Aphorisms 246, 247 and 248 of the 6th Organon.2

[David Little]

Dear Colleagues,

I would like to share some of the experience I have gather over the
last 20+ years I have been giving the LM potency. When I first read the 6th
Organon I underestimated the importance the 1st sentence of aphorism 246,
which speaks of not repeating the remedy during a noticeably perceptive and
strikingly increasing amelioration. This is because I mistakenly associated
this phenomena only with Hahnemann's "old method". I only focused on the
second part of the aphorism 246 which deals with speeding the cure of
chronic diseases and aphorism 248 which teaches the use the daily and
alternate dose in protracted chronic diseases. At this time I started my
chronic LM cases with either the daily or alternate day dose and continued
this dose unless there was an aggravation or new symptoms.

This method worked well enough on a good number of cases but I found
that a significant number of patients aggravated rather quickly on these
rapid repetitions. I tried to use several dilutions glasses but this did
not help most of these patients. I found that daily and alternate day dose
aggravated too many cases no matter how I adjusted the dose. In some
patients strong aggravations appeared after only 1, 2, 3, 4, or 5 doses,
etc. This meant I had to stop giving the remedy and wait out the
aggravations in a decent percentage of cases. The cycle in these cases was
give the split-doses - aggravate - wait out the aggravation - repeat the
split-doses - aggravate - wait out the aggravation again and on and on..
There seemed to be no way around these aggravations with the methods I
understood at the time.

At the same time, I noticed there was a some cases where the patient
improved dramatically at first on the split-doses but then they would
relapse or experience strongly aggravations. No matter how I adjusted the
doses after this I could not reinstate these dramatic reactions very
easily. Many patients only improved slowly or moderately over a longer
period of time after these complications. I asked myself why did these
remedies cause a dramatic improvement at the start of the repetition and
then no longer work as well?

Although I was having very good success in many cases the number of
aggravations and relapses after a dramatic improvements greatly bothered
me. This reminded me of what happens when one repeated the dry dose to
soon or too often. This did not seem right according to the new method.
What was I doing wrong? These failures are what lead me back to reading the
6th Organon more carefully and searching for answers. Then I again read
sentence 1 of aphorism 246 which says:

"Every perceptible progressive and strikingly increasing amelioration
during treatment is a condition which, as long as it lasts, completely
precludes every repetition of the administration of any medicine
whatsoever, because all the good the medicine taken continues to effect is
now hastening towards its completion."

At this point I realized that what Hahnemann was saying in the 1st
sentence of the aphorism 246 might be important! Hahnemann said in "every
perceptible and strikingly increasing amelioration during treatment" the
remedy should not be repeated. He did not say only in acute diseases,
Hahnemann said "EVERY". This statement could be applied to the beginning,
middle and end of the treatment. What if I stopped the remedy when I saw a
dramatic noticeably perceptive and strikingly increasing amelioration?
Would that solve some of my problems? I had to test the method to find out.

Anytime, I saw a dramatically progressive and strikingly increasing
amelioration I began to stop the dose as long as this state lasted. I was
pleased to see that there was a significant group of patients where this
effect happened. I was amazed when in many of these cases the strikingly
increasing amelioration lasted for many days and even weeks! In some cases
it lead to very speeding cures of some very old chronic diseases without
any repetition. In some patient the effect was extraordinary! These
experiences made me really respect what Hahnemann says in the 1st sentence
of aphorism 246.

For this reason, I began to a single test dose or a short series of test
doses over a period of one week or so at the start of treatment. After this
testing period I acted according to the action of the remedy on the
patient. If there was a strikingly increasing amelioration I did not repeat
the remedy as longs as this state lasted. At this point I decided it was
irresponsible to make up predetermined schedules in advance. Now every case
needed to go through a testing period so I could individualized the case
management and posology to the sensitivity of the patient and the action of
the remedy. In cases that do not show a striking response I begin to repeat
the remedy at suitable intervals like daily and alternate days for another
week and see what happens. In some patient I deem a little more sensitive I
may give the remedy every three or four days.

There were still some patients that were aggravating during the course
of the treatment. What would happen if I slowed down the daily and
alternate day repetitions to every 3 or 4 days when the patient started to
show significant improvement? Hahnemann suggested a similar action in his
teachings on how to complete the cure in aphorism 281. Could this prevent
some of the aggravations I witnessed on the daily and alternate day dose? I
decided to test this idea in the clinic. Many patients that were prone to
aggravations on continuos daily and alternate day repetitions did much
better when I slowed down the repetitions after witnessing significant
improvements.

I also noted that hypersensitive patients could not tolerate the
repetition of the remedy every day or every other day no matter how many
glasses the remedy was diluted in. That meant that hypersensitive patients
had to be treated in a special manner. So when I treated overly sensitive
patients and those with a history of easy aggravation I gave them a single
dose and waited and watched for at least 4 to 7 days or more. Then I
assessed their progress and acted accordingly. I was please to see that
patients who aggravate quickly on a series of split-doses did wonderful in
single doses and infrequent repetitions! Those who were hypersensitive did
very well when starting with a single dose.

When I read the two LM cases Hahnemann sent to Boenninghausen in 1843.
I immediately noticed how much placebo Hahnemann was really using. He was
not repeating the LM potency daily or alternate day dose for weeks and
months on end! He was using an "on again - off again" method based on the
action of the remedy. I also noticed that Hahnemann gave single doses by
olfaction and waited for longer periods before repeating the olfaction! Dr.
Croserio confirmed Hahnemann's use of this method in his letter. So
Hahnemann was still using the single dose on patients he thought might be
aggravated by a series of doses! This accorded with my personal experience.

Dr. Creoserio also stated that when Hahnemann saw strong remedial
actions he would reduce the dose or stop the medicine and give placebos. He
told Beonninghausen that it would be impossible for him to explain all "the
shadings of his [Hahnemann's] treatment" in a letter as "his mode of action
was not always the same." Now I realized that the was much more to giving
the LM potency than just repeating the remedy daily or every other day
until something went wrong! One still had to use individualization
according to the time and circumstances.

When I got copies of the microfiches of the Paris casebooks I
immediately noticed that at the start of treatment Hahnemann would give
either a single dose (usually by olfaction) or a short series of 3 to 7
doses and have the patient come back in 7 days. In some cases he had the
patient come back in 3 or 4 days at the start. If there was strong remedial
actions he would then give the patient a week of placebo and have them come
back in 7 days. If he thought he need more medicinal action he would give
another single olfaction and 7 days of placebo or repeat the oral
split-doses for another week. In some cases Hahnemann gave placebos for 2
even 3 weeks! Hahnemann never gave the daily or alternate day dose for
months on end! He constantly alternated periods of placebos with his active
doses. This was a great revelation.

I noticed that in the Paris casebooks that Hahnemann also varied the
time periods for raising the LM potencies according to time and
circumstances. He did tended to raise the potency every one or two weeks
but this was not absolute nor exclusive. Sometimes he raised the potencies
faster and sometimes he raised them slower. Then I realize what he was
suggesting in the Organon were baseline examples that he individualized
according to the needs of the patient, time and circumstances. I was now
sure that to use the LM potency in a safe and effective manner one had to
individualize the dose and repetition much more careful than I first thought.

These are the reasons why I emphasize the importance of the 1st sentence
of aphorism 246 on stopping the dose when there is a strikingly increasing
amelioration well as the words IF NECESSARY in its footnote. When I
realized that Hahnemann was using single test doses of the LM potency as
wells as a short series of 3 to 7 test doses at the start of his cases most
of my problems were solved. Once I began to follow these methods most of
the aggravations and relapses I was witnessing disappeared and my problem
cases became more manageable. I was also very happy to find out that it was
easier to treat hypersensitive patients with single doses and infrequent
repetitions. Hahnemann also used this method in the 1840s. I found single
doses by olfaction very effective as they resolved some cases where the
oral solution failed no matter how I adjusted the dose and repetition.

I learned all of this in the "school of hard knocks" by causing
unnecessary aggravations and relapses of symptoms that slowed down the
cure. The discussion over aphorism 246, 247 and 248 is not just an
intellectual exercise for me. It is not about one quote or another. This is
because I caused much unneeded suffering and spoiled some cases that were
doing fantastic because I did not slow down or stop the dose at the right
time. I not only cause unneeded pain in some of my patients - I also
suffered a good amount of guilt, worry and frustration in the night. What I
say about the LM potency took me many years to learn and I hope that my
mistakes at the beginning of my career will prevent others from making the
same mistakes in the end.

Simila Minimus
Sincerely, David Little
---------------
"It is the life-force which cures diseases because a dead man needs no more
medicines."

Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic
Academy at
http://www.simillimum.com
David Little © 2000

[Rosemary C Hyde, Ph.D., C.C.H.]

Thanks, David, for this really clear exposition of your experiences with LMs and frequency. Although I was taught to give LMs mechanically daily or every other day, I can attest that what you've described here corresponds perfectly to what I've observed with many clients. I've been experimenting with doing what you describe, and appreciate the guidance based on your experience that you've provided in this post. ) Rosemary