Remedy outcomes and case management

What is happening when you give a remedy, it holds for a short time only and the symptoms return? What questions will you ask yourself as you decide what to do? The objective of this article is to open up a more precise form of discussion of remedy outcomes and case management. The suggestions I’ve made below based on Hahnemann’s discussion of similar and dissimilar disease actions in nature are just that – suggestions.

In the Organon, Hahnemann gave his proposal as to how homoeopathy works, although he himself offered it as a possibility, not a certainty. He states in Aphorism 28 of the Organon his view that “it matters little what may be the scientific explanation of how it takes place; and I do not attach much importance to the attempts made to explain it. But the following view seems to commend itself as the most probable one, as it is founded on premises derived from experience.”

Although in terms of the method itself it is less important to know exactly how the principle of “like cures like” works on the organism, just as it’s less important for us to understand the inner workings of our computers and more important to know how to use them – for case management we need to have some way of interpreting what is happening in order to determine our next steps in any case.

When we give the remedy, we are actually producing an artificial set of symptoms in the patient, to match the existing disease symptoms presented in the case-taking. So instead of talking of remedy action, it can be helpful to see our prescriptions as artificial stronger or weaker, similar or dissimilar diseases, and look at Hahnemann’s discussion of this issue in the Organon.

In Aphorism 36, Hahnemann talks of the ability of the stronger older dissimilar disease to REPEL a new dissimilar disease giving various examples.

The basic parallel in giving remedies is that when the remedy is not homoeopathic to the case – i.e., it is dissimilar – unless it is made stronger than the dissimilar natural disease, it will not affect it at all. This points indirectly to the risks involved in hammering away at a case with a remedy that is incorrect and that initially has not provoked any immune response. By doing so we change the definition of our incorrect remedy from a weaker to a stronger dissimilar disease, capable of suspending but never curing the natural disease, and in the worst case scenario, capable of combining with the natural disease to form a complex disease of two dissimilar diseases of equal strength, which “cannot remove, cannot cure one another” (Aphorism 40).

In aphorism 38, Hahnemann talks of the stronger dissimilar disease which can SUSPEND the original natural disease as long as it is active in the body, but after it passes the natural disease returns as before, and possibly even with greater virulence.

When drawing parallels with the progress of a case, this example would reflect a situation where we have given a remedy, all the disease symptoms disappeared for a while, and then came back the same as before or even stronger. Often this kind of situation gives rise to miasmatic mutterings – but perhaps we have just given the wrong remedy, which is acting just like a stronger dissimilar disease in nature, suspending but never curing the original disease.

And what of two similar diseases? In Aphorism 44 Hahnemann states that two similar diseases “can neither…repel one another, .. suspend one another so that the old one shall return after the new one has run its course… [nor] exist beside each other in the same organism or together form a double complex disease.” He continues in Aphorism 45 “…two diseases…very similar in their phenomena and effects and in the sufferings and symptoms they severally produce, invariably annihilate one another whenever they meet together in the organism…the stronger disease namely annihilates the weaker, and that for this simple reason, that …the new similar but stronger morbific potency controls the feelings of the patient…”

In case management, when a remedy holds for a time and then symptoms reappear, the question we must ask ourselves is whether we are dealing here with a dissimilar artificial disease which suspended the original natural disease – or with a similar artificial disease that was not consistently stronger than the similar natural disease and therefore was not able to annihilate it completely. The way in which we answer the question will determine whether we will change the remedy or stay with the same remedy and adjust potency or dose.

So within the context of similar and dissimilar diseases in nature let’s look at some possible outcomes in treatment:

1. The remedy has no effect at all. Here there are two possibilities: the remedy may be the equivalent of the weaker dissimilar disease, which is simply repelled by the existing natural disease; or the remedy may be the equivalent of the similar weaker disease, with its effects annihilated by the natural stronger disease in the body. In the first case, we will change the remedy. The second situation is more complicated, as we have to examine the reasons for our remedy choice, and how certain we are of the remedy we prescribed. If we are certain, it’s time to go into obstacles to cure, ways in which the patient may be inadvertently antidoting the remedy, and change potency or dose.

2. The patient responds very well to the remedy, the symptoms disappear for a shorter or longer time – and then the whole symptom complex comes back as before. This may be a case of the stronger dissimilar disease, as stated above, which merely suspended the remedy. If the whole complex is back unaltered, it is unlikely that the first remedy was in any way a similar artificial disease, as we would expect to see some curative alteration in the symptoms, not an exact return of the original disease. This is the kind of case where “constitutional” prescribers tend to hammer away at the first remedy, because it helped originally and therefore should be given over and over again. This kind of prescribing runs the risk of creating a complex disease in the patient, just as when two dissimilar diseases combine to form a double or multiple complex disease (Aphorism 44). I have seen cases where previous homoeopathic treatment involved constant raising of potency and dose of remedies with two unpleasant outcomes: in some of these cases patients became dependent on treatment, with potencies going higher and higher, where in the absence of a dose the symptoms would come back stronger than before; and in others patients began producing other symptoms which were not picked up by the homoeopath, resulting in an altered condition which became “invisible”, the prescriber continuing along the blissful Kentian track of “if it helped in the past it’s the holy constitutional.”

3. The patient aggravates, and then improves. After a time, some of the symptoms come back but in a weaker or altered form, and other symptoms emerge. Here we would appear to be within the sway of a similar artificial disease, which has initially been significantly stronger than the existing natural disease and therefore provoked some artificial disease symptoms in the patient similar to the existing natural disease state, and then acted in a way which was partially curative. Re-examination and possible change of remedy will be required at this stage, as the natural disease has changed.

These are just three examples of the many possible outcomes of treatment. One thing is clear though, and it takes us back to Aphorism 6 and the importance of noting what has changed as a result of treatment, just as the initial prescription focuses on what has changed in the health of the patient to render him sick. If our treatment has ultimately not changed anything – we are probably within the realm of dissimilar disease action and need to re-examine our case (and investigation of miasm/infection will be part of that examination). If our treatment has changed something, whether in aggravation or in a clearly curative manner – we may be within the realm of similar disease action.

Ultimately we need to ask at least the following questions when assessing our prescription:

1. Was our artificial disease prescription (remedy) REPELLED by the existing stronger dissimilar natural disease?

2. Was the natural disease only SUSPENDED by the stronger dissimilar artificial disease prescription (remedy)?

3. Has our equal strength dissimilar artificial disease prescription (remedy) merely COMBINED with the existing dissimilar natural disease to form a COMPLEX disease?

4. Did the stronger similar natural disease merely ANNIHILATE our weaker similar artificial disease prescription?

The answers we give to these questions will go a long way to determining the next steps in our case management.