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| Hpathy Ezine - October 2008 | ||||
Potency Selection Guidelines by Dr. Hahnemann- Dr. Manish Bhatia |
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Guidelines in 4th Edition of Organon of Medicine (1829)All emphasis (bold/italic/underline) and summary notes by Dr. Manish Bhatia § 248. The dose of the same medicine should be repeated until a cure is effected, or until it ceases any longer to afford relief; in the latter alternative, the remnant of the disease, with its altered group of symptoms, will require another homoeopathic remedy. Summary Notes
§ 249. Every medicine which, in the course of its operation, produces new symptoms that do not appertain to the disease to be cured, and that are annoying, is incapable of procuring real amendment,* and cannot be considered as homoeopathically chosen. If the deterioration of symptoms be important, the effect of the medicine must be extinguished, in part, without delay, by means of an antidote, before another and more homoeopathic remedy is given, or if the new symptoms be not violent, the other remedy must be immediately given, to take the place of that which has been so unfitly chosen. * All experience teaches us, that scarcely any homoeopathic medicine can be prepared in too minute a dose to produce perceptible benefit in a disease to which it is adapted (§ 161. 279). Hence it would be an improper and injurious practice, when the medicine produces no good effect, or an inconsiderable exacerbation of the symptoms, after the manner of the old school, to repeat or increase the dose under the idea that it cannot prove serviceable on account of its minuteness. Every exacerbation caused by new symptoms, when nothing injurious has occurred with regard to diet or mental impressions, always proves the unsuitableness of the medicine previously given, but never indicates the weakness of the dose. Summary Notes
§ 250. When in urgent cases, after the lapse of six, eight, to twelve hours, it becomes manifest to the observant physician who has accurately investigated the character of the disease, that he has made a false selection of the remedy last administered, when, during the appearance of new symptoms, the disease becomes, though slightly, yet evidently worse from hour to hour, it is not only admissible, but duty renders it imperative on him to rectify the mistake he has made, and administer another homoeopathic remedy not only tolerably, but the best possibly adapted to the morbid condition at the time (§ 167). Summary Notes
* As I have explained more circumstantially in the introduction to the article Ignatia (Mat. Med. vol. ii.) Summary Notes
§ 252. But if in a chronic disease (psoric) the most homoeopathic remedy (anti-psoric), administered in the smallest and most suitable dose, does not produce an amendment, it is a sure sign that the cause which keeps up the disease still exists, and that there is something either in the regimen or condition of the patient that must be first altered before a permanent cure can be effected. Summary Notes
§ 253. In all diseases, particularly those which are acute, the state of mind and general demeanor of the patient are among the first and most certain of the symptoms (which are not perceived by everyone) that announce the beginning of any slight amendment or augmentation of the malady. If the disease begins to improve, though in ever so slight a degree, the patient feels more at ease, he is more tranquil, his mind is less restrained, his spirits revive, and all his conduct is, so to express it, more natural. The very reverse takes place where there is only a slight increase; an embarrassment and helplessness, which call for commiseration, are observable in the mind and temper of the patient, as well as in all his actions, gestures, and postures—something both remarkable and peculiar which cannot escape the eye of an attentive observer, but which it would be difficult to describe in words.* * In order to have a determinate rule for the moderate development of power of the fluid medicines, multiplied experience and observation have led me to retain two shakes for every vial, in preference to a greater number, which had previously been used, but which developed the energy in too great a degree. On the contrary, there are homoeopathists who, in their visits to the sick, carry about their persons the medicines in a fluid state, which, they nevertheless affirm, do not in time become increased in energy by the frequent agitation to which they are thus subjected. This declaration, however, betrays on their part the want of a talent for accurate observation. I dissolved a grain of natron in half an ounce of a mixture of water and a little alcohol, poured the solution into a vial, which was thereby filled two-thirds, and shook it uninterruptedly for half an hour. By this agitation, the fluid attained an energy equal to that of the thirtieth dilution. Summary Notes
§ 270. If two drops of a mixture of equal parts of alcohol and the recent juice of any medicinal plant (see § 267) be diluted with ninety-eight drops of alcohol in a vial capable of containing one hundred and thirty drops, and the whole twice shaken together, the medicine becomes exalted in energy (potenzirt) to the first developement of power, or, as it may be denominated, the first potence. The process is to be continued through twenty-nine additional vials, each of equal capacity with the first, and each containing ninety-nine drops of spirits of wine; so that every successive vial, after the first, being furnished with one drop from the vial or dilution immediately preceding (which had just been twice shaken), is, in its turn, to be shaken twice," remembering to number the dilution of each vial upon the cork as the operation proceeds. These manipulations are to be conducted thus through all the vials, from the first up to the thirtieth or decillionth developement of power (potenzirte Decillion-Verdünnung, X.), which is the one in most general use. Summary Notes
§ 272. In no instance is it requisite to employ more than one simple medicinal substance at a time.* * have been made by some homoeopathists in cases where, imagining that one part of the symptoms of a disease required one remedy, and that another remedy was more suitable to the other part, they have given both remedies at the same time, or nearly so; but I earnestly caution all my adherents against such a hazardous practice, which never will be necessary, though, in some instances, it may appear serviceable. Summary Notes
§ 275. The appropriation of a medicine to any given case of disease does not depend solely upon the circumstance of its being perfectly homoeopathic, but also upon the minute quantity of the dose in which it is administered. If too strong a dose of a remedy, that is even entirely homoeopathic, be given, it will infallibly injure the patient, though the medicinal substance be of ever so salutary a nature; the impression it makes is felt more sensibly, because, in virtue of its homoeopathic character, the remedy acts precisely on those parts of the organism which have already been most exposed to the attacks of time natural disease. Summary Notes
§ 276. Even a homoeopathic medicine is, on this account, always injurious when given in too large a dose, and hurtful to the patient in proportion to the extent of the quantity administered. But the increase of the dose itself is also prejudicial in the same degree as the remedy is more homoeopathic; and a strong dose of such a medicine would do more harm than the dose of all allopathic medicinal substance (which bears no analogy whatever to the disease) of equal strength; for, in that case, the homoeopathic aggravation (5 157-160)—that is to say, the artificial malady, which is very analogous to the natural one excited by the remedy in the most suffering parts of the organism—is carried to a height that is injurious (§ 246, note); whereas, if it had been confined within proper limits, it would have effected a gentle, prompt, and certain cure. It is true the patient no longer suffers from the primitive malady which has been homoeopathically destroyed, but he suffers so much more from the medicinal one which was much too powerful, and from unnecessary debility. Summary Notes
§ 281. All diseases have an extraordinary tendency to undergo a change when operated upon by the influence of homogeneous medicinal agents. There is no patient, however robust his constitution may be, who, if attacked merely by a chronic disease, or by what is called a local malady, does not speedily experience a favourable change in the suffering parts after having taken the appropriate homoeopathic remedy in the smallest dose possible. In short, the effects of this substance will make a greater impression on him than they would upon a healthy child twenty-four hours after its birth. How insignificant and ridiculous is mere theoretic incredulity, when opposed to the infallible evidence of facts! § 282. However feeble the dose of a remedy may be, provided it can in the slightest degree aggravate the state of the patient homoeopathically provided it has the power of exciting symptoms similar to those of the primitive disease, but rather more intense, it will, in preference, and almost exclusively, affect those parts of the organism that are already in a state of suffering, and which are strongly irritated and predisposed to receive any irritation analogous to their own. Thus an artificial disease rather more intense is substituted in the place of the natural one. The organism no longer suffers but from the former affection, which, by reason of its nature, and the minuteness of the dose by which it was produced, soon yields to the efforts of the vital force to restore the normal state, and thus leaves the body (if the disease was an acute one) free from suffering—that is to say, in a healthy condition. § 283. To proceed, therefore, in a manlier conformable to nature, the true physician will only administer a homoeopathic remedy in the precise dose necessary to exceed and destroy the disease to which it is opposed, so that if by one of those errors, pardonable to human frailty, he had made choice of a remedy that was inappropriate, the injury that might result from it would be so slight that the development of the vital force, and the administration of the smallest close of another remedy more homoeopathic, would suffice to repair it. § 284. The effects of a dose are by no means diminished in the same proportion as the quantity of the medicinal substance is attenuated in the homoeopathic practice. Eight drops of a tincture taken at once do not produce upon the human body four limes the effect of a dose of two drops ; they merely produce one that is nearly double. In the same manner the single drop of a mixture, composed of one drop of a tincture and ten of a liquid void of all medicinal properties, does not produce ten limes the effect that a drop ten times more attenuated would produce, but merely an effect that is scarcely double. The progression continues according to this law, so that a single drop of a dilution, attenuated in the highest degree, ought, and does in fact, produce a very considerable effect.* * Suppose, for example, that one drop of a mixture containing the tenth of a grain of any medicinal substance produces art effect = a; a drop of another mixture containing merely a hundredth part of a grain of this same substance will only produce an effect= a/2; if it contains a ten thousandth part of a grain of medicine, the effect will be = a/4; if a millionth, it will be = ; and so on progressively, to an equal volume of the doses, the effects of the remedy on the body will merely be diminished about one half each time that the quantity is reduced nine tenths of what it was before. I have often seen a drop of the tincture of Nux vomica at the decillionth degree of dilution, produce exactly half the effect of another at the quintillionth degree, when I administered both one and the other to the same individual, and under the same circumstances. § 285. By diminishing the volume of the dose, the power of it is also diminished—that is to say, when instead of one entire drop of attenuated tincture merely a fraction of this drop be administered,* the object of rendering the effect less powerful. is then very perfectly attained. The reason of this may be easily conceived: the volume of the dose being diminished it must necessarily follow that it will touch a less number of the nerves of the living organism, by contact with which, it is true, the power of the medicine is communicated to the whole body, but it is transmitted in a smaller degree. * The best mode of administration is to make use of small globules of sugar, the size of a mustard seed ; one of these globules having imbibed the medicine, and being introduced into the vehicle, forms a close containing about the three hundredth part of a drop, for three hundred of such globules will imbibe one drop of alcohol ; by placing one of those on the tongue, and not drinking anything after it, the dose is considerably diminished. But if the patient is very sensitive, and it is necessary to employ the smallest dose possible, and attain at the same time the most speedy results, it will be sufficient to let him smell once. (See § 288, note). Summary Notes
§ 286. For the same reason, the effect of a homoeopathic dose is increased when we augment the quantity of the liquid in which it is dissolved to administer it to the patient ; but then the remedy comes in contact with a much more extended surface, and the nerves that feel its effects are far more numerous. Although theorists have asserted that the extension of a medicine in liquid weakens its action, experience proves the reverse, at least as far as regards homoeopathic remedies.* * Only wine and alcohol, which are the most simple of all excitants, lose a portion of their heating and exciting power when they are attenuated in a large quantity of water. Summary Notes
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Guidelines in 5th Edition of Organon of Medicine (1833)All emphasis (bold/italic/underline) and notes by Dr. Manish Bhatia § 246 Fifth Edition On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred 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 shown, under three conditions: firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; and thirdly, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals,1 which experience shall have pronounced to be the best adapted for accelerating the cure to the utmost extent, yet without the vital force, which it is sought to influence to the production of a similar medicinal disease, being able to feel itself excited and roused to adverse reactions. Summary Notes
Footnote to Aph 246 in 5th edition 1 In the former editions of the Organon I have advised that a single dose of a well-selected homoeopathic medicine should always be allowed first fully to expend its action before a new medicine is given or the same one repeated - a doctrine which was the result of the positive experience that neither by a larger dose of the remedy, which may have been well chosen (as has been again recently proposed, but which would be very like a retrograde movement), nor, what amounts to the same thing, by several doses of it given in quick succession, can the greatest possible good be effected in the treatment of diseases, more especially of chronic ones; and the reason of this is, that by such a procedure the vital force dose not quietly adapt itself to the transition from the natural disease to the similar medicinal disease, but is usually so violently excited and disturbed by a larger dose, or by smaller doses of even a homoeopathically chosen remedy given rapidly one after the other, that in most cases its reaction will be anything but salutary and will do more harm than good. As long as no more efficacious mode of proceeding than that then taught by me was discovered, the safe philanthropic maxim of sin non juvat, modo ne noceat, rendered it imperative for the homoeopathic practitioner, for whom the weal of his fellow-creatures was the highest object, to allow, as a general rule in diseases, but a single dose at a time, and that the very smallest, of the carefully selected remedy to act upon the patient and, moreover, to exhaust its action. The very smallest, I repeat, for it holds good and will continue to hold good as a homoeopathic therapeutic maxim not to be refuted by any experience in the world, that the best doses of the properly selected remedy is always the very smallest on in one of the high potencies (X), as well for chronic as for acute as for acute diseases - a truth that is the inestimable property of pure homoeopathy and which as long as allopathy and the new mongrel sect, whose treatment is a mixture of allopathic and homoeopathic processes is not much better continues to gnaw like a cancer at the life of sick human beings, and to ruin them by large and ever larger doses of drugs, will keep pure homoeopathy separated from these spurious arts as by an impassable gulf. On the other hand, however, practice shows us that though a single one of these small doses may suffice to accomplish almost all that it was possible for this medicine to do under the circumstances, in some, and especially in slight cases of disease, particularly in those of young children and very delicate and excitable adults, yet that in many, indeed in most cases, not only of very chronic diseases that have already made great progress and have frequently been aggravated by a previous employment of inappropriate medicines, but also of serious acute diseases, one such smallest dose of medicine in our highly potentized dynamization is evidently insufficient to effect all the curative action that might be expected from that medicine, for it may unquestionably be requisite to administer several of them, in order that the vital force may be pathogenetically altered by them to such a degree and its salutary reaction stimulated to such a height, as to enable it to completely extinguish, by its reaction, the whole of that portion of the original disease that it lay in the power of the well-selected homoeopathic remedy to eradicate; the best chosen medicine in such a small dose, given but once, might certainly be of some service, but would not be nearly sufficient. But the careful homoeopathic physician would not venture soon to repeat the same dose of the same remedy again, as from such a practice he has frequently experienced no advantage, but most frequently, on close observation, decided disadvantage. He generally witnessed aggravation, from even the smallest dose of the most suitable remedy, which he has given one day, when he repeated the next day and the next. Now, in cases where he was convinced of the correctness of his choice of the homoeopathic medicine, in order to obtain more benefit for the patient than he was able to get hitherto from prescribing a single small dose, the idea often naturally struck him to increase the dose, since, for the reason given above, one single dose only should be given; an, for instance, in place of giving a single very minute globule moistened with the medicine in the highest dynamization, to administer six, seven or eight of them at once, and even a half or a whole drop. But the result was almost always less favourable than it should have been; it was often actually unfavourable, often even very bad - an injury that, in a patient so treated, is difficult to repair. The difficulty in this case is not solved by giving, instead, lower dynamizations of the remedy in a large dose. Thus, increasing the strength of the single doses of the homoeopathic medicine with the view of effecting the degree of pathogenic excitation of the vital force necessary to produce satisfactory salutary reaction, fails altogether, as experience teaches, to accomplish the desired object. This vital force is thereby too violent and too suddenly assailed and excited to allow it time to exercise a gradual equable, salutary reaction, to adapt itself to the modification effected in it; hence it strives to repel, as if it were an enemy, the medicine attacking it in excessive force, by means of vomiting, diarrhoea, fever, perspiration, and so forth, and thus in a great measure it diverts and renders nugatory the aim of the incautious physician - little or no good towards curing the disease will be thereby accomplished; on the contrary, the patient will be thereby perceptibly weakened and, for a long time, the administration of even the smallest dose of the same remedy must not be thought of if we would not wish it to injure the patient. But it happens, moreover, that a number of the smallest doses given for the same object in quick succession accumulate in the organism into a kind of excessively large dose, with (a few cases excepted) similar bad results; in this case the vital force, not being able to recover itself betwixt every dose, though it be but small, becomes oppressed and overwhelmed, and thus being incapable of reacting in a salutary manner, it is necessitated passively to allow involuntary the continuance of the over-strong medicinal disease that has thus been forced upon it, just in the same manner as we may every day observe from the allopathic abuse of large cumulative doses of one and the same medicine, to the lasting injury of the patient. Now, therefore, in order, whilst avoiding the erroneous method I have here pointed out, to attain the desired object more certainly than hitherto, and to administer the medicine selected in such a manner that it must exercise all its efficacy without injury to the patient, that it may effect all the good it is capable of performing in a given case of disease, I have lately adopted a particular method. I perceived that, in order to discover this true middle path, we must be guided as well by the nature of the different medicinal substances, as also by the corporeal constitution of the patient and the magnitude of the disease, so that - to give an example from the use of sulphur in chronic (psoric) diseases - the smallest dose of it (tinct, sulph. X°) can seldom be repeated with advantage, seen in the most robust patients and in fully developed psora, oftener than every seven days, a period of time which must be proportionally lengthened when we have to treat weaker and more excitable patients of this kind; in such cases we would do well to give such a dose only every nine, twelve, or fourteen days, and continue to repeat the medicine until it ceases to be of service. We thus find (to abide by the instance of sulphur) that in sporic diseases seldom fewer than four, often however, six, eight and even ten doses (tinct. sulph. X°) are required to be successively administered at these intervals for the complete annihilation of the whole portion of the chronic disease that is eradicated by sulphur - provided always there had been no previous allopathic abuse of sulphur in the case. Thus even a (primary) scabious eruption of recent origin, though it may have spread all over the body, may be perfectly cured, in persons who are not too weakly, by a dose of tinct sulph. X° given every seven days, in the course of from ten to twelve weeks (accordingly with ten or twelve such globules), so that it will seldom be necessary to aid the cure with a few doses of carb. veg. X° (also given at the rate of one dose per week) without the slightest external treatment besides frequent changes of linen and good regimen. When for other serious chronic diseases also we may consider it requisite, as far as we can calculate, to give eight, nine or ten doses of tinct. sulph. (at X°) it is yet more expedient in such cases, instead of giving them in uninterrupted succession, to interpose after every, or every second or third dose, a dose of another medicine, which in this case is next in point of homoeopathic suitableness to sulphur (usually hep. sulph.) and to allow this likewise to act for eight, nine, twelve or fourteen days before again commencing a course of three doses of sulphur. But it not infrequently happens that the vital force refuses to permit several doses of sulphur, even though they may be essential for the cure of the chronic malady and are given at the intervals mentioned above, to act quietly on itself; this refusal it reveals by some, though moderate, sulphur symptoms, which it allows to appear in the patient during the treatment. In such cases it is sometimes advisable to administer a small dose of nux vom. X°, allowing it to act for eight or ten days, in order to dispose the system again to allow succeeding doses of the sulphur to act quietly and effectually upon it. In those cases for which it is adapted, puls. X° is preferable. But the vital force shows the greatest resistance to the salutary action upon itself of the strongly indicated sulphur, and even exhibits manifest aggravation of the chronic disease, though the sulphur be given in the very smallest dose, though only a globule of the size of a mustard seed moistened with tinct. sulph X° be smelt, if the sulphur have formerly (it may be years since) been improperly given allopathically in large doses. This is one lamentable circumstance that renders the best medical treatment of chronic disease almost impossible among the many that the ordinary bungling treatment of chronic diseases by the old school would leave us nothing to do but to deplore, were there not some mode of getting over the difficulty. In such cases
we have only to let the patient smell a single time strongly at
a globule the size of a mustard seed moistened with mercur
metall. X, and allow this olfaction to act for about nine days,
in order to make the vital force again disposed to permit the sulphur
(at least the olfaction of tinct. sulph.
X°) to exercise a beneficial influence on itself - a discovery for
which we are indepted to Dr. Griesselich, of
Summary Notes
Under these conditions, the smallest doses of the best selected homoeopathic medicine may be repeated with the best, often with incredible results, at intervals of fourteen, twelve, ten, eight, seven days, and, where rapidity is requisite, in chronic diseases resembling cases of acute disease, at still shorter intervals, but in acute diseases at very much shorter periods - every twenty - four, twelve, eight, four hours, in the very acutest every hour, up to as often as every five minutes, - in every case in proportion to the more or less rapid course of the diseases and of the action of the medicine employed, as is more distinctly explained in the last note. Summary Notes
§ 248 Fifth Edition The dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy. Summary Notes
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
§ 275 Fifth 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 Fifth 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 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 (allopathic) to the morbid state; for in the former case the so-called homoeopathic aggravation (§§157-160) - that is to say, the very analogous medicinal disease produced by the vital force stirred up by the excessively large dose of medicine, in the parts of the organism that are most suffering and most irritated by the original disease - which medicinal disease, had it been of appropriate intensity, would have gently effected a cure - rises to an injurious height;2 the patient, to be sure, no longer suffers from the original disease, for that has been homoeopathically eradicated, but he suffers all the more from the excessive medicinal disease and from useless exhaustion of his strength. 1 The praise bestowed of late years by some few homoeopathists on the larger doses is owing to this, either that they chose low dynamizations of the medicines to be administered, as I myself used to do twenty years ago, from not knowing any better, or that the medicines selected were not perfectly homoeopathic. 2 See note to §246 § 277 Fifth 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
§ 278 Fifth 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. Pure experiment, careful observation, 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. § 279 Fifth Edition This pure experience shows UNIVERSALLY, that if the disease do not manifestly depend on a considerable deterioration of an important viscus (even though it belong to the chronic and complicated diseases), and if during the treatment all other alien medicinal influences are kept away from the patients, the dose of the homoeopathically selected remedy can never be prepared so small that it shall not be stronger than the natural disease, and shall not be able to overpower, extinguish and cure it, at least in part as long as it is capable of causing some, though but a slight preponderance of its own symptoms over those of the disease resembling it (slight homoeopathic aggravation, (§§ 157-160) immediately after its ingestion. Summary Notes
§ 284 Fifth Edition The action of a dose, moreover, does not diminish in the direct ratio of the quantity of material medicine contained in the dilutions used in homoeopathic practice. Eight drops of the tincture of a medicine to the dose do not produce four times as much effect on the human body as two drops, but only about twice the effect that is produced by two drops to the dose. In like manner, one drop of a mixture of a drop of the tincture with ten drops of some un-medicinal fluid, when taken, will not produce ten times more effect than one drop of mixture ten times more attenuated, but only about (scarcely) twice as strong an effect, and so on, in the same ratio - so that a drop of the lowest dilution must, and really does, display still a very considerable action.1 1 Supposing one drop of a mixture that contains 1/10 of a grain of medicine produces an effect = a; one drop of a more diluted mixture containing 1/100th of a grain of the medicine will only produce an effect = a/2; if it contain 1/10000th of a grain of medicine, about = a/4; if it contain 1/100000000th of a grain of medicine it will produce and effect = a/8; and thus it goes on, the volume of the doses being equal, with every (perhaps more than) quadratic diminution of the quantity of medicine, the action on the human body will be diminished each time to only about one-half. I have very often seen a drop of the decillion-fold dilution of tincture of nux vomica produce pretty nearly just half as much effect as a drop of the quintillion-fold dilution, under the same circumstances and in the same individual. Summary Notes
The diminution of the dose essential for homoeopathic use, will also be promoted by diminishing its volume, so that, if, instead of a drop of a medicinal dilution, we take but quite a small part1 of such a drop for a dose, the object of diminishing the effect still further will be very effectually attained; and that this will be the case may be readily conceived for this reason, because with the smaller volume of the dose but few nerves of the living organism can be touched, whereby the power of the medicine is certainly also communicated to the whole organism, but it is a weaker power. 1 For this purpose it is most convenient to employ fine sugar globules of the size of poppy seeds, one of which imbibed with the medicine and put into the dispensing vehicle constitutes a medicinal dose, which contains about the three hundredth part of a drop, for three hundred such small globules will be adequately moistened by one drop of alcohol. The dose is vastly diminished by laying one such globule alone upon the tongue and giving nothing to drink. If it be necessary, in the case of a very sensitive patient, to employ the smallest possible dose and to bring about the most rapid result, one single olfaction merely will suffice (see note to §288). § 286 Fifth Edition For the same reason the effect of a homoeopathic dose of medicine increases, the greater the quantity of fluid in which it is dissolved when administered to the patient, although the actual amount of medicine it contains remains the same. For in this case, when the medicine is taken, it comes in contact with a much larger surface of sensitive nerves responsive to the medicinal action. Although theorists may imagine there should be a weakening of the action of dose of medicine by its dilution with a large quantity of liquid, experience asserts exactly the opposite, at all events when the medicines are employed homoeopathically.1 1 It is only the most simple of stimulants, wine and alcohol, that have their heating and intoxicating action diminished by dilution with much water. Summary Notes
§ 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
§ 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.
§ 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).
§ 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.
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.
§ 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.
§ 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.
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.
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.
§ 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.
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
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.
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
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