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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.

Summary Notes

 

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.

When for other serious chronic diseases also we may consider it requisite, as far as we can calculate, to give eight, nine or ten doses of tinct. sulph. (at X°) it is yet more expedient in such cases, instead of giving them in uninterrupted succession, to interpose after every, or every second or third dose, a dose of another medicine, which in this case is next in point of homoeopathic suitableness to sulphur (usually hep. sulph.) and to allow this likewise to act for eight, nine, twelve or fourteen days before again commencing a course of three doses of sulphur.

But it not infrequently happens that the vital force refuses to permit several doses of sulphur, even though they may be essential for the cure of the chronic malady and are given at the intervals mentioned above, to act quietly on itself; this refusal it reveals by some, though moderate, sulphur symptoms, which it allows to appear in the patient during the treatment. In such cases it is sometimes advisable to administer a small dose of nux vom. X°, allowing it to act for eight or ten days, in order to dispose the system again to allow succeeding doses of the sulphur to act quietly and effectually upon it. In those cases for which it is adapted, puls. X° is preferable.

But the vital force shows the greatest resistance to the salutary action upon itself of the strongly indicated sulphur, and even exhibits manifest aggravation of the chronic disease, though the sulphur be given in the very smallest dose, though only a globule of the size of a mustard seed moistened with tinct. sulph X° be smelt, if the sulphur have formerly (it may be years since) been improperly given allopathically in large doses. This is one lamentable circumstance that renders the best medical treatment of chronic disease almost impossible among the many that the ordinary bungling treatment of chronic diseases by the old school would leave us nothing to do but to deplore, were there not some mode of getting over the difficulty.

In such cases we have only to let the patient smell a single time strongly at a globule the size of a mustard seed moistened with mercur metall. X, and allow this olfaction to act for about nine days, in order to make the vital force again disposed to permit the sulphur (at least the olfaction of tinct. sulph. X°) to exercise a beneficial influence on itself - a discovery for which we are indepted to Dr. Griesselich, of Carlsruhe.

 

Summary Notes

 


§ 247 Fifth Edition

Under these conditions, the smallest doses of the best selected homoeopathic medicine may be repeated with the best, often with incredible results, at intervals of fourteen, twelve, ten, eight, seven days, and, where rapidity is requisite, in chronic diseases resembling cases of acute disease, at still shorter intervals, but in acute diseases at very much shorter periods - every twenty - four, twelve, eight, four hours, in the very acutest every hour, up to as often as every five minutes, - in ever case in proportion to the more or less rapid course of the diseases and of the action of the medicine employed, as is more distinctly explained in the last note.

Summary Notes

 

§ 248 Fifth Edition

The dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy.

Summary Notes


§ 249

Every medicine prescribed for a case of disease which, in the course of its action, produces new and troublesome symptoms not appertaining to the disease to be cured, is not capable of effecting real improvement,1 and cannot be considered as homoeopathically selected; it must, therefore, either, if the aggravation be considerable, be first partially neutralized as soon as possible by an antidote before giving the next remedy chosen more accurately according to similarity of action; or if the troublesome symptoms be not very violent, the next remedy must be given immediately, in order to take the place of the improperly selected one.2

1 As all experience shows that the dose of the specially suited homoeopathic medicine can scarcely be prepared too small to effect perceptible amelioration in the disease for which it is appropriate (§§ 275-278), we should act injudiciously and hurtfully were we when no improvement, or some, though it be even slight, aggravation ensues, to repeat or even increase the dose of the same medicine, as is done in the old system, under the delusion that it was not efficacious on account of its small quantity (its too small dose). Every aggravation by the production of new symptoms - when nothing untoward has occurred in the mental or physical regimen - invariably proves unsuitableness on the part of the medicine formerly given in the case of disease before us, but never indicates that the dose has been too weak.

2 The well informed and conscientiously careful physician will never be in a position to require an antidote in his practice if he will begin, as he should, to give the selected medicine in the smallest possible dose. Like minute doses of a better chosen remedy will re-establish order throughout.

Summary Notes

 

§ 275

The suitableness of a medicine for any given case of disease does not depend on its accurate homoeopathic selection alone, but likewise on the proper size, or rather smallness, of the dose. If we give too strong a dose of a medicine which may have been even quite homoeopathically chosen for the morbid state before us, it must, notwithstanding the inherent beneficial character of its nature, prove injurious by its mere magnitude, and by the unnecessary, too strong impression which, by virtue of its homoeopathic similarity of action, it makes upon the vital force which it attacks and, through the vital force, upon those parts of the organism which are the most sensitive, and are already most affected by the natural disease.

 

§ 276 Fifth Edition

For this reason, a medicine, even though it may be homoeopathically suited to the case of disease, does harm in every dose that is too large, the more harm the larger the dose, and by the magnitude of the dose it does more harm the greater its homoeopathicity and the higher the potency1 selected, and it does much more injury than any equally large dose of a medicine that is unhomoeopathic, and in no respect adapted (allopathic) to the morbid state; for in the former case the so-called homoeopathic aggravation (§§157-160) - that is to say, the very analogous medicinal disease produced by the vital force stirred up by the excessively large dose of medicine, in the parts of the organism that are most suffering and most irritated by the original disease - which medicinal disease, had it been of appropriate intensity, would have gently effected a cure - rises to an injurious height;2 the patient, to be sure, no longer suffers from the original disease, for that has been homoeopathically eradicated, but he suffers all the more from the excessive medicinal disease and from useless exhaustion of his strength.

1 The praise bestowed of late years by some few homoeopathists on the larger doses is owing to this, either that they chose low dynamizations of the medicines to be administered, as I myself used to do twenty years ago, from not knowing any better, or that the medicines selected were not perfectly homoeopathic.

2 See note to §246

 

§ 277

For the same reason, and because a medicine, provided the dose of it was sufficiently small, is all the more salutary and almost marvellously efficacious the more accurately homoeopathic its selection has been, a medicine whose selection has been accurately homoeopathic must be all the more salutary the more its dose is reduced to the degree of minuteness appropriate for a gentle remedial effect.

Summary Notes

 

§ 278 Fifth Edition

Here the question arises, what is this most suitable degree of minuteness for sure and gentle remedial effect; how small, in other words, must be the dose of each individual medicine, homoeopathically selected for a case of disease, to effect the best cure? To solve this problem, and to determine for every particular medicine, what dose of it will suffice for homoeopathic therapeutic purposes and yet be so minute that the gentlest and most rapid cure may be thereby obtained - to solve this problem is, as may easily be conceived, not the work off theoretical speculation; not by fine-spun reasoning, not by specious sophistry can we expect to obtain the solution of this problem. Pure experiment, careful observation, and accurate experience can alone determine this; and it were absurd to adduce the large doses of unsuitable (allopathic) medicines of the old system, which do not touch the diseased side of the organism homoeopathically, but only attack the parts unaffected by the disease, in opposition to what pure experience pronounces respecting the smallness of the doses required for homoeopathic cures.

 

§ 279 Fifth Edition

This pure experience shows UNIVERSALLY, that if the disease do not manifestly depend on a considerable deterioration of an important viscus (even though it belong to the chronic and complicated diseases), and if during the treatment all other alien medicinal influences are kept away from the patients, the dose of the homoeopathically selected remedy can never be prepared so small that it shall not be stronger than the natural disease, and shall not be able to overpower, extinguish and cure it, at least in part as long as it is capable of causing some, though but a slight preponderance of its own symptoms over those of the disease resembling it (slight homoeopathic aggravation, (§§ 157-160) immediately after its ingestion.

Summary Notes

 

§ 284 Fifth Edition

The action of a dose, moreover, dose not diminish in the direct ratio of the quantity of material medicine contained in the dilutions used in homoeopathic practice. Eight drops of the tincture of a medicine to the dose do not produce four times as much effect on the human body as two drops, but only about twice the effect that is produced by two drops to the dose. In like manner, one drop of a mixture of a drop of the tincture with ten drops of some unmedicinal fluid, when taken, will not produce ten times more effect than one drop of mixture ten times more attenuated, but only about (scarcely) twice as strong an effect, and so on, in the same ratio - so that a drop of the lowest dilution must, and really does, display still a very considerable action.1

1 Supposing one drop of a mixture that contains 1/10 of a grain of medicine produces an effect = a; one drop of a more diluted mixture containing 1/100th of a grain of the medicine will only produce an effect = a/2; if it contain 1/10000th of a grain of medicine, about = a/4; if it contain 1/100000000th of a grain of medicine it will produce and effect = a/8; and thus it goes on, the volume of the doses being equal, with every (perhaps more than) quadratic diminution of the quantity of medicine, the action on the human body will be diminished each time to only about one-half. I have very often seen a drop of the decillion-fold dilution of tincture of nux vomica produce pretty nearly just half as much effect as a drop of the quintillion-fold dilution, under the same circumstances and in the same individual.

Summary Notes


§ 285 Fifth Edition

The diminution of the dose essential for homoeopathic use, will also be promoted by diminishing its volume, so that, if, instead of a drop of a medicinal dilution, we take but quite a small part1 of such a drop for a dose, the object of diminishing the effect still further will be very effectually attained; and that this will be the case may be readily conceived for this reason, because with the smaller volume of the dose but few nerves of the living organism can be touched, whereby the power of the medicine is certainly also communicated to the whole organism, but it is a weaker power.

1 For this purpose it is most convenient to employ fine sugar globules of the size of poppy seeds, one of which imbibed with the medicine and put into the dispensing vehicle constitutes a medicinal dose, which contains about the three hundredth part of a drop, for three hundred such small globules will be adequately moistened by one drop of alcohol. The dose is vastly diminished by laying one such globule alone upon the tongue and giving nothing to drink. If it be necessary, in the case of a very sensitive patient, to employ the smallest possible dose and to bring about the most rapid result, one single olfaction merely will suffice (see note to §288).

 

§ 286 Fifth Edition

For the same reason the effect of a homoeopathic dose of medicine increases, the greater the quantity of fluid in which it is dissolved when administered to the patient, although the actual amount of medicine it contains remains the same. For in this case, when the medicine is taken, it comes in contact with a much larger surface of sensitive nerves responsive to the medicinal action. Although theorists may imagine there should be a weakening of the action of dose of medicine by its dilution with a large quantity of liquid, experience asserts exactly the opposite, at all events when the medicines are employed homoeopathically.1

1 It is only the most simple of stimulants, wine and alcohol, that have their heating and intoxicating action diminished by dilution with much water.

Summary Notes

 

§ 287 Fifth Edition

But in this increase of action by the mixture of the dose of medicine with a larger quantity of liquid (before its ingestion), the result is vastly different whether the mixture of the dose of medicine with a certain quantity of liquid is performed merely superficially and imperfectly, or so uniformly and intimately1 that the smallest portion of the diluting fluid received the same quantity of medicine in proportion as all the rest; for the latter becomes much more medicinally powerful by the diluting mixture than the former. From this every one will be able to judge for himself how to proceed with the regulation of the homoeopathic medicinal doses when he desires to diminish their medicinal action as much as possible, in order to make them suitable for the most sensitive patients.2

1 By the word intimately I mean this: that when, for instance, the drop of a medicinal fluid has been shaken up once with one hundred drops of spirits of wine; that is to say, the phial containing both, held in the hand, has been rapidly moved from above downwards with a single smart jerk of the arm, there certainly ensues a thorough mixture of the whole, but with two, three, ten and more such strokes, this mixture becomes much more intimate; that is to say, the medicinal power becomes much more potentized, and the spirit of this medicine, so to speak, becomes much more unfolded, developed and rendered much more penetrating in its action on the nerves. If, then, the required object we wish to attain with the low dilutions be the diminution of the doses for the purpose of moderating their powers upon the organism, we would do well to give no more than two such succussion-jerks to each of the twenty, thirty, etc., dilution phials, and thus to develop the medicinal power only moderately. It is also advisable, in attenuating the medicine in the state of dry powder by trituration in a porcelain mortar, to keep within certain limits, and, for example, to triturate strongly, for one hour only, one grain of the crude entire medical substance, mixed with the first hundred grains of milk-sugar (to the 1/10000th attenuation) likewise only for one hour, and to make the third attenuation (to 1/1000000) also by one hour of strong trituration of one grain of the previous mixture with one hundred grains of milk-sugar, in order to bring the medicine to such an attenuation that its development of power shall remain moderate. A more exact description of this process will be found in the prefaces to Arsenic and Pulsatilla in the Materia Medica Pura.

2 The higher we carry the attenuation accompanied by dynamization (by two succussion strokes), with so much the more rapid and penetrating action does the preparation seem to affect the vital force and to alter the health, with but slight diminution of strength even when this operation is carried very far, - in place, as is usual (and generally sufficient) to X when it is carried up to XX, L, C, and higher; only that then the action always appears to last a shorter time.

Summary Notes

 

§ 288 Fifth Edition

The action of medicines in the liquid from1 upon the living human body takes place in such a penetrating manner, spreads out from the point of the sensitive fibers provided with nerves whereto the medicine is first applied with such inconceivable rapidity and so universally through all parts of the living body, that this action of the medicine must be denominated a spirit-like (a dynamic, virtual) action.

1 It is especially in the form of vapour, by olfaction and inhalation of the medicinal aura that is always emanating from a globule impregnated with a medicinal fluid in a high development of power, and placed, dry, in a small phial, that the homoeopathic remedies act most surely and most powerfully. The homoeopathic physician allows the patient to hold the open mouth of the phial first in one nostril, and in the act of inspiration draw the air out of it into himself and then if he wished to give a stronger dose, smell in the same manner with the other nostril, more or less strongly, according to the strength it is intended the dose should be, he then corks up the phial and replaces it in his pocket case to prevent any misuse of it, and unless he wishes it he has no occasion for an apothecary’s assistance in his practice. A globule of which ten, twenty or one hundred weigh one grain, impregnated with the thirtieth potentized dilution, and then dried, retains for this purpose all its power undiminished for at least eighteen or twenty years (my experience extends this length of time), even though the phial be opened a thousand times during that period, if it be but protected from heat and the sun’s light. Should both nostrils be stopped up by coryza or polypus, the patient should inhale by the mouth, holding the orifice of the phial betwixt his lips. In little children it may be applied close to their nostrils whilst they are asleep with the certainty of producing an effect. The medicinal aura thus inhaled comes in contact with the nerves in the walls of the spacious cavities it traverses without obstruction, and thus produces a salutary influence on the vital force, in the mildest yet most powerful manner, and this is much preferable to every other mode of administering the medicament in substance by the mouth. All that homoeopathy is capable of curing (and what can it not cure beyond the domain of mere manual surgery affections?) among the most severe chronic diseases that have not been quite ruined by allopathy, as also among acute disease, will be most safely and certainly cured by this olfaction. I can scarcely name one in a hundred out of the many patients that have sought the advice of myself and my assistant during the past year, whose chronic or acute disease we have not treated with the most happy results, solely by means of this olfaction; during the latter half of this year, moreover, I have become convinced (of what I never could previously have believed) that by this olfaction the power of the medicines is exercised upon the patient in, at least, the same degree of strength, and that more quietly and yet just as long as when the dose of medicine is taken by the mouth, and that, consequently, the intervals at which the olfaction should be repeated should not be shorter than in the ingestion of the material dose by the mouth.

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