medulla, but poor functioning of the adrenal cortical. It corresponds to the phosphoric biotype or the nervous biotype.
  • Stenic longilineum, characterized by an increased functioning of both the medullary and the adrenal cortical (hypersurrenicism). It corresponds to the lean sulfuric biotype (muriatic) or the bilious biotype,although in reality the latter biotype can be associated with any constitution.

A further evolution of this theory of Constitutions is due to the French physician Marcel Martiny (1897-1982), a brilliant disciple of Pende, who with his studies introduced an embryogenetic constitutional analysis to see to give an answer to the origins of morphological, physiological, neuroendocrine and psychological signs, which enter into the characterization of the biotype. According to Martiny, in fact, the constitution of each individual depends on the development of the germinative disc and therefore of the embryonic leaflets that will give rise by differentiating, to all the structures of the human being. In the first three weeks of gestation, in fact, following the process of gastrulation, the germinative disc develops consisting of three layersthe endoblast from which the mouth, esophagus, stomach, intestines and numerous internal organs originate; the mesoblast from which the heart, blood vessels, muscles, lungs, blood elements (white blood cells, red blood cells and platelets) originate, etc., and the ectoblast from which the skin, brain, nerves etc. Originate. The predominance in the development of an embryonic leaflet over the others determines an exuberance of the respective organs of belonging and consequently the origin of three constitutions, to which a fourth is added when the three leaflets are in a situation of perfect balance. More precisely, the human constitutions according to Martiny are:

  • Endoblastic, in which the endoblast leaflet prevails. It corresponds to the asthenic brevilineum or the carbonic or lymphatic biotype.
  • Mesoblastic, in which the mesoblast leaflet prevails. It corresponds to the stenic brevilineum or the fatty sulfuric biotype or the sanguine.
  • Ectoblastic, in which the ectoblast leaflet prevails. It corresponds to the asthenic longilineum or phosphoric biotype or nervous.
  • Cordoblastic, in which the balance in quantity of the three embryonic leaflets is obtained. It corresponds to the stenic longilineum or to the lean sulfuric biotype (muriatic) or to the bilious, for which the considerations previously expressed apply.

In conclusion, the constitutional models and the theories related to them that have followed one another over time have been increasingly enriched and completed with the knowledge of the time. We started from the humoral model of Hippocrates based on the theory of the four humors, to move on to the psycho-somatic model of French Vannier based on the analysis of the physical and psychic characteristics of the individual, to which were added the endocrinological model of Pende based on the analysis of the endocrine functions of the main human endocrine glands and finally to the embryological model of Martiny based on the embryogenetic analysis of the primordial leaflets.

All these models, although starting from different or apparently different considerations and approaches, present points of evident similarity and profound convergence that confirm their validity and the correspondence of the methods thus treated. It is therefore possible to draw a schematic summary picture of the different models with their correspondences:



Brevilineo/ast. Brevilineo/sten. Longilineo/ast. Longilineo/sten. Model PendeMESOBLASTIC ECTOPLASTIC CO-EDOPLASTIC ENDOBLASTIC Martiny Model

It appears, from what has been explained and summarized, that the study of human constitutions assumes considerable clinical interest, in particular in Homeopathic Medicine, because it allows to obtain indispensable information on the characteristics of the patient and on his pathological predispositions, that is the “constitutional terrain“, in order to prescribe the most suitable remedy, that is, the one most “similar” to the subject or his simillimum. This will allow to implement a therapy of the disease in progress, also removing the possible root causes, and to prepare a preventive therapy aimed at the predispositions to get sick of the subject, so homeopathic therapy if well applied allows to carry out in addition to curative activity of acute pathologies, also to perform the important function of preventive medicine, always following the concept of individualization of Hahnemannian inspiration and that is that “homeopathy is the medicine of the sick with that disease“.


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