§ 287 Fifth Edition

But in this increase of action by the mixture of the dose of medicine with a larger quantity of liquid (before its ingestion), the result is vastly different whether the mixture of the dose of medicine with a certain quantity of liquid is performed merely superficially and imperfectly, or so uniformly and intimately1 that the smallest portion of the diluting fluid received the same quantity of medicine in proportion as all the rest; for the latter becomes much more medicinally powerful by the diluting mixture than the former. From this every one will be able to judge for himself how to proceed with the regulation of the homoeopathic medicinal doses when he desires to diminish their medicinal action as much as possible, in order to make them suitable for the most sensitive patients.2

1 By the word intimately I mean this: that when, for instance, the drop of a medicinal fluid has been shaken up once with one hundred drops of spirits of wine; that is to say, the phial containing both, held in the hand, has been rapidly moved from above downwards with a single smart jerk of the arm, there certainly ensues a thorough mixture of the whole, but with two, three, ten and more such strokes, this mixture becomes much more intimate; that is to say, the medicinal power becomes much more potentized, and the spirit of this medicine, so to speak, becomes much more unfolded, developed and rendered much more penetrating in its action on the nerves. If, then, the required object we wish to attain with the low dilutions be the diminution of the doses for the purpose of moderating their powers upon the organism, we would do well to give no more than two such succussion-jerks to each of the twenty, thirty, etc., dilution phials, and thus to develop the medicinal power only moderately. It is also advisable, in attenuating the medicine in the state of dry powder by trituration in a porcelain mortar, to keep within certain limits, and, for example, to triturate strongly, for one hour only, one grain of the crude entire medical substance, mixed with the first hundred grains of milk-sugar (to the 1/10000th attenuation) likewise only for one hour, and to make the third attenuation (to 1/1000000) also by one hour of strong trituration of one grain of the previous mixture with one hundred grains of milk-sugar, in order to bring the medicine to such an attenuation that its development of power shall remain moderate. A more exact description of this process will be found in the prefaces to Arsenic and Pulsatilla in the Materia Medica Pura.

2 The higher we carry the attenuation accompanied by dynamization (by two succussion strokes), with so much the more rapid and penetrating action does the preparation seem to affect the vital force and to alter the health, with but slight diminution of strength even when this operation is carried very far, – in place, as is usual (and generally sufficient) to X when it is carried up to XX, L, C, and higher; only that then the action always appears to last a shorter time.

Summary Notes

• With liquid solutions, the strength of the dose can be moderated to suit individual needs, by changing the amount of dilution and or number of succussions given.
• If the medicine is diluted and dynamized simultaneously, the action of the medicine becomes more rapid and penetrating with each successive potentization.
• BUT if the medicine is dynamized without successive dilution, the medicine works for a shorter time.

§ 288 Fifth Edition

The action of medicines in the liquid from1 upon the living human body takes place in such a penetrating manner, spreads out from the point of the sensitive fibers provided with nerves whereto the medicine is first applied with such inconceivable rapidity and so universally through all parts of the living body, that this action of the medicine must be denominated a spirit-like (a dynamic, virtual) action.

1 It is especially in the form of vapour, by olfaction and inhalation of the medicinal aura that is always emanating from a globule impregnated with a medicinal fluid in a high development of power, and placed, dry, in a small phial, that the homoeopathic remedies act most surely and most powerfully. 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 he 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, he then corks up the phial and replaces it in his pocket case to prevent any misuse of it, and unless he wishes it he has no occasion for an apothecary’s assistance in his practice. A globule of which ten, twenty or one hundred weigh one grain, impregnated with the thirtieth potentized dilution, and then dried, retains for this purpose all its power undiminished for at least eighteen or twenty years (my experience extends this length of time), even though the phial be opened a thousand times during that period, if it be but protected from heat and the sun’s light. Should both nostrils be stopped up by coryza or polypus, the patient should inhale by the mouth, holding the orifice of the phial betwixt his lips. In little children it may be applied close to their nostrils whilst they are asleep with the certainty of producing an effect. The medicinal aura thus inhaled comes in contact with the nerves in the walls of the spacious cavities it traverses without obstruction, and thus produces a salutary influence on the vital force, in the mildest yet most powerful manner, and this is much preferable to every other mode of administering the medicament in substance by the mouth. All that homoeopathy is capable of curing (and what can it not cure beyond the domain of mere manual surgery affections?) among the most severe chronic diseases that have not been quite ruined by allopathy, as also among acute disease, will be most safely and certainly cured by this olfaction. I can scarcely name one in a hundred out of the many patients that have sought the advice of myself and my assistant during the past year, whose chronic or acute disease we have not treated with the most happy results, solely by means of this olfaction; during the latter half of this year, moreover, I have become convinced (of what I never could previously have believed) that by this olfaction the power of the medicines is exercised upon the patient in, at least, the same degree of strength, and that more quietly and yet just as long as when the dose of medicine is taken by the mouth, and that, consequently, the intervals at which the olfaction should be repeated should not be shorter than in the ingestion of the material dose by the mouth.

Guidelines in 6th Edition of Organon of Medicine (1842)

All emphasis (bold/italic/underline) and notes by Dr. Manish Bhatia

§ 245 Sixth Edition

Having thus seen what attention should, in the homoeopathic treatment, be paid to the chief varieties of diseases and to the peculiar circumstances connected with them, we now pass on to what we have to say respecting the remedies and the mode of employing them, together with the diet and regimen to be observed during their use.

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 new 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.

Summary Notes

• Whenever there is a striking or marked amelioration, DO NOT repeat the medicine, as long as the amelioration lasts.

§ 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. This is not infrequently the case in 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. 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 affected, as recent and oft-repeated observations have taught me under the following conditions: 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.

1 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).

Summary Notes

• A single dose may often bring about striking improvement in acute cases.
• But in chronic cases, it is often not enough to prescribe a single dose.
• The most rapid cure can be attained in chronic cases if -
  • The medicine selected is perfectly similar
  • The medicine is dissolved in water to prepare the dose.
  • The medicine is repeated at suitable intervals
• The dose should be altered every time. No two doses should be alike. Slight difference should be made by succussing the medicine every time.
• This alteration of dose can be done with LM scale. After using one potency for a week or two, advance should be made to subsequent potency in LM scale.

§ 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). 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, 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) 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. 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. But through modification of every dose in its dynamiztion 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.

Summary Notes

• If a medicine is repeated in the same potency and dose then medicinal symptoms will appear.
• Medicines, even highly potentized, can be repeated frequently if the dose is varied each time.

§ 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. Thus in chronic diseases, every correctly chosen homoeopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success. If the solution is used up (in seven to fifteen days) it is necessary to add to the next solution of the same medicine if still indicated one or (though rarely) several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one more homoeopathically related medicine must be chosen in place of the last 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. On the other hand, should there appear during almost daily repetition of the well indicated homoeopathic remedy, towards the end of the treatment of a chronic disease, so-called (§ 161) homoeopathic aggravations by 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 several days, in order to see if the convalescence need no further medicinal aid. The apparent symptoms (Schein – Symptome) caused by the excess of the homoeopathic medicine will soon disappear and leave undisturbed health in its wake. If only a small vial say a dram of dilute alcohol is used in the treatment, in which is contained and dissolved through succussion one globule of the medicine which is to be used by olfaction every two, three or four days, this also must be thoroughly succussed eight to ten times before each olfaction.

1 Made in 40, 30, 20, 15 or 8 tablespoons of water with the addition of some alcohol or a piece of charcoal in order to preserve it. If charcoal is used, it is suspended by means of a thread in the vial and is taken out when the vial is succussed. The solution of the medicinal globule (and it is rarely necessary to use more than one globule) of a thoroughly potentized medicine in a large quantity of water can be obviated by making a solution in only 7-8 tablespoons of water and after thorough succussion of the vial take from it one tablespoon and put it in a glass of water (containing about 7 to 8 spoonfuls), this stirred thoroughly and then given a dose to the patient. If he is unusually excited and sensitive, a teaspoon of this solution may be put in a second glass of water, thoroughly stirred and teaspoonful doses or more be given. There are patients of so great sensitiveness that a third or fourth glass, similarly prepared, may be necessary. Each such prepared glass must be made fresh daily. The globule of the high potency is best crushed in a few grains of sugar of milk which the patient can put in the vial and be dissolved in the requisite quantity of water.

Summary Notes

• Method 1 to prepare & give medicinal solution.
  • Take one (or more, if required) globule of the indicated remedy, crush it in a few grains of sugar of milk.
  • Put it in a glass vial and add 120 ml (8 tablespoons) to 600 ml (40 tablespoons) water depending upon the amount and strength of solution required.
  • Add to it some alcohol as a preservative.
  • Succuss the bottle vigorously.
  • Give 1 to 2 teaspoons from this bottle as one dose.
  • Succuss the bottle twice before each dose.
• Method 2 to prepare medicinal solution.
  • This method removes the need for large bottles and lots of liquid solution.
  • Take one (or more, if required) globule of the indicated remedy, crush it in few grains of sugar of milk.
  • Put it in a glass vial with approx. 100 ml (7-8 tablespoons) water.
  • Add to it some alcohol as a preservative.
  • Succuss the bottle vigorously.
  • Take a glass with 100 ml water and Put 1 spoon (15 ml) solution from the bottle in it.
  • Stir and give 1 to 2 teaspoons from this glass as one dose.
  • Succuss the bottle twice before each dose.
  • If the patient is very sensitive, put 1 spoonful from the first glass in a second glass of 100 ml water. Stir and give the dose from the second glass. Dilute further for more sensitive patients.
• In chronic cases, repeat in such fashion daily or on alternate days; in acute diseases, every 2 to 6 hours; in emergency or very acute cases, every hour or even every few minutes.
• Once one bottle of medicinal solution is finished, prepare the next bottle with a globule of higher potency.
• Repeat the same medicine in increasing dynamization as long as the patient continues to improve.
• If new symptoms (medicinal) are experienced, medicine should be stopped and case reassessed.
• If after a considerable period of improvement, the patient experiences a homeopathic aggravation, stop the medicine. Most likely the aggravation will subside in a few days and the patient will be cured.
• Method for olfaction
  • Take a 1 dram glass vial and fill it with dilute alcohol.
  • Put 1 crushed globule in it and sucuss vigorously.
  • Smell the bottle every 2 to 4 days. Sucuss 10 times before each olfaction.

§ 249 Sixth Edition

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 real improvement,1 and cannot be considered as homoeopathically selected; it must, therefore, either, 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.2

1 As all experience shows that the dose of the specially suited homoeopathic medicine can scarcely be prepared too small to effect perceptible amelioration in the disease for which it is appropriate (§§ 275-278), we should act injudiciously and hurtfully were we when no improvement, or some, though it be even slight, aggravation ensues, to repeat or even increase the dose of the same medicine, as is done in the old system, under the delusion that it was not efficacious on account of its small quantity (its too small dose). Every aggravation by the production of new symptoms – when nothing untoward has occurred in the mental or physical regimen – invariably proves unsuitableness on the part of the medicine formerly given in the case of disease before us, but never indicates that the dose has been too weak.

2 The well informed and conscientiously careful physician will never be in a position to require an antidote in his practice if he will begin, as he should, to give the selected medicine in the smallest possible dose. Like minute doses of a better chosen remedy will re-establish order throughout.

Summary Notes

• If a medicine produces medicinal symptoms, then it is not the simillimum
• In such case, if the medicinal symptoms are severe, an antidote should be given.
• If medicinal symptoms are not severe, another remedy should be given.

§ 272 Sixth Edition

Such a globule,1 placed dry upon the tongue, is one of the smallest doses for a moderate recent case of illness. Here but few nerves are touched by the medicine. A similar globule, crushed with some sugar of milk and dissolved in a good deal of water (§ 247) and stirred well before every administration will produce a far more powerful medicine for the use of several days. Every dose, no matter how minute, touches, on the contrary, many nerves.

1 These globules (§ 270) retain their medicinal virtue for many years, if protected against sunlight and heat.

§ 275 Sixth Edition

The suitableness of a medicine for any given case of disease does not depend on its accurate homoeopathic selection alone, but likewise on the proper size, or rather smallness, of the dose. If we give too strong a dose of a medicine which may have been even quite homoeopathically chosen for the morbid state before us, it must, notwithstanding the inherent beneficial character of its nature, prove injurious by its mere magnitude, and by the unnecessary, too strong impression which, by virtue of its homoeopathic similarity of action, it makes upon the vital force which it attacks and, through the vital force, upon those parts of the organism which are the most sensitive, and are already most affected by the natural disease.

§ 276 Sixth Edition

For this reason, a medicine, even though it may be homoeopathically suited to the case of disease, does harm in every dose that is too large, the more harm the larger the dose, and by the magnitude of the dose and in strong doses’ it does more harm the greater its homoeopathicity and the higher the potency1 selected, and it does much more injury than any equally large dose of a medicine that is unhomoeopathic, and in no respect adapted to the morbid state (allopathic).

Too large doses of an accurately chosen homoeopathic medicine, and especially when frequently repeated, bring about much trouble as a rule. They put the patient not seldom in danger of life or make this disease almost incurable. They do indeed extinguish the natural disease so far as the sensation of the life principle is concerned and the patient no longer suffers from the original disease from the moment the too strong dose of the homoeopathic medicine acted upon him but he is in consequence more ill with the similar but more violent medicinal disease which is most difficult to destroy.2

1 The praise bestowed of late years by some homoeopathists on the larger doses is owing to this, either that they chose low dynamizations of the medicine to be administered (as I myself used to do twenty years ago, from nor knowing any better), or that the medicines selected were not homoeopathic and imperfectly prepared by their manufacturers.

2 Thus, the continuous use of aggressive allopathic large doses of mercurials against syphilis develops almost incurable maladies, when yet one or several doses of a mild but active mercurial preparation would certainly have radically cured in a few days the whole venereal disease, together with the chancre, provided it had not been destroyed by external measures (as is always done by allopathy). In the same way, the allopath gives Peruvian bark and quinine in intermittent fever daily in very large doses, where they are correctly indicated and where one very small dose of a highly potentized China would unfailingly help (in marsh intermittents and even in persons who were not affected by any evident psoric disease). A chronic China malady (coupled at the same time with the development of psora) is produced, which, if it does not gradually kill the patient by damaging the internal important vital organs, especially spleen and liver, will put him, nevertheless suffering for years in a sad state of health. A homoeopathic antidote for such a misfortune produced by abuse of large doses of homoeopathic remedies is hardly conceivable.

Summary Notes

• A similar drug in large, often repeated doses can do more harm to the patient than an allopathic drug.
• The more similar a medicine, the greater are the adverse effects of its frequent repetition.
• Large doses of medicine (allopathic or homeopathic) often make the case incurable.
• Hahnemann calls large doses of even the ‘similar’ remedies – allopathic and unhomeopathic!

§ 277 Sixth Edition

For the same reason, and because a medicine, provided the dose of it was sufficiently small, is all the more salutary and almost marvellously efficacious the more accurately homoeopathic its selection has been, a medicine whose selection has been accurately homoeopathic must be all the more salutary the more its dose is reduced to the degree of minuteness appropriate for a gentle remedial effect.

Summary Notes

• The more similar a remedy, higher the potency, lesser the dose.

§ 278 Sixth Edition

Here the question arises, what is this most suitable degree of minuteness for sure and gentle remedial effect; how small, in other words, must be the dose of each individual medicine, homoeopathically selected for a case of disease, to effect the best cure? To solve this problem, and to determine for every particular medicine, what dose of it will suffice for homoeopathic therapeutic purposes and yet be so minute that the gentlest and most rapid cure may be thereby obtained – to solve this problem is, as may easily be conceived, not the work off theoretical speculation; not by fine-spun reasoning, not by specious sophistry can we expect to obtain the solution of this problem. It is just as impossible as to tabulate in advance all imaginable cases. Pure experiment, careful observation of the sensitiveness of each patient, and accurate experience can alone determine this; and it were absurd to adduce the large doses of unsuitable (allopathic) medicines of the old system, which do not touch the diseased side of the organism homoeopathically, but only attack the parts unaffected by the disease, in opposition to what pure experience pronounces respecting the smallness of the doses required for homoeopathic cures.

§ 280 Sixth Edition
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. This indicates an approaching cure through a gradual ascending of the moderate doses modified each time by succussion (§ 247). It indicates that the vital principal no longer needs to be affected by the similar medicinal disease in order to lose the sensation of the natural disease (§ 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.

Summary Notes

• A suitably selected medicine should be given in increasing dose (succussion) till there is continued amelioration.
• If the original symptoms appear to aggravate after a long period of amelioration, then the medicine should be discontinued as this is a sign of cure.

§ 281 Sixth Edition
In order to be convinced of this, the patient is left without any medicine for eight, ten of fifteen days, meanwhile giving him only some powders of sugar of milk. If the few last complaints are due to the medicine simulating the former original disease symptoms, then these complaints will disappear in a few days or hours. If during these days without medicine, while continuing good hygienic regulations nothing more of the original disease is seen, he is probably cured. But if in the later days traces of the former morbid symptoms should show themselves, they are remnants of the original disease not wholly extinguished, which must be treated with renewed higher potencies of the remedy as directed before. If a cure is to follow, the first small doses must likewise be again gradually raised higher, but less and more slowly in patients where considerable irritability is evident than in those of less susceptibility, where the advance to higher dosage may be more rapid. There are patients whose impressionability compared to that of the insusceptible ones is like the ratio as 1000 to 1.
1 The rule to commence the homoeopathic treatment of chronic diseases with the smallest possible doses and only gradually to augment them is subject to a notable exception in the treatment of the three great miasms while they still effloresce on the skin, i.e., recently erupted itch, the untouched chancre (on the sexual organs, labia, mouth or lips, and so forth), and the figwarts. These not only tolerate, but indeed require, from the very beginning large doses of their specific remedies of ever higher and higher degrees of dynamization daily (possibly also several times daily). If this course be pursued, there is no danger to be feared as is the case in the treatment of diseases hidden within, that the excessive dose while it extinguishes the disease, initiates and by continued usage possible produces a chronic medicinal disease. During external manifestations of these three miasms this is not the case; for from the daily progress of their treatment it can be observed and judged to what degree the large dose withdraws the sensation of the disease from the vital principle day by day; for none of these three can be cured without giving the physician the conviction through their disappearance that there is no longer any further need of these medicines.

Since diseases in general are but dynamic attacks upon the life principle and nothing material – no materia peccans – as their basis (as the old school in its delusion has fabulated for a thousand years and treated the sick accordingly to their ruin) there is also in these cases nothing material to take away, nothing to smear away, to burn or tie or cut away, without making the patient endlessly sicker and more incurable (Chron. Dis. Part 1), than he was before local treatment of these three miasms was instituted. The dynamic, inimical principle exerting its influence upon the vital energy is the essence of these external signs of the inner malignant miasms that can be extinguished solely by the action of a homoeopathic medicine upon the vital principle which affects it in a similar but stronger manner and thus extracts the sensation of internal and external spirit-like (conceptual) disease enemy in such a way that it no longer exists for the life principle (for the organism) and thus releases the patient of his illness and he is cured.

Experience, however, teaches that the itch, plus its external manifestations, as well as the chancre, together with the inner venereal miasm, can and must be cured only by means of specific medicines taken internally. But the figwarts, if they have existed for some time without treatment, have need for their perfect cure, the external application of their specific medicines as well as their internal use at the same time.

Summary Notes

• To confirm that the patient is cured, keep the patient on placebo for a few weeks.
• If all the symptoms disappear, the case is cured.
• If some symptoms continue to linger, raise the potency.
• The general rule for treatment of chronic disease is – Start the treatment with low (lowest?) potency and then gradually ascend to higher potencies using the medicinal solution.
• But if an infectious chronic disease – say scabies, syphilis or gonorrhea – is present in its active form, then it may be necessary to begin the treatment with higher potencies and the medicine may be repeated daily. What this means is that if one is suffering from any deep, chronic disease – infectious in nature – in its acute, active state – then the medicine may be repeated daily in high potencies. This will not apply if the patient has a history of any such disease or if the disease has been treated/suppressed allopathically.
• Warts may require external application of the suitable medicine along with the internal administration.

§ 284 Sixth 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 inunction is connected with simultaneous internal administration.1

1 The power of medicines acting upon the infant through the milk of the mother or wet nurse is wonderfully helpful. Every disease in a child yields to the rightly chosen homoeopathic medicines given in moderate doses to the nursing mother and so administered, is more easily and certainly utilized by these new world-citizens than is possible in later years. Since most infants usually have imparted to them psora through the milk of the nurse, if they do not already possess it through heredity from the mother, they may be at the same time protected antipsorically by means of the milk of the nurse rendered medicinally in this manner. But the case of mothers in their (first) pregnancy by means of a mild antipsoric treatment, especially with sulphur dynamizations prepared according to the directions in this edition (§ 270), is indispensable in order to destroy the psora – that producer of most chronic diseases – which is given them hereditarily; destroy it both within themselves and in the foetus, thereby protecting posterity in advance. This is true of pregnant women thus treated; they have given birth to children usually more healthy and stronger, to the astonishment of everybody. A new confirmation of the great truth of the psora theory discovered by me.

Summary Notes

• Medicine can be given through mouth, tongue, nose, or intact skin.
• Medicines can be applied on intact skin and given internally at the same time.
• For an infant, medicines can be given to the mother if the baby is breast-feeding.

Guidelines in Chronic Diseases (1828-1830)

All emphasis (bold/italic/underline) and notes by Dr. Manish Bhatia

Summary Notes

• By 1830, Hahnemann was already using the liquid medicinal solution extensively. He was still experimenting with it, therefore Chronic Diseases has guidelines for the dry dose similar to the 4th edition and guidelines for the medicinal solution similar to the 5th edition.
• It might be necessary to repeat medicines frequently in acute disease or chronic disease or acute nature/aggravation.
• In chronic cases we have to wait before repetition, till the first dose exhausts its action.
• The medicine should be repeated in another potency preferably.
• At this time Hahnemann was repeating potencies without any fixed criteria – either ascending or descending the scale (giving 12 c after 30c or 24c after 18c etc).
• A similar medicine may need some intercurrents to get the best result. For e.g.., a patient on Sulphur may need Hepar-sulph, Nux-vomica or Mercury in between.
• If the physician is sure of his prescription, the first potency should be dissolved in 4 ounce (110 ml) water. One third of it should be taken immediately as one dose and the rest should be repeated for the subsequent two days to finish the 4 ounce prepared. The medicine should be stirred each time before it is taken, to raise the potency. This appears to be the the first experiment of Hahnemann with the liquid solutions.
• In a chronic case, the energy levels (vitality) of the patient should start increasing right from the start of the treatment.
• The best time to take an antipsoric medicine is in the morning in fasting state.
• If you need a feeble effect, take a dry globule on your tongue. For better effect, dissolve the globule in 2-3 teaspoon of water and drink it.
• Do not take anything for half an hour (at least) after taking the medicine.
• The patient should avoid undue mental or physical excitement during the course of treatment.
• After taking the medicine, the patient should not involve himself in any mental or emotional activity (like reading, talking, computers, electronic games etc) for at least one hour.
• In chronic cases, the medicine may be repeated every other day or even daily in medicinal solution in ascending potency.
• In acute cases, dissolve 1 to 2 pills in 100 to 200 ml water and give the patient half to one teaspoon every hour to every 6 hours depending upon the case. If the symptoms start aggravating with frequent repetition, increase the interval between two doses.
• For chronic cases, medicinal solution should be prepared using half water and half alcohol.
• Dissolve 1 or more pills in 10 to 20 ml solution of water and alcohol. Shake well till pills dissolve. From this solution put one or more drops of water in a cup with 15 ml water and stir well. Give patient this solution as one dose or give half internally and apply half on skin. Before each dose, give the bottle of medicinal solution 6 to 10 strokes.

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But if these appropriately selected antipsoric medicines are not allowed to act their full time, when they are acting well, the whole treatment will amount to nothing. Another antipsoric remedy which may be ever so useful, but is prescribed too early and before the cessation of the action of the present remedy, or a new dose of the same remedy which is still usefully acting, can in no case replace the good effect which has been lost through the interruption of the complete action of the preceding remedy, which was acting usefully, and which can hardly be again replaced.

It is a fundamental rule in the treatment of chronic diseases: To let the action of the remedy, selected in a mode homoeopathically appropriate to the case of disease which has been carefully investigated as to its symptoms, come to an undisturbed conclusion, so long as it visibly advances the care and the while improvement still perceptibly progresses. This method forbids any new prescription, any interruption by another medicine and forbids as well the immediate repetition of the same remedy. Nor can there be anything more desirable for the physician than to see the improvement of the patient proceed to its completion unhindered and perceptibly. There are not a few cases, where the practiced careful Homoeopath sees a single dose of his remedy, selected so as to be perfectly homoeopathic, even in a very severe chronic disease, continue uninterruptedly to diminish the ailment for several weeks, yea, months, up to recovery; a thing which could not have been expected better in any other way, and could not have been effected by treating with several doses or with several medicines. To make the possibility of this process in some way intelligible, we may assume, what is not very unlikely, that an antipsoric remedy selected most accurately according to homoeopathic principles, even in the smallest dose of a high or the highest potency can manifest so long-continued a curative force, and at last cure, probably, only by means of a certain infection with a very similar medicinal disease which overpowers the original disease, by the process of nature itself, according to which (Organon, § 5, Fifth Edition,) two diseases which are different, indeed, in their kind but very similar in their manifestations and effects, as also in the ailments and symptoms caused by it, when they meet together in the organism, the stronger disease (which is always the one caused by the medicine, §33, ibid.) destroys the weaker (the natural one). In this case every new medicine and also a new dose of the same medicine, would interrupt the work of improvement and cause new ailments, an interference which often cannot be repaired for a long time.
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The only allowable exception for an immediate repetition of the same medicine is when the dose of a well-selected and in every way suitable and beneficial remedy has made some beginning toward an improvement, but its action ceases too quickly, its power is too soon exhausted, and the cure does not proceed any further. This is rare in chronic diseases, but in acute diseases and in chronic diseases that rise into an acute state it is frequently the case. It is only then, as a practiced observer may recognize – when the peculiar symptoms of the disease to be treated, after fourteen, ten, seven, and even fewer days, visibly cease to diminish, so that the improvement manifestly has come to a stop, without any disturbance of the mind and without the appearance of any new troublesome symptoms, so that the former medicine would still be perfectly homeopathic suitable, only then, if say, is it useful, and probably necessary to give a dose of the same medicine of a similarly small amount, but most safely in a different degree of dynamic potency.* When the remedy is thus modified, the vital force of the patient will allow itself more easily to be further affected by the same medicine, so as to effect by it everything that may be expected of this medicine and in this ailment.

To adduce an example: a freshly arisen eruption of itch belongs to those diseases which might soonest permit the repetition of the dose (sulphur), and which does permit it the more frequently, the sooner after the infection the itch is received for treatment, as it then approaches the nature of an acute disorder, and demands its remedies in more frequent doses than when it has been standing on the skin for some time. But this repetition should be permitted only when the preceding dose has largely exhausted its action (after six, eight or ten days), and the dose should be just as small as the preceding one, and be given in a different potency. Nevertheless it is in such a case often serviceable, in answer to a slight change of symptoms, to interpose between the doses of pure sulphur, a small dose of Hepar sulphuris calcareum. This also should be given in various potencies, if several doses should be needed from time to time. Often also, according to circumstances, a dose of Nux vomica (x) or one of mercury (x)** may be used between.

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(* If it, has first been given in the 30th potency it will now be given in perhaps the 18th, and if a repetition should, be again found serviceable and necessary, it might afterwards be given in the 24th. and later perhaps also in the 12th and 6th, etc., if, the chronic disease should have taken on itself an acute character. A dose of medicine may also have been suddenly counteracted and annihilated by a grave error in the regimen of the patient, when perhaps a dose of the former serviceable medicine might again be given with the modification mentioned above.)

(In cases where the physician is certain as to the homeopathic specific to be used, the first attenuated dose may also be dissolved in about four ounces of water by stirring it, and one-third may be drunk at once, and the second and third portions on the following days; but it should each time be again stirred so as to increase the potency and thus to change it. Thereby the remedy seeing to take a deeper hold on the organism and hasten the restoration in patients who are vigorous and not too sensitive.)

(** That the itch-patient during such a treatment must avoid every external application, however harmless it may appear, e.g., the washing with black soap, is not necessary to emphasize.)

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If I except sulphur, Hepar sulphuris and in some cases Sepia, the other antipsoric remedies can seldom be usefully given in immediately repeated doses. Indeed it is hardly ever needed in chronic diseases, as we have a goodly supply of antipsoric remedies at our disposal, so that as soon as one well selected remedy has completed its action, and a change of symptoms, i.e., a change in the total image of the disease, appears, another antipsoric remedy homeopathic appropriate to the altered case may be chosen to greater advantage and with a more sure prospect of hastening the cure, than if we take the risk of prescribing the former medicine which now is no longer altogether adequate. Nevertheless in very tedious and complex cases, which are mostly such as have been mismanaged by allopathic treatment, it is nearly always necessary to give again from time to time during the treatment, a dose of Sulphur or of Hepar (according to the symptoms), even to the patients who have been before dosed with large allopathic doses of Sulphur and with sulphur-baths; but then only after a previous dose of Mercury (x).
Where, as is usually the case in chronic diseases, various antipsoric remedies are necessary, the more frequent sudden change of them is a sign that the physician has selected neither the one nor the other in an appropriately homeopathic manner, and had not properly investigated the leading symptoms of the case before prescribing a new remedy. This is a frequent fault into which the homeopathic physician falls in urgent cases of chronic diseases, but oftener still in acute diseases from over haste, especially when the patient is a person very dear to his heart. I cannot too urgently warn against this fault.

Then the patient naturally falls into such an irritated state that, as we say, no medicine acts, or shows its effect,* yea, so that the power of response in the patient is in danger of flaring up and expiring at the least further dose of medicine. In such a case no further benefit can be had through medicine, but there may be in use a calming mesmeric stroke made from the crown of the head (on which both the extended hands should rest for about a minute) slowly down over the body, passing over the throat, shoulders, arms, hands, knees and legs down over the feet and toes. This may be repeated if necessary.
A dose of homeopathic medicine may also be moderated and softened by allowing the patient to smell a small pellet moistened with the selected remedy in a high potency, and placed in a vial the mouth of which is held to the nostril of the patient, who draws in only a momentary little whiff of it. By such an inhalation the powers of any potentized medicine may be communicated to the patient in any degree of strength. One or more such medicated pellets, and even those of a larger size may be in the smelling-bottle, and by allowing the patient to take longer or stronger whiffs, the dose may be increased a hundred fold as compared with the smallest first mentioned. The period of action of the power of a potentized medicine taken in by such inhalation and spread over so large a surface (as that of the nostrils and of the lungs) last as long as that of a small massive dose taken through the mouth and the fauces.
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(* That a homeopathic potentized dose of medicine should ever fail of having an effect in a treatment conducted with care, I think impossible; I have never experienced it.)

(Even persons born without the sense of smell or who have lost it through disease, may expect equally efficient help from drawing in the imperceptible vapor (proceeding from the medicine and contained in the vial) through one nostril or the other, as those do who are gifted with the sense of smell. From this it follows that the nerves possessing merely the sense of touch receive the salutary impression and communicate it unfailingly to the whole nervous system.)

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The strength of a patient under an antipsoric treatment, even if it should be continued ever so long, ought continually to increase from the very commencement of the correct treatment even to the restoration of health and of the normal state. The strength increases during the whole of the cure without the use of the so-called tonics, and the patients joyously rise up again of themselves in proportion as their life is delivered from its corroding enemy.*

The best time for taking a dose of antipsoric medicine seems to be, not an hour before going to bed but, rather, early in the morning while fasting. The medicine in the numbered paper (as also all that succeed) if it is desired that it should act but feebly, should be taken dry and allowed to dissolve on the tongue, or be moistened with two or three drops of water on a spoon, and by itself, without in either case drinking anything after it or eating anything within half an hour or a whole hour.**4
After taking the medicine the patient should keep perfectly quiet at least a full hour, but without going to sleep (sleep delays the beginning of the action of the medicine). He must avoid during this hour, as indeed throughout the treatment, all disagreeable excitement, nor should he strain his mind immediately after taking the dose, in any way, either by reading or computing, by writing, or by conversations requiring meditation.

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(* It is inconceivable how allopathic physicians could think of curing chronic diseases through a continuance of exhausting and debilitating treatments, without being restrained by their lack of success from repeating continually their perverse treatment. The amara which they give between, together with the quinine, without being able to supply the strength lost, only add new evils.)
(Numbering the powders continuously has the convenience that the physician when the patients render their daily report (especially those living at a distance) putting first the date and the number of the powder taken that day, can recognize the day when the patient took his medicine, and can judge of the progress of its action according to the report of the following day.)

(** If the medicine is to act more strongly it must be stirred in a little more water until dissolved before taking it, and in still more water if it is to act still more strongly, and the physician should order the solution taken a portion at a time. If he orders the solution taken in one or three days it must be stirred up not only the first time, but also the other two times, by which every part thus stirred acquires another somewhat higher degree of potency, and so is received more willingly by the vital force. To direct the use of the same solution for a greater number of days is not advisable, as the water, kept longer, would begin to putrefy. How a dose for smelling may be adapted to all degrees of strength, I have mentioned above.)

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In chronic diseases I have found it best to give a dose (e.g., a spoonful) of a solution of the suitable medicine at least every two days, more usually every day.

But since water (even distilled water) commences after a few days to be spoil, whereby the power of the small quantity of medicine contained is destroyed, the addition of a little alcohol is necessary, or where this is not practicable, or if the patient cannot bear it, I add a few small pieces of hard charcoal to the watery solution. This answers the purpose, except that in the latter case the fluid in a few days receives a blackish tint. This is caused by shaking the liquid, as is necessary every time before giving a dose of medicine, as may be seen below.

Before proceeding, it is important to observe, that our vital principle cannot well bear that the same unchanged dose of medicine be given even twice in succession, much less more frequently to a patient. For by this the good effect of the former dose of medicine is either neutralized in part, or new symptoms proper to the medicine, symptoms which have not before been present in the disease, appear, impeding the cure. Thus even a well selected homeopathic medicine produces ill effects and attains its purpose imperfectly or not at all. Thence come the many contradictions of homeopathic physicians with respect to the repetition of doses.

But in taking one and the same medicine repeatedly (which is indispensable to secure the cure of a serious, chronic disease), if the dose is in every case varied and modified only a little in its degree of dynamization, then the vital force of the patient will calmly, and as it were willingly receive the same medicine even at brief intervals very many times in succession with the best results, every time increasing the well-being of the patient.

This slight change in the degree of dynamization is even effected, if the bottle which contains the solution of one or more pellets is merely well shaken five or six times, every time before taking it.

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Now when the physician has in this way used up the solution of the medicine that had been prepared, if the medicine continues useful, he will take one or two pellets of the same medicine in a lower potency (e.g. if before he had used the thirtieth dilution, he will now take one or two pellets of the twenty-fourth), and will make a solution in about as many spoonfuls of water, shaking up the bottle, and adding a little alcohol or a few pieces of charcoal. This last solution may then be taken in the same manner, or at longer intervals, perhaps also less of the solution at a time; but every time the solution must be shaken up five or six times. This will be continued so long as the remedy still produces improvement and until new ailments (such as have never yet occurred with other patients in this disease), appear; for in such a case a new remedy will have to be used. On any day when the remedy has produced too strong an action, the dose should be omitted for a day. If the symptoms of the disease alone appear, but are considerably aggravated even during the more moderate use of the medicine, then the time has come to break off in the use of the medicine for one or two weeks, and to await a considerable improvement.*
When the medicine has been consumed and it is found necessary to continue the same remedy, if the physician should desire to prepare a new portion of medicine from the same degree of potency, it will be necessary to give to the new solution as many shakes, as the number of shakes given to the last portion amount to when summed up together, and then a few more, before the patient is given the first dose; but after that, with the subsequent doses, the solution is to be shaken up only five or six times.
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(*In treating acute cases of disease the homeopathic physician will proceed in a similar manner. He will dissolve one (two) pellet of the highly potentized, well selected medicine in seven, ten or fifteen tablespoonfuls of water (without addition) by shaking the bottle. He will then, according as the disease is more or less acute, and more or less dangerous, give the patient every half hour, or every hour, every two, three, four, six hours (after again well shaking the bottle) a whole or a half tablespoonful of the solution, or, in the case of a child, even less. If the physician sees no new symptoms develop, he will continue at these intervals, until the symptoms present at first begin to be aggravated; then he will give it at longer intervals and less at a time.
As is well known, in cholera the suitable medicine has often to be given at far shorter intervals.
Children are always given these solutions from their usual drinking vessels; a teaspoon for drinking is to them unusual and suspicious, and they will refuse the tasteless liquid at once on that account. A little sugar may be added for their sake.
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I have, therefore, lately found the following mode of administration preferable with careful patients. From a mixture of about five tablespoonfuls of pure water and five tablespoonfuls of French brandy – which is kept on hand in a bottle, 200, 300 or 400 drops (according as the solution is to be weaker or stronger) are dropped into a little vial, which may be half-filled with it, and in which the medicinal powder or the pellet or pellets of the medicine have been placed. This vial is stoppered and shaken until the medicine is dissolved. From this solution one, two, three or several drops, according to the irritability and the vital force of the patient, are dropped into a cup, containing a spoonful of water; this is then well stirred and given to the patient, and where more especial care is necessary, only the half of it may be given; half a spoonful of this mixture may also well be used for the above mentioned external rubbing.

On days, when only the latter is administered, as also when it is taken internally, the little vial containing the drops must every time be briskly shaken five or six times; so also the drop or drops of medicine with the tablespoonful of water must be well stirred in the cup.

It would be still better if instead of the cup a vial should be used, into which a tablespoonful of water is put, which can then be shaken five or six times and their wholly or half emptied for a dose.

Frequently it is useful in treating chronic diseases to take the medicine, or to rub it in in the evening, shortly before going to sleep, because we have then less disturbance to fear from without, than when it is done earlier.

When I was still giving the medicines in undivided portions, each with some water at a time, I often found that the potentizing in the attenuating glasses effected by ten shakes was too strong (i.e., the medicinal action too strongly developed) and I, therefore, advised only two succussions. But during the last years, since I have been giving every dose of medicine in an incorruptible solution, divided over fifteen, twenty or thirty days and even more, no potentizing in an attenuating vial is found too strong, and I again use ten strokes with each. So I herewith take back what I wrote on this subject three years ago in the first volume of this book on page 149.

In cases where a great irritability of the patient is combined with extreme debility, and the medicine can only be administered by allowing the patient to smell a few small pellets contained in a vial, when the medicine is to be used for several days, I allow the patient to smell daily of a different vial, containing the same medicine, indeed, but every time of a lower potency, once or twice with each nostril according as I wish him to be affected more or less.