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The Refining of a Paradigm
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© David Little 1996-2007, all rights reserved.
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The Aphorisms of the 4th, 5th and 6th Organon

The 4th, 5th, and 6th editions of Organon represent the development of Homoeopathy over a critical fourteen-year period in which Hahnemann perfected his healing art. It is very important to study the historical progression of Homoeopathy to understand the methods of the 6th Organon. Some of the most important passages deal with administering the first dose and following the case to cure. The 4th Organon (1829) and the 1st Chronic Diseases (1828) established the method that most contemporary homoeopaths still use. This was a decisive moment in homoeopathic history as Hahnemann introduced the vital force, chronic miasms, very small doses and the 30C potency.

In these works, the Founder suggests the use of a single unit dose of one poppy seed size pill, olfaction and the early liquid solution of the 30C potency. This method is called the single dose, wait and watch philosophy.

"As long, therefore, as the progressive improvement continues from the medicine last administered, so long we can take for granted does the duration of the action of the helpful medicine, in this case at least, continue, and hence all repetition of any dose of medicine is forbidden."

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Editions), Appendix, 4th Organon, Aphorism 242, page 212.

The first single unit dose of a homoeopathic remedy is a test to see if the remedy, dose and potency are appropriate for the patient. If there is a strikingly progressive improvement from the single test dose the remedy should not be repeated. Sometimes the single dose performs a complete cure. More commonly there will come a time when the action of the remedy slows down and a relapse of symptoms appears. At this time, a second dose of the remedy is indicated. The repetition of the dry dose is only allowed when there is a definite relapse of the symptoms. This warning was introduced to prevent the relapse of the symptoms that often accompanies the premature repetition of the dry pellets.

In the 5th Organon (1833) Samuel Hahnemann completely revises his system of administering the C potency remedies. In aphorisms 286, 287 and 288, he introduces a new delivery system, the medicinal solution. He also emphasized the effectiveness of olfaction for similar purposes. With these improved delivery systems comes a new case management procedure. In aphorism 245 of the 5th edition Hahnemann reviews the ideas raised in aphorism 242 of the 4th edition.

"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 towards 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."

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Editions), 5th Organon, Aphorism 245.

Whenever there is a dramatic increasing response to the first dose of a homoeopathic remedy it is best to leave well enough alone! Unfortunately, many cases only demonstrate a slow progressive amelioration over a period of weeks to months and then there is a relapse. In the 1820s Hahnemann had no special strategy to speed the cure in these slow or moderately improving cases. For this reason, the Founder started to experiment with the medicinal solution and olfaction and repeating the dose to reduce the time it takes to cure.

"On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily effected, as recent and oft-repeated observations have shown, under three conditions."

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Editions), 5th Organon, Aphorism 246.

A strikingly progressive increasing amelioration is the best possible response to a homoeopathic remedy. What do we do with slow moving cases? In the footnote to this aphorism the Founder suggested that one could repeat the dose at suitable intervals in slow moving cases rather than waiting for a complete relapse of symptoms. Hahnemann called his new posology the “middle path” because it stands half way between the single doses wait and watch method and the mechanical repetition of the medicines. In the footnote to aphorism 246 he suggested that a 30c should not be repeated more often than every seven days in robust patients and every nine, twelve to fourteen days in those more weak and excitable. This shows that Hahnemann was already using the medicinal solution of the C potency and developing his new posology system long before he discovered the LM potency.

Aphorism 246 of the 6th Organon

Aphorism 246 of the 6th edition is based on a synthesis of the ideas introduced in aphorisms 245 and 246 of the 5th edition with the addition of five new conditions to speeding the cure. It represents the entire 6th Organon method in a nutshell. The first topic taken up is when a single dose of the LM potency produces a strikingly progressive improvement in the patient’s symptoms.

"During treatment, every noticeably progressing and conspicuously increasing improvement is a state which, as long as it persists, generally excludes any repetition of the medicine being used because all the good being produced by the medicine is still hastening towards completion. This is not seldom the case in acute diseases."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

When a single dose of the LM potency produces an obvious progressively increasing amelioration the remedy should not be repeated. This is because the simillimum is already hastening toward cure at the fastest possible rate. A strikingly increasing amelioration is one in which the patient feels better day by day as the symptoms are rapidly reduced and the vitality increases The repetition of the LM potency under this condition can cause aggravations and relapse of the symptoms or just slow down the cure. Single dose cures are more common in acute diseases but there are also chronic patients that only need a single dose or very infrequent repetitions. For the above reasons, I usually give my patients a single test dose of the chosen remedy at the start of the treatment. On rare occasions, I may give a patient a series of three test doses with the instructions to stop the remedy immediately if there is any aggravation or striking amelioration. I only use this triple-split dose on those patients that appear hyposensitive when they cannot return for a quick follow up assessment.

"On the other hand, with somewhat chronic diseases, there are, to be sure, some cases that have slow, continuous improvement based on one dose of an aptly selected homeopathic medicine (taking 40, 50, 60, 100 days to complete the cure, depending on the nature of the medicine) but this is very seldom the case. Also, it must be a matter of great importance, to the physician as well as to the patient, to foreshorten this period, if possible, by half, three-quarters, indeed even more, in order that a far more rapid cure might be attained. The most recent and frequently repeated experiences have taught me that such rapid cures can be favorably carried out under the following conditions:"

Organon of the Medical Art; Hahnemann (O’Reilly 6th Edition), Aphorism 246.

Many individuals read the above paragraph but fail to note that Hahnemann makes a grand differentiation between two fundamental types of remedy reactions. In the first part of aphorism 246 the Founder describes the reaction as a “noticeably progressing and conspicuously increasing improvement”. This is a strikingly progressive increasing amelioration is a reaction that is enhanced day by day. Under such conditions the repetition of the LM potency is normally “excluded” because the first single dose is already moving the patient toward cure at the fasted possible rate. In the second section of aphorism 246 the Founder uses the words “slow, continuous improvement”. There is a vast difference between a rapid improvement where the patient feels much better every day and a slow improvement where the patient barely notices any changes! It is only in these slow moving cases that aphorism 246 permits the repetition the LM potency at suitable intervals to speed the cure.

When Necessary!

All of the statements about repeating the dose to speed the cure relate only to those cases that demonstrate only a slow amelioration that may take 50, 60 or 100 days to show any significant improvement. These circumstances condition all the following statements made about the use of daily and alternate day doses in aphorism 248. If the patient is doing very well on a single dose or infrequent repetitions more rapid repetitions do not apply. There are homoeopaths that mechanically administer the LM potency daily for days, weeks and months on end with every patient. They have not yet understood the fine print in the footnote to aphorism 246. Every case must be individualized and the repetition adjusted accordingly. In this footnote the Founder explains some of the changes he made in the 6th Organon and when the daily dose is applicable.

"What I said in a long footnote to this paragraph in the fifth edition of The Organon of the Medical Art was all that my experience allowed me to say at the time. It was written with the purpose of preventing these adverse reactions of the life principle. However, during the last four to five years, all such difficulties have been fully lifted through the modifications I have made since then, resulting in my new, perfected procedure [for fiftly-millesimal potency medicines]. The same well-chosen medicine can now be given daily, even for months when necessary [bold by DL] In the treatment of chronic diseases, after the lowest degree of potency has been used up (in one or two weeks) one proceeds in the same way to higher degrees of potency (for in the new [fifty-millesimal] manner of dynamization, use begins with the lowest degrees, as is taught in the following paragraphs)."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), footnote, Aphorism 246.

In the footnote to aphorism 246 Hahnemann suggests that a well chosen remedy (not a poorly chosen one) may be given daily when necessary in slow improving cases. When repetition of the remedy is not necessary the LM potency will cause strong aggravations, unproductive accessory symptoms, and slow down the cure. Unneeded repetition can make a patient more hypersensitive or make them non reactive due to over exposure. Hahnemann’s new posology method spans the single unit dose in striking responses and the repetition of remedies at suitable intervals to speed the cure in slower moving cases when necessary. In this way, the posology strategy can be tailored to a great variety of patients and conditions.

Boenninghausen sought detailed information about how Hahnemann administered his medicines in his last years from Dr. Croserio, a close colleague of the Founder. In Boenninghausen’s Lesser Writings Croserio said that Hahnemann would reduce the dose or stop the repetition of his remedies as soon as he observed definite medicinal reactions. He also noted that Hahnemann often gave a single dose of olfaction with placebo and usually did not repeat the dose for at least one week. In my review of the microfiches of the Hahnemann’s Paris casebooks I found that in most cases the Founder often stopped his medicines, gave placebo, and waited and watched for long periods. Hahnemann did not mechanically gave the LM potency daily for weeks, months and years on end! It was more common for him to use a series of doses followed by, or interspersed with, series of placebos. In his later years he sometimes gave a LM potency and placebo at the same time but he did not note down the schedules. This means that some of the prescriptions could be a single dose and others could be the interpolation of placebo with the medicine at various intervals. Hahnemann only recommends the daily dose when it was necessary.

Speeding the Cure

Simple acute diseases are often removed by a single dose of the C or LM potency. This phenomena, however, is not as common in long term chronic diseases. Many times, a single dose only produces a slow or moderate improvement that make take 50, 60 or 100 days to produce any signification improvement in the state of health. This is a very difficult situation for the 4th Organon homoeopath because they cannot intervene to speed the cure. They must wait until there is a clear relapse of the symptoms before a second dry dose can be given. Hahnemann found this aspect of his homoeopathic posology very frustrating and worked for several years to find a more efficient method.

Once Hahnemann found the methods of adjusting the dose of the medicinal solution he claimed he could speed the cure of slow moving cases by one half, one third, or less than the time it takes with his old method. This is a statement well worth testing in clinical trials. This goal can only be attained when all five following conditions are met in full. Vide the secondary part of aphorism 246 in five parts.

"1. Select with all circumspection, the aptly homeopathic medicine."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

The first condition for speeding the cure is the selection of a true simillimum. A preliminary testing phase allows the homoeopath to confirm the suitability of the remedy, potency, and the size of the dose. A remedy may only be repeated to speed the cure if the medicine is a good simillimum. If the remedy is incorrect it may cause a dissimilar aggravation and new symptoms. If such a medicine is given at rapid intervals for too long it may damage the vital force of the patient. If the prescription is of questionable value it does not pass the first of Hahnemann’s conditions. So the first point for speeding the cure is that the remedy must be perfectly homoeopathic.

I and my colleagues have witnessed several single dose LM cures of acute and chronic diseases. Such things will not be witnessed by those who mechanically repeat the LM potency because they spoil their cases by over medication. We have also witnessed many cases that only needed very infrequent repetitions of the LM potency. For example, one single dose of Ferrum 0/1 removed the symptoms of severe arthritis for five years. When there was a relapse of a few of the symptoms the single dose was given again. The more perfect the simillimum, the potency, and the adjustments of the medicinal solution, the more chance it has of producing progressively increasing amelioration over a longer period of time.

When there is a marked, progressive amelioration of the symptoms on the single test dose, I do not repeat the remedy. I very carefully observe the number of days that this increasing amelioration lasts. This offers the homoeopath insights into the duration of the remedy and reveals what a suitable interval might be for the patient. If the striking response lasts forever one does not need to repeat the remedy at all! If the markedly progressive improvement lasts for 1, 2, 3, 4, 5, or 6 days, the remedy is only given every 1, 2, 3, 4, 5, or 6 days respectively. If the increasing amelioration lasts 1, 2, or 3 weeks, the remedy may be repeated every 1, 2, or 3 weeks. If the increasing amelioration lasts 1, 2, or 3 months, the remedy may be repeated every 1, 2, or 3 months. If it lasts 1, 2, or 3 years, give the remedy every 1, 2, or 3 years, etc.

"2. Use a highly potentized [fifty-millesimal] dose, dissolved in water."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

In the O’Reilly edition the author put in brackets “[fifty-millesimal]” but it is not in the original German publication. The Paris casebooks show that from 1840 to 1843 Hahnemann was using both the C and LM potency in a similar manner. What he wrote in aphorism 246 also applies to the C potencies. Contrary to what some modern commentators believe, Hahnemann frequently used the 200c and had tested the 1M potency. He continued to use the C potency along side of the LM potency for his last three years.

The second condition for speeding the cure is the use of a highly potentized remedy only in medicinal solution or by olfaction. The change from the static dry dose to the dynamic liquid solution is the foundation of Hahnemann’s advanced method. The remedy solution is not only more flexible than the dry dose but also more powerful.

"3. Administer a properly small dose of this to the patient."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

The third condition is that the remedy must be given in a properly small dose. That is why Hahnemann only used 1 or 2 poppy seed size pills in a minimum of a 7 tablespoons solution. This aphorism shows that the potency factor and the size of the dose are two different aspects of homoeopathic posology. There are many who still believe that the small dose refers to the immaterial amount of the original substance found in the homoeopathic potency. They still following Kent’s mistaken idea that the size of the dose does not matter. This is a grand mistake that leads to many aggravations and makes it very hard to repeat the remedy to speed the cure. The size of the dose includes three factors; the number of pills used to make a medicinal solution; the number of teaspoons taken from the medicinal solution and placed in the dilution glass; and the number of teaspoonfuls given to the patient as the dose. In all three aspects of preparing the medicine, the size of the dose should be kept at a minimum. The smallest dose produces the most gentle primary action and a long enduring secondary curative action.

"4. Give a dose of the solution at intervals that experience has shown to be the most distinctly appropriate for the best possible acceleration of the treatment."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

The fourth aspect of speeding the cure is the repetition of the remedy at suitable intervals according to one’s experience. This statement is more important than the examples that speak of using the daily and alternate day dose in slow moving cases. One must use one’s clinical experience to find out what are the most appropriate intervals between doses for each and every patient. When the first test dose produces little or no improvement then the time has come to test a series of split-doses. I call this a test series.

This judgment is based on the sensitivity of patient, the nature and stage of the diseases state, and the condition of their vital force and vitality. The most common intervals for those who need rapidly repeated doses of the 0/1 potency are the alternate day, every third day, every forth day, etc. The use of the daily dose is rather rare. If the patient begins to improve on the test series then the remedy may be continued at these suitable intervals to speed the cure. As the patient improves I slow down the intervals between doses to prevent aggravation in the middle of treatment. This allows the homoeopath to personalize the remedy schedule to the reaction of the patient avoiding the use of mechanistic prescriptions that may prove negative in the long run.

The fifth aspect of the complete dose is the succussions of the remedy solution just prior to the ingestion of the medicine. This is the fifth condition for speeding the cure.

"5. Prior to each administration of a dose of the solution, alter the degree of potency of the dose. It is very important that the degree of potency of each dose deviate somewhat from the previous and subsequent ones. This is so that the life principle, whose tunement is to be altered to that of the similar medicinal disease, may never feel itself agitated to adverse counter-actions and enraged, as happens when repeated, unmodified doses are given, especially when such doses are rapidly repeated one after another."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

The succussion of the medicinal solution just prior to administration changes the potency slightly so that the vital force never receives the exact same potency twice in succession. This helps prevents the relapse of symptoms that appears from the repetition of an unadjusted dry dose before signs of a full relapse. The medicinal solution of the C and LM potency may only be repeated to speed the cure when all five of Hahnemann’s conditions are met in full. This is the secret of success.

Administering the Remedy

A homoeopathic medicine must be prepared correctly, and administered properly at the right time, to produce a rapid, gentle and permanent cure. In the second part of aphorism 248, Hahnemann offers some examples of how to apply the medicinal solution in slow moving protracted cases.

"2. In protracted diseases, give the medicine daily or every second day. In acute diseases, give the medicine every six, four, three or two hours. In the most urgent cases, give the medicine every hour or even more frequently. In chronic diseases, every correctly chosen homeopathic medicine, even one whose action is of long duration, may be repeated daily for months with ever-increasing success [when fifty-millesimal potencies are used]."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 248.

In paragraph 248 Hahnemann says in protracted diseases (those that improve very slowly on a single dose) the patient “may” receive the remedy daily. He dose not say that the LM potency must be repeated daily in every case. Some read this sentence without acknowledging that the first part of aphorism 246 says whenever there is strikingly progressive amelioration on a single dose, or anytime during the treatment, the remedy should not be repeated. They also ignore the fine print in the footnote to aphorism 246 that emphasizes that the daily repetition is only used when necessary. In the beginning of aphorism 246 Hahnemann says that LM single dose cures of acute diseases where not uncommon. If one ignores all these conditioning factors, and only follows the above suggestions, they will over medicate many of their patients. All the statements concerning the rapid repetitions in aphorism 248 relate only to those patients that slowly improve on a single dose or infrequent repetitions. In any case, the remedy must be stopped as soon as there is any aggravation, new symptoms, or a marked increasing amelioration. I have not found one case in the Paris casebooks where Hahnemann gave a daily dose for months on end without stopping the remedy and interspersing placebos with equally long periods of observation.

Changes of Symptoms and the Second Prescription

One of the most satisfying experiences for a homoeopath is when one remedy completes the cure of a chronic patient. If a chronic remedy is a true simillimum it will be beneficial in a number of potencies without unnatural changes of the symptoms. When a remedy is a distant partial simillimum it will remove a few symptoms but then produce new medicinal signs in other areas changing the natural symptom pattern. Many who are inexperience in this area think that these changes are new diseases or deeper layers coming to the surface. If one is not careful one may continue to give more partial simillimums until the natural symptom pattern is totally disrupted. One must be very careful when new symptoms appear to give a better remedy that is a more perfect simillimum. I can always tell how well I understand a case by how many remedies I have given over a period of 1 or 2 years. If I have to give more than 1, 2, or 3 remedies for the chronic symptoms something is usually wrong with my approach. There are exceptions to this rule, but in general a good remedy should act over long periods of time in higher and higher potencies without major changes of symptoms.

Every homoeopath must learn to recognize when it is time for a change of prescription. When the patient experiences new ailments and the rest of the symptoms take on an altered pattern, the time has come to retake the case and give a better remedy. Hahnemann offers an example of a change of symptoms in point 4 of aphorism 248.

"4. If the patient undergoes one or another important ailment that he never had before in his life, and the rest of the disease appears in a group of altered symptoms, then another medicine, more homeopathically appropriate, must now be selected in place of the one that was used. The new medicine should be administered in just such repeated doses. Again, each dose of the solution should be modified with the proper vigorous succussions in order to somewhat alter and heighten its degree of potency."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 248.

A definite change in symptoms is an indication to retake the case and give a new remedy. The new prescription should be started in the lowest degrees (LM 0/1-0/7) and the potency is raised in a serial fashion to the higher degrees. It does not matter if the previous remedy reached an ultra high potency like the 0/20. One always starts a new remedy with the lower potencies and works upward through the scale stage by stage. In aphorism 171 Hahnemann notes that a new remedy is often chosen by the remaining symptoms after the previous remedy has accomplished all it can.

"In chronic diseases that are not venereal (therefore those most usually arising from psora) one often needs to employ several antipsoric remedies in succession to bring about a cure, each to be homeopathically selected in accordance with the result of an examination of the group of symptoms that remain after the pervious means has completed its action."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 171.

Sometimes certain symptoms remain or old symptoms appear that are not well suited to the present remedy. This is a different situation than the appearance of new symptoms caused by new factors affecting the case or the use of partial simillimums. As long a remedy causes the old symptoms to reduce in number and decline in strength, one can rest assured that the case is progressing in the right direction. Sometimes one remedy is not sufficient to cure a protracted degenerative disorder, especially those based on layers and complex miasms. Under these circumstances one must determine the proper time to change the remedy. James Kent wrote:

When the demonstration is clear that the present remedy has done all it is capable of doing - and this demonstration can not be made until much higher potencies than usually made have been tried - then the time is present for the next prescription.

To change to the next remedy becomes a ponderous problem, and what shall it be?"

Kent’s Lesser Writings; J. T. Kent, The Second Prescription, page 418-419.

What should we do when there is a change of symptoms not affected by a previous remedy? At this time, the homoeopath should ask themselves the following questions. What is the cause of the change in symptoms? Are they produced by a new exciting or fundamental causes? Is the patient doing anything different that could be causing these new symptoms? Is this a dissimilar layer of symptoms coming to the surface after the removal of a previous layer? How do we know the difference?

There are three major reasons for a change in symptoms, i.e., an artificial change caused by an inappropriate medicine, the appearance of new exciting and fundamental causes, and the arousal of deeper dissimilar layers of illness during the process of cure. A wrong remedy or a partial simillimum may artificially change the nature of the symptom pattern. At this time, the symptoms produced by the remedy and the remaining natural symptoms must be combined and a better medicine prescribed. This should regularize the vital force and move the case toward cure. If the patient receives two, three or four inappropriate remedies in a row the natural symptom pattern may be seriously altered. Such a muddled case can only be restored to health by an experienced homoeopath. For this reason, the greatest care must be applied to each and every prescription.

Sometimes, the patient comes in contact with new causes that may change the symptom pattern. Perhaps, the patient suffers from a virulent acute disease that produces a sequel. Maybe the patient becomes infected with a chronic miasm (psora, sycosis, etc.) that they previously did not suffer. There may be a new befallment like a physical or mental trauma that changes the nature of the symptoms. The nature of the new phenomena must be investigated, the case retaken, and a new remedy chosen. These unhappy situations are conditions where the disease state has actually become more complex.

The third reason for a change in the symptom pattern is the appearance of old dissimilar disease layers as the reversal of symptoms takes place under a curative treatment. These deeper layers may represent old unresolved disorders, suppressions, and the activation of latent states. Deeper layers also appear when one sided disease states begin to resolve. If the new symptoms are found in the materia medica under the same remedy, there is no need to change the prescription. When these symptoms are not similar to the remedy under employment, the case must be retaken and a new simillimum administered. In order to comprehend this process one must have some understanding of how layers and complex disorders develop.

How to Complete a Cure

A properly adjusted LM remedy should not produce an aggravation at the start of the treatment as is often witnessed after the administration of a centesimal potency, especially when given dry. Even the C potency in medicinal solution tends toward aggravation more quickly. An aggravation caused by the LM potency should only appear at the end of the treatment when the patient is feeling better and their vitality has returned. This is a sign that the cure is almost attained and the repetitions of the LM potency should be slowed down or stopped.

"5. If so-called homeopathic aggravations (§161) appear towards the end of treatment of a chronic disease, after almost daily repetition of the fully homeopathically fitting medicine (i.e. so that the remaining disease symptoms seem to be somewhat heightened) then this is an indication that the medicinal disease, which is so similar to the original disease, is now audible almost all by itself. Therefore, the doses must be reduced still more and repeated at longer intervals, or even entirely suspended for several days in order to see whether or not any more medicine is needed for recovery. If no more medicine is needed, these apparent symptoms (stemming merely from the overflow of the homeopathic medicine) will soon disappear by themselves, leaving behind unclouded health."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 248.

There is a great difference in an aggravation at the beginning of treatment when the patient is ill and weak and an aggravation at the end of the treatment when the patient is healthy and strong. The aggravation at the start of treatment is much more uncomfortable and dangerous because the patient is still sick. The LM aggravation comes at the end of treatment when the patient is healthier. This is a sign that the cure is nearing completion. It indicates that that the patient now suffers mostly, if not entirely, from a medicinal disease alone.

As one moves upward through the potencies (0/1 to 0/30) it is often wise to gradually slow down the repetition of the remedy so that the patient is not overmedicated. If the 0/1 was given daily, the 0/2 might be given every other day, and the 0/3 every third day, etc. In this way, aggravations can be prevented in the beginning, middle and the end. If an aggravation is produced at the end of the treatment it is a sign that the patient may not need any more medicine. How to complete the cure is discussed in more detail in aphorism 280 and 281.

The aggravation at the end of treatment should be light rather than heavy as seen with overmedication during treatment. Most of the time there is only an increase of a few general symptoms or a general malaise as if one is going to get sick. At this time, the repetition of the remedy is stopped so the vital force can remove the remains of the medicinal disease and retune to heath and full vitality. If this is not done the signs of overmedication will get stronger and stronger.

The remedy should now be stopped to test if there is any more need for medicinal aid. The patient is left without medicine for eight, ten, or fifteen days so that the true situation can be assessed. If the aggravation is only due to remedial excess it will disappear in a matter of a few hours or days. When there is no relapse of symptoms after the signs of aggravation cease, the patient is truly well. If there is a relapse of the symptoms during the waiting period, the patient still needs more of the same medicine in increasing potencies.

When there is a relapse of symptoms during the waiting period traces of the original disease still remain. This is a sign that the remedy should be continued until there are no signs of the original disease. At this time, the homoeopath must be careful not to overmedicate the patient by giving overly rapid repetitions.

The 7th Organon

Hahnemann only used the LM potency for 3 years before leaving for his Heavenly Abode. If he had lived another four or five years he would have written the 7th edition of the Organon. I am not qualified to write the 7th Organon but over the last 18 years I have gathered a large volume of clinical experience. It would appear from my studies, and those of my colleagues, that today’s patients are more sensitive than Hahnemann’s patients in Germany in the 1840s. For this reason, I have made certain adjustments to the way in which I practice and teach the use of the LM potency.

First of all I would like to say that I, and my colleagues, have not found it necessary to give the daily dose very often, especially with well chosen remedies. The daily dose has proved itself useful only in those patients we were quite hyposensitive or on heavy allopathic medications that were reducing the effect the remedy. Even the alternate day dose is not all that common, especially over a longer period of time. The most common rapid repetitions are those that are given every 3 or 4 days. We have also noticed that the daily and alternative day dose must be reduced as soon as there a signs of improvement to prevent aggravations. The more sensitive the patient is the less often they will need a dose of the remedy. I have many patients that only take the LM potency once every 4, 5, 6 or 7 days. Some only need the remedy every one or two weeks, while other only need it once a month, etc. As Hahnemann said, it is most important to use your own experience to figure out what is best for each and every patient. All mechanistic schedules and mechanical repetitions should be avoided.

In part 1 of aphorism 248 Hahnemann spoke of using between 8 and 12 succussions of the medicinal solution prior to administration. We have found that a minimum of 8 succussions is far too many for today’s hypersensitive patients. Therefore, I have suggested that the potential range of succussions should be between 1 and 12 depending on the sensitivity of the patient. A modern hypersensitive patient can only tolerate between 1 to 3 succussions, and a moderately sensitive patient may only need 4 to 7. We have found that succussions should not be overly hard or they may “shake up the vital force”. I was once asked by an experienced homoeopath new to the LM method why he was seeing a strange pattern of accessory symptoms in some of his cases. I asked him how he was succussing his doses. He was giving the medicinal solution very hard slams on a book. I advised him not to use such hard succussions and the problem never reoccurred.

In part 1 of aphorism 248, Hahnemann suggests that the patient should be given 1, or ascendingly, several teaspoons of the medicinal solution from the remedy bottle. In his example in footnote 248 he speaks of stirring one tablespoon of the medicinal solution into a dilution glass containing 8 to 10 tablespoons of water. This has caused some practitioners to always start out with a tablespoon instead of using 1, or increasing more teaspoons as needed, as suggested in the main aphorism.

Doctor Croserio’s letter, however, points out that Hahnemann used both large and small spoons depending on the case. It has been our experience that 1 tablespoon is too large a dose from the remedy bottle for the very sensitive and moderately sensitive modern patient. Therefore, we suggest that the instruction in the aphorism take precedent over the example in the footnote. We recommend 1 teaspoon as the average starting point for most patients, and that this amount is increased to 2, 3, or even more teaspoons, if and when needed.

In part 3 of aphorism 248 Hahnemann suggests changing the potency every 7-8 to 14-15 days. The Paris casebooks show that this suggestion was not a rigid rule because he often gave long periods of placebo and raised his potencies much more slowly. It has been our experience that such rapid changes in potency are not necessary or even beneficial in many cases. Those who are very sensitive do not take to such rapid changes of potency without aggravations, and in some cases, relapses. We have found that a certain percentage of individuals do better if they are left on the same potency for a longer period of time. This, however, is not always easy to tell in advance. Sometimes a change to a higher potency does not suit the patient and one has to return to the previous potency to correct the case. It seems that certain patients need to stay on a particular potency for a longer period than Hahnemann suggested. Once again, trial and error is the greatest teacher.

Hering said in his preface to the American edition of the Chronic Diseases (1845) that it is important for all of us to go further in the practice of Homoeopathy than Hahnemann and correct the errors of the past while remaining true to our principles. In this spirit I have done my best to share my many years of experience with the LM potency. For this reason, I have made certain modifications to some suggestions given by the Founder while staying true to the philosophy he introduced. I have repeated some statements several times in this discourse because I feel that certain essential ideas must be repeated from a number of different vantage points. The most important maxims of homoeopathic posology and case management are individualization and the words “if and when necessary”. For the sake of easy reference I will offer a brief review of my posology methods.

1. I begin my cases with a single test dose (C or LM) of a well chosen remedy, potency, and dose adjustments. Under rare circumstances I may give a short series of three test doses at the most suitable intervals (daily, alternate day, every three days, every four days, etc.). In this case, I tell the patient to stop the medicine immediately if there is any aggravation, new symptoms or a strikingly progressive improvement. I only do this with relatively hyposensitive patients with stable vitality that live too far away for me to observe the case more closely in the beginning. In India most people do not have a phone.

2. When there is a strikingly progressive amelioration from a single test dose, or a short series of test doses, the remedy is not repeated. This is because there is no need to speed the cure. My colleagues and I have witnessed many cases cured by a single dose and infrequent repetitions.

A. Once the strikingly progressive amelioration slows down the remedy may be repeated at similar intervals to continue the rapid cure. If the strikingly progressive amelioration last for 3, 4, 5, or 6 days, I repeat the remedy every 3, 4, 5, or 6 days. If the progressive improvement last for 1, 2, 3, or 4 weeks, I give the remedy every 1, 2, 3, or 4 weeks. If the progressive improvement lasts for 1, 2, 3, 4 months, I give the remedy every 1, 2, 3, or 4 months, etc. If it lasts for 1, 2, 3 or 4 years I give the remedy every 1, 2, 3 or 4 years, etc.

3. When there is little or no amelioration or only a slow improvement in response to the single test dose, or short series of test doses, the remedy is repeated at more rapid intervals. These suitable intervals are (as Hahnemann said) what "experience has shown to be the most suitably appropriate for the best possible acceleration of the cure".

A. I judge the appropriate intervals in accordance with the sensitivity of the patient, the nature and stage of the disease state, the age of the patient, and the state of their vitality. Those that seem hyposensitive yet have relatively stable vitality may receive the remedy daily. Those that seem a little less hyposensitive may receive the remedy on alternate days. Those that are a little more sensitive may receive the remedy every three or four days, etc. At this time the patient is given a series of three to seven doses to see if the sensitivity and disease condition has been judged correctly. I tell the patient to stop the remedy immediately if there is any aggravation, new symptoms, or strikingly progressive amelioration.

B. If the chosen interval produces a satisfactory improvement the remedy is continued at this rhythm to speed the cure. When the patient experiences a significant improvement these intervals are slowed because the patient no longer needs as much medicinal stimulation. In this way aggravations in the middle of treatment can be avoided.

C. When the patient reaches the point where they no longer show any symptoms, and the vitality has completely returned, the medicine is stopped to test the cure. If there is no relapse of symptoms after waiting and watching for a reasonable amount of time they are cured. If some of the symptoms return the remedy is again repeated at slightly longer intervals to complete the cure.

D. If there is an aggravation toward the end of treatment the medicine is stopped and a period of waiting and watching is begun. If the symptoms pass off quickly, and the patient does not relapse, the cure is complete. When there is a return of symptoms the remedy is again administered but at slightly longer intervals in order to prevent any reoccurrence of the aggravation and complete the cure. After carrying out this procedure the methods described in point 3C or point 3D are repeated if necessary.

There are many more adjustments of the medicinal solution and potency that may be needed during the process of cure but this offers the basic methodology in relationship to the single dose, infrequent repetitions and repeating the dose at more rapid intervals to speed the cure.

David Little is an American living in India with his family. He has done an in depth study of the original microfiches of the Hahnemann’s Paris Casebooks, especially those from the years 1840-1843 when Hahnemann used both the higher potency C and LM potency. David is publishing a two volume work called, The Homoeopathic Compendium, which contains around 2500 pages of ground breaking material on the clinical practice of homoeopathy.

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