Aphorism 246 | Organon of Medicine By Dr. Hahnemann
Aphorism 246 – Fifth Edition
On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred days. 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. And this may be very happily affected, as recent and oft-repeated observations have shown, under three conditions: firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; and thirdly, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals,1 which experience shall have pronounced to be the best adapted for accelerating the cure to the utmost extent, yet without the vital force, which it is sought to influence to the production of a similar medicinal disease, being able to feel itself excited and roused to adverse reactions.
1 In the former editions of the Organon I have advised that a single dose of a well-selected homoeopathic medicine should always be allowed first fully to expend its action before a new medicine is given or the same one repeated – a doctrine which was the result of the positive experience that neither by a larger dose of the remedy, which may have been well chosen (as has been again recently proposed, but which would be very like a retrograde movement), nor, what amounts to the same thing, by several doses of it given in quick succession, can the greatest possible good be effected in the treatment of diseases, more especially of chronic ones; and the reason of this is, that by such a procedure the vital force dose not quietly adapt itself to the transition from the natural disease to the similar medicinal disease, but is usually so violently excited and disturbed by a larger dose, or by smaller doses of even a homoeopathically chosen remedy given rapidly one after the other, that in most cases its reaction will be anything but salutary and will do more harm than good. As long as no more efficacious mode of proceeding than that then taught by me was discovered, the safe philanthropic maxim of sin non juvat, modo ne noceat, rendered it imperative for the homoeopathic practitioner, for whom the weal of his fellow-creatures was the highest object, to allow, as a general rule in diseases, but a single dose at a time, and that the very smallest, of the carefully selected remedy to act upon the patient and, moreover, to exhaust its action. The very smallest, I repeat, for it holds good and will continue to hold good as a homoeopathic therapeutic maxim not to be refuted by any experience in the world, that the best doses of the properly selected remedy is always the very smallest on in one of the high potencies (X), as well for chronic as for acute as for acute diseases – a truth that is the inestimable property of pure homoeopathy and which as long as allopathy and the new mongrel sect, whose treatment is a mixture of allopathic and homoeopathic processes is not much better continues to gnaw like a cancer at the life of sick human beings, and to ruin them by large and ever larger doses of drugs, will keep pure homoeopathy separated from these spurious arts as by an impassable gulf.
On the other hand, however, practice shows us that though a single one of these small doses may suffice to accomplish almost all that it was possible for this medicine to do under the circumstances, in some, and especially in slight cases of disease, particularly in those of young children and very delicate and excitable adults, yet that in many, indeed in most cases, not only of very chronic diseases that have already made great progress and have frequently been aggravated by a previous employment of inappropriate medicines, but also of serious acute diseases, one such smallest dose of medicine in our highly potentized dynamization is evidently insufficient to effect all the curative action that might be expected from that medicine, for it may unquestionably be requisite to administer several of them, in order that the vital force may be pathogenetically altered by them to such a degree and its salutary reaction stimulated to such a height, as to enable it to completely extinguish, by its reaction, the whole of that portion of the original disease that it lay in the power of the well-selected homoeopathic remedy to eradicate; the best chosen medicine in such a small dose, given but once, might certainly be of some service, but would not be nearly sufficient.
But the careful homoeopathic physician would not venture soon to repeat the same dose of the same remedy again, as from such a practice he has frequently experienced no advantage, but most frequently, on close observation, decided disadvantage. He generally witnessed aggravation, from even the smallest dose of the most suitable remedy, which he has given one day, when he repeated the next day and the next.
Now, in cases where he was convinced of the correctness of his choice of the homoeopathic medicine, in order to obtain more benefit for the patient than he was able to get hitherto from prescribing a single small dose, the idea often naturally struck him to increase the dose, since, for the reason given above, one single dose only should be given; an, for instance, in place of giving a single very minute globule moistened with the medicine in the highest dynamization, to administer six, seven or eight of them at once, and even a half or a whole drop. But the result was almost always less favourable than it should have been; it was often actually unfavourable, often even very bad – an injury that, in a patient so treated, is difficult to repair.
The difficulty in this case is not solved by giving, instead, lower dynamizations of the remedy in a large dose.
Thus, increasing the strength of the single doses of the homoeopathic medicine with the view of effecting the degree of pathogenic excitation of the vital force necessary to produce satisfactory salutary reaction, fails altogether, as experience teaches, to accomplish the desired object. This vital force is thereby too violent and too suddenly assailed and excited to allow it time to exercise a gradual equable, salutary reaction, to adapt itself to the modification effected in it; hence it strives to repel, as if it were an enemy, the medicine attacking it in excessive force, by means of vomiting, diarrhoea, fever, perspiration, and so forth, and thus in a great measure it diverts and renders nugatory the aim of the incautious physician – little or no good towards curing the disease will be thereby accomplished; on the contrary, the patient will be thereby perceptibly weakened and, for a long time, the administration of even the smallest dose of the same remedy must not be thought of if we would not wish it to injure the patient.
But it happens, moreover, that a number of the smallest doses given for the same object in quick succession accumulate in the organism into a kind of excessively large dose, with (a few cases excepted) similar bad results; in this case the vital force, not being able to recover itself betwixt every dose, though it be but small, becomes oppressed and overwhelmed, and thus being incapable of reacting in a salutary manner, it is necessitated passively to allow involuntary the continuance of the over-strong medicinal disease that has thus been forced upon it, just in the same manner as we may every day observe from the allopathic abuse of large cumulative doses of one and the same medicine, to the lasting injury of the patient.
Now, therefore, in order, whilst avoiding the erroneous method I have here pointed out, to attain the desired object more certainly than hitherto, and to administer the medicine selected in such a manner that it must exercise all its efficacy without injury to the patient, that it may effect all the good it is capable of performing in a given case of disease, I have lately adopted a particular method.
I perceived that, in order to discover this true middle path, we must be guided as well by the nature of the different medicinal substances, as also by the corporeal constitution of the patient and the magnitude of the disease, so that – to give an example from the use of sulphur in chronic (psoric) diseases – the smallest dose of it (tinct, sulph. X°) can seldom be repeated with advantage, seen in the most robust patients and in fully developed psora, oftener than every seven days, a period of time which must be proportionally lengthened when we have to treat weaker and more excitable patients of this kind; in such cases we would do well to give such a dose only every nine, twelve, or fourteen days, and continue to repeat the medicine until it ceases to be of service. We thus find (to abide by the instance of sulphur) that in sporic diseases seldom fewer than four, often however, six, eight and even ten doses (tinct. sulph. X°) are required to be successively administered at these intervals for the complete annihilation of the whole portion of the chronic disease that is eradicated by sulphur – provided always there had been no previous allopathic abuse of sulphur in the case. Thus even a (primary) scabious eruption of recent origin, though it may have spread all over the body, may be perfectly cured, in persons who are not too weakly, by a dose of tinct sulph. X° given every seven days, in the course of from ten to twelve weeks (accordingly with ten or twelve such globules), so that it will seldom be necessary to aid the cure with a few doses of carb. veg. X° (also given at the rate of one dose per week) without the slightest external treatment besides frequent changes of linen and good regimen.
When for other serious chronic diseases also we may consider it requisite, as far as we can calculate, to give eight, nine or ten doses of tinct. sulph. (at X°) it is yet more expedient in such cases, instead of giving them in uninterrupted succession, to interpose after every, or every second or third dose, a dose of another medicine, which in this case is next in point of homoeopathic suitableness to sulphur (usually hep. sulph.) and to allow this likewise to act for eight, nine, twelve or fourteen days before again commencing a course of three doses of sulphur.
But it not infrequently happens that the vital force refuses to permit several doses of sulphur, even though they may be essential for the cure of the chronic malady and are given at the intervals mentioned above, to act quietly on itself; this refusal it reveals by some, though moderate, sulphur symptoms, which it allows to appear in the patient during the treatment. In such cases it is sometimes advisable to administer a small dose of nux vom. X°, allowing it to act for eight or ten days, in order to dispose the system again to allow succeeding doses of the sulphur to act quietly and effectually upon it. In those cases for which it is adapted, puls. X° is preferable.
But the vital force shows the greatest resistance to the salutary action upon itself of the strongly indicated sulphur, and even exhibits manifest aggravation of the chronic disease, though the sulphur be given in the very smallest dose, though only a globule of the size of a mustard seed moistened with tinct. sulph X° be smelt, if the sulphur have formerly (it may be years since) been improperly given allopathically in large doses. This is one lamentable circumstance that renders the best medical treatment of chronic disease almost impossible among the many that the ordinary bungling treatment of chronic diseases by the old school would leave us nothing to do but to deplore, were there not some mode of getting over the difficulty.
In such cases we have only to let the patient smell a single time strongly at a globule the size of a mustard seed moistened with mercur metall. X, and allow this olfaction to act for about nine days, in order to make the vital force again disposed to permit the sulphur (at least the olfaction of tinct. sulph. X°) to exercise a beneficial influence on itself – a discovery for which we are indepted to Dr. Griesselich, of Carlsruhe.
Aphorism 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. This is not infrequently the cause in acute diseases, 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. 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. And this may be very happily affected, as recent and oft-repeated observations have taught me under the following conditions: 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 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).
-Dr. Samuel Hahnemann