ARTICOLI CLINICI

The Concept of Constitution According to Ivo Bianchi

Clinical medicine differs from other biological sciences (physiology and general pathology) because it’s object is to study the sick taken singolarly, while these sciences try to know the “phenomenon” of human and animal organism.
For scientific and teaching reasons we have to define specific diseases.studied individually. These derive from the observation of many cases,where we try to find a common denominator.but single observations are never ,on the whole,comparable one with another;so we say:there are no diseases but only sick people.
Clinical medicine has,therefore,the peculiar characteristic to pick up the individual differences in pathological manifestations of sick people; to consider the patient as an undivided bio-psycological unity.
In other words the patient is not considered as the sum of different apparatus and functions,that could be singolarly altered.but as a whole person with it’s own individual characteristics,with many organic structures,biological functions and psychic activities.these are connected one another;the sofference of one can be reflected to the others and the complex of structural,functional psychic characteristics can influence the clinical picture,even if localized.
It is not enough,then,to know the external causes of the disease,like infective and toxic agents,traumas, environmental influences.
The physician must investigate,if possible,on the psyco-physical peculiarities of the patient,that influence the organism response to external agents and can be the principal cause of diseases.this is the study field of the individual constitution.
No doubt ,the science of constitution is ,today, less developed  than disciplines that study phenomena  common to all human organisms and  also external agents of disease.
That’s because modern medicine is generally bounded to the needs of industry and economy .it searches,therefore,with major interest,drugs with global application,easy to use and to be manufactured.
The possibility of a specific  and individual therapy is sacrificed for  economical profit and market interest.nevertheless every new drug will cause side effects,sometime serious, in 20% of patients,for it’s scarce specifity to the patient.

Clinical medicine has been always based on the concept of constitution.

The ancient  indian vedic medicine classifies everybody  according to their reactivity,in 3 types:vata,kapa,pitta.in relation to the constitution  ayurvedic medicine suggests not only  specific drugs,but  also individual hygienic and dietetic advices.
Chinese medicine classifies medicines and patients with the complex and fascinating law of 5 element.all therapeutical methodologies including acopunture and phytotherapy are based on this concept.
Western medicine has bees always based on hyppocratic concepts of humoral constitutional theory.it is wrong and simplistic to think that only modern medicine can get results.hyppocratic constitutional medicine has bees very helpful to mankind,even if results in big epidemics were not so good.this because they were influenced by historical moments with poor immunological and constitutional reactivity of the populations.the old time  physician true healer,not so technical like today,has always dedicated long time to the comprehention of constitution and reactivity of the patient.
In this way, it was assured the efficacy of bland  non toxic remedies,choosed according to specificity to the patient.
In 1700-1800 the progress of medicine has been parallel to the development of the constitution concept.famous physician like pasteur,murri,pende never deny the theoretical and practical importance of it.
They thought ,the aim of the physician was to find the constitution and reactivity of the patient and to select,then,the most suitable medicine.
The second part of our century has been characterized by the search of confort and easyness.man has made  machines to avoid physical exertion,like escalator,lift dish-washer and mental exertion like television,calculators and computers.he has put the premeses for brain and muscles atrophy,which is already present.
Greek  and roman scientists were a step from technology and in alexandria of egipt,in 300 bc,the doors of the famous library make use of steam energy to open.then they decided to stop,because of deep phylosophical reasons as they refused to upset the natural balance.
Todays’ man realizes the enormous damage of technocratic world,and starts desperatly to do jogging everyday , risking heart attack and lung cancer from smog.
Meanwhile,scientists discover that our forefathers of neandenthal which had to do their best to hunt,to find and prepare medicinal herbs,to make working tools,had a bigger brain than today’man.
The concept of confort and easiness arrived from america in the forties,together with bombs that made distruction in dresda,hyroshima & nagasachi;to win a war with no ability and eroism ,that was hiding economic and egemonic tasks.
In medicine too,the bombs arrived;they were the antibiotics and in the beginning seemed an easy solution to everything.
It was enough a bomb or an antibiotic to kill,far away,with no effort, german, japaneses,or microbes.the easy strategy wos,in the beginning,winning and effective.
Soon,it was clear the price for this all: deep and deadly damages of radiations, pollution,the dizzy increase of cancer due to known or unknown radioctive leakage and the possibility of improper or distructive use of these weapons.the world has been for long time immobilized from fear.now it is dominated by a military and economical power that controls,with no scruples,through media,the lives and cosciences of everyone, in every state.
The same people,the same groups of power,the same dull phylosophy have introduced on vast scale, the bombing with antibiotics,cortisons and chemiotherapies on patients.as usual,the immediate effect is clear,but in a long term,undermines the microcosms man,like atomic bomb has undermined the macrocosms hearth.discoveries ,for itself,good like antibiotics and atomic energy have been used in a thoughtless and distructive way.wanting to level and tanking about democracy of medicine,it has been given to everybody the same antibiotic,it has been lost the study of the indivi-dual and the specific prescription,causing at intestine level a burned land.
In the dry planet-man post antibiotic are growing fungi,seaweeds and primitive forms of life that produce an immunological weakness,ground  of allergies, de-generative and autoimmune  diseases.
It is therefore undestood,why,the refusal of man’s constitutional study and of therapeutical implications to it connected,has deep political and cultural basis,today.it is difficult to study and reason,all aroud  wants to divert us from this.only returning to the old traditional medical method can,anyway,save the patient from the heavy collateral effects of not specific drugs;and the physician,from the cerebral atrophy induced by the use of generic files for various pathologies.
Though there is a misunderstanding as we speak of constitution always referring to body,teeth,joints and muscles structures.it must be clear that to the constitution belongs not only somatic types,but psychical and behaviuor one.
Very often ,for constitution we mean, precisely,somatic characters,while psychic one come under the word personality ,temperament  or disposition.
It is still debatable,if constitution is related only to genotype characters (genetic structure),or phenotype characters(result of genotype character with environment).
In spite of this speculation,we define,here, a modern and practical concept of constitution:

The constitution of a person is the complex of physical and psychical characters that belong to him,in a definite moment of his life.

The constitution,then,coincides with the actual state of a person and changes during life,in the course of the year,the same day and during a disease.many stimuli coming from inside or outside can modify these whole factors,in balance one another that make the constitution.
We will see ,how many homeopatic remedies,called constitutional, will influence the genotype constitution,while the “nosode”constitutional remedy the phenotype constitution;therefore it will be influenced the reactivity,the psychic constitution and the temperament with other homeopathic remedies.
We will see,however,how the constitution can be influenced in many other ways,like diet or psychic events.also,mineral and vitamins in the diet,can deeply influence the constitution,like a special type of light or of music could change the constitutional specific reactivity of a person.
To understand completely the concept of constitution,we have to go a step backward,to try to get clear the philosophical scientifical concept at the base of it.
Oriental philosopy(ying-yang),greek philosopy and modern science identify two principal elements in nature and in life:matter and energy.
Life itself is permitted and originared by the continuous change between energy and matter and viceversa.nothing is created,nothing is destroyed
All get constantly changed and this transformation corresponds to the flow of life.the same principle of macrocosm  applies itself to man-microcosm;he has two tendences:mental(psychic) and physical corresponding to energy and matter.in the course of life and of physical development there is a costant tendence to swing between catabolism (distruction) and anabolism (construction).
At biological level,many inputs like these show themselves through hormonal mechanisms.these act on endocrine glands that are in relation one another.
On the constitution and on the structure of human body, hormonal factors act already in embryo and in fetus,but also further in life.so we could understand from the study of constitution which endocrine gland is prevalent in a person.some endocrine glands like thyroid and soprarenal bodies are influencing the metabolism  by making and using energy.
Often anyway,our endocrine glands work as a pair.stimolating each others.
In fact there is a balanced interaction between thyroid ,which stimolate catabolism and heat dispersion and suprarenal glands,which stimolate anabolism and  stored energy in the form of fat.
Therefore,there are two great possibilities of endocrine influence on human constitution.these two structures affect body metabolism,the production and use of energy,and consequently all the physical psychical aspects to then related.
There is a constitution where prevails the activity of thyroid.it is characterized by thin and hyperactive subjects,with prevalence of catabolic phenomena speeding up every process and movement.these people have very active and sharp mind,with hysteric depressive excesses .
There is a constitution where prevail the activity of suprarenal glands.the constitution make up is pletoric hyporeactive hyposensitive type,with prevalence of anabolic processes that are a consequence of a chronic gland stimulation .these people have a physiologic stress background,the mind is essential with disposition to survival then meditation.
Only in a “normal balanced subject” there is a perfect stable syncronism between the two glands,with a  fine and stable answer to stress,a right energy equilibrium and an adeguate tendecy to storage.in reality,this equilibrium is very unstable in relation  to inner and outer changeable situations,influenced by alimentary climatic factors.
Moving away from the perfect balance ,there is all a range of possibilities in between.
We can have the subject with prevalent thyroid functions,less apt to stress then,with great tencency in wasting energies and crisis,but more efficent mentally.
We have the subject with prevalent  suprarenal  functions,very strong physically but less elevated mentally.
Another important influence on organic constitution derives from the function of neurovegetative system,this is in the hypothalamus.it has central control and is part of the diencephalon.the hypothalamic nuclei serve to activate, control,and integrate the peripheral autonomic mechanisms, endocrine activities,and many somatic functions.this control is regulated through hormonal messages which stimulate endocrine glands.
One side there is a gland called pineal gland. This is a primitive but fundamental structure.it is connected with exernal environment through retinas.this is the innermost tunic of the eye.it gets any change of light and influences,thruogh this gland, circardian rhythms of our body, that are so in relation with seasons and day/night phases.
This fundamental endocrine structure allows our body and mind to rest, concentrates body attention on reproduction,stimulating sexual istinct;but in the same time it can block and inhibit.
When the pineal influence overwhelms,there is a tendency to rest,depression and closure.the outside is less interesting and the person is more centred on himself.
The energy is channelled inside, stimulating body and mind,but also stagnation:in a hyperthyroid sympathicotonic patient,the enclosed energy makes depressive whirls.
On the other side, hypophysis or pituitary gland makes a balance with the previous structure.it is in connection with external environment through cerebral cortex and inside with several endocrine glands through the hypotalamus. Hypophysis stimulates body mind and tissues;it is sensitive to different environmental and organic situations.
The whole body is activated to react  and to grow.
Hypophysis is the gland of energy,vitality and reactivity.in usa is fashinable to take medicines based on hypophysis and growth hormon to stimolate growth and muscular tone;reactitity and mental,physical youth.during the day,the continuous stimulation of this gland on other organs,tissues and endocrine structures gives vitality and activity to the person .hypophysis is the gland of “esternalization”,of irritability,of abnormal growth stimulation.that’ way di bella treatment,which has a specific pituitary blockage,brings about a stop of all tissue growth,hence neoplastic cells too.
On the contrary,it is not possible to stop completely pituitary activity which is needed to grow immunocompetent cells and organ trophism.
This therapy could then bring about psychologic depression,kidney deficiency and general decline of organic trophism.
All body structures are activated by hypophyseal hormons,expecially somatotropin (growth hormon).it is easy to understand, why in the changeable american market,therapies based on growth hormon are so trendy for people willing to stay young with physical and sexual strenth.anyway this artificial stimulus is often not helpful,as today many things can activate the pituitary gland:food full of hormons and the continuous exposition to sound and artificial light .
If patient’s problems are due to atrophy or hyporeactivity of a tissue,(aplastic anemia,precocious senility,muscles atrophy)the stimulation of this gland can be usefull. But if the patient has an initial neoplastic growth,this can be speeded up.
Once again,the organic balance is made by the perfect interaction between these two glands,while their unbalance bring about pathological changes.
This glands’ interaction classifys our patients in four groups,two with thyroid-induced catabolism,two with suprarenal-induced anabolism.the influence of hypophysis and epiphysis (pineal body) make a further difference between patients who express themselves outward and others who do it inward.

This is the endocrine base of four hippocratic constitutions

This explanation of constitution has a practical importance in homotoxicology,as it is possible to influence the activity of several glands with specific remedies (made from homeopathic dilution of the same gland) capable to give them a  stimolation. Particularly ,there are complex remedies able to act on neuro-vegetative situations or on the opposite one:fucus compositum activates the action of thyroid hormons at connective tissue level (usefull in a hypometabolic sympathetic  patient) while vis hell activates the immunologic reactivity often low in the hypermetabolic sympathetic patient.
It is possible to stimulate the endocrine structures of the constitution with single remedies,where there is a deficiency.for the phlegmatic patient it will be helpful glandula thyroidea suis injeel plus hypophis suis injeel.for the irascible subject glandula  suprarenalis suis injeel and glandula pinealis suis injeel.for the full-blooded patient  glandula thyroidea suis injeel plus glandula pinealis suis injeel.if good results appear, after a first weekly prescription ,we can carry on with the treatment,while with no reaction,perhaps it is better to use injeel form.
Let us see in details the four constitutions looking through their characteristics and the therapeutic possibilities.first of all, there are few  fundamental arguments to point out  about prescribing and analizing a constitution:

1) There is no pure constitution but a range of constitutions.a patient can be phlegmatic , but still balanced,situated towards the centre of the diagram. He could be ,anyway,completely unbalanced in his phlegmaticity and he will be at the side of the diagram.this data is not only theoretic but practical as,the more constitutional unbalance,the more should be the constitutional remedy diluition.

2) Individual constitution varies with time,in relation to different situations.must be studied the actual constitution,which is the one to be cured and we should not be deceived by the physical one.in fact our morphology often belongs to a previous moment of the life.physical appearance is important,but should not be the only aspect of our constitution.

3)  Being unsure about the constitution,must be always treated the most dangerous one:the depressed before the full-blooded,the phlegmatic before the irascible and so on,thinking about the specific pathological risk for that particular patient.

Phlegmatic constitution

Belongs to the anabolic patient for thyroid deficit, reserved,sleepy and hyporeactive for the prevalence of epiphyseal (pineal body) activity.this patient lives for himself and inside himself,basically little involved with the outside world.he has got to work for himself,as he is a growing child and this is physiologic phlegmaticity,or he is an hyporeactive adult unable to express himself outside for low energy and little will.this constitution is comparable with winter season,which is also,the aggravation time of this hyporeactive chilly person.he loves to be covered,and get close to the heat , needed to be  balanced.winter,as a season of the year and of life. Is the best moment for undergrown (inside) growth.during this time,without noting anything outside,there are changes,growths and anabolic storage,that allow  to keep going further.
Often,this  patient is unable to throw out catarrh and get pulmunary infections.he is not capable to react at cutaneous level and his skin get infected.he has low growing cancers at pulmunary,prostatic and intestinal level, expression of his low reactivity.
This patient lives a structural problem(excess or lack of growth).he has a specific relation with calcium and this constitution is the expressionof this deranged metabolism.
An intravenous or oral treatment with calcium can,often, induce in a normal patient, this state of hyporeactivity.this is in connection with the suppression of calcium metabolic functions induced by massive  dosage.
On the contrary,the administration of an homeopathic dilution of calcium (calcium carbonicum,calcarea carbonica) heals the patient stimulating the metabolism, with a minimum dose of the element.it is interesting to notice,how the substance in material dose can induce a particular constitutional attitude,while the homeopathic medicine made through dilution and “dinamization” can cure or prevent affections of the same constitution.
Though  calcium carbonicum represents the key homeopathic element of this constitution,there is a vast range of it,with different expressive modalities, sometime.possible to pick up.hence there are complementary remedies for these subtle constitutional aspects.among these:sepia,kali carbonicum,thuja, graphites, bryonia.
Stimolating a phlegmatic patient with calcium carbonicum will always give good results,but it is wise to complete the treatment with a more specific complementary remedy.often we can get good result with “psorinum” the constitutional nosode.

The homotossicological constitutional remedy for a phlegmatic patient is graphites homaccord,powerful activator of all metabolic functions.it is important to use,when a patient manifests the classical characteristics of his constitution:fatness,slow healing wounds,retarded escretory functions.
Has already said,this patient gets easily bacterial infections and a lot of catarrh.a medicine like echinacea compositum forte will be preventive,if given once a week,or therapeutic given in acute fasis,two or three times a day. Complex symptomatic remedies can be also useful in some constitutions, rather than in others and it could be valuated the use of osteo heel.
The selection of the constitution is a guide for prescribing homeopathic-homotoxicological remedies. For any other therapy in the adult, the right  oligo-element for  this constitution is aurum – argentum – cuprum. There are , anyway,mineral complexes particularly  suitable for this constitution (magnesium,nickel,cromium) and toxic minerals like aluminium,that easily can be stored in these subjects.vitamins too,must be prescribed on constitutional basis and these patients can be helped by vit d,b1,b3 and b10.
Every constitutional type can be influenced by specific wave lengths or different colours.yellow is very effective and music is therapeutically helpful, expecially mozart in his  juvenile fase ,with many acute sounds,which are  good stimuli for these patients.

The irritable constitution

It is that of catabolic patient,with increase in thyroid hormon and sensitivity to it.this subject is open,reactive and involved in everything.he is the exact opposite of the  previous constitutional type; very sensitive and an artist,he likes to work creating something outside.also,this constitution can be structural and congenital,imprinted in the genoma,readable in the somatic lines of the individual or simply due to particular situation of life.in fact this constitution is physiological  in the middle-aged person .he lives the age of major stress and productivity and tend to  be hyperactive and frantic.
Anyway,this energetic waste can lead to exhaustion and stress up to various pathologies,especially vlrals.aids,for instance has more incidence in people with cocaine addiction,as they are artificially accelerated.
This constitution is comparable to summer season,which is the aggravation time of this subject,hyperthyroid,hypereactive and hot.he loves cool weather and fresh air.summer,as season of the year and of life,is the time of major external production.it is the great moment of maturity,the time of fruits,of the best espressive capacity,but it needs a lot of energies and can wear and weaken parenchimal structures,like liver,kidney,pancreas.
This patient lives an energetic problem(excess or exhaustion).he has often phosphorus metabolism derangement .this element is essentian in the atp processes,in the storage and utilization of energy.
A massive treatment with phosphorus can induce ,in a patient,this hyperactivity,sleeplessness..on the contrary  homeopathic dilution of phospho-rus quiets and balaces  the patient.
Phosphorus is the principal of a range of remedies suitable to this constitution;among then: lachesis, argentum nitricum, hyosciamus, arsenicum album, cuprum metallicum …often  these patients have good results with the constitutional nosode tubercolinum.
The homotoxicological constitutional remedy for the irritable patient is phosphorus homaccord.great energetic and relaxing medicine for this exhausted patient.it is useful in situation like: viral pathologies,renal and  kidney derangement,chronic laringitis,viral broncho-pneumonias.
Also engystol can be helpful,as a preventive ,once a week;or for the treatment of the acute fase six times a day.another simple medicine useful in this constitution is hepeel.
Manganese is the  diathesic oligo-element suitable for this constitution like other complex medicines  made with toxic minerals (plumbum)easily stored in the body of these patients.vitamins must be choosen on a constitutional basis.among these  vit.a,b2,b7,b8,b13 are useful.yellow colour is an efficient tranquillizer and the music of bach is helpful to these subjects.

The melancholy constitution

In this constitution the patient has a lot of energy related to the activity of thyroid hormons.he has psyco-physical difficulty to espress himself outside.his energy causes an internal reactive blockage ,that involves the patient at all levels:from the mind (timidity) to all the cells (immunological hyporeactivity).
Thyroid hormon level is too high, or there is too much sensitivity to it,therefore this constitution is the most complex and problematic ,from the mental point of view.hyperthyroid patient is chronically depressen and deeply unbalanced,in the serious cases.
This constitution is usually physiologic in a young subject prone to timidity, inhibition and introversion.he does not valuate his actions,can be addicted or suicidal and must be supported in these difficult moments.the habitual use or minerals and vitamins will ,gradually,stimulate  this constitution,which is compa-rable to spring season.frequest changes of weather and heat can make the melancholic patient worse and he gets allergic troubles especially in spring.
This subject lives a reactive problem (excess with autoimmume phenomena or lack with immunologic deficit).he has ,often,troubles in silica metabolism.this element stimulates leucocytes in general and fibroblasts in particular.
Material doses of silica are inactive ,but his homeopathic dilution is a specific activator of immune system;always contro-indicated in patients with inplants and transplants. The assumption of this homeopathic remedy,stimolates excretion of foreign bodies.also a patient, with a previous “tb primary complex”is not a good candidate for silica,as it helps the expulsion of  myco-bacterium from calcified tissues.
These silica and natrum muriaticum melancholic patients,are very frequent today.they must be recognized ,as prevention only,can help to avoid serious pathologies related to this constitution.
Silica and natrum muriaticun are related to several remedies,among these must be remembered:fluoric acid,mercurius vivus,borax,aurum metallicum… Syphilinum (luesinum) is the nosode used in this constitution ,with good results.
The related homotoxicological costitutional remedy in natrium homaccord. Powerful  reactive remedy,used in those classical clinical situations of this constitution:allergies,skin lesions like aphae and ulcers,acrid corrosive secretions.
As this patient is prone to serious degenerative pathologies,for his immunologic deficit,vis heel can be preventive,if taken once a week and therapeutical ,if taken two or three times a week during acute fasis.this remedy will be useful also during difficult times like depressive crisis,vaccinations,poisoning and intercurrent pathologies.pareira heel is a valuable medicine if kidney deficency functions is present.
The diathesic oligo-element for this constitution especially in the child is copper-manganese. Other mineral complex useful are molybdenum,potas-sium, zincum and toxic minerals easily stored like mercury.helpful are also vit.e, C,b1, and b5.red colour is an effective stimulus like the music of beetoven.

The sanguine constitution

It is the one of anabolic patient with excess of suprarenal hormons,cortisone in Prevalence.there is a malfunction in the suprarenal gland,which is hypertro-phic,with excessive production of cortisol than other corticosteroids (dhea,aldosterone…)The thyroid hypofunctionality with reduced metabolism explains the plethoric structure of the patient,while the good hypophyseal function explains the  great vitality.this patient is the exact constitutional opposite of the previous one.he is a friendly fellow,enjoying company,good food and drink.he is direct,open,not shy ;for sure not very well educated and not introverted.he is an explosive subject,which manifests himself outside both on the psychic  and physical level,and find in this his balance.
This constitution is often physiological in the old patient,which is prone to pletora and intoxication for the decrease of kidney  and epatic functions.
These subjects need “drainage” remedies to prevent or treat pathologies due to  toxic storages like liver steatosis,atherosclerosis or deranged metabolism of colesterol,uric acid and glucose.
This constitution is  symbolically comparable to autumn season.the dampness of this season,often make these patients worse,as they don’t like stress and changes.
This subject is living an intoxication for an excess of food or toxins and for the  reduced reactive  emunctorial capacities.sulphur  is the key element for the depurative organic processes,made principally in the liver.
A massive treatment with sulphus can mimic this picture,with cutaneous, pulmonary and intestinal problems.on the contrary,an homeopathic dilution of sulphur reduces these expulsive stimuli,often together with fastidious itching and  inflammations.the use of homeopathic sulphus must be cautious,as it can suppress  the expulsive action of a natrum muriaticum patient.therefore we must be very careful to re-balance this constitution,using previously diet and “drainage” remedies.
With sulphur ,here,we  have to valuate remedies like:nux vomica,antimonium crudum,lycopodium,capsicum… We can get good results with a constitutional nosode called medorrhinum.
The homotoxicological constitutional remedy for this patient is schwef heel:a good way to give sulphur.it is an important medicine to use mainly in clinical situations,common in this constitution like:allergies,toxic  hepatopathy, hyper-colesterolemias,dermatosis and pruriti.
As already said, this patient is incline to get  dismetabolic and toxic patholo-gies,for his peculiar tendency to accumulations.a remedy like lycopodium compositum will be preventive if given once a week,even for long periods.
It can be used when needed,after alimentary disorders.if itching is present, sulphur heel could be a useful complement.
The diathesic oligo-element suited for this constitution,especially in young people  is manganese-cobalt.other complex mineral used are copper, sele-nium and silica .cadmium  as a  toxic mineral .vitamins helpful in this constitution are vit f,b9,b12.green is a good relaxing colour for these patients as well as hendel music.
We have here introduced a relatively new concept:the constitution is not the same for all the life,but changes in relation to different situations.anyway there is  seen how children tend to be phlegmatic,while adolescents are prone to melancholic crisis ; adults, instead, become stressed and accelerated; old people tend to be ”sanguine” and store toxins.constitution is also related to weather changes…and every season can exacerbate a constitutional type:summer light is stimulating,while winter darkness has a slowing effect.we also noted that these four constitutions correspond to four great mineral metabolisms:calcium,phosphorus,silica and sulphur.we can see in everybody.
The unbalanced situation related to these metabolisms:calcium as problems with growths,phosphorus with the energy of the individual, too much or too little; silica has structural and “crystallization” problems,while sulphur deals with de-toxication.
If  these four substances are fundamentals for the life of human beings, the related homeopathic substances,which influence metabolism,are the key remedies in homeopathy.it is,then, important to study the mareria medica  of these remedies.they are the main one and it is possible to be more accurate,searching  for the “similimum”,the most similar remedy among this group.
Every homeopathic remedy has a constitutional characteristic like the patient; so, while it is necessary to define the patient constitution,also we have to know which medicine works better for any constitution.
Not only homeopathic remedies can be classified constitutionally,but all substances with therapeutic effects .therefore all plants,minerals and vitamins have different effects on different patients and must be related to the constitution.
As we said,age influences greatly the constitution and there are specific constitutional medicines for the very young and for the old person.
In particular for the child,the constitutional remedy must be always chosen among the “calcareas”,medicines involved in body growing.
For the old people we have to look at the metabolism of potassium,with different “kalis”,as these subjects have an energetic problem with a specific difficulty in the physiological  potassium storage.
It must be remembered,the expessive modality or the disease is in relation to the reactive  constitution of the individual,as the same disease manifests itself in different ways for different constitutions.
The constitutional homeopathic remedy is fundamental in the treatment of a disease,because it acts on the peculiar immunologic reactivity.
Also cell function is influenced by the constitution;the choice of intermediate catalysts  and quinones ,for single patients,must be done at the light of the constitution.
All must be directed to understand patient’s constitution,to be placed in the neurovegetative diagram.the object of constitutional therapy is to bring back the patient into the centre of the diagram,in the  psyco-physical equilibrium.

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