This article was presented in The American Homoeopath, the Journal of the North American Society of Homoeopaths, 1998, page 128.
Homoeopathy as commonly practiced was first established by Samuel Hahnemann in the late 1820s. These were watershed years for our healing art as they represent the beginning of the most productive years of Hahnemann's career. The year 1828 brought the publication the 1st edition of The Chronic Diseases, their Peculiar Nature and their Homoeopathic Cure. This masterpiece was quickly followed by the publication of the 4th Organon (1829) which further elucidated homoeopathic philosophy, case taking and methodology.
In the 1st Chronic Diseases, and its companion volume, the 4th Organon Hahnemann taught the administration of a single unit dose of one or two poppy seed size pellets placed dry on the tongue. The single dose was then followed by a period of observation of the client to assess the remedy's action. Vide aphorism 242 of the 4th Organon.
The Single Unit Dose
"As long, therefore, as the progressive improvement continues from the medicine administered, so long we can take for granted that the duration of the action of the helpful medicine, in this case at least, continues, and hence all repetition of any dose of medicine is forbidden."
The same point is also stressed in Aphorism 245.
"Even one dose of the same medicine which has up to now proved beneficial, if repeated before the improvement has begun to stand still in every direction, will, like an untimely interference, only aggravate the state....."
The Wait and Watch Method
These aphorisms introduced the "wait and watch philosophy" which is a manifestation of the principles of minimal intervention and the minimal dose. If the client is improving after the administration of the first dose of a remedy all repetitions of the dose are completely counter indicated. It is only when there is a clear relapse of the symptoms that a second dose of a remedy may be contemplated. This injunction was introduced to prevent disruption of the natural healing process by the premature repetition of the homoeopathic remedy.
Hahnemann observed that premature repetition of the homoeopathic pellets often caused a relapse of the disorder as well as accessory symptoms of the remedy. This mixture of natural and remedial symptoms confuses the picture and slows down the curative process. This is why classical homoeopaths are very conservative about the repetition of the remedy before there is a definite relapse of the symptoms. This demands great patience as even during slow progressive improvement the client must experience a relapse of symptoms before a remedy can be repeated.
Over the following fifteen years Homoeopathy went through a dramatic transformation as Hahnemann sought to improve his new system. The Master Homoeopath introduced several innovations which brought Homoeopathy closer to perfection. The 5th Organon was published by Samuel Hahnemann in 1833. This was followed by the publication of the 3rd, 4th and 5th editions of The Chronic Diseases in years 1835, 1837 and 1839 respectively. In these twin manuscripts he shares the outcome of his new experiments. The 6th and final edition of the Organon was finished in 1843 but was not published until 1920.
Hahnemann was not completely satisfied with the posology and case management procedures he published in the 4th Organon, especially in complex diseases and chronic miasms. The old master felt there must be a more flexible delivery system for homoeopathic dynamizations. In aphorisms 285, 286, 287 and 288 of the 5th edition he introduces the method of using a freshly succussed aqueous solution in teaspoon doses. He gives one of the principal reasons for this in aphorism 286.
For the same reason the effect of a homoeopathic dose of medicine increases the greater the quantity of fluid in which it is dissolved when administered to the patient although the actual amount of medicine it contains remains the same. For in this case, when the medicine is taken, it comes in contact with a much larger surface of sensitive nerves responsive to the medicinal action. Although theorists may imagine there should be a weakening of the action of the dose of medicine by its dilution with a large quantity of liquid, experience asserts exactly the opposite, at all events when the medicines are employed homoeopathically."
At the same time, Hahnemann elucidated one more critical aspect of the new posology in the note to aphorism 287. This is the importance of succussing the remedy solution immediately before administration in the same manner as one succusses the homoeopathic dynamizations when preparing the stock potencies. In the note to this aphorism Hahnemann points out that anywhere from 1, 2, 3, to 10 or more succussions are used to progressively increase the potency of the aqueous remedy solution. For this purpose the homoeopath uses a 4 to 8 oz bottle filled with a solution made from 1 globule of the homoeopathic dynamization.
From this remedy bottle Hahnemann was witnessed stirring 1, or increasing more, teaspoons of the solution into a 4oz. of water in a glass. From this glass he would then give 1, 2, or 3 teaspoons of the aqueous solution as a dose. In Hahnemann's new posology the potency, size of the dose, number of succussions given to the remedy bottle, and the number of teaspoons administered are all adjusted to suit the constitutional sensitivity of the client. The renewed posology system offers more power and more flexibility than the static dry pellets. These methods of adjusting the dose are one of the greatest gifts of the 5th Organon and the 1837 edition of The Chronic Diseases.
The Middle Path
Another important aspect of the 5th Organon is Hahnemann's review of dose and repetition. In the 4th edition he outlined the single unit dose and the philosophy of the "wait and watch" method. In the aphorisms 245, 246 and 247 of the 5th Organon Hahnemann introduces what he calls the middle path concerning the methods of administrating homoeopathic remedies. He begins his discourse on posology by clarifying the proper view of the single unit dose and when it is appropriate in treatment. He begins his new review in aphorism 245.
Every perceptibly progressive and strikingly increasing amelioration in a transient (acute) or persistent (chronic) disease, is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hastening toward its completion. Every new dose of any medicine whatsoever, even of the one last administered, that has hitherto shown itself to be salutary, would in this case disturb the work of amelioration."
Anytime there is a "strikingly increasing amelioration" on a dose of a homoeopathic remedy there is no need for the repetition of the remedy. If the remedy is repeated when it is not needed it will only slow the cure or disrupt the case. Unfortunately, many chronic patients only slowly improve over a period of weeks to months on a single dose of the appropriate remedy and potency. What can we do to speed the cure? Hahnemann sheds light on this subject in aphorism 246. Vide Organon.
One the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it meets with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable of performing by its nature in a given case, in a period of forty, fifty or a hundred days.
This is however, rarely the case, and besides, it must be a matter of great importance to the physician as well as the patient that were it possible, this period be diminished to one-half, one quarter, and even still less, which many often repeated observations have shown under three conditions.
Firstly, the correct homoeopathic remedy must be chosen by the totality of the symptoms. Secondly, the remedy is to be given in the minimal dose so as not to overexcite the vital force [refer aphorisms on the medicinal solutions]. Thirdly, the remedy may be repeated at suitable intervals to speed the cure, if necessary, without producing aggravations."
The new posology maxim states that anytime the first dose produces a striking amelioration no more medicine is needed for the time being. If, one the other hand, the first dose only produces a slow amelioration the remedy may be repeated at suitable intervals to speed the cure.
This new methodology can only be carried out if the remedy is prepared in a medicinal solution and given in a "split-dose". If the homoeopath is still using the dry pellet dose then they must follow the rules as given in the 4th Organon. This means the homoeopath can only repeat a remedy when there is a definite relapses of the symptoms even if the person is only slowly improving.
With the medicinal solution, however, the remedy may be repeated at suitable intervals as long as the patient is improving without any aggravations. This is how the cure can be reduced to 1/2, 1/4 or less the time it takes with the ordinary dry dose method. These are some of the directions contained in the 5th Organon on the advanced methods of using the centesimal potencies.
It is often said that Hahnemann's introduction of the medicinal solution was only for the LM potencies and that he used his centesimal potencies dry. This is not the case. For a least during the last years of his life Hahnemann used both his centesimal and LM potencies exclusively in the medicinal solution with the addition of a dilution glass. In 1843, just prior to the Master's death, Hahnemann sent Boenninghausen two cases in which he used the C and LM potencies in exactly the same fashion. This proves two important points; first that the new methods of using the aqueous solutions is for all homoeopathic remedies. The second point is that Hahnemann considered the two potency systems to be complementary and used them both to increase the range of the homoeopathic pharmacy. Now he had 6c to 1M centesimal and 0/1 to 0/30 LM potencies at his disposal.
The Limitations of the Dry Dose
Hahnemann suggested that each edition of The Organon and The Chronic Diseases should be studied together as companion volumes. In the 1837 commentary of The Chronic Diseases Hahnemann begins by assessing his experience of the dosing procedures that he used during the late 1820's and shares the outcome of his latest research in homoeopathy.
"Since I last addressed the public concerning our healing art I have had among other things also the opportunity to gain experience as to the best possible mode of administering the dose of the medicines to the patients, and I herewith communicate what I have found best in this respect. A small pellet of one of the highest dynamizations of a medicine laid dry upon the tongue, or the moderate smelling of an open vial where one or more such pellets are contained proves itself the smallest and weakest dose with the shortest period of duration in its effects."
Due to the great diversity of constitutions and sensitivity, a homoeopath needs a flexible delivery system which allows for the adjustment of the remedy in each individual case. This is something that the medicinal solution supplies. Vide The Chronic Diseases.
"Nevertheless the incredible variety among patients as to their sensitivity, their age, their spiritual and bodily development, their vital powers, and especially in the nature of their disease necessitates a great variety in their treatment, and also in the administration to them of the doses of medicine."
Also of great importance is the following revelation which explains why the untimely repetition of an unmodified dose causes complications and explains the reason homoeopaths disagree so much about the repetition of doses.
"Before proceeding, it is important to observe, that our vital principle cannot bear well that the same unchanged dose of medicine be given even twice in succession, much less more frequently to a patient. For by this the good effect of the former dose of medicine is either neutralized in part, or new symptoms proper to the medicine, symptoms which have never before been present in the disease appear, impeding the cure. Thus even a well selected homoeopathic medicine produces ill effects and attains its purpose imperfectly or not at all. Thence come the many contradictions of homoeopathic physicians with respect to the repetition of doses."
The observation that the vital force is disturbed by the repetition of an unadjusted dose is the conclusion of around 35 years of experimentation and should not be taken lightly. In the 6th Organon Hahnemann adds that even with the perfect remedy it is unwise "to let the patient have a second or third dose taken dry.". The production of these complications is the main reason why repeating remedies before the relapse of symptoms is counter indicated in the classical Homoeopathy of the 4th Organon. The use of the medicinal solution however, overcomes this problem because it can be adjusted with succussions so that the patient never receives the exact same potency twice. Vide The Chronic Diseases.
"But in taking one and the same medicine repeatedly (which is indispensable to secure the cure of a serious chronic disease) if the dose is in every case is varied and modified only a little in its degree of dynamization, then the vital force of the patient will calmly, and as it were willingly, receive the same medicine even at the briefest intervals, very many times in succession with the best results, every time increasing the well being of the patient. This slight change in the degree of dynamization is even effected, if the bottle which contains the solutions of one or more pellets is merely well shaken five or six times."
The Discovery of a New Potency System
Hahnemann was not completely satisfied with the medicinal solutions of centesimal potencies. especially in complex disorders and chronic miasms. He found in those with hypersensitivity, low vitality, complex chronic miasms and organic pathology that the high potencies produced unproductive aggravations while the lower potencies could not cure. How could he make a potency which could fill this lacuna in homoeopathic treatment? Surely the answer to the question did not lie in raising the centesimal potency to still higher levels so he decided to increase the dilution rate instead.
After many experiments Hahnemann settled on the 1/50,000 dilution ratio called the LM potency. His new potencies use a serial dilution system which begins with the LM 0/1 potency and progresses through 0/2, 0/3, 0/4, 0/5, 0/6, onward to 0/30. This gradually increasing scale of 30 potencies is the perfect balance to the rapidly ascending centesimal scale. Now the new posology included the adjustments of medicinal solutions of two complementary yet opposite potency systems. This expanded the range of homoeopathic treatment.
Human beings have always been subject to the stresses of birth, life and death. Such conditions are universal in their proportions. Nevertheless, our modern times present the homoeopath with tremendous challenges. We live in a world of environmental degradation and endangered species, nuclear radiation, chemical and toxic waste, universal immunization and drug use, rapid urbanization, psychological complexities and spiritual crisis. This is accompanied by the rapid mutation of acute and chronic miasms into new drug resistant strains and the appearance of new miasmic diseases that lead to auto immune diseases and immuno-deficiency disorders.
Today's homoeopath sees mixtures of inherited predispositions, inherited and acquired miasms, multiple immunizations (iatrogenic miasms), along with chemical exposures, drug suppression and psychological and physical traumas. This makes it all that much more important that the entire legacy of Samuel Hahnemann is put into practice in the field. Many cases that were incurable with the method of the 4th Organon were cured by the methods of the 5th and 6th Organon. Hahnemann's claim that the new posology could speed the cure to 1/2 or 1/4 the time of the method of the 4th Organon must be put to the test by experienced classical homoeopaths.
Much of this new material has been misrepresented because it has been misunderstood. The posology methods of the 5th and 6th Organon are placed on top of the strong foundation of the 4th Organon. The "wait and watch method" is the basis on which the careful repetition of remedies to speed the cure is placed. Many people think that the LM potencies can be given in some mechanical manner daily or every other day as if they are some low potency. This is a great mistake as the repetition of the LM potency when it is not needed will either slow down the cure or cause aggravations. LM potencies will aggravate cases the same as the centesimals if they are given when they are not needed to speed the cure.
The first dose of any homoeopathic remedy should be a single unit test dose (C or LM) which is left to act for a reasonable period of time. When there is a striking response to the first dose there is nothing else to do for the moment. If there is only a slight or slow improvement the remedy may be repeated to speed the cure if the four cardinal rules are followed. These are that the remedy is perfectly homoeopathic, that the remedy is given in medicinal solution, that this solution is succussed before each dose to change the potency slightly and that the remedy is repeated at suitable intervals to speed the cure without causing aggravations.
The Size of the Dose
There is a commonly held belief in modern homoeopathy that the size of the dose makes no difference in the action of a homoeopathic remedy. Therefore, it follows that the administration of 1 or 1000 drops, globules or teaspoons are all "the same". Some of these ideas originate with James Kent in his Lectures on Homoeopathic Philosophy where he combines the Swedenborgian view of energy as a simple substance with the homoeopathic potency. As the simple substance represents the fourth state of matter it could have qualities but no quantity. Therefore the size of dose makes no difference. This is one area where our two great teachers disagree.
Hahnemann taught that potentization releases dynamic forces similar to electromagnetism which carry the inner medicinal energies of a substance. He discovered that each pellet contained a certain "quantum" of pure remedial energy at specific potency levels. As both the amplitude and frequency affect the wave form of a signal, the size of the dose,and the potency affects the remedial powers. The Old Doctor's views of energy dynamics are more similar to modern physics than the Swedenborgian paradigm. He taught that the more perfect the simillimum, and the higher the potency, the more the size of the dose dose must be controlled. Vide aphorism 275.
"For this reason, a medicine, even though it may be homoeopathically suited to the case of disease, does harm in every dose that is too large, and in strong doses it does more harm the greater its homoeopathicity and the higher the potency selected, and it does much more injury than any equally large dose of a medicine that is unhomoeopathic and in no respect adapted to the morbid state (allopathic)".
The Founder taught that the phenomenon of the aggravation was related to the size of the dose as well as the the potency. These two factors become far more critical in individuals with sensitive constitutions, weakened vitality, chronic miasms and organic pathology. Hahnemann wrote of his own experience in relationship to the size of the dose in The Chronic Diseases.
"I have myself experienced this accident, which is very obstructive to cure and cannot be avoided too carefully. Still ignorant of the strength of its medicinal power, I gave Sepia in too large a dose. This trouble was still more manifest when I gave Lycopodium and Silica potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. Discite moniti!"
Hahnemannian posology is based on the size of the dose, the potency factor and the nature of the delivery system. All of the breakthroughs of the 5th and 6th Organon are founded on the medicinal solution, olfaction, and the methods of adjusting the dose. In my own 12 years study I have put Hahnemann's theory to the test in the field and found his postulate to be true. Kent faithfully applied the methodology of the 4th Organon and never put the posology of the 5th Organon into practice. He did not see the 6th edition nor know about the LM potency. It seems he was not privy to Hahnemann's final insights in homoeopathic methodology. Even our grand teacher of Constitutional Homoeopathy still had something to learn from The Elder Homoeopath.
The following examples demonstrate the Hahnemannian methods of posology and highlight the methods of adjusting the dose.
1. A very hypersensitive lady who was taking one 6c pill dry was experiencing strong aggravations every time she took the dose after which she would improve a little and then relapse. She thought she was too sensitive for Homoeopathy and may have given up. On making a medicinal solution, and taking one teaspoon, the remedy no longer aggravated, and she was able to repeat the remedy at suitable intervals until she was cured. This is an example of how changing from the dry dose to the liquid dose, and succussing before each teaspoon dose transmuted an aggravation and made the remedy repeatable in a sensitive who had trouble taking even one dose dry. This is an example of changing from a dry dose to a liquid dose which shows there is a difference in the way you give the dose and its amount.
2. A homoeopath who took Carbo Veg. 200c in a dry dose did not react. The remedy seemed to fit her case. She then was told to try it again but in a medicinal solution. The dose was one teaspoon. A few doses of the 200c succussed 5 times before each dose to slightly change the potency cure rapidly. This is another example of a solution curing where a dry dose failed. If dosage makes no difference wet or dry as Kent said why did this work?
3. A woman who took one dose of Cimicifuga LM 0/1 in a 4oz. solution for migraine headaches experienced a similar aggravation. After increasing the amount of water in the solution by making an 8oz solution there was no aggravation and she was able to repeat the remedy every three days for a month and her migraines never came back. She never experienced aggravation again. This is an example of adjusting the dose by using more water in the original solution. This made the remedy act more gently on her constitution and made it repeatable without aggravation.
4. A person suffering from sleep apnea was given Arsenicum Album LM 0/1 in a 6oz solution, succussed 3 times before ingestion, 1 teaspoon was taken and stirred into 6oz of water, 1 teaspoon was given as a dose. After taking the remedy there was an aggravation of some of the concomitant symptoms for three days, then a slight improvement for a short while, and a relapse. The remedy was given again, but 1 teaspoon was taken out of the first dilution glass, and placed in a second glass from which the client was given 1 teaspoon. The succussions were the same. This caused a radical improvement and removed the sleep apnea. There was no aggravation on the dose made in this manner. This is an example of diluting the remedy through two glasses of water and getting a striking response when the remedy out of the first glass caused an aggravation and then only a made a small improvement. Doesn't this show a difference in the size of the dose? According to modern Homoeopathy this would not make any change in the effect of the remedy.
5. A patient was given a remedy in a medicinal solution which was succussed 5 times before ingestion. He responded well to the first dose, but when he was told to take a second dose, he forgot to succuss the bottle and the remedy did not act. After the situation was discussed he was reminded to succuss the remedy before taking it again and it worked just as well as the first time. This is an example of taking the same unsuccussed, unmodified remedy twice in succession and having no affect at all. When the remedy was "potentized anew" as Hahnemann suggested in paragraph 248 it acted very deeply. This demonstrates the important of succussion and changing the potency of each dose. This is a related subject but does not really deal with changing the amount of the dose.
Hahnemann mentioned in Organon that there are special conditions when the size of a dose must be increased to overcome a disease. The first example he gives is when there are the primary eruptions of the chronic miasms are on the skin. Here are some example of this method.
6. In a case of scabies (one of psora's primary eruptions) the normal one teaspoon dose did not act deep enough to remove the mites. In aphorism 248 Hahnemann mentions giving "one or increasing more teaspoons" of the remedy when needed. By gradually increasing the amount of the dose from 1 teaspoon to 2 then 3 teaspoons the parasites were quickly removed. (I have done similar cases to this many times.)
7. A case of ringworm (a primary eruption on the skin related to the TB miasm) was only responding slowly to repeated doses of Bacillinum LM1 given in teaspoon doses. The succussions were raised but it did not help. The dose was repeated more often but there was no change. The size of the dose was increased to 3 teaspoons and the ringworm immediately responded and began to disappear. This larger dose acted where a smaller dose did not. The succussions were kept the same.
Another example Hahnemann gave of cases that often need an increase of the size of the dose is when the general health of a person has improved but a stubborn local complaint remains. I have often seen cases where there is a general improvement but a lesional or pathological complaint lingers on. In cases like this it is best to start with the smallest possible doses to get a reaction and slowly augment them until there is an effect on the local complaint.
8. I gave Calcarea Carb LM1 to a gentleman who had an incredible number of symptoms including impotency which brought him great despair. He responded mentally and vitally to the first doses but the local complaint lingered until the size of the dose was gradually augmented over a period of time by increasing the number of teaspoons taken as a dose. The impotency vanished and he has remained cured to this very day.
Another reason for increasing the size of the dose is when a case no longer seems to be moving forward.
9. A person was suffering from a swollen prostate with concomitant melancholia and impotence, and obstruction of the flow of urine, a pressure-like sensation in the perineum. He was first given 1 teaspoon of Conium which caused a fair response. He increased the 1 teaspoon to 2 on his own and got an similar aggravation (too large of a dose). He was advised to stop the dose for a few days and to start again with 1 teaspoon. This worked very well as LM1 and LM2 were used and the worst symptoms disappeared. Then it seemed as if the movement of the remedy forward had reached a plateau so the size of the dose was slowly increased from 1 teaspoon to 2 then to 3, and the case once again started moving rapidly forward and is much, much better. If the size of the dose makes no difference, how did this all happen?
These are examples of cases where the methods of adjusting the dose made a difference between success and failure. If I did not adjust the size of the dose in these cases the correct remedy might have been called into question. These methods are all connected to the innovations that Samuel Hahnemann introduced in the 5th (1833) and 6th Organon (finished 1842) and the 1837 edition of the Chronic Diseases. This methods demand more artistry on the part of the homoeopath but with more knowledge comes more responsibility.
How to Make a Medicinal Solution
The preparation of the remedy solution for the centesimal and LM potencies can be summarized in 3 easy steps.
1. Take an 8 oz bottle and drop in one, rarely two, # 10 pills of the chosen remedy. The minimal amount of water mentioned by Hahnemann is 7 tablespoons which is 3 1/2 oz. I usually use 4 to 6 oz solutions. That leaves at least 2 oz. as a small air gap which makes for good succussions. The larger bottles (6 oz., 12 oz. etc.) are only necessary when one is treating a hypersensitive as the larger amount of water makes the dose act more gently. Add a sufficient amount of brandy or pure alcohol for a preservative. Up to 1/4 or 1/3 of the solution should be brandy to assure lack of spoilage.
2. The bottle is to be succussed just prior to ingestion in order to activate the remedy and slightly raise the potency. The number of succussions greatly affects the action of the remedy on the vital force. For those who are hypersensitive 1, 2 or 3 succussions is usually enough. Those of an average sensitivity more normally use 4, 5, 6 or 7 succussions. Those who have rather low sensitivity will need 8, 9 or 10 succussions. It is best to start with a lower number of succussions and increase the amount if and when necessary. This is one of the primary methods of adjusting the dose.
3. From this bottle 1, 2, or 3 teaspoons (depending on sensitivity) are stirred into a 4oz glass of water. From this dilution glass 1, 2 or 3 teaspoons are giving to the adults. Infants are given 1/4 teaspoon or less depending on age and the average child 1/2 teaspoon, The size of the dose can be gradually increased if more reaction is needed. A constitution of a lower sensitivity might need 2 or 3 teaspoons before they will react sufficiently to the remedy. This is another way to adjust the dose. An extreme hypersensitive may need the remedy diluted through 1, 2, or 3 such dilution glasses. In this case a teaspoon or less is taken from the first glass and stirred into a second or third glass.
Give the client one test dose and wait and watch for a reasonable amount of time to see how they react to the remedy. This time period depends on the nature of the disease you intend to treat. Acute and chronic disease each have their own peculiar cycles. If there is a striking response and a dramatic improvement let the single dose act without interference. If there is only a slow or moderate improvement the dose may be repeated at proper intervals to speed the cure. Slow down the repetition of the remedies as the client improves. If the remedy produces any aggravation it is best to wait and watch for the expected amelioration. This is the middle path. Why not put Hahnemann's postulates to the test for yourself! The study of the 5th and 6th Organon will make this all possible.