HAHNEMANN’S MIDDLE WAY

The author, one of the world’s leading scholars on Organon, reveals popular and crucial misconceptions about Hahnemann’s teaching on posology.

A Search for a Rapid, Gentle and Permanent Cure

I was originally taught the American tradition of Classical Homeopathy and was familiar with the writing of luminaries like James Kent, T.F. Allen, H.C. Allen, J.H. Allen, S. Close, C.M. Boger et al. I had heard of the Founder, Samuel Hahnemann, and the Organon but mostly from quotes from sources like the above practitioners. For the most part, I used the single dose wait and watch method as was elucidated by great masters of the past. The first time I read the Organon it was the Boericke 6th Edition. I immediately resonated with the statements about likes cure likes, the single remedy, the minimal dose and the potentized medicine. The passages on the vital force were inspiring and immediately useful for clinical observation. Nevertheless, much of the text was too deep for limited understanding and the posology sections were very hard for me to truly understand.

At that time, I followed the Kentian theory that the size of the dose and delivery system by which the medicine was given made no difference to the action of the remedy. I normally administered a random number of dry pills sublingually, and if there was any improvement whatsoever, I did not repeat the remedy until there was a clear relapse of symptoms. In the Organon I was reading Hahnemann spoke of the use of the mysterious 50 millesimal potencies, the medicinal solution in divided doses and repeating the remedy to speed the cure, when necessary. This was all new to me and most of the material just flew right over my head. I decided to put the Organon aside for the time being and continued to practice in the manner with which I was most familiar.

The next time I took up the Organon, I came to understand that there were six editions that spanned the years 1810 to 1842-3. Each of these serial editions built on the preceding publications as Hahnemann developed his new healing art over a period of 33 years. When I reread the Organon I began to see that these paragraphs were presenting a sophisticated system that I did not really understand. How come I was never taught about these strange methods I was reviewing? Why were we giving all our doses in random numbers of dry pills when Hahnemann wrote passage after passage on the importance of the delivery system, the size of the dose, and subtle adjustments of the potency factor by succussions? Kent viewed remedial powers as a “simple substance” that had quality but no quantity, so the size of the dose did not matter. Hahnemann, however, viewed remedial powers as quantum energies in which both the potency (degrees of dilution and succussions) and the amounts (number of pills, drops or teaspoons) were all important. Such issues troubled me day and night. Nevertheless, I could not find one single homeopath that knew of these methods let alone practiced them.

Around this time I decided it was time to carry my education into the field and I left on a trip around the world. I knew that there were a number of experienced homeopaths in India and I wanted to see firsthand how they practiced in Third World conditions. While in India I decided to read the Organon for a third time. This time I came across a copy of The Organon of Medicine 5th & 6th Editions, which is based on Dudgeon’s translation of the 5th edition and Boericke’s translation of the 6th edition. After comparing the passages of the 5th and 6th editions I finally got a grasp of the differences between the administration of the centesimal and the 50 millesimal potencies. This work also possesses some important aphorisms taken from the 1st, 2nd, 3rd and 4th editions of the Organon. I was simply flabbergasted by my lack of understanding of the evolution of Homeopathy and a “fever-like state” came over me where I could not eat, sleep or wake without thinking about the subject.

I came to realize that the Organon is not written in an A to Z fashion like a modern textbook. It is the last of the medical classics and the 6th Organon is written in the form of 291 aphorisms. Each aphorism builds on the understanding of the previous maxims as Hahnemann develops the cardinal themes. The key points are introduced in a specific order and then reintroduced on a deeper level as the themes unfold. For this reason, one needs to contemplate the meaning of each aphorism carefully before proceeding to the next passage. It became obvious to me that the Organon was not a user friendly manual that one read once and then put it away. One has to study the maxims and then put them into practice stage by stage to gather experience in the methods. It is in the clinic that the Organon comes to life when one applies the principles and praxis carefully. I knew I had to try but I did not know where to start.

In time I discovered that the 6th Organon was not published in Hahnemann’s lifetime and only appeared in public in 1921 in German and English. This is the reason why there were no references to the 6th Organon methods and the LM potency in the writings of Hering, Kent and other 19th century homeopaths. Nevertheless I still wondered why contemporary homeopaths showed so little interest in any of these “new methods”. I decided that I should study the posology and case management methods of the 5th and 6th editions of the Organon side by side. To my greater surprise I found that the way I was taught to practice was not in the 5th Organon either! I finally came to comprehend that the Homeopathy I was using was more similar to the 3rd and 4th Organon than the 5th and 6th editions. Why were we practicing the Homeopathy of the 1820s when Hahnemann lived through the 1830s and into the 1840s and published two more editions of the Organon? Why were the techniques that he used in his last ten years virtually unknown? I decided it was time for me to get to the root of the matter so I began a new series of clinical experiments.

My plan was to begin with a clinical trial using the methods of the 4th, 5th and 6th editions of the Organon and compare the results over a longer period of time. This meant I would evaluate the results of using the centesimal potency in a dry dose as suggested in the first edition of The Chronic Diseases (1828) and the 4th Organon (1829) with the results using the medicinal solution and split-doses of the 5th Organon (1833) and the preface of the Chronic Diseases (1837). This trial was conducted during a period of over one year when I was treating hundreds of patients in free clinics During this process I began to investigate the mysterious 50 millesimal potencies of the 6th Organon (c. 1842-43) and compare their actions with the C potencies.

The Case Management Procedures of the 4th Organon

In the 4th Organon of the Healing Art the Founder gave careful rules regarding the repetition of the remedy and perfected what may be called “the single dose wait and watch method”. This approach is clearly explained in aphorisms 242, 243, 244 and 245. By this time, Hahnemann moved away from the use of the drop dose of the pharmaceutical liquid and taught that the size of the dose should be kept as small as possible yet still large enough to be effective. For this purpose he suggested that one drop of pharmaceutical liquid be placed on a great number of tiny poppy-seed size pellets. Then the patient could be given 1 or 2 of these tiny pellets dry. The Founder begins his discourse in aphorism 242 by explaining that the remedy should not be repeated until the action of the previous dose had ceased.

“So long, then, as the progressive amendment resulting from the dose continues, it must at least be admitted that, in this case, the action of the remedy has not yet ceased, and consequently no other medicine should be prescribed.”

The Homeopathic Medical Doctrine or The Organon of the Healing Art; S. Hahnemann (Translation of the 4th Organon by Charles H. Devriant, 1833), Aphorism 242.

In this passage Hahnemann clearly explains that as long as there is a progressive improvement one must assume that the duration of the remedy still continues. As long as the patient is getting better in any way the repetition of any medicine whatsoever is forbidden. Hahnemann continues by explaining that the improvement produced by a well-selected remedy may continue for an intermediate period after the duration of the remedy ceases. He notes that the symptoms of the diseases that have been truly cured will not return, and an increase in health will be observable for some time even without additional medicine. At some point, however, all this improvement will come to a standstill and then there may be a relapse of the symptoms. This is a clear sign that the remedy duration has ceased and the time has come to repeat the remedy.

The Middle Path

During Hahnemann’s time, as today, there was great disagreement in the homeopathic world between the “conservatives” who used the single dose, wait and watch method exclusively and the “liberals” that tended to repeat remedies by preconceived schedules on most patients. The first group will not repeat the remedy until they are sure that the duration of the previous dose has completely ceased and the second repeat the remedy without considering the action of any particular dose whatsoever. Although these two groups are practicing in opposite modes they both claim success, and to be truthful certain difficulties are apparent with both techniques. Those using the single dose wait and watch method often proceed so slowly that the patient becomes disappointed and leaves, while those using mechanical repetition move so fast they produce aggravations and accessory symptoms that drive people away. Hahnemann was well aware of the debate being carried on around him and in secret he was working to overcome the problems associated with both methods.

The Chronic Diseases (1828) and the 4th Organon (1829) present Hahnemann’s final views on the single unit dose and the wait and watch method. The only exceptions to the single dose wait and watch method was presented in The Chronic Diseases where Hahnemann suggests administering the remedy in divided doses in aqueous solution over a three day period, rather than the single dose of globules.

“In cases where the physician is certain as to the homeopathic specific to be used, the first attenuated doses may also be dissolved in about 4 oz. 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 seems to take a deeper hold on the organism and hasten the restoration in patients who are vigorous and not too sensitive.”

The Chronic Diseases Their Peculiar Nature and Their Homeopathic Cure; S. Hahnemann (Theoretical Part), Psora, footnote, page 217.

In this method one or two pellets of the remedy are placed in four ounces of water and stirred well to slightly raise the potency just prior to administration. This slight change of the potency level alters the remedy so that the organism never receives the exact same dose twice in succession. In this passage Hahnemann is already pointing toward a future where the single dose and split doses will be united in a grander vision of a unified posology strategy.

On the Repetition of the Remedy and the 5th Organon

In the second edition of Boenninghausen’s A Systematic Alphabetic Repertory of Homeopathic Remedies, Part First, Embracing the Antipsoric, Antisyphilitic, and Antisycotic Remedies (1833), Hahnemann wrote an introduction for this work entitled On the Repetition of the Homeopathic Remedy. After reviewing the pros and cons of various methods of posology, the Founder suggests for the first time that the dose may be repeated before the cessation of the duration of a remedy if it was done in the proper manner. For this purpose he suggested the best delivery system was the olfaction of the remedy rather than the dry dose.

The German Casebook D38, which covers 1833 to 1835, shows that between November 1833 and March 1834 Hahnemann used olfaction almost exclusively. For example, on December 23rd, 1833 Hahnemann gave Charlotte Reupsch (D38, p. 14) “14§ Graph R.”, which means the patient was given an olfaction of Graphites and 14 placebos. It recorded in the casebook that the patient returned to see Hahnemann 14 days later on January 7th, 1834. It is estimated that around 80% of the prescriptions in D38 were delivered through the respiratory route. For this reason, the 5th Organon (1833) contains his most detailed explanation of the inhalation of homeopathic remedies.

Following the publication of On the Repetition of the Homeopathic Remedy, Hahnemann introduced new posology and case management procedures in aphorisms 245, 246 and 247 of the 5th Organon (1833). He begins his discourse on case management with aphorism 245, which clarifies the proper view of the single dose and when it is applicable in treatment.

“Every perceptibly progressive and strikingly increasing amelioration in a transient (acute) or persistent (chronic) disease, is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hastening toward its completion. Every new dose of any medicine whatsoever, even of the one last administered, that has hitherto shown itself to be salutary would in this case disturb the work of amelioration.”

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), 5th Organon, Aphorism 245.

Whenever there is a noticeably vigorous and ever-increasing amelioration this is a sign that the dose should not be repeated as long as this extraordinary state lasts. This is because the remedy is speeding toward cure at the fastest possible rate and any untimely dose runs the risk of causing aggravations, accessory symptoms and a relapse of the symptoms. This statement is reminiscent of the method of the 4th Organon but it is qualified by the terms “perceptibly progressive and strikingly increasing improvement”.

Perceptibly progressive means that the action of the remedy is visibly making progress. Strikingly increasing amelioration means that this positive action is building day by day and week by week. This is the best case scenario and one that should be allowed to continue without any interference whatsoever. Unfortunately, such a dramatic response is not witnessed in a great number of cases. In most cases one only witnesses a slow to moderate improvement, which by the rules of the 4th Organon, still precludes the repetition of the remedy until there is a clear standstill or a relapse of symptoms. To address this situation, Hahnemann made the following suggestions in aphorism 246.

“On the other hand, the slowly progressive amelioration consequent on a very minute dose, whose selection has been accurately homeopathic, when it has met with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable from its nature of performing in a given case, in periods of forty, fifty or a hundred days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily affected, as recent and oft-repeated observations have shown, under three conditions: firstly, if the medicine selected with the utmost care was perfectly homeopathic; secondly, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; thirdly, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals, which experience shall have pronounced to be the best adapted for accelerating the cure to the utmost extent, yet without the vital force, which it is sought to influence to the production of a similar medicinal disease, being able to feel itself excited and roused to adverse reactions.”

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), 5th Organon, Aphorism 246.

A progressive and strikingly increasing amelioration is a wonderful occurrence but a great many cases respond only with a slow progressive advance. Under these conditions it may take 40, 50 to 100 days to see any significant improvement. These slow moving cases frustrated Hahnemann, because by the rules of the 4th Organon he could not repeat the remedy until there was a standstill of improvement or a relapse of symptoms. Samuel was not satisfied with waiting and watching while the patient was barely improving, so he performed new experiments in an effort to accelerate the time of recovery. In aphorism 246 Hahnemann stated that his new management strategy could speed the cure of slowly progressing cases to one half, one quarter or less the time possible, with the methods of the 4th Organon. This is because the Founder’s new protocol teaches the practitioner when it is appropriate to wait and watch and when it is better to act and observe the action of timely repetition.

In the footnote to aphorism 246 Hahnemann spoke of the “middle path” that forms a balance between the mandatory single dose and the routine repetition of remedies. Here the Founder explains the information one must take into account to assess suitable intervals for repetition and offers various options.

“I perceived that, in order to discover this true middle path, we must be guided as well by the nature of the different medicinal substances as also by the corporeal constitution of the patient and the magnitude of his disease, so that – to give an example from the use of Sulphur in chronic (psoric) disease – the smallest dose of it (tinct. sulph X [30C [DL]]) can seldom be repeated with advantage, even in robust patients and in fully developed psora, oftener than every seven days, a period of time which must be proportionally lengthened when we have to treat weaker and more excitable patients of this kind; in such cases we would do well to give such a dose only every nine, twelve, or fourteen days, and continue to repeat the medicine until it ceases to be of service.”

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), 5th Organon, footnote, Aphorism 246.

In this footnote Hahnemann points out the reason for the difficulty of repeating the dry dose until the cessation of the duration of the remedy. Hahnemann wrote that “a number of the smallest doses given for the same object in quick succession accumulate in the organism into a kind of excessively large dose, with (a few rare cases excepted) similar bad results”. Too many dry doses given before the relapse of symptoms accumulate in the vital force until they act as one excessively large dose producing all the difficulties associated with over medication. Knowing this was the situation Hahnemann was searching for a better method of administering his remedies. This was the primary reason why he began to use olfaction and the medical solution in divided doses rather than the dry pellets.

Hahnemann’s new case management strategy offers insights into when to allow the single dose to act alone and when to repeat the remedy at suitable intervals to speed the cure. In order to assess the periods for appropriate repetition the homeopath must understand three essential factors. The first is the nature of the medicinal substance, which includes the size of the dose, the selection of the delivery system and the choice of the potency. The second is the condition of the patient’s constitution including its predispositions, sensitivity and stores of vitality. The third is the nature and stage of the disease state as well as its magnitude. Understanding these three vital points help guide the homeopath in the selection of the remedy, dose and potency as well as case management. In aphorism 247 Hahnemann offers examples of the intervals used when repeating remedies in acute and chronic diseases as well as in acute-like flare-up of chronic conditions.

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

Organon of Medicine, 5th & 6th Edition; S. Hahnemann (Dudgeon & Boericke Translation), 5th Organon, Aphorism 247.

The directions found in the footnote to aphorism 246 and aphorism 247 is based predominantly on the 30C. These recommendations must be adjusted to suit the deeper actions of higher potencies like the 200C, 1M, 10M, etc. If the 30C can be repeated every 7 to 14 days, then all things being equal, the 200C might be repeated every 14 to 30 days or more. The 1M might only need repetition every 30 days or more. The 10M may act for months. In some cases these periods may be shorter or longer depending on the symptoms and circumstances. Sometimes a remedy might need to be repeated more frequently, especially when chronic disease states take on a more acute-like pattern. These suggestions are only guidelines that must be adjusted according to the patient’s individual reaction to the remedy.

The single dry dose is considered sacrosanct by many modern homeopaths. Nevertheless, Hahnemann found this method too limited, in difficult to cure acute and chronic cases. In the 5th Organon he suggests that remedies may be repeated at definite intervals, if necessary, and makes clear his preference for olfaction and liquid solutions. In the final German casebook D38 (1833-1835), Hahnemann only occasionally uses the oral dry dose and preferred to give remedies in olfaction. At the same time he was experimenting with various liquid solutions. At first he placed 1 pill in ½ spoonful of water and gave the entire amount to the patient. Later in the casebook he put 1 or more pills in a glass of water and gave various liquid portions such as ¼ and ½ a glass. The earliest recovered Paris casebook, DF-2, shows that by 1835 and 1836 Hahnemann was using the medicinal solution in a bottle with the addition of a dilution glass from which he was giving divided doses in spoonfuls. In 1837 Hahnemann made public his view that the well preserved medicinal solution used in split doses was the most effective delivery system. With this method in mind the Founder gave new instructions on how to treat acute, half-acute and chronic diseases. Vide the 1837 edition of The Chronic Diseases.

“Experience has shown me, as it has no doubt also shown to most of my followers, that it is most useful in diseases of any magnitude (not excepting even the most acute, and still more so in the half-acute, in the tedious and most tedious) to give to the patient the powerful homeopathic pellet or pellets only in solution, and this solution in divided doses.”

The Chronic Diseases Their Peculiar Nature and Their Homeopathic Cure; S. Hahnemann (Theoretical Part), Preface, Concerning the Technical Part of Homeopathy, page 262.

In the same article Hahnemann wrote that the dry dose laid on the tongue was the “the weakest dose with the shortest period of duration in its effects”.  He found that dry pellets were too static of a delivery system because there are few ways to adjust the dose other than give more or less pills. It was his experience that a medicinal solution acted more deeply yet more gently on the organism. Furthermore, he noted that a remedy bottle succussed just prior to ingestion slightly raises the degree of potency so that the vital force never receives the exact same dose twice in succession. This subtle change makes it possible for the homeopath to repeat a remedy as needed to speed the cure in slower moving cases without waiting for a relapse of symptoms. Some practitioners state that the medicinal solution was developed only for the 50 millesimal potencies. This, however, is not the case as the medicinal solution was originally developed for the C potencies during the 1830s.

Aphorism 246 of the 6th Organon

Aphorism 246 of the 6th Organon is based on a synthesis of the ideas introduced in the 5th Organon in §245 on the single dose, and §246 on the repetition of the remedy, along with new conditions needed to speed the cure. This rendition is based on the use of the 50 millesimal potencies and the medicinal solution in split-doses taken from a dilution glass. The first topic taken up is when a single dose of a remedy produces an obviously progressive and strikingly increasing amelioration of the patient’s symptoms. This discussion is similar to §245 of the 5th edition. The second part of the aphorism deals with those cases in which a single dose can only produce a slow, continuous improvement where the remedy takes 40, 60 or 100 days to produce a substantial improvement. This aphorism is similar to §246 in the 5th edition but the techniques are modified to suit the 50 millesimal potencies. Vide Organon.

“During treatment, every noticeably progressing and conspicuously increasing improvement is a state which, as long as it persists, generally excludes any repetition of the medicine being used because all the good being produced by the medicine is still hastening towards completion. This is not seldom the case in acute diseases. On the other hand, with somewhat chronic diseases, there are, to be sure, some cases that have slow, continuous improvement based on one dose of an 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. Also, it must be a matter of great importance, to the physician as well as to the patient, to foreshorten this period, if possible, by half, three-quarters, indeed even more, in order that a far more rapid cure might be attained. The most recent and frequently repeated experiences have taught me that such rapid cures can be favorably carried out under the following conditions:

About the author

David Little

David Little

David Little was born in the USA in 1948 and has been a student of Homeopathy since the early 1970s. He has studied Homeopathy in the USA and India. His first teacher was the late, great Dr Manning Strahl and he was a colleague of the late Dr Harimohan Choudhury. He started HOE, Homeopathic Online Education in 1999. David Little has recently published The Homoeopathic Compendium, a unique series of textbooks designed to provide a complete guide to Homoeopathy. This monumental work is presented in 6 volumes, with over 4,500 pages. To order online and for more information, including free chapters visit: www.friendsofhealth.com

4 Comments



  • Thanks Dr David Little for such a valuable article !! There are several misconceptions among homeopaths for the dosage schedule . Most of the Indian homeopaths use wait & watch method & no doubt they get the good results but at the same time those using the method are confident of better results than wait & watch . Thus a fair trial should be done in OPDs’ of different homeopathic medical colleges eventually it raises confidence among students regarding method.

  • i think there is no need to read any other books to understand Organon, sixth edition is sufficient enough to know the depth of Organon.

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