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Saturday, September 16, 2006

REPETITION OF DOSE

The repetition of the remedy is always a controversial issue & under constant debate in homeopathy. There is no clear-cut rule that can be laid down, and it is very difficult thing to teach and to understand; rather it can only come by experience and by using powers of observation .
The safe rule to follow is, never repeat the dose after reaction begins.
If more than one dose is necessary repeat the dose until there is improvement and then stop; more doses will only retard the cure. When reaction is taking place never repeat the remedy; when reaction ceases or improvement stops, the remedy may be repeated.

1.-Hahnemann’s view on repetition:-
We find certain rules given us for the repetition of the remedy in Chronic Diseases and Hahnemann discusses these on pages 209-213, in speaking of the third mistake in the treatment of diseases. Quoting in part, we find, on page 209: “The third leading mistake that the Homoeopathic physician cannot too carefully or steadfastly avoid is in hastily and thoughtlessly giving some other medicine ... but if once a medicine ... is acting well and usefully, which is seen by the eight or tenth day, then an hour or even half a day may come when a modern homoeopathic aggravation again takes place. The good results may not appear in their best light before the twenty-fourth or thirtieth day. The dose will probably have then exhausted its favorable action about the fortieth or fiftieth day, and before that time it would be injudicious and an obstruction to the progress of the cure to give any other medicine. Experience teaches that a cure cannot be accomplished more quickly and surely than by allowing the suitable antipsoric to continue its action so long as improvement continues ... Whoever can restrain his impatience as to this point will reach his object the more surely and the more certainly ... periods of aggravation will occur, but so long as only the original ailments are renewed and no new, severe symptoms present themselves, they show a continuing improvement, being homoeopathic aggravations which do not hinder but advance the cure. The physician must; therefore, in chronic diseases, allow all antipsoric remedies to act thirty, forty or even fifty and more days by themselves, so long as they continue to improve the diseased state perceptibly to the acute observer, even though gradually; for so long the good effects continue with the indicated doses and these must not be disturbed and checked by any new remedy.”
In footnote, page 212, we find: “But he who will not allow himself to be convinced of this and imitate what I now teach, he who is not willing to imitate it exactly, can leave the most important chronic diseases uncured.”
2:- Kent’s Observation:-
From the study of the Organon and the Chronic Diseases, we learn that there are certain other things that we may expect after the prescription has been made.Kent gives these observations as eleven in number. I will simply give them without further comment, as an explanation may be found in Kent’s Lectures on Homoeopathic Philosophy.
Following the dose one of the following results is to be expected:
1st. A rapid cure will take place with no aggravation of symptoms.
2d. The aggravation will be rapid, short and strong, and is followed by rapid improvement of the patient.
3d. A long aggravation with final and slow improvement of patient.
4th. A long aggravation with final decline of patient.
5th. Full time amelioration of symptoms with no special relief of patient.
6th. Amelioration comes first and aggravation come afterward.
7th. Too short relief of symptoms.
8th. Old symptoms are seen to appear.
9th. New symptoms appearing after the remedy is given.
10th. Patients who prove every remedy given.
11th. That symptoms take the wrong direction.

. Yesterday I was reading an article of Dr Rajan Sankaran in Homeopathic Links & this article impressed me a lot. I am quoting the whole text of this article from Homeopathic Links.


3:- Dr Rajan Shankaran’s view:-

Dr Gerhardus Lang, M.D., posed a question to Rajan Sankaran: How often can we repeat a dose? Dear Rajan Sankaran, you wrote in your book The Spirit of Homoeopathy that we have to repeat when the dose is exhausted. In chapt. 25 you describe a case of Aurum met. and you gave him Aur.m.200 and 1 M over a period of a year in weekly doses. I should like to know if Aurum was always exhausted after a week and if you did really observe the patient to be sure if the dose was exhausted.

Rajan Sankaran, Bombay :
I have, in the past ten years of practice, in some chronic cases of definite structural pathology, repeated the dose of the indicated remedy despite amelioration. I did this because I found that sometimes by not repeating the dose of the medicine progress comes to a standstill and despite the patient feeling better the pathology remains the same. Further, I found that such repetition did not seem to create any kind of trouble. I must also state that in some cases I found even chronic structural pathology reversing with a single dose. I therefore started thinking in which case a repetition is needed and in which case it is not needed. My conclusions are as follows:
One of the cases I would definitely repeat regularly would be osteoarthritis that requires a remedy like Calc.fluor. A similar example would be a case like hypertension which is chronic and persistent. A third example would be a case of vitiligo. These kind of cases which share a common feature, namely they are chronic and slow in progression. I found in such cases that even though a single dose acts, its action seems to stop after some days or weeks and another dose takes it one step forward, its action lasting for another few weeks and so forth. Gradually I started experimenting with repeating doses even when the person was improving as if anticipating that the dose would exhaust its action. I found this kept the progress uninterrupted. It seemed to depend upon the onset of pathology. If the onset was slow and gradual, repetition was needed in days or weeks. If the onset was sudden and the exciting factor was not there, then repetition was not needed, e.g. sprain or an injury or a fright etc. If the exciting factor was present e.g. certain severe infective pathology as in severe tonsillitis, severe pneumonia, typhoid etc. then repetition would be called for every few hours. The same happens in chronic cases especially in cases where the exciting factor is found in the life of a person, these cases require definite repetition. One must remember that an exciting factor is one that excites a sick person - the same factor may not excite healthy people.
Another factor that influences repetition is excitability of the root within. If the root is strong, the dose exhausts its action quite soon. The excitability of the root can be judged by how sensitive the person is to the exciting factor. Taking all these above factors into consideration, when we look at the case of Aur. given in my book we find
1) Very excitable Aurum root as shown in the fact that increased responsibility excited in him a intense state of Aurum.
2) Such a responsibility was still present (felt by him) as a continuous exciting factor.
3) The pathology was slow and gradual showing the need of repetition. Pathology in the form of IHD (Ischaemic Heart Disease) HT (Hypertension) and diabetes and also peripheral vascular disease - all slow progressive pathology which I feel cannot be reversed by a single dose.
In such cases I can anticipate that the dose will be exhausted very soon. I judge how long to wait by seeing how long the first dose lasts. When its action is over I repeat the dose at the same interval each time, even before the improvement stops. If I know that the first dose lasted two weeks I would repeat the remedy once in 12 days in anticipation.
From experience I found that if other things are constant, i.e. there is no new addition or subtraction of exciting factors, the dose acts for almost the same amount of time. There comes a point, after a few days, months or years, where the dose stops acting or acts for a much shorter time. This is the time to raise the potency. Each time the potency is raised it is advisable to again wait and watch for how long the dose of the new potency works and to repeat at this interval.
The logic of repetition.
What I have stated is from clinical experience of innumerable cases. I have thought about this phenomenon and explain it thus:
1) What is repetition?
Repetition is giving a reminder (an awareness) and is needed as fast as the person forgets the previous lesson. Who is likely to forget and need a reminder? The one who has fallen into such a pattern that just telling him once doesn't make enough impression. There is a tendency to fall into the same pattern again and again and we see this in a chronic or acute case which has a strong exciting factor.
For example, a person coming for an interview is nervous for 3 days before. You give an awareness and his nervousness recedes until he is faced with the interview. His nervousness returns and he needs to be reminded again. As the period of interview comes closer and closer he needs repeated doses of awareness. So, in such a case you might have to repeat Gelsemium again and again.
Where is repetition not required?
An acute where the exciting factor which is not repeated, can easily be dealt with in one dose. Even a chronic case which began with one exciting factor which is no longer there needs very little repetition, I have seen this with Carcinosin. E.g. Carc. is a situation of a child where the parents are asking for perfection and the child fits into this pattern, but if in adulthood this exciting factors no longer exists a single awareness is enough. Here the exciting factor doesn't exist in the present, and little or no repetition is necessary. If you see a case of Calc.fluor where the fellow is struggling about money, with an excitable root from the past plus exciting factors from present, it is impossible to cure with a single dose and the dose will exhaust its action very soon. Even when there is no pathology, but there is only a prominent state, repetition may be needed if the state has come from a very excitable root and there are continual exciting factors around e.g. we see a very strong Bar- carb child coming from a very strong Bar-carb mother. This child is slow dull, laughed at, criticised which makes him even more vulnerable to criticism. People start laughing at him, his family itself considers him an idiot, this child surely requires repetition of Bar-carb very often to get out of this state. The same child in the family which is encouraging and doesn't laugh at him will require less repetition of Bar-carb. Similarly if the child's state has resulted from a strong state of the mother during pregnancy this child is likely to require repetition. If the child's present state resulted from some incident in the child's own past, one isolated incident like fright, this child is not likely to require repetition.
"It is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition (and at short intervals in order not to delay the cure). The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those similar to the disease to be cured, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homoeopathic to the original disease, hence no step towards cure can follow, only a true aggravation of the condition of the patient. But if the succeeding dose is changed slightly every time, namely potentised somewhat higher then the vital principle may be altered without difficulty by the same medicine (the sensation of the natural disease diminishing) and thus the cure brought nearer" - said Hahnemann in the Organon. This goes against not only my experience, but that of many homoeopaths. As far as I know no homoeopath has refrained from repeating the same dose and so not only Hahnemann's explanation goes beyond logic but goes beyond experience also.

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