In
our quest for the cure of the patient, we always have to overcome three major
problems:
–
finding the right remedy;
–
choosing the right potency;
–
determining the
right dose.
The
right combination of these three factors creates ‘the similimum’.
Indeed, it is not enough to discover the correct remedy!
As
Hahnemann stated in aphorism 275:
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…
Still
many homeopaths say that potency doesn’t matter, that, whatever potency you
choose, if the remedy is correct, it will cure the patient. This is not
correct!
In
aphorism 27,
Hahnemann says:
The curative power of
medicines, therefore, depends on their symptoms, similar to the disease but
superior to it in strength, so that each individual case of disease is most
surely, radically, rapidly and permanently annihilated and removed only by a
medicine capable of producing (in the human system) in the most similar and
complete manner the totality of its symptoms, which at the same time are
stronger than the disease. (emphasis added)
In
aphorism 26
he also says:
This depends on the
following homeopathic law of nature which was sometimes, indeed, vaguely
surmised but not hitherto fully recognized, and to which is due every real cure
that has ever taken place:
A weaker dynamic affection
is permanently extinguished in the living organism by a stronger one, if the
latter (whilst differing in kind) is very similar to the former in its
manifestations. (emphasis added)
So,
it may be clear that a well chosen remedy, given in a potency that is less
powerful then the original affection, will be extinguished (and for that will
not work) by the latter. (Fig.1)
This pure experience shows
UNIVERSALLY, that if the disease do not manifestly depend on a considerable
deterioration of an important viscus (even though it belong to the chronic and
complicated diseases), and if during the treatment all other alien medicinal
influences are kept away from the patients, the dose of the
homeopathically selected and highly potentized remedy for the
beginning of treatment of an important, especially chronic disease can never be
prepared so small that it shall not be stronger than the natural disease and
shall not be able to overpower it, at least in part and extinguish it from the
sensation of the principle of life and thus make a beginning of a cure.
(emphasis added)
First
of all, there has to be made an important difference between potency
and dose. The potency determines the power of our remedy; the
dose is the quantity the patient will take of it. This brings us back to the
beginning of this article: the similimum is:
– Right remedy
– Right potency
– Right dose
Now,
how can we determine which potency and which dose we will use, once we have
found the right remedy? There’s no mathematical formula to figure this
out (which is one of the reasons that some scientists call homeopathy
‘quackery’).
Hahnemann
himself told us in aphorism 278:
Here the question arises,
what is this most suitable degree of minuteness for sure and gentle remedial
effect; how small, in other words, must be the dose of each individual
medicine, homeopathically selected for a case of disease, to effect the best
cure? To solve this problem, and to determine for every particular medicine,
what dose of it will suffice for homeopathic therapeutic purposes and yet be so
minute that the gentlest and most rapid cure may be thereby obtained – to solve
this problem is, as may easily be conceived, not the work off theoretical
speculation; not by fine-spun reasoning, not by specious sophistry can we
expect to obtain the solution of this problem. It is just as impossible as
to tabulate in advance all imaginable cases. Pure experiment, careful
observation of the sensitiveness of each patient, and accurate experience can
alone determine this in each individual case; and it
were absurd to adduce the large doses of unsuitable (allopathic)
medicines of the old system, which do not touch the diseased side of the
organism homeopathically, but only attack the parts unaffected by the disease,
in opposition to what pure experience pronounces respecting the smallness of
the doses required for homeopathic cures. (emphasis added)
In
other words, the choice of the potency and the dose of the remedy have to be
determined, based on experience, keen observation and prudence! However,
there are some guidelines that can help us. Do we have a chronic or an
acute case; are there only physical symptoms (or couldn’t we discover the
mental ones…); is there severe pathology; do we have to deal with a hyper- or
hyposensitive patient…?
After
we decided which potency we’re going to use, we must see how we will administer
it and what will be the dose. As with many homeopaths, I used to work with dry
doses; 3 pellets under the tongue, then wait or repeat after a certain
time… However, the ‘waiting time’ often turned out to be ‘wasted time’.
Due to wrong potency/dose choice, there were times the remedy showed either no
action at all or too much action which resulted in aggravations.
As
it is most of the time, Hahnemann tells us what to do. First of all, we should
use water potencies of the remedy (aphorism 272):
Such a globule, placed dry
upon the tongue, is one of the smallest doses for a moderate recent case of
illness. Here but few nerves are touched by the medicine. A similar globule,
crushed with some sugar of milk and dissolved in a good deal of water
and stirred well before every administration will produce a far more
powerful medicine for the use of several days. Every dose, no matter how
minute, touches, on the contrary, many nerves. (emphasis added)
The Importance of Potency
Choice, Dilution and Dose
On
the one hand, the medicine will be more powerful since it touches more nerves
but on the other hand, we have lots more flexibility to adapt the dose to the
patient’s needs/sensitivity. You can make the remedy bottles yourself and give
them to your patients or the patients themselves can easily make these. I
usually advise to take a bottle of spring water, empty it for about 1/4th
(to get space to give succussions), put 2 pellets of the remedy in
it and eventually, add a little bit of alcohol as a preservative.
Again,
as with the potency choice, we have to determine which dose we will
advise. So again, we must consider the case (acute/chronic) and the
sensitivity of the patient.
Knowing
this, I always start with a ‘test dose’ (one teaspoon of the remedy bottle in a
glass of water, stirring, take one teaspoon of the glass).
The
result of this test dose provides you with information:
–
Best case (not very often…): striking amelioration;
remedy-potency-dose were perfect; no repetition as long as amelioration holds.
– Slight improvement
of the symptoms. Now, the remedy can be repeated at certain intervals, as
long as each new dose brings on a little bit more improvement. How
frequently the doses should be taken is, again, not mathematically determined;
in acute cases, you can take more frequently than in chronic cases. At
least, you should allow time for the vital force to react and to show you the
results of the remedy. Most of the time, I start repeating every other
day.
Very
IMPORTANT! You have to tell
(teach) the patient to succuss the bottle every time before taking a new dose.
As Hahnemann told us in aphorism 246:
…firstly, if the medicine
selected with the utmost care was perfectly homeopathic; 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…
And
in aphorism 247:
…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) and thus the cure
brought nearer.
Usually,
I start with 6 succussions. Since the succussions change the degree of
dynamization, you reinforce the power of the remedy. If necessary, due to
poor reaction or due to aggravation, you can easily increase or decrease the
amount of succussions.
– No reaction.
Supposing that we made a good anamnesis and we’re quite sure of the remedy,
this means that either potency or dose is insufficient.
Before
increasing the potency, I try to give more successions for a couple of days,
especially when I know or suspect that the patient is very sensitive.
The
biggest difference when using watery solutions is that you can almost perfectly
adjust the dose to the sensitivity/need of your patient.
Adjustments
can be made on different planes:
–
You can increase the power of the remedy by increasing the potency or by
increasing the number of successions.
–
You can adjust the dose by increasing or decreasing the number of
teaspoons. If a teaspoon is even too much, you can advise one or a few
drops.
–
For sensitive patients, you can dilute further to second, third, etc. glass.
Indeed,
this system gives you all the tools to fine-tune your homeopathic remedy in
such a way that you will really find the similimum – right remedy, right
potency, right dose.
There’s
one important note: The use of this system demands a more frequent contact
between homeopath and patient. It may be clear that you need a regular
feedback from your patient in order to follow up the case more closely, adjust
potency-dose right on time etc. About 200 years ago, Hahnemann could do it so
why shouldn’t we be able to, having (cell) phone or e-mail at our disposal.
We
also have to educate our patients. They have to be made clear about the
‘how and why’s’ of the system, so that they get motivated to give you their
feedback. It’s important that they know when they should contact you, when they
should stop taking the remedy etc…
Case 1
A
young man, 21 years old, suffers from severe sleepiness. As soon as he stops
working, he falls into a deep sleep. These problems began after he was
beaten up by some guys, without any reason. He was severely injured on
the head, needed a few operations etc…
Remedy:
Opium 200 (one teaspoon from remedy
bottle in glass of water, one teaspoon of that taken)
Test
dose: No reaction
Follow
up: Opium 200 – 6 succussions – once a day for 5
days
No
reaction
Follow
up: Opium M – 6 succussions – once a day
for 5 days
Great
improvement – sleepiness is completely gone.
Follow
up: Stop the medicine – No return of the
symptoms
Remark: The remedy was not changed since there was no
change of symptoms. It was still an Opium picture so the only thing that had to
be changed was the power of the remedy (potency) or the dose.
Case 2
Woman,
40 years old, chronic fatigue syndrome. Many problems of joint and muscle
pains, exhausted, depressed. History of unhappiness, parental domination,
etc…
She
seems to be very sensitive to medication, certain food, alcohol etc…
Remedy:
Nat mur 6C (one teaspoon from remedy bottle in glass of water, one
teaspoon of that taken
Test
dose: Aggravation on all planes.
Follow
up: Nat mur 6C – 2 succussions – diluted to
2nd glass – one teaspoon
Follow
up: Another aggravation
Follow
up: Nat mur 6C – 2 succussions – diluted to
4th glass – one teaspoon
Follow
up: Slight improvement on all planes –
improvement lasts for about 3 days
Follow
up: Nat mur 6C – 2 succussions – diluted to
4th glass – one teaspoon – every 3 days
By
Marc Van Wijk
Follow
up: More improvement after each dose.
She’s still on medication today.
Remark: Instead of diluting to 4th glass, I
could also try to give drop doses instead of teaspoons
Case 3
Woman,
48 years old, menopausal complaints accompanied with joint problems, emotional
disturbances, painful menses, etc. Her history shows she’s a sensitive person.
Remedy:
Sepia 30
Test
dose: No reaction
Follow
up: Sepia 30 – 6 succussions – every other
day for 6 days
Follow
up: No reaction
Sepia
200 – 6 succussions – every other day for 6 days
Follow
up: No reaction
Sepia
M – 6 succussions – every other day for 6 days
Follow
up: After 3 days she contacts me to
announce a great improvement (joints – emotionally – energy)
Follow
up: Since the improvement lasts for about 5
days, I tell her to take the remedy every 5 days.
Follow
up: After about 2 months, the remedy was no
longer needed.
Remark: In this case, I was convinced that Sepia had
to be the right remedy so if improvement failed to occur, it had to be due to
wrong potency/dose choice.
Acknowledgment:
Although
Hahnemann has told us how to use this system in his 6th edition of
the Organon, I only ‘discovered’ it after reading ‘Hahnemann revisited’ and
‘Achieving and Maintaining the Similimum’, both by the hand of Luc De Schepper.
Every
homeopath who is determined to practice homeopathy in the way Hahnemann did,
should study those books. They’re written in such a clear way that every tip is
ready-to-use. Every chapter of the book improves your practice. The
advice Luc De Schepper gives concerning case management (Achieving and
Maintaining the Similimum) is so useful that I decided to make an interactive
PowerPoint presentation of it. It’s free to use and it can be downloaded
at: http://hpathy.com/download/
References:
–
Organon 6th edition – S. Hahnemann
–
Hahnemann revisited – Luc De Schepper
–
Achieving and maintaining the similimum – Luc De Schepper
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