Tolle causam. Treat the cause. This direc­tive seems so sim­ple and obvi­ous at first glance. Like any good detec­tive, it implores us to search through the patient’s story, signs, and symp­toms to seek out the root of ill health. Tolle causam urges us to uncover the source of dis­ease, remove any obsta­cles to cure, and let the vis med­ica­trix nat­u­rae work its beau­ti­ful magic to restore health. If only it were so easy. Mer­ci­fully for both doc­tor and patient, some­times it is.

Tolle causam is some­times trans­lated as “iden­tify and treat the cause.” (1) Other def­i­n­i­tions allow for more plu­ral­ity: “Iden­tify and treat the causes.” (2, 3) A direct trans­la­tion says some­thing a lit­tle dif­fer­ent. The Latin imper­a­tive “tolle” com­mands us to remove, take away, destroy, and lift up the cause (causam in Latin). The use of the sin­gu­lar noun here implies there is one sin­gle cause to dis­ease. Indeed, this is some­times the case in prac­tice where a sin­gle fac­tor, such as lack of sleep, poor pos­ture, or inad­e­quate nutri­tion, is cre­at­ing a health con­cern that is alle­vi­ated by remov­ing the cause. More often than not how­ever, there is no sin­gle cause to point to.

Peo­ple, and their lives, are more com­plex than a sin­gu­lar event or cause. Another natur­o­pathic prin­ci­ple serves to remind us to address the whole per­son. Tolle totum points out that the whole entire per­son must be taken into account dur­ing all stages of treat­ment, from intake to assess­ment, diag­no­sis, treat­ment, and beyond. Dis­ease, in natur­o­pathic med­i­cine, is viewed as a process rather than a dis­crete entity. When we look at the whole pic­ture, we rarely see a lin­ear pro­gres­sion from health to ill­ness where cause and effect are neatly related to each other like a flow chart. Instead, we must open our eyes to the com­plex­ity of non-linearity, where causes may exist on top of one another or side-by-side, cre­at­ing over­lap­ping and holo­graphic lay­ers of cause and effect. Look­ing at things holis­ti­cally, requires both patients and doc­tors to become com­fort­able think­ing in terms of inter­re­la­tion within cau­sa­tion. This approach invites us to bring aware­ness to pat­terns of health and ill­ness and explore the mean­ing of dis­ease. A focus on pat­terns is nec­es­sary to help us under­stand the per­son who is griev­ing the loss of a loved one and expe­ri­ences a chronic cough, or the per­son who has indi­ges­tion, acne, and aller­gies. It asks us to uncover how seem­ingly dis­parate symp­toms, sen­sa­tions, and feel­ings fit together, and how we might effect change in these patterns.

Tolle causam encourages us to approach our health story like a journalist and ask the "six Ws". Why does she have anemia? How did he come to have this pain? When and where and what else was going on in their life when they began to feel unwell? As Hippocrates said: "It is more important to know what sort of person has a disease than to know what sort of disease a person has." This quote beautifully captures the essence of both Tolle causam and Tolle totum.

Coming back to definitions, what if we step back and first ask: Do we need a clear cut chicken or the egg answer as to what came first? Is understanding the interconnections and overall pattern enough, or do we need to break it down into specific factors and/or causes? What possible therapies might act as stimuli for this person's vis med­ica­trix naturae, as cat­a­lysts for health? Does the order of treat­ment move in rela­tion to the process of dis­ease? Or, can the direc­tion of cure be tan­gen­tial to the dis­ease process, pre­sent­ing a third or fourth or fifth way of becoming?

Para­phras­ing what many of my patients have said: “Great. I’ve iden­ti­fied that my health con­cerns are related to ___________ (e.g. not feel­ing uncon­di­tional love as a child, stunted cre­ativ­ity, repeated antibi­otics, socio-economic strain, genet­ics, etc…). So now what?” Unfor­tu­nately, this is where Tolle causam often leaves us hang­ing. Some­times, obsta­cles to health can­not be eas­ily removed. Some­times, new (or under­ly­ing) concerns/causes come up or are uncov­ered in the process. In the com­plex­ity of causes and pat­terns, there isn’t always an obvi­ous direc­tion for treat­ment. This com­plex­ity high­lights an appar­ent para­dox: natur­o­pathic med­i­cine may be con­cur­rently reduc­tion­is­tic (search­ing for spe­cific causes) and holis­tic (pattern-thinking). Nonethe­less, it is always an art, and a practice.