Guidelines in 4th Edition of Organon of Medicine (1829)
All emphasis (bold/italic/underline) and summary notes by Dr. Manish Bhatia
§ 248. The dose of the same medicine should be repeated until a cure is effected, or until it ceases any longer to afford relief; in the latter alternative, the remnant of the disease, with its altered group of symptoms, will require another homoeopathic remedy.
- 4th Edition of (1829)
§ 249. Every medicine which, in the course of its operation, produces new symptoms that do not appertain to the disease to be cured, and that are annoying, is incapable of procuring real amendment,* and cannot be considered as homoeopathically chosen. If the deterioration of symptoms be important, the effect of the medicine must be extinguished, in part, without delay, by means of an antidote, before another and more homoeopathic remedy is given, or if the new symptoms be not violent, the other remedy must be immediately given, to take the place of that which has been so unfitly chosen.
* All experience teaches us, that scarcely any homoeopathic medicine can be prepared in too minute a dose to produce perceptible benefit in a disease to which it is adapted (§ 161. 279). Hence it would be an improper and injurious practice, when the medicine produces no good effect, or an inconsiderable exacerbation of the symptoms, after the manner of the old school, to repeat or increase the dose under the idea that it cannot prove serviceable on account of its minuteness. Every exacerbation caused by new symptoms, when nothing injurious has occurred with regard to diet or mental impressions, always proves the unsuitableness of the medicine previously given, but never indicates the weakness of the dose.
- If a remedy produces new symptoms during treatment, it cannot be considered the simillimum.
- If the new symptoms are mild, reassess the case and give the right remedy immediately.
- If the new symptoms are severe, first antidote the wrong remedy and then reassess the case and give the right remedy.
§ 250. When in urgent cases, after the lapse of six, eight, to twelve hours, it becomes manifest to the observant physician who has accurately investigated the character of the disease, that he has made a false selection of the remedy last administered, when, during the appearance of new symptoms, the disease becomes, though slightly, yet evidently worse from hour to hour, it is not only admissible, but duty renders it imperative on him to rectify the mistake he has made, and administer another homoeopathic remedy not only tolerably, but the best possibly adapted to the morbid condition at the time (§ 167).
- In emergency cases or in cases regressing rapidly, the physician should not wait even if new symptoms have appeared. He should reassess the case and give the right remedy immediately without waiting.
§ 251. There are some medicines, for example, Ignatia amara, Bryonia, Rhus, and sometimes Belladonna, whose power of changing the human economy chiefly consists in the production of alternate effectsâ€”a kind of primary symptoms, partly in opposition to each other. If the physician find no improvement after the strict homoeopathic selection and administration of one of these remedies (in acute cases, after a few hours), then by repeating it in the same dilution, he will quickly obtain the desired effect.*
* As I have explained more circumstantially in the introduction to the article Ignatia (Mat. Medorrhinum vol. ii.)
- If you are very sure of your remedy selection but the patient does not react to your first dose, repeat the same medicine in the same dose again and you will most likely see a positive reaction, esp. when your remedy has some alternating action.
§ 252. But if in a chronic disease (psoric) the most homoeopathic remedy (anti-psoric), administered in the smallest and most suitable dose, does not produce an amendment, it is a sure sign that the cause which keeps up the disease still exists, and that there is something either in the regimen or condition of the patient that must be first altered before a permanent cure can be effected.
- But if you still fail to produce a positive reaction from the right remedy in a chronic case, look for a maintaining cause which might be working as an obstruction to cure.
§ 253. In all diseases, particularly those which are acute, the state of mind and general demeanor of the patient are among the first and most certain of the symptoms (which are not perceived by everyone) that announce the beginning of any slight amendment or augmentation of the malady. If the disease begins to improve, though in ever so slight a degree, the patient feels more at ease, he is more tranquil, his mind is less restrained, his spirits revive, and all his conduct is, so to express it, more natural. The very reverse takes place where there is only a slight increase; an embarrassment and helplessness, which call for commiseration, are observable in the mind and temper of the patient, as well as in all his actions, gestures, and posturesâ€”something both remarkable and peculiar which cannot escape the eye of an attentive observer, but which it would be difficult to describe in words.*
* In order to have a determinate rule for the moderate development of power of the fluid medicines, multiplied experience and observation have led me to retain two shakes for every vial, in preference to a greater number, which had previously been used, but which developed the energy in too great a degree. On the contrary, there are homoeopathists who, in their visits to the sick, carry about their persons the medicines in a fluid state, which, they nevertheless affirm, do not in time become increased in energy by the frequent agitation to which they are thus subjected. This declaration, however, betrays on their part the want of a talent for accurate observation. I dissolved a grain of natron in half an ounce of a mixture of water and a little alcohol, poured the solution into a vial, which was thereby filled two-thirds, and shook it uninterruptedly for half an hour. By this agitation, the fluid attained an energy equal to that of the thirtieth dilution.
- In all disease, but especially in acutes, after the administration of the right remedy, the first change that will be noticed is that the energy levels of the patient will increase and the patient will feel more relaxed, more at peace and less anxious.
- Hahnemann though that 10 or more strokes/succussions between each dilution raises the potency too much and he settled at two strokes between each dilution.
§ 270. If two drops of a mixture of equal parts of alcohol and the recent juice of any medicinal plant (see § 267) be diluted with ninety-eight drops of alcohol in a vial capable of containing one hundred and thirty drops, and the whole twice shaken together, the medicine becomes exalted in energy (potenzirt) to the first developement of power, or, as it may be denominated, the first potence. The process is to be continued through twenty-nine additional vials, each of equal capacity with the first, and each containing ninety-nine drops of spirits of wine; so that every successive vial, after the first, being furnished with one drop from the vial or dilution immediately preceding (which had just been twice shaken), is, in its turn, to be shaken twice,” remembering to number the dilution of each vial upon the cork as the operation proceeds. These manipulations are to be conducted thus through all the vials, from the first up to the thirtieth or decillionth developement of power (potenzirte Decillion-Verdünnung, X.), which is the one in most general use.
- Two strokes are to be used to prepare each potency in centesimal scale.
- 10C was the potency that he most often used at this time.
§ 272. In no instance is it requisite to employ more than one simple medicinal substance at a time.*
* have been made by some homoeopathists in cases where, imagining that one part of the symptoms of a disease required one remedy, and that another remedy was more suitable to the other part, they have given both remedies at the same time, or nearly so; but I earnestly caution all my adherents against such a hazardous practice, which never will be necessary, though, in some instances, it may appear serviceable.
- Give a single remedy at any given time.
§ 275. The appropriation of a medicine to any given case of disease does not depend solely upon the circumstance of its being perfectly homoeopathic, but also upon the minute quantity of the dose in which it is administered. If too strong a dose of a remedy, that is even entirely homoeopathic, be given, it will infallibly injure the patient, though the medicinal substance be of ever so salutary a nature; the impression it makes is felt more sensibly, because, in virtue of its homoeopathic character, the remedy acts precisely on those parts of the organism which have already been most exposed to the attacks of time natural disease.
- A medicine becomes the simillimum for a case not just by covering the symptoms of the case but also when given in the right dose (potency and quantity).
- Even a right remedy, given in too high a dose will harm the patient.
§ 276. Even a homoeopathic medicine is, on this account, always injurious when given in too large a dose, and hurtful to the patient in proportion to the extent of the quantity administered. But the increase of the dose itself is also prejudicial in the same degree as the remedy is more homoeopathic; and a strong dose of such a medicine would do more harm than the dose of all allopathic medicinal substance (which bears no analogy whatever to the disease) of equal strength; for, in that case, the homoeopathic aggravation (5 157-160)â€”that is to say, the artificial malady, which is very analogous to the natural one excited by the remedy in the most suffering parts of the organismâ€”is carried to a height that is injurious (§ 246, note); whereas, if it had been confined within proper limits, it would have effected a gentle, prompt, and certain cure. It is true the patient no longer suffers from the primitive malady which has been homoeopathically destroyed, but he suffers so much more from the medicinal one which was much too powerful, and from unnecessary debility.
- If the right medicine is given in a very large dose (potency or quantity), it will create strong homeopathic aggravation.
§ 281. All diseases have an extraordinary tendency to undergo a change when operated upon by the influence of homogeneous medicinal agents. There is no patient, however robust his constitution may be, who, if attacked merely by a chronic disease, or by what is called a local malady, does not speedily experience a favourable change in the suffering parts after having taken the appropriate homoeopathic remedy in the smallest dose possible. In short, the effects of this substance will make a greater impression on him than they would upon a healthy child twenty-four hours after its birth. How insignificant and ridiculous is mere theoretic incredulity, when opposed to the infallible evidence of facts!
§ 282. However feeble the dose of a remedy may be, provided it can in the slightest degree aggravate the state of the patient homoeopathically provided it has the power of exciting symptoms similar to those of the primitive disease, but rather more intense, it will, in preference, and almost exclusively, affect those parts of the organism that are already in a state of suffering, and which are strongly irritated and predisposed to receive any irritation analogous to their own. Thus an artificial disease rather more intense is substituted in the place of the natural one. The organism no longer suffers but from the former affection, which, by reason of its nature, and the minuteness of the dose by which it was produced, soon yields to the efforts of the vital force to restore the normal state, and thus leaves the body (if the disease was an acute one) free from suffering that is to say, in a healthy condition.
§ 283. To proceed, therefore, in a manlier conformable to nature, the true physician will only administer a homoeopathic remedy in the precise dose necessary to exceed and destroy the disease to which it is opposed, so that if by one of those errors, pardonable to human frailty, he had made choice of a remedy that was inappropriate, the injury that might result from it would be so slight that the development of the vital force, and the administration of the smallest close of another remedy more homoeopathic, would suffice to repair it.
§ 284. The effects of a dose are by no means diminished in the same proportion as the quantity of the medicinal substance is attenuated in the homoeopathic practice. Eight drops of a tincture taken at once do not produce upon the human body four limes the effect of a dose of two drops ; they merely produce one that is nearly double. In the same manner the single drop of a mixture, composed of one drop of a tincture and ten of a liquid void of all medicinal properties, does not produce ten limes the effect that a drop ten times more attenuated would produce, but merely an effect that is scarcely double. The progression continues according to this law, so that a single drop of a dilution, attenuated in the highest degree, ought, and does in fact, produce a very considerable effect.*
* Suppose, for example, that one drop of a mixture containing the tenth of a grain of any medicinal substance produces art effect = a; a drop of another mixture containing merely a hundredth part of a grain of this same substance will only produce an effect= a/2; if it contains a ten thousandth part of a grain of medicine, the effect will be = a/4; if a millionth, it will be = ; and so on progressively, to an equal volume of the doses, the effects of the remedy on the body will merely be diminished about one half each time that the quantity is reduced nine tenths of what it was before. I have often seen a drop of the tincture of Nux vomica at the decillionth degree of dilution, produce exactly half the effect of another at the quintillionth degree, when I administered both one and the other to the same individual, and under the same circumstances.
§ 285. By diminishing the volume of the dose, the power of it is also diminishedâ€”that is to say, when instead of one entire drop of attenuated tincture merely a fraction of this drop be administered,* the object of rendering the effect less powerful. is then very perfectly attained. The reason of this may be easily conceived: the volume of the dose being diminished it must necessarily follow that it will touch a less number of the nerves of the living organism, by with which, it is true, the power of the medicine is communicated to the whole body, but it is transmitted in a smaller degree.
* The best mode of administration is to make use of small globules of sugar, the size of a mustard seed ; one of these globules having imbibed the medicine, and being introduced into the vehicle, forms a close containing about the three hundredth part of a drop, for three hundred of such globules will imbibe one drop of alcohol ; by placing one of those on the tongue, and not drinking anything after it, the dose is considerably diminished. But if the patient is very sensitive, and it is necessary to employ the smallest dose possible, and attain at the same time the most speedy results, it will be sufficient to let him smell once. (See § 288, note).
- Small, mustard seed size sugar pills are the best mode for administering a remedy.
- One such globule will comprise one dose.
- If the patient is oversensitive, he can just smell one such globule.
§ 286. For the same reason, the effect of a homoeopathic dose is increased when we augment the quantity of the liquid in which it is dissolved to administer it to the patient ; but then the remedy comes in with a much more extended surface, and the nerves that feel its effects are far more numerous. Although theorists have asserted that the extension of a medicine in liquid weakens its action, experience proves the reverse, at least as far as regards homoeopathic remedies.*
* Only wine and alcohol, which are the most simple of all excitants, lose a portion of their heating and exciting power when they are attenuated in a large quantity of water.
- The quality of the homeopathic medicine increases with the dilution.
Guidelines in 5th Edition of Organon of Medicine (1833)
All emphasis (bold/italic/underline) and notes by Dr. Manish Bhatia
§ 246 Fifth Edition
On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homoeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily affected, as recent and oft-repeated observations have shown, under three conditions: firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; and thirdly, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals,1 which experience shall have pronounced to be the best adapted for accelerating the cure to the utmost extent, yet without the vital force, which it is sought to influence to the production of a similar medicinal disease, being able to feel itself excited and roused to adverse reactions.
- A single dose may be able to bring about a cure in chronic cases IF its action continues unhindered for many months.
- BUT this happens only rarely. A single dose is often not sufficient to cure chronic diseases.
- The medicine should be repeated to hasten the cure. After all, the ideal cure has to be rapid (aph 2).
- The medicines should not be repeated blindly. They should only be repeated at suitable intervals.
Footnote to Aph 246 in 5th edition
1 In the former editions of the Organon I have advised that a single dose of a well-selected homoeopathic medicine should always be allowed first fully to expend its action before a new medicine is given or the same one repeated – a doctrine which was the result of the positive experience that neither by a larger dose of the remedy, which may have been well chosen (as has been again recently proposed, but which would be very like a retrograde movement), nor, what amounts to the same thing, by several doses of it given in quick succession, can the greatest possible good be effected in the treatment of diseases, more especially of chronic ones; and the reason of this is, that by such a procedure the vital force dose not quietly adapt itself to the transition from the natural disease to the similar medicinal disease, but is usually so violently excited and disturbed by a larger dose, or by smaller doses of even a homoeopathically chosen remedy given rapidly one after the other, that in most cases its reaction will be anything but salutary and will do more harm than good. As long as no more efficacious mode of proceeding than that then taught by me was discovered, the safe philanthropic maxim of sin non juvat, modo ne noceat, rendered it imperative for the homoeopathic practitioner, for whom the weal of his fellow-creatures was the highest object, to allow, as a general rule in diseases, but a single dose at a time, and that the very smallest, of the carefully selected remedy to act upon the patient and, moreover, to exhaust its action. The very smallest, I repeat, for it holds good and will continue to hold good as a homoeopathic therapeutic maxim not to be refuted by any experience in the world, that the best doses of the properly selected remedy is always the very smallest on in one of the high potencies (X), as well for chronic as for acute as for acute diseases – a truth that is the inestimable property of pure homoeopathy and which as long as allopathy and the new mongrel sect, whose treatment is a mixture of allopathic and homoeopathic processes is not much better continues to gnaw like a cancer at the life of sick human beings, and to ruin them by large and ever larger doses of drugs, will keep pure homoeopathy separated from these spurious arts as by an impassable gulf.
On the other hand, however, practice shows us that though a single one of these small doses may suffice to accomplish almost all that it was possible for this medicine to do under the circumstances, in some, and especially in slight cases of disease, particularly in those of young children and very delicate and excitable adults, yet that in many, indeed in most cases, not only of very chronic diseases that have already made great progress and have frequently been aggravated by a previous employment of inappropriate medicines, but also of serious acute diseases, one such smallest dose of medicine in our highly potentized dynamization is evidently insufficient to effect all the curative action that might be expected from that medicine, for it may unquestionably be requisite to administer several of them, in order that the vital force may be pathogenetically altered by them to such a degree and its salutary reaction stimulated to such a height, as to enable it to completely extinguish, by its reaction, the whole of that portion of the original disease that it lay in the power of the well-selected homoeopathic remedy to eradicate; the best chosen medicine in such a small dose, given but once, might certainly be of some service, but would not be nearly sufficient.
But the careful homoeopathic physician would not venture soon to repeat the same dose of the same remedy again, as from such a practice he has frequently experienced no advantage, but most frequently, on close observation, decided disadvantage. He generally witnessed aggravation, from even the smallest dose of the most suitable remedy, which he has given one day, when he repeated the next day and the next.
Now, in cases where he was convinced of the correctness of his choice of the homoeopathic medicine, in order to obtain more benefit for the patient than he was able to get hitherto from prescribing a single small dose, the idea often naturally struck him to increase the dose, since, for the reason given above, one single dose only should be given; an, for instance, in place of giving a single very minute globule moistened with the medicine in the highest dynamization, to administer six, seven or eight of them at once, and even a half or a whole drop. But the result was almost always less favourable than it should have been; it was often actually unfavourable, often even very bad – an injury that, in a patient so treated, is difficult to repair.
The difficulty in this case is not solved by giving, instead, lower dynamizations of the remedy in a large dose. Thus, increasing the strength of the single doses of the homoeopathic medicine with the view of effecting the degree of pathogenic excitation of the vital force necessary to produce satisfactory salutary reaction, fails altogether, as experience teaches, to accomplish the desired object. This vital force is thereby too violent and too suddenly assailed and excited to allow it time to exercise a gradual equable, salutary reaction, to adapt itself to the modification effected in it; hence it strives to repel, as if it were an enemy, the medicine attacking it in excessive force, by means of vomiting, diarrhoea, fever, perspiration, and so forth, and thus in a great measure it diverts and renders nugatory the aim of the incautious physician – little or no good towards curing the disease will be thereby accomplished; on the contrary, the patient will be thereby perceptibly weakened and, for a long time, the administration of even the smallest dose of the same remedy must not be thought of if we would not wish it to injure the patient.
But it happens, moreover, that a number of the smallest doses given for the same object in quick succession accumulate in the organism into a kind of excessively large dose, with (a few cases excepted) similar bad results; in this case the vital force, not being able to recover itself betwixt every dose, though it be but small, becomes oppressed and overwhelmed, and thus being incapable of reacting in a salutary manner, it is necessitated passively to allow involuntary the continuance of the over-strong medicinal disease that has thus been forced upon it, just in the same manner as we may every day observe from the allopathic abuse of large cumulative doses of one and the same medicine, to the lasting injury of the patient.
Now, therefore, in order, whilst avoiding the erroneous method I have here pointed out, to attain the desired object more certainly than hitherto, and to administer the medicine selected in such a manner that it must exercise all its efficacy without injury to the patient, that it may effect all the good it is capable of performing in a given case of disease, I have lately adopted a particular method.
I perceived that, in order to discover this true middle path, we must be guided as well by the nature of the different medicinal substances, as also by the corporeal constitution of the patient and the magnitude of the disease, so that – to give an example from the use of sulphur in chronic (psoric) diseases – the smallest dose of it (tinct, sulph. X°) can seldom be repeated with advantage, seen in the most robust patients and in fully developed psora, oftener than every seven days, a period of time which must be proportionally lengthened when we have to treat weaker and more excitable patients of this kind; in such cases we would do well to give such a dose only every nine, twelve, or fourteen days, and continue to repeat the medicine until it ceases to be of service. We thus find (to abide by the instance of sulphur) that in sporic diseases seldom fewer than four, often however, six, eight and even ten doses (tinct. sulph. X°) are required to be successively administered at these intervals for the complete annihilation of the whole portion of the chronic disease that is eradicated by sulphur – provided always there had been no previous allopathic abuse of sulphur in the case. Thus even a (primary) scabious eruption of recent origin, though it may have spread all over the body, may be perfectly cured, in persons who are not too weakly, by a dose of tinct sulph. X° given every seven days, in the course of from ten to twelve weeks (accordingly with ten or twelve such globules), so that it will seldom be necessary to aid the cure with a few doses of carb. veg. X° (also given at the rate of one dose per week) without the slightest external treatment besides frequent changes of linen and good regimen.