Tag Archives: dry dose

Dry-dose envy…

glass cup street musician

glass cup street musician

I envy dry dose prescribers in chronic cases. There, I’ve said it.

When you prescribe dry dose, you (frequently) get to give the patient a remedy to take and send them away for 4-6 weeks.https://pandwisrael.wordpress.com/wp-admin/post.php?post=2098&action=edit

Aggravation? Of course there’s aggravation, as you explain carefully to them. No pain, no gain, right? And painfulness is right up there with godliness, correct? But the amelioration is so worth it… Continue reading

בונינגהאוזן ושיטת ה-LM – חלק 3: מכתב של ד"ר קרוזריו

Dr. Croserio’s Letter

Boenninghausen shared the two LM cases sent by Hahnemann in Stapf’s Archive. Dr. Stapf raised a number of questions about the Founder’s revolutionary new methods. In order to answer these queries the Baron sought help of Dr. Croserio, who was a close colleague of Samuel and Melanie Hahnemann. Only Croserio and Jahr were invited to Hahnemann’s deathbed to see the Founder lying in state. Dr. Croserio assisted Melanie in her practice after the Founder passed away and defended Melanie in court when she was charged with practicing without a license. For these reasons, I call him “faithful Dr. Croserio”.

Dr. Croserio responded to Boenninghausen with a letter written on Jan. 28th, 1844 that was published with Boenninghausen’s commentary in the Neus Archive f.hom, Heilkunst Volume 1 number 12, 1844. This letter may be found in Boenninghausen’s Lesser Writings, in an article called Hahnemann’s Doses of Medicines. The Baron wrote:

“In order to be quite sure as to the matter I applied to those homeopaths in Paris, who were most intimate with Hahnemann, visited him almost daily, and in consequence, were best informed as to his practice during the last times , namely, to Dr. Croserio, from whom I had before had a very friendly communication, could therefore also feel sure that he would give me as detailed an account as possible.”

Hahnemann’s Paris casebooks contain only personal notes of the Founder’s practice and leave many questions unanswered. He rarely wrote down exactly how often he was administering his remedies. Boenninghausen understood this, and for this reason he sought an eyewitness account to fill in the details. Dr. Croserio’s letter is a very valuable testimony because it gives insights as to how Hahnemann actually practiced in the clinic. Dr. Croserio wrote:

“As to his [Hahnemann’s] mode in which he prescribed the medicines to be taken I am able to give you all the information that you may wish, as I have quite frequently been witness of it.”

Croserio confirmed that Hahnemann was dissolving 1, or rarely 2, tiny pills into 8 to 15 tablespoons of water and taking a tablespoon of this solution and stirring it into a tumbler of water. He notes that Hahnemann would start with 1 spoonful of the solution from the tumbler and increase this amount on successive doses, if necessary:

“until he observed some action.”

“Then he [Hahnemann] would diminish the dose or would stop the medicine.”

Dr. Croserio stated that when Hahnemann saw definite medicinal action he either diminished the dose or stopped the remedy and gave the patient placebo. This is an extremely important observation of a technique that is not clearly elucidated in the 6th Organon. This pattern, however, was witnessed in the case of O-T where Hahnemann used almost as much placebo as medicine. This is common to all the cases found in the Paris casebooks.

Dr. Croserio stated in his letter that Hahnemann frequently gave single doses by olfaction . The doctor wrote:

“Hahnemann in the last years of his practice seemed to devote his whole dexterity to continually diminish the doses of his medicines. On this account he in the last years frequently contented himself to allow his patients to smell of the medicine. In chronic diseases he would in no case allow the patient to smell at the medicines oftener than once a week, and would give nothing but sugar besides; and in this way he would make the most admirable cures, even in cases where we others had not been able to do anything.”

Dr. Croserio noted in his eyewitness account that Hahnemann “frequently” gave single doses by olfaction followed by at least 7 days of placebo. The Paris casebooks confirm the fact that the Founder often administered single doses by olfaction and occasionally by oral solution and gave the patient placebo for at least 1 week! In some cases he would wait for longer periods than 7 days, even up to 14 or 21 days before repeating the dose. Some patients received infrequent olfactions and placebos almost exclusively. This proves that Hahnemann did not always use the daily or alternate day dose. His method was artistic not mechanical and was individualized by the symptoms, time and circumstances.

Sometimes Hahnemann gave a single dose followed by at least 7 days of placebo while he waited and watched. At other times, he gave a short series of 3 to 7 doses over a period of seven days and had the patient come back in one week. At this time, he would re-evaluate the case. If the remedy caused a strong medicinal action or an aggravation, he would give the patient placebos for another seven days. When there was a strikingly increasing amelioration he also would stop the repetition as long as this state lasted. If he thought he needed more medicinal action he would continue the repetitions for another week.

In this way, Hahnemann individualized his case management strategies. He did not give the C or LM potency daily in a mechanical manner over long periods. He constantly interpolated and followed his medicinal doses with placebos at different intervals during the progress of the case. This balance of single doses and infrequent repetitions and split-doses at rapid intervals to speed the cure offers a wide range of methods in the clinic. The idea Hahnemann gave the daily dose to everyone is a complete falsehood.

These are very important details that do not come through clearly in the 6th Organon. That is one of the reasons why it is not sufficient to try and practice only by the text. One must study Hahnemann’s casebooks and eyewitness account of his practice to grasp the whole method. One also needs to consult those who have experience with Hahnemann’s true clinical methods. The Founder frequently alternated a period of medicinal doses with period of placebos throughout the treatment. In this way, he found a perfect balance between acting and observing and waiting and watching. Boenninghausen commented further on this important aspect of Hahnemann’s practice.

“This passage in the communication of Dr. Croserio give the most clear and complete exposition of the mode practiced by the closely observing Master of the art during the last times, on his patients, and explains most satisfactorily what might have appeared obscure in the two cases lately reported. The addition “until he felt an effect” is of the greatest importance, and must always be closely observed, in order that nothing may be spoiled afterwards by giving too much or too often.

Dr. Croserio also notes:

“In order to pacify the patients or their relatives he frequently allowed them to take simple sugar of milk”

Hahnemann called placebos a gift from God in the Chronic Diseases. He used placebos to satisfy his patients and their relatives and to keep the clients away from other medicines. Many of his patients were so conditioned to the idea that they needed medicine daily that it was necessary to use placebos. Sometimes their relatives were even worse than the ill person! In my practice I try to educate my clients to the fact that homeopathic remedies have actions that last for long durations and they do not need medicine daily under most circumstances.

There are, however, situations where the placebo is a very useful tool. The most common example is when there is an aggravation or healing crisis that will pass off quickly but the patient is desperate for help. Here the placebo effect often provides the attention, comfort and psychological relief necessary to pass through a difficult moment. This is a trade secret that should never be related to the patient or other persons even to make a point. Placebo is a psychological simillimum for the patient who thinks they need medicine when they do not.

The LM remedies are not a “low potency” system. One cannot compare the C and LM potency solely by the amount of the original substance left in the dilution. There is a great difference between a mathematical and dynamic equivalence. 1 pill of the LM 0/1 potency in an 8 tablespoon solution has around the same amount of medicinal substance as the 6C but its power is much greater due to its 1/50,000 dilution and 100 succussions per dilution. Boenninghausen was well aware of this fact. In 1863, just one year before his death, the Baron reminisced over the two LM cases Hahnemann had sent him in 1843.

“Of the other remedies used in these two cures (Sulphur, Mercurius, Nitric Acid), new dynamizations were used, which will be described in the next edition of the Organon , the peculiar preparation of which is known to me and which requires less time and trouble, but essentially presents our present high and highest potencies, but having given my word of honor, I am not as yet at liberty to publish the same. Also these the preparations were given in the dose of one single pellet either dissolved in just as much water, or applied by simply smelling of it. By means of these before unheard of minimal doses, there was effected a restoration of both these cases in a comparatively short time; the first of these cases was an acute ailment of the brain, the other a chronic complicated disease. It is especially curious that the proper action of these remedies, and even their first action, could be clearly distinguished in the course of the disease.”

The Lesser Writings; C. M. F. Boenninghausen , Boenninghausen’s Last Work, Atropa Belladonna L, page 316.

בונינגהאוזן ושיטת ה-LM – חלק 1

מאחר שרוב הומאופתים היום עובדים בעיקר על פי שיטות המהדורה הרביעית של ה”אורגנון” במינון יבש (dry dosing) ,  חלטתי להביא קטעים מתוך מאמר מצוין של דוד ליטל על דרך עבודתו של הנמן לקראת סוף חייו. בדיון שלו, דוד ליטל מציג תכתובת בין בונינגהאוזן והנמן,  עדות ראייה של ד”ר קרוזריו בנושא מרפאתו של האנמן בפריז,  ודיון בשיטות של הנמן כפי שהם מופיעים מתוך סיכומי מקרה שלו מפריז   (The Paris Casebooks).

Hahnemann’s Final Methods

Shortly before Samuel Hahnemann passed away he shared the method of administering the LM potency with Baron von Boenninghausen. After Samuel’s death Melanie Hahnemann told the Baron von Boenninghausen that the 6th Organon would soon be published. When he announced this event to his colleagues, Melanie asked him to remain quiet on the subject until after she published the work. Out of respect for Hahnemann’s widow the Baron did not disclose all the information in his possession. Apart from Samuel and Melanie Hahnemann it appears that only Baron von Boenninghausen had tested the LM potency in the clinic. In 1857 the Baron wrote:

“In the new edition of the Organon which will probably appear yet in the course of this year, improved and completed by Hahnemann himself, a new simplified procedure for the potentizing of medicines will be taught, which has considerable advantages over the former and yields a preparation as to the efficacy of which I can, from my own experience, give full praise. I know this procedure but according to my pledged word of honor, am not as yet permitted to communicate it to anyone.”

The Lesser Writings; C. M. F. Boenninghausen, Aluminium Metallicum, footnote, page 74.

In this quote Boenninghausen clearly states that the praise he lauded on the new dynamizations was based on his “own experience”. He would not have used these words unless he had tested the LM potency personally. The Aluminium cases quoted in this article are dated 1856 to 1857, which shows this statement must have been made at least 14 years after Hahnemann’s passing. Unfortunately, the 6th edition remained unpublished until Richard Haehl’s edition appeared in German in 1920 and the Boericke edition in English in 1921. By that time, all those with first hand information on how Hahnemann actually used the LM potency has passed away.

There is quite a bit of confusion about Hahnemann’s Paris methods in general and the LM potency in particular. The most controversial area arises over the subject of the daily and alternate day dose. This is because it is very difficult to learn how to use the LM potency properly just from reading the text of the 6th Organon without a lineage of teachers going back to Hahnemann. The only way to understand the bigger picture is to study the final edition along with the Paris Casebooks and remaining eyewitness accounts. First of all we will review exactly what the 6th Organon actually says about posology and case management.

Aphorism 246 gives the most precise details on how to administer the LM potency. The statements made in this paragraph must be put in context with the information presented in aphorism 248 about the daily and alternate day dose. Here Hahnemann clearly says, “Every noticeably progressive and conspicuously increasing improvement is a state which, as long as it persists, generally excludes any repetition of the medicine.” This is because the remedy is “hastening toward completion” at the quickest possible speed and any repetition may slow down the cure or cause a relapse of symptoms. This reflects what Hahnemann said in aphorism 245 of the 5th Organon on the single dose.

Then Hahnemann says, “On the other hand” some patients experience only a “slow, continuous improvement based on one dose of a aptly selected homeopathic medicine (taking 40, 50, 60 100 days to complete the cure, depending on the nature of the medicine) but this is very seldom the case.” It is much more common for the slow remedy action to cease and the patient to relapse. Then the Founder goes on to state how important it is to “foreshorten this period” to 1/2, 1/4 or less so that a more rapid cure is attained. This reflects what Hahnemann said in aphorism 246 of the 5th Organon on repeating the remedy to speed the cure.

Hahnemann makes it very clear that there are two major types of remedy actions that must be treated differently.

A. The first condition is a visibly progressing and strikingly increasing amelioration. In this instance Hahnemann says to leave the single dose to act without repetition as long as this state lasts. This statement also applies to any time during treatment that there is a dramatically increasing amelioration on a series of doses. I would like to report that my colleagues and I have witnessed several cures of chronic diseases with single and infrequent doses of the LM potency.

B. The second remedy action is a slow continuous improvement that could take up to 100 or more days to cure. Some cases show little or no response to a single dose although the remedy is correct. This is because the sensitivity of the patient and the nature of disease state require more medicinal stimulation. In this case one should repeat the dose at suitable intervals to speed the cure. This is quite common in protracted chronic disease and complex miasms. One may repeat the dose to speed the cure only if they follow all five conditions noted at the end of the paragraph.

1. The remedy is perfectly homoeopathic (Not a wrong remedy or a partial simillimum.)

2. The remedy is potentized and dissolved in water. (Not the dry dose.)

3. The remedy is given in a small dose (1 pill in a 7-8 tablespoon medicinal solution, given in a split-dose, etc.)

4. The remedy should be given at suitable intervals based on what experience has shown to be the correct timing. (Individualization.)

5. The degree of dynamization must be changed on each dose (The medicinal solution must be succussed prior to ingestion to slightly raise the potency.)

There is a great difference between a visibly progressing and strikingly increasing amelioration and a slow continuous improvement that may take up to 100 days to show any significant improvement. In most cases of slow improvement the patient tends to relapse rather than progress to cure. What Hahnemann is offering is a very clear differential analysis of two different types of remedy actions. When the patient is already hastening toward cure on single or infrequent doses the cure does not need to be sped! If the remedy is repeated under these conditions it will either slow down the action of the previous dose, aggravate the patient, or cause a relapse of symptoms. In the footnote to aphorism 246 it says the LM may be given daily “when necessary”. It does not say to give the LM potency to everybody no matter what!

All the statements about the daily and alternate day dose that follow in aphorism 248 are about how to speed the cure in slowly improving cases. These are the cases where one needs to foreshorten this period to 1/2, 1/4 or less the time so that a more rapid cure is attained. In aphorism 248 Hahnemann says that the remedy may be repeated daily or on alternate days in “protracted diseases”, which means long drawn out and prolonged illnesses. If the patient is experiencing a strikingly increasing amelioration on a single dose or a short series of doses, the repetition of the remedy is counter indicated as long as this state lasts. These aphorisms teach when it is best to wait and watch and when it is best to act and observe. This is the best of both worlds!