Aggravation as a sign of cure: aphorism 280 in practice
The first time I came to know my brother was when I was 4.5 years old and I held him a day after he was born. The second time I came to know him was 22 years later when we agreed that I would treat him with homeopathy. My brother then was an average height, dark haired, blue eyed, fair skinned young man with a full dark beard and… angry looking red and purple acne. Although he was generally friendly with outsiders, at home he would have his spells of irritability. One Christmas during my second year as a homeopathy student, the acne had become so bad that it had spread to his scalp. The itching prevented him from sleeping and he was irritable and tired all the time but refused to see a homeopath, doctor, or dermatologist despite my parents’ pleading. I could see the desperation in my mother’s eyes that communicated: “How will he ever get a job? A girlfriend?”. He agreed to a therapeutic prescription “just to try”, so I gave him Sulphur 12c and Graphites 12c each in a bottle of water to be taken by the plussing method. Both remedies covered the itching and the big infected boils on his scalp. He quickly felt better but soon relapsed and he then, irritable as he still was, did not want to try anything else. He did not want anything to do with homeopathy anymore, or me for that matter.
The following summer, the heat and perspiration made the skin even worse. He had started losing hair due to the boils and desperation had kicked in with him too, as the itching and pain were so intolerable at night that he could hardly lie on a pillow. Because I had heard in my student clinic that Sulphur often aggravates skin symptoms while Natrium-Muriaticum in those instances cure, I made a second attempt to offer my help. In the mean time he had warmed up to homeopathy as remedies had done wonders for his sporting injuries and he now said he was willing to try anything to alleviate the problem.
I washed and cleaned the wounds and infections on his scalp while tears rolled down my cheeks seeing how he must have been suffering. I had to be ever so gentle as the littlest touch was immensely painful although he put on a brave face. There was almost no clear skin and there were boils on top of boils, oozing a sticky yellow discharge. After an hour of cleaning, I gave him Natrium-Muriaticum 1M.
We homeopaths do not always have the luxury of repertorising a case and we prescribe on “hear-say” or a gut feeling because it feels better than not doing anything at all. But after this bold prescription of course I read up on Natrium-Muriaticum while keeping my fingers crossed hoping to find any justification for it. As I read my materia media I saw the remedy picture in a different light than before and recognized my brother in it entirely. Although the skin appeared “angry” and very Sulphur-like, I knew my brother as generally showing very little emotion apart from the occasional irritability. Often in discussions he would say “ I no longer want to talk about it” or he would walk away. He even said to have no particular feeling about the way the acne made him look, although it did prevent him from getting a haircut! I remembered him as a 10-year old when our dad announced he was going to leave us. My brother just shook my dad’s hand and thanked him for telling us. Not once did he cry, although he often had tummy aches and hyperventilated now and then, revealing that it affected him much more deeply than it appeared to. Even now he was still generally happiest when he was alone. Not that he avoided people, but he genuinely liked his own company. There was also a sensitivity to him; he loved animals and nature, had immense patience with elderly people, volunteered every year as a guide on trips for handicapped people, and could not – and still cannot – get enough of music…. any music. Natrium-Muriaticum turned out not to be the wildest prescription after all.
Giving him a 1M in retrospect was, well, let’s call it brave. However, it was intentional; if he had aggravated on 12c the year before, I did not want to risk that again and followed Hahneman’s principle of the minimum dose (§160, Brewster-O’Reilly 1996). Not without result! My brother noticed improvement already on the second day after taking the remedy. Unfortunately the symptoms worsened again after a week, so I suggested he repeat it. We did this about 4 or 5 times. Every time the itching subsided and the eruptions dried up but after 5-6 days the itching would return followed by new eruptions. Despite the relapses, after 6 weeks of repetition the skin had cleared up 30% and the itching was almost non-existent. This was of course wonderful, but my worry was that the remedy did not seem to hold and I wondered if the remedy was perhaps only a partial one (Vithoulkas 1981). I tried to get more symptoms but when I asked if he had any worries or fears he responded with “No” which could either be due to his Natrium-Muriaticum state or the fact of course that I am his sister. He did tell me though that he had been suffering from frequent diarrhea for a long time which appeared to be triggered when getting chilled. I could still see the Sulphur picture I had seen the Christmas before, especially because of the marked itching and because he was generally quite hot, but I was apprehensive to go there again.
This time I repertorised. Lo and behold, Natrium-Muriaticum came up highest followed by Phosphorus and Sulphur. Because this well indicated remedy relapsed I considered miasmatic blocks (Sycosis?) and the possible need for bowel nosodes, especially because of the recurring diarrhea (Saxton 2008; Watson 2010). I also wondered if the relapsing of the remedy was actually an indication of the remedy needed. For example Carcinosin is bold-type in “Clinical, homeopathic, remedies, reactions to oversensitive to, overacts, without curing” (Murphy 2005; Vermeulen 2002). Carcinosin also seemed to suit the remarkable lack of expressed emotions in this case.
However, I’m a big fan of keeping things simple and I was not convinced we were so to say done with the remedy, after all, it had helped. Considering the apparent need for repetition but me fearing the 12c, I thought it may be safer to try LM potencies. As I read up on the fifty-millesimal potencies I came to learn that these are less likely to aggravate skin disorders, can be repeated for months, and according to Barker (1997) are suitable in cases of suppression where centesimal potencies do not always seem to touch on this. So I let my brother take Natrium-Muriaticum LM1, twice daily, two drops, with only one bash of the bottle per administration… just to make sure his vital force was not over stimulated.
Very quickly he had the same response as with the 1M however… without relapse! He continued improvement on LM1 and LM2. Not only the skin improved, but he seemed to become a different person. He admitted to feeling much better in himself and he picked up his interest in cooking, even visiting our mother to cook for her. He would write both my mother and me paragraphs in e-mails and texts instead of the usual one-word messages and he would be on the phone with me for several hours and show an interest in my life. He was no longer just my brother who was there for family occasions and with whom I shared my childhood and the same sense of humor, I was finding a friend in him!
A cloud seemed to appear over the case when after about 2.5 months the skin symptoms returned. I was confused for a moment and wondered if the remedy had indeed been no more than palliation but doubted that, considering the almost miraculous changes on the mental and emotional planes. Then I remembered what Hahnemann wrote about the fifty-millesimal potencies:
“…However, when medicines of longer duration of action have to combat an old or very old wasting sickness, no such apparent heightenings of the original disease should show themselves during the course of treatment; and they will not show themselves if the aptly selected medicine is administered in properly small, only gradually heightened doses which become somewhat modified every time by new dynamization. Such heightenings of the original symptoms of the chronic disease can then only come to light at the end of such treatments when the cure is almost or entirely completed.”
(Brewster-O’Reilly 1996; §161)
“One should continue giving gradually heightened doses of the persistently serviceable medicine that engenders no new troublesome symptoms until the patient with general improvement of condition begins to sense anew, in a moderate degree, one or more of his old, original ailments” (Brewster-O’Reilly 1996; §280)
Indeed Natrium-Muriaticum had proved beneficial in this case, and the doses were raised continually with the succussions. And now the old complaint seemed to return.
“This renewal of old ailments indicates:
- The patient is near cure due to the moderate doses that have, each time, been gradually heightened by means of succussion.
- Namely, the life principle almost no longer needs to be affected by the similar medicinal disease in order to lose the feeling for the natural disease.
- The life principle, now freer from the natural disease, is beginning to suffer somewhat from the homeopathic medicinal disease which is otherwise called a homeopathic aggravation”
(Brewster-O’Reilly 1996; §280)
In other words, according to Hahnemann, cure with LM’s occurs if after general improvement, there is a return of the original symptoms because the patient is in essence proving the remedy. In §281 he says this is confirmed if the remedy is stopped for 8-15 days and the complaint subsides again. My brother and I so decided that he would stop the remedy, and within 24 hours he noticed the new boils going down and the itching subsiding, just as when he had started the remedy.
This case is beautiful evidence of both aphorisms 161 and 280. Indeed he improved on LM1 and LM2, aggravated after 2.5 months but then improved again when he stopped the remedy, suggesting that cure had taken place and he started to prove the remedy. This phenomenon is quite unique as most patients stop using the remedy when they feel better and therefore never come to that point of aggravation (Barker 1997).
After waiting two weeks, the skin was still well but the diarrhea had worsened and I felt he needed another remedy. He said that he in fact used to have diarrhea daily with rectal bleeding. The latter had stopped and the preceding now only occurred every two days, but further improvement had stopped a while ago. It would still come on suddenly when he was chilled and the worst for him was that when it came on, he could not stop it. Very inconvenient for anyone, but especially for a young man that uses public transport all the time to attend appointments, classes, work and sports trainings. He said he even started wearing more layers, making sure his back and stomach were covered and that he had stopped walking around without socks to reduce the episodes, despite him still feeling warm. In our phone conversation, more than before I felt like he was reading out the Sulphur picture from a materia medica book instead of telling me about himself! I asked him again about fears and he – now more open to share – said that of course he had fears. He thought for a moment and then said: “Basically all of them have to do with survival”. My ears almost fell off my head when I heard this but I managed to sort of try to be the unpredjudiced observer and asked him to expand on that. He explained that he worried about having work or a house in the future, that he likes to read articles from “preppers”, people that prepare for disasters…and that he would even like to prepare a backpack as well in case something terrible happened. I explained to him how his picture suited the psoric miasm and Sulphur as a leading psoric remedy so well and we laughed how well it fit (Watson 2009). Because I remembered him as a little boy playing happily with toys in the bath I joked and said: “Too bad you don’t hate bathing”. To which he replied: “Are you kidding me? I HATE it with a passion! I always have to force myself to shower, brush my teeth and clean up after myself!”.
This time in repertorising Sulphur “won” against Natrium-Muriatium, as was to be expected from the key symptoms that my brother volunteered in that conversation. Since starting Sulphur LM1 the frequency and intensity of the diarrhea have reduced. After about a month the old skin symptoms returned again but subsided after stopping the remedy for a few days. Because the diarrhea was not gone completely and Sulphur was still indicated I gave Morgan Bach 30c as an intercurrent daily for a week (Saxton 2008). After this he continued with the same bottle of Sulphur LM1, which now, a month later he is still improving on. This case had proceeded over the course of 1.5 years. Till the next cure aggravation?
Barker, R., ed., 1997. LM Potencies. Third edition. Norfolk: The Homeopathic Supply Company.
Brewster O’Reilly, W., ed., 1996. Organon of the Medical Art. By: S. Hahnemann. Third edition. Palo Alto: Birdcage Books.
Murphy, R., 2005. Homeopathic Clinical Repertory. Third edition. Blacksburg: R.R. Donnelley and Sons.
Saxton, J., 2008. Bowel Nosodes in Homeopathic Practice. Glasgodw: Saltire Books Ltd.
Vithoulkas, G., 1981. The Science of Homeopathy. New York: Grove Press.
Watson, I., 2004. A Guide to the Methodologies of Homeopathy. Devon: Cutting Edge Publications.
Watson, I., 2009. The Homeopathic Miasms: A Modern View. Devon: Cutting Edge Publications.
Vermeulen, F., 2004. Prisma: The Arcana of Materia Medica Illuminated. Third edition. Haarlem: Emryss bv Publishers.