Hahnemann’s advanced methods – Part 3: Managing the Case
How the Medicinal Solution Works
In order to understand how the medicinal solution works we must understand the meaning of primary and secondary actions and how homoeopathic remedies heal. Hahnemann discusses this subject in aphorisms 63-69 of The Organon of Medicine. When an ill person takes a remedy its medicinal energy makes a deep impression on the deranged vital force which replaces the confused image of the natural disease. This is called the primary action.
During this phase the vital force passively receives a delusive image of the disease magnified by the energy of the homoeopathic remedy. After experiencing the primary action of the remedy the vital force produces what Hahnemann called the secondary curative action. It is the curative secondary reaction of the vital force that removes the remedial disease from the constitution and replaces it with the state of health. Using this explanation as a basis Hahnemann explains how the medicinal solution works in the preface to the 4th edition of The Chronic Diseases.
"But if we physicians are able to present and oppose to this instinctive vital force its pathological enemy, as it were magnified through the action of homoeopathic medicines (even if it should be enlarged every time only by a little), if in this way the image of the morbific foe be magnified to the apprehension of the vital force through homoeopathic medicines which, in a delusive manner, simulate the original disease, we gradually cause and compel this instinctive vital force to increase its energies by degrees, and to increase them more and more, and at last to such a degree that it becomes far more powerful than the original disease."
By the end of the 1830s Hahnemann was using all the levels of potency available from the lowest to the highest but only in medicinal solutions. It is a known fact that he had both Jenichen's and Karsokoff's high potencies. We have in our possession a copy of a letter written by Madame. Hahnemann to an American doctor named Breyfogle in which Melanie answers a question about what Hahnemann's views were on potency and dosage in his later life. This is recorded in Haehl’s Samuel Hahnemann, His Life and Works, Volume 1, on page 328.
"Your inquiry as to whether Hahnemann altered his views about potencies in the last period of life and whether he made use of only high potencies, I can answer in this way: Hahnemann used all the degrees of dilutions, the lower as well as the higher according to the individual case. I have seen him use the 3rd trituration but I have also seen him use 200th and even 1000, every time he thought it necessary."
That fact that Hahnemann used high potencies was confirmed in 1845 in the Bulletin de la Societe Homoepathique de Paris by a Dr. Molin. Also a Dr. Malan witnessed Hahnemann using the latest of Jenichen's ultra high potencies effectively in Paris. This is recorded in Haehl’s Samuel Hahnemann, His Life and Works on page 328.
"I frequently saw Hahnemann prescribe very high dilutions. One of the most remarkable cures had been brought about by one single dose of a very high potency: as far as I know this remedy came from Jenichen. I have often heard him say that the 30c potency should by no means form a fixed limit for medicinal dilutions."
It has been said by some modern homoeopaths that Hahnemann never used potencies beyond the 30c. For this reason they opine that his case management suggestion can be ignored when using higher potencies. James Kent made a similar statement in his writings as he was not aware of Hahnemann's use of high potencies and his advanced methods. Once Hahnemann developed the medicinal solutions he found the freedom necessary to experiment with the highest potencies available at the time. The aqueous solution is a perfect medium for controlling the power of the high potencies because the dose can be carefully adjusted to fit the sensitivity of the individual.
The Two Types of Aggravation
Hahnemann taught that the phenomena associated with the homoeopathic aggravation was caused by the remedy causing too strong of a primary action (Organon, aphorism 161). This excessive primary action suppresses the secondary response of the vital fore and displays the medicinal symptoms of the remedy. The reasons for aggravations are administering too high of a potency, giving too large of a dose, and repeating the remedy too often. This is all too easy when a random number of dry pills of high potency are dropped under the tongue, or when there is the premature repetition of a dry remedy, especially of the same, unadjusted potency.
If after a time the vital force is able to overcome this excessive primary action of the remedy it will produce its own secondary response and move the constitution toward cure. This is neither the most rapid nor gentle way to heal a disease. If the dose is far too powerful for the state of the constitution being treated, it may produce a long lasting medicinal disease. To overcome these limitations Hahnemann developed the methods of adjusting the dose of the medicinal solutions to fit the sensitivity of the constitution. When there is an aggravation, lower the potency, give the solution bottle less succussions, reduce the size of the dose, and do not repeat the remedy unless it is needed to speed the cure.
Hahnemann points out in his writings that there are two types of aggravation, the similar aggravation and the dissimilar aggravation. A similar aggravation is an increase of the symptoms the individual is experiencing or the appearance of old diseases. This is a sign of the correct remedy but too strong of a dose. It is best to wait out this reaction if it is not dangerous or extremely uncomfortable. If a second dose is needed it will have to be adjusted in the downward direction. This means less succussions, more water in the solution, the use of more dilution glasses, a lower potency, a smaller amount such as 1/2 a teaspoon, etc. These are all methods of adjusting the dose.
A dissimilar aggravation is the appearance of new symptoms which the client has never experienced before or do not relate to the disease being suffered. They are medicinal symptoms produced by the remedy that are not homoeopathic to the condition of the individual who took the remedy. This is a sign of the wrong remedy. Vide Organon, aphorism 249.
"Every medicine prescribed for a case of disease, which in the course of its action, produces new and troublesome symptoms not appertaining to the disease to be cured, is not capable of effecting a real improvement and can not be considered as homoeopathically selected [DL]; it must, therefore, if the aggravation be considerable, be first partially neutralized as soon as possible by an antidote before giving the next remedy chosen more accurately according to similarity of action; or if the troublesome symptoms be not very violent, the next remedy must be given immediately, in order to take the place of the improperly selected one."
Let us look at the following examples to clarify the subject. If a person has a painful lower back condition which is < resting and on first motion and is > by continued motion while at the same time they are very restless, chilly, weeps without knowing why, etc., we may give them Rhus-t. If the lower back pain becomes a little more painful it is a similar aggravation. This is a sign that the primary action of the remedy has replaced the natural disease so we can expect the secondary reaction of the vital force to remove the pain. This is a positive aggravation. If, on the other hand, the individual develops headaches and stomach discomfort, it is a dissimilar, negative aggravation. This is a sign of the wrong remedy!
If the dissimilar symptoms are not excessive a new more proper remedy should be chosen by the combination of the new medicinal symptoms and the natural symptoms. This grand totality will correct the problem by regularizing the vital force and move the case toward cure. If the dissimilar aggravation is very strong, it should be antidoted immediately, and a new remedy given as soon as possible. It is very important for a homoeopath to understand the two types of aggravation.
Many homoeopaths think that all reactions are good reactions or that they are a cleanse crisis. Unfortunately, this is not the case. A correct simillimum, or an incorrect remedy, or a partial simillimum all elicit a different reaction from the vital force. Only the Organon gives detailed instructions on how to recognize these situations and make the necessary adjustments in case management.
Following a Case
The administration of the first dose of a homoeopathic remedy is a test dose. A single dose should be given and its reaction carefully studied. Acute and chronic diseases have different natures. Acute diseases are rapid in their onset, reach crisis quickly, and end with the return to health or the demise of the individual. Chronic diseases are insidious in their onset, slow in developing pathology, and fatal in the end. Depending on the developmental timeline of the disease we must wait an appropriate amount of time to see if the remedy is acting. In an acute injury or emergency this could be only a few minutes, in an acute disease it could be a few hours, and in a chronic disease a certain number of days. In general when treating a chronic disease we must wait at least 4, 7, 14 days, or more, to see if the dose is acting.
As we have pointed out every striking reaction to the first dose of a homoeopathic remedy precludes the repetition of the remedy until this dramatic response slows down or there is a slight relapse of symptoms. The number of days in which the dramatic effects last should be counted and the remedy is repeated accordingly. If the dramatic effect lasts for 14 days, and then slows down, the remedy should be repeated every 12 or 13 days just before the relapse of symptoms.
If there is only a slow improvement the remedy may have to be repeated at more rapid intervals to speed the cure. In slowly moving cases the remedy may have to be repeated daily or every other day. If there is a moderate reaction the remedy may have to be repeated every 3, 4 or 5 days. In cases that are progressing rather well the remedy may have to be repeated only 1 time a week or so. Some individuals may only need the remedy very occasionally whereas others will need it quite often.
Much of this depends on how high a potency level the case is begun with and how dramatic its effects are on the vital force. In general, high potencies such as 200c, 1m and 10m are suited to single doses and infrequent repetitions. Lower potencies such as 6c, 12c, 24c, and 30c are suitable for more frequent repetitions. Nevertheless, the response of the constitution to the remedy is the most important indicator for how often a remedy is repeated. The key to the split-dose method is to understand the nature of the constitution, the nature of the remedy, and the nature of the disease. If knowledge of these three factors is combined with the methods of adjusting the dose one can safely repeat the remedy at suitable intervals as long as the client is improving and no aggravations appear. The idea is to find a rhythm of repeating the remedy that speeds the cure, prevents relapses of symptoms, and produces no aggravations.
How to Complete a Cure
If you have been repeating the remedy for sometime, and the client is improving, slow down the repetitions of the remedy accordingly. If all the symptoms are gone, stop the remedy, and wait to see if there is any relapse. If there is no relapse the client is healed! If there is a slight relapse repeat the remedy at slower intervals until you feel it is time to stop again. If this time there is no relapse of symptoms the case is cured. As you repeat the remedy the client should be looking and feeling better. If after such an improvement there is a slight similar aggravation it is a sign that the patient may no longer need any treatment. When you stop the remedy the symptoms should disappear in a few hours or days depending on the situation.
After the removal of the symptoms the homoeopath waits to see if the individual is completely cured. If there is a relapse of the symptoms after a period of time continue giving the remedy but at slower and slower intervals until it is no longer needed. When one uses the medicinal solution correctly one should not see aggravations at any point in the curative process. If one does, there are several ways to adjust the dose to make the remedy more suitable for the sensitivity of the constitution.