Causation in Homeopathic Case Taking: Getting 'Ailments From' Right

In homeopathy, "ailments from" (causation, or aetiology) is the event or influence after which the patient's illness began: a grief, a fright, a soaking, an injury, a suppressed discharge. It is a separate category in the case, distinct from the Complete Symptom and from concomitants, and when it is definite it is one of the strongest pointers to the remedy.

This article covers what the Organon says about causes, the kinds you will meet, how to confirm a cause rather than accept a guess, and how to record it.

What does "ailments from" mean in homeopathy?

"Ailments from" names the cause of a state: the patient has never been well since a particular event. The phrase is the language of the repertories; Knerr's Repertory of Hering's Guiding Symptoms, for example, has a rubric "Grief, ailments from."

Causation stands on its own. It is not one of the three parts of the Complete Symptom (Location, Sensation, Modalities), and it is not a concomitant (a symptom that appears alongside the complaint). It answers a different question: not "what is the complaint like?" but "what did it come from?"

What does the Organon say about the cause?

Hahnemann distinguishes several kinds of cause.

The exciting cause. §5 says that "useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm."

The maintaining cause. §7 speaks of "a manifest exciting or maintaining cause (causa occasionalis)" that has to be removed. §94 asks the physician to look at occupation, mode of living, diet and domestic situation "to ascertain what there is in them that may tend to produce or to maintain disease, in order that by their removal the recovery may be promoted."

Acute exciting causes. §73 lists excesses in food or too little of it, chills, overheating, strains, physical irritations and "mental emotions" as exciting causes of acute illness.

How to find it. §93 says that if a disease was brought on by "some obvious cause," the patient, "or his friends when questioned privately," will mention it "either spontaneously or when carefully interrogated." Its footnote lists causes patients may not volunteer, among them "unfortunate love, jealousy, domestic infelicity, worry, grief," and over-indulgence, which the physician must elicit "by skilfully framing his questions, or by private information."

Why does causation carry so much weight?

Boenninghausen made the cause one of his considerations for choosing the remedy, in the essay Boger reprinted in Boenninghausen's Characteristics and Repertory (1905). In a passage the essay draws from his commentary on the Aphorisms of Hippocrates (VII, 12), he wrote:

So much depends upon a knowledge of the cause (Anamnesis) of disease, that without it the choice of a homoeopathic remedy cannot be made with safety.

He also noted that "practice has extracted and rendered the anamnesic symptoms easy of access, thus greatly restricting the list from which the selection is to be made," and gave colds as an example: "it makes a great difference whether they are contracted while sweating, by exposure of a part, being drenched all over or partly."

In other words, a definite cause can shrink the field more than any single symptom of the complaint itself.

The weight differs between acute and chronic cases. In an acute illness the exciting cause is usually recent, clear and easy to confirm, and it often leads straight to a small group of remedies. In a chronic case the cause may lie years back, and §5 asks you to look at "the most significant points in the whole history" rather than a single event, so causation is one strong element of the totality rather than the whole of it.

What kinds of causes will you meet?

Emotional causes are the easiest to miss and the hardest to ask about. The patient may not link a digestive complaint to a business loss, or may not want to.

How do you confirm a cause rather than guess one?

Patients often offer a cause that is really an explanation they have been given. A cause is reliable when:

• The timing fits. The complaint began within a plausible interval after the event, and the patient was well before it.

• The patient has "never been well since." The phrase itself, said without prompting, is strong evidence.

• The impression was strong. The event affected this patient deeply, whatever it might mean to someone else.

• The pattern repeats. Each episode follows the same exposure, for example every cold after getting wet.

Be cautious when the cause is a diagnosis ("it's my thyroid"), a guess from a relative, or something that happened years before the first symptom with nothing in between.

Ask openly, and give the patient room (§87):

• "When did you last feel completely well?"

• "What was happening in your life around the time this began?"

• "Has anything happened that you feel you never got over?"

Some answers only come at a second visit, or when the patient is seen without family present, exactly as §93 anticipates.

How do you record causation?

Write it in its own section of the case, in the patient's words, with the date or interval. A de-identified example:

Woman, 52. Joint pains, insomnia and palpitations for 18 months.

• Causation: "Everything started after my son moved abroad and stopped calling. I felt so insulted, after all I did for him." Onset about two months later.

• Complete Symptom (joints): small joints of both hands; stiff and sore; worse in the morning, better from continued motion.

• Concomitant: palpitations whenever the joint pain flares.

• Mind: dwells on the slight; cannot speak of it without trembling.

The cause here is not simply grief but a sense of insult and humiliation, and the difference changes which rubrics apply. Recording her words keeps that nuance, so you can choose the right "ailments from" rubric rather than the nearest one.

What mistakes should you avoid?

• Mixing cause into the complaint. "Joint pain after son left" buries the cause in a particular.

• Accepting the first explanation. Check timing and the "never well since."

• Flattening the emotion. Grief, mortification, disappointed love and indignation lead to different rubrics.

• Forgetting maintaining causes. If the cause is still active (a damp house, a hostile workplace), §94 asks you to address it, or the case will relapse.

• Over-weighting a weak cause. An uncertain cause should not eliminate remedies in repertorisation.

How does HomeoNetix record causation?

HomeoNetix keeps causation as its own section of the case, separate from the Complete Symptom and concomitants, so a definite "ailments from" is never lost in the history. The Kent, Knerr, Boger and Boericke repertories open from inside the case, and the AI case analysis writes out its classical reasoning for you to review; the doctor always decides. For the wider method, see our case-taking guide and concomitant symptoms, or book a free guided demo.

This article is for practitioners and students. It is not medical advice for patients.