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 .

Aphorism 224 – mental disease

These days so many situations are classified as mental disorders, from defiance in children to reasonable depression (where it is normal to be unhappy, due to  temporary or changeable situations of loss, firing etc.) in adults.  So many people are on anti-depressants these days, and the age of those taking the drugs is constantly dropping.

But where will these mental states fit into our prescribing?  Are we looking at early stages of a mental disease, which is part of a systemic problem, or at a reasonable mood change resulting from events and lifestyle where what is really needed is encouragement and advice from friends or professionals?  I am of necessity simplifying a complex differential for this article, as when a reasonable mood change becomes prolonged and entrenched, encouragement and advice may no longer be of use.

Viewed through proving: IGNATIA’s alternating symptoms

Alternating Ignatia

OK, you prescribed Ignatia.  You’re absolutely sure of the remedy.  You’ve looked at it, repped it, slept on it, thought about it, checked materia medica, checked your patient notes, and you know.  You just do.

You gave the remedy and it did nothing.  Or it aggravated but didn’t seem to do anything interesting, worthwhile or exciting for homoeopathy.  But you were absolutely certain!

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.

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.

How confident are you? How confident should you be?

On confidence:

How confident should we be as practitioners? This is a question which worried me greatly when I started out. I felt uncertain (not surprisingly as I was entering the world of sickness and health armed with a copy of Kent’s repertory – a copy of which a colleague justly through out of a window in a different continent – and some basic core delusions about Sankaran’s teaching.). I was qualified, I had the grades, supervised clinical work and diploma to prove it. And after all that training, I did not feel confident.

It will come, some said. The more patients you work with, the more confidence you’ll feel. Until a cold voice cut through the general internet babble, as a colleague (armed with a handbag full of plumbum crude – if you’re reading this, you know who you are) said sharply “if you’re not confident in what you’re doing, you shouldn’t be practicing.”

I see my own inner debate of that time reflected in many forums, where some few honest souls admit to worry and lack of confidence. With hindsight and its freedom of constraint, I see that confidence, for a homeopath, actually relates to at least two separate issues.

We must feel confident in our tools. If we do not feel confident in the principles of homoeopathy – not a blind faith but a clear understanding of the rationale of our practice, if we only know how to parrot “like cures like” without understanding what that means and more specifically, what that demands of us – we really should not be practicing. If we do not grasp that there is a quirk and a default in nature, whereby a stronger similar disease can annihilate a weaker one and will always do so unless something else is standing in the way of cure, whether it is a maintaining cause or a deeper inherited miasmatic taint – if we don’t get that then we really should not be practicing. We’re not talking about confidence in our ability. Here this is the confidence that our tools work. That “like cures like” is a prescribing principle, not a holistic “airy-fairy” slogan.

Personal confidence is another thing altogether. We have to get used to working with patients, to eliciting the information we need for prescribing, to listening to our patients without interrupting, to allow the picture of the disease to take shape before our eyes. We have to keep studying Organon, materia medica, provings, Hahnemann and Boenninghausen’s writings and works of similar value to keep our abilities honed and our homoeopathic knowledge checked and re-checked. We have to gain confidence in prescribing, in case-management, in effective follow-up.

Personal confidence is something every practitioner gains in time – in any field. But without confidence in our tools, that personal confidence is worthless. It’s worthless in the sense that if we are genuinely trying to work according to principle and don’t understand it, our confidence is a thin shell, a shiny veneer covering a world of insecurity in practice.

However, the worst expression of the worthlessness of personal confidence without true professional conviction is that those bumping up their levels of such personal confidence to overcome the lack of professional conviction are drawn to the new and the shiny, to developing their own new and shiny theories to astound the world.  As a result, they never investigate the tools properly, and learn to work faithfully and honestly to principle.

Something Hahnemann said in the Organon within a slightly different context seems an apt quote to close this post:

“A true homoeopathic physician, one who never acts without correct fundamental principles, never gambles with the life of the sick entrusted to him as in a lottery where the winner is in the ratio of 1 to 500 or 1000 (blanks here consisting of aggravation or death)…” (note to Aphorism 285).

Homoeopathy – on one leg…

Pulsatilla, anyone

“If it’s so easy, why isn’t everyone working this way?”

I was asked this question at a seminar I gave several years ago. This is a question that frequently puzzles us at the IHM. Because it is easy.

True, a lot of hard work is needed to get expertise, and then to improve expertise. To read, re-read, and analyze materia medica. To read and discuss cases. To comb the Organon and Hahnemann’s other writings for better understanding of the underpinning of homoeopathy – essential for prescription and case-management; for case-taking clues; for accurate work with remedies. It’s not always easy to get rid of our preconceptions regarding remedies, to learn to be able to prescribe Pulsatilla on prescribing symptoms whether the patient is a sumo wrestler or a petite, sweet blonde. It’s not always easy to focus on absolute, presenting symptoms when our learned “knowledge” is giving us all kinds of useless hints regarding constitutionals, core delusions, sensations and similar.

Jewish tradition records a story of someone who came to a venerable Rabbi and asked him to explain the entire teachings of the law while standing on one leg.

Well here’s homoeopathy on one leg. Take your case. Take only what has changed and is presenting for prescribing, against the backdrop of the patient’s life and habits. Only use symptoms you could swear to in a court of law. Use symptoms which show the individual expression of illness in your patient.  Look for a remedy that can produce similar symptoms in the healthy, and thus create a similar, slightly stronger, artificial state in your patient. Find the core of that information in the proving. Prescribe.

Still standing here…

The thing is, once you drop the theories, the speculations, once you move away from trying to be clever and insightful, you start looking at what is in front of you. You work with the information the patient gives you about his state of illness (morbid state) – not with your speculations about his personality, or information about whether he’s always loved chicken, or whether he played with Barbie dolls as a child. You work with what you can know about remedies – information contained in the provings. You work with some information gleaned from poisoning and clinical work.  Some of this information was chosen by Hahnemann for inclusion in his provings.   This information should only be taken from the most reliable practitioners (in case you didn’t get it, at the IHM we focus mainly on Hahnemann and Boenninghausen’s work). You put it together and prescribe.

Aphorism 3, my friends. And as the learned Rabbi is reputed to have said, now go and learn the rest…

Aphorism 273: If something is not necessary it is not permissible…

just another IKEA philosophy statement…

As I think people reading this blog are aware, I have no patience with those who relegate the Organon the status of philosophy, and thus consigning it to dusty shelves rather than using it as a manual of practice. It’s a bit like calling the instruction leaflet you get with your IKEA kitchen / bookshelf / cupboard “the IKEA philosophy statement”, and not referring to it when you try to build the darn thing.

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.