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| Hpathy Ezine - April, 2008 | |||||
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David Little<-- Interviewed by Dr. Manish Bhatia |
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First of all, I would like to know, what
are the most positive and significant aspects of Hahnemann’s legacy
in your opinion? In aphorism 6 of the Organon Hahnemann taught that the essential nature of the totality of the symptoms makes up the only perceivable “gestalt of the disease”. On this basis, Homoeopathy is founded on a gestalt philosophy in which the whole is more than the sum of its parts. This is why Hahnemann said that one symptom no more makes up the whole disease than one foot makes up a whole person. This holistic vision stands apart from the reductionist view associated with orthodox medicine. Rather than standardizing patients by the most common symptoms associated with the names of disease, Homoeopathy individualizes the striking, exceptional, uncommon and odd symptoms characteristic of the patient. Taking a homoeopathic case is like putting together a jigsaw puzzle so that one can see the nature of the portrait it contains. Each piece of the puzzle only contains one fragment of a total picture that must be placed in combination with other related parts in the proper manner to solve the riddle. One may look at one piece and see that it is a nose but one cannot tell whether that nose belongs to a man or woman let alone the color of their eyes and hair, the expression on their face, what they are doing, nor what is in the background. Only when a number of the most important pieces are placed together can one see the bigger picture. In a similar manner each symptom fragment represents one piece of a puzzle that makes up the gestalt of the disease. The homoeopath has to select the most important symptom segments and fit them together in the proper order until the underlying portrait of the disease becomes visible. In this manner, the inquirer uses the characteristic locations, sensations, modifications and concomitants to make up complete symptoms that are united in the unique patterns of distinctive homoeopathic remedies. The vehicle used to accomplish this goal is the homoeopathic repertory, which acts as a guide to the greater materia medica. The repertory is an open systems tool in which the symptoms of homoeopathic remedies have been redacted and distributed by the regions of the human being from the mind within to the skin without. This allows for the recombination of the various rubrics in innumerable permutations that reflect the medicinal powers of the homoeopathic remedies found in the materia medica. This system of reference forms a large integrated data base that allows for the maximum individualization of the causes, symptoms and attendant circumstances. These are some of the most important aspects of the philosophy and practice that Hahnemann introduced in the Organon, the Chronic Diseases, and the Lesser Writings.
MB: What do you think is
the greatest danger to homoeopathy in modern times? The danger to Homoeopathy today is twofold; one is from without and the other is from within. It is obvious that segments of the orthodox establishment have declared war on Homoeopathy in a number of places around the world. A combination of narrow minded reductionist scientists and so-called quack busters would like to reinstate an “inquisition” in which homoeopaths are declared medical heretics. This is not the first time in history such a campaign has been run as there have always been those that seek to destroy any alternative to allopathic medicine. That is why it is important that homoeopaths around the world defend the right of patients to choose homoeopathic treatment. I would like to thank you, Dr. Manish Bhatia, and your colleagues for taking up this challenge whole heartedly. My second concern is that some homoeopathic educational institutions and educational programs are not teaching the history, philosophy and practice of homoeopathy in the proper manner. In some courses little or no effort is made to teach the classical paradigm associated with the 4th, 5th and 6th Organon, the Chronic Diseases, and the Lesser Writings. There are some students and teachers that have never really bothered to study this material seriously. They depend almost exclusively on information provided by popular teachers over the last 35 years. Today, we have an increasing number of new systems being presented to persons that do not have a proper education in the traditional works. If this trend continues the foundation of Homoeopathy may be weakened in such a manner that it gives way from within. I agree with Hering, that it is the duty of all of us to go further in the theory and practice of Homoeopathy than Hahnemann, but without overturning the universal principles on which our healing art is founded. Some persons have yet to master the repertory and materia medica, while at the same time they are trying to use a number of experimental methods taught on the seminar circuit or in certain schools. I have heard persons say that they have gone “beyond” the repertory and materia medica when they never really learned it in the first place. Others opine they do not need all that “old stuff” because they are already practicing the “highest methods”. On questioning one usually finds out that such persons do not have much experience with the true classical methods. Some of the new insights have been developed by well trained
classical homoeopaths while others are being spread by those who
never practiced the traditional methods in a proper manner. Some
of the methods are harmonious with the traditional teachings while
others stand in complete opposition. It is our opinion that the
best of the new information naturally acts as a complement to the
traditional repertory and materia medica, not its replacement. It
is best to have a solid education in the classic methods before
taking up new, experimental ideas. This is because without a proper
education it is impossible to separate the wheat (useful, new information)
from the chaff (unsafe, unreliable methods). MB:
That Hahnemann was a genius and much ahead of his times, is something
upon which we all agree. But I have found that nearly every school,
everyone with a new thought or a divergent philosophy and practice,
finds something from Hahnemann to support its work. Some people
misquote the words, present opinions without references, and even
tell untruths at times. What in your opinion is the most significant
misinformation about Hahnemann and his work? DL: Perhaps some of some of the most distorted information circulates around how Hahnemann actually gave his remedies. Some of the reasons for this lack of understanding are that Hahnemann’s German and French casebooks have not been studied in detail until more recent times. Some of the early information on Hahnemann’s Paris casebooks was done by persons that did not know what was in Hahnemann’s German casebooks, or what methods were actually published in the 1st through 5th editions of the Organon, the various editions of the Chronic Diseases, and other lesser known writings. The mystery was further compounded by the fact that the 6th Organon was not published until 1920, after Hering, Boenninghausen, Jahr, Lippe, Allen and Kent had died. For this reason, one does not find any discussion of the methods Hahnemann used between 1833 and 1843 in the writings of most classical homoeopaths. Another problem with much of the early information is that it was spread by persons who had no practical experience in the methods discussed in the 6th Organon, the Paris casebooks, or the LM potency. For the above reasons, they imagined that Hahnemann was using all sorts of methods he never used before and was keeping them secret. This lack of understanding of the historical progression of Hahnemann’s works led to the claim that Hahnemann did not really follow the methods he taught in the Organon in his final years in Paris. Some persons have even claimed that the Founder was routinely using more than one remedy “at the same time” but did not make it public because it would be so controversial. They use polypharmacy terms like “two remedies at once” to describe Hahnemann’s alternation of two single remedies at different times, and “remedy combinations” to describe his application of a sequence of single remedies over time. These individuals tend to make up their own combination remedies or use mixtures produced by certain companies. They say that they are following the way Hahnemann practiced in his final years. What is the truth about such assertions? What do Hahnemann’s casebooks have to say about this? I have been studying Hahnemann’s German casebooks from 1821, 1830 and 1833-35 as well as his French casebooks from 1835-1843. These journals contain the record of how Hahnemann actually practiced in the clinic. In the 1st, 2nd and 3rd Organon Hahnemann wrote that due to the limited number of remedies it was sometimes hard to find one remedy that covered the totality of the symptoms. For this reason, he evolved strategies that involved a chief remedy in alternation with an intercurrent medicine. This method, he said, worked better than only using one partially fitting remedy. The use of a chief remedy, alternations, intercurrents and a sequence of remedies are found in German casebook D-22 (1821). This casebook corresponds to the period just after the 2nd Organon and records cases two years after Hahnemann began his group study of Psora. Hahnemann was marking symptoms that he considered psoric in nature with “Scab” “NB scab” or “NB sc”. Later these symptoms appear in the rubric list found in the theoretical part of the Chronic Diseases in 1828. Some point to Hahnemann’s use of Sulphur in Paris as if this was something completely new, but even in these early years Sulphur was his most prescribed remedy. His use of Sulphur was based on the presence of a psoric terrain and its group symptoms. At the same time, Hahnemann used a number of intercurrent remedies for a variety of reasons depending on the symptoms, time and circumstances. In chronic disease these sequences were usually started, continued and ended with Sulphur. The doses of Sulphur were typically complemented by the interspersing of intercurrents and placebos at various intervals. The Founder would send the patient home with various numbered packets that contained medicinal and non-medicinal doses. The most common intercurrent remedies in the German casebook D-22 were Nitricum Acidum and Stannum, both of which would later be classified as anti-psoric remedies. The application of alternations and intercurrents in acute disease did not generally include the use of Sulphur. Nevertheless, the most commonly used “intercurrent remedy” was actually a placebo that accompanied a single remedy. Hahnemann used placebo to control the patient and mark the spacing between doses and remedies. In some prescriptions the use of Sulphur seems to be directed at the psoric terrain while the other remedies were prescribed more on the individualized symptoms of the patient. In other cases, the role of the intercurrent remedy seems to be to calm the organism and prepare the vital force for more repetitions of Sulphur. The most common interval for sequencing a chief remedy and the intercurrent medicine was around 7 to 8 days. This period seems to correspond to what Hahnemann wrote in aphorism 279 of the 3rd Organon. In this paragraph he stated that the primary action of a remedy of the potencies he was using at the time generally lasted for around 7 to 8 days. This may be the reason for the near weekly doses in the remedy sequences. In the 4th Organon in 1829 Hahnemann removed the aphorisms on the chief remedy and the intercurrent medicine from the main body of the text although references to alternations were still found in the footnotes. It seems that by this time, Hahnemann felt that there were enough well proven remedies to find a single remedy in most cases. At this time, the Founder’s main focus was on the anti-miasmatic remedies and the treatment of the miasms psora, sycosis and syphilis. By this time, Hahnemann was starting most of his chronic cases
with Sulphur, in accordance with his belief that psora is the principle
cause of chronic disease. For example, Hahnemann’s German casebook
D34 (1830) includes 74 first prescriptions. Out of these 74 first
prescriptions, 57 are of Sulphur, which makes up 77% of the cases.
Hahnemann appeared to use this method in patients who suffered from
a combination of psora, suppression and drugging. Although the liberal
use of Sulphur has been associated with the Paris epoch, in truth
it started well before Hahnemann left for France in 1835. MB: What
were some of Hahnemann’s most controversial experiments? In 1833 a student of Hahnemann named Dr. Aegidi suggested that Hahnemann test the use of two remedies given at the exact same time. A record of these trials is found in Hahnemann’s German casebook D-37, which records some unusual prescriptions between June and August 1833. For example, on August 3rd, 1833 Hahnemann gave a patient “Coloc with Graph” and 14 placebos (D-37, p. 338). For a time Hahnemann considered including this experiment in a footnote in the 5th Organon but he changed his mind due to a combination of clinical realities and concerns about the negative effects that such a method would have on homoeopathic theory and practice. Hahnemann noted in a letter to Boenninghausen (Samuel Hahnemann, His Life and Works, R. Haehl, VII, p. 253) that “As it is never, as we know, absolutely necessary” to use a double remedy, any advantage gained from this sometimes useful method was greatly overbalanced by the disadvantages that would arise from its misuse. If Hahnemann thought that it was absolutely necessary to use double remedies, the advantages of the method would have surely outweighed the abuse of the technique, but this was not the case. Hahnemann wrote that out of his “many attempts of this kind only one or two have been successful, which is insufficient for the incontrovertible establishment of a new rule”. If most of Hahnemann’s many attempts had turned out well, he might have had a different opinion. In the same letter Hahnemann called this procedure “a very difficult and doubtful method” (Samuel Hahnemann, His Life and Works, R. Haehl, V.II, p. 253-254). After discussing the ramifications of Aegidi’s method with his followers, Hahnemann decided that it would be best to withdraw the footnote on the subject from the 5th Organon and write a strong caution against the procedure instead. In a footnote to aphorism 272 of the 5th Organon Hahnemann wrote that administering two remedies at the “same or almost same time” was “a hazardous experiment, which can never be necessary, though it may sometimes seem to be of use”. In January 1834 the Founder wrote a letter to Dr. Aegidi in which he emphasized the difficult and doubtful nature of the double remedies. He also points out that if the homoeopath finds a well suited remedy based on the characteristic symptoms there is no need to find the next most suitable one. In this light, Hahnemann wrote: “You presuppose that imitators could easily find the correct Simmilimum in such a case of illness not only for one part of the symptoms but also the other part and in such a way that they could always achieve good results. Ah! if most homoeopaths could or would discover only ONE remedy, exactly suitable in accurate similarity to the characteristic symptoms, we would gladly excuse them in the necessity of finding the nearest suitable one!.....For my part I find the discovery of the right remedy difficult and laborious in every case. Therefore I do not see how they would hit upon the first, to say nothing of the second twin remedy so easily! Pardon me for being so incredulous in this matter.”(Samuel Hahnemann, His Life and Works, Haehl, VI, p. 395). In aphorism 273 of the 6th Organon Hahnemann
continued on the “not necessary” theme when he stated that “In no
case of cure is it necessary to employ more than a single simple
medicinal substance at one time with a patient. For this reason
alone, it is inadmissible to do so.” The double remedy method
is not necessary because if one well chosen remedy needs to be complemented,
a second remedy can be given in the form of an alternation, a chief
remedy and intercurrent medicine or a tandem prescription in which
one remedy follows after another. These methods are much more sophisticated
in terms of application and timing than is possible with the double
remedies. That is why Hahnemann said, “It is wrong to attempt to
employ complex means when simple means suffice”. MB: What
about the idea that Hahnemann "continued" to give two
remedies for a chronic disease in the same day? DL: Where are the case histories? How many times did Hahnemann do this? Where are the exact references with casebook numbers, names, dates and page numbers? Such a method is either very rare if not completely non-existent. Proof of this assertion would require a number of clear case histories where the prescriptions say something like “today take remedy A and B” with full details. Vague listing of more than one remedy with words like “then” or “after” or suggested remedies in brackets proves nothing. In the 1833 to 1835 casebook (D-38) Hahnemann writes single remedy prescriptions as well as numbered sequences of medicines as he had done earlier in his career. For example, on March 6th, 1834 Mrs. Carlin von Roitsch (D-38, p. 44) was given a prescription in which two chronic remedies are noted. The journal reads, “28, 1 sulph.., 15 calc ./X”. The number 28 records that the treatment plan spanned 28 days. On the 1st day the patient was given Sulphur 30C and on the 15th day she was given Calcarea 30c. An example of an alternation of two remedies can be found in the case of Mr. Keil (D-38, p. 9). The patient came to see Hahnemann on December 9th, 1833 and was prescribed “7, 1 sil 3 euphr 5 sil”. This means that in a 7 day period the patient was given Silica on the 1st day, Euphrasia on the 3rd day, and Silica again on the 5th day. This is the alternation of an acute apsoric remedy and chronic anti-psoric medicine. Hahnemann sometimes used a series of remedies in which three remedies were given in a particular sequence. On February 16th, 1834 the Founder gave Mr. Reiche (D-38, p. 34a) a multiple prescription that included; “28 1 sulph, 10 natr m, 19 hs”. This mean that over a 28 day period the patient was given Sulphur on the first day, Natrum Muriaticum on the 10th day, and Hepar Sulphuris on the 19th day. The rest of the time the patient was given placebos. Hahnemann’s favorite days for numbered sequences of remedies appear to be 1st, 3rd, 5th; 1st, 5th, 9th; 1st, 8th; and 1st, 15th; and 1st, 10th, 19th. Sometimes he would write down to take one remedy for a specific number of days and another remedy afterwards. The greatest majority of the prescriptions in the Paris casebooks (1835-1843) are of one single remedy at a time. By the time Hahnemann began writing the 6th Organon in the 1840s there are no prescriptions involving numbered sequences and preconceived schedules let alone the routine use of two chronic remedies given in the same day. At this time, Hahnemann was more conservative with his remedies than he had been during his earlier career. Occasionally, Hahnemann would alternate an acute remedy with a chronic remedy or two chronic remedies in the case of complex miasms. For example, in the case of Robert Everest (DF-14, p.7) Hahnemann gave Cannabis 30C in medicinal solution for the primary symptoms of gonorrheal sycosis on December 28th, 1842. This prescription was followed by placebos on January 4th and 7th. On January 11th the patient was given an olfaction of Thuja and placebos that was followed by more placebos on January 14th. On January 18th Hahnemann gave an olfaction of Cannabis and more placebos and noted that he was planning to alternate Thuja and Mercury to clear the presence of sycosis and syphilis. On January 21st he gave an olfaction of Mercury and four placebos. Then on January 25th Hahnemann gave Thuja 0/1 in a medicinal solution. On February 3rd he gave Thuja 0/2 in medicinal solution. This was followed by placebos on February 10th and 17th. Finally, on February 25th Hahnemann returned to Mercury in the 0/1 potency in medicinal solution. This was followed by placebo on March 7th. This treatment successfully removed the acquired gonorrheal sycosis and addressed an underlying syphilitic miasm. In this case, Hahnemann first alternated Cannabis and Thuja interspersed with periods of placebo over a period of days to treat the primary stage of gonorrhea and the sycotic miasm. After this he alternated Mercury and Thuja interspersed with placebos and periods of waiting and watching for syphilis and the remaining sycosis. These timely alternations were not done by preconceived numbered remedy schedules. They were the alternation of single remedy prescriptions in accordance with the nature of the signs and symptoms and the actions of the remedies on the patient. This is characteristic of the way in which Hahnemann alternated acute and chronic remedies and used intercurrent medicines between 1840 and 1843. Some individuals try to portray the Paris casebooks as if they
contain all sorts of unusual methods not found in Hahnemann’s published
works. The entire way the Paris epoch is presented by these revisionist
historians is absolutely backwards. The historical truth is that
Hahnemann used more prearranged alternations and numbered sequences
of remedies in 1821(D-22), 1830 (D-34), 1833 (D-37), and 1833-1835
(D-38) than he did in the French casebooks from 1835 to 1843 (DF-2
through DF-14). All of these techniques were already published in
the various editions of the Organon, the Chronic Diseases,
and other lesser known articles. In the years 1840 to 1843 Hahnemann’s
most common prescription was a single remedy and his most popular
“second remedy” was a placebo! MB: Many
people who support complexes even go to the extent of calling Hepar-sulph
and Causticum to be complexes prepared by Hahnemann! Is there any
validity in such ideas? DL: Our medicinal substances are made up of the minerals of the periodic table, and organic molecules in various combinations. The minerals of the periodic table readily combine according to their atomic structures which forms more complex organic plant life and finally zoological species. All of our medicines involve combinations of these building blocks of life. The point here is that each homoeopathic remedy has been tested on the healthy as a single remedy and the symptoms brought out during treatment of the ill have been recorded. Then the most dependable of these symptoms have been included in our materia medica. Hepar Suphuris Calcareum is made from Calcarea Ostrearum and flowers of Sulphur that was proved and tested as a single remedy. In a letter to Boenninghausen in 1836 Hahnemann wrote that “Hepar Sulphuris and the neutral alkalis, which in accordance with the laws of nature, always contain their constituent parts in the same proportion”, and that such a remedy can “be used suo jure as simple remedies and gives no excuse for that dangerous heresy and mixture”. Natural combinations of elements of the periodic table through chemistry are not the same as mixtures of several diverse remedies such as Nux Vomica, Lachesis and Plumbum that do not combine naturally. In the same letter Hahnemann called combination medicines “an abominable heresy which give the death blow to true homoeopathy and throws it back to blind allopathy”. Homoeopathic remedies are tested on living human beings as single
remedies and given to the ill as single remedies based on similar
symptoms. To think that such a careful scientific method is the
same as mixing several remedies together in the form of unproven
mixtures is rather misguided. No one can predict the action of several
different homoeopathic remedies given in combination all at once.
How can one tell which remedy is well suited from one that might
be counter indicated or causing aggravations or new symptoms? Using
combination remedies makes case management more confusing and runs
the risk of producing idiosyncratic reactions. This is one of the
cardinal reasons Hahnemann rejected polypharmacy and the mixture
of homoeopathic remedies. MB: Hahnemann
also experimented with the vehicle, scale and dilutions. He moved
from dry dose to liquid solutions to LM potencies. What was his
preferred method to dispense medicines at the time of writing the
4th, 5th and 6th editions of Organon?
Do his case records reflect what he wrote in the Organon? DL: At the time of the 1st edition of the Chronic Diseases (1828) and the 4th Organon (1829), Hahnemann was dispensing his remedies on poppy seed sized globules that were given dry or occasionally dissolved in water as he described in the Chronic Diseases. In these works, Hahnemann suggested allowing the remedy to act as long as there was an improvement and only repeating the remedy when the case came to a standstill or there was a relapse of the symptoms. This is called the “wait and watch method”. In aphorisms 245 and 246 of the 5th Organon (1833) Hahnemann revolutionized his approach by explaining when to allow the single dose to act alone and when to repeat the remedy to speed the cure. In aphorism 245 the Founder wrote that “Every perceptibly progressive and strikingly increasing amelioration” completely precludes the repetition of the remedy as long as this state lasts. This is because the strikingly increasing effect of the remedy is already moving toward completion as fast as possible. In this case, any additional doses may “disturb the work of amelioration” and cause a relapse of symptoms or aggravation. Then Hahnemann says, that on the other hand, there are cases where a single dose only produces a “slowly progressive amelioration” in which the single dose accomplishes all the good it can over a period of “40, 50 or 100 days”. In many cases even this slow continuous improvement does not take place. Therefore, it is a matter of great importance to reduce this period to ½, ¼ or less of the time so that a more rapid cure takes place. Today, homoeopaths tend to fall into two general groups. There are those who always give a single dose and wait and watch for longer periods and those who repeat the dose at short intervals in all their cases. What Hahnemann is offering is a protocol that transcends these polarized extremes and presents a middle path that embraces both methods used at the proper time in the proper way. In cases where a single dose produces a striking, increasing healing action the remedy should be allowed to act as long as this condition lasts. In those cases where a single dose can only produce a slow improvement over a longer period of time, the remedy may be repeated at the appropriate times to speed the cure. To accomplish this goal, Hahnemann states that first of all the remedy must be well chosen and given in a small dose at “suitable intervals”. Therefore, whether one only gives the single dose over a longer
period, or whether one repeats the remedy at shorter intervals depends
on the nature of the remedy action in the individual patient, not
on a rigid belief system or a preconceived notion about what is
right or wrong for everyone. If there is a strikingly progressive
increasing improvement then it is best to allow the single dose
to act alone. If there is only slow improvement that will take many
days, weeks and months to show significant results, then the remedy
may be repeated at suitable intervals to speed the cure as long
as it causes no aggravations, accessory symptoms or new symptoms.
MB: How
did Hahnemann administer his remedies at this time? In aphorisms 286 to 288 of the 5th Organon Hahnemann states his preference for administering remedies in medicinal solution but he did not give exact details on how to prepare the medicine. In the footnote to this aphorism Hahnemann offers his most detailed explanation of olfaction. He wrote that in his experience olfaction has the same strength and duration as the oral dose, but it acts more gently on the vital force. He also wrote about this liberal use of olfaction in his preface to Boenninghausen’s first repertory published in 1833. He felt that olfaction caused fewer aggravations when repeated than the dry dose, yet acted just as deeply. He often used this method to speed the cure. The German casebook D-38, which covers the years 1833-1835, confirms that the majority of Hahnemann’s doses were given by olfaction not the dry oral dose. In March 1834 Hahnemann’s casebook records the use of the liquid solution in which 1 pill was placed into ½ teaspoon of water and given to the patient. In May, 1834 the casebook shows Hahnemann placing the pills in a cup of water, stirring the solution and giving the patient teaspoon doses. It also records the use of brandy as a preservative when a remedy was going to be used over a longer period of time. So even during the early 1830s, Hahnemann was moving away from the dry dose to olfaction and the medicinal solution. The first clear explanation of the preparation of the 7 to 20 tablespoon medicinal solutions appears in the preface to the 1837 edition of the Chronic Diseases. In this work Hahnemann speaks of making up a remedy bottle and giving the patient spoonful doses over a longer period of time. Paris casebook DF-5 from the same year shows that Hahnemann was already using the medicinal solution and dilution glass method by this time. Therefore, the medicinal solution and dilution glass method was first developed for the C potency and then later applied to the LM potency. In the 6th Organon (c. 1842-1843) Hahnemann combined the information found in aphorism 245 and 246 of the 5th Organon into aphorism 246 and applied it to the LM potency. In the first sentence of the aphorism Hahnemann offers a slight variation on the theme he introduced in aphorism 245 of the 5th Organon. The Founder states that, “Every perceptibly progressive and strikingly increasing amelioration during treatment” completely precludes any repetition of the remedy as long as this state lasts. This, he states, is often the case in acute disease, but in chronic diseases, it is more common to witness a slow progressive improvement that takes place over 30 to 100 days. Then Hahnemann states that this longer period may be reduced by ½, ¼ or less the time it takes with the old single dose wait and watch method provided certain conditions are met. These conditions are that the remedy is a suitable simillimum, is highly potentized, dissolved in water, given in a proper small dose, and the medicine is repeated at suitable intervals that experience has shown to be the most appropriate for the acceleration of the cure. He also notes that the medicinal solution should be succussed prior to administration so that the degree of potency of every dose is slightly different. This, he opined, allows the life principle to be altered in a beneficial manner without the antagonistic counter actions witnessed when repeating the unmodified dry dose. In aphorism 248 and its footnote Hahnemann explains in detail
how to prepare the medicinal solution which includes both a remedy
bottle and a dilution glass, as well as a specially prepared solution
in a vial for olfaction. At this time, Hahnemann’s predominant delivery
system was the oral medicinal solution but he still used olfaction
on a good number of occasions. The Paris casebooks from the years
1835 to 1843 show that Hahnemann gave all of his remedies in this
fashion. MB:
What was Hahnemann’s protocol for repeating remedies during this
period? It has been said that Hahnemann always gave the LM potency daily or more often even in chronic diseases. They point to aphorism 246 and its footnote and say that Hahnemann said you should give the LM potency daily for months. They ignore the first sentence of the aphorism that states that any time in treatment there is a clearly progressive and strikingly increasing amelioration, the remedy should not be repeated. This means that if the first, second, third, or more doses suddenly causes a dramatically increasing amelioration the remedy should be stopped and the patient put under observation. On this basis, Hahnemann proceeds to explain how to repeat the remedy to speed the cure in chronic diseases where a single dose, or infrequent doses, can only produce a slow response. Then in the footnote Hahnemann says that with his new method a well chosen remedy may now be given daily for months, WHEN NECESSARY. It does not say that one should give the daily dose to everyone for months! If it is NOT necessary such a rapid repetition for very long periods runs the risk of causing serious aggravations and grafting strong medicinal symptoms on the vital force. In aphorism 248 Hahnemann teaches how to give the remedy in chronic cases that do not respond quickly to a single dose or infrequent repetitions. He says that in protracted diseases the remedy may be given daily, or on alternate days, or in the case of olfaction, every 1, 2, 3 or 4 days, etc. The remedy may be repeated as long as the patient improves and there are no aggravations, accessory symptoms or new complaints. These are signs that the repetitions of the remedy should cease. The repetition should also be stopped if there is a visibly progressive and strikingly increasing amelioration anytime during the treatment. In this way, one learns when to wait and watch and when to act and observe the action of repetition. The Paris casebooks record the way the Founder actually gave the LM potency in the clinic. At the beginning of treatment, Hahnemann tended to give either a single dose (usually but not always by olfaction), or a short series of 3 to 7 liquid doses over a period of one week. Then he would reassess the action of the remedy on the patient. At this time, Hahnemann would either repeat the medicine or give the patient a series of placebos depending on the nature of the remedy action. As the case became more stabilized he might see the patient after two weeks. An example of a single dose of the LM potency may be found in the case of Mr. Tarbocher (DF-13, p.56). On May 22, 1842 Hahnemann gave the patient a single olfaction of Sulphur 0/1 followed by 8 days of placebos. Then Hahnemann repeated the process. In a letter found in Boenninghausen’s Lesser Writings (p. 213), Dr. Croserio confirms that Hahnemann “frequently” used this method in his final years. In his eyewitness account he states that in chronic diseases Hahnemann would not allow the patient “to smell the medicine oftener than once a week and would give nothing but sugar of milk besides” Although Hahnemann often gave the LM potency daily or every other day, he also repeated the dose at longer intervals. For example, on April 30th, 1842 Hahnemann gave Madame Gardy (DF-13, p. 410) a dose of Graphites 0/1 in medicinal solution every third day. On the two intervening days he gave the patient placebo. The Paris casebooks show that Hahnemann sometimes gave the LM potency daily, every other day, every third day, every fourth day, or once a week, etc. The case of Robert Everest (DF-14, p.7) is an example of how Hahnemann alternated a series of medicinal doses with a series of placebos. On October 5th, 1842 Hahnemann gave the patient a series of doses of Sulphur 0/1 and on October 12th he gave Sulphur 0/2. This was quickly followed by 12 days of placebos from October 14th to October 26th. Then Hahnemann gave the patient a series of doses of Sulphur 0/3 until November 4th. After this the patient received placebos for one month until December 3rd when he received Sulphur 0/4. Over a period of seven months Hahnemann gave this patient 17 remedial prescriptions interspersed with 16 prescriptions of placebos. Even during the LM epoch Hahnemann gave almost as much placebo as medicine! This “on again-off again” method is witnessed in a great majority
of Hahnemann’s LM cases. I have not seen one LM case in which Hahnemann
gave the daily or alternate day dose for months on end without interspersing
placebos and periods of waiting and watching. The Paris casebooks
show that Hahnemann gave the C and LM potency in medicinal solution
in a great variety of ways and made liberal use of placebos. The
idea that Hahnemann gave all his patients the daily dose for weeks
and months on end is a complete myth! MB: Apart
from the misrepresentation of prescriptions, many people say that
Hahnemann did not practice what he preached and that it’s difficult
to find cured cases in his records. What is your opinion about this?
Are his cases not documented properly? DL: Those who say Hahnemann did not practice what he preached usually connect such statements with comments like “so why should we”? This is used as an excuse to ignore everything Hahnemann wrote in the Organon so that the individual can do whatever they like in the name of Homoeopathy. Individuals who say such things usually have no idea of what Hahnemann actually introduced in the various editions of Organon and other writings. The contradictions they pose are usually based on bits and fragments taken out of context without regard for the historical time-line in which they developed. The truth is that what one finds in Hahnemann’s German and French casebooks corresponds perfectly with the successive editions of the Organon, the Chronic Diseases, and Hahnemann’s letters to colleagues. If one mixes up all this material and turns it on its head, one comes up with all sorts of peculiar ideas, which more often than not, have a hidden agenda behind them. I have reviewed hundreds of Hahnemann’s cases and one clearly finds a number of cures, a number of cases that partially improve over time, and a number of cases that do not go very well. Hahnemann had good success with acute and simple chronic diseases, but like most of us, he had a much harder time with patients who suffered from chronic miasms, suppressions and heavy drugging. One must remember that Hahnemann was breaking new ground and did not have the advantage of several generations of knowledge. His major role was to open the door for all those who followed. How many of Hahnemann’s critics could have developed the complete homoeopathic system in the first place? How many could have accomplished what Hahnemann did in one lifetime? Dare I say none? They are benefiting from Hahnemann’s 50 years of experience but they don’t want to give the Founder any credit for it! Hahnemann pointed the way to the medicine of the future but some are only looking at his finger. Is it any wonder they cannot see the bigger picture? They live in ivory towers and have yet to learn that those who live in glass houses should not throw stones. Hahnemann is the Alpha of Homoeopathy not the Omega. He introduced a sophisticated system of healing that is unequalled in many respects. He set the foundation on a sound philosophy and a clear system of checks and balances that makes Homoeopathy a safe and effective system. What one finds in his casebooks is the growth of a new system from its infancy toward maturity. We are not saying that everyone should stop with Hahnemann’s works, but we are saying that everyone should start there. Hahnemann only used around 100 remedies and his access to repertories and materia medicas was quite limited. Today we have hundreds of well known remedies and very large repertories and materia medicas that are easily searchable by computers. Homoeopathy has grown greatly over the years and we are the carriers of this legacy. Nevertheless, many of today’s homoeopaths are only employing a small percentage of Hahnemann’s original paradigm. Most are still using the methods the Founder developed in the 3rd and 4th Organon and too few have truly integrated the teachings found in the 5th and 6th editions in any practical manner. In many areas modern Homoeopathy has stopped growing with the methods of the 1820s, while most of the enhancements Hahnemann introduced in the 1830s and 1840s are overlooked. Many persons are busy seeking new avant-garde systems before they really understand the original classical paradigm. In truth, those that are best suited to use the new, experimental methods are those who truly understand Hahnemann’s legacy. This allows such persons to reach for the sky while keeping their feet well planted on the ground. Others try to climb too high without any grounding so their practice ends up lacking the reliability and safety of the classical system. All I can say about the situation is that it is much easier to
tear down than to build up, to cover over than to discover, and
to divide and rule than to unify and share. The constant flood of
poorly sourced research and iconoclastic attacks on the Founder
do more to cloud than enlighten and do not make us better homoeopaths.
Much of the information that is being passed around about Hahnemann’s
life and works is so distorted that it only serves to confuse students
and teachers alike. It is high time that credible research by experienced
homoeopaths takes place and the historical record is corrected in
our educational institutions. This material is not easy to assess
if one has absolutely no understanding of the clinical methods they
contain. Some of the bitterest critics have never even practiced
classical Homoeopathy in a clinical environment for any period of
time. MB: I
have personally used the liquid solutions of the centesimal scale
with great success, and in fact, they are my preferred way to give
homeopathic medicines these days. I wonder why the liquid solutions
never came into vogue and are still only used by a handful of homeopaths.
Can you share your own views and experiences about this? DL: James Kent taught that the size of the dose and the delivery system made no difference in the action of the homoeopathic remedy. He never saw the 6th Organon and had no access to Hahnemann’s Paris casebooks. His sources of information were rather limited and his application of the dose never progressed past the methods of the 4th Organon. He did not think it mattered whether one gave 1 or 1000 pills or stirred the pills in water and gave 1 or 100 spoonfuls. This is because Kent believed that potentization reduced the remedy to the “simple substance”, which had qualities but no quantity. Most homoeopaths still follow Kent’s views and use his series of seven potencies, i.e. 30C, 200C, 1M, 10M, 50M, CM and MM. Those who follow Kent’s teachings tend to use a random number of dry pills of the high and highest potencies. They do not seem to understand the importance of the minimal dose, and often mistakenly think that this term refers to the negligible amount of original substance found in potentized remedies. These ideas are still being taught by most educational institutes although the winds of change have begun to blow. Hahnemann taught that the size of the dose and the method of the delivery system have a great effect on the action of homoeopathic remedies. In this view each pellet is considered to hold a certain quantum package of remedial power that increases when 1, 2, or 3 pellets are used. In aphorism 276 he made it clear that the more perfect the remedy, and the higher the potency, the more important the size of the dose becomes. Too large of the dose of a potentized remedy is directly linked to the production of aggravations and antagonistic secondary actions of the vital force. This is the reason that Hahnemann progressively reduced the size of the dose as he increased the potencies of his medicines. At first, Hahnemann used material doses in grains and drops. He began to dilute his medicines to reduce what he perceived as toxic side effects but later came to understand that many of the aggravations he witnessed were caused by the primary action of the remedy. As he increased his potencies in the 1820s, he took one drop of the pharmaceutical potencies like the 30C and dropped the alcohol preparation on 300 tiny pellets. Later he increased the number of pellets to 500 per drop. Then the Founder would use 1, 2, or more of these pellets as a dose. This was a significant reduction in the size of the medicine that was made for clinical reasons. By the 1830s Hahnemann began to reduce the size of the doses further, by dissolving 1 pill in various amounts of water that was given in divided doses via the oral tract. He also administered the minimal dose through the inhalation of the subtle vapors of the potency via the olfactory nerve and respiratory tract. At this time, Hahnemann was experimenting with higher potencies like the 60th, 90th, 100th, 150th, 200th, and 300th. The movement toward the medicinal solution and olfaction was the direct outcome of his use of progressively higher potencies. By 1837-1839 these methods were more or less perfected. By 1839 to 1840 Hahnemann changed the direction of his experiments
and was engaged in clinical trials in which he tested a number of
new potency systems. These experiments were witnessed by Reverend
Everest, his patient and close confidant. In 1853 Everest wrote
about the nature of these experiments in a letter to Dr. Luther
published in the London Homoeopathic Times. After testing
a number of experimental potencies side by side the Founder came
to the conclusion that the 1/50,000 ratio called the LM or Quinquagenimillesimal
potency was the most suitable new potency system. Now Hahnemann
applied the liquid delivery system and olfactory methods he originally
developed for the C potency to the LM potency. This brought about
certain modifications in his posology and case management procedures
that were further elucidated in the 6th Organon.
MB: What
are some of the advantages of using the medicinal solutions? DL: The process of reducing the size of the dose and refining the delivery system was intimately related to the changes in Hahnemann’s case management procedures introduced in the 5th Organon and the 1837 edition of the Chronic Diseases, and the 6th Organon. The method of speeding the cure by repeating split-doses at suitable intervals is best carried out by the use of the more flexible medicinal solution. The stagnant, unmodified dry dose does not bear repetition as well and more easily leads to aggravations, accessory systems and antagonistic counter actions of the vital force. Hahnemann taught that the sensitivity of patients varies in a scale of 1 to 1000. A preparation that would not even affect a number 1 hyposensitive patient will produce serious complications in the number 1000 hypersensitive patient. The great advantage of the medicinal solution is the methods of adjusting the dose to suit the patient’s sensitivity, the nature, degree and magnitude of the disease state, and the condition of the vital force and vitality. These adjustments include the size of the medicinal solution,
the use of 1 or more pills, different sizes and numbers of teaspoons,
varying numbers of succussions prior to administration, and the
option of using a series of dilution glasses for hypersensitive
patients. This allows for the fine-tuning of the remedial powers
in a manner that is impossible when using the dry dose. In this
way, it is possible to speed the cure with the use of split-doses
when necessary, while at the same time, avoid aggravations and crises.
MB: Can
you tell us about your personal journey and how you came to the
way you practice today? DL: James Kent was a great homoeopath whom I admire and whose works I have studied for over 35 years. In my first decade of practice he was my primary source of information and I followed his posology methods. Nevertheless, his teachings that the size of the dose does not matter is linked with his acceptance of strong aggravations as more or less normal during the process of cure. Using too large a dose of the high potencies was also responsible for some of the prolonged crises produced during the reversal of symptoms as witnessed in Hahnemann’s direction of cure, usually called Hering’s laws. In my Kentian years everything was very dramatic. The successes were dramatic, the aggravations and crises were dramatic, and the failed cases were dramatic. Everything was far too dramatic! I remember those phone calls and interviews in which the patient told me how aggravated they felt, and I can still hear myself telling the patient that this was a good sign. This is because we were taught that without pain there is no gain. Somehow, I never really believed it because there were also cases of radical cure that took place without any such aggravations. I felt that something was wrong and it bothered me greatly. This is the reason I began to read the Organon more seriously and it changed my practice forever. Hahnemann wrote in the 2nd aphorism of the Organon that the cure should be a “rapid, gentle and permanent” restoration of the state of health. Well, I had seen the rapid and permanent but many times the “gentle” evaded me. I noticed that a quick, short aggravation was usually followed by a rapid and well sustained improvement. I also noticed that in stronger and more prolonged aggravations this was often not the case. Through reading the Organon I came to understand that an aggravation is caused by the primary action of the remedy as it replaces the natural disease. It is not a natural healing crisis. Now I understood that the secondary curative action of the vital force was actually working to remove the similar remedial disease from without while reinstating true health within. Now it became clear that too large a dose, too high a potency, and giving the remedy when it was not needed, was the source of most aggravations. I also noticed that prolonged aggravations actually used up the patient’s vitality, leaving little or no vital energy for a long enduring amelioration. To attain a rapid, gentle and permanent cure involves finding the right remedy or remedies, giving one single remedy at a time, and using the minimal dose in a suitable delivery system in the proper potency. These are the checks and balances that make homoeopathy a safe and effective system. It was Hahnemann who taught the basics that every homoeopath should know. I learned through a careful study of his works that the size of the dose and delivery system are a very important part of posology while most persons were only thinking in terms of potency. Then I applied Hahnemann’s advanced methods in a step by step manner in a series of clinical trials that lasted years. Once I made this change the number of aggravations and complications were dramatically reduced and my cures were truly more rapid as well as gentle. I call on all open minded homoeopaths to study Hahnemann’s advanced posology and case management procedures and then run their own clinical trial. Use the dry dose wait and watch method on one group and Hahnemann’s advanced methods and the medicinal solution on the other group. Administer single doses and infrequent repetitions of the medicinal solution, in those cases that respond in a strikingly progressive manner. Use split-doses of the medicinal solution at more rapid intervals in protracted disease states that require more frequent repetition to speed the cure. Learn the methods of adjusting the size of the dose and the
number of succussions to suit the sensitivity of the patient and
the time and circumstances. Learn Hahnemann’s advanced methods properly
from the start and follow the protocols we have discussed carefully.
If you do this for one year you will see that the size of the dose
really matters and the dynamic liquid delivery system is a very
efficient way to give remedies. You will also see that it is truly
possible to speed the cure of slow moving cases dramatically. MB: In
India, there is a trend to give the liquid potency (not solution)
directly on the tongue of the patient, especially higher potencies.
Is this appropriate? DL: Yes, there are those who use pharmaceutical liquids without using the intermediate step of medicating a number of small pellets. It was Hahnemann’s practice to medicate 500 small pellets with 1 drop of the pharmaceutical liquid and use 1 or 2 pills in medicinal solution. This means that one or two drops of the pharmaceutical liquid is 500 to 1000 times larger than Hahnemann’s standard dry pellets. If one uses 3, 4 or 5 drops, the size of the dose is increased accordingly. These large doses are certainly not suitable for persons who are sensitive; suffering from organic pathology in the vital organs and systems; have compromised organs of elimination, and an unstable vital force and weakened vitality. Perhaps, some do it because they still think the size of the dose doesn’t matter while others believe in the maximum rather than the minimal dose. Hahnemann noted that such large doses contribute to prolonged aggravations, strong accessory symptoms and antagonistic counter actions of the vital force. Hahnemann taught that the optimum amount is the smallest possible dose prepared in the most dynamic medium. The most energetic delivery system is the medicinal solution. In this system, tiny poppy seed sized pellets are used to measure and store medicinal powers in precise quantum packages. Then 1 or 2 (rarely more) of these potentized pellets are used to impregnate a larger aqueous solution with medicinal energy. Then the medicinal solution is “potentized anew” with perhaps 8, 10 or 12 succussions just prior to administration so that the patient never receives the exact same potency twice in succession. This is truly the most dynamic way to give a homoeopathic remedy. The olfactory dose is transmitted through the olfactory nerve to the brain and passes through the sinuses, trachea and respiratory tract. The oral dose comes in contact with the mucous membranes of the tongue, mouth, throat and stomach. During this process, the dynamic remedy comes in contact with many more nerves and surfaces than the dry pellets placed on the tongue. Hahnemann felt that this difference was important as he considered the nervous system to be the medium by which the vital force perceived a homoeopathic remedy (aphorism 16). In my experience, a small dose of the medicinal solution produces the gentlest yet most penetrating primary action and stimulates the longest enduring curative secondary action of the vital force. This not only prevents aggravations but also makes the remedy far more suited to be repeated in split-doses to speed the cure when necessary. In this way, the vital force increases its energy in degrees until it is much more powerful than the original disease and complete vitality is restored. Any time one uses too large a dose, they run the risk of producing too strong of a primary action in the form of unneeded aggravations and accessory symptoms. If the dose is exceptionally large it runs the risk of producing an antagonistic secondary action, which constitutes a negative reaction of the vital force itself. For these reasons, Hahnemann taught that it was best to start with the smallest sensible dose, and only increase the amount of the remedy, if and when necessary. |
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