The Minimal Dose (Similia Minimus)

Author's Preface

There is a commonly held belief in modern Homeopathy that there is no difference in the action of a homeopathic remedy regardless of whether one administers one pill, one hundred pills, or for that manner, one thousand pills ad infinitum. Some say it does not matter whether you give a drop of the alcoholic base dynamization or drop the remedy on the standard globules or in water. This view of posology is based on Dr. James Kent's Lectures on Homeopathic Philosophy in the chapter called "On Simple Substance" as well as in his Lesser Writings. In these works Kent explains the Swedenborgian theory that energy is based on a fourth state of matter called the simple substance by the theosophists. Swedenborg taught that in the 4th state of matter there was no "quantity" of simple substance but "only quality in degrees of fineness". 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. This is what most modern homoeopaths believe but what did Hahnemann teach about the relationship between the size of the dose and the potency?

The Single Unit Dose

The 1st Chronic Diseases (1828) and the 4th Organon (1829) are companion volumes which mark Hahnemann's middle years (1820s). These watershed volumes established homoeopathy as a mature healing art and presented Hahnemann's most complete vision to date. The evolution of the minimal dose had reached a new level. Hahnemann now reduced the size of the dose from the drop doses of the base potency to 1 or 2 small poppy seed sized pellets. This reduction of the dose was accompanied by the raising of the potency to 30c. In these works Hahnemann proposed the administration of a single unit dose of one or two poppy seed size number 10 pellets. Vide aphorism 242 of the 4th Organon.

" As long, therefore, as the progressive improvement continues from the medicine administered, so long we can take for granted that the duration of the action of the helpful medicine, in this case at least, continues, and hence all repetition of any dose of medicine is forbidden."

The same point is also stressed in Aphorism 245.

" Even one dose of the same medicine which has up to now proved beneficial, if repeated before the improvement has begun to stand still in every direction, will, like an untimely interference, only aggravate the state....."

Hahnemann again reminds us at the end of this paragraph:

"In one word, we disturb the amelioration affected, and still to be expected from the first dose, if we give a second dose of the same originally well chosen remedy before the expiry of the period of action of the first; at all events, we thereby delay the recovery."

The Wait and Watch Method

These aphorisms introduce the "wait and watch" philosophy which is a manifestation of the principle of minimal intervention which is an important aspect of the maxim of the minimal dose. If the client is improving after the administration of the first dose of a remedy, all repetitions of the dose are completely counter indicated. It is only when there is a clear relapse of the symptoms that a second dose of a remedy may be administered. This injunction was introduced to prevent disruption of the healing process by the premature repetition of the remedy.

Hahnemann noticed that the premature repetition of a remedy often caused a relapse of symptoms as well as accessory symptoms (side-actions) of the remedy to appear. He also noticed that the use of too large a dose of his new high potencies also produced too many aggravations and accessory symptoms. This mixture of natural and remedial symptoms confuses the picture and slows down the cure. This is why many homeopaths are very conservative about the repetition of the remedy before there is a definite relapse of the symptoms. This demands great patience because even during a slow amelioration the sufferer must wait for a relapse of symptoms before they may take another dose.

Kent was a grand proponent of this tradition as he practiced in accordance with the methods of the 4th Organon and the first edition of The Chronic Disease.s This is the methodology practiced by most homoeopaths today. Over the next fifteen years, however, Homoeopathy went through a tremendous transformation as Hahnemann sought to perfect his system. During these years he produced four new editions of the Chronic Diseases (1830, 1835, 1837, 1839) and the 5th (1833) and 6th (1842) editions of The Organon  were written. Unfortunately, modern homoeopaths have yet to realize that the size of the dose and the nature of its delivery system is intimately related to the phenomena of aggravation.

Similia Minimus

Hahnemann's experience was quite different from Kent's as he found out very early that drops of the alcoholic dynamization were too strong and produced aggravations and accessory symptoms as a sign of too large a dose. This is the reason he introduced the first poppy seed size pills. One drop of the alcohol base potency was used to medicate 500 number 10 pellets. This reduced the size of the dose to 1/500 of what it was in the early low potency phase of Hahnemann's long career. If one studies the historical progress of the raising of the potency factor we find the corresponding reduction of the size of the dose. Why is this? If the size of the dose makes no difference why did Samuel Hahnemann restrict the amount of the dose to 1 or 2 small number 10 pills when he introduced the 30c potency? This was the dose of The Chronic Diseases (1828) and the 4th Organon (1829).

As the potency factor increased the size of the dose was reduced to avoid unnecessary accessory symptoms and aggravations. As the potency increased the drop doses began to cause too many unproductive aggravations. It was now very difficult to control the power of the simillimum in those patients with chronic miasms, weakened vitality and organic pathology. For this reason Hahnemann reduced the size of the dose from drop doses to 1 or 2 number 10 pills. The Master realized that the phenomenon of the aggravation was linked to both the potency factor and the amount of the dose administered to the client. As the old homoeopath increased the potency levels he quickly found out that a random number of pellets caused side-actions and aggravations in many cases. He echoed this experience in the 6th Organon of the Healing arts. Vide aphorism 275.

"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 homoeopathicity 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)".

The closer the simillimum and the more serious the case, the more the size of the dose becomes critical. This conclusion was the outcome of many disturbed nights in which the Hofrath contemplated how to overcome the side-effects of rapidly developing Homoeopathy and perfect the potency and the dose factors. Hahnemann openly shared with his student the problems that he caused when he gave too many dry pills of his new anti-miasmic remedies. Vide The Chronic Diseases in 1828.

" I have myself experienced this accident, which is very obstructive to cure and cannot be avoided too carefully. Still ignorant of the strength of its medicinal power, I gave Sepia in too large a dose. This trouble was still more manifest when I gave Lycopodium and Silica potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. Discite moniti!"*

*Latin, This is a warning, 'Don't do this!'. Many of those new to homoeopathy do not understand why traditional homoeopaths become so conservative with their remedies. It is the  fruit of the sleepless nights when we burned the midnight oil trying to find out what we did wrong and how to put it right. We wish to help the neophytes avoid the mistakes we have made in the past.

For this reason he offers a warning in the 5th and 6th Organon and The Chronic Diseases that the size of the dose must be controlled when using high potency homoeopathic remedies. Most modern homoeopaths pay little attention to the preparation of remedial dose and do not take the size of the dose into account when adjusting the dose to suit the sensitivity of the individual constitution and temperament. This is a great mistake and has led to the misconception that homoeopathic remedies cannot cure unless they first aggravate the disease.

Even James Kent pointed out that the best reaction is the speedy recovery of the health. Aggravations of any kind are to be avoided as much as possible. All aggravations must be studied closely to see if they are similar, dissimilar, accessory symptoms, or a natural healing crisis. This is the way the homoeopath analyzes the symptom phenomena to see if the remedy was correct but the dose incorrect, whether the remedy was incorrect, if the remedy was a partial simillimum, or if the symptoms are following Hahnemann's direction of cure (Hering's laws).

The New Posology

All the phenomena associated with "aggravations" must be studied closely by every homoeopath  because this phenomena holds the key to understanding if one has administered the correct remedy, dose and potency. To understand this the homoeopath must learn Hahnemann's advanced methods and the methods of adjusting the dose. Hahnemann was not completely satisfied with the posology methods and case management he developed in the late 1820s. He was not happy with the methods he had developed up to this point so the tireless experimenter began a new series of trials.

The use of the the dry pellets was only a short transition between the use of the liquid drop dose and the medicinal solutions of Hahnemann's last 10 years. As early as the First Provers Union (c.1814) Hahnemann used aqueous solutions to dilute medicines to control their remedial powers during provings. It was quite common to dilute a drop of the lower potencies in water and give teaspoon doses. With this in mind he decided to return to this method in trials with the aqueous solution and compare the results with that of the single unit dry dose. This further reduction of the size of the dose to 1 or 2 number 10 pellets in a minimum of 3 & 1/2 ounces of water was accompanied by the introduction of the higher and highest potencies of the day. This included  Samuel Hahnemann's experiments with 60c, 90c, 200c and 1M in Paris.

The results of these experiment are recorded in the 5th edition of The Organon  which was published by Samuel Hahnemann in  1833. In aphorism 285, 286, 287 and 288 he clearly states his view that the aqueous solution is far superior in every way to the use of dry pellets. This is the final outcome of many years of experimentation with both methods. Vide aphorism 286.

"For the same reason the effect of a homoeopathic dose of medicine INCREASES THE GREATER THE QUANTITY OF FLUID IN WHICH IT IS DISSOLVED WHEN ADMINISTERED TO THE PATIENT although the actual amount of medicine it contains remains the same. For in this case, when the medicine is taken, it comes in contact with a much larger surface of sensitive nerves responsive to the medicinal action. Although theorists may imagine there should be a weakening of the action of the dose of medicine by its dilution with a large quantity of liquid, experience asserts exactly the opposite, at all events when the medicines are employed homoeopathically."

The Middle Path

In the 4th edition the Hofrath outlined the single unit dose and the philosophy of the "wait and watch" method. In the 5th Organon Hahnemann revised his old posology methods and introduced ultra high potencies. In aphorisms 245, 246 and 247 of the 5th Organon Hahnemann introduces what he calls the *middle path* concerning the methods of repeating the remedies. Hahnemann begins his discourse on posology by clarifying the proper view of the single unit dose and when it is applicable in treatment. He begins his new review in aphorism 245.

"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."

Unfortunately, such  marvelous cures are not all that common, especially in chronic complex diseases. Many chronic patients only slowly improve over a period of months to years under the influence of a constitutional remedy. What should we do to speed the cure? Hahnemann shed light on the situation in aphorism 246. Vide Organon.

"One the other hand, THE SLOWLY PROGRESSIVE AMELIORATION consequent on a very minute dose, whose selection has been accurately homeopathic, when it meets with no hindrance to the duration of its action, sometimes accomplishes all the good the remedy in question is capable of performing by its nature in a given case, in a period of forty, fifty or a hundred days. This is however, rarely the case, and besides, IT MUST BE A MATTER OF GREAT IMPORTANCE TO THE PHYSICIAN AS WELL AS THE PATIENT THAT WERE IT POSSIBLE, THIS PERIOD BE DIMINISHED TO ONE-HALF, ONE QUARTER, AND EVEN STILL LESS, which many often repeated observations have shown under three conditions.

Firstly, the correct homeopathic remedy must be chosen by the totality of the symptoms.

Secondly, the remedy is to be given in the minimal dose so as not to overexcite the vital force.

Thirdly, the remedy may be repeated at suitable intervals to speed the cure, if necessary, without producing aggravations."

The Master Homeopath began a set of experiments with the aim of overcoming the obstacles in the way of a rapid, gentle and permanent cure. In the note to aphorism 246 Hahnemann calls his method the "middle path" in reference to the fact it represents the balance point between the exclusive single dose and the routine repetition of the remedies. The new posology maxim states that anytime the first dose produces a STRIKING AMELIORATION NO MORE MEDICINE IS NEEDED FOR THE TIME BEING. If, on the other hand, the first dose only produces a SLOW AMELIORATION THE REMEDY MAY BE REPEATED AT SUITABLE INTERVALS TO SPEED THE CURE.

This new methodology can only be carried out if the remedy is PREPARED IN A MEDICINAL SOLUTION AND GIVEN IN A "SPLIT-DOSE". Hahnemann called his new method a 'split-dose' rather then a 'multi-dose' because the entire medicinal solution was make from only one small number 10 pill, i.e. one single seminal dose. If the homoeopath is still using the dry pellet dose then they must follow the rules as given in the 4th Organon because they give more than 1 pill as soon as they give a second dry dose. This means the homoeopath can only repeat a remedy when there is a definite relapse of the symptoms even if the person is only slowly improving. Hahnemann avoided the multi-dose method because the amount of the dose is cumulative in the vital force and leads to aggravations sooner or later if abused. For this reason he changed the homoeopathic dose from the dry static dose to a dynamic liquid delivery systems which can be adjusted in such a manner that it may be repeated if and when necessary to speed the cure.

With the medicinal solution, however, THE REMEDY MAY BE REPEATED AT SUITABLE INTERVALS AS LONG AS THE PATIENT IS IMPROVING WITHOUT ANY AGGRAVATIONS. This is how the cure can be reduced to 1/2, 1/4 or less the time it takes with the ordinary dry dose method. These are some of the directions contained in the 5th Organon on the advanced methods of using the centesimal potencies.

This methodology led the way to the methods of the 6th Organon and the LM potency. In his last years Hahnemann was observed preparing both the centesimal potencies and the LM potency for administration in exactly the same manner. The use of the medicinal solution and the methods of adjusting the dose were introduced equally for both of Hahnemann's potency ranges. The is no difference in the way Hahnemann gave his LM or centesimal potencies. In the new method one test dose of the medicinal solution is given to assess the sensitivity and correctness of the remedy. If there is a striking response the single test dose should be left to act alone without a second dose.

It is a great mistake to think that the LM 0/1 is a low potency which must be repeated daily or on alternate days to cure in chronic cases. Hahnemann wrote that the LM potency may be repeated daily 'when necessary' to speed the cure. If it is not necessary such a dose schedule will only cause accessory symptoms and unhomoeopathic aggravations that will lead those new to homoeopathy astray. I have many LM cases who have responded dramatically to a single dose of the 0/1 potency. Some are complete cures of very chronic diseases. Many others only receive an occasional dose every few months. These cases are exactly the marvelous potential cures that turn into the homoeopaths' biggest disaster if they repeat the dose in a mechanical way. This is why the teachings of the 1st Organon are the foundation of the new methods. Without the deeper understanding that the watch and watch philosophy offers one cannot practice Hahnemann's advanced methods.

Many new to Homoeopathy think the methods of Hahnemann's last 10 years are somehow easier because one can give mechanical doses of LM remedies for days, weeks and months. This is really the exact opposite of the truth. Hahnemann's advanced methods are more sophisticated and more difficult to learn than the methods of the 4th Organon. That is why many have not made the great leap of faith that it takes to enter new territory. To practice the advanced methods you must first master the 4th Organon methods and then place the 5th and 6th editions on that solid foundation. Without this the modern version of the 'new methods' is like building a proverbial house upon the sand of one's own pipe dreams. It will not stand the test of time. The 4th Organon is the bedrock of our art and science.

I call the period of the 4th Organon the 'limit maker' because Hahnemann put a number of restrictions on homoeopathic potencies. At this time there was the restriction of the potency to 30c in private letters, then the reduction of the dose to 1 or 2 number 10 pills, and the exclusive use of the single unit dose and the watch and watch philosophy. The 5th Organon may be called the 'limit breaker' because Hahnemann removed the limit on potency, began using the medicinal solution instead of the static dry dose and because he introduced the repetition of the "split-dose" at suitable intervals to speed the cure. In the 6th Organon Hahnemann introduced the LM potency and his most perfected case management procedures. The last 10 year s of Hahnemann's career were his most fruitful yet modern Homoeopathy has put little of this information into practice. This is beginning to change.

Although Kent believed that it did not matter whether you gave 1 pill or 1000, or whether you give 1 teaspoon of solution or100, the methods introduced by Hahnemann in the 1837 edition of the Chronic Diseases and the 6th Organon show that this is not true. I put these ideas to a field test for 12 years and have 100's of cases that show Hahnemann was correct and Kent was wrong. Here are just a few examples I have posted in the past.

I have had several cases in which the previous homoeopath had given the correct remedy at the start but it did not act very well. This caused them to leave that remedy for a whole series of wrong remedies. Many times I have reintroduced the same remedy and potency in medicinal solutions and the person responded well and went on to cure with a few well timed doses or a series of doses in medicinal solution. This demonstrates the point that finding the remedy is only half of the problem. The homoeopath must learn how to adjust the size of the dose, the potency and the number of times it is given. This can only be done if we use the medicinal solution. Here are a few examples.

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 teaspoon full, transmuted an aggravation and made the remedy repeatable in a sensitive patient 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 her rapidly. This is another example of a remedy in 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 Cimicfuga LM1 in a 4oz. solution for migraine headaches experienced a similar aggravation. After increasing the amount of water in the solution by making an 8oz 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 6oz solution, succussed 3 times before ingestion, 1 teaspoon was taken and stirred into 6oz of water, 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 worked 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 changing 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 increasing 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. (I 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 then began to disappear. This larger dose acted where a smaller dose did not. The succussions were kept the same.
   
8. 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.
   
9. 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.
   
10. 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.

I hope the repetition of some of these quotes and cases has not been boring but the subject does merit some review and study occasionally.