Proper dosing strategies, as per Hahnemann, is something that most of us are in the dark about. How people are dosing is generally something they’re making up as they go along or something they’re picking up casually at case conferences. I often get clients from other homeopaths, who had the right remedy, but just couldn’t keep the case moving because of bizarre dosing strategies that have no reflection in classical homeopathy at all!
Words in brackets [ ] represent my summary of The Organon’s sometimes exasperating run-on sentences! Though this doesn’t speak to every question or cover every contingency in a case, we should at least know this much. Here is Hahnemann’s Organon of the Medical Art:
§ 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.
[A striking improvement precludes further dosing! Stop dosing! For the love of God, STOP DOSING!!!!! If you’ve taken a remedy and you feel better…. wait! The improvement continues, you don’t need to keep dosing. If a patient has made noticeable improvement after a dose of a remedy, stop giving it for as long as the improvement lasts! The remedy continues to work on its own! Listen people, our remedies are double-edged swords: If you’re sick, the remedy will heal you; if you’re well, the remedy will CAUSE what it formerly healed! That’s why once you are feeling better, you have to STOP DOSING! But if you should relapse, then you are justified in taking it again.]
This is not infrequently the case in acute diseases
[especially if you’re dealing with an acute disease]
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.
[In a chronic case, however, a single dose may cure in a month to three months’ time.]
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.
[While a single dose may cure a patient with chronic disease in one to three months, this is entirely too slow. A patient is entitled to expect a cure in much less time.]
And this may be very happily affected, as recent and oft-repeated observations have taught me under the following conditions
[Here’s how I’ve learned to cure more rapidly]:
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. Find the right remedy. 2. It should be “highly potentized”. 3. It should be in water–a bottle of water. 4. Give a suitable small dose at intervals that experience has taught you makes the most sense for the fastest cure but with this advisory: you can’t give the exact same dose over and over again, each dose must differ somewhat from the one before so you don’t arouse the vital force to untoward reactions, which always happens when you give the exact same dose over and over again (and when you give doses in too rapid succession.]
There is just one warning I have about the video I posted above: the homeopath is not using disposable cups and plastic spoons. This is a mistake, so, don’t you do it! Don’t use the good glassware, the good china; buy plastic bottles, plastic spoons, straws, cups, etc. A dose is a sip or a swallow from the bottle–at “intervals” but not so frequently that you cause an aggravation, and make sure the dose itself isn’t so large in size that it, too, causes an aggravation. Base your repetitions on what the previous dose achieved–if there was a perceptible improvement, no repetition is necessary! If there was an aggravation, an improvement may follow so, wait until you see where the case is going to land before dosing again. We will talk about succussion later.]
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).
[Since writing the 5th ed. of the Organon, I have found a way to greatly diminish aggravations, I’ve got a new perfected method now. We start with the lower degrees of potency for one or 2 weeks in chronic disease and gradually go up in potency at one to two week intervals.]
§ 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).
[Don’t give repeated dry doses! (That means, don’t dose with the pellets over and over again.)]
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
[Your immune system, or “vital force”, doesn’t accept unchanged, unaltered doses! Giving the exact same dose of a remedy or medicine over and over again can cause “provings” or aggravations.]
, 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.
[Hahnemann is saying that if you give unchanged, unaltered doses over and over again–as in giving remedies in pellet-form over and over again, or giving remedies in water, unsuccussed and/or unstirred over and over again, you will wind up with an aggravation or a “proving”. “Proving” means taking on the symptoms of the remedy; for example, poison ivy is known for an “itchy rash”. If you mindlessly repeat homeopathic poison ivy (Rhus tox) over and over again, you could find yourself with such a rash! We’d call this a Rhus tox proving. This is why Hahnemann is so adamant about people learning to dose safely and properly. He doesn’t want these “untoward” reactions to occur.
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)
[But if you alter the dose slightly each time–by making the potency somewhat higher–you can prevent these untoward reactions!]
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.
[We cannot allow the patient to take a second or third dose of a dry pellet, even if the first pellet worked really well! Why? It’s the exact same potency! He does not want exact same potencies repeated!]
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.
[Similarly, we can’t let the patient have subsequent sips of remedy water, from a bottle that has been left standing, undisturbed, even if the first sip worked really great; it’s the same thing, the same principle; namely, repeated, unaltered doses lead to untoward reactions!]
But through modification of every dose in its dynamization 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.
[But if you can change the potency before each dose, “there will be no offence”. It appears absolutely essential to continually alter the potency before each dose in order to “extract the disorder” from the patient.]
§ 248 Sixth Edition
For this purpose, we potentize anew the medicinal solution1 (with perhaps 8, 10, 12 succussions) from which we give the patient one or (increasingly) several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener.
[For the purpose of curing, and protecting the patient from aggravations and provings, we have to potentize anew before each dose. How do we do that? By succussing the bottle! Your remedy has to be in water. A half-filled bottle of water, with one or two pellets dropped in. That’s your Remedy Solution Bottle. Hahnemann says to succuss this bottle 8, 10 or 12 times before each dose (a dose is a teaspoon, or, as time goes on, increasing the number of teaspoons to “several”) daily, or every other day; but in acute diseases, every 2 to 6 hours and in really urgent cases, every hour or even oftener. Note: he seems to be implying, that as you go forward, your remedy needs to get stronger and stronger and the size of your dose needs to get larger and larger.]
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.
[He’s saying, in chronic disease, the daily–if needed– dosing in the lower potencies, in water, with succussions before each dose, with the potency raised weekly or every other week, is the most efficacious way to treat disease. Notice what he’s not saying. Nowhere does he say, Give one dose of a high potency and just wait. He said he used to say that! But he doesn’t believe that anymore.]
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.
[He’s saying here, when you finish your bottle in roughly one to two weeks, and you still need the same remedy, go to the next potency. You can do that by starting a new Remedy Solution bottle (get rid of the old bottle) with new (one or several) pellets from the next potency (for example, if you were taking a 6C, you can order the 9C and 12C and be ready to make a new water bottle with the higher potency when the previous bottle is finished.) Or, you can simply raise the potency by yourself just by refilling your empty bottle half-way with water, and succussing 40 times. That will bring your 6C up to a 7C. You can keep going in this manner unless new symptoms break out.]
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.
[When new symptoms appear in the case, stop the remedy; a new remedy that matches these new symptoms may be needed at this time.]
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.
[When the remedy is no longer needed, an “aggravation” might occur. It might look like the original symptoms are coming back! This is your cue to stop dosing and watch and see what happens. If health is evident after the aggravation wears off, the remedy is no longer needed.]
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.
[Hahnemann assures us that this “aggravation” at the end of treatment will soon disappear if we stop dosing, leaving only health in its wake. He then talks about dosing by olfaction–sniffing the bottle. Even in olfaction, you have to succuss the bottle before each dose; and, the bottle has to contain a certain amount of alcohol, like brandy, and he’s talking about a dram vial, a much smaller bottle than your Remedy Solution Bottle.]
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)
[He’s talking here about how to prepare the olfaction bottle, that it must contain alcohol or charcoal in order to preserve it. However, the charcoal sounds like a hassle since it has to be taken out before succussion. He says it’s rarely necessary to use more than one pellet when you’re putting the remedy into a water bottle.]
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.
Going to the first cup, going to the second cup, etc. for patients who are hyper-sensitive to the remedy. When your patient is hypersensitive, succuss your bottle, pour a tsp. from the bottle into a plastic cup of water, stir and then give a tsp. dose. That’s a dose from “the first cup”. If even this dose aggravates, take a tsp. from the first cup, and add it to a second cup, stir, and give a dose from the second cup. Again, this is demonstrated in the video below:
There’s no limit to the number of cups a hypersensitive person may need to go to in order to keep from aggravating. But you know what? I have a much easier way of doing this! Fill up a cup with cold water from the sink, add a drop or so from your remedy solution bottle to the cup. (Succuss your bottle first, of course.) Now, with the cold water on, dump the cup out and refill 6 times, now, take a small sip. This is how you have to dose with sensitive patients. And P.S., your sensitive patient who aggravates all the time might need only 2 succussions before each dose, and the size of the dose might have to be only one or two drops.]
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.
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
[An aggravation that is considerable must be antidoted! Don’t tell your patient, “You just have to wait it out!” or, as I’ve heard, “Push through it!”]
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
See my FAQ article and scroll down to “How To Stop An Aggravation”.
[Back to Hahnemann: If the aggravation isn’t bad, but consists of symptoms that aren’t similar to the case but are new and troublesome, give a better-selected remedy to replace it right away!]
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.
[Hahnemann says, first of all, no dose should be thought of as being too small to get a reaction from the patient. Secondly, he warns: Don’t repeat the remedy during an aggravation!!!!!]
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.
[The homeopath won’t find himself scrambling around in crisis looking for antidotes if he would only start the case with the smallest, lowest appropriate dose.]
Like minute doses of a better chosen remedy will re-establish order throughout.
When … it is evident, in urgent cases after the lapse of only six, eight or twelve hours, that [the practitioner] has made a bad selection in the medicine last given, in that the patient’s state is growing perceptibly, however slightly, worse from hour to hour, by the occurrence of new symptoms and sufferings, it is not only allowable for him, but it is his duty to remedy his mistake, by the selection and administration of a homoeopathic medicine not merely tolerably suitable, but the most appropriate possible for the existing state of the disease (§ 167).
[If the homeopath has made the patient worse in an urgent case by his selected remedy, he has to do something about it, he can’t just let this downward turn go on unabated. He has to give an appropriate remedy to stop the decline.]
Notice that Hahnemann doesn’t give any specific instructions like, “Start with 6C,” or “Treat acutes with 30C.” What he says is, if you read carefully: give the suitable dose: the proper dose that experience has taught is the most suitable. He can’t know what your patient needs! Every case is different. But what he’s doing here is giving you a framework:
1/ He has left the idea of one-dose-high-and-wait, behind! We’ve picked this up from Kent, I gather, because it’s known as “Kentian Prescribing”, but Kent didn’t read the 6th ed. of The Organon! Hahnemann was not satisfied with the weeks and months that this method was taking. He said a patient deserved to get better a lot faster. So he found out that if you gave a lower potency, you could give it daily or perhaps every other day, but it would have to be in water, with 8, 10 or 12 succussions before each dose, which would move the case along faster without risking ruining it with aggravations and provings.
2/ He said that when your bottle gets nearly empty, after about a week, go to the next higher potency, which you can do by adding more water to the half-way mark and succussing 40 times. DO NOT ADD MORE PELLETS just because you’re adding more water! Why the half-way mark? Because you cannot succuss a full bottle! He’s saying that as you go forward, your remedy bottle should be getting stronger and stronger and the size of your dose should be getting larger and larger.
3/ Stop dosing during an aggravation!
4/ A striking improvement means stop dosing for as long as the improvement lasts.
5/ New symptoms in a case: stop the remedy and represcribe to match the new symptoms! What does this remind you of? It sounds like a patient on constitutional treatment who suddenly gets an acute–stop the chronic remedy and take the case of the acute! Should a person be taking his constitutional remedy during an acute? Probably not! I say “probably” because, maybe you’re a constitutional Arsenicum with an Arsenicum flu! Then maybe you need to stop your daily Arsenicum 6C and take a dose of Arsenicum 200C for your flu. If at the end of your acute case, you’re still in your chronic state, then go back to your previous dosing schedule with Arsenicum 6C.
6/ Correct your mistakes! If you caused an aggravation, antidote it. If your remedy isn’t working and the patient is getting worse, represcribe!
OK, I think that’s it.
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online cases. Write to her at [email protected]
Visit her website: https://ElaineLewis.hpathy.com