The Medicinal Solution and Olfaction

The key to the advanced methods of Homoeopathy is the use of the medicinal solution. The remedy solution, however, has other avenues of delivery than just the oral tract. This is more difficult by the old method that exclusively uses dry pills as they are usually placed in the mouth. At times alternative methods of applying the dose may be more suitable or used in conjunction with the oral dose to speed the cure. These methods may also be of use if the remedy can not be given orally due to the nature of an injury or unconsciousness on the part of the patient. Vide aphorism 284 of the 6th edition.

"Besides the tongue, mouth and stomach, which are most commonly affected by the administration of medicine, the nose and respiratory organs are receptive of the action of medicines in fluid form by means of olfaction and inhalation through the mouth. But the whole remaining skin of the body clothed with epidermis, is adapted to the action of medicinal solutions, especially if the injunction is connected with simultaneous internal administration".

The homoeopathic remedies can be given by a variety of methods. The average median sensitivity does best on an oral dose of the medicinal solution. Those who are somewhat hypersensitive may do better on a dose given by olfaction. The preparation and administration of the olfactory dose can be summarized in four steps.

1. Take one #10 pill and place it into a one dram vial.

2. Drop one drop of water to melt the pill. Then fill the small vial with alcohol leaving one third of the vial empty so that there is sufficient air gap left for succussions.

3. The vial is to be succussed an average of 5, 6, 7 times. The hypersensitive types may only need 1, 2, 3 or 4 succussions. Those of a lower sensitivity may need up to 8, 10, or 12 succussion. The remedy should be succussed just prior to the ingestion of the remedy as with the medicinal solution.

4. The vial is then held under the nose and the vapors inhaled by the patient. One dose is given to assess the sensitivity of the individual and the remedy repeated, if and when necessary. In the Organon Hahnemann says such a dose may be repeated every 1, 2, 3, 4, or more days, as needed. In the Paris casebooks we find that Hahnemann continued to use olfaction until his last days. Dr. Croserio, a close colleague of Samuel, stated that Hahnemann often gave an olfaction dose and waited one week. This is recorded in Boenninghausen’s Lesser Writings. In the 5th edition Hahnemann recommends not to give the olfactory remedy any more frequently than one would give the dose by mouth.

A more complete explanation of administering olfaction can be found in the note to aphorism 288 of the 5th Organon.

"The homoeopathic physician allows the patient to hold the open mouth of the phial first in one nostril, and in the act of inspiration draw the air out of it into himself and then, if it is wished to give a stronger dose, smell in the same manner with the other nostril, more or less strongly according to the strength it is intended the dose should be..... Should both nostrils be stopped up by coryza or polypus, the patient should inhale by the mouth, holding the orifice of the phial between his lips. In little children it may be applied close to their nostrils while they are asleep with the certainty of producing an effect."

When using olfaction a sensitive may only need to use one nostril and take just a tiny breath. If a stronger effect is needed a deeper breath may be used. Those of a more moderate sensitivity may need to breathe the dose in each nostril separately. There are some individuals that are so hypersensitive they only need to put their hand over the closed vial, or touch the top, and breathe in to open their "aura" to the remedy. This is the subtlest form of "olfaction". After this they may remove their hand from the remedy.

Hahnemann used olfaction almost exclusively for a period of time but decided later that the oral medicinal solution was much more appropriate as a median dose. He also mentions the application of the medicinal solution directly on the healthy areas of the skin, while at the same time, taking the oral solution to speed the cure of a slow moving chronic disease. There is also a discussion of giving the remedy to infants through the milk of the mother.

Assessing the First Dose

After administering the first dose the homoeopath should wait an appropriate period to observe the action of the remedy. This time period varies according to the nature of acute and chronic diseases. Acute diseases are rapid in their onset and move rapidly toward crisis. The period of waiting for the reaction to the dose may be a matter of minutes to hours depending on the nature of the acute illness. Any "striking" response precludes the repetition of the remedy in any fashion as the vital force is moving rapidly toward cure.

On the other hand, any slow progressive improvement is a sign that the homoeopath may repeat the dose to speed the cure when necessary. In a mild acute disease one dose a day is usually enough to stimulate a rapid cure. In a more  moderate case of acute illness the dose may have to be repeated twice daily. In a more serious acute illness the dose may have to be given as much as three or four times daily until there is an improvement. Hahnemann reminds us that in urgent cases the dose may have to be given every hour or oftener. As soon as there is a clear improvement in an acute disease the dose should be slowed down and gradually stopped as the state of health returns.

The nature of chronic diseases is slow and insidious in their development as they reach their crisis after a longer period of time. For this reason the homoeopath should assess the dose over a period of at least 3, 7, 11, or more, days depending on the nature of the complaint and the sensitivity of the constitution. It is sometimes necessary to wait for longer periods when treating hypersensitive patients who have many alternations of their symptoms. Any strikingly progressive amelioration is a sign that there is no reason to give a second dose as the case is already moving rapidly toward a cure.

If there is a relapse of the symptoms before the attainment of the cure, the time has come to give a second dose. Many cases only need a few infrequent doses to carry them through to completion. If there is only a slowly progressive improvement on the single dose the medicinal solution may be repeated at suitable intervals to speed the cure. These intervals depend on the duration of the reaction of the vital force to the remedy as there is no set fixed pattern that will work for each and every individual.

After giving the first one or two doses the homoeopath should have some idea of how long the reaction to the remedy continued. For example, if the LM 0/1 potency produced a great improvement for one week, and then the case relapses, the remedy may be repeated around every 6 days in the beginning. If the reaction to the remedy lasts for two weeks it may be repeated every 12 or 13 days to maintain a continual improvement without relapse. When a remedy shows very little response after 4, 7, 11, or more days, the remedy should be repeated at conservative intervals until there is a response and then assessed. Once there is a secondary reaction by the vital force the remedy should be repeated at suitable intervals to maintain that response. The repetition of the remedy may be needed every 2, 3, 4, or more days under these conditions.

It is only in the more hyposensitive patients that the LM potency may be given every day or every other day for weeks on end. The Paris casebooks show that Hahnemann liked to give a series of doses followed by a series of placebos. There is not one case in the Paris casebooks where the Founder gave the daily dose for weeks, months and years on end. Hahnemann tended to give placebo anytime there was a striking improvement as well as an aggravation of symptoms. Sometimes he would give placebo when the symptom picture was  confused in order to let the symptoms settle before proceeding. In some cases Hahnemann gave almost as much placebo as medicine. As we said, Dr. Croserio's eyewitness account of the Founder's practice states that Hahnemann would reduce the dose or stop the medicine anytime there was significant medicinal action. This is a point that is not well enough emphasized in the 6th Organon.

A Change of the Symptoms

One of the most satisfying experiences for a homoeopath is when one constitutional remedy given in a single dose cures a chronic case. Unfortunately, this extraordinary response is a fairly rare occurrence in the complex miasmic cases. More commonly we find that a person moves slowly but surely towards cure under the skillful repetition of the correct remedy. If the response to the first dose is striking it is a sign that no repetition is needed. If the response to the first dose is more moderate the remedy may be repeated at suitable intervals.

If the patient relapses while on the LM 0/1 potency, the LM 0/2 is given in a single dose, and its response is assessed. If the response is dramatic the remedy is left to act without repetition. Where the response is more moderate the remedy may then be repeated at suitable intervals as needed. The LM remedies are used in a gradually ascending fashion through the potencies LM 0/1, LM 0/2, LM 0/3 and LM 0/4 up to LM 0/30 until the cure is completed.

This technique forms the middle path between the exclusive single unit dose method and the mechanical repetition of remedies. Normally, the repetitions of the remedy are slowed down as the potency is increased so as not to provoke unwarranted aggravations. Individuals who only need one remedy throughout the treatment of a chronic disease possess relatively healthy constitutions. Chronic patients with complex chronic diseases often present more of a challenge. These individuals have several layers of disease that can produce changes in the symptoms as the case proceeds toward cure. What should we do when a patient has been improving but then there is a change of symptoms? Let’s see what Hahnemann say about such a situation. Vide aphorism 248.

"For if this happens, if the balance of the disease appears in a group of altered symptoms, one more homoeopathically related medicine must be chosen in place of the last [DL] and administered in the same repeated doses, mindful, however, of modifying the solution of every dose with thorough vigorous succussions, thus changing its degree of potency and increasing it somewhat."

A perfect simillimum is a remedy that can be used over a longer period of time in higher and higher potencies without changing the symptoms. A partial simillimum is a remedy that only suits one aspect of the case while producing new accessory symptoms in other areas that change the natural symptoms. Partial simillimums also seem to work at first but then are found to be less and less effective as time passes. Completely new symptoms that do not appertain to the disease under treatment are a sign that wrong remedy has been given. I can always tell how well I understand a chronic case by how many remedies I have given over a period of a year or two. The fewer remedies I have had to use the better. Frequent changes in symptoms calling for new medicines often mean that the patient is receiving too many partial simillimum.

Anytime there is a change of the symptoms it is time to reassess the nature of the case. Old symptoms coming to the surface is a sign that the correct remedy is being used but one should be careful not to overmedicate the patient. Too many doses at this time may force an unneeded crisis. The surfacing of an old dissimilar layer can produce a natural change in the symptom pattern that calls for a new remedy. New symptoms have a number of different causes. Do the new symptoms mean the patient has been given a partial simillimum or the wrong remedy? Are they produced by a new cause affecting the patient? Is the patient doing anything different that is affecting their constitution? After a careful assessment of the cause of the change in symptoms a new remedy may have to be selected. The new remedy must be carefully chosen by the new characteristic symptoms and a test dose given. The response to this test dose should be carried out in the same manner as when giving the first remedy.

Completing the Case

As a case progresses toward completion the repetition of the medicinal solution should be slowed down to prevent any unnecessary aggravation. As the cure begins to reach its final stages there should be a great improvement in the general health of the individual and all serious tissue pathology should be healed. If this process is carried out perfectly the remedy may finally stop without any aggravations or relapses. This is the most perfect cure; one which is rapid, gentle and permanent. If the remedy is not slowed down as we approach the completion of the case we will see the homoeopathic aggravation at the end of the treatment. Vide aphorism 248.

"On the other hand, should there appear during the repetition of the well indicated homoeopathic remedy, towards the end of the treatment of a chronic disease, the so-called {refer #161} homoeopathic aggravation [DL] which the balance of the morbid symptoms seem to again increase somewhat (the medicinal disease, similar to the original, now alone persistently manifests itself). The doses in that case must then be reduced still further and repeated in longer intervals and possibly stopped for several days in order to see if convalescence needs no further medicinal aid [DL]. The apparent symptoms caused by the excess of the homoeopathic medicine will soon disappear and leave undisturbed health in its wake."

The aggravation at the end of treatment is a sign that the remedy chosen is completing its action on the healthy constitution. At this time the remedy needs to be stopped or repeated at longer intervals if still needed. Hahnemann returns to the subject of completing a case in aphorism 280. Vide Organon.

"The dose of the medicine that continues serviceable without producing new troublesome symptoms is to be continued while gradually ascending, so long as the patient with general improvement begins to feel in a mild degree the return of one or several old original complaints [DL]. This indicates an approaching cure through a gradual ascending of the moderate doses modified each time by succussion {refer #247}. It indicates that the vital principle no longer needs to be affected by the similar medicinal disease [DL] in order to lose the sensation of the natural disease {refer #148}. It indicates that the life principle now free from the natural disease begins to suffer only something of the medicinal disease hitherto known as homoeopathic aggravation."

In order to test to see if the aggravation is a sign that no further medicinal aid is needed, the remedy should be stopped. Leave the patient without any medicine for eight, ten, or fifteen days so that you can assess the nature of the new symptoms. If the complaints are due to an excess of the remedy they will disappear in a few hours to days. If there is no relapse of symptoms after the dissipation of the aggravation the patient is truly well. If there is a relapse of the symptoms during this waiting period the patient still needs more of the same medicine but at slower intervals. This remedy is continued until the time comes when it is necessary to again test the patient’s state to see if the cure is complete.

If during the second test the patient has fully recovered there will be no relapse after the medicine is stopped. Those of us who have experience with LM potency have seen this process through to completion many times. Our case histories confirm that there is no need of aggravation at the beginning or end of treatment. We have also observed at times the phenomena of the aggravation at the end of treatment as a sign that the constitution needs no more medicine. The general treatment plan is to always use the least number of remedies, smallest amounts, and least number of doses possible. New remedies are introduced only when there are definite changes in the symptoms calling for their employment.

If at the end of treatment the homoeopath observes the so-called homoeopathic aggravation then the time has come to stop the remedy and watch for a relapse of symptoms. If there is a relapse the remedies must be reintroduced in gradually ascending potencies. If there is no relapse the condition is cured. This process clears the constitution of both the acquired and inherited forms of disease and leaves the vital force free to perform its primary duty of ruling the state of health.

Much of what has been said about the LM potencies is true for the centesimal potencies given in the medicinal solutions. The methodology is the same for both if one is using Hahnemann's advanced methods. I hope this series of 7 postings have cleared up some of the confusion around the many different statements attributed to Samuel Hahnemann. Once homoeopaths understand the 7 levels of homoeopathic methodology that our founder introduced many apparent contradictions will be transformed into a clear understanding of the evolution of Hahnemann's thought. Once this is comprehended all the information found in the various editions of the Organon and The Chronic Diseases can be put into practical use in our lives.

Some may say that there is no need to study such "dusty old fashioned books" as they are all outdated and we need to modernize Homoeopathy. Who needs Hahnemann, Hering, Boenninghausen, Kent, Lippe, Allen, etc., and their outdated 19th century baggage? Such hubris knows no bounds! Our homoeopathic heritage is very valuable as it is the sum total of our founder's efforts and the experience of the 100's of men and women who followed him. This information forms the fundamental basis of our science and art and should not be underestimated by those who have never researched it.

To "modernize" Homoeopathy by ignoring this legacy is like throwing the baby out with the bath water. Such an endeavor is like building the proverbial house on a base of sand. Sooner or later the wind of clinical realities will blow and the rains of difficult cases will fall and their house of conjecture will come crashing down. It is much better to build a house upon the rock of the Organon so that when hard times come there is a strong foundation. This foundation is based upon the works of Samuel Hahnemann and the men and women who have dedicated their entire livesto the enrichment of Homoeopathy. No one is saying that we must stop growing with the works of Samuel Hahnemann but we should certainly start there!

After all, Homoeopathy is De Medicina Futura.