Aphorism 3: what the true practitioner needs to know

In Aphorism 3, Hahnemann discusses what you need to know to be a homeopath: The physician has to know:

…what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication)…

We have to remember here that Hahnemann is talking about individual cases of disease, and what is to be cured. For this we need careful, accurate case taking. While knowledge of common disease pathways is important, and understanding of physiology, anatomy and pathology is crucial, Hahnemann stresses the “individual case of disease”. It’s not the nature of the injury, it’s the way the patient is experiencing it, the unique symptoms and physical-emotional-mental symptom mix that the patient presents which leads us to appropriate remedies.

Next?

…what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers)…

How do we learn what is curative in medicines? First from tests conducted on healthy volunteers – i.e. provings. That is our primary source material for understanding what a medicine can do. Here we must also distinguish between poisoning (giving crude arsenic will give information perhaps more useful for killing than curing), and proving (who knew what table salt in homeopathic preparation could do to help cure?). Furthermore we must understand the true place of clinical experience within understanding what is curative in a medicine. When the individuality of each case is perceived and grasped, it should be clear that because a remedy helped five people with the flu, it doesn’t necessarily follow that the same remedy would be curative in all cases. There is a vastness in the individuality of each person, whether in terms of personality, remedy response, resilience, and response in general to the outside world. Many traits may be shared, but the individuality of the combination brings snowflakes to mind in their diversity. So we can see a certain hierarchy: provings, poisonings (frequently included in Hahnemann’s provings) and last, clinical sources. Many materia medica don’t distinguish between these sources of information in describing remedies. Which is why you should look at provings first.

Next?

…how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient…

This requires case analysis, which can only be effectively conducted when the case has been properly taken and the individual case of disease understood, and when there is clarity about the principles for prescribing. This clarity about principles also indicates clarity about case management, which can often be much more complex – and rewarding and informative – than the first prescription.

And Hahnemann continues, when giving a remedy we must also take into account:

…the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose…

How large should the dose be? Understanding how much and why is a crucial part of learning how to practice homoeopathy. As a rule, the size of the dose should be the smallest amount required to trigger a response. And that can be a very small amount indeed.

How often should a remedy be repeated? Confusion regarding repetition is one of the greatest pitfalls in practice. Repeating too often may muddy a case. Not repeating often enough may lengthen the time it takes to recover. When the principles of practice are clearly defined, this will give the practitioner a “road-map” for managing the case.

And one last thing? The practitioner must know

…the obstacles to recovery in each case and … how to remove them…

This often requires sleuthing (I recommend reading Sherlock Holmes…). Is there an obstacle we know nothing about? Apart from elements not reported by patients for “don’t judge me” reasons, there are many things that patients don’t report because it just doesn’t occur to them – whether it’s use of essential oils or that extra healthy supplement they started taking that contains a mix of homoeopathic remedies which will interfere with the case. Sometimes the obstacle can be a toxic relationship, sometimes a damp apartment or poor diet, or working occasional night shifts.

So any solid homoeopathy course curriculum should include all of these elements in its foundation course. To repeat the whole aphorism here:

If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that the recovery must ensue – to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated), as also in respect to the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose; – if, finally, he knows the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent, then he understands how to treat judiciously and rationally, and he is a true practitioner of the healing art .

LMs – what are the odds (or the evens)…

hardworking horses…

I have recently been asked about changing potencies in LMs, with people mentioning using odd numbers, even numbers, going up in steps of 2 potencies (LM1 – LM3 – LM5) etc.

I came across this issue before I started studying with David Little, from a post he wrote on the Minutus list, sometime around 2005.  He mentioned that while most people do just
fine on a series of ascending potencies (LM1 – LM2 – LM3 etc.)  he had noticed that some seem to do better on odd or even numbers of dilutions or succussions.  He also noted that Hahnemann didn’t always start with LM 1.

There are two issues in play here, in my view.

The first is the risk of putting theory before experience.  The beauty of homoeopathy is that Hahnemann first observed, then developed a way of harnessing the power of the similar stronger artificial disease without harming the patient, and  what he thought was the most probable explanation for what he was observing.  In Aphorism 28 (and elsewhere), Hahnemann sets out the basis for his thinking on experience versus explanations of how something happens:

“As this natural law of cure manifests itself in every pure experiment and every true observation in the world, the fact is consequently established; 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.”

The second issue is the sensitivity of the patient, something that is difficult to assess ahead of time.  In Aphorism 278 Hahnemann explains that individual sensitivity can’t be deduced through “fine-spun reasoning” or “specious sophistry.”  In order to learn the appropriate dose, “pure experiment, careful observation of the sensitiveness of each patient and accurate experience can alone determine this in each individual case…”

To my mind it comes down to “specious sophistry” if we adopt a theory of odds and evens, where there is no solid backing for the theory, or to apply it and then say it worked – especially when there is a body of material showing that many patients do well just going up through the potency scale.  On the other hand, some patients do especially well on a particular potency, but we cannot know if it was the potency itself or if the improvement was built up by the work of the previous potencies and only manifested itself with the current one.

And furthermore – although it is natural to look for protocols, for theories which provide rules for action which can be employed in every case, we will then have moved away from the individualization of the patient, and of the patient’s sensitivity.

In my own experience, many patients do very well going up the scale, some seem to advance more with specific potencies in the scale, and if the remedy is going to help it is usually already visible in the patient’s response to LM1.

However, looking for a pattern in the sensitivity of individual patients and developing theories to govern posology rather than drawing on pure experiment, careful observation and accurate experience on an individual case-by-case basis seems to be a case of putting the dazzling cart of theory in front of the plodding hardworking horse of experience.  Specious to say the least.

 

 

Preparation of medicinal solutions

I’m often asked about preparation of remedies for dosing, especially in connection with use of LM potencies.  I’ve quoted David Little’s article on Solutions Large and Small below in full.  You can read the original here.  David also describes the experiments he carried out.

 

Solutions Large and Small
Preparation of the Medicinal Solution

The question of how to make a medicinal solution has been raised. Our research group uses the Hahnemannian Standard as discussed in The Chronic Diseases and The 6th Organon of the Healing Arts. The reason for this is twofold.

10 Tips for Homoeopathy Students

Read Primary Sources!

10 Tips for Homoeopathy Students

1.  Read the Organon yourself.  Read Chronic Diseases.  Read Hahnemann and Boenninghausen’s Lesser Writings.  You are not a baby, don’t stick to the pureed version.

2. Never let anything go unchallenged.  Ask why, and if you don’t get answers from your teachers look for them yourself.  This includes everything from the law of similars, to plastic cups, dosing methods, antidotes, choices of remedies, concepts of miasms.

Hahnemann’s Ten Questions

Hahnemann’s Ten Questions – how do you score?

A Dr. Steinestel of Stuttgart, who later turned out to be a fake, wrote to Hahnemann claiming that he was a homoeopath and was being persecuted by the local Board of Health. He asked Hahnemann for a written testimony stating that he had the necessary knowledge to practice homoeopathy.

Hahnemann wrote back, saying “…in answer to your request, I put the following questions to you, and from your answers to them I shall be able to judge of your capability to practise homoeopathy and to treat patients of all kinds…” (From Richard Haehl’s Samuel Hahnemann, His Life and Work, Vol 2)

Aphorisms 5 and 6 – the changed and the unchanged…

What has changed?  And what has stayed the same?  How is the patient in health and how does he change in sickness?  How do we reconcile “take note of nothing…except the deviations from the former healthy state” (Aphorism 6), with “the most significant points in the whole history of the chronic disease” (Aphorism 5)?

Let’s look at them… (text taken from 6th edition)

Aphorism 5:

Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the whole history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration.

The “Aggravation Quiz” results

First of all, I acknowledge that the quiz I posted was essentially superficial.  My objective was to see what people out there think about aggravations in homoeopathic treatment.

Over the years I have heard so many people panic over new symptoms (OMG! it’s a proving…!), over extreme aggravations (what do I do?! what have I done?!) and more.  I have heard people express sentiments like “it’s just an aggravation, it will get better..” without thinking properly about what is happening to their patient.  I have heard of situations where patients were told “it’s just an aggravation” and landed up in the emergency room.  None of this does homoeopathy any good.

So-called aggravations, in the words of someone who really knows…

and where do you keep your copy of the Organon…

So there I was, working on an extremely erudite article on so-called aggravations, mildly and elegantly nuanced with subtle humour, sharp wit and penetrating wisdom…. And then I realized there was really not much point (actually I think I looked up and asked myself a question beginning with WT…). Because it has all been said before, by someone who knows the subject much better than I do (I think perhaps I win points on the subtle humour bit, but he has me beat on the sharp wit…)

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.

Case of pain in the hip joint

The following is a case of pain in the hip joint presented by Gary Weaver on the main Institute for Homoeopathic Medicine site blog.  I have presented both Gary’s initial case presentation and the follow-up published by Gary the next day.