Dear Colleagues,

The subject of posology and case management is vast. First of all, lets look at what is in the Organon. Hahnemann wrote in aphorism 246 that any strikingly progressive improvement is a sign to let the single dose act without repetition. Then is says in cases where there is only slow improvement over 30, 60 or 100 days we may need to repeat the remedy to speed the cure. This offers two scenarios. Those cases in which there is a strikingly progressive improvement that continues day to day, and those cases in which there is little, slow or no improvement over a longer period of time. It is these slow moving cases that Hahnemann says his "new methods" can speed the time of cure to 1/2, 1/3 or even less the time it takes with the single dry dose. To do this, he says, on must met the following 5 conditions.

1. The remedy must be a good simillimum. There is no way to fulfill condition number one in advance. How do not know if the remedy is good or bad before we give it? Perhaps, the first dose, or the second, third, four, five, sixth or seven dose caused a serious aggravation or new symptoms to appear showing it was the wrong remedy. This can not be told in advance. The first testing phase of giving a remedy must be carried out carefully. Giving the daily dose to everyone automatically is a grand mistake.

2. It should be highly potentized and dissolved in water. To speed the cure one should use dynamic potency in the medicinal solution for oral, nasal and dermal applications. This is a very important requirement in speeding the cure.

3. Use the remedy in small doses. The small divided doses used in the medicinal solution are central to the new posology. Too many dry pills accumulate until they produce prolonged aggravations and antagonistic secondary reactions of the vital force.

4. The remedy should be given at suitable intervals according to "experience". Then one must decided what the suitable intervals are for the individual patient according to the time and circumstances.

5. The remedy should be succussed prior to administration of the remedy so that the patient never receive the exact same potency twice in succession. This makes the remedy act much more gentle on the vital force.


First of all, one must understand the difference between a "strikingly progressive" improvement and a "slow" improvement. The instructions for repeating the dose to speed the cure relate only to those cases are not cured with single or infrequent doses. All of the statements that follow about the daily and alternate day dose relate to slow moving and "protracted cases". The daily dose may be given only, as Hahnemann, "when necessary".

These are the baseline instructions given by Hahnemann in the 1840s. How did Samuel practice this in the clinic? My review of the microfiches of Hahnemann's Paris Casebooks from RBI has revealed a few interesting observations in the areas of posology and case management. The Paris casebooks and eyewitness accounts allows one to put together the following picture.

It appears that Hahnemann liked to give his single doses by olfaction followed by placebo for at least one week. There are some patients that are given most, if not all, their remedies by olfaction accompanied by placebos. These persons are receiving relatively infrequent doses. Some of his liquid doses may also have been single doses. The second method was to give a short series 3 to 7 oral liquid doses and have the patient return in one week. The single dose and short test series were Hahnemann's baseline method at the start of the case. He did such things quite often with both the C and LM potency in medicinal solution.

On this basis the Founder would individualize his case management according to the reaction of the remedy. At the beginning of treatment he gave either a single dose followed by placebo or short series of 3 to 7 divided doses interpolated with or followed by placebo. He rarely repeated a remedy for very long without giving placebo and waiting and watching for some time. Hahnemann used almost as much placebo as medicine in most his cases. Anytime there was a strikingly progressive amelioration, aggravations or a confusion in the symptoms he stopped the remedy, gave placebos and waited and watched.

There is not one case in the Paris journals in which Hahnemann uses the daily dose for weeks, months and years on end. The idea that Hahnemann always gave the daily dose is a complete myth. His method uses the single dose followed by placebo or an "on again - off again" approach in which a series of divided doses and placebo are alternated. Hahnemann's remedy and posology were individualized according to the symptoms, the reaction and the circumstances. His final methods are a perfect balance of waiting and watching and acting and observing as needed. This is the middle path that avoids the extremes of always giving a single dose or using the daily dose on all patients!

There is no one method of giving or repeating a remedy that is suitable for all patients all the time. This is a mechanistic idea in which all individuals are reduced to a panacea-like single formula for the masses. This does not work as well as the method of individualization taught by Hahnemann in the aphorism 246 and elsewhere. The most prudent thing to do is give a single dose or a short series of doses and see the patient in 7 days and then decided what the next step should be. This next step could be using placebo and waiting, giving another single dose, or perhaps, giving short of doses at suitable intervals depending on circumstances. In cases where there is a strikingly progressive response to a single dose or short series of doses the remedy should not be repeated as long as this state lasts.

Giving the daily dose to everyone for days, weeks or months before testing the remedy leaves too much to chance and delay to say nothing of complications. The first rule of healing is, "Do no harm". It is one's responsibility to test the remedy before repeating it too many times. To start slow in the beginning and test the remedy means to reach the goal of cure quickly in the end. To start off to fast with too many doses means delaying, and sometimes, even spoiling the cure. This is because we have not properly tested the remedy in the beginning to find out how often the patient really needs the remedy. Once in a lifetime? Once a month? Once a week? Every other day? Once a day? Once a ???????

How do we know if the patient would respond to a single dose olfaction in strikingly progressive manner if we give them the daily dose for one week to one month? At this time, we do not know if our remedy causes a good or bad reaction? How do we know how the patient will react *before* we give the remedy? Maybe the remedy will make them feel better, maybe it will cause an aggravation, maybe it will make them sicker! How do we know if the remedy meets the first condition of aphorism 246. We are not fortune tellers.

The only way to know who will have a striking response, who will have a slow response, and who will have no response is to test the remedy first with a single dose or a short series of divided doses. This tells one whether to let the single dose or short series act and wait and watch or to repeat the remedy at suitable intervals to speed the cure. There are no magic formula like "do this then do that" that is good for all patients! Some patients need single doses at very infrequent periods. Others might need a dose once a week, or a series of 2 or 3 doses over a week. Some might need the remedy on every day or alternate days until they begin to improve. There are as many possibilities and there are people in this world.

I would never give a patient a homeopathic remedy for 7 days straight at the start of treatment unless I had a very special reason for do so! That would spoil my single dose cures and infrequent repetitions! These are one's most dramatic cures. If you repeat the remedy for a week on such people at the beginning of treatment may cause aggravations, accessory symptoms and antagonistic counter actions of the vital force. This interferes with testing a series of 3 doses over a 3 to 7 day period and other often used intervals. To give the daily dose mechanically to most patient is not in harmony with the golden Homoeopathic principle of INDIVIDUALIZATION. Hahnemann's case management methods are open, individualized, responsive and flexible according to the circumstances - not generalized, fixed, mechanistic and predetermined.

Similia Minimus
Sincerely, David Little

"It is the life-force which cures diseases because a dead man needs no more
medicines."
Samuel Hahnemann

Visit our website on Hahnemannian Homoeopathy and Cyberspace Homoeopathic Academy at
http://www.simillimum.com