| The Limitations
of the Dry Dose
The next major renovations in the practice of Hahnemannian Homoeopathy
appear in the second part of the 1837 edition of The Chronic
Diseases in the article called Concerning the Technical
Part of Homoeopathy. This is a very valuable article as it
acts as the technical complement to the methods he introduced in
the 1833 edition of the 5th Organon.
Hahnemann intended that the various editions of Organon
and The Chronic Diseases should be read together as they
form a complete picture of the latest developments in Homoeopathy.
These techniques not only brought the centesimal system of Homoeopathy
closer to perfection, but also pointed out the direction it would
be taking in the future. In the 1837 commentary Hahnemann begins
by assessing his experience of the dosing procedures that he used
during the late 1820s and shares the outcome of his latest research
in Homoeopathy.
He says:
"Since I last addressed the public
concerning our healing art I have had among other things also
the opportunity to gain experience as to the best possible mode
of administering the dose of the medicines to the patients, and
I herewith communicate what I have found best in this respect.
A small pellet of one of the highest dynamizations
of a medicine laid dry upon the tongue, or the moderate smelling
of an open vial where one or more such pellets are contained proves
itself the smallest and weakest dose with shortest period of duration
of its effects."
Due to the great diversity of age, predispositions, sensitivities,
physical constitutions, mental temperaments, reserves of vital powers,
and environmental factors, etc., a homoeopath needs a flexible dosage
system that allows for the adjustment of the remedy for each individual
case. This is something that the medicinal solution supplies.
Vide Concerning the Technical Part of Homoeopathy.
"Nevertheless the incredible variety
among patients as to their sensitivity, their age, their spiritual
and bodily development, their vital powers, and especially in
the nature of their disease necessitates a great variety in their
treatment, and also in the administration to them of the doses
of medicine."
The
best way to adjust each individual dose of a remedy to the sensitivity
of the individual constitution is to use the medicinal solution.
This is because the aqueous solution is far more flexible than the
dosage of the dry pills.
Also of great importance is the following revelation that tells
us why the untimely repetition of an unadjusted dose causes complications
and explains the reason homoeopaths disagree so much about the repetition
of doses.
"Before proceeding, it is important
to observe, that our vital principle cannot bear well 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 never
before been present in the disease appear, impeding the cure.
Thus even a well selected homoeopathic
medicine produces ill effects and attains its purpose imperfectly
or not at all. Thence come the many contradictions of homoeopathic
physicians with respect to the repetition of doses."
The fact that the vital force cannot adapt to the repetition of
an unadjusted dose is the conclusion of around 40 years of experimentation
and should not be taken lightly. In the 6th Organon, Hahnemann
adds that even with the perfect remedy it is unwise "to let
the patient have a second or third dose taken dry."
The production of these side-effects is the main reason why repeating
remedies before the relapse of symptoms is contraindicated in the
Homoeopathy of the 4th Organon. The use of the medicinal
solution overcomes this problem because it can be adjusted with
succussions so that the patient never receives the exact same potency
twice.
Vide Concerning the Technical Part of Homoeopathy
"But in taking one and the same medicine
repeatedly (which is indispensable to secure the cure of a serious
chronic disease) if the dose in every case is 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 the briefest 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 solutions of
one or more pellets is merely well shaken five or six times."
The single unit dose is considered by many to be the only pure
form of Classical Homoeopathy as they are only familiar with the
4th Organon "wait and watch" method.
By 1833 the founder of Homoeopathy was using the remedy solution
in a split dose so he could repeat a homoeopathic medicine whenever
he felt it was necessary. Homoeopathy as commonly practiced has
not progressed past the techniques Hahnemann introduced between
1828 and 1829 although his more progressive techniques were published
in the 5th Organon in 1833 and The Chronic Diseases
in 1837.
The Use of the Medicinal Solution
Hahnemann often communicated his new techniques privately with
some of his most respected students before he made them public.
One year before the publication of the 1837 edition of The Chronic
Diseases, Hahnemann wrote a letter to Constantine Hering in
which he gave detailed instructions of the latest techniques relating
to the medicinal solutions. He gave the following advice to his
life long friend.
This is recorded in Bradford's Life and Letters of Hahnemann,
page 367.
"I have made some improvements in
the technicalities of our art, which I will now first communicate
to you.....Now, as my medicines are very powerful, I seldom
dissolve more than one globule in 7, 15, 20, 30, tablespoons of
water [DL], and, because the patient has no distilled water
(which, besides, after a few days becomes spoilt and ferments),
I employ for this purpose spring or river water mixed with 1-15th
or 1-20th part of spirits of wine or I put three or four small
pieces of hard wood charcoal into the solution.
This mixture, (of which the patient affected
with a chronic malady takes a tablespoon or 1, 2 or 3 teaspoons
[DL] every day, or every other day, is to be shaken in the
bottle five or six times every dose taken, in order to change
the degree of dynamization each time. [DL]"
This is the first document we have that Hahnemann gives the full
details of the split dose and medicinal solution. Hahnemann suggested
that the medicinal solution be preserved with 1-15th or 1-20th parts
of spirits of wine. Where alcohol was unsuitable Hahnemann used
three of four small pieces of hard wood charcoal instead.
He was witnessed later in his career putting 1 teaspoon of alcohol
into 4 oz. of water as a preservative. We find that in environments
that tend toward easy spoilage, up to 1/3 of the solution must be
preserved with brandy.
In Hahnemann's letter to Hering he mentions the proper amount of
the solution to be given to the patient varies from 1, 2 or 3 teaspoons,
depending on the sensitivity of the constitution, age, nature of
the disease, etc.
In the following year of 1837 Hahnemann released to the public
the conclusion of his experiments with the technical methods of
giving the homoeopathic dose. In this article he also gives the
advice about the repetition of the remedies in acute and chronic
diseases.
Vide Concerning the Technical Part of Homoeopathy
"Experience has shown me, as it has
no doubt also shown to most of my followers that it is most useful
in diseases of any magnitude (not excepting even the most acute,
and still more so in the half-acute, in the tedious and most tedious)
to give to the patient the powerful homoeopathic pellet or
pellets only in solution, and this solution in divided doses
[DL].
In this way we give the medicine, dissolved
in seven to twenty tablespoons of water without any addition,
in acute and very acute diseases every hour or every half hour,
a tablespoon at a time, with weak persons or children, only a
small part of a tablespoon (one or two teaspoons or coffee spoonfuls)
may be given as a dose.
In chronic diseases I have found it best
to give a dose (e. g., a spoonful) of a solution of the suitable
remedy at least every two days, more usually every day."
Hahnemann had experimented with the use of the homoeopathic remedies
in water ever since the early provings of homoeopathic remedies
in 1813. He used the water dose as one of his techniques of controlling
the toxicity and power of the remedies during the provings. The
new split-dose is succussed just before each dose is ingested to
raise the potency in an upward direction.
By replacing the single unit dose with the new split-dose it became
possible to use one pill several times! This apparent contradiction
is resolved by the fact that the remedy solution is made with only
one #10 pill that is dissolved into several liquid portions that
are used repeatedly.
For this reason Hahnemann called his new technique the "split-dose"
method instead of a "multi-dose" method, as in this sense
it is a still only one dose (i.e., one pill).
Hahnemann realized early on that too many doses of the dry pills
accumulated until they produced troublesome aggravations. Even though
the patient may be taking the solution more times they are still
receiving a smaller amount than they would if they repeated a dry
dose even once. This is a very subtle aspect of the theory of the
minimal dose that took Hahnemann many years to fully understand.
Preparing and Administering the Medicinal
Solution
The preparation of the remedy solution for the centesimal potencies
can be summarized in 7 easy steps.
1. Take a 6 to 8 oz. bottle and drop in one, rarely
two, # 10 pills of the chosen remedy. Hahnemann suggested that the
size of the medicinal solution could vary from 3.5 to 4 oz. (7 to
8 tablespoons) up to 20 ounces (4O tablespoons) of water mixed with
brandy. I usually use between 4 to 6 oz. of liquid in my medicinal
solutions. I use slightly larger bottles because this leaves enough
space to produce good succussions. When speaking of succussing to
make potencies Hahnemann suggested leaving up to 1/3 of the vial
empty. The larger medicinal solutions (8 oz., 12 oz., etc.) are
only necessary when one is treating a hypersensitive, as the larger
amount of water makes the dose act more gently.
2. Add enough water mixed with brandy to fill
the bottle up to 2/3 to 3/4 full with liquid. A sufficient amount
of brandy or pure alcohol, as a preservative, should be included
in the solution. If the solution is to be used over a long period
of time mix 30% to 50% brandy with the water used in the solution.
A lesser amount of ever-clear would do the job.
3. The bottle is to be succussed just prior to
ingestion in order to activate the remedy and slightly raise the
potency. The number of succussions greatly affects the action of
the remedy on the vital force. For those who are hypersensitive
1, 2, or 3 succussions is usually enough. Those of an average sensitivity
more normally need 4, 5, 6 or 7 succussions. Those who have rather
low sensitivity may need 8, 9, 10, 11, 12 or more succussions. It
is best to start with a lower number of succussions and increase
the amount if and when necessary. Succussions are one of the methods
of adjusting the dose.
4. In this article Hahnemann suggests that 1,
2, or 3 teaspoons of the medicinal solution should be given to the
client depending on their sensitivity. Children are given 1/2 teaspoon.
Infants should receive 1/4 teaspoon or less depending on their age.
Most adults do quite well starting out with 1 teaspoon. The size
of the dose can be gradually increased if more reaction is needed.
A constitution of a lower sensitivity might need 2 or 3 teaspoons
before they will react sufficiently to the remedy.
Hahnemann's Paris casebooks demonstrate that the old master later
preferred to use a medicinal solution and a dilution glass to further
attenuate his dose. 1, 2, or 3 teaspoons of the medicinal solution
are stirred into 4 oz. of water and 1, 2, or 3 teaspoons are given
to the patient as a dose. Hahnemann gave his centesimal potencies
for the most part in the exact same manner as his LM potencies.
The dose can also be adjusted by the amount of the remedy given.
5. The dose should be adjusted through a series
of dilution glasses when treating a hypersensitive, an elderly person,
severe pathological tissue changes, allergies or any dangerous condition.
Succuss the remedy bottle with a conservative number of succussions
and take one teaspoon and stir it into the first dilution glass.
From this glass take a teaspoon and stir it into a second dilution
glass and from this a dose is given to the client.
An extreme hypersensitive may need the remedy diluted through 2
or 3 such dilution glasses. In this case a teaspoon or less is taken
from the first glass and stirred into a second or third glass. These
individuals are normally almost impossible to treat with Homoeopathy
but adjusting the dose in this manner brings them great relief.
6. Give the client one test dose and wait and
watch for a reasonable amount of time to see how the remedy reacts.
This time period depends somewhat on the timeline of the disease
you intend to treat. Acute and chronic diseases each have their
own peculiar nature. If there is a striking response and a dramatic
improvement let the single dose act without interference. If there
is only a slow or moderate improvement the dose may be repeated
at proper intervals to speed the cure.
7. If the remedy produces any aggravation it is
best to wait and watch for the expected amelioration. If the remedy
is going to be given again it must be adjusted in a downward direction.
This means one could use a lower potency, less succussions, a smaller
dose, one or more dilution glasses, or give only one dose or repeat
the remedy at longer intervals. The homoeopath can use one or more
of these techniques as needed. These are examples of how to adjust
the dose in a downward direction.
Of course, all the normal precautions should be taken and the client
asked not to eat or drink 1/2 hour before and after taking the remedy.
These are the basic instructions on how to prepare and administer
the liquid dose.
It may take some time to learn how to adjust the dose to fit the
sensitivity of the individual as well as to match the nature of
the disease to be treated. This comes with time and experience.
Some may ask why go through all the trouble to use the medicinal
solutions? The answer is quite simple. Do you want to treat the
most chronically ill and the most hypersensitive persons? Do you
want to speed the time of cure to 1/2, 1/4 or less the time it takes
with the dry dose? Do you want to use Hahnemann's most advanced
methods and walk in his footsteps?
If you do, then a little more effort on your part is well worth
while. |