In recent past, an esteemed colleague (Saine, 15) had doubted the veracity of terming the direction of cure a law, since he could not observe every aspect fulfilled. His wide influence on other homeopaths through his article is regrettable. He states (Saine, 15) “It is reasonable to assume that Kent was the one that officialized the term “Hering’s law” and so inadvertently popularized the concept of the existence of a clear and precise law of direction of cure.” I suggest a better understanding and application of the law instead.
This paper seeks to restore faith in this law as an indispensable clinical tool with the help of reliable perspectives from homeopaths of great capability. Dr. C. Hering described this “law of order” in his Preface (12, Appendix 1) to the 1845 American edition of The Chronic Diseases (9, Appendix 2, 2.1) by Samuel Hahnemann.
The 5 directions of cure Dr. Hering observed were from above, downwards; within, outwards; center to periphery; from more important to less important organs and in the chronologically reverse order of disease development (Appendix 1).
A Law speaks of a recurrent pattern that exists in Nature. With a thorough conceptual understanding of these patterns and conditions necessary to fulfill or violate them, one uses the law with hindsight in the various clinical decisions of remedy choice or change, as well as posology. Often this is not a conscious application, but an intuitive guide after achieving adequate conceptual training of the patterns of cure, supported by clinical experience.
Dr. ML Dhawale, MD, FAMS, (5,6) a pioneering homeopath and founder of the Institute of Clinical Research, Mumbai, that today runs over 6 successful homeopathic hospitals (apart from clinics) in and around Mumbai (Pavaskar,13), wrote in his article on Experimental design for Clinical Research in Homeopathy (Dhawale, 6):
“Homeopathy is scientific in that it is governed by two laws:
1. The Law of Similars: The fundamental law of selection of the similar dynamic force which demands a total understanding of the concept of the Hahnemannian totality, the ability to perceive it in the area of disease (drug as well as natural) and the capacity to achieve its establishment on the similar plane through the adoption of suitable techniques and the application of the right clinical judgment.
2. The Law of Direction of Cure (Hering): The law of verification that gives us the requisite feedback in respect of the accuracy we have achieved in respect of the correct application of the Law of Similars.
And we must ever remember that Law does not recognize exceptions.”
If such an intelligent, medically trained, scientific homeopath, with clinical experience spanning over 50 years had little reason to doubt the clinical veracity of Hering’s Law of Cure, we must think seriously before we trivialize the law.
An Embryological Perspective of the Law:
Dr. Praful Vijaykar, (8, 16, 17) an extremely successful homeopath from Mumbai, developed a reliable correlation of Hering’s Law based on an irrefutable pattern in nature – the in-utero development process of an embryo. His book, The Theory of Suppression (16) states, (quoted for brevity)
“The (fertilized) human egg, like that of any chordate egg differentiates into various organs and systems. Before it differentiates…., it gives rise to 3 germinal layers:
The fourth is a specialized ectoderm called the neuroderm or neuro-ectoderm.
Ectoderm: Gives rise to all the organs which are in connection or exposed to the external environment (skin). It is of least importance, …our first layer.
Endoderm: Forms the respiratory tube lining, gastro-intestinal tube lining and urinary tract lining. This is also … exposed to the external environment. … forms our 2nd layer.
Mesoderm: Gives rise to the viscera (lungs, heart, kidneys) or parenchyma of viscera. These organs arise out of mesothelium of mesoderm. (4th layer)
Connective tissue: …connection between endoderm derivatives and mesoderm derivatives …is established by tissues arising out of the mesenchyme of the medoserm…. the connective tissue includes blood, lymph, bones, cartilages, muscles, dermis and fascias, and coverings of organs. (3rd layer)
The neuro endocrine glands are externally derived from ectoderm, endoderm or even mesoderm, But the functional part of it, i.e. the secretary cells are of either neural crest in origin or neuroectodermal in origin. (5th Layer)
The nervous system, whether it is central or peripheral and the brain are derived from the neuroectoderm which is a specialized ectoderm. (6th layer)
….As the embryo grows, the nutrition is supplied from the first formed organ which acts as the chief source.
*The first to form is the Precordial plate which represents the head part. In the cure axis, the head or brain or upper part is more important than other parts which are formed later.
* The cephalo-caudal axis so formed denotes the higher to lower level importance
* The spread of mesoderm paraxially from inside out
* and from dorsal to ventral region also denotes the importance of that direction.
All these indicate the 4 directions of cure:
a) More important to less important
b) Above downwards
c) Inside out and
d) Centre to periphery
Ectoderm is least important when it forms skin and most important when it forms brain and neural tissue. The Endoderm and Mesoderm give rise to organs which are in between. How beautifully the circle becomes complete! From ectoderm – to endoderm – to mesoderm – to neuro-ectoderm – to ectoderm once again.”
Explanatory details can be read in my article (D’souza, 8). Embryological development involves serious study, but is worth the investment. One develops a conceptual idea of natural patterns in this process, which is a sophisticated explanation of Hering’s Law of Cure. Dr. Vijaykar’s insight into embryology, maps suppression (in 7 layers) and miasmatic deterioration therapeutically, and is brilliant and clinically reliable.
Clinical Perspective of the Law:
Science today has realized the necessity of natural laws; universal patterns in nature, though these rely on inductive logic based on a priori premises. We could add to our conditions on laws, that in addition to being universal in form, they support counterfactual conditions. It is crucial to bear in mind that this is a symptom of their being laws, not an explanation of it (Rosenberg, 14). This is how we understand the difference between a law and an accidental generalization. Laws are not expected to express logical necessities of truth. It is not necessary for a universal law to hold true in every instance, because there will exist counterfactual conditions to them (Appiah, 2).
Hence it’s possible to detect an anomaly in natural law, as a clash with observation or experiment, without rejecting the law. What makes a mere generalization a law, is the necessity of linking cause with effect as seen in applications of Hering’s Law. It is expected that universal laws continue to be modified over time, as conditions are added to it and anomalies further explained. Straightforward cases and acute clinical conditions always support the law of cure. One counterfactual condition for observed anomalies of the law in complicated clinical cases is Hahnemann’s theory of miasms.
Groups of homeopaths who perceived miasmatic expression in individual disease evolution, also successfully applied Hering’s Law. Among contemporary groups, listed in ‘References’ are Dr. ML Dhawale’s ICR, Mumbai (5, 6, 13); Dr. Praful Vijaykar (8, 16, 17), Mumbai; David Little (12) . Among master homeopaths that had effectively done so, were JT Kent, JF Allen and HC Allen, Stuart Close, PC Muzumdar. These homeopaths also correlated the philosophy of miasms parallel to their spiritual backgrounds.
JH Allen, reflects the necessity of combining Hering’s Law with miasms, in The Chronic Miasms Vol 1 (1), pg.106-108
“We can only understand the forces of nature by and through law; because law is the relater of all things, as it is only through it the unknown principle (the miasm) is clearly revealed to us with all its attending phenomena. It is also true that we can only see through law the mystery of suppression, for suppression itself is a retrograde process or a deflection of law, or it is a physiological law opposed. The physician who suppresses any miasmatic state, or disease process if you wish, is an enemy of law or at least there is no mutual understanding between him and law. We must first know that law rules not alone the visible things, but all invisible as well…… Why? Because both the life and the disease (and you know disease is perverted life) work from within outward and from above downward and not from without inward; even the very unit of life (the cell) works from within outward or from its nucleus. The life is within, not without; the disease is within, not upon the surface. It is only an expression of it that you see. You can never see disease any more that you can see life itself. ……
….Therapeutically speaking then, we must enter into correspondence with it (life), we must deal with that which animates the organism and gives it its being, the life. Nature is the complement of life; but we must assist nature through its right channels and by the way of law. Disease appears through the medium of the same law that governs life, and we must work with it along these lines.
The miasm is the opposing force to the life force; therefore the forces being against it must be in true opposition to the miasm and not alone against the life itself or we disturb it more. It must go with the life (force) and work through the life (force) and be in co-operation with life (force). Any other procedure endangers suppression or a greater deflection of the perverted life force.”
When is the Law not clinically obvious?
In my clinical experience, some reasons why Hering’s Law may not be obvious in certain instances are:
1. Lack of proper conceptual understanding of the patterns described in this natural law: Without a conceptual idea of observing these patterns in various disease conditions, and knowledge of how differently various diseases manifest, a homeopath can make inappropriate observations of clinical processes and symptom expressions. A lot of this application is learnt over a lifetime, following adequate exposure to the myriad of clinical manifestations of diseases. With a sincere motivation to learn and an open mind, affordable training is available (4, 5).
2. Lack of adequate correlation of clinical response with the miasmatic evolution of disease in every individual case: Most homeopaths have not been taught to observe Hering’s Law and miasmatic evolution from the phenomenological standpoint.(D’Souza, 7) For example, in the process of cure in a clinical case, a disease condition will manifest with an expression of inherited miasmatic traits, contrary in direction to the dominant miasm. I referred to this as a “counterfactual condition” to Hering’s Law. A manifestation of disease comes up during cure contrary to expected pattern. This is often related to an ‘old’ symptom in the individual’s life caused by inherited diathesis, whose expression was partially suppressed in favour of the individual’s own active, acquired miasm. The remedy indicated in this stage is an anti miasmatic remedy that covers the inherited miasmatic totality (Appendix 2, 2.3). When this ‘block’ is overcome, the constitutional remedy will be indicated again and cure will proceed as per the law.
Dr. JH Allen states; The Chronic Miasms Vol 2, pg. 109,
“The cases of chronic trouble that do not receive the basic miasmatic remedy sometime in the course of their treatment are either palliated, or as Hahnemann says, ‘suspended for a time, only to return more grievous than before’. Again the basic miasmic remedy fulfills all the requirements of the law, indeed the law is only satisfied or brought to its height of action against the contending forces of disease by an anti-miasmatic selection.
3. Inveterate Diseases as described by Hahnemann explained in the Organon (10) Aph.51, 206 and in The Chronic Diseases (9, Appendix 2: 2.2): These cases may have combined miasms, both inherited and acquired that have been subject to suppressive treatments and surgical intervention. Some of these suppressive treatments include: Steriods; anti-allergic drugs; long term symptomatic allopathic treatment for a particular long term ailment like diabetes, hypertension; long term painkillers; un-indicated antibiotics; hormonal treatments and contraceptives; gold salts; etc.
The similimum remedy will certainly work in most of these situations, but will it cure?? First, these drugs produce DRUG disease, Hahnemann explains in Aphorism 74, (10). Second, a specifically indicated remedy may be needed, different from the constitutional remedy. Third, continued allopathic medications produce masking symptoms and proving symptoms (artifacts) that interfere with the prescriptive totality, making it difficult to perceive the similimum and appropriately interpret remedy-response. Fourth, Hering’s Law becomes unclear or manifests partially due to these ‘artifacts’. Managing such cases (Case Examples, Barvalia, 3) is an art of anti-miasmatic prescribing, requiring training, (4, 5) experience with (quite) a few failed attempts. If the vital force remains strong, and not over ridden by these external assaults, there is hope for long term cure – but the ride ahead is bumpy.
4. Dr. Vijaykar points out some instances where disease expression and its cure may be apparently contrary to Hering’s law: (16, pgs 44-49).
a) Chicken pox, small pox, measles, herpes, eruptions have a direction of expression opposite to that of common ectodermal diseases. These viral diseases have enanthema followed by exanthema to release toxins. These are neuro-ectodermal diseases which throw out toxins from the centre to the periphery, from above downward. Hence when they resolve, the direction is from periphery to centre and from below upward! Suppression of these diseases in miasmatically vulnerable individuals causes neurological complications like encephalitis, etc.
b) In incurable diseases, (7th Layer, diseases of the genetic code), compensatory cure takes place, with a restoration to almost normal function. The constitutional similimum brings about as much cure possible, given structural genetic abnormalities. These compensatory cures do not manifest Hering’s directions of cure.
Clinical Steps when Hering’s Law isn’t perceived:
Presuming we have accurately obtained information in a case, to analyze the evolution of disease with miasmatic interpretation, we need to be critical of our remedy choice and case management when the case appears to move contrary to Hering’s Law. A cursory approach towards observing Hering’s law could amount to homeopathic medical negligence.
Questions to ask when the movement of symptom expression is contrary to the law:
1) Is the remedy truly a similimum? Is it a partial similimum? Is it palliating the case? Do I need to review for an appropriate similimum?
Remedies prescribed on mental state only or on a core delusion that is not correlated with physical generals and characteristics are often partial remedies or palliatives. These remedies may cause a feeling of ‘well being’ but in cases of sycotic or syphilitic miasmatic backgrounds, the disease process continues unabated, with superficial amelioration. Others, who prescribe on specific physical symptoms and keynotes, with no concern for the mental state, cause similar palliation.
Dr. Vijaykar, admitting his mistakes in early practice, perceived the need to prescribe the accurate “genetic constitutional similimum“, where Hering’s Law was fulfilled for true cure. (16, pgs. 59-64) His point: if remedy choice is truly similar, it has to be balanced, covering both mental and physical characteristics according to the merits of the case. Perceive the case in totality of what is characteristic in both the mind and the body.
2) If the remedy is truly similar, partially curing but not following Hering’s law; evaluate the miasmatic expression; Aph.206 (10).
Is there a miasmatic block requiring an anti-miasmatic remedy? Eg: Sulphur, Thuja, Sepia, Nitric Acid, Merc, Tub or other nosodes. Hahnemann (9) observed clinically, when combined miasms existed, one had to carefully unwind the miasmatic suppression, being vigilant with frequent follow up for change in symptom picture indicating a change in miasmatic remedy.(D’Souza, 7) Clinically this involves judicious interpolation of anti-miasmatic remedy for the active miasm, followed by the constitutional remedy.
3) If no miasmatic block is seen, investigate the patient’s past history for suppressive intervention around the presenting symptoms; Aph.207, (10).
a) Is this a picture of an old acute condition suppressed by antipathy, allopathy, wrong homeopathic remedies, surgery? An acute similimum is required which may be alternated with or supported by the constitutional remedy, based on change/alternation of symptom picture; Aph.232-234, (10).
b) Is there an incurable pathological or structural change? The case requires palliation. A constitutional remedy palliates when the vital power and susceptibility are good. But in patients with poor susceptibility e.g. close to death, the specifically indicated (partial) remedy or acute remedy is a better choice.
c) Is this a new picture of a true acute condition? It is possibly an acute and strong onslaught (infection) from the environment (acute miasm), as in epidemics, and requires the genus epidemicus or an acute similimum, followed by chronic similimum.
4) All 5 directions of cure do not have to manifest at every instance in disease development in a case. The direction of cure in time (chronology), takes precedence over the other 4 directions at any point in time. The intelligent perception and experience of the homeopath is vital for this intuitive interpretation. Embryological correlation further clarifies this.
Important to training in clinical observation is the phenomenological approach to disease evolution and miasmatic management (7) that supports and is complementary to concepts in Hering’s Law of Cure. The phenomenological approach of miasmatic evolution is one major contribution from ML Dhawale’s ICR (5). Unfortunately, published clinical cases explaining the law are few (18) and this should be remedied in the future.
One must perceive the depth of homeopathic philosophy in health and disease, to successfully interpret the Law of Cure clinically. Often this is a lifelong learning process, as with everything else in homeopathy. Each case evolves differently and individually, and has to be investigated with its individuality of evolution in miasm and suppression. Then, Hering’s Law can be successfully applied to guide healing with appropriately prescribed similimums. Dr. Vijaykars’ ‘levels of disease’ is a reliable correlation to understanding this application, seek to study it. (8,16, 17)
I suggest that counterfactual to anomalies in Hering’s Law of Cure, is the theory of miasms as Hahnemann taught. I quote a renowned professor and successful clinician Dr. PM Barvalia, on the importance of understanding miasmatic correlation, (Barvalia, 3)
“An integration of the miasmatic totality is crucial in the Anamnesis of cases with genetic disorders(and diseases where Hering’s Law isn’t clear – Leela)
Revisiting this area of disease from the Homoeopathic perspective will be immensely helpful to the entire homeopathic medical fraternity, enabling us to handle many serious genetic disorders where very little can be done by Modern Medicine. NOSODES are the most potent, deeper forces of our remedy armamentarium that can play decisive role in the cure of these diseases. This will demand a whole hearted acceptance of Hahnemann’s miasmatic doctrine in the Theory of Chronic Diseases, while keeping our analytical faculty open, agile and active. Any ambivalence to our own philosophy will be disastrous and self-destructive.”
Visit Dr. Leela D’Souza at her website :
and her at: [email protected]
1. Allen, J. Henry: The Chronic Miasms Volume I and II; Reprint edition 2006, BJain Publishers.
2. Appiah, Anthony: Causation and Law; Thinking it Through: An Introduction to Contemporary Philosophy, Cary, NC, USA: Oxford University Press, Inc., 2003, Pgs 171-174
3. Barvalia, Dr. Praful: Hotseat Interview on facekom.info with Dr. Leela D’Souza September 2006, Ref: discussion on Inveterate Diseases.
4. Barvalia, MB, Foundation’s Spandan Holistic Institute of Applied Homoeopathy, Global Fellowship Course
5. Dhawale’s ICR Training Programme
6. Dhawale, M.L: Experimental Design for Clinical research in Homeopathy; Standardization; Category H-14; ICR Symposium Council, Part III, 3rd Edition, 2003.
7. D’Souza, Leela: Miasms in Case Management, Part 2: Disease Evolution and its Miasmatic Management, 3rd edition, 2006
8. D’Souza, Leela: Miasms in Case Management, Part 3 : Perceiving (Hahnemann’s) Miasms through Genetics and Embryology, 2005 URL http://facekom.info/organon-philosophy/miasms-in-case-management-iii/
9. Hahnemann, Samuel: The Chronic Diseases; Their Peculiar Nature and their Homeopathic Cure; Volume I ; Translated by Prof Louis H. Tafel; B.Jain Publishers, Reprint Edition 2005. (REFER: Appendix 2)
10. Hahnemann, Samuel: Organon of Medicine, Translated by William Boericke, MD, BJain Publishers Ltd., Reprint edition 1986.
11. Karnad, S; Sunder Rajan, P.K.: Professional Rejuvenation through re-education, Consumer Education in Homeopathy; Standardization; Category H-13; ICR Symposium Council; Part III; 3rd Edition 2003.
12. Little, David: A Commentary on Dr. Constantine Hering’s Preface to the 1845 American edition of The Chronic Diseases by Samuel Hahnemann, 2006. (REFER: Appendix 1)
13. Pavaskar, Dr. Navin, MD(Hom): ML Dhawle’s Homeopathic Hospitals; Hot-seat Interview on facekom.info with Dr. Leela D’Souza, October 2006,
URL : http://facekom.info/homeopathy-interviews/dr-navin-pavaskar/
14. Rosenberg, Alex: Explanation, Causation and Laws; Philosophy of Science: A Contemporary Introduction, Florence, KY, USA: Routelege, 2000, pgs. 32-34
15. Saine, Andre: Hering’s Law: Law, Rule or Dogma?
Presented at the Second Annual Session of the Homeopathic Academy of Naturopathic Physicians in Seattle, Washington, April 16-17, 1988.
16. Vijaykar, Praful: Predictive Homeopathy Part 1; Theory of Suppression; 4th Edition 2002, Mumbai
17. Vijaykar, Praful: Predictive Homeopathy Part III; The End of Myasmtion of Miasms; Chapter 27; reprint 2004; Mumbai
18. Hering’s Law of Cure: Published Cases documented by Ovid Online:
a)Ambani B, A Case of Senile Dementia: Treated with Baryta phosphorica. Homoeopathic Links 2006 Spring;19(1):42-4. AN: 0085462
b) Kapse A, Hering’s law demonstrated. National Journal of Homoeopathy 2004, Jan-Feb;6(1):44. AN: 0077511
c) Borkar P, Hering’s law of direction of cure. Homoeopathic Heritage 2005 Aug;30(8):21-3. AN: 0077218
d) Robinson K, The centralization phenomenon in radicular nerve pain: An addendum to Hering’s Law of Cure. J Am Inst Homeopath 2001 Summer;94(2):134-7. AN: 0029019
e) Vijaykar P, Hering’s law: Its importance in clinical practice. Homoeopathic Links 2001 Spring;14(1):19-20. AN: 0023428
f) Hakimji M, Epilepsy – case study showing Hering’s law. Indian Journal of Homoeopathic Medicine 1995;30(2):79-80. AN: 9143287
g) King FJ, The homeopathic healing process: Hering’s law of cure, and retracing. Dig Chiropractic Econ 1994 May-Jun;36(6):44-5. AN: 9129299
h) Herscu P, Hiccoughs and Hering’s Law. Homoeopath 1990 Aug;10(3):71-3. AN: 8537480
Excerpt of Dr. Constantine Hering’s Preface to the 1845 American edition of The Chronic Diseases by Samuel Hahnemann.
From a commentary by David Little:
Dr. Hering’s preface (excerpt):
“Every homoeopathic physician must have observed that the improvement in pain takes place from above downward; and in disease, from within outward. This is the reason why chronic diseases, if they are thoroughly cured, always terminate in some cutaneous eruption, which differs according to the different constitutions of the patients. This cutaneous eruption may be even perceived when a cure is impossible, and even when the remedies have been improperly chosen. The skin being the outermost surface of the body, it receives upon itself the extreme termination of the disease. This cutaneous eruption is not a mere morbid secretion having been chemically separated from the internal organism in the form of gas, a liquid or solid; it is the whole of the morbid action which is pressed from within to outward, and is characteristic of a thorough and rally curative treatment. The morbid action of the internal organism may continue either entirely or more or less in spite of this cutaneous eruption. Nevertheless, this eruption always is a favorable symptom; it alleviates the sufferings of the patient, and generally prevents a more dangerous affection.
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.
Even the superficial observer will not fail in recognizing this law of order. An improvement which takes place in a different order can never be relied on. A fit of hysteria may terminate in a flow of urine; other fits may either terminate in the same way, or in hemorrhage; the next succeeding fit shows how little the affection had been cured. The disease may take a different turn, it may change its form, and, in this new form it may be less troublesome; but the general state of the organism will suffer in consequence of this transformation.
Hence it is that Hahnemann inculcates with so much care the important rule to attend to the moral symptoms, and to judge the of the degree of homoeopathic adaptation, existing between the remedy and the disease, by the improvement which takes place in the moral condition, and in the general well-being of the patient.
But alas!, the rules which the experienced founder of Homoeopathy lays down in the subsequent work with so much emphasis, are not always practiced, and therefore cannot be appreciated. Many oppose them; cures which otherwise might be speedy and certain, are delayed; much injury is being done by the wiseacres who intrude themselves into our literature and mix with it as chaff and wheat. On all this we may console
The law of order which we have pointed out above, accounts for the numerous cutaneous eruptions consequent upon homoeopathic treatment, even where they never have been seen before; It accounts for the obstinacy with which many kinds of herpes and ulcers remain upon the skin, Whereas others are dissipated like snow. Those which remain, do remain because of the internal disease is yet existing. This law of order also accounts for the insufficiency of violent sweats, when the internal disease is not yet disposed to leave its hiding-place. It lastly accounts for one cutaneous affection being substituted for another.
This transformation of the internal affection of such parts of the organism as are essential to important functions, to a cutaneous affection- a transformation which is entirely different from the violent change effected by means of Autenrieth’s ointment ammonium, croton-oil, cantharides, mustard, etc.- is chiefly effected by the anti psoric remedies.
Other remedies may sometimes effect that transformation even the use of water, change of climate, of occupation, etc; but it is more safely, more mildly and more thoroughly effected by the anti psoric remedies.
This latter is altogether an individual opinion; others may have different opinions relative to the same subject; This needs not to prevent us from aiming all of us at the same end side by side in perfect harmony.
It is the duty of all of us to go further in the theory and practice of Homoeopathy than Hahnemann has done. We ought to seek the truth which is before us and forsake the errors of the past. But woe unto him who, on that account, should personally attack the author of our doctrine; he would burthen himself with infamy. Hahnemann was a great savant, inquirer, and discoverer; he was as true a man, without falsity, candid and open as a child, an inspired with pure benevolence and with a holy zeal for science.
When at last the fatal hour had struck for the sublime old man who had preserved his vigour almost to his last moments, when it was the heart of his consort who had made his last years the brightest of his life, was on the point of breaking. Many of us seeing those who are dearest to us engaged in the death-struggle, would exclaim: “Why should’st thou suffer so much!” So to exclaimed Hahnemann’s consort:”Why should’nt thou who hast alleviated so much suffering, suffer in thy last hour? This is unjust. Providence should have allotted to thee a painless death.”