Homeopathy Papers

Case-Management in a Hop, Skip and a Jump

Elaine Lewis
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How to manage a case according to the Organon, translated into plain English!

Proper dosing strategies, as per Hahnemann, is something that most of us are in the dark about.  How people are dosing is generally something they’re making up as they go along or something they’re picking up at case conferences. I am trying to do something about that!I often get clients from other homeopaths, who had the right remedy, but just couldn’t keep the case moving because of bizarre dosing strategies that have no reflection in classical homeopathy.

Words in brackets [ ] represent my summary of The Organon’s exasperating run-on sentences! Though this doesn’t speak to every question or cover every contingency in a case, as a profession we should at least know this much:

§ 246 Sixth Edition

Every perceptibly progressive and strikingly increasing amelioration during treatment 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 striking improvement precludes further dosing. If a patient has made noticeable improvement after a dose of a remedy, stop giving it! The remedy continues to work on its own. Needless to say, if the case stalls or relapses, give another dose.]

This is not infrequently the case in acute diseases

[especially if you’re dealing with acute diseases]

but in more chronic diseases, on the other hand, a single dose of an appropriately selected homoeopathic remedy will at times complete even with but slowly progressive improvement and give the help which such a remedy in such a case can accomplish naturally within 40, 50, 60, 100 days.

[In a chronic case, however, a single dose may cure in up to three months’ time.]

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.

[While a single dose, a 200C, for example, may cure a patient with chronic disease in one to three months, this is entirely too long for a person to have to wait to be cured. A patient is entitled to expect a cure in much less time.]

And this may be very happily affected, as recent and oft-repeated observations have taught me under the following conditions

[Here’s how I’ve learned to do that]:

firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it is highly potentized, dissolved in water and given in proper small dose that experience has taught as the most suitable in definite intervals for the quickest accomplishment of the cure but with the precaution, that the degree of every dose deviate somewhat from the preceding and following in order that the vital principle which is to be altered to a similar medicinal disease be not aroused to untoward reactions and revolt as is always the case1 with unmodified and especially rapidly repeated doses.

[Put your correctly-chosen, potentized remedy in a bottle of water, succuss the bottle before each dose, “succuss” means pound the bottle into your opposite palm; see this video which shows you how to do it.  It’s called “How To Make A Remedy Solution Bottle”:

http://www.youtube.com/watch?v=xTPJbxn1GMk

There is just one warning I have about the video: the person is not using disposable cups and spoons.  This is a mistake, so, don’t you do it!  Anyway… Give the dose–a sip or teaspoon–at intervals but not so frequently that you cause an aggravation, and make sure the dose itself isn’t so large in size that it causes an aggravation.   Base your repetitions on what the previous dose achieved.  If there was a perceptible improvement, no repetition is necessary.  If there was an aggravation, an improvement may follow so, wait until you see where the case is going before dosing again.  When improvement stops, dose again.  Always succuss your bottle roughly 5 times before each dose.] 

What I said in the fifth edition of the organon, in a long note to this paragraph in order to prevent these undesirable reactions of the vital energy, was all the experience I then had justified. But during the last four or five years, however, all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely, after the lower degree of potency has been used for one or two weeks in the treatment of chronic disease, advance is made in the same way to higher degrees, (beginning according to the new dynamization method, taught herewith with the use of the lowest degrees).

[We can avoid aggravations by starting with the lowest potencies, given daily if need be, and raising the potency by degrees after one or two weeks time.]  How do you raise your potency?  By “plussing” the bottle: pour 90% of your bottle down the drain.  Refill half way with spring or distilled water, not tap water, succuss 40 times, and you will then have the next higher potency.  For example, your 30C will be a 31C.  Go back to succussing 5 times before each dose as before–and don’t add more pellets!!!

§ 247 Sixth Edition

It is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition (and at short intervals in order not to delay the cure).

[Don’t give repeated dry doses! (That means, don’t dose with pellets over and over again.)]

The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those similar to the disease to be cured

[Your immune system doesn’t accept unchanged, unaltered doses.  It’s the reason why your 2.5 mg. of Valium eventually stops working; your body just ignores it, or may even be aggravated by it.  Giving the exact same dose of a remedy or medicine over and over again can cause provings or aggravations, you have to raise the potency before each dose by succussing the bottle, and by doing so, repeated doses will not become irritants as time goes on.]

, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homoeopathic to the original disease, hence no step towards cure can follow, only a true aggravation of the condition of the patient. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher (§§ 269-270) then the vital principle may be altered without difficulty by the same medicine (the sensation of natural disease diminishing)

[put the remedy in water and succuss the bottle before each dose and you’ll be less likely to cause an aggravation and more likely to keep the case moving forward.]

and thus the cure brought nearer.1

1 We ought not even with the best chosen homoeopathic medicine, for instance one pellet of the same potency that was beneficial at first, to let the patient have a second or third dose, taken dry.

[Don’t repeat dry doses if the first dose was successful! (I did this on a few occasions and completely cancelled the remedy out; and by that I mean, I antidoted a remedy that was actually working.)]

In the same way, if the medicine was dissolved in water and the first dose proved beneficial, a second or third and even smaller dose from the bottle standing undisturbed, even in intervals of a few days, would prove no longer beneficial, even though the original preparation had been potentized with ten succussions or as I suggested later with but two succussions in order to obviate this disadvantage and this according to above reasons.

[Even if the remedy is in a water bottle or cup, don’t give a second or third dose in an unstirred, unsuccussed, or unshaken manner. You will cause just the same reaction as if you had repeated dry pellets over and over again as stated above.]

But through modification of every dose in its dynamization degree, as I herewith teach, there exists no offence, even if the doses be repeated more frequently, even if the medicine be ever so highly potentized with ever so many succussions. It almost seems as if the best selected homoeopathic remedy could best extract the morbid disorder from the vital force and in chronic disease to extinguish the same only if applied in several different forms.

§ 248 Sixth Edition

For this purpose, we potentize anew the medicinal solution1 (with perhaps 8, 10, 12 succussions) from which we give the patient one or (increasingly) several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener.

About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom. Elaine is a passionate homeopath, helping people offline as well as online. Contact her at LEWRA@aol.com Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at: http://elainelewis.hpathy.com/ and TheSilhouettes.org

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7 Comments

  • Wonderful article with a summary of the Organon that is simple and pleasing. I was a victim of overdosing and that too in high potency (10M) when a homeopath I visited prescribed Lycopodium 10M and Lachesis 10M to be taken alternately after a span of 10 days for my psoriasis. I was travelling and took the medicines. The result? Every scar, every scratch I had since my bith showed on my skin to such an extent that I was ashamed to show my hands which was full of black spots. I hated homeopathy then. I love it now.
    Nisar

  • In reading over this section, I feel I should make a clarification:

    [Going to the first cup, going to the second cup, etc. for patients who are hyper-sensitive to the remedy: When your patient is hypersensitive, succuss your bottle, put a tsp. from the bottle into a cup of water, stir and then give a tsp. dose. If even this dose aggravates, take a tsp. from the first cup and add it to a second cup, stir, and give a dose from the second cup. There’s no limit to the number of cups a hypersensitive person may need to go to in order to keep from aggravating.]

    When I said this (“If the dose aggravates, take a tsp. from the first cup and add it to a second cup, stir, and give a dose from the second cup”) obviously I meant that if you give a dose of a remedy to a patient and it aggravates, the NEXT time you give the remedy, don’t dose directly from the bottle as you did before! Put your dose, rather, in a cup of water, stir and take a sip from the cup rather than the bottle. If even THAT causes an aggravation, the next time you dose, go to TWO cups–put a tsp. from the first cup into a second cup of water and stir. The idea to is find the point where you can give a dose of the remedy to your patient without causing an aggravation.

    When you find that non-aggravating cup, you can actually take that cup, let’s say it’s the 10th cup, and make a new remedy bottle out of that! So now, your remedy solution bottle is Nat-mur 30C in the 10th cup! Now your patient can dose from the bottle rather than going to extra cups all the time. Still you have to succuss your bottle before each dose.

    These are dosing strategies you positively CANNOT do if you’re limiting yourself to dry pellet dosing. If your patient aggravates on dry pellets, you have to have a strategy for lessening the impact of the dose. You can only do that by going to water.

  • Dear Nisar,
    It is amazing to me the way so many people have hung in there with homeopathy despite being badly damaged by inept prescribing. Going directly to high potencies in skin diseases, risking an aggravation that could result in horrendous itching, swelling and spreading …I just don’t know where people ever got these ideas but it was certainly not from Hahnemann as I have tried to show here! And Lycopodium AND Lachesis??? Geez, which one is it? Pick one! Give it a try, and wait and see what you’re left with when it’s over! How can you evaluate an experiment if you’re working with more than one independent variable? This is elementary scientific method. You have to control for every variable in an experiment except for the one you’re testing! That way, if something goes wrong, you’ll know why and on what to focus the blame.

  • It is such a pleasure to understand what I am reading – your ‘translation’ in red does make a huge difference!

  • Dear Ms Lewis
    Regarding your article “Case-Management in a Hop, Skip and a Jump” i would like to point out to some misunderstandings that could arise to the beginner if not explained in detail. Please forgive misspellings or grammatical errors – I am not a native speaker.
    If I understood it right, you recommended – based on Hahnemanns writings in the 6th edition of the organon – to dissolve the “chosen remedy at the lowest potency” in a bottle of water and to succuss every time before intake. We should start at the lowest potency, if needed, given daily.
    Given the fact that you do not comment about the exact potency we have to start with, I would like to clarify some points here because Hahnemann gave detailed instructions about that matter. In the comments section following your article you mention nat mur 30c so I guess you are referring to c-potencies.
    The aphorisms cited indeed point out to the fact that the remedy has to be diluted in a bottle of water and succussed before each intake, but: Hahnemann is not referring to the c-potencies! Hahnemann is referring to his new developed q-potencies (see footnote of aph. 246). H. dedicated his last years to the development of these q-potencies. One can read the appropriate dilution process in aph. 270.
    This is key to understand, because if you do dissolve lets say a commonly prescribed c30 and apply it daily with succussions, you will be likely to get aggravations or proving symptoms. Its nearly the same effect as taking a pellet daily but worse, because you increase the level of dynamisation of the remedy each time by succession, even if you dilute it in water. It is not about starting with a c12, dissolving it in a bottle and then proceed to a c30 dissolved, then c200 dissolved etc… this method is not suited for the C-potencies!
    Q-Potencies undergo a totally different process of fabrication, i.e. each q-potency is diluted 1:50000 and succussed 100 times compared to a c-potency which is diluted 1:100 and succussed 10 times each step. Also note that the trituration process is totally different, permitting the substance to be dynamized even better. This method results in high dilution/low succussion, thus acting very deep but aggravations – if they occur- will last only a few days and can be dealt with easily by reducing the dosage, increasing the dilution or reducing the number of succussions.
    H. rarely prescribed above the c200, in fact in his historical pharmacy were only found a few c200. The use of high potencies such as c1000 were promoted by later homeopaths like Kent. The way of prescribing and case-managing with C-potencies was already well established when the sixth edition of the organon appeared 79 years after the dead of H. Therefore there are relatively few homeopaths today who prescribe in the classical way of the late H., using the q-potencies.
    In short: The method illustrated by H. in the sixth edition of dissolving the remedy in a bottle of water, succussing every time before intake and going to the next potency level each bottle was meant to be applied with Q-potencies (starting at Q1), not with C- or D-potencies.
    If you apply this method to c-potencies I would recommend that you make a remark that this is your modified method in order to avoid misinterpretation of the original.
    To better understand the use of q-potencies i would like to recommend to the inclined reader the work of Choudhury “50 Millesimal Potency in Theory and Practice” or Luc de Schepper’s “Hahnemann Revisited”. It is worth the effort, because the Q-potencies are the most valuable tool the late Hahnemann developed before passing away. Case managing is much easier and the patient is more likely to be cured in a shorter amount of time.

    Best regards

    S. Haack, MD
    Berlin, Germany

  • S.Hack says:
    July 13, 2010 at 7:36 am (Edit)
    Dear Ms Lewis

    YES?

    Regarding your article “Case-Management in a Hop, Skip and a Jump”

    YES?

    i would like to point out to some misunderstandings that could arise to the beginner if not explained in detail. Please forgive misspellings or grammatical errors – I am not a native speaker.
    If I understood it right, you recommended – based on Hahnemanns writings in the 6th edition of the organon – to dissolve the “chosen remedy at the lowest potency” in a bottle of water and to succuss every time before intake. We should start at the lowest potency, if needed, given daily.
    Given the fact that you do not comment about the exact potency

    ALL I DID WAS “TRANSLATE” THE ORGANON FOR THOSE WHO ARE STILL DOSING ACCORDING TO THE EARLIER 4TH EDITION. THEY ARE GIVING ONE DRY DOSE AND WAITING ONE TO THREE MONTHS FOR RESULTS. HAHNEMANN HERE IS SEEN REJECTING THIS WAY OF PRACTICING.

    we have to start with, I would like to clarify some points here because Hahnemann gave detailed instructions about that matter. In the comments section following your article you mention nat mur 30c so I guess you are referring to c-potencies.

    NO, NO, NO. I AM NOT REFERRING TO ANY CERTAIN KIND OF POTENCY, WHETHER IT BE C, X OR Q. IN THE COMMENTS SECTION, I WAS SHOWING HOW YOU CAN ACCOMODATE A HYPERSENSITIVE PATIENT BY DOSING IN WATER AND GOING TO EXTRA CUPS. WHEN YOU FIND THE CUP THAT DOES NOT AGGRAVATE, YOU CAN MAKE A REMEDY BOTTLE OUT OF THAT CUP, AND DISPOSE OF THE ORIGINAL BOTTLE, MAKING YOUR NEW BOTTLE NAT-MUR 30C (FOR EXAMPLE) IN THE 10TH CUP. I WAS NOT ADVOCATING THAT PEOPLE START THEIR CASES WITH 30C. THAT WAS JUST AN EXAMPLE OF HOW YOU CAN HAVE A REMEDY SOLUTION BOTTLE THAT’S EXTREMELY DILUTED AND TAILORED TO A PARTICULAR PATIENT.

    The aphorisms cited indeed point out to the fact that the remedy has to be diluted in a bottle of water and succussed before each intake, but: Hahnemann is not referring to the c-potencies!

    HE’S NOT REFERRING TO ANY POTENCY, PER SE. HE’S JUST SAYING START WITH THE LOWEST DEGREES. IT’S IN THE FOOTNOTE OF 246. HERE IT IS:

    “…after the lower degree of potency has been used for one or two weeks in the treatment of chronic disease, advance is made in the same way to higher degrees….”

    IN OTHER WORDS, START LOW AND GO UP GRADUALLY.

    Hahnemann is referring to his new developed q-potencies (see footnote of aph. 246). H. dedicated his last years to the development of these q-potencies.

    I KNOW. ALL I DID WAS TRANSLATE THE APHORISMS ABOVE. HE HASN’T STARTED TALKING ABOUT THE LM’S YET. HOWEVER, WHAT HE’S SAYING HOLDS TRUE REGARDLESS OF THE POTENCY SCALE YOU’RE ON.

    One can read the appropriate dilution process in aph. 270.
    This is key to understand, because if you do dissolve lets say a commonly prescribed c30 and apply it daily with succussions, you will be likely to get aggravations or proving symptoms.

    IT IS POSSIBLE TO GET AGGRAVATIONS OR PROVING SYMPTOMS REGARDLESS OF THE POTENCY SCALE YOU’RE USING. THIS IS WHY WHAT HE IS SAYING HERE IS SO IMPORTANT. HE IS SAYING, IF THERE’S A STRIKING IMPROVEMENT, STOP DOSING. IF THERE’S AN AGGRAVATION, STOP DOSING–AND DO SOMETHING ABOUT IT.

    Its nearly the same effect as taking a pellet daily but worse, because you increase the level of dynamisation of the remedy each time by succession,

    NO ONE SHOULD BE GIVING DAILY DOSES WITHOUT REGARD TO HOW THE PATIENT IS RESPONDING. BUT SINCE YOU MENTION LUC DE SCHEPPER’S BOOK, DR. LUC SAYS THAT THE LOWEST POTENCY IS 6C, THEN 12C, THEN 30C, THEN LM/1. DR. LUC ACTUALLY THINKS THAT LM/1 IS MORE POWERFUL THAN A 30C.

    even if you dilute it in water. It is not about starting with a c12, dissolving it in a bottle and then proceed to a c30 dissolved, then c200 dissolved etc… this method is not suited for the C-potencies!

    NO, THIS METHOD IS SUITED FOR ALL POTENCIES, IT IS EVEN SUITED FOR ACUTES WHERE YOU CAN RIGHTLY START YOUR CASE WITH A 200C, AND YOUR NEXT DOSE WOULD, THEREFORE, BE 200C IN WATER, AND YOUR NEXT DOSE AFTER THAT WOULD BE 200C WITH 10 SUCCUSSIONS.

    Q-Potencies undergo a totally different process of fabrication, i.e. each q-potency is diluted 1:50000 and succussed 100 times compared to a c-potency which is diluted 1:100 and succussed 10 times each step.

    YOU MEAN THAT GOING FROM 10C TO 11C ONLY INVOLVES A DILUTION AND 10 SUCCUSSIONS? THAT’S THE FIRST I’M HEARING THAT.

    Also note that the trituration process is totally different, permitting the substance to be dynamized even better. This method results in high dilution/low succussion, thus acting very deep but aggravations – if they occur- will last only a few days and can be dealt with easily by reducing the dosage, increasing the dilution or reducing the number of succussions.

    YES, BUT THIS PROCESS SHOULD BE LEARNED AND APPLIED TO ANY POTENCY SCALE THAT IS BEING USED.

    H. rarely prescribed above the c200, in fact in his historical pharmacy were only found a few c200. The use of high potencies such as c1000 were promoted by later homeopaths like Kent. The way of prescribing and case-managing with C-potencies was already well established when the sixth edition of the organon appeared 79 years after the dead of H. Therefore there are relatively few homeopaths today who prescribe in the classical way of the late H., using the q-potencies.
    In short: The method illustrated by H. in the sixth edition of dissolving the remedy in a bottle of water, succussing every time before intake and going to the next potency level each bottle was meant to be applied with Q-potencies (starting at Q1), not with C- or D-potencies.

    SURELY YOU CAN’T BELIEVE THAT HE MEANT FOR ALL HIS WARNINGS ABOVE TO BE APPLIED TO THE LM/Q POTENCIES ALONE? ALL HIS WARNINGS ABOUT REPEATED DRY DOSES? THAT’S JUST FOR THE Q/LM’S? ALL HIS WARNINGS ABOUT STARTING WITH THE LOWEST POTENCIES, THAT’S JUST FOR LM’S TOO?

    If you apply this method to c-potencies I would recommend that you make a remark that this is your modified method in order to avoid misinterpretation of the original.

    THERE IS NO MENTION OF THE LM/Q POTENCIES IN THE PARAGRAPHS ABOVE; AND HENCE, NO NEED TO MENTION THAT I AM MODIFYING ANYTHING THAT HE IS SAYING ABOUT THE Q POTENCIES.

    To better understand the use of q-potencies i would like to recommend to the inclined reader the work of Choudhury “50 Millesimal Potency in Theory and Practice” or Luc de Schepper’s “Hahnemann Revisited”. It is worth the effort, because the Q-potencies are the most valuable tool the late Hahnemann developed before passing away. Case managing is much easier and the patient is more likely to be cured in a shorter amount of time.

    Best regards

    S. Haack, MD
    Berlin, Germany