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Jul 14, 2011

The Repetition Of The Remedy – R. Gibson Miller

If you've come to this page directly via a search engine, please note this article is mainly for homeopaths and students of homeopathy, so assumes a certain level of understanding of homeopathic concepts and terminology.

The Repetition of the Remedy
By R. Gibson Miller, M.D., Glasgow, Scotland

“As homoeopath we properly give our chief consideration to the selection of the correct remedy for the cure of any individual case of disease. But however accurately we may select the remedy; it will prove of little value unless properly administered. It is a safe statement to make, that more cases are spoiled by improper repetition of the remedy than through any other cause and the purpose of this short paper is to restate the rules that must guide us and to elicit the views of the members of this congress on this important subject.”
Much as all those who accept the master law of Similia Similibus Curantur differ with regard to sub laws, yet there is almost complete unanimity with regard to the following, viz:- that whenever the remedy has produced a positive effect, no repetition is permissible until that action has spent itself.
Two theories have been put forward to explain the action of remedies in a Homoeopathic cure, viz:- (a) Hahnemann’s: that the remedy excites a contrary but stronger disease than natural one, so extinguishing the latter, and (b) the more modern theory: that the remedy causes a reaction on the part of Nature, which reaction is the true cause of cure. But let the theoretical explanation be what it may, the fact remains, that in some way or other the remedy restores the equilibrium of the bodily forces.
In our endeavors to restore the equilibrium, great care must be exercised that we do not overdo things and add unnecessarily to the sufferings of the patient.
It is true that this overreaction in many cases does small harm, beyond retarding somewhat the recovery of the patient; but in more critical cases improper repetition may make all the difference between life and death. That this is true will be borne out by all who have had any lengthened experience in homoeopathic prescribing, when they recall cases where, through errors in judgment and above all through excessive zeal, in their anxiety to hasten the cure they have by too hasty repetition turned back the flowing tide, and converted what seemed certain victory into disaster.
To turn to the practical application of this law we find, as is the case with most natural laws, that here also, while the theory is simple, the application is at times exceedingly difficult. In the first place we shall, I think, find it convenient to look at the question of repetition from two aspects, viz:- the primary and the secondary, each of which requires different consideration.
After a remedy has been exhibited in any case, be it an acute or a chronic one, we have always, when considering its effects, to ask ourselves three questions.
(1) Have we selected the proper remedy?
(2) Have we chosen the proper potency?
(3) How long a period must be allowed for the manifestation of a positive action?
This paper has nothing to do with the first and will only allude later to the second, and at this stage we shall consider only the last.
Elements To Be Considered
It is obvious that the duration of this period will vary within very wide limits, according to whether we are dealing with acute, subacute or chronic diseases, and also that many other factors must be taken into consideration in determining the time that we may reasonably allow for the manifestation of this action.
In many ordinary acute diseases, the period that is required for a positive action to show itself will, as a rule, be of short duration; sometimes the action is almost instantaneous, and the improvement, as experienced by the patient and observable by the physician, is so sharply defined that in this class of cases there will be little difficulty in deciding when to stop the remedy.
But even in acute disease we cannot always expect the positive action to show itself in this prompt manner. For such diseases differ largely, in regard to intensity of suffering, in plane of action and also in what may be called their normal duration.
Patients also vary greatly in their responsiveness to remedies- some being over- sensitive, and promptly and involuntarily proving every remedy they receive, whilst in others the reaction is very slow. We must accordingly vary our tactics in each class, though it must be confessed that in dealing with a case for the first time it is not easy to determine how to classify the patient. A very similar condition of affairs is observable with regard to the causation of acute disease. Of two persons exposed- say to a cold wind- at the same time and under exactly similar conditions, one will invariably sicken within a few hours while his companion may feel nothing wrong for forty- eight hours.
The rapidity of response to the remedy will not infrequently be found to be very much diminished in cases that have been long drugged allopathically, and in many such cases it is necessary to repeat the remedy frequently before a positive action can be obtained.
Even in such cases we must not assume that, because the case has been extensively drugged, the ability to respond to the remedy promptly has necessarily been diminished, for experience demonstrates that in many such cases the positive action shows itself after the normal interval. A probable explanation of this difference in rapidity of response in such drugged cases is that when the abused drug has borne little resemblance to the patient in disorder and consequently had no power deeply to influence the same, the medicinal load being removed, the elasticity of the individual enabled the disorder to resume its ordinary course and the patient to react normally to the similimum.
When the abused drug has borne a more or less close resemblance to the true similimum, and has, as a consequence, been able considerably to distort the true image of the disease, then the response to the proper remedy will naturally be slower. A glaring example of this is found in old syphilitic cases where Mercury and Iodide of Potash had been used for long periods. Such cases are often very slow in responding to the similimum, so much so, that many claim that it is not possible, by homoeopathic remedies, to cure them. This view, I am convinced, is erroneous, and all that is required is the patient use of the correct remedy, until a response is obtained, though at times it is necessary, first of all, to antidote the drugging before the true symptoms can show themselves and so lead to the selection of the similimum.
Closely akin to these cases are those which have been treated by inappropriate, somewhat similar, potentized remedies until the entire case is so confused, and the sensitiveness of the patient to remedies so blunted, that it is not possible at first to obtain any prompt response.
Another factor of importance in this connection is the Sphere of action of the disease and the selected remedy. When we are able to select the similimum or a near simile, then the rapidity of response will, as a rule, be normal. But if it is possible only to select a remedy whose sphere of action very partially coincides with that of the disease, the positive action will not be induced so easily.
The pace of the disease also profoundly influences the rapidity with which the primary response manifests itself. In very violent diseases with severe suffering – such as neuralgia – the positive action will, as a rule, manifest itself very quickly for from the very nature and pace of such a disease we expect suddenness of onset and comparative briefness of duration. In such cases a single dose may be all that is needed, though of course it is at times necessary to repeat the remedy frequently.
Acute Cases
In the ordinary run of acute cases, where the pace is slower and the suffering much less acute, it will as a rule be found necessary to repeat the dose several times before reaction occurs. Still more manifest is this in cases of continued fever. Here the entire course of the disease is slower. There is usually a prodrome, during which marked changes indiscernible by the patient or physician are taking place; and even when the onset is abrupt, the disturbance of the economy that has preceded it has in reality been very profound. In such cases it is not reasonable to expect that one dose or a few doses will be sufficient to produce a reaction, and it is necessary, in the vast majority of such cases, to repeat the remedy every few hours for at least two or three days, before a positive reaction is manifest. While this holds true in most of the cases of continuous fever, yet if the vitality of the patient is very low, it is often dangerous to repeat frequently, for the reaction induced by a series of doses, rapidly following one another, may be too violent for the strength of the patient to withstand.
Improper habits of life, or unsuitable hygienic surroundings, always interfere more or less with the production of the positive reaction, and may at times absolutely prevent it. We do not always know or fully appreciate the circumstances and habits of our patients. Doubtless at times, upon observing no effect, after giving the number of doses that as a rule would be sufficient to induce a reaction, we have all decided that the remedy selected for the individual case under consideration was not truly indicated, whereas our mistake lay in not realizing what a load of resistance was required to be overcome. In such circumstances, even when reaction is induced it is apt to be so imperfect and short lasting that very frequent repetition is absolutely necessary.
Patients nowadays habitually make use of so many cosmetics, perfumes etc. – to say nothing of tobacco and alcohol – that at times it is almost impossible to induce reaction. It is true that frequently the potencies, especially the higher ones, will act in spite of these substances even when they are distinctly antidotal to the drugs in the crude form. For example, who has not seen one or two doses of high Phosphorus or Sepia act promptly and after the normal interval when given to excessive smokers? There are many cases where no action can be obtained, unless by frequent repetition, and it is to be feared that often, in our ignorance of such counteracting forces, we muddle along with most unsatisfactory results, and after a time conclude either that the law has failed or, if humble-minded enough, that the failure has been ours in selecting the improper remedy. Then, turning to some other and unsuitable remedy we make confusion worse confounded.
Much of the foregoing has had relation to the amount of repetition that is necessary to induce a primary positive reaction in acute or subacute cases. In such, mistakes are as a rule discerned and corrected with comparative ease. But when we turn to the truly chronic diseases (and this term I use in the Hahnemannian sense of the chronic miasmatic diseases); the problem is much more difficult. In such chronic diseases a considerable time must naturally elapse between the exhibition of the remedy and appearance of reaction. Here again we have to decide in each case how many doses must be given, and how long we must reasonably wait for reaction. So far as I know, no law governing this phase has yet been formulated – though law there must be.
In these circumstances we can only turn to the accumulated experience of the masters in Homoeopathics and learn what they have to teach us until the law is discovered. The consensus of their opinions is that in chronic cases of people of ordinary constitution, the best procedure is to give a single dose and then wait at least ten or fifteen days, before concluding that one dose is insufficient to produce a positive effect.
In many long standing, chronic cases, where the suffering is not very acute, it may be necessary to wait three weeks or more. It is in such cases we are apt to go wrong in our over eagerness to cure. We do not realize that, once reaction has begun, any interference will likely bring it to a stop – for action and reaction are contrary and opposite.
While the foregoing is the best routine procedure, it must ever be borne in mind that there are patients of less sensitive nature, and that with such it is necessary to give repeated doses before a primary reaction can be induced.
I am well aware that some teachers claim that even in ordinary chronic cases it is necessary to give very frequent doses in order to obtain an action, but the experience of the masters absolutely traverses this view. It is well to keep in mind the fact that it is possible, by repeated doses, of even the highest potency, to suppress symptoms for a time without truly curing the disease.
While in acute cases it is true that almost any potency at all removed from the crude substance will, in the majority of cases, prove curative if properly indicated, yet I have no hesitation in stating that the medium and high potencies act much better in such cases, and induce a positive action much more quickly than do the lower potencies. Accordingly, while in acute cases the exact potency is not, as a rule, a matter of vital importance; it is very different when we come to do deal with chronic disorders.
In chronic cases, the almost unanimous experience of those who use the medium and higher potencies is that such potencies induce, as a rule, not only a much quicker positive reaction, but also as infinitely deeper and more lasting one, with the result that it is not necessary to wait so long for the reaction as when using the lower ones. As I have already stated, we know only in a very imperfect manner the laws that govern such phases, and most of us have learned from bitter experience that the foregoing does not always hold true, and that, at times, little or no positive action can be obtained, at least at first, from the higher or medium potencies, and only the lower or lowest bring response.
Chronic Cases
In chronic cases, how can we know that the desired positive reaction is taking place? As a rule, the earliest indication is the appearance of the homoeopathic aggravation. This is at times of such severity that the patient believes himself to be poisoned; is at other times slight; not infrequently, entirely absent. This last is doubtless the ideal, if only we could always attain thereunto. But to attain it habitually implies a profound knowledge which experience alone can confer, both of remedial and of disease forces, so as to render it possible to adjust things so nicely that equilibrium is established.
Apart from the homoeopathic aggravation, I take it that the most important indication that reaction is taking place is the general feeling of the patient. If he declares he is again experiencing the return of that indefinable feeling of well- being and comfort that is the very antithesis of disease, we may safely conclude that the medicine is acting. So unmistakable is this indication that even if the patient paradoxically declares that though his headache or backache is unchanged, or even worse than formerly, yet he feels better in himself, then we know with absolute assurance that reaction is taking place and no more medicine is required in the meantime.
Secondary Repetition
Let us now consider what I called the secondary repetition. We will take for granted that, as the result of either a single dose or repeated doses, an improvement has been brought about. It is agreed by all that such reaction must be allowed to exhaust itself – for no remedy can be homoeopathic to reaction. Consequently, so long as the patient continues to improve, even though slowly, we can only wait until it is evident that reaction has come to an end. If after the remedy the patient steadily improves and the symptoms change in an orderly manner – even new symptoms appear, but finally the symptoms go back to their original state, yet are not marked enough to cause any special suffering – then we must wait, even for months. If no other symptoms appear we can only give another dose of the same remedy. If the symptoms first prescribed for now return unchanged, and there is otherwise no alteration in the case, then all that is necessary is to repeat the medicine, and as a rule, in the same potency. In acute or subacute cases this procedure is all that is necessary. In chronic cases, after several doses at long intervals have acted well, it will usually be found that the action becomes much more feeble, and, if the same remedy is called for, it must be given in a different potency.
Experience demonstrates that generally in chronic cases when a change of potency is necessary, it is better to give a higher one – though at times a lower one will work, and work well.
When several doses, given at long intervals, have acted well and the range of available potencies is small, we may, instead of changing the potency, give a series of rapidly repeated doses of the same potency, which will often induce deeper and stronger action than a single dose has done.
In many chronic cases, where it would at first be decidedly dangerous to give more than a single dose of one of the higher potencies, it will be found that after a number of such single doses at long intervals, it becomes quite safe, and often advantageous, to give a series of rapidly repeated doses.
Very frequently the problem of secondary repetition is not so simple. It is by no means uncommon to have the improvement in chronic cases interrupted by short secondary aggravations, and before repeating it is necessary to make sure that the recrudescence is truly permanent and not simply temporary.
Apart from such minor difficulties it is not always easy, in chronic cases, to determine whether real improvement continues to take place or not.
Owing to the complex nature of miasms, and at times to the presence of more than one, to say nothing of the distortion they have usually undergone through previous inappropriate treatment, the progress of cure is often apparently very erratic, so that the patient deems himself worse when improvement has truly set in and is continuing. In such a state of affairs, however disturbing it may be to the patient, so long as the symptoms progress from within outwards, in the reverse order of their original appearance and from above downwards, we may rest absolutely assured that there is as yet no call for any repetition.
In incurable cases the same law holds true, viz:- that so long as reaction is occurring no medicine may be given. It is to be noted that is such cases, however accurately the remedy may correspond to the symptoms, its force is soon exhausted and frequent repetition is necessary. In this class of cases the symptoms tend to change with much rapidity, and consequently no one remedy accurately corresponds for any length of time.
In diseases that are characterized by periodic attacks of sufferings, it is often difficult to know when to repeat. In many such cases the patient feels absolutely well during the intervening period, and it is only when the paroxysm appears that it is possible to judge what progress is being made.
So long as such attacks come at longer intervals or the attacks are less severe, it is best to assume that the deeply – acting remedy is working curatively and that there is, so far, no need for repetition.
If it is evident that the action of the last given dose is exhausted, the proper time to repeat is after the periodic attack is past. To give another dose of the deep acting remedy immediately before or during the acute phase would in all probability cause an unnecessary aggravation. If, however, the suffering is so severe as to necessitate interference, there can be no objection to exhibition of the appropriate short – acting remedy.
I have purposely spoken at greater length with reference to the primary than to the secondary repetition. The latter has had much attention paid to it, and there is a more general agreement with regard to the proper procedure, between the different sections of our school, than there is in connection with the former.

1 comment:

Dr. Ashutosh Tripathi said...

thank u very much....i was looking for this article for a very long time...........