The third aphorism [The Organon by Samuel Hahnemann, MD] states:
If the physician clearly perceives what is to be cured in diseases, that is to say, in every individual case of disease (knowledge of disease, indication), if he clearly perceives what is curative in medicines, that is to say, in each individual medicine (knowledge of medical powers), and if he knows how to adapt, according to clearly defined principles, what is curative in medicines to what he has discovered to be undoubtedly morbid in the patient, so that the recovery must ensue – to adapt it, as well in respect to the suitability of the medicine most appropriate according to its mode of action to the case before him (choice of the remedy, the medicine indicated), as also in respect to the exact mode of preparation and quantity of it required (proper dose), and the proper period for repeating the dose; – if, finally, he knows the obstacles to recovery in each case and is aware how to remove them, so that the restoration may be permanent, then he understands how to treat judiciously and rationally, and he is a true practitioner of the healing art .
In the first aphorism, Hahnemann discussed the aim of a physician (to cure). In the second aphorism, he discussed what is an ideal cure and in the third aphorism, Hahnemann lists the tools that a physician needs to treat and cure his patients.
If you are asked to hit a target with a bullet, the first piece of information that you will need is ‘what is the target?’. Then you will need to have a gun and some bullets at hand and last but the most important, you must know how to fire a gun precisely. Similarly, when you have to treat a patient, the first piece of information that you need is – what is it that you need to treat? Is it the symptoms, the pathogen, the pathology, the nosological disease or the person as a whole? Hahnemann says that you have to know what is curable in ‘every individual case of disease‘. This means that the focus of our treatment should be the individual who has the ‘disease’. Now this causes confusion for many. People think that they have to focus all their attention on the ‘person’, the ‘individual’, and often ignore the disease. People will say – ‘This patient needs Calc-carb because she is fat, fair and flabby‘ or ‘This patient needs Sulphur because he sits with stooped shoulders‘. Unless the remedy covers the symptoms of the disease process, such prescriptions are not justified. You do not have to study the person excluding his disease state.
You have to find a remedy which best covers the disease process, the pathology, the individualizing symptoms and the personal/constitutional traits. And for this you have to study the person with the disease picture. And then you have to differentiate one patient suffering from a particular disease, from other patients suffering from ‘similar’ condition, using the causative factors, individualizing characteristics of the case and the rare, peculiar and uncommon symptoms. If a person comes to you with malaria like symptoms, you will not give her Calc-carb because she is ‘timid, irresolute and fat’. You will first find out medicines which cover the patient’s disease process, be it acute or chronic, and then you will study the patient for the individualizing characteristics – ‘What is it that differentiates this patient of Malaria from other similar patients?’. So the first piece of information that you need for curing a patient is a thorough knowledge of the disease process and individualization.
So now you know what is your target and you need a gun and some ammunition to fire. You will need to know what are the types of guns available in the market, what are the bullet sizes available, what ammunition fits which gun and what is the range and precision of a particular gun. In medical terms, you need to have the knowledge of the medicines that you will need to target the disease process. You will need to know what medicines are available, what symptoms and conditions they cover (range and precision), and how to differentiate one medicine from other medicines producing similar symptoms. This means that you should have a good command over Materia Medica. These days students often become so dependent on repertories and computer software for finding the remedy that they often do not give enough time for studying our Materia Medica. Repertory is a tool that can help us select a ‘group of possible remedies’. It is not necessary that every time the medicine that gets most points in repertorization will be the right one for your patient. You have to use your knowledge of Materia Medica to select the best remedy from this ‘group of possible remedies’.
Now you know your target and you know about the guns, all you need now is the knowledge of firing a gun. It looks simple – just pick a gun, keep in front of the target and fire! But it is not as simple as it sounds. This is where the ‘art’ in homeopathy begins. You need to know which gun is suitable for this targe. What is the range that you have to fire from? If your target is a small circle, you will need a precision rifle, if your target is a dummy, you will probably need a pistol and if your target is an army, you will probably need a machine gun! Similarly, you have to match the medicine with your target (the simillimum) – the disease process. You have to find out the most suitable remedy for the case at hand and then use it properly to eradicate the disease process and restore the health.
But a medicine does not become a ‘simillimum’ for a case just because the symptoms match. A medicine will assist in curing a case only if –
- The symptoms match.
- The potency matches the intensity of the presentation and the totality of the case.
- The dose, which includes the potency, form and quantity of medicine are appropriate.
- The medicine is repeated appropriately.
Each of these points needs further elaboration. I will offer some brief insights here.
Prescribing homeopathy medicines looks easy in the begriming. All you have to do is list the symptoms of the patient, find a medicine which covers most of them and ‘Boom!!’, a magical cure will take place!! But in reality, it is not that simple. Not all the symptoms are of equal importance. You need to understand what are the common symptoms of the nosological disease, what are the uncommon symptoms that this particular patient is manifesting and what are the personality traits. The symptoms need to be analyzed and evaluated before they can be used for finding the right remedy. I you pick the wrong symptoms, you get the wrong remedy. The choice of the medicine and dose will also depend upon your aim – whether you wish to palliate or cure.
After the remedy is selected, you also need to choose the right potency. If the medicine is the amplitude of a wave, then the potency is the inherent frequency of the wave. Choice of potency depends upon a multitude of factors and it is not possible to go into those details here. If you wish to learn more about potency selection, you can refer to another essay by me, titled Homeopathy Posology.
After the potency is selected, we also need to decide the dose, which includes the form and the quantity of medicine. We need to decide whether we wish to give the medicine as dry sugar pills, liquid potency, water based liquid solutions, sugar of milk etc. We also need to decide the quantity of the medicine that will constitute one dose – it can be one small globule or four, it can be a drop of potency or a spoonful of liquid solution. The potency and the dose also needs to be individualized.
Now we come to the judicious repetition. Often (not always), a single dose of the right medicine would not be enough to bring about a radical cure, unless the case is at functional level and the patient has strong vitality. We will need to repeat the medicine at appropriate intervals depending upon the reaction that we generate from our initial doses. The repetition also depends upon the scale (decimal, centesimal or LM) and the form chosen. All this needs very good understanding of case management. Majority of our cases fail not because we are unable to find the simillimum, but because we are unable to manage our cases well after the first prescription.
Another important but often overlooked aspect of this aphorism is ‘the exact mode of preparation‘. Many times I have come across cases that have not responded to a remedy from a particular pharmacy but did very well when the same remedy was ordered from other pharmacy. The quality of our medicines does matter. Today homeopathic remedies are prepared by a variety of methods – by hands, mechanical hammers, electronic machines, electronic vibrators. Some of these methods, especially ones which do not use any back potencies, are very doubtful and you should always use medicines from a good and reputable pharmacy.
So now you have the knowledge of the disease and the knowledge of the medicine. Plus you have also decided the right potency and dose. There might still be many cases which will not show a curative response even with the simillimum. If you do not address the causative, contributing and maintaining factors for a disease condition, even your right remedy will not be able to bring about a radical cure. The patient will improve and relapse. Suppose a patient comes to you with fibrosis of oral mucosa and is addicted to tobacco chewing, you won’t be able to help much even with the right remedy because the tobacco will work as a maintaining factor. Same will happen in a case of allergic bronchitis, if the person is a heavy smoker. If a person with acute spinal disc prolapse or sciatica is not suggested bed rest, the physical exertion and trauma will work as an aggravating factor and your remedy will not give the desired results. If the causative factor for backache is a bad posture or an uncomfortable chair, the pain won’t go away unless you remove the causative factor. If there is a corn in a foot due to a shoe that bites, the corn won’t go away even when you administer a remedy, till the person changes his shoes. If a wife or a child suffers from psychological trauma due to abuse or family situations, the remedy will not bring about a radical cure unless the abuse stops or the causative situation changes. Occasionally it might happen that the right remedy may give a person enough courage or insight to resolve a problem relationship or situation. But that is not going to happen always. Our life style, food habits, relationships often work as causative and maintaining factors for our sickness. Unless and until the doctor understands these factors well and knows how to remove them, he will be unable to cure a large majority of his patients.
So in the end, I would like to enumerate the tools that are essential to cure a sick person. A good physician must have the –
- Knowledge of Disease and Individualization.
- Knowledge of Materia Medica.
- Knowledge of laws and methods by which he can apply the knowledge of medicines to his knowledge of disease process. These include:
- Remedy selection
- Potency and dose selection
- Knowledge of causative and maintaining factors
If you develop a good understanding of all these variables, you will be able to perform many ‘ideal’ cures!
Dr. Manish Bhatia