HAHNEMANN'S PARIS METHODS

Hahnemann’s teaching on causation and the categorizations of disease went through a radical change between 1805 and 1843. Nowhere are the changes in the homœopathic paradigm more obvious than in aphorism five of the 4th edition compared with aphorism five of the 5th edition. This aphorism remains the same in the 6th Organon. Although Samuel Hahnemann introduced the subject of the chronic miasms in The Chronic Diseases he had not yet integrated his advanced theories into the main body of the 4th Organon. Vide aphorism 5.

"It may be conceded that every disease is dependant on an alteration in the interior of the human organism. But this alteration is only guessed at by the understanding in a dim and illusory manner from what the morbid symptoms reveal concerning it (and there are no other data for it in non-surgical diseases); but the exact nature of this inner invisible alteration cannot be ascertained in any reliable manner."

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), Appendix, 4th Organon, Aphorism 5, page 183.

In his early years Hahnemann taught that similia and individualization were sufficient to treat all diseases. His central doctrine of the totality of the symptoms countered the one-sided tolle causum of the orthodox school. Hahnemann used this method from 1810 to 1824 but he was not completely satisfied with its results. It was Hahnemann’s failure to permanently cure chronic disease based on miasms that led him to reassess this clinical approach. As early as The Medicine of Experience (1805) he speaks of causation but he did not see the complete picture until the 1840s. Like all good things Homoeopathy developed over time.

Every medical practitioner knows the difficulty of finding the true cause of all disease states. Many causes are hidden in the past in such a manner they can only be witnessed in the signs and symptoms. For this reason, even with the rapid development of modern sciences, studies at major institutions show that the diagnosis of the true cause of many diseases is still outside our grasp. This did not stop Hahnemann from changing his view of causation, constitution, temperament, hereditary dispositions, susceptibility, miasms and complex disease states. These new insights are contained in the Chronic Diseases and 5th and 6th edition of the Organon. Aphorism 5 in the 5th Organon contains the essence of the insights of the Chronic Diseases in a nutshell.

"Useful to the physician in assisting him to cure are the particulars of the most probable exciting cause of the acute disease, as also the most significant points in the complete history of the chronic disease, to enable him to discover its fundamental cause, which is generally due to a chronic miasm. In these investigations, the ascertainable physical constitution of the patient (especially when the disease is chronic), his moral and intellectual character, his occupation, mode of living and habits, his social and domestic relations, his age, sexual function, etc., are to be taken into consideration."

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), 5th Organon, Aphorism 5.

This aphorism is the same in the 5th and 6th edition of the Organon. No longer were the cause and processes of disease an inner invisible alteration that cannot be ascertained in any reliable manner. The aetiology could be assessed by the exciting cause of acute disorders and fundamental causes of chronic diseases, which are usually related to the chronic miasms. At the same time, Hahnemann requests the homeopath to study the details of the complete case history; chronic miasms; the observable condition of the physical body; the character of the intellect and emotional disposition as well as situational circumstances like occupation factors, life style and habits; social and domestic relationships and age, sexuality, etc.

These categories related to the innate or acquired constitution, character traits related to the intellect and emotional disposition; occupational talents as well as relationships to work and co-workers; mode of living and personal habit patterns; aging issues and critical stages of life like conception, birth, infancy, puberty, adolescence, middle age, and old age; as well as sex, sexuality, sexual fantasy, sexual performance, and gender issues. Hahnemann called these seven areas of human life the “attendant circumstances” and considered them an essential foundation for understanding the patient and their disease.

By 1828 Homœopathy was no longer only a system based on Similia and individualization. Now it was necessary to recognize individual causes (personal case) and collective causes (group cases for miasms) as well as singular disorders and complex chronic diseases. Homœopathy had developed beyond the simple matching of the presiding symptoms of the disease state with the symptoms of the materia medica. Now Hahnemann was speaking in terms of four major sources of useful rubrics, i.e. the significant factors of the entire case history, acute and chronic causations and miasms; and concomitant factors related to psyche and soma and environmental conditioning; as well as the objective signs, coincidental befallments and objective symptoms.

The nature of these categories of symptoms is nowhere more apparent than in aphorism 5, 6 and 7 of the 5th and 6th Organon when compared with the previous editions. Aphorism 5 focuses on causation, miasms and the patient's circumstances while aphorism 6 adds the totality of the signs, befallments and symptoms that make up the disease state. Aphorism 7 points out the importance of assessing these twin categories of rubrics in case taking. Now taking a case was based on the essential nature of the totality of the symptoms (aph 6) and original causes, miasms and the concomitant circumstances (aph 5).

The are some who say the "only" the presiding symptoms are to be considered when taking a case. This does not square with the what Hahnemann has written in aphorism 5, 6, and 7, which are the first instructions on case taking. Hahnemann does NOT say "just assess the presiding symptoms and nothing else". He clearly says ]to assess the "most significant points in the complete history of a chronic disease". The Paris casebooks show that Hahnemann recorded very detailed cases histories during the first appointment. He did not just write down the presiding symptoms. He looked at the complete case history and noted any important causes, symptoms and circumstances that may have arose. This included incidents or causes from the past, important diseases states, the start of certain symptoms, various past treatments and the symptoms they caused, etc.

For example, there is an LM case taken by Hahnemann in Boenninghausen's Lesser Writings. The patient's symptoms were a sore throat and when he was not suffering from the sore throat he suffered a fissure in the anus. Hahnemann treated patient with the apsoric remedy Belladonna based on the presiding throat symptoms. This removed the symptoms of the throat and brought back the fissure in the anus. Hahnemann then discovered a very significant point in the case history. This patient had suppressed syphilis! He already knew about the sore throat and anal fissure but he did no yet know about the syphilis. This knowledge caused Hahnemann to immediately change his approach to the case and then prescribe his major anti-syphilitic remedy, Mercury. This shows how a past history, cause and miasm can affect the present approach to a case.

Hahnemann taught that all the important factors along the timeline of the complete case history must be noted because they offer information about the case as a whole. The information gathered from the past is then assess with the presiding symptoms of the present in order to understand the causes, potential obstructions the cure, chronic miasms, attendant circumstances as well as the totality of the objective signs, accidental or coincidental befallments and subjective symptoms. Once the cases is under treatment the homeopath follows up by addressing the *remaining symptoms*. In this way, one follows the case to complete cure using one or more remedies in accordance with what the causes, symptoms and concomitant circumstances dictate .

Symptoms and Circumstances (§7, 18, 24)

Aphorism 7 begins by reminding homœopaths of the importance of removing any occasioning or maintaining causes (causa occasionalis) that might produce disease symptoms or form an obstacle to the cure. A situational or maintaining cause either produces pseudo chronic diseases or blocks the action of the curative remedy. A pseudo chronic disease is caused when there is a continual negative influence to which the patient is susceptible. If this negative influence is removed quickly the symptoms usually improve by themselves. When the maintaining cause continues to act over a long period of time it may produce pathological damage that requires longer term homœopathic treatment.

For example, if a person sleeps in a damp basement for one week their bones may ache, but once they are no longer exposed to the damp, they tend to improve on their own. If they sleep in a damp basement for years they may develop rheumatic and arthritic joints that never feel well since the exposure. To cure this patient they must move out of the damp basement because it will still pose an obstacle to the cure. At the same time, they will need treatment for the long term symptoms. This class of causations complicates the signs and symptoms and makes curing more difficult. Hahnemann wrote:

"In cases of disease where there is no obvious occasioning or maintaining causes (causa occasionalis) to be removed, we can perceive nothing but the disease signs. Therefore, it must be the symptoms alone by which the disease demands and can point to the appropriate medicine for its relief, *along with regard for any contingent miasm and with attention to the attendant circumstances (§5).*

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 7.

In cases where there are no obstructive occasioning or maintaining causes it is the signs and symptom (aph 6) along with regard for the miasms,and the attending circumstances (§5) that point to the curative remedy. Some practitioners are very averse to acknowledging a role for any attendant circumstances related to the condition of the constitution, nature of the character, occupation factors, lifestyle, habits, relationships, etc. Some take statements like the “symptoms alone” out of context while ignoring the inclusion of the study of causation, miasms and the attendant circumstances in the Gestalt of the disease. It is as if there case taking methods are frozen in time and can not proceed past the 1st, 2nd and 3rd Organon. This method does not utilize the teachings of The Chronic Diseases and the 4th, 5th and 6th Organon in any practical manner. In aphorism 18 Hahnemann once more speaks about the need to assess the “symptoms and circumstances” and refers to aphorism 5 again.

"It is an undeniable truth that nothing can, by any means, be discovered in diseases whereby they could express their need for aid *besides the totality of the symptoms, with consideration for the accompanying circumstance (§5).* Therefore, it follows incontestably that the *complex of all the symptoms and circumstances* perceived in each individual case of disease must be the only indicator, the only reference in choosing a remedy."

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 18.

The theme proclaiming the dual role of the totality of symptoms ((§6) and the Causa, the collective miasms and the accompanying circumstances (§5) is repeated in aphorisms 7, 18, 24, 85 and 145. In aphorism 24 Hahnemann says:

“In homeopathy, a medicine is sought for the totality of the symptoms of the case, with regard for the originating cause (when it is known) and for the accessory circumstances”.

These aphorisms show that Hahnemann reviewed three classes of essential rubrics i.e, cause and coincidence, the totality of the symptoms and the concomitant accessory circumstances. This combination includes all the objective signs and subjective symptoms of the disease case as well as any concomitant factors and accessory circumstances related to the patient.

The complete case includes all significant factors in the entire medical history, exciting, maintaining and fundamental causations; acute and chronic miasms, the observable condition of the physical body, the intellectual and emotional character, the occupational factors, lifestyles and habits, the civic and domestic relationships, age and aging factors and sexuality as well as a study of objective signs, coincidental befallments; and subjective symptoms. Hahnemann makes it extremely clear that the “only indicator” for choosing a remedy is the complex of observable symptoms ((§6) and concomitant circumstances ((§5).

In aphorism 85 in the section that teaches how to record a case, Hahnemann speaks of using a fresh line to record “every new symptom or circumstance” mentioned by the patient or their relatives. In aphorism 245 he says,

“We have seen what considerations should be given, in homoeopathic cures, to the main varieties of disease and to the particular circumstances connected with them.”

All these aphorisms show the importance Hahnemann placed on both the totality of the symptoms and concomitant circumstances. It is a combination of the totality of symptoms and the attendant circumstances that makes up the only conceivable Gestalt of the disease. First and foremost Hahnemann case taking methods are based on the essential nature of the totality of the symptoms with consideration of originating causes, the miasms and the attendant circumstances which he defined as condition of the bodily constitution, mental and emotional character, occupational factors, lifestyle and habit, social and domestic relationships, age, sexual function, etc.

The are those who say we must treat the patient not the disease and those who say we must treat the disease not the patient. Then they say, "No you must treat only the symptoms" and "No "you must treat only the patient!" Yes, no, yes no and around and around it goes where it stops they don't know! What neither of the parties holding these extreme views understand is common sense and the middle path. The disease and the patient form a unity. The definition of the "patient" is one who seeks medical treatment for their "disease". No disease - No patient. No patient - No disease. The patient and their disease come together. to the office.

In Hahnemann's methods in the 1830s and 1840s he made it extremely clear that one had to address the totality of the symptoms of the diseases case with special attention of the causes, miasms and concomitant circumstances that affect the patient including the condition of the bodily constitution, the mental and emotional character, occupational factors, lifestyle and habits, familial and social relationships, stages of life related to age, sexual function, etc. Hahnemann repeated the theme of the *symptoms and circumstances* five times in aphorism 7, 18, 24, 85 and 145. The Founder's chronic case taking methods are essential based on the Causa, miasms, symptoms and concomitant circumstances.

There are some who only use the methods of the 1st, 2nd and 3rd Organon (1810-1824) and think only term of the presiding symptoms and nothing else. They pay no practical attention to the chronic miasms nor do they tend to assess the entire cases history, the causes and the attendant circumstances (aph. 5). There view of case taking has yet to grow past the 3rd Organon. Some of these individuals only want to use the remedies found in Materia Medica Pura and the Chronic Diseases and the only repertory they approve of is the Therapeutic Pocket Book or some other early work. When combined these works contain no more than 125 remedies from the 1830s.. If the patient needs a common remedy like Gelsemium or Baptisa, they will not even find them in the their reference works! I simply cannot run a full modern practice on so few remedies. Nevertheless, I do love the methodology of the TPB and use this repertory when I think it is appropriate but I always keep an eye on symptoms and remedies that might not be included in it while referring to it.

There are others that only use the single dry dose and wait and watch method of the 4th Organon (1829). This is a good method but it has its limitations, especially when it comes to the need of repeating the dose at suitable intervals to speed the cure of slow moving cases. The "take this and come back in a month" method is very slow in quite a few cases and patients sometimes leave because of this fact. It is actually quite amazing that many in the homeopathic community have yet to seriously experiment with the methods Hahnemann introduced in the 1830s and 1840s! This includes the C and LM potency in medicinal solution by olfaction and the oral dose as well as the single dose in strikingly progressive reactions and the repetition of the remedy at suitable intervals in slowly reacting cases. This is the middle path approach that transcends the exclusive single dose and the mechanical repetition of remedies.

Many times one gives a single dry dose and it acts well the first time but then no longer acts well. Then one ends up changing the remedy and the case moves downward in circles. Many times the methods of adjusting the liquid dose by succussions and changing the size of the dose will cause a remedy to act well each time it is given. Why? Because the vital force reacts better to very small liquid doses of a remedy slightly changed each time by succusions than the repetition of the dry pills. At other times, it seems the patient needs the repetition of the dry dose but it begins to cause more aggravations or accessory symptoms over time. This is because the number of dry pills used throughout the treatment act cumulatively until it makes one very large dose in the vital force that causes over-medication. That is why Hahnemann only used 1 small pill in a minimum of 7 tablespoons of water. The smaller the dose the more gentle the remedy acts and the more often it can be given over a longer periods of time. This IS a method to the madness!

Another advantage is that when using the medicinal solution one does not have to wait for the complete relapse of symptoms before repeating the dose. When using the 4th Organon method a single dry dose is given, then there is often an aggravation, then the patient improves, and then one must wait for a full relapse of the symptoms. This causes an *aggravation - better - relapse patten* that involves going up and down again. If the new method is used properly this patten can be avoided in most cases. When needed the remedy can be given at suitable intervals as long as the patient is improving and there are no aggravations. There is no need for the aggravation or the relapse of symptoms. When done correctly there is only a *better-better-better pattern*. These intervals, however, should be lengthened as the patient improves to prevent aggravations in the middle and toward the end of treatment.

There are some who think the LM remedies are "low potencies" when they are compare the number of times the C potency is diluted. This is grand mistake. The LM potency with its 1/50, 000 has its own medicinal qualities that cannot be compared with the C potency in this fashion. The only way one can compare the LM potency with the C potency is by its action on patients. Hahnemann considered the 6c to 30c to be his low potencies and the 60C to 200C and the LM 0/1 to 0/30 to be higher potencies. Boenninghausen wrote that the LM potency acted like the higher and highest potencies of the day. The LM 0/1 acts like a much higher potency than the 30c. and should not be considered a low potency. I would say the LM potency has some of the best qualities of the high and low potency in that it is very deep acting yet also quite repeatable if and when necessary. Be warned, however, over repetition with the LM potency when it is not necessary will cause aggravations!

These improved results will only experienced is the methods of the 1840s are applied to the C and LM potency in the proper manner. If individuals give the C or LM potency in medical solution daily like an assembly line they are not following Hahnemann's instructions as given in aphorism 246. Here Hahnemann clearly says that in any strikingly progresses reaction caused by a single dose the remedy should NOT be repeated! Sometimes the C or LM potency will produce a single dose cure! At other times, all the patient needs are a few infrequent doses to complete the cure over time.

Hahnemann then goes on to say that in cases where there is only a *slow improvement* the remedy may be repeated at suitable intervals to speed the cure. The intervals between doses are to be based on what "experience has shown" is the best schedule. All of the statements about the daily and alternate doses that follow are conditioned by the fact that these are for "protracted cases" that show only slow ameliorations. When speaking of the daily dose Hahnemann says to use this only "when necessary". If it is "not necessary" then giving the daily dose in a mechanical manner leads to problems due to over medication in many cases.

The Paris casebooks show that Hahnemann often used a single doses (often by olfactions) or a test series of 3 to 7 doses spread out over a week and then had the patient return. He constantly alternated periods of placebos and periods of waiting and watching with his active doses. He constantly used an *on again - off again method* and commonly gave the remedy for a week or two followed by a week or even two weeks of placebos. Hahnemann gave almost as much placebo as he gave medicine. This fact dose not come through well in the Organon. Perhaps, it was a trade secret he did not want to make so public? He NEVER gave the daily or alternate day dose for days, weeks and months on end! That is a complete myth.

Some patient do better on the centesimal potency (C) and some patients do better on the 50 millesimal potency (LM). This is because the C and LM potency are complementary opposites that greatly expand the therapeutic horizons of Homoeopathy. What you can not cure with one potency system you can often cure in the other. Some cases may take both potency systems to perform a permanent cure. Due to the great variety of disease states, constitutions and dispositions one needs as many therapeutic options as possible. Hahnemann used the C and LM potency side by side in medicinal solution in single doses as well as split-doses during the 1840s.

I know some say "Oh God, it is too much trouble to use these methods" and "I just give the single dry dose and wait for a month ". Yes, this is easier for the homeopath but is it what is best for the patient? Does the Organon say our highest calling is to take the easiest way out or to cure the patient in the most rapid, gentle and permanent fashion'? Hahnemann felt that his advanced posology could speed the cure of slow moving cases to the 1/2, 1/3 of even less the time of the single dry dose wait and watch method! He also claimed this could be done without the strong aggravations, accessory symptoms and antagonistic secondary actions witnessed with the old dry dose method, especially with the high and highest potencies.

Aren't these are claims of the Founder well worth testing the method in the clinic for a year or two? Isn't a little more effort in the beginning worth better results and less aggravations in the end? What is needed is the open mind of a beginner and the wisdom to follow the experience of the aged. If one ignores Hahnemann's artistic directions and takes up the mechanical repetition of doses don't blame Hahnemann or the C and LM potency in medicinal solution for the failures. The source of the problems is self evident if one looks in a mirror.

Similia Minimus
Sincerely, David Little



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

Samuel Hahnemann

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