HAHNEMANN’S MIDDLE WAY

1.    Select with all circumspection, the aptly homeopathic medicine.

2.    Use a highly potentized [fifty-millesimal] dose, dissolved in water.

3.    Administer a properly small dose of this to the patient.

4.    Give a dose of the solution at intervals that experience has shown to be the most distinctly appropriate for the best possible acceleration of the treatment.

5.    Prior to each administration of a dose of the solution, alter the degree of potency of the dose. It is very important that the degree of potency of each dose deviate somewhat from the previous and subsequent ones. This is so that the life principle, whose tunement is to be altered to that of the similar medicinal disease, may never feel itself agitated to adverse counter-actions and enraged, as happens when repeated, unmodified doses are given, especially when such doses are rapidly repeated one after another.”

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), Aphorism 246.

Many individuals read the above paragraph but fail to note that Hahnemann makes a clear differentiation between two fundamentally different types of remedy reactions. Hahnemann clearly stated that anytime “during treatment” there is a noticeably progressive and strikingly increasing amelioration the remedy should not be given as long as this state lasts. This means that whenever a single dose or a series of doses creates an extraordinary increasing amelioration the repetition should cease as long as this state lasts. The repetition of the remedy at this time is counterproductive because it only slows down the cure or produces medicinal symptoms. Excessive repetition runs the risk of producing adverse secondary actions of the vital force which are counterproductive. This is true with both the C and LM potency in medicinal solution even when given in the smallest liquid doses.

Hahnemann’s close colleague, Dr. Croserio, noted in his letter to Boenninghausen (Hahnemann’s Doses of Medicine, The Lesser Writings, Boenninghausen) that Hahnemann “frequently” gave single doses by olfaction followed by placebo for at least one week. This statement finds ample confirmation in the Paris casebooks. For example, a patient named Mr. Fontaine (DF-12, p. 546-548) was suffering from a kidney disease that caused him to take a long time to void urine. On July 31st, 1841 Hahnemann prescribed a light olfaction of Pulsatilla and a placebo made in a 7½ tablespoon aqueous solution. The patient returned to see the doctor 13 days later. On August 13th Melanie noted in the follow-up appointment that the “Pulsatilla Resp. did him great good”.

Hahnemann sometimes gave single doses of the oral medicinal solution followed by placebos. In the case of Adele Sanson (DF-11, p. 155, January 25th, 1841) Hahnemann prescribed number 1, Phosphorus stirred into a glass with 1 coffeespoon to be given to the patient “one time” and prescription number 2 was 2 placebos. The patient returned 6 days later. In my personal practice I have seen a single dose of the 50 millesimal potencies cure cases, even those of very chronic duration. Many times, I find that all that is needed is an infrequent repetition of the LM potency to complete a cure. I use this method with those who demonstrate a strikingly increasing amelioration on a single dose or short series of doses, which makes more rapid repetitions completely unnecessary and in this case counter indicated.

In the second section of aphorism 246 the Founder states there are many cases where a single dose only causes a “slow, continuous improvement” that may take 50, 60, or 100 days to produce a cure but this is rarely the case. It is much more common for the slowly improving patient to experience a relapse of symptoms that calls for the repetition of the remedy much earlier. Days, weeks and months may pass while the individual only experiences the slightest amelioration. It is very important to the healing artist as well as to the patient that this period be reduced by half, three-quarters or more so that much more rapid cure is attained. There is a great difference between a noticeably progressive, strikingly increasing amelioration where the patient feels better and better and slow improvement where the patient barely notices any changes. Each of these scenarios must be handled in a completely different manner.

When Necessary!

All of the statements about repeating the dose to speed the cure only pertain to protracted cases in which a single dose can only cause, at best, a slowly progressive amelioration. This circumstance conditions all the following statements by Hahnemann about the use of daily and alternate day doses in the footnote to aphorism 246 and aphorism 248. If the patient will do very well on a single dose, or infrequent repetition, suggestions about rapid repetitions do not apply. There are homeopaths who mechanically administer the LM potency daily for weeks and months to every patient. They have not yet understood the fine print in the footnote to aphorism 246. In this footnote the Founder explains why he made changes in the 6th Organon and when the daily dose is applicable.

“What I said in a long footnote to this paragraph in the fifth edition of The Organon of the Medical Art was all that my experience allowed me to say at the time. It was written with the purpose of preventing these adverse reactions of the life principle. However, during the last four to five years, all such difficulties have been fully lifted through the modifications I have made since then, resulting in my new, perfected procedure [for fifty-millesimal potency medicines]. The same well-chosen medicine can now be given daily, even for months when necessary. In the treatment of chronic diseases, after the lowest degree of potency has been used up (in one or two weeks) one proceeds in the same way to higher degrees of potency (for in the new [fifty-millesimal] manner of dynamization, use begins with the lowest degrees, as is taught in the following paragraphs).”

Organon of the Medical Art; S. Hahnemann (O’Reilly 6th Edition), footnote, Aphorism 246.

In the footnote to aphorism 246 Hahnemann suggests that a perfect simillimum (not a poorly chosen remedy) may be given daily when necessary. The daily repetition of the LM potency is only necessary in the slower moving cases and for hyposensitive patients who do not respond to treatment any other way. Repetition of the LM potency daily when it is not necessary causes aggravations, unproductive accessory symptoms, and adverse counter-actions of the vital force. Some patients may only need to take the remedy every 2, 3, 4, 5 or 6 days. Others may only need the medicine every 7 to 14 days or at longer intervals.  Unneeded repetition may make the patient’s vital force non-reactive to the remedy or ultra hypersensitive to the medicine due to overexposure. This can make it difficult to use even the correct remedy again on the patient. For all these reasons it is very important to avoid overmedication caused by excessive repetition of the medicine when it is not needed.

In my review of the microfiches of Hahnemann’s Paris casebooks I found that in most cases where the Founder gave the daily or alternative day dose he often stopped his medicines and gave placebos for periods like 1, 2, even 3 or more weeks, etc. A perfect example of Hahnemann’s final methods can be found in the case of Robert Everest taken from the Paris casebooks (DF-14, p. 257). This casebook contains records from October 1841 to Hahnemann’s passing on July 2nd, 1843. This case history includes single doses by olfaction, a short series of doses of the medical solutions and a good amount of placebos. In the Everest case, Hahnemann administered 8 remedies between October 5th, 1842 and May 2nd 1843 in 17 remedial prescriptions and 16 prescriptions containing placebos. The dates of the remedy prescriptions and placebos are listed below for easy reference

October 5th, 1842; Sulphur 0/1 in 7 tablespoons medicinal solution.

October 12th; Sulphur 0/2 in 7 tablespoons medicinal solution.

October 14th; Placebo.

October 26th, Sulphur 0/3 in 7 tablespoons medicinal solution.

November 4th; Placebo.

December 3rd; Sulphur 0/4 in 7 tablespoons medicinal solution.

December 14th; Sulphur 0/5 in 7 tablespoons medicinal solution.

December 21st; Placebo.

December 28th; Cannabis 30C in 7 tablespoons medicinal solution.

January 4th, 1843; Placebo.

January 7th; Placebo.

January 11th; Single dose olfaction of Thuja and placebos.

January 14th; Placebos.

January 18th; Single dose olfaction of Cannabis and placebos.

January 21st; Single dose olfaction of Mercury and four placebos.

January 25th; Thuja 0/1 in 7 tablespoons medicinal solution.

February 3rd; Thuja 0/2 in 7 tablespoons medicinal solution.

February 10th; Placebo.

February 17th; Placebo.

February 24th; Placebo.

February 25th; Mercury Vivus 0/1 in 7 tablespoons medicinal solution.

March 7th; Placebo.

March 15th; Ambra Grisea 0/1 in 7 tablespoons medicinal solution.

March 20th; Placebo.

March 25th; Cinnabaris 0/21 in a 7 tablespoons medicinal solution.

March 31st; Placebo.

April 3rd; Placebo cont.

April 8th, Sulphur 0/6 in 7 tablespoons medicinal solution.

April 21st, Aurum 30C in 7 tablespoons medicinal solution.

April 24th, Placebo.

April 28th; Nux Vomica 0/2 in 7 tablespoons medicinal solution.

May 2nd; Nux Vomica 0/3 in 7 tablespoons medicinal solution, for the West Indies.

The Everest case is a perfect example of how Hahnemann used single doses as well as a series of liquid doses in an “on again – off again” fashion. In many cases he gave almost as much placebo as medicine! This was true with both the C and LM potency in medicinal solution in the 1840s. In this way, the posology method can be tailored to a great variety of patients and their conditions. Hahnemann’s final posology method spans the single dose and infrequent repetition in striking responses and the repetition of remedies at suitable intervals to speed the cure in slow moving cases if necessary. Hahnemann makes it clear in the 6th Organon that as the patient moves toward cure the intervals between the doses should be lengthened and then ceased to see if the cure is complete. The idea that the Founder mechanically gave the 50 millesimal potencies daily for days, weeks, months and years on end is a complete myth!

Some persons try to make the 6th Organon an issue of the LM potencies versus the C potencies.  The Paris casebooks from 1840 to 1843 make it very clear that Hahnemann used both the centesimal and 50 millesimal potencies side by side up until his death. The Founder never intended practitioners to learn how to use the 50 millesimal potencies or the medicinal solution from the text of the 6th Organon alone. Hahnemann was grooming Baron von Boenninghausen to carry the banner of the new methods and pass them to the next generation. He was expecting the Baron to fill out the details that were missing in the text of the 6th Organon. For example, Hahnemann never mentioned his extensive use of placebos in the text, but in the letter cases the Founder sent to Boenninghausen, all this was very clear. Unfortunately, Samuel passed away before the process was completed and the 6th Organon was published.

It seems that other than Melanie Hahnemann, only the Baron knew exactly how the LM potency was being made and administered to patients. Melanie requested Boenninghausen not to speak about the new methods until she could publish the text so he put the project aside. Regrettably, the 6th Organon was not published during the Baron’s lifetime and the essential moment was lost. It appears that Melanie did not train anyone in the method so when she passed away the living lineage of practitioners that had experience with the 50 millesimal potencies was broken.

The 7th Organon

Hahnemann used his most advanced methods with the C and 50 millesimal potencies for around a 3 year period spanning 1840 to 1843. This was the time that he was writing the 6th Organon. I have used these C and LM potencies in the medicinal solution for over 25 years. Although I am not qualified to write a “7th Organon”, I do have many years of experience with bringing Hahnemann’s final methods up to date for practice in our times. With this in mind, I do my best to share with students and colleagues the fruits of my endeavors in the fields of research and clinical practice.  First of all, I would like to say that the medicinal powers of the C and LM potency are complementary opposites that greatly expand the therapeutic horizons of Homoeopathy. For this reason, there are cases that do better on the centesimal potencies and cases that do better on the 50 millesimal potencies as well as cases that need both the C and LM potency during the process of cure. If the homeopath can gain experience in the characteristic actions of these two potency systems they will be able to customize their treatments to suit the circumstances in a manner that is just not possible by the older 4th Organon methods alone.

The centesimal potencies are aggressive in their onset, promote rapid aggravation and produce a long curative secondary action. The Kentian system is based on seven major degrees of the potency degrees from 30C to 200C to 1M to 10M to 50M to CM to MM. These very large jumps of potency produce a rapid vertical arc in degrees of power. The aggressive nature of the centesimal potencies is similar to strong exciting causes, accidents, trauma, strong acute diseases, virulent acute miasms, chronic diseases that begin with an intense crisis and progress quickly and acute-like flare-ups of chronic states and miasms. The prolonged aggravations caused by using the higher potencies at the start of treatment can be counterproductive in cases of organic pathology and lack of vitality.

The 50 millesimal potencies are gentle in their onset, reach aggravation slowly and produce a deep enduring curative action in stages. This scale utilizes 30 microtonal degrees of potency that reach their full remedial power in gradually increasing increments. The arc of potency is similar to a gentle ascending plane that moves upward in a gradual manner. The ever-increasing nature of this scale is similar to conditions produced by prolonged maintaining causes, long-term degenerative diseases, old one-sided states, pathological conditions and protracted chronic miasms. The LM potency tends to produce aggravations at the end of the treatment when the pathology is healed and the vitality is restored. This quality can be very useful in cases where organic pathology and weakened vitality makes the centesimal potencies difficult to use without complications. The Paris casebooks show that Hahnemann tended to use the C potency for acute conditions and crisis and the LM potency for chronic diseases and miasms although not exclusively.

The methods of the 4th, 5th and 6th Organon represent the evolution of a similar technique rather than a contradictory change in methods as they are sometimes portrayed. If the practitioner has not really understood the wait and watch method of the 4th level of Homoeopathy they do not really understand how to judge the action of single doses over time. Nevertheless, those that have not evolved to the 5th and 6th level of Homeopathy imagine that the single dose is suitable for all cases. In aphorism 245 of the 5th and 246 of the 6th Organon Hahnemann makes it clear that the hallmark of the single and infrequent dose cures are an observably progressive and strikingly increasing amelioration. Many do not understand that cases that respond to single or infrequent doses with a slow improvement are perfect candidates for the repetition of the remedy to speed the cure. These more rapid intervals must be selected in accordance with the nature of the remedy, the size of the dose and the degree of the potency; the patient’s constitutional sensitivity and vitality, and the nature and magnitude of the disease state. If these factors are understood the time of cure of these slow moving cases can be reduced tremendously.

On the other hand, there are those that imagine that using Hahnemann’s “new method” means that one should repeat the remedy at rapid intervals all of the time for long periods. They have a tendency to administer too many doses too quickly, which produces aggravations and accessory symptoms of the remedy. Some of these individuals make it a standard practice to give the remedy daily for up to a month without reassessing the action of the remedy on the patient. They tell others that this is how Hahnemann practiced in Paris but nothing could be further from the truth. They do not realize that Samuel still used the single doses (usually by olfaction) when using the C or LM potency and often gave a short series of medicinal doses followed by placebos while he waited and watched. They do not understand that the daily dose should only be used “when necessary” and only as long as it is truly required. For this reason, they cause medicinal symptoms that have given split-doses of the medicinal solution of the C and LM potency a bad reputation in certain circles. All of these problems are caused by using a mechanistic approach that more often than not leads to overmedication in the long run.

The six editions of the Organon embody the evolution of a method over a 33 year period in which Hahnemann sought to perfect the homeopathic healing art. The last 10 years of Samuel’s life (1833-1843) represent an epoch in which the Founder introduced his most advanced techniques. In the final Middle Path approach the dichotomy between the single dose wait and watch method and the repetition of the remedy at specific intervals is removed. What appears to some as a conflict of interests is replaced with a system of flexible response that offers maximum individualization according to the time and circumstances. Hahnemann stated that by using these techniques he sped the cure of protracted cases by ½, ¾ or even less the time it took with the methods of the 1820s. This is especially true for those who have mastered the complementary opposite actions of the C and LM potency. Shouldn’t this extraordinary statement by the Founder be tested by a new generation? Should we just continue to use the same old methods year after year without testing Hahnemann’s hypothesis in the clinic? What is needed to carry out this experiment is a “beginners mind tempered with the wisdom of experience”.

During the period of the 5th and 6th Organon, Hahnemann introduced his most sophisticated delivery system for dynamic potencies, i.e. the medicinal solution and the methods of adjusting the dose. Nevertheless, we often hear that the size of the dose and the nature of the delivery system make “no difference” in Homeopathy. Should we just continue to mechanically repeat the same old concepts rather than study the final experiments of the Founder for ourselves? Shouldn’t we test the methods of the medicinal solution with both the C and LM potencies as Hahnemann did in his final years? Is clinging to past methods really the way forward to the medicine of the future? I think not! I call on all those with an open mind to carefully read the aphorisms of the 5th and 6th Organon and test the Founder’s final methods in a clinical trial as I did all those years ago. Since that time, I have guided hundreds of people through a similar process and they have found that the Founder’s observations are most certainly true. I have seen that those who take the time to truly investigate Hahnemann’s advanced methods never regret the experience.

Similia Minimus

Sincerely, David Little

David Little has studied Hahnemann’s Paris casebooks intensively and is considered a leading authority on the way in which the Founder used the C and LM potencies in his final years. He is currently at work on The Homoeopathic Compendium, which is a six volume 4000 page textbook spanning the history, theory and practice of the homeopathic healing art.



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.

Leave a Comment