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.

 

 

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בונינגהאוזן ושיטת ה-LM – חלק 4: סיכום ומסקנות לגבי טיפול ב-LM

It was Boenninghausen’s opinion that the actions of the LM potency were very similar to the “our present high and highest potencies” . By 1863 Boenninghausen personally used the 200C potency made by Hahnemann’s methods and Jenichen’s 1M, 2M, 4M, 6M, 8M up to 40M. The Baron also had experience with Korsakov’s 1000th and 1500th . This offers a glimpse into the true medical powers of the LM potency. The Baron noticed that the recovery of both cases, one a dangerous acute disorder and the other a complicated chronic disease, was comparatively short and that the first action of the remedies could be clearly distinguished. This shows how the LM potency acts quickly and deeply yet these preparations have a different medicinal quality than the C potencies. Hahnemann’s opening potencies were between the 0/1 and 0/7. These seven degrees have remedial powers that are similar to the moderate to high potency centesimal remedies and must be treated with the greatest respect.

In over 20 years of comparing the LM with the C potency I would say that the LM 0/1 acts deeper and longer than the 30C. If one studies Hahnemann’s cases one comes to the conclusion that Hahnemann thought likewise. All things equal, I would say the LM 0/1, 0/2 and 0/3 act with a similar depth to the 200C or 1M although the durations might not be as long. The LM 0/4, 0/5 and 0/6 act as deeply as much higher potencies. To think the LM remedies are low potencies that can be repeated daily in every case is a big mistake.

This higher power yet slightly shorter duration can be used to one’s advantage in many chronic cases. This is because one can make more frequent adjustment of the dose, potency and repetition so that the remedy can be customized more artistically to the case. If one is continually forced to wait out overly long remedy actions, it is hard to make adjustments when the remedy is causing aggravations or accessory symptoms due to too large a dose or too high a potency. These long durations can also be counterproductive when the wrong remedy is chosen. Being able to adjust the size of the dose, the level of potency and the repetition according to the present time and circumstance has its advantages in complex cases.

The LM potency will cause strong aggravations when misused. I have seen it, my colleagues have seen it, and I have received many letters from patients who were strongly aggravated by receiving the LM potency daily or alternate days in a mechanical fashion. Many times they felt very, very good in the first week or so (strikingly progressive amelioration) and then got worse and worse because the dose was never slowed down or stopped. It is always best to either slow down or stop the remedy when there is a sudden great improvement. These are the clinical facts.

I have found that overmedication either causes the patient to become non responsive to the remedy due to overexposure or it causes aggravations that make them overly sensitive to the remedy. Sometimes this can make it hard to use even the correct remedy later in the case. The cases that are spoiled the most are those who only needed a single dose, infrequent doses or only a short series of doses but were never given a chance to respond correctly. What should be one’s “best case scenarios” turns into one’s “worst case situations”. One must be very careful with the LM potency because overmedication will cause aggravations, accessory symptoms or adverse counter actions of the vital force if abused. Hahnemann had some strong aggravations at times! Like all homoeopathic potencies, the LMs must be treated with the greatest respect!

Hahnemann spoke about raising the LM potency every 7 to 14 days in aphorism 248 but the Paris casebooks show that this was only a baseline example. He would sometimes raise his potencies very fast before the bottle was finished and in other cases he would keep the patient on the same potency interspersed with or followed by placebo for longer periods. Sometimes he would move up to find a better potency and at other times he would move downward because of aggravations. There was no fixed rule. The time of raising the potency was dependant on when the medicine was consumed, how much placebo he was giving, and the symptoms and circumstances.

I know that some give all patients the daily or alternate day dose and only stop if they see aggravations. This only reflects one aspect of Hahnemann’s method. It does not take into account what Hahnemann says in aphorism 246, Dr. Croserio’s eyewitness account or what is found in the Paris casebooks. Sometimes Hahnemann gave a single dose and placebos and other times he gave a series of split-doses at intervals like daily, alternate days, or on the third day, etc. It all depended on the cause, symptoms and circumstances affecting the patient and the action of the remedy. Hahnemann constantly alternated series of medicinal doses with placebos and waiting and watching. He used so many different methods that a simplistic mechanical approach cannot embrace his artistic techniques. As Croserio said,

“It would be impossible for me to give in a letter all the shadings of his treatment. By your constant correspondence with the learned sage you have had abundant opportunity to learn to appreciate his rare powers of observation, and you will therefore easily see that his mode of action was not always the same.”

Hahnemann varied the adjustments of the size of dose, the degree of the potency, and the intervals of repetition based on what the individual needed. He did not have one predetermined method that was supposed to suit all patients. The 6th Organon only contains baseline examples not a fixed mechanical method. He used single doses and infrequent repetition interspersed by placebo as well as frequent repetition daily, every other day, every three days, etc. One cannot oversimplify Hahnemann’s methods because “his mode of action was not always the same.” All of his case management strategies were individualized to suit the symptoms, time and circumstances.

There are too many people that think they can give the LM potency daily for long periods in a mechanical fashion. One patient was told to take the LM potency daily for 6 weeks just to test the remedy! The idea that one can give the daily dose for months is often separated from the words if necessary found in the footnote to aphorism 246. I have not seen one LM case in the Paris Casebooks where Hahnemann thought it was necessary. The Founder used almost as much placebo as medicine!

Hahnemann groomed Baron von Boenninghausen as one of his successors. That is why the Founder shared the methods of the LM potency with him before he passed away. The Baron knew the pharmaceutical methods of making the remedies as well as the case management scenarios necessary to safely apply the new dynamizations. Other than Melanie Hahnemann, Boenninghausen seems to be the only person who was privy to this information. He was well placed to teach the new system and comment on the ramifications of the 6th edition. It seems that this was the Founder’s original intention.

Melanie Hahnemann asked Boenninghausen not to release information about the LM potency until after she published the 6th Organon. Unfortunately, Madam did not complete the task and the Baron passed away before he was allowed to share his experience. Melanie was the only remaining person with knowledge of the LM potency, but unfortunately she never released the 6th Organon or Hahnemann’s casebooks. This was a great loss to the homoeopathic community as the 6th Organon and the LM potency became one of the lost teachings of Samuel Hahnemann.

In our times there has been a great resurgence of interest in Hahnemann’s advanced methods and the 6th Organon is finally receiving the attention it deserves. Although there has been some confusion and agenda-driven abuse of this subject, a group of mature homoeopaths is now spreading the true techniques throughout the world. I am sure Samuel Hahnemann would be pleased to know that his final efforts were not in vain.

I hope this information is useful to the homoeopathic community.

Similia Minimus,
Sincerely, David Little

את הטקסט המלא של המאמר ניתן לקרוא כאן

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 2: ניתוח ניהול מקרה של הנמן

Hahnemann Sends LM Cases to Boenninghausen

Hahnemann sent Baron von Boenninghausen two LM case histories in 1843, shortly before he left for his Heavenly Abode.  The Baron shared these cases with his colleagues in the Neus Archive f. hom, Heilkunst (Stapf’s Archives) Volume 1 number 1 1844, page 69. These cases can be found in Boenninghausen’s Lesser Writings in an article called, Three Precautionary Rules of Hahnemann, in the section called, 1. Warning, the Smallness of the Dose. These cases were very instructive as they show how the Founder administered olfaction as well as the oral medicinal solution of the C and LM potency.

The following case history has been checked with the original case found in the Paris Casebooks. This information was presented in an article by Hanspeter Sailer called Di Entwicklung von Samuel Hahnemann’s aertzukcger Praxis, Verlag, Haug, 1988. The Baron noted that Hahnemann dictated the example cases to a secretary and dated and signed the letter in his own hand. This was the last letter he received from his honored teacher.

On January 14, 1843 a patient referred to as O-T came complaining of sore throat alternating with an anal fissure. Sailer noted that the patient’s name was Varlet. For several years the patient had a sore throat but the present attack had lasted for one month. The last time he had a sore throat it lasted for six weeks. The patient reported that when he swallowed saliva he feel a pricking sensation with constriction and soreness. When he was not suffering from the sore throat he experienced a fissure of the anus with violent pains as from a chap. At this time, the anus was inflamed, swollen and constricted. The patient could only discharge his stool with great exertion with swollen, extruding hemorrhoidal veins.

1. January 15, 1843 – Belladonna in a 7 tablespoon solution.

Hahnemann prescribed Belladonna for sore throat on the 14th but told the patient to take the remedy the next morning on an empty stomach before breakfast. The potency was not noted in his letter to Boenninghausen but Sailer confirmed that it was the LM 0/3 from the original casebook. The patient was instructed to put one tablespoon of the medicinal solution into a glass of water, stir it well and take one coffeespoon as a dose.

2. January 16 – Merc. 0/1 in a 7 tablespoon solution.

The throat ache was gone but the fissure returned immediately! This shows that these conditions were related. The patient then revealed that eight years earlier he had a syphilitic chancre that was destroyed by corrosives. All his problems started after the suppression of the syphilitic miasm. Hahnemann immediately prescribed Mercury 0/1, his cardinal anti-syphilitic remedy. The fissure and the chap were very painful. How often he gave the dose is not noted. This may be a daily dose as the symptoms were in an acute-like crisis. The Mercury 0/1 was to be prepared and taken in the same way as the Belladonna.

3. January 20 – Merc. 0/2 in 7 tablespoons.

The patient returned for his check up 4 days later. This example shows how closely Hahnemann was following this rather serious case at the start. There are no “take this daily for one month” prescriptions in his casebooks. The patient’s throat pain returned slightly and the anus was better although there was still soreness during stool. At this time, Hahnemann raised the potency! The journal says: “One pellet of the Mercurius viv., 2 dynamization, prepared and taken in the same manner in the morning”. If the patient took the Mercury 0/1 in the “same manner in the morning” the 7 tablespoon medicinal solution would not be finished yet. Nevertheless, Hahnemann immediately raised the potency to 0/2.  This shows that the Founder raised the potency when he considered it necessary and did not always wait for the bottle to be finished.

4. January 25 – Sailer says Hahnemann gave 2 placebos. This is not in Boenninghausen’s text.

The 0/2 continued to improve the throat but there was severe lancination in the anus. This may have been a similar aggravation caused by the remedy. The patient was then given 2 placebos. It seems these two placebos were alternated with the remedy so he was now taking the alternate day dose.  This can be deduced because Hahnemann wrote on Jan. 30th that the patient had taken the last dose of medicine that afternoon. He only had 7 doses and this was 10 days later so he could not be taking the remedy daily. The Mercury 0/2 was taken daily for 4 days and then slowed down to alternate days interspersed with placebo. This shows Hahnemann slowing down the remedy, which is an important method used to prevent overmedication. The daily dose of Mercury was not continued.

4. January 30 th – 7 days of placebo in medicinal solution.

The anus was now better but the throat was worse. This shows the alternation of the symptoms still continuing although the symptoms are a little better in general. There was no particular aggravation yet Hahnemann decided to give placebos for 1 week and wait and watch. He must have observed enough medicinal action so he stopped the remedy. This prescription demonstrates how the Founder alternated periods of active doses with periods of placebo and waiting and watching.

5. February. 7 – Sulphur 0/2 in 7 tablespoon solution.

The anus was still well but there was severe pain as if an ulceration in the throat. Hahnemann wrote in The Chronic Diseases that the suppression of syphilis could cause a flare up of psora that obstructs the cure. On this basis, Hahnemann gave Sulphur 0/2 as a chronic intercurrent remedy. It was his hope that this anti-psoric remedy would assist the action of his anti-syphilitic remedy in removing the complex miasmic disorder. Exactly how often the remedy was administered is not noted. Just because the patient returned in one week one cannot assume it was a daily dose but it may have been.

6. February 13  – Mercury olfaction.

The Sulphur brought out clear Mercury symptoms on the 11th and 12th. The throat felt ulcerated and the saliva was increased and now was in great quantities! This was a sign that the anti-psoric intercurrent had an effect on the overall symptom pattern. There was also some constriction in the anus from yesterday. Rather than alternating, the symptoms were both present at the same time. At this time, the patient was given a single olfaction of Mercury, potency not noted.

7. February 14 – Merc 0/2 in 7 tablespoon medicinal solution.

Hahnemann now gave the patient a medicinal solution of Merc. 0/2. This was to be taken “as before”. Hahnemann kept the patient on the same potency as given on January 20th, around 25 days previously. In this case he did not raise the potency every 7 or 14 days as suggested by the example in aphorism 248 of the 6th Organon . This shows that the paragraph is only offering a baseline example, not a rigid predetermined schedule. Hahnemann individualized all these procedures. In one prescription he raised the potency before the bottle was finished and in others he kept the patient on the same potency for longer periods.

8. February 20 – Placebo in 7 tablespoon medicinal solution.

The throat was better since the 18th but there was much suffering at the anus. There seemed to be strong aggravation so Hahnemann waited and watched for around 11 days.

9. March 3 – Single Dose Olfaction of Nitric Acid.

After the aggravation passed the symptoms of the patient improved. The sore throat was now ameliorated. On going to stool a hemorrhoidal vein still extrudes although it did not cause as much pain as before. Now there is only a bit of itching in that spot. Hahnemann wrote, “I let him smell of Ac. Nitr.” Sailer confirms that this prescription was a single inhalation of the remedy. In this example, Hahnemann is using this method to give a gentle but deep dose toward the end of the treatment in an effort to complete the cure without aggravation.

10. March 20 – Single Dose Olfaction of Nitric Acid. (Patient cured)

Now there was hardly any pain after stool, throat well, although he feels some sensation on drinking cold water. Hahnemann wrote, “Now he is allowed to smell of Ac. nitr.” This means that before this and since March 3rd the patient was not allowed to smell Nitric acid! This dose was allowed to act over a period of 17 days. How long the second olfaction acted one cannot tell from the record because Hahnemann only wrote, “His health was permanently restored”. The prescriptions in this case show the following pattern.

1. Jan. 14, 1843. Belladonna in LM 0/3 in a 7 tablespoon solution.

2. Jan 16. Merc. 0/1 in 7 tablespoons medicinal solution.

3. Jan. 20. Merc. 0/2 in 7 tablespoons medicinal solution.

4. Jan. 25. 2 placebos to be alternated with final doses of the Mercury.

4. Jan. 30. 7 days of placebo in medicinal solution.

5. Feb. 7. Sulphur 0/2 in a 7 tablespoon medicinal solution.

6. Feb 13.  Merc. olfaction.

7. Feb 14. Merc 0/2 in a 7 tablespoon medicinal solution.

8. Feb 20. Placebo in a 7 tablespoon medicinal solution.

9. March 3. Single dose olfaction of Nitric Acid (17 days on an olfaction).

10. March 20. Second single dose olfaction of Nitric Acid (Patient cured).

What does this case tell us? First of all, Hahnemann’s prescriptions were individualized according to the cause, symptoms, miasms and attending circumstances. He did not use preconceived schedules over long periods of time. He responded to each change in the symptoms and customized his case management methods according to the time and circumstances. Secondly, this case shows how the Founder often interpolated and followed his medicinal doses with a series of placebos. In this example the patient spent around 37 days on placebos over a period of 64 days! The idea that Hahnemann gave the daily dose for weeks, months and years on end is a complete myth!

Hahnemann’s case examples offer a true picture of how Samuel Hahnemann actually practiced in Paris in the 1840s. Over the last 8 or so years I have reviewed scores of LM cases that show a similar pattern. Hahnemann used single doses (usually by olfaction) followed by placebos as well as a series of oral doses interpolated with and/or followed by placebos. Hahnemann did not speak about his liberal use of placebos in the 6th Organon. This may have been because he did not want to state this in a public work, as the placebo was his “secret simillimum”.  If the public found out it could have caused problems.

Hahnemann never gave the daily dose or alternate day dose for long periods without stopping the medicine, giving placebos and waiting and watching. Some patients remained on placebo for 7, 14 , 21 or even more days at times. This “on again – off again” technique was used with all of his patients. I have not seen a single case in the microfiches of the Paris casebooks between 1840 to 1843 where Hahnemann gave the daily or alternate day dose of the LM potency for months without stopping the remedy and giving placebos. This is true in the Casebooks DF-10, 11, 12, 13, 14, etc., which are replete with LM prescriptions

Any time there is a noticeably progressive and strikingly increasing amelioration the LM potency should not be repeated as long as this state lasts. These cases may be cured by a single dose or infrequent repetitions of the remedy. If the patient is only slowly improving, the remedy should be repeated at suitable intervals to speed the cure. Any time during the treatment that there is a sudden strikingly increasing amelioration, or an aggravation or strong accessory symptoms, the dose should be stopped as long as the state lasts. In the case of light to moderate similar aggravation it is usually best to wait and watch for the expected amelioration. In the case of strong aggravations, obstructive accessory symptoms, and the appearance of new troublesome symptoms, the situation should be rectified by skilful intervention to regularize the symptoms.

As long as the patient is improving at a reasonable rate the remedy should be repeated at suitable intervals to speed the cure. In “protracted diseases” the remedy may be repeated daily or on alternate days, if necessary, to speed the cure in otherwise long drawn out cases. The more frequent repetition may be used as long as the patient is improving and there are no aggravations or new symptoms. As the patient improves over time it is best to slow down the repetition of the remedy as the potencies are increased to prevent aggravations.

If there is an aggravation toward the end of treatment when the patient is well in most respects this is a sign of that the cure is reaching completion. To test this scenario one stops the medicine, gives placebo if necessary, and waits and watches. If the aggravation is followed by a period of amelioration and then a relapse of symptoms, the remedy should be again administered but at longer durations until the cure is complete. If the aggravation is followed by the complete restoration of health the remedy is no longer needed. This is the case management method of the 6 th Organon in a nutshell.

 

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!