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Guidelines in Chronic Diseases (1928-1930)
All emphasis (bold/italic/underline) and notes by Dr. Manish Bhatia
- By 1930, Hahnemann was already using the liquid medicinal solution extensively. He was still experimenting with it, therefore Chronic Diseases has guidelines for the dry dose similar to the 4th edition and guidelines for the medicinal solution similar to the 5th edition.
- It might be necessary to repeat medicines frequently in acute disease or chronic disease or acute nature/aggravation.
- In chronic cases we have to wait before repetition, till the first dose exhausts its action.
- The medicine should be repeated in another potency preferably.
- At this time Hahnemann was repeating potencies without any fixed criteria - either ascending or descending the scale ( giving 12 c after 30c or 24c after 18c etc).
- A similar medicine may need some intercurrents to get the best result. For e.g.., a patient on Sulphur may need Hepar-sulph, Nux-vomica or Mercury in between.
- If the physician is sure of his prescription, the first potency should be dissolved in 4 ounce (110 ml) water. One third of it should be taken as one dose and should be repeated for 3 subsequent days to finish the 4 ounce prepared. The medicine should be stirred each time before it is taken, to raise the potency. This appears to be the the first experiments of hahnemann with the liquid solutions.
- In a chronic case, the energy levels (vitality) of the patient should start increasing right from the start of the treatment.
- The best time to take an antipsoric medicine is is morning in fasting state.
- If you need a feeble effect, take a dry globule on your tongue. For better effect, dissolve the globule in 2-3 teaspoon of water and drink it.
- Do not take anything for half an hour (at least) after taking the medicine.
- Patient should avoid undue mental or physical excitement during the course of treatment.
- After taking the medicine, the patient should not involve in any mental or emotional activity (like reading, talking, computers, electronic games etc) for at least one hour.
- In chronic cases, medicine may be repeated every other day or even daily in medicinal solution in ascending potency.
- In acute cases, dissolve 1 to 2 pills in 100 to 200 ml water and give the patient half to one teaspoon every hour to every 6 hours depending upon the case. If the symptoms start aggravating with frequent repetition, increase the interval between two doses.
- For chronic cases, medicinal solution should be prepared using half water and half alcohol.
- Dissolve 1 or more pills in 10 to 20 ml solution of water and alcohol. Shake well till pills dissolve. From this solution put one or more drops of water in a cup with 15 ml water and stir well. Give patient this solution as one dose or give half internally and apply half on skin. Before each dose, give the bottle of medicinal solution 6 to 10 strokes.
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But if these appropriately selected antipsoric medicines are not allowed to act their full time, when they are acting well, the whole treatment will amount to nothing. Another antipsoric remedy which may be ever so useful, but is prescribed too early and before the cessation of the action of the present remedy, or a new dose of the same remedy which is still usefully acting, can in no case replace the good effect which has been lost through the interruption of the complete action of the preceding remedy, which was acting usefully, and which can hardly be again replaced.
It is a fundamental rule in the treatment of chronic diseases: To let the action of the remedy, selected in a mode homoeopathically appropriate to the case of disease which has been carefully investigated as to its symptoms, come to an undisturbed conclusion, so long as it visibly advances the care and the while improvement still perceptibly progresses. This method forbids any new prescription, any interruption by another medicine and forbids as well the immediate repetition of the same remedy. Nor can there be anything more desirable for the physician than to see the improvement of the patient proceed to its completion unhindered and perceptibly. There are not a few cases, where the practiced careful Homoeopath sees a single dose of his remedy, selected so as to be perfectly homoeopathic, even in a very severe chronic disease, continue uninterruptedly to diminish the ailment for several weeks, yea, months, up to recovery; a thing which could not have been expected better in any other way, and could not have been effected by treating with several doses or with several medicines. To make the possibility of this process in some way intelligible, we may assume, what is not very unlikely, that an antipsoric remedy selected most accurately according to homoeopathic principles, even in the smallest dose of a high or the highest potency can manifest so long-continued a curative force, and at last cure, probably, only by means of a certain infection with a very similar medicinal disease which overpowers the original disease, by the process of nature itself, according to which (Organon, § 5, Fifth Edition,) two diseases which are different, indeed, in their kind but very similar in their manifestations and effects, as also in the ailments and symptoms caused by it, when they meet together in the organism, the stronger disease (which is always the one caused by the medicine, §33, ibid.) destroys the weaker (the natural one). In this case every new medicine and also a new dose of the same medicine, would interrupt the work of improvement and cause new ailments, an interference which often cannot be repaired for a long time.
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The only allowable exception for an immediate repetition of the same medicine is when the dose of a well-selected and in every way suitable and beneficial remedy has made some beginning toward an improvement, but its action ceases too quickly, its power is too soon exhausted, and the cure does not proceed any further. This is rare in chronic diseases, but in acute diseases and in chronic diseases that rise into an acute state it is frequently the case. It is only then, as a practiced observer may recognize - when the peculiar symptoms of the disease to be treated, after fourteen, ten, seven, and even fewer days, visibly cease to diminish, so that the improvement manifestly has come to a stop, without any disturbance of the mind and without the appearance of any new troublesome symptoms, so that the former medicine would still be perfectly homeopathic suitable, only then, if say, is it useful, and probably necessary to give a dose of the same medicine of a similarly small amount, but most safely in a different degree of dynamic potency.* When the remedy is thus modified, the vital force of the patient will allow itself more easily to be further affected by the same medicine, so as to effect by it everything that may be expected of this medicine and in this ailment.
To adduce an example: a freshly arisen eruption of itch belongs to those diseases which might soonest permit the repetition of the dose (sulphur), and which does permit it the more frequently, the sooner after the infection the itch is received for treatment, as it then approaches the nature of an acute disorder, and demands its remedies in more frequent doses than when it has been standing on the skin for some time. But this repetition should be permitted only when the preceding dose has largely exhausted its action (after six, eight or ten days), and the dose should be just as small as the preceding one, and be given in a different potency. Nevertheless it is in such a case often serviceable, in answer to a slight change of symptoms, to interpose between the doses of pure sulphur, a small dose of Hepar sulphuris calcareum. This also should be given in various potencies, if several doses should be needed from time to time. Often also, according to circumstances, a dose of Nux vomica (x) or one of mercury (x)** may be used between.
(* If it, has first been given in the 30th potency it will now be given in perhaps the 18th, and if a repetition should, be again found serviceable and necessary, it might afterwards be given in the 24th. and later perhaps also in the 12th and 6th, etc., if, the chronic disease should have taken on itself an acute character. A dose of medicine may also have been suddenly counteracted and annihilated by a grave error in the regimen of the patient, when perhaps a dose of the former serviceable medicine might again be given with the modification mentioned above.)
(In cases where the physician is certain as to the homeopathic specific to be used, the first attenuated dose may also be dissolved in about four ounces of water by stirring it, and one-third may be drunk at once, and the second and third portions on the following days; but it should each time be again stirred so as to increase the potency and thus to change it. Thereby the remedy seeing to take a deeper hold on the organism and hasten the restoration in patients who are vigorous and not too sensitive.)
(** That the itch-patient during such a treatment must avoid every external application, however harmless it may appear, e.g., the washing with black soap, is not necessary to emphasize.)
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If I except sulphur, Hepar sulphuris and in some cases Sepia, the other antipsoric remedies can seldom be usefully given in immediately repeated doses. Indeed it is hardly ever needed in chronic diseases, as we have a goodly supply of antipsoric remedies at our disposal, so that as soon as one well selected remedy has completed its action, and a change of symptoms, i.e., a change in the total image of the disease, appears, another antipsoric remedy homeopathic appropriate to the altered case may be chosen to greater advantage and with a more sure prospect of hastening the cure, than if we take the risk of prescribing the former medicine which now is no longer altogether adequate. Nevertheless in very tedious and complex cases, which are mostly such as have been mismanaged by allopathic treatment, it is nearly always necessary to give again from time to time during the treatment, a dose of Sulphur or of Hepar (according to the symptoms), even to the patients who have been before dosed with large allopathic doses of Sulphur and with sulphur-baths; but then only after a previous dose of Mercury (x).
Where, as is usually the case in chronic diseases, various antipsoric remedies are necessary, the more frequent sudden change of them is a sign that the physician has selected neither the one nor the other in an appropriately homeopathic manner, and had not properly investigated the leading symptoms of the case before prescribing a new remedy. This is a frequent fault into which the homeopathic physician falls in urgent cases of chronic diseases, but oftener still in acute diseases from overhaste, especially when the patient is a person very dear to his heart. I cannot too urgently warn against this fault.
Then the patient naturally falls into such an irritated state that, as we say, no medicine acts, or shows its effect,* yea, so that the power of response in the patient is in danger of flaring up and expiring at the least further dose of medicine. In such a case no further benefit can be had through medicine, but there may be in use a calming mesmeric stroke made from the crown of the head (on which both the extended hands should rest for about a minute) slowly down over the body, passing over the throat, shoulders, arms, hands, knees and legs down over the feet and toes. This may be repeated if necessary.
A dose of homeopathic medicine may also be moderated and softened by allowing the patient to smell a small pellet moistened with the selected remedy in a high potency, and placed in a vial the mouth of which is held to the nostril of the patient, who draws in only a momentary little whiff of it. By such an inhalation the powers of any potentized medicine may be communicated to the patient in any degree of strength. One or more such medicated pellets, and even those of a larger size may be in the smelling-bottle, and by allowing the patient to take longer or stronger whiffs, the dose may be increased a hundred fold as compared with the smallest first mentioned. The period of action of the power of a potentized medicine taken in by such inhalation and spread over so large a surface (as that of the nostrils and of the lungs) last as long as that of a small massive dose taken through the mouth and the fauces.
(* That a homeopathic potentized dose of medicine should ever fail of having an effect in a treatment conducted with care, I think impossible; I have never experienced it.)
(Even persons born without the sense of smell or who have lost it through disease, may expect equally efficient help from drawing in the imperceptible vapor (proceeding from the medicine and contained in the vial) through one nostril or the other, as those do who are gifted with the sense of smell. From this it follows that the nerves possessing merely the sense of touch receive the salutary impression and communicate it unfailingly to the whole nervous system.)
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The strength of a patient under an antipsoric treatment, even if it should be continued ever so long, ought continually to increase from the very commencement of the correct treatment even to the restoration of health and of the normal state. The strength increases during the whole of the cure without the use of the so-called tonics, and the patients joyously rise up again of themselves in proportion as their life is delivered from its corroding enemy.*
The best time for taking a dose of antipsoric medicine seems to be, not an hour before going to bed but, rather, early in the morning while fasting. The medicine in the numbered paper (as also all that succeed) if it is desired that it should act but feebly, should be taken dry and allowed to dissolve on the tongue, or be moistened with two or three drops of water on a spoon, and by itself, without in either case drinking anything after it or eating anything within half an hour or a whole hour.**4
After taking the medicine the patient should keep perfectly quiet at least a full hour, but without going to sleep (sleep delays the beginning of the action of the medicine). He must avoid during this hour, as indeed throughout the treatment, all disagreeable excitement, nor should he strain his mind immediately after taking the dose, in any way, either by reading or computing, by writing, or by conversations requiring meditation.
(* It is inconceivable how allopathic physicians could think of curing chronic diseases through a continuance of exhausting and debilitating treatments, without being restrained by their lack of success from repeating continually their perverse treatment. The amara which they give between, together with the quinine, without being able to supply the strength lost, only add new evils.)
(Numbering the powders continuously has the convenience that the physician when the patients render their daily report (especially those living at a distance) putting first the date and the number of the powder taken that day, can recognize the day when the patient took his medicine, and can judge of the progress of its action according to the report of the following day.)
(** If the medicine is to act more strongly it must be stirred in a little more water until dissolved before taking it, and in still more water if it is to act still more strongly, and the physician should order the solution taken a portion at a time. If he orders the solution taken in one or three days it must be stirred up not only the first time, but also the other two times, by which every part thus stirred acquires another somewhat higher degree of potency, and so is received more willingly by the vital force. To direct the use of the same solution for a greater number of days is not advisable, as the water, kept longer, would begin to putrefy. How a dose for smelling may be adapted to all degrees of strength, I have mentioned above.)
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In chronic diseases I have found it best to give a dose (e.g., a spoonful) of a solution of the suitable medicine at least every two days, more usually every day.
But since water (even distilled water) commences after a few days to be spoil, whereby the power of the small quantity of medicine contained is destroyed, the addition of a little alcohol is necessary, or where this is not practicable, or if the patient cannot bear it, I add a few small pieces of hard charcoal to the watery solution. This answers the purpose, except that in the latter case the fluid in a few days receives a blackish tint. This is caused by shaking the liquid, as is necessary every time before giving a dose of medicine, as may be seen below.
Before proceeding, it is important to observe, that our vital principle cannot well bear that the same unchanged dose of medicine be given even twice in succession, much less more frequently to a patient. For by this the good effect of the former dose of medicine is either neutralized in part, or new symptoms proper to the medicine, symptoms which have not before been present in the disease, appear, impeding the cure. Thus even a well selected homeopathic medicine produces ill effects and attains its purpose imperfectly or not at all. Thence come the many contradictions of homeopathic physicians with respect to the repetition of doses.
But in taking one and the same medicine repeatedly (which is indispensable to secure the cure of a serious, chronic disease), if the dose is in every case varied and modified only a little in its degree of dynamization, then the vital force of the patient will calmly, and as it were willingly receive the same medicine even at brief intervals very many times in succession with the best results, every time increasing the well-being of the patient.
This slight change in the degree of dynamization is even effected, if the bottle which contains the solution of one or more pellets is merely well shaken five or six times, every time before taking it.
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Now when the physician has in this way used up the solution of the medicine that had been prepared, if the medicine continues useful, he will take one or two pellets of the same medicine in a lower potency (e.g. if before he had used the thirtieth dilution, he will now take one or two pellets of the twenty-fourth), and will make a solution in about as many spoonfuls of water, shaking up the bottle, and adding a little alcohol or a few pieces of charcoal. This last solution may then be taken in the same manner, or at longer intervals, perhaps also less of the solution at a time; but every time the solution must be shaken up five or six times. This will be continued so long as the remedy still produces improvement and until new ailments (such as have never yet occurred with other patients in this disease), appear; for in such a case a new remedy will have to be used. On any day when the remedy has produced too strong an action, the dose should be omitted for a day. If the symptoms of the disease alone appear, but are considerably aggravated even during the more moderate use of the medicine, then the time has come to break off in the use of the medicine for one or two weeks, and to await a considerable improvement.*
When the medicine has been consumed and it is found necessary to continue the same remedy, if the physician should desire to prepare a new portion of medicine from the same degree of potency, it will be necessary to give to the new solution as many shakes, as the number of shakes given to the last portion amount to when summed up together, and then a few more, before the patient is given the first dose; but after that, with the subsequent doses, the solution is to be shaken up only five or six times.
(*In treating acute cases of disease the homeopathic physician will proceed in a similar manner. He will dissolve one (two) pellet of the highly potentized, well selected medicine in seven, ten or fifteen tablespoonfuls of water (without addition) by shaking the bottle. He will then, according as the disease is more or less acute, and more or less dangerous, give the patient every half hour, or every hour, every two, three, four, six hours (after again well shaking the bottle) a whole or a half tablespoonful of the solution, or, in the case of a child, even less. If the physician sees no new symptoms develop, he will continue at these intervals, until the symptoms present at first begin to be aggravated; then he will give it at longer intervals and less at a time.
As is well known, in cholera the suitable medicine has often to be given at far shorter intervals.
Children are always given these solutions from their usual drinking vessels; a teaspoon for drinking is to them unusual and suspicious, and they will refuse the tasteless liquid at once on that account. A little sugar may be added for their sake.
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I have, therefore, lately found the following mode of administration preferable with careful patients. From a mixture of about five tablespoonfuls of pure water and five tablespoonfuls of French brandy - which is kept on hand in a bottle, 200, 300 or 400 drops (according as the solution is to be weaker or stronger) are dropped into a little vial, which may be half-filled with it, and in which the medicinal powder or the pellet or pellets of the medicine have been placed. This vial is stoppered and shaken until the medicine is dissolved. From this solution one, two, three or several drops, according to the irritability and the vital force of the patient, are dropped into a cup, containing a spoonful of water; this is then well stirred and given to the patient, and where more especial care is necessary, only the half of it may be given; half a spoonful of this mixture may also well be used for the above mentioned external rubbing.
On days, when only the latter is administered, as also when it is taken internally, the little vial containing the drops must every time be briskly shaken five or six times; so also the drop or drops of medicine with the tablespoonful of water must be well stirred in the cup.
It would be still better if instead of the cup a vial should be used, into which a tablespoonful of water is put, which can then be shaken five or six times and their wholly or half emptied for a dose.
Frequently it is useful in treating chronic diseases to take the medicine, or to rub it in in the evening, shortly before going to sleep, because we have then less disturbance to fear from without, than when it is done earlier.
When I was still giving the medicines in undivided portions, each with some water at a time, I often found that the potentizing in the attenuating glasses effected by ten shakes was too strong (i.e., the medicinal action too strongly developed) and I, therefore, advised only two succussions. But during the last years, since I have been giving every dose of medicine in an incorruptible solution, divided over fifteen, twenty or thirty days and even more, no potentizing in an attenuating vial is found too strong, and I again use ten strokes with each. So I herewith take back what I wrote on this subject three years ago in the first volume of this book on page 149.
In cases where a great irritability of the patient is combined with extreme debility, and the medicine can only be administered by allowing the patient to smell a few small pellets contained in a vial, when the medicine is to be used for several days, I allow the patient to smell daily of a different vial, containing the same medicine, indeed, but every time of a lower potency, once or twice with each nostril according as I wish him to be affected more or less.
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