Chicken or eggTolle 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.

Lindlahr's tree of diseaseTolle 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.