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| Hpathy Ezine - October, 2005 | |||||
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David Little<-- Interviewed by Dr. Leela D'Souza |
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| Leela: How did Hahenmann decide to overcome a delayed or poor reaction to the first dose? David: In aphorism 246 of the 5th Organon Hahnemann offers a method that covers those cases in which there is a poor to moderate response to the single dose. The Founder noted that when there is only slow improvement in which it might take 40, 50 or even 100 days to cure the patient this period can be speeded up to 1/2, 1/4 or less the time of the single dose. This can be accomplished by following three conditions, i.e. the remedy is perfectly homoeopathic, it is given in a small dose, and the medicine is repeated at suitable intervals to speed the cure. In the footnote to this aphorism Hahnemann makes it clear that under these conditions the remedy may be repeated before the duration of the former dose ceases. In aphorism 286 and 287 he makes it clear that the best way to prepare the dose for administration is to dissolve it in water and give the patient a small portion of the aqueous solution. Therefore, the teaching of the 1830s recommends the single dose wait and watch method in cases where there is a strikingly increasing amelioration, while the repetition of the remedy at suitable intervals is to speed the cure of slow moving cases.
David: That’s right. There are those who only think in terms of the single dose and those who think only in terms of repeating remedies. What Hahnemann offered was a flexible posology system that teaches one when it is best to use the single dose and when it is best to repeat the remedy at suitable intervals to speed the cure. This is a middle path posology method that represents the best of both worlds as it transcends the exclusive single dose method and the mechanical repetition of the remedy. I have found Hahnemann's altered methods to be the single most significant changes made in the 1830s. As I mentioned the last time, I decided I should do an extensive clinical trial in which I would use the methods of the 5th Organon (1833), the Paris edition Chronic Diseases (1837) and the 6th Organon (c. 1842-43) and compare them with the methods of the 4th Organon (1829) and first edition of the Chronic Diseases (1828). When one adds the full medicinal solution and split-doses presented in the 1837 Paris edition of the Chronic Diseases, the advanced posology system is complete. By this time the Paris casebooks show Hahnemann using a remedy bottle and dilution glass to prepare the dose for the patient. No longer was one tied to the dry single dose and waiting for the duration of the action of the remedy to cease no matter whether the progress was fast or slow. Now one could adjust their posology and case management strategies according to the action of the remedy on the patient. There is little doubt that this method does speed the cure of protracted cases greatly and lowers the number and strength of aggravations that slow down the cure. At present, there are many practitioners that have yet to take advantage of this aspect of Hahnemann's advanced methods.
David: One of the first things I noted was that I saw fewer aggravations than with the dry dose and those that did appear were much easier to manage. I think this is because of using a significantly smaller dose and succussing the remedy bottle so the patient never received the exact same potency twice in succession. Of course, if one gives doses of the medicinal solution when not necessary, it will cause aggravations but if used prudently one can avoid unnecessary aggravations. When I was using the exclusive dry dose, I found that there were a number of cases that either did not improve or only seem to slowly ameliorate over a longer period of time. By the rules of the 4th Organon one should not repeat the remedy until relapse even if they were hardly getting better. I found that if one carefully repeated the split-doses of the medicinal solution on these patients, the time of cure was greatly speeded. Instead of waiting and watching these slow moving cases I found that observing closely and acting worked much faster! I also found in chronic diseases that sometimes the remedy no longer seems to work as well as it did in the beginning of the treatment. It was as if the vital force was getting used to the medicine and it no longer acted even when the remedy still seemed well indicated. This would have led me to changing the medicine before it was really necessary and moving away from a perfectly good remedy. But when one understands the method of adjusting the dose and potency, the remedy can be given in a variety of ways which causes the remedy to act as it did at the beginning of the case! This is very important in chronic cases with degenerative pathology which require treatment over a longer period of time. This combination of less aggravation and speedier cures makes the time needed to learn a more sophisticated posology and case management method well worth the effort. The only way this can be done is to test these methods in the clinic over a sufficient amount of time and gain personal experience.
David: After experimenting with Hahnemann's new methods for the C potencies I decided it was time for me to test the mysterious LM potency. The essence of aphorisms 246 and 247 of the 5th Organon are integrated into paragraph 246 of the 6th Organon. Once again Hahnemann states that in observably progressive and strikingly increasing ameliorations the remedy should not be repeated. He notes, however, that in chronic diseases it is rare for a single dose to perform a complete cure in such a dramatic fashion. He explains that one may speed the cure of slow moving chronic cases if the remedy is perfectly homoeopathic, highly potentized, dissolved in water, given in a small dose, and the remedy bottle is succussed prior to administration so that the patient never receives the exact same potency twice in succession. I immediately found that the LM potency acted quite differently than the C potencies. In fact, I believe that their medicinal powers are complementary opposites that greatly enhance the therapeutic range of Homoeopathy. This is because some cases do better on the C potencies and some cases do better on the LM potency and some seem to need both at different times. There is little doubt that it is better to walk on two legs rather than one! At last I felt like I had finally learned my basics properly and could proceed to grow as a good homoeopath on a solid foundation.
David: The next important step was obtaining the microfiches of the Paris casebooks. Once again my wife came to my aid as she reads French very well and was capable of doing high quality translations of Hahnemann's case history records. This helped advance my understanding of the 6th Organon because it provides a record of how Hahnemann actually gave the C and LM potency in medicinal solution in his last years. When this material is combined with the eye witness account of Reverend Everest and Dr. Croserio it fills in the details presented in the 6th Organon and provides new information not found in the text. Too many persons are spreading the idea that the LM potency can be given daily in a mechanical fashion for weeks, months and years on end. This is not what Hahnemann taught in the Organon neither is it found in the Paris casebooks. In the footnote to aphorism 246 Hahnemann says the LM potency may be given daily “when necessary” not all the time. When the daily dose repetition is "not necessary" it will either cause aggravations, relapses or slow down the cure.
David: That’s right. The Paris casebooks show that the Founder either gave single doses usually by olfaction followed by 7 days of placebo or a short series of 3 to 7 split-doses and had the patient come back in one week. At this time he would reassess his case and decide whether to continue the remedy or stop the medicine and give placebos. Hahnemann never gave the daily or alternate day dose for very long without stopping the remedy and giving placebos for a period of one, two even three weeks or more.
David: Hahnemann used placebos for a number of reasons. His patient's were so used to taking medicine every day that he used placebos to pacify them and keep them away from taking other medicines. In general, I like to educate my patients so they understand that they do not always need medicine every day. I save my placebos for the moments that I really need them. This could be during an aggravation or crisis where the patient really thinks they need medicine but I know the symptoms are going to pass off soon. Hahnemann's method was to assess the action of his remedy and then decide whether to put the patient on placebo or continue to give the medicine. Dr. Croserio told Boenninghausen that anytime Hahnemann saw definite medicinal actions he would either slow down the dose or stop the medicine and give placebos. This fact is confirmed by the Paris casebooks because they show that Hahnemann used almost as much placebo as medicine whether using the C or LM potency. These are very important details not contained in the 6th Organon. The idea that the Founder gave the daily dose to all his patients for weeks, months and years is a complete myth. Leela: So some of us have a lot of unlearning to do, followed by good re-learning! I know this is also something that concerns you – the state of contemporary homeopathic education and subsequently homeopathic practice in the word today. David: New students need to be taught the correct foundation right from the start. They need to be taught the full range of the traditional methods and study the repertory and materia medica carefully. There are no shortcuts or new methods that replace the need to understand the teachings of Hahnemann, Boenninghausen, Hering, Jahr, Kent, Boger and others. Old students like myself need to keep a beginner's mind and combine openness with the wisdom of age. We all need to keep growing and not become complacent with what already feels comfortable. I know homoeopaths who are practicing the exact same posology and case management methods they did 20 years ago. This is not the way forward. What I found from my research was that most contemporary homoeopaths were only practicing a small portion of the material Hahnemann introduced. This was not only in the region of posology and case management but also in many other areas of practice. To give you an idea of how insufficient is the teaching available today, let me mention a few areas:
Are we teaching all these subjects in our schools, societies and colleges? I am sorry to say that we are not. These are part of what I call the "lost teachings of Samuel Hahnemann". This has to change.
The only other multi-volume set I have encountered that has dealt with almost the entire range of philosophy and clinical homeopathy are the Symposium Volumes of the Dhawle’s Institute of Clinical Research, Mumbai. David: It concerns me that too many of today's practitioners are not learning the fundamentals of Hahnemannian Homoeopathy before taking up new experimental modern methods. I take quite a bit of "flack" for referring to the teachings of Samuel Hahnemann and requesting people to review his works in their original paradigm more closely. Sometimes, I tire of having to deal with charges that my work is "religion" or "fundamentalism", etc. Some persons seem to imagine that I only read material from the 19th century! This, of course, is not true. I am a modernizer but I don't reject the traditional material. I use the classics as a basis of my studies. I am working to make Homoeopathy the medicine of the future but I keep my feet well planted in the past. There are some persons who do not understand my motives or reasons for emphasizing the Organon, Chronic Diseases and the Lesser Writings of Hahnemann. Why do I do this? I do this because it is my duty to humanity to spread the foundational teachings of Homeopathy because too much of this material is being overlooked or misunderstood. I am just keen to make sure that we all know our basics so we all have a strong foundation to build on as we gain experience.
David: When I began this campaign on the WWW around a decade ago, too much of this material was being ignored and many were only practicing a watered down, simplified version of homeopathy. Some people say "you only need to record the symptoms -nothing else matters". How simplistic! Is this really what Hahnemann taught? In aphorism 6 Hahnemann wrote that all the perceptible symptoms experienced by the patient, reported by friends and relatives and observed by the homeopath make up the "only conceivable Gestalt of the disease". Then in aphorism 7 Hahnemann says: "Therefore, it must be the symptoms alone by which the disease demands and can point to the appropriate medicine for its relief, along with regard for contingent miasms and with attention to the attendant circumstances (Aph. 5)". It is very important to note that Hahnemann speaks of the symptoms, miasms and attendant circumstances and then refers to aphorism 5. This aphorism teaches the importance of examining the complete case history, exciting and fundamental causes, constitution, temperament, lifestyles, habits, personal and social relationships, occupation, age, sex, etc. Added to this are similar statements about the need to understand the cause, symptoms and circumstances in aphorisms18 and 24. Hahnemann continues: "The totality of the symptoms is the outwardly reflected image of the inner wesen [essence, nature, being] of the disease, that is, of the suffering of the life force." One cannot see the mistuning of the invisible vital force but one can witness its derangement by the essential nature of the totality of the signs, befallments and symptoms of the body and soul. These perceptible signs make up the total display of the disease-Gestalt. The essential nature of the totality of the symptoms expresses the true Esse in Hahnemannian Homoeopathy.
David: Yes, there has been much talk about the mind only approach, the essence, the core delusion, the vital sensation, the central disturbance, the grand theme of the remedy, etc. Such ideas are helpful in focusing on what is important in a case but when carried too far become a form of "homeopathic reductionism" that clouds the nature of the totality of the symptoms and leaves behind the Gestalt of the disease in which the whole is more than the sum of its parts. This can lead to a one-sided over simplification in which the true Esse represented by the Gestalt-Qualities of the disease are replaced by stereotypical keynotes.
David: Even "gifted people" need to understand their basics very well or their cases become ungrounded and their remedies are either a "hit or miss" situation. There is no consistency when one leaves the inductive method of Hahnemann too far behind. If one gets overly subjective without the balance of objectivity their results lack coherence. I have seen this many times. When such homeopaths are confronted with degenerative diseases and complex pathology in a clinical setting they often do not know what to do. Why is this? The psychic butterfly that resides in the brain has two wings. The right side of the brain emphasizes intuition while the left side emphasizes logic. In order for the psyche to "fly" its two wings must move in harmony. If one wing or the other dominates it will fall to the earth. What a homoeopath needs is a "whole brain" education in which they use both their right and left hemisphere in harmony. In this way, intuition and logic support each other in a manner that allows for understanding of both causal linear and a-causal synchronistic information. This makes one a true healing artist because they can response to a great variety of situations. To use logic and intuition together is the best of both worlds.
That is an interesting term “homeopathic reductionism”. David: I'll try to explain what I mean by this. Every homeopath needs to understand that the true central disturbance is the mistuning of the vital force which can only be witnessed through the essential nature of the totality of the symptoms with regard to causation, miasms and attending circumstances. In this endeavor the homeopath focuses their attention on the striking, extraordinary, uncommon and odd characteristic symptoms of the disease state not those symptoms common to all diseases (Aph. 153). It is these characteristic signs and symptoms that are the most appropriate aid in finding a suitable remedy for the patient. In some cases our multifaceted medicines are being reduced to overly
simplistic singularities. Then the multifaceted display of a remedy
or family is replaced by a one sided essence that reduces rather
than expands our vision, by ignoring other facets. Yes, we do need
to study the essential threads of our remedies so we understand
their important characteristics and generals symptoms. Nevertheless,
when making themes is taken too far there is a danger of focusing
on a one sided stereotypical concept. This is what I call ‘reductionism’.
David: For me, studying patients, remedies and remedy families is like putting together a jigsaw puzzle. Every puzzle represents a complete portrait with form, color and meaning that is presented in fragments. One cannot tell what this portrait is from by just looking at 1 or 2 pieces even if they form the center of the puzzle picture. One must take all the individual pieces that fit together and connect them one by one until various areas of the portrait become clearly visible. Once most of the pieces are in place, one begins to understand the nature of the total picture. As more pieces are connected together it becomes easier to see where the remaining pieces should go. When all the pieces are in place, then one sees the complete picture that carries an image which is more than just the sum of its parts. One piece does not makes up the whole puzzle by itself, as each section is part of a greater whole that is not known until all the most important sections are connected together.
David: Precisely. After one fits together all
the essential pieces of a jigsaw, they get a glimpse of the total
picture. It is not enough to say that the portrait is a picture
of a man or woman by looking at their nose. Are they young or old?
Are they European, Asian or African? What color is their hair? What
color are their eyes? What is the expression on their face? What
position are they in? What are they doing? What is in the background?
What are the time and circumstances related by the picture? Without
understanding who, |
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