There is no aspect of the history of Dr. Hahnemann’s medical discoveries that is less known, less understood, and more ignored and denied than the curious story of his use of dual remedies. It is a story that has critical implications for understanding both his earlier and his later insights and writings. It is a story that has only been partially told and then that part only in disjointed bits and pieces. Thanks to extensive research several years ago, the whole story was published in the book, An Affair to Remember: The Curious History of the Use of Dual Remedies, Its Significance and Suppression.
Historical understanding is one of the three pillars of human comprehension according to the Greeks, the other being didactical (rational explanation) and polemical (critical analysis).
The story of dual remedies starts ostensibly in the Spring of 1833 with the receipt by Dr. Hahnemann of a letter from one of his closest proteges, Dr. Julius Aegidi. Dr. Hahnemann was at the pinnacle of an illustrious career, having written the Organon and also the radical Chronic Diseases, which insights were the basis for a revised edition of the Organon, its fifth since 1810, but the first major revision of this seminal work. Hahneman was just completing these revisions, and in his 78th year could look back with pride on what he had accomplished.
Aegidi was an Italian physician converted to homeopathy through Hahnemann’s cure of his psoric disease in 1823. He subsequently became an enthusiastic supporter of Hahnemann, perhaps the closest, next to Boenninghausen  , as shown in the intimacy of letters exchanged and the personal relationship developed with the founder of homeopathy. At the time of our story, Dr. Aegidi was working in Düsseldorf, Germany thanks to Hahnemann’s personal interventions with certain of the aristocracy in that city.
Dr. Aegidi’s letter was most remarkable. Dated 15 May 1833, the letter reported on 233 cured cases. That, in and of itself, was not remarkable. However, the method of cure used by Aegidi was: two highly potentized substances at the same time.
Hahnemann replied in a letter a month later, 15 June 1833  . His reply was equally, if not more, remarkable. Hahnemann assured Aegidi that he welcomed the approach and that it was entirely consistent with his previous teachings. Anyone with a passing knowledge of homeopathy would be forgiven for expressing surprise at this point and perhaps suspecting an April Fool’s prank. In this light, let’s consider the reply and the ensuing events in some detail. First, we have the text of Hahnemann’s reply:
Dear Friend and Colleague,
Do not think that I am capable of rejecting any good thing from mere prejudice, or because it might cause alterations in my doctrine. I only desire the truth, as I believe you do too. Hence I am delighted that such a happy idea has occurred to you, and that you have kept it within necessary limits; ‘that two medicinal substances (in smallest dose, or by olfaction) should be given together only in a case where both seem Homoeopathically suitable, but each from a different side.‘ Under such circumstances the procedure is so consonant with the requirements of our art that nothing can be urged against it; on the contrary, homoeopathy must be congratulated on your discovery. I myself will take the first opportunity of putting it into practice, and I have no doubt concerning the good result. I am glad that von Boenninghausen is entirely of our opinion and acts accordingly. I think, too, that both remedies should be given together; just as we take Sulphur and Calcarea together when we cause our patients to take or smell Hepar sulph, or Sulphur and Mercury when they take or smell Cinnabar. Permit me then to give your discovery to the world in the fifth edition of the ‘Organon,’ which will soon be published. Until then, however, I beg you to keep it to yourself, and try to get Mr. Jahr, whom I greatly esteem, to do the same. At the same time I there protest and earnestly warn against all abuse of the practice by a frivolous choice of two medicines to be used in combination. (Haehl, Vol. II, p. 85, bold added)
I too have made a beginning with smelling two suitably combined remedies, and hope to have some good results. I have also dedicated a special paragraph in the fifth edition of the ‘Organon,’ to this method, and in this way introduced it to the world. (Haehl,, Vol. II, p. 253, bold added)
We shall see later that Boenninghausen had already been doing similar work with dual remedies in mixtures, and that Hahneman was fully aware of this. For the moment, let’s look at what Hahnemann proposed to put in the new, 5th edition of the Organon, then already being readied for publication. The new paragraph on the use of two remedies together was to have been as follows:
Section 274b. There are several cases of disease in which the administration of a double remedy is perfectly Homoeopathic and truly rational; where, for instance, each of two medicines appears suited for the case of disease, but each from a different side; or where the case of disease depends on more than one of the three radical causes of chronic disease discovered by me, as when in addition of psora we have to do with syphilis or sycosis also. Just as in very rapid acute diseases I give two or three of the most appropriate remedies in alternation; i.e., in cholera, Cuprum and Veratrum; or in croup, Aconite, Hepar sulph. and Spongia; so in chronic disease I may give together two well-indicated Homoeopathic remedies acting from different sides, in the smallest dose. I must here deprecate most distinctly all thoughtless mixtures or frivolous choice of two medicines, which would be analogous to Allopathic polypharmacy. I must also once again particularly insist that such rightly chosen Homoeopathic double remedies must only be given in the most highly potentized and attenuated doses.” (Thomas L. Bradford, The Life and Letters of Hahnemann, p. 486, bold added)
While Aegidi’s letter marks the formal beginning of our story, the origins of this momentous part of Hahnemann’s life and works can be discovered to lie in his very early works. However, the implications of his discoveries of 1796 only bore fruit years later. We’ll pick up the story several years before Aegidi sat down to write about his discoveries with the use of two remedies in mixture.
Both Hahnemann and Boenninghausen were aware of what Aegidi was doing well before Aegidi wrote his letter on the 233 cured cases. According to Boenninghausen, writing to Hahnemann, a certain Dr. Stoll of Cologne:
…had suggested dividing the remedies into two classes, the one of which should act upon the body and the other upon the soul. He thought that these two kinds of medicine should be combined in a prescription in order to supplement each other.
His method making some noise in Cologne, and Dr. Aegidi, then at Düsseldorf, having in vain endeavoured to discover the essential secret of this novelty, the latter induced me to endeavour to find out. I succeeded in doing so. (Bradford, p. 492)
Hahnemann indicates his awareness of the matter in an earlier letter to Aegidi of 28 April 1833. At this point, Hahnemann is cautious about the use of mixtures given his general criticisms of polypharmacy and his wariness over the ability of others to undermine the hard fought gains he had made in medical reform.
Do not cease from announcing publicly in great detail your work in the Düsselthal institution. But do cease to pay any attention to Dr. Stoll’s mixtures; otherwise I might fear that you were not yet convinced of the eternal necessity of treating patients with simple unmixed remedies. I have seen even shepherds and hangmen do some wonderful things now and then. Are we to chance to luck in the same way? (Haehl, Vol. I, p. 393)
In this same letter, Hahnemann indicates his general concern to maintain the purity of his system against allopathy, echoing the struggles he was having in this regard:
The purifying and separating of the true from the false which I undertook with the highest motives and which has the unmitigated approval of the best and most dependable of my students, must draw the world’s attention to real values. What have you to fear from a frank and earnest separation of pure homoeopathy from that humbugging which must be the grave of homoeopathy if it is allowed to continue advertising itself as genuine and gradually insinuating allopathy again — a very convenient resource for the sluggards? The science and I have need of fewer but truer adherents, I do not wish to see my colleagues increased by a large number of those false coiners. I wish to count as mine only a few good men and true. (Haehl, Vol I. p. 256)
Hahnemann had reason indeed at this point to be cautious. He had just announced to the world, in 1828, his discoveries of the chronic miasms, in particular psora, after a 12 year quest. The “psora theory” had not been well accepted by many if not most homeopathic doctors of the time, a result that Hahnemann had feared would happen.  
At the same time, as a result of his concern over the introduction of allopathic methods of treatment (e.g., blood-letting, crude drugs, emetics, etc.) by those who did not have full confidence in the curative and healing powers of his new system, Hahnemann had felt the need to intervene in a dispute between homeopaths in Leipzig attendant on the opening of the first homeopathic hospital in the world in that city. The dispute was not only public, but unusually bitter and contentious.
As Hahnemann himself wrote to Boenninghausen towards the end of 1833 about the Leipzig matter:
Already four years ago, I wrote a friendly but forcible pastoral letter to the Leipsic Society, in which I showed them my displeasure at the unscrupulous and criminal behaviour of some of them, who treated their patients with homoeopathic and allopathic measures simultaneously, to the detriment and shame of our science. But I saw no signs that these arbitrary fellows, who boasted of being the most distinguished of all the homoeopathic physicians, took any heed of it.
…Yet, what happened? Of course after Müller’s public declaration of intentions, they dared not be so bold as to use venesection, leeches, emetics, laxatives, etc. in the Homoeopathic Hospital…But now there anger against me became loud…an open revolt against me signed by the whole of the Society…
…This is how I am treated by these ungrateful ones… (Haehl, Vol. II, p. 289-291)
Aegidi had taken the step of urging Hahnemann to reconcile with the Leipzig homeopaths, but Hahnemann reiterated his strong opposition to the false homeopathy of the Leipzig doctors in the letter of 28 April 1833 already referred to above.   
You have not judged my proceedings against the pseudo-homeopaths from a right point of view. How can you advise me to offer these public cheats my conciliatory hand?
It is just this purging and this division of the true from the false, that I have undertaken from higher motives, and which has met with the unanimous approval of the best and the most reliable of my pupils, that will point out to the world, what is genuine. What do you fear, from a public and serious separation of pure homoeopathy from that imposture, which is bound to become the grave of true homoeopathy, if it were to continue to proclaim itself as the genuine article, and at the same time, overshadow it with allopathic practices, which of course would be very opportune for the lazy ones?
I, and our art, have only need to a few true followers; I do not wish to have as colleagues that large crowd of forgers of base coins. I only wish to number among my own a few good men. Do speak to our worthy Boenninghausen on that subject; he will enlighten you and make you understand what I cannot accomplish by letter owing to the overwhelming amount of other work. Let it suffice that your opinion on this subject, I regret to say, is erroneous… (Haehl, Vol. II, p. 282)
Here are clear examples of the reaction of those “moderates” who saw much good in homeopathy but also wished to see a union of it and the prevailing medical system, the one thing Hahnemann most feared (that is, co-option by the Old School, leaving homeopathy gutted and lifeless).   
With this extravagance Hahnemann’s homoeopathy had reached the highest summit, and would have undoubtedly gone under, if sensible physicians had not taken the matter in hand, and protected the great discovery which this genius had made, and saved it for the benefit of humanity. There is indeed something tragic in it, if we consider how Hahnemann himself moved by hatred against the older medical school, developed his own creation more and more one-sidedly, and drove it even to a sharper point, until he nearly destroyed it. (von Brunnow, Haehl, Vol. II, p. 164).
Hahnemann remained faithful to his strict dogma in spite of all these letters, and spoke most violently against the behaviour of the more moderate school of homoeopathy …I had prefaced this second translation [in French of the Organon], which came out in 1832, with a new detailed introduction, in which I declared myself a follower of the new moderate ideas, and… he was very irate about it, and demanded from me a repudiation of all the heretical parts that displeased him, in some homoeopathic periodical.” (von Brunnow, Haehl, Vol. II, p. 165)
The “psora theory,” that is, the discovery of the chronic miasms, had brought clearly back to Hahnemann’s consciousness the supersensible (phenomenal) nature of the constant (tonic) diseases, as opposed to the more sensible dimension of the pathic diseases (symptoms), something he had discovered in 1796, but which had been overshadowed by the intense work on the elaboration of the technique to address the pathic diseases (homeopathy). It was difficult for many, still ensconced in the material world of the Old School, to accept the phenomenological reality of disease and in particular, the chronic miasms.   Haehl writes that the Psora Theory “aroused the criticism of friend and foe to a tremendous extent” right from the start and that these views “seemed to be even more idiotic than the high dilution medicines.” (Vol. I, p. 137)
Already, in Hahnemann’s lifetime, following his move to Paris, the German Central Association (of homeopaths) moved to formally rejected the theory, but nonetheless “recognised fully the efficacy of the psora remedies in chronic diseases,” (Haehl, Vol. II, p. 163). Practicality took precedence, even if rejecting the theory meant rejecting the very principles that had led to their discovery int he first place. None are so blind as those that can see, but seeing, see not.
Here we find the seeds of a still prevailing attitude to Hahnemann’s deeper insights, particularly as relate to the tonic side of disease (supersensible domain) in the form of rejection by both followers (reject the theory of disease, but accept the use of the remedies in practice on the basis of the law of similars) and critics (ridicule). His earlier works, on materia medica and on the law of similars leading to the Organon, had been criticized, but had also garnered many followers who saw here a useful and necessary reform of medicine. However, such followers and supporters, headed by Hufeland and his influential medical journal, never ceased to think that the reformers could eventually be reconciled with the “mother church” of prevailing authority in medicine. If Hahnemann at any time thought this might be possible (and there is no evidence that he did), such thoughts would have been entirely banished by his work between 1810 and 1830 which brought fully to his consciousness the dynamic (non-material), dual (constant and variable) and hierarchical (jurisdictions and layers) nature of disease and medicine.
These new insights, however, could not be grasped by those without the proper capacity to “see” them. For those living in a different paradigm or organizing idea, these new insights were ridiculous indeed. They felt that they could use the practical results of the theory without needing to accept the theory itself, a form of empiricism that Hahnemann rejected. Without the strong foundation of the theory, the practical results would simply lead to the absorption of the practice into the all-encompassing power and authority of the Old School.
It is no wonder that Hahnemann felt the need, because of the public nature of the operations of the Liepsic Homeopathic Hospital and its symbolic importance for the advance of homeopathy with the authorities and the public, to take the offensive in such a strong and uncompromising manner against the Leipzig Homeopathic Society for using allopathic methods simultaneously with homeopathic ones.  
Hahnemann also warned Aegidi against straying from the true path, telling him that he has nothing to fear from a separation of true from false homeopathy. However, at this point Hahnemann was already fully aware that Aegidi and Boenninghausen were looking into Dr. Stoll’s “mixtures.” and through his lengthy work on chronic diseases, was also becoming more conscious of the dual nature of disease (constant and variable diseases).
Hahnemann had further begun using remedies in quick alternation in acute self-limiting diseases. While he may have formally considered or intended that such use of two remedies be after the full action of the first remedy, it is conceivable that in practice Hahnemann may have found the need to use remedies in close enough proximity that there was the possibility of overlapping action (that is, that the second remedy was prescribed and ingested while the secondary action of the first remedy had not yet exhausted itself).
In a letter to Dr. Stapf of 24th April 1830, Hahnemann wrote how he had cured himself using Staphysagria and Arsenicum in short alternation. Also, during the cholera epidemic of 1831, we find a recommendation for the use of several remedies in alternation.
This evidence comes from a paper written by Dr. O.A. Julian in 1984, who also lists ten more examples of Hahnemann’s use of remedy combinations. Clearly, the concept of using more than one remedy within the time frame of action of another remedy was starting to form in his consciousness. Certainly, in the new paragraph on dual remedies proposed for the 5th Edition, Hahnemann refers to the use of dual remedies as being similar in concept to his previous use of two remedies in quick alternation in acute diseases.
Dr. Julian’s evidence is discussed in an article in Homeopathy On-line:
When Hahnemann started to develop his homeopathic treatment, orthodox doctors often used many drugs in combination. Hahnemann severely criticized this polypharmacy. In order to study the effects of each homeopathic remedy Hahnemann did not use combinations of remedies in the early years and objected to the use of remedy combinations by other homeopaths. Hahnemann’s warnings against using combinations of homeopathic remedies have become an entrenched doctrine in some homeopathic quarters.
However, combinations of homeopathic remedies have been used successfully for well over a century by homeopaths on the European Continent.
Continental homeopaths have known for over a century that Hahnemann did in fact sometimes use remedy combinations, despite what he wrote in the Organon. This was confirmed by Dr. D. Demarque during the 41st Congress of the International Homeopathic League in Rio de Janeiro in 1986. Dr. Demarque’s statement caused great controversy at the congress and it was alleged that he was advocating ‘polypharmacy.’ However, Dr. P. Fisher, editor of the British Homeopathic Journal, wrote in his report on the congress that: ‘Demarque’s historical evidence appeared to be irrefutable.’ (BHJ 1987, pp. 6-7)
The late Dr. Julian also showed clearly in a paper published in 1984 that Hahnemann had in fact used remedy combinations. In a letter to Dr. Stapf, Hahnemann wrote on 24th April 1830 how he cured himself during a serious illness by taking Staphysagria and Arsenicum alternatively at short intervals. During the cholera epidemic of 1831 Hahnemann recommended the use of several remedies, among them Bryonia and Rhus Toxicodendron, taken in alternation. (Julian 1984, p. 42)
In the paper referred to, Julian gave ten more examples, with references, showing that Hahnemann had indeed used remedy combinations. Many of the references were to Dr. Richard Haehl’s German biography, Samuel Hahnemann, sein Leben und Schaffen, which was published in 1922. An English translation of this book has only been published quite recently.
The most recent reference to Hahnemann using polypharmacy is the following: ‘Another extremely interesting feature of Hahnemann’s practice at this time is his use of two remedies at once.’ (Handley, 1988)
Continental homeopaths have known from Hahnemann’s own time that he did use combination remedies, and the material in the German biography of Hahnemann by Dr. R. Haehl has been available to homeopaths who can read German for 74 years. But these historical facts have not been easily accessible to English speaking homeopaths who do not read German. So it is not surprising that Anglo-American homeopaths have believed for a long time that Hahnemann never used remedy combinations. The documented historical fact, however, is that he did.’ (see Homeopathic Drainage Treatment According to Vannier, Dr. Eddy De Ruyter, Homeopathy On-line, Vol. 6).
Hahnemann had further developed a dual conception of the Living Power of the human being as well as a duality between the Spirit (Geist) pole and the nature (Wesen) pole. Thus, he had come to realize the profound duality of life.
Given all this, Hahnemann’s almost immediate welcoming of Aegidi’s use of dual remedies in mixture as being “fully consonant with the homeopathic art,” is not at all surprising.
Boenninghausen, who along with Aegidi, had started to explore the use of dual remedies with Hahnemann’s knowledge and tacit consent, provides us with a striking example of the dual remedy concept from this period.
Boenninghausen fell ill in April 1833 with a serious intestinal blockage, and was, he felt, on the verge of death when he found almost instant relief in Thuja. He then wrote to Hahnemann about this incident and received a reply dated 28th April 1833. Hahnemann relates that he too had fallen ill on or about 3 April 1833 for two weeks from an illness that had threatened his life.
He had been saved only by the use of several remedies in a short period of time. What is interesting is that Boenninghausen had also had to use two other remedies, approximately eight days apart, to complete the cure begun by Thuja, and that these were precisely the two remedies Hahnemann had suggested he take not knowing that Boenninghausen had already taken both, each one well-indicated for the case.
In spite of the great care I took, some vexation… may have contributed to my getting a suffocative catarrh, which for seven days before the 10th of April, and for fourteen days afterwards, threatened to choke me… Only since the last four days I feel myself saved. First by smelling twice of Coffea cr. X-o, then of Calcarea; also Ambra contributed its share…
I was sorry to hear from all my heart, that you have been so sick… Now if you would have an additional advice for the restoration of the activity of your bowels, I would call your attention to Conium and to Lycopodium, and to take daily walks in the open air. (Boenninghausen, Lesser Writings, p. 205-206)
At this point in the article Boenninghausen comments on Hahnemann’s suggestion of two remedies:
I would add here that a few days after sending off my letter [likely the 15th of April] in which I had neither asked for his advice nor spoken of any additional treatment I had taken the homoeopathically indicated Lycopodium, and so also about eight days before receiving the letter [“first days of May”] from our Hahnemann Conium, each in a minimal and single dose, and nothing else at all… What a mass of observations and of experience was required, together with what a rare divining power, in order to give in advance (in a disease which had only been communicated as to its leading characteristics and as to the mere naming of the first remedy used), two remedies which only subsequently, through their symptoms, were so distinctly and determinedly indicated, as homoeopathically suitable, that of all the other remedies none could come into competition and the result had already proved the correctness of the advice before it had become known to me! (Boenninghausen, Lesser Writings, p. 206)
We need to note that this was two medicines (Boenninghausen emphasizes “two remedies”), each indicated for the case, presented by Hahnemann as the medicines to be used, not as possible ones from a long list. Why were two needed to complete the case treated first by Thuja? How did Hahnemann know which medicines were needed with only the leading characteristic symptoms? From observation (of symptoms) on the one side and (clinical) experience on the other, joined by “a rare divining power?”
We should at this point indicate that Hahnemann, despite his illness, was seen to be in full health. The illness that he succumbed to briefly was an example of an idiopathic disease caused by constant vexation (homogenic dimension) due to the dispute with the Leipzig half-homeopaths.
But in spite of everything the “old man,” almost eighty years of age, was physically and mentally fit and cheerful, as Griesselich has so realistically described in his ‘Sketches’ taken in Koethen. Here was, indeed, remarkably blessed old age, full of keen vigour and unquenchable zeal. (Haehl, Vol. I, p. 183)  
Aegidi’s cure of cases using two remedies in mixture to address the dual nature of disease, would appear, at least on the surface to the uninitiated, to go counter to Hahnemann’s long standing opposition to polypharmacy. However, despite this apparent novelty, Hahnemann greeted the news by Aegidi with tremendous enthusiasm. Not content with this, he further decides to try the use of dual remedies in mixture himself and writes a new paragraph for the 5th edition of the Organon, then at the printer, supporting the use of dual remedies.
What is remarkable about this paragraph on dual remedies for the 5th edition is that Hahnemann felt that it could be simply inserted into the existing text of the Organon without the need for any adjustment. Hahnemann also drew attention to the link between his earlier use of two remedies in alternation and the new approach.
What seems to have assuaged Hahnemann’s earlier concerns over the mixtures of Stoll is the “happy idea” stated by Aegidi that each remedy in the mixture would approach a different disease (each is based on the law of similars and each treats disease from a different side) and that each would be in “the smallest dose.” This harkens back to Hahnemann’s own earlier discovery that there is a relationship between the size of the dose and the length of the initial action of the medicine. The implication here is that the dynamic dose (in dilutions beyond any chemical laws) is not subject to the same stricture as chemical doses, such that the giving of two suitable (that is, each from a different side) remedies in mixture does not create a problem for cure, but rather enhances it. Earlier, Hahnemann had found that the dynamized doses increased in therapeutic power despite increased dilution.
Was he now realizing that the dynamized dose in mixture, treating the duality of disease (that is the two diseases in the patient – tonic and pathic), actually enhanced the therapeutic power of treatment as well? Certainly, the experience of Aegidi, Boenninghausen, and later Dr. Lutze, would confirm this.
Aegidi’s letter of 1833 comes as a culmination of several streams of thought each moving towards this high water mark in prescribing by the law of similars. We see the discovery early on of the dual nature of medicinal action, though the emphasis is on the initial action in self-limiting and acute cases. We see the discovery of the dual nature of disease in the form of constant and variable diseases, with the early focus in the aphoristic Organon on the many individual, variable types of disease for which no effective specific remedies had yet been found. We see the concern to dilute the crude doses then in vogue so as to minimize any negative effects and yet to retain some therapeutic action, followed by the dawning of the realization of the hidden (dynamic) power in such small doses.
We then see the movement of dilution past the bio-chemical laws into a supersensible (spiritual) realm, into the world of potencies (as opposed to dilutions), coupled with the discovery of the hidden constant chronic miasms (phenomenal in nature). A schism emerged in the ranks over these two moves into the supersensible realm of nature and Hahnemann became concerned over the movement back (reaction) to the materialism of allopathy. This triggered an otherwise embarrassing and uncharacteristically bitter public feud with the Leipzig homeopaths.
Hahnemann, at the same time, became entranced by the dynamic nature of potentized medicines and tested this by another seemingly embarrassing use of olfaction to the exclusion of other methods.   He moved from the single dose and wait method of previously, to repeated doses (both through olfaction and the liquid dose), though cautiously (every week in chronic cases) to trying to speed up the time of cure. He arrived at a profound insight into the dynamic and dual nature of disease and of medicinal action and commenced with the use of overlapping doses. He apparently began the use of overlapping action of remedy in the case of self-limiting diseases (at least in his own case). Now Aegidi appears and suggests to Hahnemann the use of two remedies in mixture, each from a different side, in high potency (and Hahnemann adds, through olfaction as well). From all that has gone before this appears as the culmination of Hahnemann’s ideas. And that is exactly how Hahnemann reacted.