Dummys
Guide to LM/Q Potencies
Vergleich: Siehe: Homöopathie + Terminology in Homeopathy
(Meine eigene Erfahrungen mit LM/Q Potencies)
Natürlich rät einen Arzt mir zu Q-potencies.
Ich bin das Prototyp von Nat-m. Ich bestelle
Nat-m. Q 2. Und nehme
es ein wie angegeben. Es hilft wie erwartet, aber nach einige Tagen
nicht mehr und ich weiß nicht weiter. Eigentlich brauche ich
einen fundierte Ratschlag, aber wie diese zu bekommen. Ich wurstele noch ein
paar Tagen
Sir, why is that many homoeopathic practitioners are now frequently
using the 50 millisemal scale. Is the Centisimal and Decimal scale out of vogue?
[Dr Vaibhav Mhamane,
Satara]
Such questions have been asked time and again. Well! I generally use Centicimal potencies in my practice. But in many cases LM
potencies are required.
They are - Idiosynchronitic cases when one
reacts to each and every medicine,
- When the vitality has come down to such a lower ebb that the life is
in danger, time is short and symptoms distressing, then LM potencies work
wonders.
A typical example being management
of an acute Myocardial Infarction.
- When one requires frequent repetitions so that the action of the
remedy catches up with the pace of the disease.
- In oversensitive patients where aggravations are not tolerated at all.
[Manish Bhatia]
What are LM (or Q-)potencies?
The LM potencies were the last scale of potencies (serial agitated
dilutions of homeopathic medicines) developed by Samuel H. (1755-1842), the
founder of Homeopathy.
They are also known as Q-potencies and 50 Millesimal
potencies. The scale represents a serial dilution of 1:50,000 with each
subsequent potency.
Remember, there are two other scales in Homeopathy:
Decimal Scale (X): was created by C. Hering
(1800-1880) and has a dilution ratio of 1 : 10
Centesimal Scale (C or K or CH): was created by H. and has a dilution
ration of 1 : 100
Who created the LM Scale?
Christian Frederick Samuel H., the person who started the system of
medicine that we know as Homeopathy.
When?
Between 1837 to 1842 in Paris.
Why?
During his Paris years, H. found that many of his patients were
unusually sensitive and aggravated (homeopathic aggravation) even with the 30C
of the centesimal scale.
He also felt the need for frequent repetitions in cases with persistent
pathology but the dry centesimal doses were not ideal for this. To avoid the
aggravations and to
find a method effective for frequent repetition, he started diluting the
globules in water before administering and gave a part of the liquid as a dose.
These experiments
later resulted in the development of the LM potencies.
What’s in the name?
H. mentioned his new potencies by name: divisions infinitesemales
(infinitesimal dilutions). He called these preparations “medicamens
au globule”, to distinguish them
from the old centesimal potencies, called medicamens
a la goutte (medicines of the drop).
Dr. Pierre Schmidt of Geneva termed this new scale as “50 Millesimal”.
Rudolf Flury (1903-1977) gave the abbreviation
‘LM’ – ‘L’ for Roman ’50’ and ‘M’ for
Roman ‘1000’. However, this denotation is technically incorrect, as the Roman
numeral LM would denote the number 950 rather than 50,000.
The name ‘Q-potency’ is derived from the Latin word ‘quinquagintamilia’,
which literally means 50,000 and was introduced by Jost
Kunzli (1915-1992).
So ‘Q’ is the correct abbreviation for the 50 Millesimal
potencies. However, in spite of being the incorrect abbreviation, ‘LM’ is still
in popular use.
What is the range of available LM potencies?
The LM potencies are usually available in dry globules and the potency
range is from LM1 to LM 30.
Why is it limited to LM30?
H. found this range sufficient for most patients. But this is not an
absolute limit and many pharmacies will make it for you in dilutions beyond LM
30 on custom order.
How are the LM potencies denoted?
The LM potencies are usually written as ‘0/potency number’ like ‘0/1′,
‘0/2′ …’0/30′.
This method of noting this new scale comes straight from H.’s case records. H. did not mention anywhere what the
small zero or ‘o’ meant. Many historians feel that it
denotes the small globule used to dispense the potency.
Many people also denote these potencies as LM1, LM2 …LM30. And some even
use the Q as Q1, Q2 …Q30.
Where did H. describe the LM potencies?
Footnote to aphorism 270 in the 6th
edition of Organon of Medicine.
How to make the first LM potency?
Unlike the mother tinctures that are used to prepare the first Decimal
and Centesimal scale potencies, the first LM potency is prepared from the 3C trituration of the original
drug substance.
So if you want to prepare the LM potencies yourself, you can buy the 3C trituration of the desired medicine from the market or you
can do the trituration yourself using the
crude drug substance. Remember for preparing the trituration,
you will need one part of raw drug substance and 99 parts of sugar of milk. The
mixture has to be triturated for
1 hour according to the guidelines given in the Organon
to prepare the ‘1C’. To prepare the 2C, you take one part of 1C and 99 parts of
sugar of milk and triturate for another hour.
Repeat the process with 2C to get the 3C.
So once you have the 3C potency, you can start preparing the LM1:
– Take a grain in weight
(0.062gm) of the 3C powder and dissolve it in 500 drops (30ml) of 20% alcohol
making a 1:500 dilution of the 3c.
– One drop of this solution
is then further diluted in 99 drops of 95% alcohol, filling two thirds of a
glass vial, giving a (1 in 500 x 100 = 50,000) solution of the 3c powder.
– This tube is then succussed 100 times against a firm but elastic object (like
a leather bound book) to create the LM 1 medicating liquid.
–
The
LM 1 liquid is then poured onto some poppy-seed granules of which a hundred
weigh 1 grain (0.06gm). The granules are so small that one drop of the
alcoholic LM 1 liquid can completely
–
wet
at least 500 of them. Thus just one granule absorbs at least a 500th of a drop.
– Many homeopaths use globules
of size 10, instead of the smaller ones recommended by H.
– The globules are then dried
and filed in glass vials. This gives you the first LM potency that you get from
the market.
Why do you attain the dilution of 1:50000 using (500) globules and
alcohol (100 drops)? Why not just use liquid for the dilution?
One could theoretically dilute with one drop to 50,000 drops. Since 100
drops of 95% alcohol equal 3.6mls, 50,000 drops would mean 1.75 liters. The bottle
to be succussed 100 times would need to
be at least 2 liters in size - not a practical
size for the average human being to work with! But there are some pharmacies
that make their LM’s with the alcohol only and
without using the globules.
How do you make the subsequent LM potencies?
– Take one granule of LM1 and dissolve it in a
drop of water
– Add 99 drops of alcohol to
the bottle/vial.
– Succuss
100 times. This gives you the LM2 liquid solution.
– Medicate 500 globules with
one drop of this LM2 liquid solution. Dry on blotting paper and fill in a
well-corked bottle. Your LM2 is ready!
The LM 2 solution contains a 1/500th x 100 = 1/50,000th of the previous
LM 1 liquid. The process is continued in this way by using the granule as the
intermediary to transfer a 500th of a drop instead
of the direct addition of a whole drop, as is the case with the
centesimal 1:100 ratio.
How do you administer LM potencies?
1. Take a 4oz (120ml) to 6oz (180ml) clean glass bottle. Fill it ¾ with
water. Take 1 or 2 globules of the desired potency (often starting at LM 0/1)
and place it into the bottle. Add a few drops of pure alcohol.
2. Succuss the bottle just prior to ingestion
1 to 12x depending on the sensitivity of the patient. This slightly raises the
potency and activates the remedy.
3. Take 1, or more teaspoons of the medicinal solution and place it into
8 to 10 tablespoons of water in a dilution glass and stir it. Most cases are
started with 1 teaspoon and the amount is increased only
if necessary. In children the amount should be 1/2 teaspoon. Infants may
only need 1/4 of a teaspoon.
4. Take 1, (or rarely, 2 or 3) teaspoons from the dilution glass as a
dose. Most cases are started with 1 teaspoon and the amount increased only if necessary.
Children should be given 1/2 teaspoon. Infants should receive 1/4 or less of a
teaspoon.
The dosage of the medicinal solution can be carefully adjusted to suit
the sensitivity of the individual’s constitution.
Can LM potencies aggravate like centesimal scale potencies?
Since H. created the new scale to avoid homeopathic aggravations, many
people think that LM’s do not aggravate at all. Some
people also believe that LM’s aggravate at the end of
treatment, whereas centesimal potencies aggravate at the beginning.
Both the notions are incorrect. LM’s are
definitely gentler than centesimal scale but they can aggravate just like the C
scale in sensitive patients. Aggravations are apparently less because the
medicines
are diluted so much and also the same potency is never repeated twice.
But the aggravations can and do happen with LM potencies, so don’t use them
blindly.
How do you repeat medicines in the LM scale?
The rule is to repeat the medicine once or twice daily, till a
significant positive change becomes visible. After that medicine should not be
used mechanically. But repetition entirely depends upon the individual
sensitivity and the patient’s reaction. Ask the patient to report/call after 3
and 7 days or if s/he sees any significant reaction, to judge the initial
reaction and modify the dose and repetition accordingly.
In acute cases, you can even repeat every few hours or even every few
minutes.
What to do when the first bottle of LM1 is finished.
Do not make another bottle of LM1, graduate to LM2. Similarly when the
LM2 is over, move on to LM3 and so on.
Should I do this till LM30?
No. Usually a patient won’t need all the potencies in succession. Stop
repeating once you see a definite improvement. If your remedy were right, the
patient would be cured much before reaching the LM30.
What if the patient shows no reaction to LM1?
You can first try to increase the dose and succussion.
Ask the patient to succuss the bottle more and to
take 2 or 3 teaspoons from the dilution cup instead of one. If the patient
still does not react, move
on to a higher LM. And if it still does not work, either your remedy
selection is wrong or you need to use the centesimal scale.
What conditions can be treated with LM potencies?
Any condition and any patient can be treated with the LM scale. Earlier,
LMs were considered useful only for hypersensitive
patients but nowadays there are homeopaths who practice exclusively with
LM potencies. Many others have found them useful in selective cases
only.
Why haven’t LM potencies been as popular as the centesimal scale?
H. developed LM scale during his last years in Paris. He described the
new scale in the 6th edition but passed away before it could be published. For
many reasons, the 6th edition was not published till 1921. During this period,
the whole world was practicing with the C potencies and they had become the
norm.
Even when the world got to know about the new scale, it took another few
decades before people understood it fully. And even after that most people remained
apprehensive because of the extreme level of dilution and never used it.
Why are they becoming popular now?
LM potencies are becoming increasingly popular now because a lot of work
has been done in creating a better understanding of the 6th edition
of the Organon, as well as H.’s
case records. People like David Little and Luc de Schepper
have been instrumental in making the latest work of H. more acceptable.
Conclusion
So that’s it! Now you are ready to use the LM potencies easily and
effectively. Do share with me your experiences with the LM scale so that our
collective understanding of their use can increase further. You can write to me
at mail@hpathy.com
Aphorism 270, Organon of Medicine, 6th Edition
Ҥ270: In order to best obtain this development of power, a small part
of the substance to be dynamized, say one grain, is
triturated for three hours with three times one hundred grains sugar of milk
according to the method described below 1/3 of one hundred grains sugar of milk
is put in a glazed porcelain mortar, the bottom dulled previously by rubbing it
with fine, moist sand. Upon this powder is put one grain of the powdered drug
to be triturated (one drop of quicksilver, petroleum, etc.). The sugar of milk
used for dynamization must be of that special pure
quality that is crystallized on strings and comes to us in the shape of long
bars. For a moment the medicines and powder are mixed with a porcelain spatula
and triturated rather strongly, six to seven minutes, with the pestle rubbed
dull, then the mass is scraped from the bottom of the mortar and from the
pestle for three to four minutes, in order to make it homogeneous.
This is followed by triturating it in the same way 6 - 7 minutes without
adding anything more and again scraping 3 -4 minutes from what adhered to the
mortar and pestle. The second third of the sugar of milk is now added, mixed
with the spatula and again triturated 6 - 7 minutes, followed by the scraping
for 3 -4 minutes and trituration without further
addition for 6 -7 minutes. The last third of sugar of milk is then added, mixed
with the spatula and triturated as before 6 - 7 minutes with most careful
scraping together. The powder thus prepared is put in a vial, well corked,
protected from direct sunlight to which the name of the substance and the
designation of the first product marked /100 is given. In order to raise this
product to /10000, one grain of the powdered /100 is mixed with the third part
of
100 grains of powdered sugar of milk and then proceed as before, but
every third must be carefully triturated twice thoroughly each time for 6-7
minutes and scraped together 3 - 4 minutes before the second and last third of
sugar of milk is added. After each third, the same procedure is taken. When all
is finished, the powder is put in a well corked vial and labelled /10000, i.e.,
(I), each grain containing 1/1.000.000 the original substance. Accordingly,
such a trituration of the three degrees requires six
times six to seven minutes for triturating and six times 3 -4 minutes for scraping,
thus 60. The LM potencies in homoeopathy up to the one-millionth part in powder
form. For reasons given below (6) one grain of this powder is dissolved in 500
drops of a mixture of one part of alcohol and four parts of distilled water, of
which one drop is put in a vial. To this are added 100 drops of pure alcohol
(2) and given one hundred strong succussions with the
hand against a hard but elastic body. This is the medicine in the first degree
of dynamization with which small sugar globules (4) may
then be moistened (5) and quickly spread on blotting paper to dry and kept in a
well corked vial with the sign of (I) degree of potency. Only one (6) one hour
for every degree. After one hour such trituration of
the first degree, each grain will contain 1/000; of the second 1/10,000; and in
the third 1/1,000,000 of the drug used.*
* These are the three degrees of the dry powder
trituration, which if carried out correctly, will
effect a good beginning for the dynamization of the
medicinal substance. Mortar and spatula must be cleaned well before they are
used for another medicine. Washed first with warm water and dried. Both mortar
and pestle, as well as spatula are then put in a kettle of boiling water for
half an hour. Precaution might be used to such an extent as to put these
utensils on a coal fire exposed to a glowing heat.
(2) The vial used for potentizing is filled
two-thirds full.
(3) Perhaps on a leather bound book.
(4) They are prepared under supervision by the confectioner from starch
and sugar and the small globules freed from fine dusty parts by passing them
through a sieve. Then they are put through a strainer that will permit only 100
to pass through weighing one grain, the most serviceable size for the needs of
a homoeopathic physician.
(5) A small cylindrical vessel shaped like a thimble, made of glass,
porcelain or silver, with a small opening at the bottom in which the globules
are put to be medicated. They are moistened with some of the dynamized medicinal alcohol, stirred and poured out on
blotting paper, in order to dry them quickly.
(6) According to first directions, one drop of the liquid of a lower
potency was to be taken to 100 drops of alcohol for higher potentiation. This
proportion of the medicine of attenuation to the medicine that is to be dynamized (100:1) was found altogether too limited to
develop thoroughly and to a high degree the power of the medicine by means of a
number of such succussions without specially using
great force of which wearisome experiments have convinced me. But if only one
such globule be taken, of which 100 weigh one grain, and dynamize
it with 100 drops of alcohol, the proportion of 1 to 50,000 and even greater
will be had, for 500 such globules can hardly absorb one drop, for their
saturation. With this disproportionate higher ratio between medicine and
diluting medium many successive strokes of the vial filled two-thirds with
alcohol can produce a much greater development of power. But with so small a
diluting medium as 100 to 1 of the medicine, if many successions by means of a
powerful machine are forced into it, medicines are then developed which,
especially in the higher degrees of dynamization, act
almost immediately, but with furious, even dangerous violence, especially in
weakly patients, without having a lasting, mild reaction of the vital
principle. But the method described by me, on the contrary, produces medicines
of highest development of power and mildest action, which, however, if well
chosen, touches all suffering parts curatively.*
In very rare cases, notwithstanding almost full recovery of health and
with good vital strength, an old annoying local trouble ontinuing
undisturbed it is wholly permitted and even indispensably necessary, to
administer in increasing doses the homoeopathic remedy that has proved itself
efficacious but potenized to a very high degree by
means of many successions by hand. Such a local disease will often then
disappear in a wonderful way.
In acute fevers, the small doses of the lowest dynamization
degrees of these thus perfected medicinal preparations, even of medicines of
long continued action (for instance, belladonna) may be repeated in short
intervals. In the treatment of chronic diseases, it is best to begin with the
lowest degrees of dynamization and when necessary
advance to higher, even more powerful but mildly acting degrees.
The Wet dose of any Homeopathic remedy is made as follows:
Order the remedy in the form in Alcohol, also referred to as Liquid
Dilution in a bottle preferably with a dropper arrangement.
Get a 500ml bottle of Spring Water from the nearest supermarket.
Pour out about 3cm of water from the bottle to leave some airspace.
Insert 3 drops of the remedy into the bottle and shake the bottle hard
at least 6x before you sip a capfull of the bottle or
a large teaspoonful which is the dose.
Shaking the bottle hard is homeopathic succussion
and this enhances the effect of the remedy on the user.
[David Little]
Hahnemann's Final Methods
Shortly before Samuel Hahnemann passed away he shared the method of
administering the LM potency with Baron von Boenninghausen.
After Samuel's death Melanie Hahnemann told the Baron von Boenninghausen
that the 6th Organon would soon be published. When he
announced this event to his colleagues, Melanie asked him to remain quiet on
the subject until after she published the work. Out of respect for Hahnemann's
widow the Baron did not disclose all the information in his possession. Apart
from Samuel and Melanie Hahnemann it appears that only Baron von Boenninghausen had tested the LM potency in the clinic. In
1857 the Baron wrote:
"In the new edition of
the Organon which will probably appear yet in the
course of this year, improved and completed by Hahnemann himself, a new
simplified procedure for the potentizing of medicines
will be taught, which has considerable advantages over the former and yields a
preparation as to the efficacy of which I can, from my own experience, give
full praise. I know this procedure but according to my pledged word of honor, am not as yet permitted to communicate it to
anyone."
The Lesser Writings; C. M. F. Boenninghausen, Aluminium Metallicum,
footnote, page 74.
In this quote Boenninghausen clearly states
that the praise he lauded on the new dynamizations
was based on his "own experience". He would not have used these words
unless he had tested the LM potency personally. The Aluminium cases quoted in
this article are dated 1856 to 1857, which shows this statement must have been
made at least 14 years after Hahnemann's passing. Unfortunately, the 6th
edition remained unpublished until Richard Haehl's
edition appeared in German in 1920 and the Boericke
edition in English in 1921. By that time, all those with first hand information
on how Hahnemann actually used the LM potency has passed away.
There is quite a bit of confusion about Hahnemann's Paris methods in
general and the LM potency in particular. The most controversial area arises
over the subject of the daily and alternate day dose.
This is because it is very difficult to learn how to use the LM potency
properly just from reading the text of the 6th Organon
without a lineage of teachers going back to Hahnemann. The only way to
understand the bigger picture is to study the final edition along with the
Paris Casebooks and remaining eyewitness accounts. First of all we will review
exactly what the 6th Organon actually says about posology and case management.
Aphorism 246 gives the most precise details on how to administer the LM
potency. The statements made in this paragraph must be put in context with the
information presented in aphorism 248 about the daily and alternate day dose.
Here Hahnemann clearly says, "Every noticeably progressive and
conspicuously increasing improvement is a state which, as long as it persists,
generally excludes any repetition of the medicine." This is because the
remedy is "hastening toward completion" at the quickest possible
speed and any repetition may slow down the cure or cause a relapse of symptoms.
This reflects what Hahnemann said in aphorism 245 of the 5th Organon on the single dose.
Then Hahnemann says, "On the other hand" some patients
experience only a "slow, continuous improvement based on one dose of a
aptly selected homeopathic medicine (taking 40, 50, 60 100 days to complete the
cure, depending on the nature of the medicine) but this is very seldom the
case." It is much more common for the slow remedy action to cease and the
patient to relapse. Then H. goes on to state how important it is to
"foreshorten this period" to 1/2, 1/4 or less so that a more rapid
cure is attained. This reflects what Hahnemann said in aphorism 246 of the 5th Organon on repeating the remedy to speed the cure.
Hahnemann makes it very clear that there are two major types of remedy
actions that must be treated differently.
A. The first condition is a visibly progressing and strikingly
increasing amelioration. In this instance Hahnemann says to leave the single
dose to act without repetition as long as this state lasts. This statement also
applies to any time during treatment that there is a dramatically increasing
amelioration on a series of doses. I would like to report that my colleagues
and I have witnessed several cures of chronic diseases with single and infrequent
doses of the LM potency.
B. The second remedy action is a slow continuous improvement that could
take up to 100 or more days to cure. Some cases show little or no response to a
single dose although the remedy is correct. This is because the sensitivity of
the patient and the nature of disease state require more medicinal stimulation.
In this case one should repeat the dose at suitable intervals to speed the
cure. This is quite common
in protracted chronic disease and complex miasms.
One may repeat the dose to speed the cure only if they follow all five
conditions noted at the end of the paragraph.
1. The remedy is perfectly homoeopathic (Not a
wrong remedy or a partial simillimum.)
2. The remedy is potentized
and dissolved in water. (Not the dry dose.)
3. The remedy is given in a small dose (1 pill
in a 7-8 tablespoon medicinal solution, given in a split-dose, etc.)
4. The remedy should be given at suitable
intervals based on what experience has shown to be the correct timing.
(Individualization.)
5. The degree of dynamization
must be changed on each dose (The medicinal solution must be succussed prior to ingestion to slightly raise the
potency.)
There is a great difference between a visibly progressing and strikingly
increasing amelioration and a slow continuous improvement that may take up to
100 days to show any significant improvement.
In most cases of slow improvement the patient tends to relapse rather
than progress to cure. What Hahnemann is offering is a very clear differential
analysis of two different types of remedy actions.
When the patient is already hastening toward cure on single or
infrequent doses the cure does not need to be sped! If the remedy is repeated
under these conditions it will either slow down the action of the previous
dose, aggravate the patient, or cause a relapse of symptoms. In the footnote to
aphorism 246 it says the LM may be given daily "when necessary". It
does not say to give the LM potency to everybody no matter what!
All the statements about the daily and alternate day dose that follow in
aphorism 248 are about how to speed the cure in slowly improving cases. These
are the cases where one needs to foreshorten this period to 1/2, 1/4 or less
the time so that a more rapid cure is attained. In aphorism 248 Hahnemann says
that the remedy may be repeated daily or on alternate days in "protracted
diseases", which means long drawn out and prolonged illnesses. If the
patient is experiencing a strikingly increasing amelioration on a single dose
or a short series of doses, the repetition of the remedy is counter indicated
as long as this state lasts. These aphorisms teach when it is best to wait and
watch and when it is best to act and observe. This is the best of both worlds!
Hahnemann sent Baron von Boenninghausen two LM
case histories in 1843, shortly before he left for his Heavenly Abode. The Baron shared these cases with his
colleagues in the “Neus Archive f. hom, Heilkunst” (Stapf's Archives) Volume 1 number 1 1844, page 69. These
cases can be found in Boenninghausen's Lesser
Writings in an article called, Three Precautionary Rules of Hahnemann, in the
section called, 1. Warning, the Smallness of the Dose. These cases were very
instructive as they show how the Founder administered olfaction as well as the
oral medicinal solution of the C and LM potency.
The following case history has been checked with the original case found
in the Paris Casebooks. This information was presented in an article by Hanspeter Sailer called Di Entwicklung von Samuel Hahnemann's aertzukcger
Praxis, Verlag, Haug, 1988.
The Baron noted that Hahnemann dictated the example cases to a secretary and
dated and signed the letter in his own hand. This was the last letter he
received from his honored teacher.
On January 14, 1843 a patient referred to as O-T came complaining of
sore throat alternating with an anal fissure. Sailer
noted that the patient's name was Varlet. For several years the patient had a
sore throat but the present attack had lasted for one month. The last time he
had a sore throat it lasted for six weeks. The patient reported that when he
swallowed saliva he feel a pricking sensation with constriction and soreness.
When he was not suffering from the sore throat he experienced a fissure of the
anus with violent pains as from a chap. At this time, the anus was inflamed,
swollen and constricted. The patient could only discharge his stool with great
exertion with swollen, extruding hemorrhoidal veins.
1. January 15, 1843 - Belladonna in a 7 tablespoon solution.
Hahnemann prescribed Belladonna for sore throat on the 14th
but told the patient to take the remedy the next morning on an empty stomach
before breakfast. The potency was not noted in his letter to Boenninghausen but Sailer
confirmed that it was the LM 0/3 from the original casebook. The patient was
instructed to put one tablespoon of the medicinal solution into a glass of
water, stir it well and take one coffeespoon as a
dose.
2. January 16 - Merc. 0/1 in a 7 tablespoon
solution.
The throat ache was gone but the fissure returned immediately! This
shows that these conditions were related. The patient then revealed that eight
years earlier he had a syphilitic chancre that was destroyed by corrosives. All
his problems started after the suppression of the syphilitic miasm. Hahnemann immediately prescribed Mercury 0/1, his
cardinal anti-syphilitic remedy. The fissure and the chap were very painful.
How often he gave the dose is not noted. This may be a daily dose as the
symptoms were in an acute-like crisis. The Mercury 0/1 was to be prepared and
taken in the same way as the Belladonna.
3. January 20 - Merc. 0/2 in 7 tablespoons.
The patient returned for his check up 4 days later. This example shows
how closely Hahnemann was following this rather serious case at the start.
There are no "take this daily for one month" prescriptions in his
casebooks. The patient's throat pain returned slightly and the anus was better
although there was still soreness during stool. At this time, Hahnemann raised
the potency! The journal says: "One pellet of the Mercurius
viv., 2 dynamization,
prepared and taken in the same manner in the morning". If the patient took
the Mercury 0/1 in the "same manner in the morning" the 7 tablespoon
medicinal solution would not be finished yet. Nevertheless, Hahnemann
immediately raised the potency to 0/2.
This shows that the Founder raised the potency when he considered it
necessary and did not always wait for the bottle to be finished.
4. January 25 - Sailer says Hahnemann gave 2
placebos. This is not in Boenninghausen's text.
The 0/2 continued to improve the throat but there was severe lancination
in the anus. This may have been a similar aggravation caused by the remedy. The
patient was then given 2 placebos. It seems these two placebos were alternated
with the remedy so he was now taking the alternate day dose. This can be deduced because Hahnemann wrote
on Jan. 30th that the patient had taken the last dose of medicine that
afternoon. He only had 7 doses and this was 10 days later so he could not be
taking the remedy daily. The Mercury 0/2 was taken daily for 4 days and then
slowed down to alternate days interspersed with placebo. This shows Hahnemann
slowing down the remedy, which is an important method used to prevent
overmedication. The daily dose of Mercury was not continued.
4. January 30 th - 7 days of placebo in
medicinal solution.
The anus was now better but the throat was worse. This shows the
alternation of the symptoms still continuing although the symptoms are a little
better in general. There was no particular aggravation yet Hahnemann decided to
give placebos for 1 week and wait and watch. He must have observed enough
medicinal action so he stopped the remedy. This prescription demonstrates how
the Founder alternated periods of active doses with periods of placebo and
waiting and watching.
5. February. 7 - Sulphur 0/2 in 7 tablespoon solution.
The anus was still well but there was severe pain as if an ulceration in
the throat. Hahnemann wrote in The Chronic Diseases that the suppression of
syphilis could cause a flare up of psora that
obstructs the cure. On this basis, Hahnemann gave Sulphur 0/2 as a chronic intercurrent remedy. It was his hope that this anti-psoric remedy would assist the action of his
anti-syphilitic remedy in removing the complex miasmic disorder. Exactly how
often the remedy was administered is not noted. Just because the patient
returned in one week one cannot assume it was a daily dose but it may have
been.
6. February 13 - Mercury
olfaction.
The Sulphur brought out clear Mercury symptoms on the 11th and 12th. The
throat felt ulcerated and the saliva was increased and now was in great
quantities! This was a sign that the anti-psoric intercurrent had an effect on the overall symptom pattern.
There was also some constriction in the anus from yesterday. Rather than
alternating, the symptoms were both present at the same time. At this time, the
patient was given a single olfaction of Mercury, potency not noted.
7. February 14 - Merc 0/2 in 7 tablespoon
medicinal solution.
Hahnemann now gave the patient a medicinal solution of Merc. 0/2. This was to be taken "as before".
Hahnemann kept the patient on the same potency as given on January 20th, around
25 days previously. In this case he did not raise the potency every 7 or 14
days as suggested by the example in aphorism 248 of the 6th Organon
. This shows that the paragraph is only offering a baseline example, not a
rigid predetermined schedule. Hahnemann individualized all these procedures. In
one prescription he raised the potency before the bottle was finished and in
others he kept the patient on the same potency for longer periods.
8. February 20 - Placebo in 7 tablespoon medicinal solution.
The throat was better since the 18th but there was much suffering at the
anus. There seemed to be strong aggravation so Hahnemann waited and watched for
around 11 days.
9. March 3 - Single Dose Olfaction of Nitric Acid.
After the aggravation passed the symptoms of the patient improved. The
sore throat was now ameliorated. On going to stool a hemorrhoidal
vein still extrudes although it did not cause as much pain as before. Now there
is only a bit of itching in that spot. Hahnemann wrote, "I let him smell
of Ac. Nitr." Sailer
confirms that this prescription was a single inhalation of the remedy. In this
example, Hahnemann is using this method to give a gentle but deep dose toward
the end of the treatment in an effort to complete the cure without aggravation.
10. March 20 - Single Dose Olfaction of Nitric Acid. (Patient cured)
Now there was hardly any pain after stool, throat well, although he
feels some sensation on drinking cold water. Hahnemann wrote, "Now he is
allowed to smell of Ac. nitr." This means that
before this and since March 3rd the patient was not allowed to smell Nitric
acid! This dose was allowed to act over a period of 17 days. How long the
second olfaction acted one cannot tell from the record because Hahnemann only
wrote, "His health was permanently restored". The prescriptions in
this case show the following pattern.
1. Jan. 14, 1843. Belladonna in LM 0/3 in a 7 tablespoon solution.
2. Jan 16. Merc. 0/1 in 7 tablespoons
medicinal solution.
3. Jan. 20. Merc. 0/2 in 7 tablespoons
medicinal solution.
4. Jan. 25. 2 placebos to be alternated with final doses of the Mercury.
4. Jan. 30. 7 days of placebo in medicinal solution.
5. Feb. 7. Sulphur 0/2 in a 7 tablespoon medicinal solution.
6. Feb 13. Merc.
olfaction.
7. Feb 14. Merc 0/2 in a 7 tablespoon
medicinal solution.
8. Feb 20. Placebo in a 7 tablespoon medicinal solution.
9. March 3. Single dose olfaction of Nit-ac. (17 days on an olfaction).
10. March 20. Second single dose olfaction of Nitric Acid (Patient
cured).
What does this case tell us? First of all, Hahnemann's prescriptions
were individualized according to the cause, symptoms, miasms
and attending circumstances. He did not use preconceived schedules over long
periods of time. He responded to each change in the symptoms and customized his
case management methods according to the time and circumstances. Secondly, this
case shows how the Founder often interpolated and followed his medicinal doses
with a series of placebos. In this example the patient spent around 37 days on
placebos over a period of 64 days! The idea that Hahnemann gave the daily dose
for weeks, months and years on end is a complete myth!
Hahnemann's case examples offer a true picture of how Samuel Hahnemann
actually practiced in Paris in the 1840s. Over the last 8 or so years I have
reviewed scores of LM cases that show a similar pattern. Hahnemann used single
doses (usually by olfaction) followed by placebos as well as a series of oral
doses interpolated with and/or followed by placebos. Hahnemann did not speak
about his liberal use of placebos in the 6th Organon.
This may have been because he did not want to state this in a public work, as
the placebo was his "secret simillimum". If the public found out it could have caused
problems.
Hahnemann never gave the daily dose or alternate day dose for long
periods without stopping the medicine, giving placebos and waiting and
watching. Some patients remained on placebo for 7, 14 , 21 or even more days at
times. This "on again - off again" technique was used with all of his
patients. I have not seen a single case in the microfiches of the Paris casebooks
between 1840 to 1843 where Hahnemann gave the daily or alternate day dose of
the LM potency for months without stopping the remedy and giving placebos. This
is true in the Casebooks DF-10, 11, 12, 13, 14, etc., which are replete with LM
prescriptions
Any time there is a noticeably progressive and strikingly increasing
amelioration the LM potency should not be repeated as long as this state lasts.
These cases may be cured by a single dose or infrequent repetitions of the
remedy. If the patient is only slowly improving, the remedy should be repeated
at suitable intervals to speed the cure. Any time during the treatment that
there is a sudden strikingly increasing amelioration, or an aggravation or
strong accessory symptoms, the dose should be stopped as long as the state
lasts. In the case of light to moderate similar aggravation it is usually best
to wait and watch for the expected amelioration. In the case of strong
aggravations, obstructive accessory symptoms, and the appearance of new
troublesome symptoms, the situation should be rectified by skilful intervention
to regularize the symptoms.
As long as the patient is improving at a reasonable rate the remedy
should be repeated at suitable intervals to speed the cure. In "protracted
diseases" the remedy may be repeated daily or on alternate days, if
necessary, to speed the cure in otherwise long drawn out cases. The more
frequent repetition may be used as long as the patient is improving and there
are no aggravations or new symptoms. As the patient improves over time it is
best to slow down the repetition of the remedy as the potencies are increased
to prevent aggravations.
If there is an aggravation toward the end of treatment when the patient
is well in most respects this is a sign of that the cure is reaching completion.
To test this scenario one stops the medicine, gives placebo if necessary, and
waits and watches. If the aggravation is followed by a period of amelioration
and then a relapse of symptoms, the remedy should be again administered but at
longer durations until the cure is complete. If the aggravation is followed by
the complete restoration of health the remedy is no longer needed. This is the
case management method of the 6 th Organon in a nutshell.
[Dr. Croserio's Letter]
Boenninghausen shared the two LM cases sent by
Hahnemann in Stapf's Archive. Dr. Stapf
raised a number of questions about the Founder's revolutionary new methods. In
order to answer these queries the Baron sought help of Dr. Croserio,
who was a close colleague of Samuel and Melanie Hahnemann. Only Croserio and Jahr were invited to
Hahnemann's deathbed to see the Founder lying in state. Dr. Croserio
assisted Melanie in her practice after the Founder passed away and defended
Melanie in court when she was charged with practicing without a license. For
these reasons, I call him "faithful Dr. Croserio".
Dr. Croserio responded to Boenninghausen
with a letter written on Jan. 28th, 1844 that was published with Boenninghausen's commentary in the Neus
Archive f.hom, Heilkunst
Volume 1 number 12, 1844. This letter may be found in Boenninghausen's
Lesser Writings, in an article called Hahnemann's Doses of Medicines. The Baron
wrote:
"In order to be quite
sure as to the matter I applied to those homeopaths in Paris, who were most
intimate with Hahnemann, visited him almost daily, and in consequence, were
best informed as to his practice during the last times , namely, to Dr. Croserio, from whom I had before had a very friendly
communication, could therefore also feel sure that he would give me as detailed
an account as possible."
Hahnemann's Paris casebooks contain only personal notes of the Founder's
practice and leave many questions unanswered. He rarely wrote down exactly how
often he was administering his remedies. Boenninghausen
understood this, and for this reason he sought an eyewitness account to fill in
the details. Dr. Croserio's letter is a very valuable
testimony because it gives insights as to how Hahnemann actually practiced in
the clinic. Dr. Croserio wrote:
"As to his [Hahnemann's]
mode in which he prescribed the medicines to be taken I am able to give you all
the information that you may wish, as I have quite frequently been witness of
it."
Croserio confirmed that Hahnemann was
dissolving 1, or rarely 2, tiny pills into 8 to 15 tablespoons of water and
taking a tablespoon of this solution and stirring it into a tumbler of water.
He notes that Hahnemann would start with 1 spoonful of the solution from the
tumbler and increase this amount on successive doses, if necessary:
"until he observed some
action."
"Then he [Hahnemann]
would diminish the dose or would stop the medicine."
Dr. Croserio stated that when Hahnemann saw
definite medicinal action he either diminished the dose or stopped the remedy
and gave the patient placebo. This is an extremely important observation of
a technique that is not clearly elucidated in the 6th Organon. This pattern, however, was witnessed in the case
of O-T where Hahnemann used almost as much placebo as medicine. This is common
to all
the cases found in the Paris casebooks.
Dr. Croserio stated in his letter that
Hahnemann frequently gave single doses by olfaction . The doctor wrote:
"Hahnemann in the last
years of his practice seemed to devote his whole dexterity to continually diminish
the doses of his medicines. On this account he in the last years frequently
contented himself
to allow his patients to smell of the medicine. In chronic diseases he
would in no case allow the patient to smell at the medicines oftener than once
a week, and would give nothing but sugar besides; and
in this way he would make the most admirable cures, even in cases where
we others had not been able to do anything."
Dr. Croserio noted in his eyewitness account
that Hahnemann "frequently" gave single doses by olfaction followed
by at least 7 days of placebo. The Paris casebooks confirm the fact that the
Founder often administered single doses by olfaction and occasionally by oral
solution and gave the patient placebo for at least 1 week! In some cases he would
wait for longer periods than 7 days, even up to
14 or 21 days before repeating the dose. Some patients received
infrequent olfactions and placebos almost
exclusively. This proves that Hahnemann did not always use the daily or
alternate day dose.
His method was artistic not mechanical and was individualized by the
symptoms, time and circumstances.
Sometimes Hahnemann gave a single dose followed by at least 7 days of
placebo while he waited and watched. At other times, he gave a short series of
3 to 7 doses over a period of seven days and had the patient come back in one
week. At this time, he would re-evaluate the case. If the remedy caused a
strong medicinal action or an aggravation, he would give the patient placebos
for another seven days. When there was a strikingly increasing amelioration he
also would stop the repetition as long as this state lasted. If he thought he
needed more medicinal action he would continue the repetitions for another
week.
In this way, Hahnemann individualized his case management strategies. He
did not give the C or LM potency daily in a mechanical manner over long
periods. He constantly interpolated and followed his medicinal doses with
placebos at different intervals during the progress of the case. This balance
of single doses and infrequent repetitions and split-doses at rapid intervals
to speed the cure offers a wide range of methods in the clinic. The idea
Hahnemann gave the daily dose to everyone is a complete falsehood.
These are very important details that do not come through clearly in the
6th Organon. That is one of the reasons why it is not
sufficient to try and practice only by the text. One must study Hahnemann's
casebooks and eyewitness account of his practice to grasp the whole method. One
also needs to consult those who have experience with Hahnemann's true clinical
methods. The Founder frequently alternated a period of medicinal doses with
period of placebos throughout the treatment. In this way, he found a perfect
balance between acting and observing and waiting and watching. Boenninghausen commented further on this important aspect
of Hahnemann's practice.
"This passage in the
communication of Dr. Croserio give the most clear and
complete exposition of the mode practiced by the closely observing Master of the
art during the last times, on his patients, and explains most satisfactorily
what might have appeared obscure in the two cases lately reported. The addition
"until he felt an effect" is of the greatest importance, and must
always be closely observed, in order that nothing may be spoiled afterwards by
giving too much or too often."
Dr. Croserio also notes:
"In order to pacify the
patients or their relatives he frequently allowed them to take simple sugar of
milk"
Hahnemann called placebos a gift from God in the Chronic Diseases. He
used placebos to satisfy his patients and their relatives and to keep the
clients away from other medicines. Many of his patients were so conditioned to
the idea that they needed medicine daily that it was necessary to use placebos.
Sometimes their relatives were even worse than the ill person! In my practice I
try to educate my clients to the fact that homeopathic remedies have actions
that last for long durations and they do not need medicine daily under most
circumstances.
There are, however, situations where the placebo is a very useful tool.
The most common example is when there is an aggravation or healing crisis that
will pass off quickly but the patient is desperate for help. Here the placebo
effect often provides the attention, comfort and psychological relief necessary
to pass through a difficult moment. This is a trade secret that should never be
related to the patient or other persons even to make a point. Placebo is a
psychological simillimum for the patient who thinks
they need medicine when they do not.
The LM remedies are not a "low potency" system. One cannot
compare the C and LM potency solely by the amount of the original substance
left in the dilution. There is a great difference between a mathematical and dynamic
equivalence. 1 pill of the LM 0/1 potency in an 8 tablespoon solution has
around the same amount of medicinal substance as the 6C but its power is much
greater due to its 1/50.000 dilution and 100 succussions
per dilution. Boenninghausen was well aware of this
fact. In 1863, just one year before his death, the Baron reminisced over the
two LM cases Hahnemann had sent him in 1843.
"Of the other remedies
used in these two cures (Sulphur, Mercurius,
Nit-ac.), new dynamizations were used, which will be
described in the next edition of the Organon, the
peculiar preparation of which is known to me and which requires less time and
trouble, but essentially presents our present high and highest potencies, but
having given my word of honor, I am not as yet at
liberty to publish the same. Also these the preparations were given in the dose
of one single pellet either dissolved in just as much water, or applied by
simply smelling of it. By means of these before unheard of minimal doses, there
was effected a restoration of both these cases in a comparatively short time;
the first of these cases was an acute ailment of the brain, the other a chronic
complicated disease. It is especially curious that the proper action of these
remedies, and even their first action, could be clearly distinguished in the
course of the disease."
The Lesser Writings; C.M.F. Boenninghausen, Boenninghausen's
Last Work, Atropa Belladonna L, page 316.
It was Boenninghausen's opinion that the
actions of the LM potency were very similar to the "our present high and
highest potencies" . By 1863 Boenninghausen
personally used the 200C potency made
by Hahnemann's methods and Jenichen's 1M, 2M,
4M, 6M, 8M up to 40M. The Baron also had experience with Korsakov's 1000th and
1500th . This offers a glimpse into the true medical powers of the LM potency.
The Baron noticed that the recovery of both cases, one a dangerous acute
disorder and the other a complicated chronic disease, was comparatively short
and that the first action of the remedies could be clearly distinguished. This
shows how the LM potency acts quickly and deeply yet these preparations have a
different medicinal quality than the C potencies. Hahnemann's opening potencies
were between the 0/1 and 0/7. These seven degrees have remedial powers that are
similar to the moderate to high potency centesimal remedies and must be treated
with the greatest respect.
In over 20 years of comparing the LM with the C potency I would say that
the LM 0/1 acts deeper and longer than the 30C. If one studies Hahnemann's
cases one comes to the conclusion that Hahnemann thought likewise. All things
equal, I would say the LM 0/1, 0/2 and 0/3 act with a similar depth to the 200C
or 1M although the durations might not be as long. The LM 0/4, 0/5 and 0/6 act as
deeply as much higher potencies. To think the LM remedies are low potencies
that can be repeated daily in every case is a big mistake.
This higher power yet slightly shorter duration can be used to one's
advantage in many chronic cases. This is because one can make more frequent
adjustment of the dose, potency and repetition so that the remedy can be
customized more artistically to the case. If one is continually forced to wait
out overly long remedy actions, it is hard to make adjustments when the remedy
is causing aggravations or accessory symptoms due to too large a dose or too
high a potency. These long durations can also be counterproductive when the
wrong remedy is chosen. Being able to adjust the size of the dose, the level of
potency and the repetition according to the present time and circumstance has
its advantages in complex cases.
The LM potency will cause strong aggravations when misused. I have seen
it, my colleagues have seen it, and I have received many letters from patients who
were strongly aggravated by receiving the LM potency daily or alternate days in
a mechanical fashion. Many times they felt very, very good in the first week or
so (strikingly progressive amelioration) and then got worse and worse because
the dose was never slowed down or stopped. It is always best to either slow
down or stop the remedy when there is a sudden great improvement. These are the
clinical facts.
I have found that overmedication either causes the patient to become non
responsive to the remedy due to overexposure or it causes aggravations that
make them overly sensitive to the remedy. Sometimes this can make it hard to
use even the correct remedy later in the case. The cases that are spoiled the
most are those who only needed a single dose, infrequent doses or only a short
series of doses but were never given a chance to respond correctly. What should
be one's "best case scenarios" turns into one's "worst case
situations". One must be very careful with the LM potency because
overmedication will cause aggravations, accessory symptoms or adverse counter
actions of the vital force if abused. Hahnemann had some strong aggravations at
times! Like all homoeopathic potencies, the LMs must
be treated with the greatest respect!
Hahnemann spoke about raising the LM potency every 7 to 14 days in
aphorism 248 but the Paris casebooks show that this was only a baseline
example. He would sometimes raise his potencies very fast before the bottle was
finished and in other cases he would keep the patient on the same potency
interspersed with or followed by placebo for longer periods. Sometimes he would
move up to find a better potency and at other times he would move downward
because of aggravations. There was no fixed rule. The time of raising the
potency was dependant on when the medicine was consumed, how much placebo he
was giving, and the symptoms and circumstances.
I know that some give all patients the daily or alternate day dose and
only stop if they see aggravations. This only reflects one aspect of Hahnemann's
method. It does not take into account what Hahnemann says in aphorism 246, Dr. Croserio's eyewitness account or what is found in the Paris
casebooks. Sometimes Hahnemann gave a single dose and placebos and other times
he gave a series
of split-doses at intervals like
daily, alternate days, or on the third day, etc. It all depended on the cause,
symptoms and circumstances affecting the patient and the action of the remedy.
Hahnemann constantly alternated series of medicinal doses with placebos and waiting
and watching. He used so many different methods that a simplistic mechanical
approach cannot embrace his artistic techniques.
As Croserio said,
"It would be impossible
for me to give in a letter all the shadings of his treatment. By your constant
correspondence with the learned sage you have had abundant opportunity to learn
to appreciate his rare powers of observation, and you will therefore easily see
that his mode of action was not always the same."
Hahnemann varied the adjustments of the size of dose, the degree of the
potency, and the intervals of repetition based on what the individual needed.
He did not have one predetermined method that was supposed to suit all
patients. The 6th Organon only contains baseline
examples not a fixed mechanical method. He used single doses and infrequent
repetition interspersed by placebo as well as frequent repetition daily, every
other day, every three days, etc. One cannot oversimplify Hahnemann's methods
because "his mode of action was not always the same." All of his case
management strategies were individualized to suit the symptoms, time and
circumstances.
There are too many people that think they can give the LM potency daily
for long periods in a mechanical fashion. One patient was told to take the LM potency
daily for 6 weeks just to test the remedy! The idea that one can give the daily
dose for months is often separated from the words if necessary found in the
footnote to aphorism 246. I have not seen one LM case in the Paris Casebooks
where Hahnemann thought it was necessary. The Founder used almost as much
placebo as medicine!
Hahnemann groomed Baron von Boenninghausen as
one of his successors. That is why the Founder shared the methods of the LM
potency with him before he passed away. The Baron knew the pharmaceutical
methods of making the remedies as well as the case management scenarios
necessary to safely apply the new dynamizations.
Other than Melanie Hahnemann, Boenninghausen seems to
be the only person who was privy to this information. He was well placed
to teach the new system and comment on the ramifications of the 6th edition. It
seems that this was the H.'s original intention.
Melanie Hahnemann asked Boenninghausen not to
release information about the LM potency until after she published the 6th Organon. Unfortunately, Madam did not complete the task and
the Baron passed away before he was allowed to share his experience. Melanie
was the only remaining person with knowledge of the LM potency, but
unfortunately she never released the 6th Organon or
Hahnemann's casebooks. This was a great loss to the homoeopathic community as
the 6th Organon and the LM potency became one of the
lost teachings of Samuel Hahnemann.
In our times there has been a great resurgence of interest in
Hahnemann's advanced methods and the 6th Organon is
finally receiving the attention it deserves. Although there has been some
confusion
and agenda-driven abuse of this subject, a group of mature homoeopaths
is now spreading the true techniques throughout the world. I am sure Samuel
Hahnemann would be pleased to know that his
final efforts were not in vain.