[H] Medicinal aggravation?

[Dr. Binoy.S.Vallabhassery]

Dear Christie Keith,
Remedy and aggravation
In homoeopathic practice, a physician is frequently faced with the phenomenon of aggravation of symptoms not only when he fails to
prescribe the similimum in a particular case but also when he prescribes the similimum. It is proposed to study these aggravations
briefly under two broad groups -
(1) Case of Similar Remedy and (2) Case of Dissimilar Remedy.
Case I - Similar Remedy (Similimum)
The restoration of vital force from its state of disequilibrium, i.e. , the diseased state, to its state of dynamic equilibrium is
brought about by the drug satisfying the Law of Similars and selected on the basis of Totality of Symptoms. This drug, which is the
Similimum in a particular case, injects similar energy into the patient's system and, following Dr. Mc. Crae's nomenclature, the energy
thus injected may he called the "Drug Energy". There is already in the patients body the "Disease Energy", i.e. , the energy consumed by
the disease in the diseased state. The intake of the Similimum in the diseased state causes some reactions and the consequences likely to
follow are as under:
(a) Drug energy = Disease energy: In this case, the optimum potency is reached, leading to the ultimate cure of the disease. There are
three ways of attaining it:
(i) By a single dose of the optimum potency of the remedy. This is the ideal state, demonstrating the magic power of the single dose.
It brings about rapid cure. There is no apparent aggravation.
(ii) By careful repetition till the optimum potency is reached. In this process, the drug energy may exceed the disease energy. When
this happens, there is drug-induced aggravation and, for a cure, the symptoms are allowed to die out over time without any further
intervention. The aggravation in such cases is generally mild.
(iii) By starting with a low potency and gradually increasing it till the drug energy equals the disease energy. There may be mild
aggravation which is allowed to die out as in (ii) above.
(b) Drug energy agg. Disease energy: Here the disease continues after a brief amelioration calling for repetition of the remedy either
in the sane potency or in a higher potency till symptoms aggravate and then watched until they subside.
(c) Drug energy amel. Disease energy: In this case the disease continues with aggravated symptoms. In practice, this happens in most
cases either because a much higher potency has been selected than is warranted by the susceptibility of the patient or because the remedy
has been repeated at intervals shorter than what is needed for the case. The aggravation may be short-lived or long-lived according to
the nature of the disease and the susceptibility of the patient and is encountered mostly in chronic case. Here it is usual to wait and
carefully watch the case. This stage is critical. Any impatience either on the part of the physician or on the part of the patient would
spoil the case.
The above explains why it is necessary in a case of right selection of remedy to wait for a cure and not burden the patient with further
medication and spoil the case.
The aggravation noticed in the aforesaid cases, when the remedy has been correctly selected on the symptom-totality basis, is known as
the "Homoeopathic" or "True" aggravation. Here, although there is aggravation of symptoms, the patient feels better which is generally
regarded as an important indication that the remedy is on the right lines. What takes place is that "That particulars are worse but
generals are better" and this accounts for the sense of well-being of the patient. Even new symptoms may appear and accentuate the
aggravation but the sense of well-being is not affected because the new symptoms could he identified to he the additional symptoms of the
true remedy given. But, there may be cases where even the homoeopathic aggravation may be difficult for a patient to tolerate, e.g. ,
patients whose vital force is so low that it is unable to cope with the potency given of the true remedy or its repetition. In such
cases, the original remedy has to be antidoted fist, even though it is the true remedy, and then the same remedy re-administered in a
lower potency and dose depending upon the state of the vital force and the susceptibility of the patient. Under no circumstances, the
aggravation should be allowed to continue.A careful watch is needed. But, if with ad precaution and care the disease continues, the case
is deemed incurable-may he due to some inherent defect in the anatomy of the patient. The palliative treatment in low potency on
present-symptom basis is the only course open in such cases.
Case II - Dissimilar Remedy
When the remedy has not been correctly chosen on symptom totality basis, the question of drug energy tending to equal disease energy
does not arise. So, in this case, the drug energy is always greater than the disease energy, for the stronger energy of the drug which is
introduced into the patient's system, not being similar to the disease energy, is unable to tackle the disease and, therefore, produces
additional symptoms of its own increasing his suffering. Mentally and physically his condition deteriorates on two grounds : one, due to
the actual advancement of the disease as its course remains unaffected by the remedy given and the other, due to the additional impact of
the drug energy which remains unutilised by the vital force, because it is not similar to the disease. When this happens, the situation
demands immediate antidoting of the remedy given and fresh case-taking for selecting the correct remedy. The aggravation caused by the
advancement of the disease is called the "Disease Aggravation", while that caused by the impact of the dissimilar drug energy is called
the "Medicinal Aggravation."
It is important to have a clear knowledge about the basic nature of the above three types of aggravation. It is so helpful in bringing a
case to a successful close. A true (homoeopathic) aggravation is clearly distinguishable from the other two types in that the patient in
this case always feels better after the administration of the remedy. But, in doubtful cases, e.g. , in tubercular or mental patient,
where such feeling may he false, the physician should satisfy himself about its correctness by enquiring about general symptoms affecting
his constitution or examining other ad-hoc evidences. As between disease aggravation or medicinal aggravation, the diagnostic symptoms
aggravate in disease aggravation but in medicinal aggravation, new symptoms of the drug appear in addition, complicating the condition of
the patient. A good knowledge of the Materia Medica, particularly of its polychrest remedies, helps to distinguish such cases.
Cure
Cure means "To restore the sick to health". It is the first aphorism of Dr. Hahnemann's Organon. This restoration of the vital force to
health takes place through the medium of a remedy selected by the physician on the symptom totality basis satisfying the Law of Similars.
It is through this remedy that the disharmony of the vital force in the diseased state is brought back to harmony, to dynamic
equilibrium. When somebody fasts in diarrhoea and gets rid of the disease without the help of any medicine, it is return to health
through the healing power of Nature - Vis medicatrix naturae - and not restoration to health. So, in cure, there is the remedy prescribed
by the physician on certain indicated basis, viz., Symptom Totality and Law of Similars and following certain laid down principles, viz.,
single medicine, potentised form and minimum dose, to make it effective in rooting out the disease. This is called the "Homoeopathic
Remedy". This remedy, follows in its course of cure, a definite pattern known as the Hering's Law of Cure. The law states that in the
process of cure, the symptoms disappear (a) from above downwards, (b) from within outwards and (c) in the reverse out order of their
appearance, which means that the curative remedy removes the latest symptoms first and then reaches further and further back until it
comes to the first symptom which disappears last.
A word of explanation may now be necessary about the characteristics of the aforesaid law. The fast characteristic of the law is that
when the remedy has been correctly administered, the cure starts from above downwards. It acts in the literal sense when the organs of
the body are not involved, e.g. , skin disease, measles, etc. But, when organs are affected, the interpretation would be from more
important organ to less important organ. If throat is affected as also ears, throat will be relieved first and then cars, throat being
the more important organ. The second characteristic is that the symptom will disappear from within outwards, i.e. , from inside the body
to outside it. If a skirt disease is suppressed and patient gets chronic diarrhoea, the curative remedy will bring out the skin disease
and then cure the diarrhoea. The third characteristic is that the symptoms will disappear in reverse order of their appearance. This
means that if a patient has been suffering first from dysentery, then from colitis and then from pain in stomach before stool over a
period of time, all combining to present a complete picture of the patient, the curative remedy, which is Colocynth in this case, will
cure the pain in the stomach first, then the colitis and last the dysentery.
The important point to note is that the first two characteristics of the law deal with the symptoms of the disease existing at a
particular point of time while the third with symptoms coming one after the other over a period of time. If in the course of cure, the
symptom do not satisfy Hering's Law, the presumption will be that the remedy has not been properly selected. In that case, it has to be
antidoted and the case retaken for correct prescribing. "True Cure", according to Hahnemann is "Rapid, gentle and permanent restoration
of health, or removal and annihilation of the diseases in its whole extent, in the shortest, most reliable and most harmless way, on
easily comprehensible principles".

Regards,

dr binoy vallabhassery
INDIA.

Christie Keith wrote:
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