After establishing the basic principles of homeopathy and whilst gaining practical experience, Hahnemann constantly worked on perfecting the application methods to avoid aggravations and to provide a rapid, gentle and permanent cure. Based on his practical experience Hahnemann argued, that:
“The suitableness of a medicine for any given case of disease does not depend on its accurate homeopathic selection alone, but likewise on the proper size, or rather smallness, of the dose.” (§275 Organon)
Aggravation means the increase of intensity or degree of suffering. Each aggravation of symptoms or the appearance of new symptoms, when nothing untoward has occurred in the mental or physical regimen, invariably proves the unsuitability of the given medicine, either the remedy itself or its potency or dose.
Modalities are circumstances that modify a particular or general symptom, either appearing artificially induced during provings, or as experienced by the patient suffering from the natural disease. Modalities can make a symptom better or worse.
Each remedy has its own mode of action and acts best under certain conditions. Thus, modalities belong to the distinguishing features that help differentiating remedies. Especially, if they are strange, rare or peculiar they highly individualize a case and assist in choosing the homeopathic remedy.
Boenninghausen attached special importance to the completeness of symptoms, for which modalities are considered the most valuable features, followed by sensation and location. Concomitant symptoms, which may constitute of modalities, also represent important differentiating factors according to Boenninghausen.
Modalities can be classified as physical, temperature, time, climate, dietary modalities, localized modalities (lateralities) and miscellaneous modalities.
Similar, homeopathic aggravation
Guided by the Law of Similars homeopaths search for the remedy that is most similar to the patient’s totality of characteristic symptoms. Applied, this remedy induces an artificial disease, which, when somewhat stronger than the natural disease, replaces the natural disease and initiates cure.
A similar aggravation occurs when the original symptoms of the patient increase temporarily at the beginning of treatment. This is a sign that the remedy is correct but that the potency was too high, or the dose too large or repeated too frequently.
The similar aggravation is caused by the primary action of the remedy and displays the artificial, medicinal disease, which exceeds the natural disease in strength. As the dose of a homeopathic remedy can scarcely ever be made so small that it shall not be able to overpower the disease it is understandable why a homeopathic aggravation may occur at the beginning of treatment. (§160 Organon) However, the smaller the dose of the accurately chosen homeopathic remedy the more salutary its gentle remedial effect and the slighter and shorter the apparent increase of the disease symptoms. (§157,159, 277 Organon)
In the sixth edition of the Organon Hahnemann limited the homeopathic aggravation to the first or first few hours in acute diseases. It usually occurs immediately after ingestion for the first hour, or for a few hours, when the dose has not been sufficiently small, and for a considerable number of hours when the dose has been somewhat too large. (§160 Organon)
In chronic diseases, however, and with the application of Hahnemann’s advanced methods as described in the sixth edition of the Organon, an intensification of the original symptoms shall only appear at the end of treatment, when cure is almost finished – provided the accurately chosen remedy was given in gradually increased potency and properly small and modified doses. (§ 161 Organon) When cure is almost finished the vital force does not need further medicine to continue its curative reaction. If further medicine is applied, the symptoms of the medicine are called into play. However, if the first dose causes a homeopathic aggravation in chronic diseases, and in the same way every repeated, modified dose, this indicates that the dose was too large. (§ 282 Organon)
An aggravation caused by the smallest possible dose will be easily overcome by the vital force and does not prevent cure. It is often not perceptible in patients unless they are oversensitive. (§156, 283 Organon)
A homeopathic aggravation is often appreciated by the homeopath, especially the forth or fifth Organon prescribers, as indicating that the chosen remedy is correct and working. However, an aggravation is neither necessary to know that the remedy works, nor for cure. Any aggravation delays or might even prevent cure if the primary action of the remedy is too strong and suppresses the secondary, curative response of the vital force. Hahnemann just wrote, that a slight homeopathic aggravation is a very good prognostic that the acute disease will most probably yield to the first dose! (§ 158 Organon)
The intensity and duration of the similar aggravation gives us a clue about the correctness of the chosen remedy, the patient’s vital force, prognosis, and for case management.
- A quick and short similar aggravation followed by improvement indicates that the remedy was chosen correctly. Improvement will be long lasting. The patient has a strong vitality and good reactive power. Organic changes are unlikely or only present in non-vital organs. The case is curable, the prognosis is very good.
- A long continued aggravation but eventual and slowly progressing improvement indicates that the patient is on the borderline of incurability. The vital force is struggling to start a secondary curative reaction. Pathology is likely to be present. Prognosis is uncertain. The patient may recover if treated properly and the vital force strong enough to initiate and maintain the healing process.
- A prolonged aggravation and slow decline either indicates the incurability of the case due to irreversible organic pathology and a too weak vital force, and/or, that the vital force has been overwhelmed by a too high potency or dose and is unable to start a healing reaction.
- Hypersensitive patients may react to and aggravate on every remedy. High potencies are to be avoided.
As it is almost impossible that the symptoms of the remedy and the symptoms of the patient’s disease cover each other exactly, “there is hardly any homeopathic medicine, which during it‘s action does not bring about some very slight unaccustomed complaint or small new symptom”. (§156 Organon)
Accessory symptoms of the correctly chosen remedy may also appear when the dose was too large, the remedy repeated too frequently, and/or the potency too high, so that medicinal symptoms of the remedy which were not experienced before, are displayed. This may especially appear in oversensitive patients who prove remedies easily.
If the accessory symptoms are troublesome, the remedy will not be capable of effecting real improvement. (§249 Organon) A medicine, although homeopathic to the case, does harm in every dose that is too large. The greater its homeopathicity the greater the harm of the remedy in too large doses as the patient‘s susceptibility is increased. The danger lies in establishing an artificial, medicinal disease with new and more severe symptoms, without extinguishing the old, natural disease.
What are we to do?
- If the aggravation is trifling or not dangerous the action of the medicine should not be interrupted. Wait till the aggravation wears off and amelioration follows. If repetition is necessary, repeat the remedy in a more suitable potency and/or reduced dose, or repeat less frequently. When remedies are applied in watery solution the dose can be easily adjusted to avoid aggravations.
- If the aggravation is of burdensome intensity it should not be endured. Either repeat the same remedy in a lower dose or potency, or in descending potencies to decrease the intensity of the remedy’s action, until the aggravation subsides. Check whether the remedy is truly indicated.
- If the aggravation is very severe or even life-threatening the action of the remedy should be interrupted by giving an antidote. Apply a remedy which is known to antidote the previously given remedy and which is most similar to the new troublesome symptoms. Let it act until the symptoms subside, then return to prescribing, adjusting potency and dose. Check whether the remedy is truly indicated.
- If the homeopathic aggravation appears towards the end of treatment the doses must be reduced further and/or repeated at longer intervals, or even stopped for several days, to see whether no more medicine is necessary for cure. If no further medicine is necessary the symptoms caused by the excess of the remedy will soon disappear and leave undisturbed health. (§248 Organon)
A dissimilar aggravation occurs when an incorrectly chosen remedy produces new, persisting and possibly troublesome symptoms which the patient had never experienced before. With the wrong remedy the patient does not feel better in general apart from the palliative relief of some superficial symptoms. If the remedy is allowed to act the internal disease will be intensified, new ailments will develop, and an artificial, medicinal disease might be produced that suspends the natural disease. Beware to think the patient’s original disease has improved and another, old layer is coming to the surface!
What are we to do?
- If the remedy is similar enough to remove a considerable part of the disease without causing too many or severe accessory symptoms, the homeopathy treatment is to continue.
- Don’t repeat the remedy if it causes too many new and troublesome symptoms due to insufficient homeopathicity.
- If there appear symptoms of some moment, don‘t allow the dose to exhaust it‘s action but take corrective measures.
- If the new symptoms are not severe, a better indicated remedy should be given immediately.
- If the new symptoms are troublesome or even dangerous, the action of the remedy should be stopped by an antidote before giving a better chosen remedy. Chose an antidote that is known to antidote the action of the previously given remedy and which is similar to the new, troublesome symptoms.
- To chose a better remedy the remainder of the original symptoms and the newly developed symptoms are to combine in a grand totality, as the new symptoms are of such a nature as the disease itself was capable of producing.
An aggravation of the patient’s disease occurs if treatment is inadequate and the natural disease and pathology progresses. Inadequate treatment is the prescription of a wrong remedy as well as the improper application of the homeopathically correctly chosen remedy. Maintaining causes may also attribute to a continued diseases aggravation and should always be investigated. Intervention is necessary by retaking the case and adjusting treatment and lifestyle.
Cure and the reappearance of old symptoms
True cure means to restore the sick to health and includes the normalization of all vital processes and increased resistance against all sick making forces. This can never be reached through the suppression of symptoms or mere removal of pathology.
When following Hering‘s direction of cure a decrease of the most recent complaints and the return of old symptoms is part of the reversal of the disease timeline and indicates that the correct remedy is working deeply and towards cure. Reappearing, old symptoms should be less severe than the original incident and pass off quickly, unless the potency or dose were too large or the remedy repeated too frequently. They should resolve within a short time and be followed by a subsequent improvement in health. Their reappearance should be accompanied by an increase of well being and an amelioration on the general plane. These symptoms should not be treated by changing the remedy or using allopathic medicine.
Apart from the reappearance of old symptoms, an aggravation of symptoms as experienced before the beginning of treatment may still occur. Cure needs time and not all symptoms are going to ameliorate immediately.
The truly indicated, homeopathic remedy balances the vital force, stimulates the defense system and supports proper desintoxication so that increased discharges from the skin, mucous and serous membranes, kidneys, bowels, lungs or skin may appear. This elimination of residuals through channels is a positive sign of the vital force throwing off the disease. Related symptoms are transitory and pass off soon whilst the patient feels better and his symptoms ameliorate.
- A female patient, age 71, received Iodum LM6 in frequent, liquid doses for chronic ailments upon which her existing respiratory ailments aggravated. The homeopath increased the potency to LM18 which caused incessant coughing and new vision ailments, including the retina to detach for which the patient came to ask for my advice. These new and troublesome symptoms constitute a dissimilar aggravation as not belonging to the pathogenesis of the given remedy, although some insecurity remains as the detachment of retina is a mere clinical symptom that hardly appeared during properly conducted provings. Due to the dangerous action of the given remedy Iodum, it’s antidote Phosphorus was given immediately as Phosphorus’ pathogenetic symptoms were similar to the patient’s new and troublesome symptoms and known to antidote the action of Iodum. Afterwards, the chronic case was retaken and a better indicated remedy for the patients totality prescribed. It is to be noted that Hahnemann clearly advised us to start treatment with LM (Q) potencies with the lowest potencies (LM1-3) and increase the potency gradually, not in big jumps. Even if applied in watery solution and modified doses, the remedy is only to be repeated as long as no new symptoms appear, and not mechanically! (Dissimilar aggravation with new, dangerous and troublesome symptoms.)
- A boy, age 3, received Phosphorus 200C in watery solution for acute respiratory ailments with symptoms that indicated this remedy. After two hours the remedy was repeated which caused the cough to get worse. As no further, new symptoms developed and the aggravation was not too severe, the remedy was discontinued. The aggravation wore off soon and restoration of health followed quickly. (Similar, untrifling aggravation.)
- A girl, age 4, received a dose of Belladonna 30C to prevent her getting scarlatina which appeared sporadically in the kindergarten. Soon the child’s original, chronic symptoms aggravated indicating the need for her individualized, chronic remedy which was then applied again. Hahnemann warned that for homeoprophylaxis, a properly chosen remedy – either the patient’s constitutional remedy, the genus epidemicus (or the individualized remedy if the genus remedy does not work), or a nosode – should only be given if the subject is really in danger of taking the disease. (Dissimilar aggravation with no severe symptom aggravation.)
The different forms of aggravation demonstrate that the correct choice of the remedy, potency and dose are important in the treatment of patients. Any aggravation is to be avoided, as it delays or even prevents the cure. Ideally, the patient does not aggravate, or experiences only a slight homeopathic aggravation, followed by steady improvement that follows Hering´s rule. In practice this is not always possible to achieve. However, correct prescription and case management are only possible if the reactions of the patients and different forms of aggravations are properly understood.