Following Up in Homeopathy: Hering's Law and the Direction of Cure

Hering's law of cure describes the direction in which a chronic case improves under the right remedy: from above downward, from within outward, from more important organs to less important ones, and with symptoms leaving in the reverse order of their appearance. At a follow-up, it helps you judge whether the patient is genuinely getting better or whether the complaint has only moved.

This article traces the law to its sources, then shows how to use it, with the Organon's own follow-up rules, at the second visit and after.

What is Hering's law of cure?

Constantine Hering stated the observation in his preface to the first English translation of Hahnemann's Chronic Diseases (New York, 1845), quoting his own earlier essay:

Every homoeopathic physician must have observed that the improvement in pain takes place from above downward; and in diseases, from within outward.

He went on: "The thorough cure of a widely ramified chronic disease in the organism is indicated by the most important organs being first relieved; the affection passes off in the order in which the organs had been affected, the more important being relieved first, the less important next, and the skin last." He called it a "law of order" and warned that "an improvement which takes place in a different order can never be relied upon."

Kent made it a central part of his teaching. In his Lectures on Homoeopathic Philosophy (1900) he describes cure as proceeding "from above downward, from within out and in the reverse order of the coming of the symptoms," and adds "that the latest symptoms will be the first to go away."

Put together, the classical statement has four directions:

Where does Hahnemann fit in?

Hahnemann did not formulate this law, but the Organon gives the follow-up rules that come before it.

§253 says that the first sign of improvement or aggravation, especially in acute disease, is in "the state of mind and the whole demeanor of the patient": with improvement, "a greater degree of comfort, increased calmness and freedom of the mind, higher spirits."

§255 tells you how to confirm it with a patient who cannot say whether they are better: go "through all the symptoms enumerated in our notes of the disease one by one," and check that there are no new unusual symptoms and that none of the old ones are worse.

§256 warns against the reverse case: if the patient reports "fresh accidents and symptoms of importance," treat the state as aggravated "even though he should good-naturedly assure us that he feels better."

Hering's direction is a further check on top of these: not only whether symptoms are better, but whether they are moving the right way.

How do you apply the law at a follow-up?

1. Start with the patient's general state. Energy, sleep, mood, appetite and the sense of well-being (§253). A patient who feels better in themselves is usually on the right road, even if a local symptom is unchanged.

2. Go through the original symptoms one by one (§255). Note each as better, same, worse or gone, and in what order they changed.

3. Ask about new symptoms. Distinguish truly new symptoms from old ones returning; ask "Have you had this before? When?"

4. Map the direction. Did the change move from within outward and from above downward? Did the most recent complaints leave first?

5. Decide. Wait, repeat, or reconsider the remedy, based on the direction as well as the degree of change.

Useful open questions at this visit (§87 still applies, so avoid suggesting the answer):

• "Since the medicine, what has changed first?"

• "Is anything you used to have coming back?"

• "Has anything appeared that you have never had before?"

• "How are you in yourself, apart from the complaint?"

Record the answers against each original symptom, with the date and the order of change. A follow-up note that only says "better" cannot show direction later.

What patterns does Kent describe after a remedy?

In his lecture on prognosis after the action of the remedy, Kent lists twelve observations. Several bear directly on direction:

• Third observation: "the aggravation is quick, short and strong, with rapid improvement of the patient," a favourable sign.

• Fourth observation: no aggravation, with recovery of the patient.

• Eleventh observation: old symptoms reappear. "In proportion as old symptoms that have long been away return just in that proportion the disease is curable," and they come back "in the reverse order of their coming."

• Twelfth observation: symptoms take the wrong direction. Kent's example is joint pains in the extremities relieved at once while the patient develops distress in the region of the heart, a transfer "from circumference to centre" that he regarded as unfavourable.

The twelfth is the one Hering's law guards against: relief on the surface while something deeper worsens is not improvement.

A short follow-up example

A de-identified case: a man of 42, first seen with long-standing eczema of the hands since adolescence, acidity for five years, and for the last year anxiety with poor sleep.

First follow-up (five weeks):

Read with Hering's law, this is a favourable picture. The mind and sleep, the most recent and deepest complaints, improved first; the acidity is following; the oldest complaint, on the skin, is temporarily more active. Kent's observations would counsel patience here rather than a change of remedy or a local application.

The opposite picture would worry you: the eczema clears quickly while the anxiety deepens and new chest symptoms appear. That is movement from the surface inward, the direction Hering said "can never be relied upon."

What are the limits of Hering's law?

Use it as a guide to observation, not a mechanical rule.

• Not every case shows all four directions. Many cures show general improvement without any visible return of old symptoms.

• Incurable and palliative cases may never follow the sequence; Kent treats them separately.

• Patients forget their history. The reverse-order rule only works if the order of appearance was recorded at the first visit.

• External treatment can mimic progress. A skin complaint suppressed by an ointment can look like improvement while the inner state worsens.

The law is only as useful as the first case record. If you did not note when each complaint began, you cannot tell whether symptoms are leaving in the reverse order.

How does HomeoNetix support follow-ups?

HomeoNetix keeps follow-ups as amendments to the case rather than overwriting it, so the first-visit picture and each change after it stay visible side by side. It tracks the direction of cure across follow-ups using Hering's Law, and keeps follow-up due and overdue lists so patients are seen when they should be. See all features, read our case-taking guide, or book a free guided demo.

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