Leela: Hi David, Welcome back! It seems that almost every homeopath with a connection to the internet has read the first part of this interview. I have been reminded again and again how wonderful it was. Someone even called it a homeopathic gift! But I think we’re in for a more significant treat this time!
Isn’t it great that through the internet, homeopathic thought can be moulded to slowly reach a common platform worldwide? Different views are openly discussed in this medium, in terms of what is best for the future development of our system of healing. I realize it has been close to your heart, to help create a generation of homeopaths with a strong foundation in homeopathic principles so that homeopathy can become a clear, complete alternative system for healing people, especially for the poor.
David: The WWW has completely changed my life! In my early years in India I was very isolated from the worldwide homoeopathic community and only interacted with my Indian colleagues. As all my work in India is free, I had to leave my family and go to the West to make any money. I would teach Homoeopathy and osteopathic manipulatory technique (OMT) and Craniosacral therapy (CST) until I saved enough money to fund my clinic and feed my growing family. In the mid 1990s I spent a few years on Maui, Hawaii and went onto the internet to share my experience. This is when I joined the early homeolist when there were only a few hundred people involved. At this time I had written ‘Hahnemann Advanced Methods’, which helped stimulate a resurgence of interest in the Organon and establish serious research with the LM potency.
On my return to India in the late 1990s the WWW finally reach my village area and I was able to get online from India. This changed my life because I was able to keep in touch with the worldwide homoeopathic community without leaving Asia. I set up a website and through my online course I have been able to fund my research and free service as well as take care of my family while living in the remote Himalayan areas. This has been a great blessing to me as it has allowed me to go global while staying at home!
Leela: I completely understand! The internet has been a boon for me as well, enabling me to have an almost full time practice from my home while being available to my three children! I have learnt from homeopaths the world over. All this wasn’t possible even 10 years ago!
David: Yes, the WWW has put me in constant contact with my peers and opened up channels of information never before possible. It has put me in touch with homoeopaths from every continent and many countries. It is a source of classical material and a testing ground for new ideas. It is a wonderful place to share your research because there are a number of persons who show you your mistakes. It helped me learn how to form up ideas and express them in a clear manner. In this way, some of your worst critics become you best allies! I am sure Hahnemann, Boenninghausen and Hering would have loved working on our computers and the worldwide web!
Leela: Yes, they would have totally enjoyed it!
One area we hadn’t brought up earlier was Hahenmann’s perception of miasms and how he developed this concept. Could you talk to us about this?
David: Surely. 1828 was a watershed year for Homoeopathy as it marks the midpoint in Hahnemann’s career. From 1810 to 1828 Homoeopathy was based predominately on the ideas of Simila and individualization with the matching of the symptoms of the individual with the symptoms of the materia medica. As of yet, Hahnemann’s writings on aetiology were based mostly on refuting the allopathic reductionist view of causation. At this time, the Founder emphasized the central role of the totality of the symptoms and the need to assess each and every case on its own merits.
This has led some homoeopaths to claim that one does not need to know anything about causation or the nature and stage of the disease state affecting the patient. They claim that all one needs to look at is the presiding symptoms. This, however, is an over simplification of a much more complex situation. Even in this early period Hahnemann had pointed out the importance of understanding the nature of the disease state and explained that there were specific causations related to infectious miasms. Simply recording the symptoms without understanding their long-term significance is not sufficient when choosing a remedy that is truly curative or managing a case over a long period.
From 1828 to1833 the Founder introduced the most sophisticated causal doctrine in medicine. During this period Hahnemann pointed out that as long as humanity has existed it has been exposed individually and collectively to diseases with moral and physical causes. The idea of “individual and collective” now became central to Hahnemann’s view of disease and treatment. The individual disorders are based on a personal cause or mixed aetiologies that affect the patient in a unique manner. Under these conditions no two persons manifest the exact same symptoms or syndromes.
Leela: What this means is that there are two aspects to understanding disease expression. One is the development of disease in each individual person and second is the similar expression of disease in certain groups of people which are collective in nature.
David: Yes, collective disorders are based on diseases of a common cause and similar symptoms that affect a homogeneous group. The collective disorders found in Hahnemann’s writings include traumas, environmental induced disorders, endemic nutritional diseases and infectious miasms of a fixed character. Hahnemann found that his ideas of Simila and individualization were not complete without an understanding of diseases of common causes and collective miasms which must be studied by taking a group case. This was the number one reason for Hahnemann’s failure to cure the chronic miasms with early Homoeopathy and why he wrote the Chronic Diseases which integrated the collective anamnesis in the 5th and 6th Organon. Collective disorders are rarely consistently cured by individual remedies unless by good fortune rather than science and logic.
Leela: Hmm, expecting just the constitutional remedy to cure the miasmatic tendency would be a simplistic method of understanding and treating miasms, and not what Hahnemann perceived them to be.
David: Our constitutional remedies are miasmic and multimiasmic remedies. This means that in many cases they are capable of curing miasms as part of the overall constitutional picture. There are cases, however, where a specific miasm poses an obstacle to the cure by such means. In these cases one must study the symptoms from the miasmic perspective and utilize anti-miasmic treatment. This means one needs to do a differential diagnosis of these symptoms. If the symptoms of the patient are expressed in a unique constitutional portrait I use the constitutional remedy first. If the symptoms are expressed in terms of the collective characteristics of a miasm I use the anti-miasmic remedy first.
If one is using the constitutional remedy first and the case seems to move forward but then the remedy stops acting it may be a sign that the patient needs a chronic intercurrent remedy which might be an anti-miasmic remedy from the plant, mineral or animal world or nosode of the offending miasma. Such a remedy either moves the case forward or resensitizes the patient so that the constitutional remedy starts acting well again. Sometimes one may have tried several remedies that seem well selected but they will not work until the underlying miasm is treated. One should understand that not all cases can be approached in the exact same manner and be flexible in their clinical methods.
Hahnemann clearly pointed out that miasms were based on the inherited and acquired effects of infection. His detailed study includes observations of predisposition, heredity, susceptibility, the moment of infection, the prodromal stage, the primary stage, latent stage and secondary stage. This makes Hahnemann the Father of modern epidemiology! He presented the most detailed study, of what are now called auto-immune diseases and immuno-deficiency disorders, ever written. Many degenerative diseases like multiple sclerosis and rheumatoid arthritis, allergies, asthma, etc., are now considered autoimmune disorders. Immuno-deficiency is thought to play a serious role in cancer and AIDS. Most of these disorders are considered incurable by allopathy. What is incredible is that Hahnemann’s teachings are much more expanded than their modern counterpart in these disorders and even provide effective remedies for curing these states.
Leela: I fully agree! It’s the hope we offer our patients with so-called “incurable diseases”. But I do know that among us homeopaths there is a great deal of confusion in perceiving miasms. What has been your impression in this regard?
David: Today there are some who do not understand what Hahnemann meant by miasms in his original context. Some believe that miasms are everything BUT the inherited and acquired affects of infections. One very well known teacher explained during a seminar how a child had contracted a “miasm” from watching too much television! Others have spiritualized the miasms to the point that they have very little to do with day to day clinical realities. It is interesting to speak of a “moral decline” and a “fall from grace” but how can we forget how to treat soft tissue infections, Tb and venereal diseases?
Others have gone so far to say that what Hahnemann called miasms “don’t even exist”. I wonder if they think that acute infectious diseases like typhoid, cholera and ebola and chronic infections like malaria, leprosy, tuberculous, gonorrhea, syphilis and AIDS are figments of the imagination? These infectious diseases still kill millions of people and their negative effects are passed down through the generations. This is a medically verified fact.
Leela: Isn’t it amazing that Modern Medicine with its detailed documentation of infectious diseases and their effects has verified the concept of inherited Miasmatic traits and tendencies? What lead Hahnemann towards fully developing this concept?
David: Hahnemann published his early research in these areas in 1817 when he began his study of psora, which reached its completion in 1828. The is no greater place to assess the difference between Hahnemann’s early concepts and mature Homoeopathy than a study of aphorism 5, 6 and 7 of the 1st through 4th Organon when compared with aphorism 5, 6 and 7 of the 5th and 6th editions. Unlike early Homoeopathy, Hahnemann’s advanced system involves a deep study of Causa, co-incidental befallments, miasms as well as the symptoms and their attendant circumstances. These 3 paragraphs represent the advances made in the Chronic Diseases in a nutshell. The motto of the Chronic Diseases is Cessanto Causa – Cessant Effectus, which means if the cause ceases the effects ceases. Without rooting out the cause there will be no end to the symptoms in the long run.
In the early Organon treatment may have been the simple matching of the presiding symptoms of the patient to the symptoms of the materia medica. But now the practitioner has to assess every significant event of the complete case history. This includes a study of the exciting and fundamental causes, the chronic miasms as well as attendant circumstances like the condition of the physical constitution, the character of the intellect and emotional disposition, personal and social relationships, the occupation factors, habits, life style, aging factors, sexuality, etc. On this basis, one has to assess the nature of the signs, befallments and symptoms of the body and soul as all these present the only conceivable Gestalt of the disease.
Leela: How is this interpreted in clinical terms?
David: In individual disease one uses the personal anamnesis to find the personal remedy. In collective diseases one uses the group anamnesis to find specifics for a homogenous group. Examples of personal medicines include the constitutional remedy while the group remedies include specific anti-miasmic medicines. These collective remedies include the acute and chronic genus epidemicus remedies discovered by a collective study based on the symptom expression in many patients. This is because one patient alone cannot offer the complete portrait of a collective disease. The idea of group specifics may also be applied to physical and mental traumas, group poisonings, collective environmental induced diseases and endemic nutritional disorders. It can even be applied to “group hysteria, war fever and mass psychosis”. The idea of individual and collective mental and physical causes has yet to be given the full study it deserves. This is one of the most important aspects of Hahnemann’s advanced methods.
Leela: Certainly makes a lot of sense!
Earlier we had discussed about your investigation into various potency scales, and how Hahenamnn developed in his thought and application of posology with every edition of the Organon. Do tell us a little more about your clinical trials with various potencies.
David: The first phase of my clinical trial was to experiment with the medicinal solution of the C potency and the ideas expressed in aphorisms 246 and 247 of the 5th Organon. In aphorism 246 Hahnemann says that whenever a remedy causes a “perceptively progressive and strikingly increasing amelioration” the remedy should not be repeated. This is similar but not the same as what he said in the 4th Organon as there is added emphasis on the words progressive and increasing. If one gives a single test dose and the reaction is an observable, progressive, strikingly increasing amelioration there is no need to repeat the remedy because the remedy is already moving toward cure in the fastest possible manner.
This is because the repetition of the remedy under these conditions may cause aggravations and relapses that only slow down the cure. This is the best case scenario, but unfortunately, it does not take place all the time. In many cases the patient only responds to the remedy with slow or little improvement. By the rules of the 4th Organon and the dry dose, one still cannot repeat the remedy until the duration of its action ceases and there is a relapse of symptoms.
Leela: How did Hahenmann decide to overcome a delayed or poor reaction to the first dose?
David: In aphorism 246 of the 5th Organon Hahnemann offers a method that covers those cases in which there is a poor to moderate response to the single dose. The Founder noted that when there is only slow improvement in which it might take 40, 50 or even 100 days to cure the patient this period can be speeded up to 1/2, 1/4 or less the time of the single dose. This can be accomplished by following three conditions, i.e. the remedy is perfectly homoeopathic, it is given in a small dose, and the medicine is repeated at suitable intervals to speed the cure. In the footnote to this aphorism Hahnemann makes it clear that under these conditions the remedy may be repeated before the duration of the former dose ceases.
In aphorism 286 and 287 he makes it clear that the best way to prepare the dose for administration is to dissolve it in water and give the patient a small portion of the aqueous solution. Therefore, the teaching of the 1830s recommends the single dose wait and watch method in cases where there is a strikingly increasing amelioration, while the repetition of the remedy at suitable intervals is to speed the cure of slow moving cases.
Leela: So Hahnemann did not completely do away with the single dose or the dry dose, but instead suggested how one could be flexible in posology and repetition based on clinical response.
David: That’s right. There are those who only think in terms of the single dose and those who think only in terms of repeating remedies. What Hahnemann offered was a flexible posology system that teaches one when it is best to use the single dose and when it is best to repeat the remedy at suitable intervals to speed the cure. This is a middle path posology method that represents the best of both worlds as it transcends the exclusive single dose method and the mechanical repetition of the remedy. I have found Hahnemann’s altered methods to be the single most significant changes made in the 1830s.
As I mentioned the last time, I decided I should do an extensive clinical trial in which I would use the methods of the 5th Organon (1833), the Paris edition Chronic Diseases (1837) and the 6th Organon (c. 1842-43) and compare them with the methods of the 4th Organon (1829) and first edition of the Chronic Diseases (1828).
When one adds the full medicinal solution and split-doses presented in the 1837 Paris edition of the Chronic Diseases, the advanced posology system is complete. By this time the Paris casebooks show Hahnemann using a remedy bottle and dilution glass to prepare the dose for the patient. No longer was one tied to the dry single dose and waiting for the duration of the action of the remedy to cease no matter whether the progress was fast or slow. Now one could adjust their posology and case management strategies according to the action of the remedy on the patient. There is little doubt that this method does speed the cure of protracted cases greatly and lowers the number and strength of aggravations that slow down the cure. At present, there are many practitioners that have yet to take advantage of this aspect of Hahnemann’s advanced methods.
Leela: Could you tell us briefly your clinical observations following this trial?
David: One of the first things I noted was that I saw fewer aggravations than with the dry dose and those that did appear were much easier to manage. I think this is because of using a significantly smaller dose and succussing the remedy bottle so the patient never received the exact same potency twice in succession. Of course, if one gives doses of the medicinal solution when not necessary, it will cause aggravations but if used prudently one can avoid unnecessary aggravations.
When I was using the exclusive dry dose, I found that there were a number of cases that either did not improve or only seem to slowly ameliorate over a longer period of time. By the rules of the 4th Organon one should not repeat the remedy until relapse even if they were hardly getting better. I found that if one carefully repeated the split-doses of the medicinal solution on these patients, the time of cure was greatly speeded. Instead of waiting and watching these slow moving cases I found that observing closely and acting worked much faster!
I also found in chronic diseases that sometimes the remedy no longer seems to work as well as it did in the beginning of the treatment. It was as if the vital force was getting used to the medicine and it no longer acted even when the remedy still seemed well indicated. This would have led me to changing the medicine before it was really necessary and moving away from a perfectly good remedy. But when one understands the method of adjusting the dose and potency, the remedy can be given in a variety of ways which causes the remedy to act as it did at the beginning of the case! This is very important in chronic cases with degenerative pathology which require treatment over a longer period of time. This combination of less aggravation and speedier cures makes the time needed to learn a more sophisticated posology and case management method well worth the effort. The only way this can be done is to test these methods in the clinic over a sufficient amount of time and gain personal experience.
Leela: Yes, I’ve always believed that we need to keenly observe reactions to potencies and interpret remedy reactions at an early stage to speed up the cure. What was your experience with the LM potencies?
David: After experimenting with Hahnemann’s new methods for the C potencies I decided it was time for me to test the mysterious LM potency. The essence of aphorisms 246 and 247 of the 5th Organon are integrated into paragraph 246 of the 6th Organon. Once again Hahnemann states that in observably progressive and strikingly increasing ameliorations the remedy should not be repeated. He notes, however, that in chronic diseases it is rare for a single dose to perform a complete cure in such a dramatic fashion.
He explains that one may speed the cure of slow moving chronic cases if the remedy is perfectly homoeopathic, highly potentized, dissolved in water, given in a small dose, and the remedy bottle is succussed prior to administration so that the patient never receives the exact same potency twice in succession.
I immediately found that the LM potency acted quite differently than the C potencies. In fact, I believe that their medicinal powers are complementary opposites that greatly enhance the therapeutic range of Homoeopathy. This is because some cases do better on the C potencies and some cases do better on the LM potency and some seem to need both at different times. There is little doubt that it is better to walk on two legs rather than one! At last I felt like I had finally learned my basics properly and could proceed to grow as a good homoeopath on a solid foundation.
Leela: I think we’re all getting some idea of what it takes to be an accomplished homeopath… 😉
David: The next important step was obtaining the microfiches of the Paris casebooks. Once again my wife came to my aid as she reads French very well and was capable of doing high quality translations of Hahnemann’s case history records. This helped advance my understanding of the 6th Organon because it provides a record of how Hahnemann actually gave the C and LM potency in medicinal solution in his last years. When this material is combined with the eye witness account of Reverend Everest and Dr. Croserio it fills in the details presented in the 6th Organon and provides new information not found in the text.
Too many persons are spreading the idea that the LM potency can be given daily in a mechanical fashion for weeks, months and years on end. This is not what Hahnemann taught in the Organon neither is it found in the Paris casebooks. In the footnote to aphorism 246 Hahnemann says the LM potency may be given daily “when necessary” not all the time. When the daily dose repetition is “not necessary” it will either cause aggravations, relapses or slow down the cure.
Leela: This means that unnecessary repetition of LM doses can actually spoil a case! One has to be vigilant in managing those dosage repetitions as much as any other potency scale.
David: That’s right. The Paris casebooks show that the Founder either gave single doses usually by olfaction followed by 7 days of placebo or a short series of 3 to 7 split-doses and had the patient come back in one week. At this time he would reassess his case and decide whether to continue the remedy or stop the medicine and give placebos. Hahnemann never gave the daily or alternate day dose for very long without stopping the remedy and giving placebos for a period of one, two even three weeks or more.
Leela: I’m glad you mentioned Hahenmann’s use of Placebo. Somehow homeopaths have forgotten the use placebo dosing. Or else it seems to be shrouded in doubt, or there is a sense of not being ethical! In India, it continues to remain the most effective dosage treatment – the placebo for intervals of time, while waiting for cure.
David: Hahnemann used placebos for a number of reasons. His patient’s were so used to taking medicine every day that he used placebos to pacify them and keep them away from taking other medicines. In general, I like to educate my patients so they understand that they do not always need medicine every day. I save my placebos for the moments that I really need them. This could be during an aggravation or crisis where the patient really thinks they need medicine but I know the symptoms are going to pass off soon. Hahnemann’s method was to assess the action of his remedy and then decide whether to put the patient on placebo or continue to give the medicine. Dr. Croserio told Boenninghausen that anytime Hahnemann saw definite medicinal actions he would either slow down the dose or stop the medicine and give placebos. This fact is confirmed by the Paris casebooks because they show that Hahnemann used almost as much placebo as medicine whether using the C or LM potency. These are very important details not contained in the 6th Organon. The idea that the Founder gave the daily dose to all his patients for weeks, months and years is a complete myth.
Leela: So some of us have a lot of unlearning to do, followed by good re-learning! I know this is also something that concerns you – the state of contemporary homeopathic education and subsequently homeopathic practice in the word today.
David: New students need to be taught the correct foundation right from the start. They need to be taught the full range of the traditional methods and study the repertory and materia medica carefully. There are no shortcuts or new methods that replace the need to understand the teachings of Hahnemann, Boenninghausen, Hering, Jahr, Kent, Boger and others. Old students like myself need to keep a beginner’s mind and combine openness with the wisdom of age. We all need to keep growing and not become complacent with what already feels comfortable. I know homoeopaths who are practicing the exact same posology and case management methods they did 20 years ago. This is not the way forward.
What I found from my research was that most contemporary homoeopaths were only practicing a small portion of the material Hahnemann introduced. This was not only in the region of posology and case management but also in many other areas of practice. To give you an idea of how insufficient is the teaching available today, let me mention a few areas:
- Hahnemann spoke about the chief remedy, the acute intercurrent, the anti-miasmic remedy, the chronic intercurrent and the preventative medicine.
- Hahnemann spoke about single remedies, alternations, rotations, tandem remedies and a series of medicines when needed.
- Hahnemann spoke about susceptibility, constitution, temperament, hereditary predispositions, inherited miasms and the power of environmental factors.
- Hahnemann spoke about individual causes, collective causes, exciting causes, maintaining causes and fundamental causes.
- Hahnemann spoke about acute miasms, half-acute miasms and chronic miasms.
- Hahnemann spoke about objective signs, coincidental befallments and objective symptoms as well as attending circumstances like the condition of the physical constitution, the mental and emotional character, lifestyle, habits, social and domestic relationships as well as aging factors, sex and sexuality.
- Hahnemann spoke about mental disorders, philosophical counseling and homeopathic psychology.
- Hahnemann spoke about massage, hydrotherapy, minerals, magnets, electricity and Mesmerism.
Are we teaching all these subjects in our schools, societies and colleges? I am sorry to say that we are not. These are part of what I call the “lost teachings of Samuel Hahnemann”. This has to change.
Leela: David, we’re indeed privileged that you have written your 6 Volume book on homeopathy. EVERY homeopath ought to get a copy of it so that they have an in-depth understanding of these varied aspects of homeopathic practice along with appropriate references. This will definitely give some guideline to homeopathic schools as well, on how much a homeopath requires to be educated about, at the foundation level. I am grateful that we were taught most of this at homeopathic medical college in Mumbai.
The only other multi-volume set I have encountered that has dealt with almost the entire range of philosophy and clinical homeopathy are the Symposium Volumes of the Dhawle’s Institute of Clinical Research, Mumbai.
David: It concerns me that too many of today’s practitioners are not learning the fundamentals of Hahnemannian Homoeopathy before taking up new experimental modern methods. I take quite a bit of “flack” for referring to the teachings of Samuel Hahnemann and requesting people to review his works in their original paradigm more closely. Sometimes, I tire of having to deal with charges that my work is “religion” or “fundamentalism”, etc. Some persons seem to imagine that I only read material from the 19th century! This, of course, is not true. I am a modernizer but I don’t reject the traditional material. I use the classics as a basis of my studies. I am working to make Homoeopathy the medicine of the future but I keep my feet well planted in the past.
There are some persons who do not understand my motives or reasons for emphasizing the Organon, Chronic Diseases and the Lesser Writings of Hahnemann. Why do I do this? I do this because it is my duty to humanity to spread the foundational teachings of Homeopathy because too much of this material is being overlooked or misunderstood. I am just keen to make sure that we all know our basics so we all have a strong foundation to build on as we gain experience.
Leela: Actually my perception is that it requires courage to take a global stand. I think it was time someone emphasized the necessity to remain firmly rooted in tradition so as to make even better use of some of the brilliant modern ideas available today. Especially in our Internet Age where the world has become a global village and we are more easily exposed to a variety of ideas.
David: When I began this campaign on the WWW around a decade ago, too much of this material was being ignored and many were only practicing a watered down, simplified version of homeopathy. Some people say “you only need to record the symptoms -nothing else matters”. How simplistic! Is this really what Hahnemann taught? In aphorism 6 Hahnemann wrote that all the perceptible symptoms experienced by the patient, reported by friends and relatives and observed by the homeopath make up the “only conceivable Gestalt of the disease“. Then in aphorism 7 Hahnemann says:
“Therefore, it must be the symptoms alone by which the disease demands and can point to the appropriate medicine for its relief, along with regard for contingent miasms and with attention to the attendant circumstances (Aph. 5)“.
It is very important to note that Hahnemann speaks of the symptoms, miasms and attendant circumstances and then refers to aphorism 5. This aphorism teaches the importance of examining the complete case history, exciting and fundamental causes, constitution, temperament, lifestyles, habits, personal and social relationships, occupation, age, sex, etc. Added to this are similar statements about the need to understand the cause, symptoms and circumstances in aphorisms18 and 24. Hahnemann continues:
“The totality of the symptoms is the outwardly reflected image of the inner wesen [essence, nature, being] of the disease, that is, of the suffering of the life force.”
One cannot see the mistuning of the invisible vital force but one can witness its derangement by the essential nature of the totality of the signs, befallments and symptoms of the body and soul. These perceptible signs make up the total display of the disease-Gestalt. The essential nature of the totality of the symptoms expresses the true Esse in Hahnemannian Homoeopathy.
Leela: Isn’t in interesting that Hahnemann always referred to the body and soul as one unit in disease? It is essential to accurately analyze the outward expression of the vital force – the symptoms of disease. If we don’t start here, one would end up choosing remedies on misconceived notions of central “images” and “patterns” of the mental state that have no objective (physical) proof of expression.
David: Yes, there has been much talk about the mind only approach, the essence, the core delusion, the vital sensation, the central disturbance, the grand theme of the remedy, etc. Such ideas are helpful in focusing on what is important in a case but when carried too far become a form of “homeopathic reductionism” that clouds the nature of the totality of the symptoms and leaves behind the Gestalt of the disease in which the whole is more than the sum of its parts. This can lead to a one-sided over simplification in which the true Esse represented by the Gestalt-Qualities of the disease are replaced by stereotypical keynotes.