The Minimal Dose
James Kent was an extremely experienced homoeopath but he did make a few fundamental mistakes. This is true with all of us greater or lesser mortals. Perhaps the area where he made his biggest mistake was in his view of the dose. There is a commonly held belief in modern homoeopathy that there is no difference in the action of a homoeopathic remedy regardless of whether one gives one pill, one hundred pills, or for that manner, one thousand pills ad infinitum.
This idea originated with James Kent and can be found in his classic, Lectures on Homoeopathic Philosophy in the chapter called, On Simple Substance*. In this work Kent’s explains the Swedenborgian theory that energy is based on a fourth state of matter called the simple substance. This idea originated in the 18th century when all forms of energy were considered to have a subtle substance as their basis. This view was also reflected in the Newtonian theory that there were permanent atoms responsible for all forms of energy.
*Kent’s Lectures on Homoeopathic Philosophy, Lecture VIII, On Simple Substance, page 67, B Jain, New Delhi.
Hahnemann was one of the first visionaries to postulate the existence of pure energies that have no material basis in any substance. Aphorism 9 of the Organon states, “In the healthy condition of man the spiritual vital force animates the material body”. Kent objected to Hahnemann’s use of such words as the vital force, vital energy, or vital principle because he felt that all energy must be a subtle substance. Kent felt that what Hahnemann had written was misleading because there really was no such thing as a pure energy. Vide Kent’s Lectures.
“If he (i.e., Hahnemann) had used the words “immaterial vital substance,” it would have been even stronger, for you will see it to be true that it is a substance.”
Kent could not conceive of a purely energetic phenomena because he felt that all forces must be based on the subtle state of matter. Hahnemann equated the dynamic nature of the vital force with natural phenomenon akin to electromagnetism rather than any simple substance. He was a pure vitalist who taught that the material world is sustained by radiant energy sources not subtle forms of matter or permanent atoms. For Kent, however, such a lofty vision was impossible as he felt that everything must have a substantial basis even if it was of the most subtle nature. Vide Kent.
“For a number of years there has been a continuous discussion of force as force, or power to construct. The thought that force has nothing prior leads man’s mind into insanity. If man can think of energy as something substantial, he can better think of something substantial as having energy.
Kent believed that a “fourth state of matter” acted as a precursor to all forms of energy or force. He could not conceive of matter as being a form of condensed energy because he could not imagine that a force could come from “nothing”. The idea of a permanent atom originated ages ago with Democritus and continued until Einstein pointed the way toward quantum physics in the early 20th century. Kent felt that the process of potentization reduced a homoeopathic remedy to its “simple substance”, and correspondingly, the remedy itself entered into the fourth state of matter.
Swedenborg taught that in the 4th state of matter there was no “quantity” of simple substance but “only quality in degrees of fineness”. This is why Kentian homoeopaths believe that there is no difference in using one pill or one thousand pills of a high potency remedy. Kent felt that the fineness in degrees of the simple substance denotes the potency of a homoeopathic remedy. At the same time he felt that the simple substance has no “quantity”, so therefore, the number of pills used in a dose makes no difference. He also wrote that it makes no difference whether you take a remedy in liquid or a pill dose. Kent also felt it makes no difference whether you give 1 teaspoon or the entire glass of a medicinal solution. In Kentian homoeopathy the size of the dose is a static factor while only the potency is dynamic.
Modern physics states that all forms of energy are contained in small energy packets called quantums. The amplitude of a force is increased when the number of quantums of energy present are expanded at any given wave length. In the same way, Hahnemann taught that each pill of a homoeopathic remedy possessed a certain amount or “quantum” of medicinal energy. In a sense the potency of a remedy represents the wave form or frequency of the energy and the number of pills represents the amplitude or power of the signal. This is why the power of a homoeopathic dose increases each time the practitioner uses more pills when preparing the remedy for ingestion. Of course, this is a philosophical interpretation not one of a physicist’s.
Many modern homoeopaths interpret the size of the dose as being synonymous with the level of the potency used. They mistakenly believe that using a smallest dose relates to the tiny amount of the original substance present in a high potency remedy. This is not the case as Hahnemann speaks of the difference between the size or amount of a dose and the potency factor in his writings. In the Organon, he tells his homoeopaths that an excessively large amount of the correct remedy is dangerous, especially when it is given in high potency.
“For this reason, a medicine, even though it may be homoeopathically suited to the case of disease, *DOES HARM IN EVERY DOSE THAT IS TOO LARGE, AND IN STRONG DOSES IT DOES MORE HARM THE GREATER ITS HOMEOPATHICITY AND THE HIGHER THE POTENCY SELECTED*, and it does much more injury than any equally large dose of a medicine that is unhomoeopathic and in no respect adapted to the morbid state (allopathic)”.
Hahnemann taught that the phenomenon of the aggravation was not only linked to the potency, but also to the number of pills used when giving the dose. From this we can see that Hahnemann’s views of energy mechanics were similar to the quantum physics of the 20th century which overturned the ideas of Newton. In homoeopathy the use of the minimal dose is a very important rule because it must be utilized in daily practice as a guide while treating patients.
As one can see from this paragraph, a child eating a large number of pills of an unhomoeopathic remedy does not necessarily pose a danger. On the other hand, symptoms have been notice under these conditions at times. The real danger in an excessive dose is when the remedy is perfectly homoeopathic and the patient is sensitive, has advanced chronic diseases, or hidden tissue pathology. This is not a matter of theory to those of us who have worked with the medicinal solution and the methods of adjusting the dose. Here are some examples which demonstrate that the preparation does indeed make a difference on the action of the remedy on the vital force.
1. A very hypersensitive lady who was taking one 6c pill dry was experiencing strong aggravations every time she took the dose after which she would improve a little and then relapse. She thought she was too sensitive for homoeopathy and may have given up. On making a medicinal solution, and taking one teaspoon, the remedy no longer aggravated, and she was able to repeat the remedy at suitable intervals until she was cured. This is an example of how changing from the dry dose to the liquid dose, and succussing before each teaspoonfull, transmuted an aggravation and made the remedy repeatable in a sensitive who had trouble taking even one dose dry. This is an example of changing from a dry dose to a liquid dose which shows there is a difference in the way you give the dose and its amount.
2. A homoeopath who took Carbo Veg. 200c in a dry dose did not react. The remedy seemed to fit her case. She then was told to try it again but in a medicinal solution. The dose was one teaspoon. A few doses of the 200c succussed 5 times before each dose to slightly change the potency cured rapidly. This is another example of a solution curing where a dry dose failed. If dosage makes no difference wet or dry as Kent said, why did this work?
3. A woman who took one dose of Cimicifuga LM1 in a 4 oz. solution for migraine headaches experienced a similar aggravation. After increasing the amount of water in the solution by making an 8 oz solution there was no aggravation and she was able to repeat the remedy every three days for a month and her migraines never came back. She never experienced aggravation again. This is an example of adjusting the dose by using more water in the original solution. This made the remedy act more gently on her constitution and made it repeatable without aggravation.
4. A person suffering from sleep apnea was given Arsenicum Album LM1 in a 6 oz solution, succussed 3 times before ingestion, 1 teaspoon was taken and stirred into 6 oz of water, and 1 teaspoon was given as a dose. After taking the remedy there was an aggravation of some of the concomitant symptoms for three days, then a slight improvement for a short while, and a relapse. The remedy was given again, but 1 teaspoon was taken out of the first dilution glass, and placed in a second glass from which the client was given 1 teaspoon. The succussions were the same. This caused a radical improvement and removed the sleep apnea. There was no aggravation on the dose made in this manner. This is an example of diluting the remedy through two glasses of water and getting a striking response when the remedy out of the first glass caused an aggravation and then only a made a small improvement. Doesn’t this show a difference in the size of the dose. According to Kent this would not make any change in the effect of the remedy.
5. A patient was given a remedy in a medicinal solution which was succussed 5 times before ingestion. He responded well to the first dose, but when he was told to take a second dose, he forgot to succuss the bottle and the remedy did not act. After the situation was discussed he was reminded to succuss the remedy before taking it again and it work just as well as the first time. This is an example of taking the same unsuccussed, unmodified remedy twice in succession and having no affect at all. When the remedy was “potentized anew” as Hahnemann suggested in paragraph 248, it acted very deeply. This demonstrates the important of succussion and changing the potency of each dose. This is a related subject but does not really deal with changed amounts of the dose.
Hahnemann mentioned in Organon that there are special conditions when the size of a dose must be increased to overcome a disease. The first example he gives is when there are the primary eruptions of the chronic miasms are on the skin. Here are some examples of this method.
6. In a case of scabies (one of psora’s primary eruptions) the normal one teaspoon dose did not act deep enough to remove the mites. In aphorism 248 Hahnemann mentions giving “one or increasingly more teaspoons” of the remedy when needed. By gradually increasing the amount of the dose from 1 teaspoon to 2 then 3 teaspoons the parasites were quickly removed. (Have done this one many times)
7. A case of ringworm (a primary eruption on the skin related to the TB miasm) was only responding slowly to repeated doses of Bacillinum LM1 given in teaspoon doses. The succussions were raised but it did not help. The dose was repeated more often but there was no change. The size of the dose was increased to 3 teaspoons and the ringworm immediately responded and began disappearing. This larger dose acted where a smaller dose did not. The succussions were kept the same.
Another example Hahnemann gave of cases that often need an increase of the size of the dose is when the general health of a person has improved but a stubborn local complaint remains. I have often seen cases where there is a general improvement but a lesional or pathological complaint lingers on. In cases like this it is best to start with the smallest possible doses to get a reaction and slowly augment them until there is an effect on the local complaint.
8. I gave Calcarea Carb LM1 to a gentleman who had an incredible number of symptoms including impotency which brought him great despair. He responded mentally and vitally to the first doses but the local complaint lingered until the size of the dose was gradually augmented over a period of time by increasing the number of teaspoons taken as a dose. The impotency vanished and he has remained cured to this very day. Another reason for increasing the size of the dose is when a case no longer seems to be moving forward.
9. A person was suffering from a swollen prostate with concomitant melancholia and impotence, and obstruction of the flow of urine, a pressure-like sensation in the perineum. He was first given 1 teaspoon of Conium which caused a fair response. He increased the 1 teaspoon to 2 on his own and got a similar aggravation (too large of a dose). He was advised to stop the dose for a few days and to start again with 1 teaspoon. This worked very well as LM1 and LM2 were used and the worst symptoms disappeared. Then it seemed as if the movement of the remedy forward had reached a plateau so the size of the dose was slowly increased from 1 teaspoon to 2 then to 3, and the case once again started moving rapidly forward and is much, much better. If the size of the dose makes no difference, how did this all happen?
These are examples of cases where the methods of adjusting the dose made a difference between success and failure. If I did not adjust the size of the dose in these cases the correct remedy might have been called into question. These methods are all connected to the innovations that Samuel Hahnemann introduced in the 5th (1833) and 6th Organon (finished 1842) and the 1837 edition of the Chronic Diseases. This method demands more artistry on the part of the homoeopath but with more knowledge comes more responsibility.
Kent was truly a great homoeopath and a progressive thinker. Most of what he has contributed to homoeopathy has proved a lasting value. Yet in a few areas he was wrong, but that is only natural. In my opinion his view of the dose is the area which has had a counterproductive effect on homoeopathy and is very contrary to Hahnemann’s teaching in the Organon. This, however, is an area which the anti-Swedenborgian homoeopaths never mention as most of them have the same view of the dose as Kent. Most of the criticisms are rather unfounded or merely personal opinions rather then practical facts about methodology or posology.
My philosophy is to utilize what is appropriate and works, and leave behind what does not appear practical. In this way I can learn things from anyone. It could be Kent or Hughes, who are often played against each other by those who follow Anthony Campbell’s ideas found in The Two Faces of Homoeopathy. The so-called split between scientific and metaphysical homoeopathy does not really exist. Hahnemann was both a scientist and metaphysician as are many homoeopaths today. If someone wishes to remove all philosophy, psychology and metaphysics from homoeopathy they may, but they should not demand that others do the same thing.
Constitution and Temperament
We know from Samuel Hahnemann’s Paris casebooks* that the Founder studied Hippocratic temperaments and diathetic constitutions. For example, He described Mme del a Nois as ‘sanguine’ and Eugene Perry as a ‘choleric” in his notebook. In the case of Claire Christallo, he wrote ‘disposed to scrofula’ while for another he wrote ‘lymphatic’. This is proof positive that the Founder studied the Hippocratic temperaments and diathetic
*Refer, In Search of the Later Hahnemann, Rima Handley, page 71, 72.
The term, diathesis, is used to denote an inherited or acquired constitutional predisposition toward certain chronic disease states. These are Greek classical methods which offer much insight into the nature of the innate constitution and temperaments as well as possible disease propensities. Hahnemann’s Materia Medica Pura is the first homoeopathic work to give a full constitutional picture in a medical work. The Hofath’s gestalt includes both positive and negative natural traits much like some of our more contemporary portraits. Vide Materia Medica Pura, Lecture on Pulsatila.
“Hence the medicinal employment of Pulsatilla will be all the more efficacious when, in affections for which this plant is suitable in respect to the corporeal symptoms, there is at the same time in the patient a timid lachrymose disposition, with a tendency to inward grief and silent peevishness, or at all events a mild and yielding disposition, especially when the patient in his normal state of health was good tempered and mild (or even frivolous and good humouredly waggish). It is therefore especially adapted for SLOW PHLEGMATIC TEMPERAMENTS; on the other hand, it is but little suitable for persons who form their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered.”
The innate natural qualities of temperament, predisposition, and diathetic constitution are unique to the inner proximate causes of disease. In the above portrait Hahnemann describes the natural disposition (lachrymose, slow phlegmatic temperament), negative emotions (grief, silent peevishness), and positive qualities (mild and yielding disposition which when healthy is good tempered, mild or even frivolous and good humouredly waggish). This also shows that the innate temperament of the person in the state of health, and the mistunements caused by disease, are part of the grand gestalt in case taking. The qualities of the spiritual and emotional character, the innate temperament, and the make-up of the physical constitution are all (all) sources of general rubrics. This Vide Materia Medica Pura.
“The employment of this, as of all other medicines, is most subtle when not only the corporeal affections of the medicine correspond in similarity to the corporal symptoms of the disease, but also when the mental and emotional alternation peculiar to the drug encounter similar states in the disease to be cured, or at least in the temperament of the subject of treatment.
Once a homoeopath glimpses the Hippocratic basis of homoeopathic healing and understands the classical system of symptomatology in relationship to the four temperaments they open a new chapter of their study of Materia Medica*. In the classical system the genetic make up of the individual mind/body types is studied in great detail along with general symptoms such as, aversions and desires, thermal and atmospheric preferences, tendency toward cold, hot, wet, dry manifestation, colors of discharges, and modalities, etc.(.) They also studied the particular symptoms of the areas that tended to break down under stress in each of the four constitutions.
The modern classifications of the constitutions into glandular and morphological types are useful but involve very little symptomatology or environmental modalities. On the other hand, the four classifications of the ancient naturalists form a holistic psycho-physical view of constitutional types, their symptomatology, and their relationship to environment. This system is not to be over looked as it has thousands of years of clinical experience behind it and is one of the oldest traditions in western culture. There is a substantial amount of information on this subject in the works of the homoeopaths of the past. The illustrious homoeopath, J. H. Allen, discusses the place of temperaments in understanding the constitution in his classic, The Chronic Disease , from the chapter on Predisposition.
“Temperament can not well be left out of any case in making up our anamnesis, for as we study temperament closely we see that peculiar temperament is predisposed to certain forms of disease. In this we see a fixed law, or principle, involved. As an illustration of this we might take for example the bilious temperament so characteristic of a Nux vomica patient. We know, with a positive certainly, the disease to which he is predisposed. Are they not hepatic, gastro-intestinal, directly or indirectly, the result of an abuse or excesses peculiar to his mental makeup, and moral weakness, peculiar to himself?”
Other hints about temperament are found scattered throughout the writings of Hering, Teste, J. H. Allen, H. C. Allen, C. Knerr, H. Roberts, J. H.. Clarke, as well as hidden in old homoeopathic literature and articles. Most of the literature make references to the classical types but it does not include detailed descriptions of their physiognomy, psychology or physiology. In order to understand the usage of the constitutional temperaments, it is important to understand the classical traditions introduced by Pythagoras, Hippocrates and the early Greek naturalists. This can best be done through a study of Greek philosophy with the use of the original sources. Hahnemann and his early disciples were capable of reading the original Greek, Latin, and Arab translations, and they integrated relevant material into homoeopathy.
For a deeper study of the subject please refer to Hahnemann on Constitution and Temperament, David Little, @simillimum.com.
James Kent did not approve of the use of the Hippocratic constitutional types in homoeopathy. He questioned the nature of such information in his Lesser Writings and criticized Hering for introducing into homoeopathy the use of temperaments as a rubric in the materia medica. He complained that the idea of the constitutional types was outdated and too closely related to astrology and other forms of the “pseudo-sciences” to be of any practical use to a homoeopath. He did not seem to realize that it was Hahnemann, not Hering, who first use Hippocratic temperament, diathetic constitutions and miasms in homoeopathy.
In Kent’s Lectures he quotes the physical descriptions of the remedy pictures from Hering’s Guided Symptoms but he carefully leaves out the Hippocratic classifications of the constitutions on which they were based. Kent rejected the use of any biological constitution as a means of aiding in the choice of a remedy and stated that biology has no place in homoeopathy. Vide Kent’s Lesser Writings*.
“What benefit is it to pursue the study of biology to discover the difference in the natural constitution of human beings, when it must be the sick (morbid) condition in the constitutions of human being that must be fully and extensively evolved to guide the physician in healing sick people?”
*Kent’s Lesser Writings, Temperaments, page 277.
In Kent’s Lectures on Materia Medica he uses many of the physical descriptions introduced by Hering but removes any reference to temperaments. Nevertheless, he realized the importance of body types in homoeopathy. So much so he once wrote: “A great deal is presented that can be seen by looking at the patient, so we say: this looks like a Nat mur patient. Experienced physicians learn to classify patients by the appearance.” This appears strange to the Hahnemannian Homoeopath because temperament is the basis of the art of physiognomy, the science of reading the mind/body constitutions. Perhaps some of Kent’s confusion could have been removed by Hahnemann’s old friend, Baron Von Boenninghausen.
The Baron bemoaned the fact that most homoeopaths were ignoring Hahnemann’s suggestions relating to constitution and temperament, as well as the theory of the chronic miasms in aphorism 5. In his classic lecture called, “A Contribution to the Judgment Concerning the Characteristic Value of Symptoms”*, the Baron lists as the first priority in case taking the ascertainment of the age, sex, and physical constitution and mental temperament of the patient. He suggests that this information should be separated into the nature of the constitution in its days of relative health as well as the symptoms that developed since the individual became sick. Any of these symptoms that are common in nature need little attention, but those that are striking, rare and peculiar become very characteristic.
*Boenninghausen’s Life and Works, Chapter Two, Quis?/Who by David Little @simillimum.com
Kent did not seem aware of the depth of research that the original disciples of Hahnemann accumulated on the constitutional aspects of homoeopathic remedies or the source of their inspiration. Kent’s contribution to the debate over the adaptability of Pulsatilla to slow, tearful, blue eyed, phlegmatic blondes was to ask has anyone ever seen a Pulsatilla proving produce blond colored hair in a brunette! During his provings Constantine Hering noted the Hippocratic temperament of each prover and recorded their sensitivity to homoeopathic remedies. Pulsatilla produced the most characteristic symptoms in gentle, blood, phlegmatic temperaments. This is the origin of the characteristic Pulsatilla type as a gentle, blond haired, blue eyed, tearful, female. Hering’s temperamental portrait of Pulsatilla is based on Hahnemann’s original picture from the Materia Medica Pura. Hering’s inclusion of constitution, temperament and stages of life in his Guiding Symptoms was based on provings and clinical confirmations.
The very innate natural qualities of temperament, predisposition, and diathetic constitutions take on archetypal importance because they represent the ancient Mappa Mundi, the Map of the World*. In Greek mythology it is said that Pulsatilla was born from the tears of Venus, the Goddess of Love, when her lover Adonis was killed. This is illustrative of Pulsatilla’s gentle, sweet, loving, sympathetic, tearful nature and its tendency to feel inward grief and abandonment. In accordance with the doctrine of signatures, the Wind Flower (Pulsatilla’s common name) is so sensitive to currents of air that it is always changing its position in relationship to them. This is analogous to the use of Pulsatilla in changeable, yielding, passive individuals who need open air to feel well. It is not surprising that a remedy that was born from the tears of the Goddess of Love would be a remedy for the watery phlegmatic temperament. Another interesting point is that Pulsatilla grows mostly in Scandinavian countries where blond haired, blue eyed people are very common. This coincidence is a manifestation of natural sympathies and harmonies which go beyond any rational explanation in linear time and space.
In Hahnemann’s time many of the vitalist healers knew the constitutional physiognomy of the ancient Greeks and used the four cardinal temperaments to classify the constitutions of their patients. Hippocrates was the first physician to uphold the constitutional view of disease and to use similars to cure disease. Unfortunately, all of this insight was brought to an end with Galen’s fatal declaration that “opposites cure opposites” and the doctrine of materia peccans. Hahnemann had great knowledge of the Greek classical teachings and constantly referred to Hippocrates with the greatest of respect.