Whenever two or three homeopaths are gathered together, you may well find the conversation turning to "classical" and "non-classical" approaches to homeopathy. However, many have questioned whether these terms have any meaning. What is "classical homeopathy"? Is it homeopathy as set down by Hahnemann in the fifth edition of the Organon, or the sixth edition, or is it homeopathy as actually practiced by Hahnemann, or is it homeopathy according to the doctrines of Kent, or the practice of Kent?

To focus the discussion, let us consider some of the principles and practices surrounding the ideas of the single dose and the use of only one medicine at a time, and see how coherent our writers have been on these questions.

As would-be classical homeopaths, we often refer to the idea of "the single dose." But what do we mean? It sounds as if we mean that we should give only one dose of a particular medicine and never repeat. Did Hahnemann ever advocate this?

In the fifth edition of the Organon (Hahnemann, 1901) Hahnemann tells us that in previous editions he had recommended that a dose should not be repeated until the improvement set in train by it had come to an end. In Aphorism 246, he explains that one single unique dose of a medicine may sometimes "accomplish 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." However he goes on to say, "This is, however, but rarely the case," and notes that the selected medicine "may be repeated at suitable intervals."

Hahnemann tries to describe what he means by "suitable" as "a middle path" in an unusually long-winded (even by Hahnemann's standards) footnote. The frequency of repetition depends on the vitality of the patient, the smallness of the dose, and the nature of the individual medicine itself. In acute diseases, he adds, the medicine should be repeated more quickly, and the more rapid the course of the disease, the shorter the interval between doses. In chronic diseases he gives examples of the use of Sulphur in tincture every seven, nine, twelve or fourteen days. He also suggests the use of an intercurrent every second or third dose. There is no discussion of how these rules apply to higher potencies.

The over-complicated nature of this footnote is surely reflective of the fact that a satisfactory approach had not yet gelled in Hahnemann's mind. The guidelines given are rules of thumb, not immutable first principles. When he refers in this footnote to "a single dose" he sometimes appears to mean giving one globule, as opposed to several globules, at a time.

In the sixth edition of the Organon (Hahnemann, 1988), in Aphorism 247, Hahnemann introduced the plussing approach, in which repeated doses are given to patients with chronic illness, and the potency of the dose is raised each time by one. In a footnote he tells us that:

What I said in the fifth edition of the Organon, in a long note to this paragraph in order to prevent these undesirable reactions of the vital energy, was all that the experience I then had justified. But during the last four or five years, however, all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary . . . .

This passage is often understood to be referring to the use of LM potencies, which, being much more highly dilute, could therefore be used more frequently. (The LM range of homeopathic medicines is diluted 1:50,000 at each step of the manufacturing process, centesimal range is diluted 1:100.) But Hahnemann in fact makes no reference here about LM potencies, which he describes much later in Footnote 150 to Aphorism 270. Aphorism 247 justifies the use of frequent repetitions purely in terms of the plussing method. Plussing and use of LMs are presented as quite separate techniques in the sixth edition. Both are presented independently as methods of reducing aggravation.

Moving on to Kent, how should we understand the Kentian approach to the single dose? Kent is sometimes presented as the advocate of using one single dose of a very high potency, and no repetition. But it is clear from an episode described in one of his Lectures on Homeopathic Philosophy that he did not always confine himself to one dose.

In "Lecture XI" Kent describes a case where a child was brought back from death's door by one single dose of Podophyllum, but goes on to say, "I did not always give the single dose" (Kent, 1987, p. 106). He then goes on to discuss his approach to chronic cases:

I found that a chronic case that would be relieved by moderately high potencies would only improve for a matter of weeks, but on the administration of much higher potencies the work would be taken up, and in that way the same patient could be carried on from one potency to another. (p. 107).

Kent then gives an extended description of one particular case of a patient with "a catarrhal state of the chest" which gives us a wonderful insight into his case management approach.

Kent explains that he gave the patient a dose of Sulphur 6M, which "violently" aggravated him, and the patient came back saying he was much worse. To keep him happy, Kent gave him Sac. lac.:

At the end of another week he came back and told me he was better, much better, that he did not want me to give him any more of that first medicine, but he wanted more of the last, as it had made him so much better. So I kept him on the medicine which pleased him for a period of probably six or seven weeks.

(I like Kent's comment here -- an early example of homeopathic dry humour).

Kent then formed the opinion that the first dose had exhausted itself, so he gave another dose of Sulphur:

Within the next day or two he ran in and said, 'You young rascal, you gave me that medicine again that made me sick in the first place,' so he got sugar again and went on this time for five or six weeks, or perhaps longer.

Then the symptoms returned, and Kent retook the case and gave another dose of Sulphur 6M. This time the patient reported no reaction: "He was not stirred up this time, you see." Kent moved up in potency to Sulphur 55M, which provoked another upheaval, and another crisis in the homeopath-patient relationship. He ultimately went on to CM. Curiously, Kent gives no indication as to whether the patient was cured by the treatment.

Kent's narrative of this case makes it quite clear that in chronic cases he would repeat after lengthy intervals when the action of a dose exhausted itself (consistent with the directions in early editions of the Organon, but not with the sixth edition), and that he would go up in potency where a particular potency had exhausted itself. So what are we to make of the declaration in "Lecture XIV:" "The repetition of dose is advised by many wise heads, but if we understand this doctrine it will be clear that such repetition of dose is perfectly useless" (p. 125)?

Kent's Lectures are one of the glories of our literature, but he was guilty of the occasional lack of clarity. The key lies in his declaration, a little further on, that "whenever a medicine ceases to be homoeopathic it is of no use to administer that medicine any longer." What he means, I believe, is that when the dose is acting, the original symptoms are no longer present, and therefore an additional dose of the medicine which produces those symptoms would no longer be homeopathic. So he is really forbidding the repetition of doses until and unless the symptoms return, not forbidding repetition outright.

So it is clear that neither Kent nor Hahnemann advocated the use of a single unique dose for chronic cases. It cannot be considered a first principle. Even the principle that the action of the first dose should be allowed to exhaust itself before administering another dose was abandoned by Hahnemann, unbeknownst to Kent. My own feeling is that he ought not to have abandoned it (thus opening the way back to polypharmacy, confusion in interpreting the results of treatment, and overstimulation of the vital force), but abandon it he did.

What about the prohibition on using more than one medicine at a time? In Aphorism 272 in the sixth edition of the Organon, Hahnemann says categorically that, "In no case under treatment is it necessary and therefore not permissible to administer to a patient more than one single, simple medicinal substance at one time." While this was a constant feature of Hahnemann's writings, Rima Handley, in A Homeopathic Love Story (Handley, 1990), reveals that his notebooks show that he quite frequently prescribed two remedies to patients at once in the later phases of his life. She comments that, "perhaps we should infer from this that when Hahnemann forbade the use of more than one remedy at once he meant precisely that: not more than one remedy to be administered at exactly the same time" (p. 132).

This seems like sophistry to me. Is there any significant difference between administering two medicines at exactly the same instant and administering two remedies closely together? In both cases the vital system will come under the influence of the second remedy before the actions of the first have passed. I think we can only conclude that Hahnemann's practice in the final phase of his life was at variance in this respect with the principles expounded in the Organon.

Why did he abandon one of his own most significant and innovative principles, one of the principles of the homeopathic revolution which most clearly distinguished him from the orthodox practice of his time? Rima Handley reprints a paragraph published in an unauthorised edition of the Organon by Dr. Arthur Lutze in 1865, in which Hahnemann supposedly wrote that,

There are several cases of disease in which the administration of a double remedy is perfectly Homoeopathic and truly rational; where, for instance, each of two medicines appears suited for the case of disease, but each from a different side etc. (p. 202)

The categoric tone of this passage certainly has the ring of the old man about it. But it enters into quite dangerous territory, I believe. Most of us have experienced being in the situation early on in our practice of feeling frequently that two or more remedies seem equally indicated for a particular case. Most often this results from the fact that we have not grasped the true nature (or essence) of the core problem underlying the various manifestations of the patient's illness, or the true nature of the medicine in our materia medica which would be curative. In Aphorism 274, Hahnemann reminds us of the the wise maxim that "it is wrong to attempt to employ complex means when simple means suffice." I think in this instance what Hahnemann wrote, in the sixth edition at any rate, was wiser than what he did.

Some might object that the idea of the essence of a patient's problem referred to above is a Vithoulkian neologism. However one of our contributors to the Homeopathy Mailing List has drawn our attention to a passage from Compton Burnett's The Greater Diseases of the Liver:

If homoeopathy is to go on advancing, we must face the question of getting behind the symptoms, so that we may not only treat the symptoms homeopathically, but also the malady in its essence. In other words, it will not suffice to find the similimum of the symptoms, but, that being found, it will be needful to put this pertinent question: Is this symptomatic similimum also homoeopathic to the anatomical essence of the malady itself? (Chitkara 1992).

Compton Burnett is not advocating here, like some later authors, that more than one type of simillimum should be used. He is saying, I believe, that making a mechanical correspondence between a list of symptoms in the patient and a list of symptoms in the materia medica is of much less importance in prescribing than grasping the deep nature of a patient's illness, and matching it with the deep nature of one of our medicines.

By contrast with this searching approach, playing around with different medicines which appear to mirror different aspects of the patient's condition, in my opinion, leads us into the labyrinth of confusion which can so easily result from the attempt to match multiple symptoms in a patient to multiple symptoms in the materia medica, if we lack that deeper understanding. Perhaps Hahnemann had to resort to these sorts of shifts because he only had a relatively small number of remedies (90 or so) available to him. Many of the polychrests which we now use to match a patient closely were not yet discovered in his time. In Aphorism 169 of the sixth edition he covers the case of two medicines contending for suitability, "one of which is more homoeopathically suitable for one part, the other for another part of the symptoms of the disease," and instructs us to administer the one which is most similar and then take the case again before considering the other. Seems like good advice to me!

Others since Hahnemann have developed approaches which offer a theoretical basis for the use of more than one remedy. The famous South American homeopath Eizayaga, for example, has devised a system in which he prescribes different medicines for "lesional" terrain, "fundamental" and "constitutional" symptoms. I must confess to knowing little about this approach, but I would be very interested to learn more about the rationale behind it, even though I do not, myself, feel in sympathy with it. It is always valuable to know something about alternative approaches, even if you do not agree with them.

Hahnemann experimented with all manner of different techniques throughout his career. But I believe we should regard the sixth edition of the Organon and the works of Kent as our most authoritative guides. They contain the most coherent and systematic sets of first principles on which we can base our practice. Some ideas, such as the use of LM potencies as opposed to centesimals, are techniques only, and have no bearing on the first principles. Like Hahnemann we should never cease to experiment with different techniques.

At some stage we need to review the results of our experience and experimentation and consider whether we need to revise the first principles which should guide any practice. Although Hahnemann produced six editions of the Organon, he never saw fit to revise the principles therein pertaining to the use of one medicine at a time. This seems to me to be significant. Of course we should not slavishly follow whatever Hahnemann wrote as if it were gospel. On the other hand I think we should be wary of departing from the first principles he laid down, which have stood us in good stead for 200 years.

To conclude, the "classical" approach to the single dose above can be summarised as follows:

1. Only one medicine to be used at a time, aimed at the whole of the patient's underlying problem;

2. No repetition of the dose unless and until the original symptoms return;

3. Resort to higher potencies of the same medicine if the original potency fails to act and the original symptoms remain.

The first two of these have become a central part of the mainstream of homeopathy, and, in my opinion, rightly so. The third deserves closer examination, and I will return to it later.

In my next column I will continue examining other aspects of the theme of polypharmacy (the use of more than one medicine at a time). I would like to hear from a reader who can recount experiences using Eizayaga's approach with patients. I would also be interested in an article on Leon Vannier's approach to prescribing. Please contact me if you are interested. I look forward to hearing your views either in the pages of Homeopathy Online or on the Homeopathy Mailing List.

References

Chitkara, H.L., 1992, The Best of Burnett, Jain, New Delhi.

Hahnemann, S., 1988, Organon of Medicine, sixth edition, trans. W. Boericke, Jain, New Delhi.

Hahnemann, S., 1901, The Organon of Rational Healing, fifth edition, trans. R.E. Dudgeon, Boericke & Tafel, Philadelphia.

Handley, R., 1990, A Homeopathic Love Story, North Atlantic Books & Homeopathic Educational Services, Berkeley, California.

Kent, J.T., 1987, Lectures on Homoeopathic Philosophy, Jain, New Delhi.