Acute vs. Chronic Totality in Homeopathy

Acute vs. Chronic Totality in Homeopathy
Acute vs. Chronic approach to Totality
  • In ACUTE CASE we start with parts (perceived as symptoms, sensations) and the right remedy reveals the totality.
  • In CHRONIC CASE we start with totality (perceived as a landscape) and the right remedy reveals the parts that have been hidden so we become aware of what stands behind the disease.

Well, I see we need to work on vocabulary a bit.


There is a Totality (yes, a capitol T) that encompasses both manifested (Yang) and not-yet-manifested (Yin). It is everything. James Jealous calls it “the Tide” and that reflects his relationship with It. You may call it the God or the Consciousness or the Ultimate Reality or the Absolute… It does not matter actually, It has no name.

Our job is to keep all our attention on It until parts (sensations, symptoms, ideas, whatever – “me” including) dissolve completely. It’s inner Alchemy, it’s like making a homeopathic remedy out of practitioner: diluting myself again and again – up until I can’t find it no more, so just the pure Awareness remains. So if we speak about Totality, it’s THAT Totality.

It is divine. We may say it’s Healing in it’s pure form. The only problem (and it is not the problem at all!) is that there is no way to speak about It.

Theoretical totality

But then there is a totality as a technical term. Homeopaths speak about “totality of symptoms” so often. But even if it seems pretty clear at a first glance, they still can’t find a proper definition to it. Well, dealing with a concepts is always tricky.

Nevertheless, one aspect that all the homeopaths seem to agree on is that totality is always more than the sum of the parts. (Or maybe we should say it is beyond the parts?)

  • Intellectual homeopaths think of totality as some logical scheme where the patient’s symptoms are arranged into some order.
  • Philosophically minded colleagues refer to the totality as a meaning of the disease: discovering it appears to be essential for healing.

Both of these two concepts seem to work in practice. And yet there is an astoundingly simple yet radically different approach to the totality:

Perceptional totality

A perceptional totality is simply what we perceive by senses at a present moment. It is as simple as that. It is what we sense. But it is not what we think we sense or what we think we should sense!

Ridiculously, perceptional totality is impossible to describe. Writing a whole book on it makes no sense. Speaking much about it is of no use either.

Perception always is happening live, i.e. now. It is never in the past or in the future. We can’t see or hear or experience anything neither in the past, nor in the future. For a sensory perception the present moment is all that exists. Whenever we want to describe it, we step out of present moment… Wait! We can’t do that, there is no way to bypass it – so we create an illusionary timeline by thinking – and we loose the presence in an instant.

Our description and actually the very effort to describe what’s happening now suddenly appears to belong to the past. Present moment is always out of reach for our intellectual minds. Perceptional totality is not smart at all. It is too simple to comprehend, actually. Comprehending it is already a mistake!

Perceptional totality includes everything we perceive NOW and does not include what we do not.

For smart guys that’s a little hard to understand. When we are smart we know something exists even if we do not perceive it. Knowledge becomes superior to sensing. So if we know it has to be there – we say it’s there, even if we do not sense it.

In our present practice we’ll have to become like children looking at the performance of a magician: if a rabbit has disappeared in his hat, it has disappeared. For our senses it is the reality. Senses, perception, Heart (these are all synonyms) are not smart at all.

Trusting our senses rather than intellect may seem primitive. But in our practice we are going to experience numerous sensations that are even more ridicule than that performance of the magician. Many of them will be not only impossible to explain, but actually, hard to believe!

In our daily practice with the patients Life is a magician. And we become the witness of It’s performance. We listen to the language of senses that is the language of our bodies and the language of Life itself. Life Itself guides our attention through sensations and we learn to trust that guidance more than our minds.

If we follow this path, little by little we start to perceive reality as it is. It’s like waking up from a dream: reality appears to be radically different from what we’ve been thinking. This is the perceptional totality we are speaking about.

And maybe some day we’ll discover the Ultimate Reality, the Self or the Totality from a capital T. We’ll discover that perception is absolutely transparent and emanates from that Totality. And the true practice of Present Homeopathy will begin.

In Present Homeopathy Totality is everything. It is Alpha and Omega. We welcome the patient in It, we finish consultation in It. It is as essential as air we breathe. But it’s neither intellectual/philosophical, nor perceptional.

We should always remember a bitter truth: in no way we can perceive the Totality. Actually, all the perception is emanating from that Totality. We experience the perception from that Totality. Ultimately, Totality is the Self or Consciousness that perceives, but It has nothing to do with parts “me” including. There is no “me” who has separate perception!

There is no way we can speak about Totality. All we can do is to listen. And if we truly Listen – we do it from the Totality. But if we speak, if I write – that’s about the perceptional totality which is what we perceive in our Hearts.

Approaching perceptional totality is radically different in acute and chronic cases!

1. Acute / manifested totality

Classical Homeopathy is typical Yang approach that has been developed primarily for treating acute illnesses. ACUTE CASES present lots of details (manifestations, Yang): we have many vivid symptoms/sensations to catch our attention, but totality is missing. Therefore our job here is to reveal the totality. That’s what classical masters have been teaching.

You know, an acute case is like a mosaic. I hope Lewis Lavoie does not mind to give a small, but a very important lesson to homeopaths. Here is his Town of Cochrane Mural Mosaic “Trust” made out of 216 paintings by 190 artists. The author’s talent to arrange them into such a totality is amazing. He’s done the work that many homeopaths are trying hard to accomplish on each consultation with their patients.

Lewis Lovoie “TRUST” Town of Cochrane Mural Mosaic

In acute cases parts are pretty evident for “a keen observer” (speaking in S. Hahnemann’s words). Symptoms that are manifesting in a present moment as we sit with the patient are evident, aren’t they?

Lewis Lovoie “The Hang Glider”

Acute symptoms are like “The Hang Glider”. Just look at it. For a keen observer (all it requires is attention) “The Hang Glider” is pretty evident for what it is, isn’t it? I mean there is nothing esoteric in it, nothing our eyes can’t see by a normal sight.

What should we do (except of simply watching with 100% of our attention involved) for it to become even more evident?

  • Should we try to glimpse onto it through a microscope and reveal the details even the painter has been unaware of?
  • Should we try to reveal what’s hidden, e.g. try to figure out what’s behind these sunglasses or shawl? (Here we probe our patient with numerous questions or use some other sophisticated techniques.)
  • Or should we stay content with just what we see?
    • leaving everything as it is;
    • not enhancing the view in any way;
    • but stepping back up instead and letting the the picture to dissolve in the totality that’s around?

Well, if we choose the latter approach, The Hang Glider dissolves in totality transforming* transmuting** into… an Eye of the Horse! (Check “The Trust” above.) All the problems related to “The Hang Glider” disappear in an instant.

* – Transformation happens gradually: we listen to a sensation and we witness how it changes. We witness the very process of transformation. It’s like watching the artist to take a brush and make small or maybe huge corrections to the picture. Or watching someone repairing something. Or in our job we may be witnessing how a patient responds to a remedy and his symptoms are gradually relieved and transformed. For example, with the right remedy pain may change gradually loosing it’s sharpness, dissipating until it is completely relieved.

Pretty often that pain isn’t cured, but a translocation happens and we find ourselves on another level, e.g. in a minute or two some suppressed emotion that has been hidden behind that pain may start to manifest. Consider translocation to be a transformation extending to another level.

** – Transmutation is the ultimate cure that happens instantly, but it cannot be explained or even observed. We look at “The Hang Glider” and other paintings, maybe we step back a little and then suddenly the Totality happens and we are overwhelmed by a much bigger picture. It’s so different and so stunning we instantly forget its parts. When we recover from that surprise we start looking at parts but they are transmuted: we cannot find glider anymore, we see horse’s eye instead.

That’s exactly how symptoms undergo transmutation when we get in touch with the Health/Totality and It takes over, literally dissolving everything into Itself. James Jealous calls it the Tide and it’s hard to find a term more exact than that. When the Tide falls – we look around and see things transmuted.

Imagine we sit with our patient and play with the remedies in his/her fragmented world:

  1. We listen to parts that are prominent (symptoms, sensations, whatever) while testing (i.e. listening to) the remedies. With some particular remedy suddenly that BOOM! happens (an extremely silent one, by the way) – and we’re stunned by that instant change of perception. Everything becomes ONE.
  2. We discover The Reality in our patient’s world. It is very different from what anyone can imagine. It is simple. It does not add anything to what we perceive by senses. And nevertheless it is perfect and divine: all parts (sensations including) disappear completely.
  3. After some time they start to “come back”. We gradually return to the world we know. But parts have been transmuted: they are different now. Sometimes just a few of them, sometimes literally everything is different. We’ve seen their place in Totality and that transmuted them forever. They call it the cure in Classical Homeopathy.

The mechanism of the cure is always the same. It happens because of the Totality.

The Totality reveals Itself. We do nothing for it to happen so the real cure appears to have nothing to do with our efforts, skills or remedies.

Look, we really do nothing to discover “The Trust” (that guy hugging the horse). All we can do is to take care about parts by simply observing them. So perhaps we’ve been observing the bunch of 216 paintings and suddenly they merge into one loosing their individualities. Have you really done something for that shift in perception to happen? Not concentrating on these separate paintings is not doing!

Transmutation is always mystical and spontaneous as it belongs to Totality and not to parts. It is not magical (magic is about parts) or esoteric (dealing with something that’s hidden) at all – it is more than evident and you can witness it in each consultation.

Here is the biggest paradox in Homeopathy and actually, in every healing practice:

  • The cure happens not because of the remedy or doing. It always comes from the Totality – more like a Grace rather than reward. We may become aware of that divinity. “I bind the wound, God heals it” – Galen, Greek physician (AD 129 – c.200/c.216)
  • Nevertheless our efforts, skills, remedies and all the details are very important here. “Binding the wound” is important, isn’t it?

Being aware of these two happening simultaneously, we become… free from dealing with Totality, but extremely cautious about the parts! We perform our job as an actor who performs the most important role in their life. We do not care about overall view of performance leaving it all to the Director.

We deeply understand that our homeopathic practice has nothing to do with real Healing, but still we put all our skills, devotion, and sincerity into servicing our patients.

Actually, we cease curing them, leaving that to Totality. We just immerse into our work and stay aware of what’s happening during the consultation. After all, Totality plays this game to fulfil our interest in healing just as much as bringing Health to the sick.

At some point we cease to think in terms of Totality and parts. Parts and Totality become One. Parts become divine just as they are. When we become aware of the Totality wherever we look, we learn how to Listen. We learn through correct everyday practice:


“If you are only aware of the head, you are limited.”

I am so grateful to Rollin for his help from 1966 until he retired. He was very clear about perception, so I will begin there. Whenever you are on the body, there must be no attention directed to the part. Listen from whenever you are with a capitol L. The key is using attention to Listen not focusing one’s intention on the part. This change in perception will take years. Then all there is is wholeness and the Tide.

James Jealous, D.O. “An Osteopathic Odyssey” p. 113

Yes, it really takes years of everyday practice. But it is more than worth that. The only problem with homeopathic practice is that up until now it has been intellectual rather than perceptional. So “this change in perception” has been almost impossible.

It appears the Totality has been completely misunderstood in classical Homeopathy.

Look, in everyday classical practice similar remedies usually lead to transformations (partial changes) – so the patients get more or less relieved, but not cured. And sometimes they get cured. An accomplished master prof. G. Vithoulkas admits it happens in less than 5% of prescriptions. For a novice practitioner that rate should be significantly smaller!

While trying to explain such inconsistency in results homeopaths have created mythical simillimum. Or sometimes they call it a constitutional remedy. I know, these two are pretty different concepts, but actually both are theoretical attempts to target the Totality. Do they exist in practice?

Look, how weird it gets: if we witness a cure – we name the prescribed remedy the simillimum or constitutional. If the cure does not take place – we consider the prescribed remedy not to belong to these elite categories.

Think about that for a while. What makes a remedy to become the special one? The method used or the results? What if these results happen not because of the remedy? What if they happen because of Totality?

Actually, simillimum and constitutional remedy have become a major problem for homeopaths that ruins everyday practice experience. Attention becomes lost – it wanders looking for conceptual simillimum or constitution rather than resting in Totality.

But if attention stops and returns home to Totality, we relax and simply play with the remedies while sitting with our patients. Like little kids we find an immense interest in the game we play and we do that with great attention.

Everything that happens (all the parts) is happening in Attention.

Attention appears to be the Totality of both our practice and our life. All the sensations and experiences are here because of Attention. This text you read is totally dependent on Attention:

  • If some spelling mistake appears in Attention – it’s there. If you miss that mistake while reading – the text is flawless in Attention!
  • Understanding the meanings of the text also happens (or does not happen) in Attention. Where else can it happen?

It is impossible for us to understand Attention though. It’s because understanding itself happens in Attention. Look, Attention has no qualities. It is empty in it’s nature. Texts, sensations, thoughts – all the perception is constantly appearing and disappearing in the Attention like in the mirror.

But it’s our Attention nevertheless. It appears to be our Self, the Consciousness and… the Totality! Becoming aware of our Self is an absolutely mystical.

Totality is totally mystical: “having a spiritual meaning or reality that is neither apparent to the senses nor obvious to the intelligence” (according to Merriam-Webster Dictionary).

Parts are different in my and in your worlds. But our Self, i.e. the Totality is the same.

When we find ourselves in the worlds of our patients, they are like new planets we visit. It may seem that our job is to explore the parts, but actually it is about dissolving in the Totality.

There is absolutely nothing we can do with Totality. When we understand that bitter truth, all that is left for us are details.

In practice we seek Awareness (Self, Attention, Totality), but remedy is always for the parts.

We never target our remedies to anything mystical anymore, but only to the parts that we perceive by senses. We stop creating mystical concepts.

Practicing Homeopathy on the Yang side (dealing with manifestations, i.e. all kinds of symptoms and sensations that can be found in repertories and much more) is about loosing the abundant details for the whole picture. Such approach is ideal for acute cases and sometimes it may even work for exacerbations of chronic diseases. But it is useless in a deep seated chronic cases where the most important details are hidden.

S. Hahnemann came up with an amazing and unique method of getting in touch with the manifested totality of acute cases. Following his instructions classical homeopaths gather different symptoms from a patient paying special attention to the most vivid, peculiar and complete ones. [By the way, “The Hang Glider” falls into such a category thus becoming vital for recognizing “The Trust”.] Possessing the parts homeopaths start looking for a similar remedy/totality that encompasses these parts into one constellation.

Even if such practice may look quite intellectual and analytical, arriving to SIMILLIMUM is often a huge surprise for homeopath. It feels like something real, doesn’t it? Looking at a bunch of symptoms we arrive to the remedy and at that moment we suddenly start seeing patient’s symptoms in a different perspective.

Sometimes we discover some repeating pattern or maybe we glimpse into the cause or predisposition or… whatever. Anyway, it’s not in parts, it changes our overall perception of the case in an instant.

For homeopaths simillimum is what glues separate parts into one totality in acute cases.

I know, you may say you’re skilled enough to figure out that totality by yourself and only then you apply the remedy to that totality. Well, congratulations! If that’s the case, you do not need remedies at all. You do not need Homeopathy. Prescribing to Totality makes no sense as it is already the Health we are all looking for.

Homeopathy is for dumb guys like me and those my colleagues who do not have special talents, skills and intuition of seeing the totality that’s behind the symptoms. So we need remedies to get us there.

Actually, it is not even in the remedy, but in that special shift in awareness from a small picture to a big one. And that’s what classical way of prescribing is all about. Healing happens in a very process of “seeing” the totality. Remedy is what helps to arrive to a place where such “seeing” happens spontaneously.

Classical Homeopathy appears to be a civilized and intellectualized form of Shamanic Homeopathy we’ve been talking about for a while in a pretty long article (also, see 180° in our circle of perception of remedies). I hope you read these articles, but for now you may discover S. Cartwright’s notes from his diaries of travelling in Peru and talking to local healers fit perfectly here:

On one of these visits, perhaps even the first, the shaman ‘sees’, he understands, he ‘knows’ what is wrong with the person. The shaman would say that the spirits have shown him. And in that moment of ‘seeing’ the cure takes place. The singing that follows, the plant infusions that are given, all help; but unless the shaman has ‘seen’, no cure can take place.

Stephen Cartwright “On the Nature of Homeopathy

Classical homeopaths try to try find explanations for that seeing: starting from “a logical picture of symptoms” ending up with “a meaning of the disease“. But what if we keep simple things simple?

In Present Homeopathy such “seeing” has nothing to do with intellectual work. We learn to keep our attention on senses rather than thoughts. We build our practice on awareness of sensory perception. We learn to perceive what’s happening in the present moment as we sit with the patient (or maybe we talk with him by phone – no real difference here).

N.B. Our practice on the manifested Yang side should be pretty simple and straightforward. Do not seek depth in it! Please, read the early classical masters. Look how simple and straightforward their Homeopathy was.

Yang & Yin
manifested & hidden

Remember, we are still on the bright YANG side where manifestations dominate and Yin (not-yet manifested) is almost neglect, represented just by a tiny well of a dark and cold water. Don’t expect the well to feel like the Ocean.

Speaking about perceptual practice and listening here – we never experience all the symptoms our patient has. On the Yang side we get involved into a normal classical clinical practice. And nevertheless, we still may test and listen to the remedies. We have a couple of scenarios available:

  • We may start feeling one or two sensations of a patient. These really help to monitor the response to a remedy.
  • We may feel nothing and then as we arrive to a remedy needed – a sensation or two suddenly appears in our perception. That’s kind of inverse monitoring.

That’s it. There is nothing much to speak about here.

2. Chronic / not-yet-manifested totality

But CHRONIC CASES are very different. S. Hahnemann himself admitted Homeopathy had been “hopeless” in dealing with these. But he still thought his approach to totality was a “universal law”. And he hoped this law should work for chronic diseases with some little corrections like double remedies, LM potencies or miasms.

And yes, early masters did not speak about listening, perceptional Homeopathy, phases of perception, etc.

2.1 – Exacerbation Phase

Well, if a patient comes in EXACERBATION PHASE – usually these are sensations that dominate. So we start with experiencing the sensations as if it is an acute case.

For example, if a patient comes with a manifested migraine headache, it is pretty normal for us to experience a bad headache, too.

We call it listening. We do nothing for that to happen. We do not want to experience that headache at all. It just happens if we welcome our patient with an open Heart and synchronize with him.

N.B.! We speak about perceptional practice, based on listening. It is not going to be theoretical: you dive into patient’s world and experience it as if it belongs to you. (It’s not cool at all, but it’s real.)

This headache (or whatever) emerges together with the patient coming through the doorstep of our office. Such sensations (headache in our example) are manifestations of present interest. We don’t ask for them, we do nothing, we simply listen and something comes to senses spontaneously. We can’t move anywhere else except looking for a remedy that relieves that headache.

Acute case and exacerbation of a chronic disease may seem very similar on a perceptional level. But nevertheless there is a huge difference in how we cope with them:

  • For acute cases symptomatic prescriptions are totally adequate. Present interest is on survival here. Pains, fevers, fears, etc, are threats to life, so they are of utmost importance.
  • But we do not prescribe symptomatically in chronic ones. Chronic symptoms are never important. Present interest is always somewhere else. Chronic symptoms point to some details that are hidden.

Therefore I’ve been taught never to address symptoms directly in chronic cases by my teachers. I mean we never look into “migraine remedies” (Iris, Cimic., etc.) in case of long lasting migraine even if pain is present and it is manifesting pretty badly. We look for whatever, but a migraine remedy. We usually start with something small: some bowel or gallbladder or reproductive system remedy, etc.

When truly Listening (“from a capital L” as James Jealous tells) we do not think, we’re all in sensory perception and… we do not care about totality! When we Listen, it is the Totality that is listening – our attention is literally on Nothing. So we are absolutely comfortable with what we are presented. That’s what “capitol L” means on this phase.

And then some small remedy (or maybe even a formula – no matter how bad that sounds for classical colleagues) relieves that worst headache in seconds by at least 70-90%. That’s what we experience numerous times in our daily practice.

We get to that remedy through testing and listening. They go hand in hand and both represent the both Yang and Yin sides of the consultation process.

But there is also a special and the most essential ingredient present. No matter if we play with single or formula remedies, use one testing method or another, no matter of our listening skills, Totality is all that matters for us at the moment.

We do not understand the totality (the one that is limited to our perception) or hit it by the remedy, but we surrender to It instead, devoting all our practice to it.

When the headache is diminished greatly (that phase usually takes less than half an hour of consultation time), exacerbation is over and we find (= feel) ourselves in a usual chronic case in REMISSION PHASE.

2.2 – Remission Phase

Here the manifestations (symptoms, sensations, etc.) are vague to say the least. We are not presented with these bright details (pieces of mosaic) to start with. The starting point is almost the opposite to that of an acute case. A patient may bring some complaints like some chronic fatigue or some rash on his skin or can tell she’s having bad headaches from time to time. But most of the details are hidden at this moment.

Again, we speak about perceptional homeopathy that is based on listening, i.e. on what we actually experience in present moment while sitting with the patient. Our sensory perception works exclusively on a present moment. We can’t hear sounds that happened a minute ago, can we? So if the details are hidden – they truly are, we do not perceive them. Period.

We start a chronic case with a totality that is actually like a misty landscape: the Mist seems to hide the details, but nevertheless, we may recognize whether it is city, sea, forest or mountains – even if we can’t fully recognize and name these.

Classical homeopaths ignore the beauty of such landscapes somehow. They feel themselves extremely uncomfortable without vivid parts, they think details are missing here. So they try to transform a chronic case into acute one by hunting these details in the Mist.

In good old classics we usually gather anamnesis by asking our patients numerous questions. I’ve been doing that for years. We read the classical remedy descriptions and we find lots of interesting facts there. For example we read that certain sleeping position or food craving belongs to some remedy.

Then we start asking our patients about that hoping that this information becomes a deciding factor in a chronic case (sleeping position may really become a deciding factor in acute state, e.g. pneumonia).

We ask questions about things we know and think are important. And we don’t ask questions about things we are not aware of and think they are of little importance. Neutral questioning of the patient without intentions and projections is an art.

And even if we end up with a bunch of details we’re still in quite tricky situation:

  • Some homeopaths believe symptoms are enough, so they do not care about totality much. They simply match “patient’s symptoms” (actually, these are symptoms they’ve managed to pull out of the mist – so they reflect homeopath’s views rather than the patient’s) with symptoms of a remedy. They think remedies possess symptoms of their own (causing these to healthy volunteers during provings).
  • Some homeopaths think totality is important. They are not content with only just parts, so they look for a totality in a patient (even if no one seems to know exactly what it means) and then look for a totality of remedy (they think remedies possess totalities somehow…). And then they try to match these two totalities together.

I’d really like to favor “the totality” guys. But intellectual and philosophical talks about totality make no sense. Our fragmented and partial minds (being a part of totality themselves) are simply incapable of perceiving the whole picture. That’s why we still haven’t got any satisfactory explanation of totality or some working methodology to deal with it.

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