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 .

Back to the Organon

So who is the best person to ask about any method – the person who discovered and developed it, or the student who interpreted it? We often don’t have a choice – the originators are unavailable, deceased, or their work is inaccessible.

However, in homoeopathy we have the luxury of seeing Hahnemann’s words, speaking to us from 200 years ago. And it’s not as if he was an esoteric hermit mumbling around his pipe in some hidden chamber, with one trusted aging student to decipher his words. Hahnemann was active. He experimented, pondered, taught, and wrote constantly. His writing is pithy, his rants heartfelt and sometimes elegaic, and he writes with a directness and often with a sharp sense of humour. But I’m not writing literary criticism here. The Organon was intended as a manual, to explain the principles of homoeopathy and present how to practice.

So what do I need to know in order to practice? See Aphorism 3 which gives the basis, the optimal syllabus for any course in homoeopathy.

How do I work with patients with mental issues? What’s the connection between mental and physical diseases? see from Aphorism 214.

Watch out not to make favorites of some remedies and neglect others? Aphorisms 257 and 258

What to do about sensitivity? How to relate to aggravation? How to prepare LM remedies? Exactly how to take a case? How to manage a case? What kind of questions to ask? What to focus on in a case? What symptoms will be more helpful in determining a remedy? What symptoms, although undeniably present, must be set aside in the process of choosing a remedy?

Or even what cooks in Hahnemann’s time did to avoid kitchen burns? (hint, it’s in the introduction, see here for my personal experiences with the method)

Here’s a rant about mineral spas – this one’s quite mild but you can hear Hahnemann’s voice (and black sense of humour) loud and clear:

A genuine physician and practitioner of our art will therefore never send the sick to any of the numerous mineral baths, because almost all are unknown so far as their accurate, positive effects on the healthy human organism is concerned, and when misused, must be counted among the most violent and dangerous drugs. In this way, out of a thousand sent to the most celebrated of these baths by ignorant physicians allopathically uncured and blindly sent there perhaps one or two are cured by chance more often return only apparently cured and the miracle is proclaimed aloud. Hundreds, meanwhile sneak quietly away, more or less worse and the rest remain to prepare themselves for their eternal resting place, a fact that is verified by the presence of numerous well-filled graveyards surrounding the most celebrated of these spas.

Yes, the language is a bit archaic. Translations either become too interpretive, or by sticking to the structure of the original German give us long convoluted sentences. As Mark Twain put it:

When a German dives into a sentence, you won’t see him again until he emerges at the other end with the verb between his teeth.

See here if you want to learn more about Mark Twain on the German language

A quote that gives significant insight into how Hahnemann thought is to be found at the end of Chronic Diseases. The full quote is eerily prophetic – I will present it in a future article:

“this true theorem is not to be reckoned among those which should be comprehended, nor among those for which I ask a blind faith.  I demand no faith at all, and do not demand that anybody should comprehend it.  Neither do I comprehend it; it is enough that it is a fact and nothing else.  Experience alone declares it, and I believe more in experience than in my own intelligence.“

Videos, stills and nagging – dosing in homoeopathy

Jerusalem Homeopathy Clinic

I’m writing this because lately I have been asked, on the one hand, why I prescribe so many remedies – and on the other hand, why I prescribe so few doses.  It all boils down to videos, stills and nagging…

Do people essentially remain the same, or do they change the whole time? And when someone gets sick, does that mean they’re in a different place, a different state to when they are healthy – or are they still basically in the same state and just need a little tweaking?

In essence – is the human being a dynamic video, constantly shifting and changing, or are human beings just a series of stills photographs with occasional retouching?

Samuel Hahnemann, the founder of homoeopathy, saw the human organism as highly dynamic, constantly shifting and changing.  The job of the homoeopath, as defined by Hahnemann in his Organon of Medicine (first version…

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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.

 

 

Workshop 15th November – and who’s in love with provings…

Earlier this week, I was accused of being in love with provings.  To be a bit more precise, I was told “you’re in love with them – but no-one else is interested.  Wake up and smell the antidoting coffee…” or words to that effect.

But, as I explained to my insistent interlocutor, I’m not in love with provings.  I’m in love with certainty in prescribing.  And one of the best ways to achieve that certainty is through – ta-da! – provings.

Even the best prescribers among us have to deal with some uncertainty – it’s part of what goes on in treatment.  We can’t know the exact level of resilience a patient has, how much he or she can be restored to health.  We can’t always know how sensitive the patient is to remedies at the outset.  And we can’t know what the patient has not told us – the vaccination he was embarrassed to report, the home herbal remedy he was convinced wouldn’t interfere with treatment.

So personally, I take whatever certainty I can get, and knowing how to study and work directly with provings helps me towards the certainty I crave…

A little girl, a newborn, was suffering from a rash.  There wasn’t much to go on and several remedies were indicated.  I went through them looking for the eruption, and Phosphorus turned up trumps, with a description  that fitted my little patient’s rash perfectly.  The remedy also contained several others of the few presenting symptoms in the case.  When I gave the remedy, I had a great degree of certainty that it would help my patient, because I knew for a fact that this substance can cause this symptom in a healthy person.  And that, dear readers, is what homoeopathy is all about.

I’ll be giving a workshop on the study of provings in a couple of weeks.  It will be a hands-on hard work seminar – you’ll come out of it knowing how to study provings and you’ll have a clearer idea of how to work with provings in prescribing.

Where?!  Jerusalem, exact location to be announced.

When?!  on Wednesday 15 November, from 9:45-13:30

How much will it cost?!  NIS 370

Any early bird reduction?!  Of course, NIS 320 for those who pay by Friday 10th November.

To register? Write to me on vera.homeopath@gmail.com.

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I’m considering giving the workshop online at a different time.  Please write to me on vera.homeopath@gmail.com or using the contact form if you’d be interested in such a workshop. 

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The art of Medicine: The “state”

another kind of state…

By GARY WEAVER

In homoeopathy, we often talk about the “state” of a patient. The phrase, as well at the reality is that the “state” of a person is actually the full picture of the disease.

“The particular condition that someone or something is in at a specific time.”

The state represents the symptoms of a disease in its entirety. It is the picture a reactive process either mentally, emotionally or physically. It is how the pathology is arranged at a given moment or time.

Viewed through proving: a sideways look at Oleander

Hahnemann writes about Oleander: “It will be found to be if not a complete remedy yet an indispensable intermediate remedy in some kinds of mental derangements, e.g. absence of mind, and in certain kinds of painless paralysis, in eruptions on the head, and some external head affections.”

Viewed through proving: Camphor – a brief overview

One last post before leaving Camphor.

This proving of 345 symptoms does not go far enough in understanding the extent of Camphor’s potential use. Hahnemann stated in his introduction that (bold is mine):

“In its curative action camphor is just as puzzling and wonderful, for it removes the violent effects of very many, extremely different, vegetable medicines (and even those of the animal drug cantharides and of many mineral and metallic drugs), and hence it must have a sort of general pathological action, which, however, we are unable to indicate by any general expression; nor can we even attempt to do so for fear of straying into the domain of shadows, where knowledge and observation cease, whilst imagination deceives us into accepting dreams as truth; where we, in short, abandoned by the guiding of plain experience, grope about in the dark, and with every desire to penetrate into the inner essence of things, about which little minds so presumptuously dogmatize, we gain nothing by such hyperphysical speculations but noxious error and self-deception.”

Organon Audios: Aphorisms 1-9

This is a new project – opinions please…

(and for the observant, there are at least two misread words…, I know…)

10 Tips for working with homoeopathy provings

Some things are certain…

Don’t think I haven’t noticed. Some of you are very interested in articles on provings, and some of you avoid them like the plague. It would be easy enough to blame it all on students who don’t want to read lengthy shopping lists of gory symptoms – but many, if not most practitioners don’t read provings either.