Part 8: The Single Remedy and Polypharmacy
One of the fundamental aspects of Dr. Hahnemann’s criticisms of the allopaths was that they practised polypharmacy, that is, the use of more than one remedy at one time with the patient.
Medicine in his day was one of accumulated authority and academic theories, with little or no real observation as to the actual nature of disease and little or no true knowledge as to the curative powers of medicines. The practice at the time was largely one of prescribing set mixtures according to various theories and in large doses.
There were sweetening medicines, diluting and dissolving ones, coagulating, blood-cleansing, cooling, evacuating, phlegm-secreting ones, etc. To prescribe one medicine alone never occurred to anyone and would not have satisfied anyone. After an old custom every medicine prescribed for the patient had to consist of a basis, a constructive part (the constituens), a supporting part (adjuvans) and a taste-improving part (the corrigers), to which Hahnemann ironically proposed to add a “dirigens.” (Haehl, Vol. I, p. 306)
Hahnemann realised that this practice of mixtures could never lead to any true knowledge of the curative power of medicines. His initial work on reform of medicine was a clarion call to create a true materia medica, Essay on a New Principle for Ascertaining the Curative Powers of Drugs (1796). Here Hahnemann reviews the various ways in which one could discover the curative power of a substance, including chemistry and botany, but concludes that this cannot furnish anything other than a partial understanding at best.
What is needed is to test each substance on a healthy person, as testing on sick persons would mix the disease process with the effects of the medicine on the patient, leaving the physician no wiser as to the action of the medicine. He does not disparage the discovery of curative remedies through clinical work, as this can reveal the specific remedy in cases of diseases of constant nature (Wesen), but he does not see this as a very effective means of discovery for the many diseases of changing nature, which are more numerous.
Nothing remains for us but experiment on the human body. But what kind of experiment? Accidental or methodical?
I have no intention of denying the high value of this [accidental, empirical] mode of discovering medicinal powers – it speaks for itself. …Will the chance of such discoveries suffice to perfect the healing art, to supply its numerous desiderata? From year to year we become acquainted with new diseases, with new phases and new complications of diseases …what we imagine, or what appear to us to be, similar diseased states. But how often shall we fail in accomplishing our object, for if there be any difference, the disease cannot be the same! Sadly we look forward into future ages, when a peculiar remedy for this particular form of disease, for this particular circumstance, may, perhaps, be discovered by chance, as was bark for pure intermittent fever, or mercury for syphilitic disorders.
Such a precarious construction of the most important science – resembling the concourse of Epicurean atoms to make a world – could never be the will of the wise and most bountiful Preserver of mankind. (Lesser Writings, p. 258-259)
Nothing then remains but to test the medicines we wish to investigate on the human body itself. (Lesser Writings, p. 263) [italics and brackets added]
Hahnemann also condemned the use of large doses of crude drugs, realising from his knowledge of chemistry that these substances mingle and mix in a way that is completely unpredictable. This is unlike the potentised medicines that do not obey such chemical laws, but are more akin to radio waves that can mingle in the air without cross interference.
Thus, Hahnemann came to strongly condemn the practice of established mixtures of medicines in crude dose for presumed similar diseases, or for presumed partial roles in the treatment of a presumed single disease.
I have no hesitation in asserting that whenever two medicines are mingled together, they almost never produce each its own action of the system, but one almost always different from the action of both separately – an intermediate action, a neutral action, – if I may be allowed to borrow the expression from chemical language.
… Formerly I was infected with this fever; the schools had infected me…
Are we in earnest with our art?
Then let us make a brotherly compact, and all agree to give but one single simple remedy at a time, for every single disease, without making much alteration in the mode of life of our patients (Lesser Writings, p. 320)
Dare I confess, that for many years I have never prescribed anything but a single dose until the action of the former one had ceased… (Lesser Writings, p. 321)
And thus, as though they were independent beings endowed with free volition, each ingredient in a complete prescription has its task allotted to it [by the doctor]… For there are many learned considerations in a regular classical prescription. This indication and that one must be fulfilled; three, four and more symptoms must be met by as many different remedies. Consider, Arcesilas! how many remedies must be artistically combined in order to make the attack at once from all points. Something for the tendency to vomit, something else for the diarrhoea, something else for the evening fever and night-sweats, and as the patient is so weak, tonic medicines must be added, and not one alone, but several, in order that what the one cannot do (which we don’t know) the other may.
But what if all the symptoms proceeded from one cause, as is almost always the case, and there were one single drug that would meet all these symptoms? (Lesser Writings, p. 349) [italics added]
From this beginning, the need to have accurate knowledge of the curative action of medicines in true diseases (not fragments of one, or false diseases that are but conditions arising from several diseases) became the lodestar of Hahnemann’s system. Already in 1805, in the Medicine of Experience, the prescursor of the Organon of 1810, he writes:
The knowledge of diseases, the knowledge of remedies, and the knowledge of their employment, constitute medicine. [viz.§3]. (Lesser Writings, p. 439)
While Hahnemann did accept, as we have seen, the validity of clinical knowledge, in the case of diseases of constant Wesen (tonic side) to find the specific remedy, as the cause would normally be known (e.g., exposure to measles), he realised that the specific remedy for the variable, individual (pathic) diseases could only really be found through an analysis of the symptoms. In addition, he had not yet fully comprehended the principles underlying the tonic side, through its various dimensions. Accordingly, he attempted to find the specific remedy for the as yet undiscovered specifics for already known tonic diseases (e.g., Scarlet Fever), as well as for newly discovered tonic diseases, through the symptoms as well (e.g., Sulphur for Psora).
What we come to see here, as did Hahnemann, is that disease is a phenomenon that is a unity. This unity cannot be broken down into separate, abstract parts (the false unity of the materialists), or a unity that somehow exists outside the parts (the false unity of the vitalists). It is an emergent unity that can be approached either directly, through the phenomenon itself, using our organs of supersensible knowledge (Geistes– und Gemüths-Organe) or indirectly through the meaningful parts (characteristic symptoms).
Thus, there can be only one remedy per disease. Polypharmacy is the giving of more than one remedy for a given disease.
To prescribe a mixture of medicines as was done by the allopaths was false, according to Hahnemann, because it was based on no true knowledge of disease and no true knowledge of the medicines used. Without both, there could only be blind empiricism (simply prescribing for effect), or the breaking up of the unity of the disease being treated on arbitrary grounds, such that each part of the medicinal recipe was to treat a supposed part of the disease.
Let us look at what Hahnemann states regarding this matter in the final edition of the Organon.
§273.1. In no case of cure is it necessary, and on this account alone even admissible, to employ more than a single, simple medicinal substance at one time with a patient.
§273.2. It is inconceivable how it could be subject to the least doubt as to whether it be more in accordance with nature and more reasonable to prescribe only a single, simple well-known medicinal substance at one time per disease, or a mixture of several different ones.
§273.3. In Homeopathy, the only true and simple Remedial Art in accordance with nature, it is absolutely prohibited to administer two different medicinal substances at one time to the patient.
§273 was wholly re-written for the 6th Edition. Hahnemann here combined §272 and 273 from the 5th Edition and added a third sentence. He also eliminated the footnote he had added to §272 in the 5th Edition to caution against, for political reasons, the use of two remedies “at the same or almost at the same time.”
Hahnemann gives us in this sentence a time reference “at a time” (auf einmal). Time is a very concrete term, more so in German than English. Time exists in units depending on the circumstances. Time, in living organisms, is a function of the life energy. Time can be slow or fast depending on the organism and its functions. We know that time passes very slowly for children and much more quickly for adults. Veterinarians know that time goes more quickly for animals and that they seem to be able to take remedies more quickly, that is, within a shorter time frame. We have also seen that the duration of the action of a remedy is dependent on the disease and the dose, the smaller doses having a shorter action and the action being shorter in the more intense diseases, particularly as regards the initial action.
So, we need to understand what unit of time Hahnemann is referring to here. The use of auf (upon) is the clue. If we look elsewhere in the Organon for a similar reference, we find §63, which speaks of the initial action of the remedy.
|§63.1.||Jede auf das Leben einwirkende Potenz, jede Arznei, stimmt die Lebenskraft mehr oder|
|Each upon the Life in-working Potence, each medicine, tunes the Living Power more or|
|weniger um, und erregt eine gewisse Befindens-VerÃ¤nderung im Menschen auf lÃ¤ngere oder|
|less, around and arouses a certain condition-alteration in the human for a longer or|
|§63.1. Each Life-impinging Potence, each medicine, re-sonifies the Living Power more or less and arouses a certain alteration of condition in man for a longer or shorter time.|
|§63.2.||Man benennt sie mit dem Namen: Erstwirkung.|
|One names it with the name: first-working.|
|§63.2. One designates it by the name of initial-action.|
The measure of time Hahnemann is speaking of is, thus, the time of the initial-action of the remedy on the Living Power. This is consistent with Hahnemann’s own continued use of two remedies in one day in protracted and chronic diseases, or even acute situations, wherein the full action of the remedy would not yet have been completed before the giving of the second remedy or the second dose.
Now let’s look at the next sentence which links time with the disease(s) to be treated:
|§273.2.||Es ist nicht einzusehen, wie es nur dem mindesten Zweifel unterworfen seyn koenne,|
|It is not realizable, how it even to the least doubt subjected be could,|
|ob es naturgemÃ¤ÃŸer und vernünftiger sey, nur einen einzelnen, einfachen,|
|whether it more in accord with nature and more reasonable be, only a single, simple,|
|wohl gekannten Arzneistoff auf einmal in einer Krankheit zu verordnen, oder ein Gemisch von|
|well kenned medicinal stuff at one time in a disease to prescribe, or a mixture of|
|several, different ones.|
|§273.2. It is inconceivable how it could be subject to the least doubt as to whether it be more in accordance with nature and more reasonable to prescribe only a single, simple well-known medicinal substance at one time per disease, or a mixture of several different ones.|
Thus, Hahnemann has here laid down the rule that derives from his previous practice and insight, namely that two remedies, each for a different disease should not be prescribed within the initial action one of the other. When we examine the history and issue of dose and potency, we shall see that the duration of the initial action compresses exponentially as the potency increases by degrees, such that in potencies above 30C, the action is almost instantaneous.
Glossary Contribution 9:
Single Remedy: a specific remedy for a given disease (medicinal remedy) or a given imbalance (regimenal remedy) that is prescribed according to the appropriate law of remediation (disease – law of similar resonance; imbalance – law of opposites). There can only be one specific remedy (whether simple or complex in nature, such as Kali-p or Aur-m-n) for a specific disease or imbalance. There can be only one medicine or dose taken at a time, namely that there can not be a second medicine given within the initial action of the first medicine, the duration of the initial action being determined by the crude or dynamic nature of the dose given – high potencies, those generally past Avogadro’s constant, having almost instantaneous action and cessation of initial action.
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Rudi Verspoor is Dean and Chair Department of Philosophy Hahnemann College for Heilkunst, Ottawa. He served as the Director of the British Institute of Homeopathy Canada from 1993 to early 2001 and helped to found and is still active in the National United Professional Association of Trained Homeopaths (NUPATH) and the Canadian/International Heilkunst Association (C/IHA).
Part of his time is spent advising the Canadian government on health-care policy and in working for greater acceptance of and access to homeopathy. His publications include:
Homeopathy Renewed, A Sequential Approach to the Treatment of Chronic Illness (with Patty Smith);
A Time for Healing; Homeopathy Re-examined: Beyond the Classical Paradigm (with Steven Decker);
The Dynamic Legacy: Hahnemann from Homeopathy to Heilkunst (with Steven Decker).
Visit his website at http://www.heilkunst.com/