Maintaining Causes X Obstacle to Cure
Author : Claudia di Bisceglie
Date : 18th July 2026
3 minute read
Hahnemann points us towards two important things that every physician should consider when treating a patient: maintaining causes and obstacles to cure
“Now, as in a disease, from which no manifest exciting or maintaining cause (causa occasionalis) has to be removed…”
— Organon of Medicine, §7
"...the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent...”
— Organon of Medicine, §3
These two concepts are closely related, and it is easy to treat them as if they mean the same thing. But they are not quite the same. Understanding the difference helps us think more clearly about what is actually happening with the patient.
Maintaining cause
A maintaining cause is something that is actively keeping the disease going.
Imagine a person whose eczema keeps returning because they are continually exposed to something that irritates their skin. Or someone with respiratory symptoms who continues to live in an environment with a harmful exposure. The illness is not simply something that happened in the past—the factor is still present and continuing to act.
In this situation, we can think of the maintaining cause as something that is feeding the problem.
Some simple examples might be:
Ongoing exposure to an allergen or irritant.
Continuing to work in a harmful chemical environment.
Repeated physical injury to the same area.
Persistent sleep deprivation contributing to recurrent headaches.
An ongoing stressful circumstance that repeatedly triggers symptoms.
A poorly fitting denture continually irritating the mouth.
The important point is that the cause is still there.
If we remove it, the situation may change considerably. The body may be able to recover once the thing that was continually disturbing it is no longer present.
So, in simple terms:
Maintaining cause = something that continues to keep the illness going.
This is why Hahnemann says in §7 that when there is a manifest exciting or maintaining cause, it should be considered and, where possible, removed.
Obstacle to cure
The idea of an obstacle to cure is not necessarily what is causing the disease, but on what is getting in the way of recovery.
For example, imagine someone who has already developed a chronic condition. Poor nutrition may not have been the original cause of the condition, but if the person's general health and nutritional state are poor, this may make recovery more difficult.
Other possible examples include:
Poor nutrition.
Persistent lack of sleep.
Excessive alcohol or drug use.
Severe or ongoing stress.
An unhealthy living environment.
Emotional stress that continually interfere with recovery.
So the question changes slightly.
With a maintaining cause, we ask:
“What is keeping this illness going?”
With an obstacle to recovery, we ask:
“What is preventing this person from recovering properly?”
So, what is the difference?
The easiest way to understand it is to imagine someone has a small hole in their boat.
The maintaining cause is the hole itself. Water is continuously entering. Even if you keep removing the water, the problem continues because the source is still there. Stop the leak, and you have removed what is actively maintaining the problem.
An obstacle to recovery, however, might be that the person doesn't have the tools to repair the boat or is too exhausted to make the repair. These things don't necessarily cause the hole, but they prevent the boat from being restored.
They are therefore closely related, but the emphasis is different.
Can the same thing be both?
Absolutely.
This is where the distinction becomes a little less black and white.
Take smoking, for example. Someone with chronic respiratory problems who continues to smoke is being exposed to something that can continue to damage and irritate the respiratory system. In that sense, smoking can act as a maintaining cause.
At the same time, smoking may also make it harder for the person to recover. In that sense, it can also be an obstacle to cure.
The same can happen with chronic stress.
A stressful situation might repeatedly trigger a person's headaches, digestive symptoms, or other complaints. In that case, the stress may be helping to maintain the problem. At the same time, the constant stress may make it harder for the person to regain health, making it an obstacle to cure as well.
So the two concepts can overlap.
The simplest way to remember it
I always keep these two questions in mind when taking a case:
Maintaining cause:
“What is continuing to feed or sustain the illness?”
Obstacle to recovery:
“What is getting in the way of this person getting better?”
Sometimes the answer will be the same thing. Sometimes it will be completely different.
And this is important in the context of Hahnemann's approach because the physician is not simply looking for a remedy. The physician is also trying to understand the patient, the disease, what caused it, what is maintaining it, and what may be preventing recovery.
When Are Maintaining Causes and Obstacles to Cure Important in Case Taking?
These concepts become particularly important when we are trying to understand why a person is not recovering, why symptoms keep returning, or why a well-chosen remedy does not seem to be working as expected.
They are not necessarily the first things we look for in every case. In an acute illness, for example, the maintaining cause may be quite obvious: perhaps the person has been exposed to cold, has overexerted themselves, or has eaten something that has disturbed them. Once the acute situation has passed, there may be no continuing factor to consider.
In chronic cases, however, it becomes much more important to ask these questions.
They are part of understanding the whole case
When taking a case, we are not simply collecting symptoms and trying to find a remedy that matches them. We are trying to understand the story of the illness.
This means looking at things such as:
When did the problem begin?
What was happening around that time?
Was there an identifiable trigger?
What has happened since?
What seems to make the symptoms better or worse?
Is there something that continues to aggravate the condition?
Is there something in the person's life or environment that may be interfering with recovery?
This can sometimes reveal an important piece of the puzzle.
For example, imagine someone who has recurrent sinus problems and keeps taking a remedy for the symptoms, but the symptoms return every few weeks. During case-taking, you discover that they are working in a damp, poorly ventilated environment where they are exposed to irritants every day.
The environmental exposure may be an important maintaining cause. If it is not addressed, the remedy may be working against something that is continually disturbing the person.
This does not mean that every recurring symptom has an external maintaining cause. It simply means that it is something worth looking for.
They help us understand why a case may be stuck
Sometimes a person has been taking remedies for a long time but seems unable to make lasting progress.
This is when I find the idea of obstacles to cure particularly useful.
Rather than immediately assuming that the remedy is wrong, it can be helpful to step back and ask:
“Is there something interfering with this person's ability to recover?”
Perhaps they are severely sleep-deprived. Perhaps they are continually overworking themselves. Perhaps their living conditions are making recovery difficult. Perhaps there is an ongoing source of physical or emotional strain that has not been addressed.
The purpose of asking these questions is not to blame the patient or suggest that they are somehow responsible for being ill. It is about understanding the conditions in which the healing process is taking place.
They can change the way we interpret the case
A maintaining cause or obstacle can also prevent us from seeing the case clearly.
Imagine someone who has headaches every week. If we only ask, “What does your headache feel like?”, we may collect useful information about the symptom itself.
But if we also ask:
“What is happening in your life when these headaches occur?”
we might discover that they happen after several nights of very little sleep.
Or perhaps they occur every time the person spends long hours working at a computer.
Or perhaps there is an ongoing situation that repeatedly brings them under considerable stress.
These details don't automatically tell us which remedy to prescribe. But they give us a much better understanding of the case.
They are especially important when symptoms keep returning
Recurrence is often a useful reason to investigate maintaining causes.
If a symptom improves and then repeatedly comes back, it is worth asking:
“What happens between the improvement and the return of the symptoms?”
Sometimes there is a clear pattern.
For example:
Symptom → improves → exposure happens again → symptom returns
Or:
Symptom → improves → person returns to the same stressful or physically demanding situation → symptom returns
Recognising these patterns can be very valuable.
It may also help us distinguish between a case that simply needs more time and a case in which something continues to interfere with recovery.
They are important when a remedy appears not to be working
This is another situation where these concepts can be useful.
If the remedy seems well chosen but there is little or no progress, there are several questions we might consider before simply changing the remedy.
Is the remedy actually appropriate?
Has there been enough time for it to act?
Are we expecting too much too quickly?
Has something changed in the case?
Is there a maintaining cause that is still present?
Is there an obstacle to recovery that we have overlooked?
This is one reason good case-taking is so important. A lack of improvement is itself information.
Rather than automatically adding another remedy, repeating more frequently, or changing direction, we can pause and reassess the case.
So when should we look for them?
1. The illness began after an identifiable event or exposure.
Ask what happened before the symptoms started and whether that factor is still present.
2. Symptoms repeatedly return.
Look for a pattern between improvement and recurrence.
3. The patient is not improving as expected.
Step back and reassess rather than automatically changing the prescription.
4. The case is chronic or complicated.
There may be several factors interacting over time.
5. There is an obvious ongoing physical, environmental, emotional or lifestyle factor.
Consider whether it is maintaining the problem or interfering with recovery.
6. The patient's circumstances make recovery difficult.
Sometimes the obstacle is not hidden in the symptoms themselves but in the conditions surrounding the person.
And this brings us back to the purpose of case-taking
For me, this is one of the things that makes homeopathic case-taking so interesting.
We are not just asking:
“Which remedy looks like these symptoms?”
We are asking a much bigger set of questions:
What happened?
Why did this person become ill?
What is keeping the problem going?
What is preventing recovery?
And what does this person's individual symptom picture tell us about the remedy they may need?
The maintaining cause and the obstacles to cure are therefore not separate from case-taking. They are part of understanding the case as a whole.
And sometimes, finding one of these factors can be just as important as finding the remedy.
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