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====== Questions for André Saine ======
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This is the place to submit your questions to Dr. André Saine, who will pick __one__ from the list and answer it for our newsletter (issued monthly, you can freely [[en:start#newsletter|subscribe here]]).

To improve the chances of your question being answered, make sure your question:
  * pertains to Hahnemannian homeopathy
  * is not trivial (such as "How are homeopathic remedies made?")
  * is clearly formulated and makes sense((there is no good answer to a stupid question))

====== Write your questions here ======

  - How many times should an anti-psoric remedy of the same potency be ideally repeated? Is there some advisable restrictions on the number of times that the repetition should be done?
  - Do you use LM potencies for longer term treatment of chronic diseases where daily doses are necessary? For example, controlling bipolar behavior (rapid cycling, irritability) where the remedy replaces a psychiatric drug.
  - Could you describe your homeopathic protocol for surgery i.e. what remedies to take before / after surgery to prevent complications, facilitate healing etc.?
  - In repertories we find a single remedy for some rubrics, and in case the said remedy does not respond as expected, then what is the next suggested course of action? For example, the characteristic symptom -- No sneezing when lying down either day or night but starts when up and about -- there is only one remedy for  this rubric -- Merc.	But when this single remedy does not respond as expected what should be done? Kent in  his Lectures  on  Materia Medica under Merc. has  mentioned “not to  give many doses of Merc. in psoric cases; but to look for a deeper medicine”.  What is a deeper antipsoric medicine than Merc for such? How  to resolve such cases?


====== Answered questions ======

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**Q:** **How do you deal with failures i.e. when you do your best and yet the seemingly indicated remedy does not help the patient? How do you convince your patients to bear with you while you keep trying to find the remedy with high degree of similarity? How many maximum futile attempts did it take you to make a breakthrough in a case?**

**A:** I will here assume that these patients present with conditions that are curable with homeopathy, the case is not defective, there are no factors preventing a response to dynamic remedies and the posology has been appropriate.

The first thing I tell such patients is, as we are dealing with a law of nature and a law has no exceptions, we have to thrive together to fulfill the requirements of this law ([[en:hahnemann:organon:start#section3|paragraph 3]]) by searching for a remedy having a sufficiently high degree of similarity to produce a curative reaction.

The fact that we have so far been unsuccessful means that key elements of the case are missing and/or symptoms have been misunderstood or not properly analyzed or the materia medica search has been unsuccessful.

The best way to obtain the highest degree of certainty in prescribing is to obtain a complete case at the beginning. No stones should be left unturned during case taking and particularly in very serious cases.

One of the main objectives of case taking is to obtain the totality of the symptoms, even though it is somewhat utopian, as many symptoms are not observed or reported while others have been long forgotten. In any case, we must persist in our examination of the patient until a clear image of the disease appears. Objective symptoms can be further obtained by interrogating attendants, relatives and friends and conducting a good physical examination of the patient.

In milder cases, it may take years for the disease picture to become sufficiently developed to lead to the simillimum. Patience is here required and particular attention to any acute condition is a must, as it is one of the way to open up a defective case.

Also it is important to understand that people respond differently to dynamic remedies. Some are hypersensitive while others are hyposensitive to these influences. These varying degrees of responsiveness are well illustrated by a [[wp>Normal_distribution|bell curve]]. Patients on the hyposensitive side of the curve tend to only respond to remedies having a very high degree of similarity, those approximating the absolute simillimum. As these patients tend to become more sensitive to homeopathic remedies during acute conditions — the more intense is the acute condition the more sensitive they become — it is often a good way to begin such recalcitrant cases.

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**Q:** **Could you comment on situations when a change of potency (rather than a change of remedy) is called for? For example, when a patient improved after a certain remedy, but is now relapsing (with the same symptoms) and a repetition of the same remedy brings aggravation and only a small healing response, is a change of potency warranted in such a situation?**

**A:** As the responses to previous doses of the same potency of a remedy become less long and less important it will be soon the time to move upward in the scale of potencies of that remedy. Depending of the case, acute or chronic or maybe due to other factors, the next potency or a jump of several potencies can then be prescribed.

However, if there is an aggravation followed by only a small beneficial response after the repetition of a remedy it signifies as a rule that the remedy has a too low degree of similarity and a more similar remedy should then be sought after.

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**Q:** **Is psoriasis fully curable? Have you, in any of your cases with psoriasis, found it to have link with Obssesive Compulsive Disorder / Neurosis, mind symptom of forebodings (in the sense that one has fears which he is not able to explain -- like fear of dogs, fear of tall buildings etc.) and the stress it creates?**

**A:** Yes, I have seen psoriasis disappear completely following homeopathic treatment as it is with other autoimmune diseases. However, as psoriasis tends to be more resistant to all form of treatment, the greater the degree of similarity of the remedy to the disease of the patient the greater can we expect a favorable response. Also, recovery of health will be enhanced by attenuating or correcting any maintaining cause, such as stress or diet, during homeopathic treatment.

I have never observed any particular link to OCD.

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**Q:** **With rising antimicrobial resistance of many bacteria, viruses etc. to allopathic drugs, is it your experience that the infections connected with these are also increasingly difficult to treat homeopathically? In other words, is there any relationship to a widespread (mis)use of antibiotics and difficulty of homeopathic treatment of acute infections?**

**A:** It is my experience that microorganisms that are drug resistant are also more resistant for our immune system to deal with. Therefore, it could take a bit longer to cure patients infected with such microorganisms but it is not clinically significant. I have never seen a patient with a life-threatening infection not respond to the simillimum, regardless of the microorganism.
 
I have not observed any greater difficulty dealing with patients with acute infections, e.g. pneumonia, than when I began practice over 35 years ago. In fact, I have never observed any difficulty dealing with patients with any serious acute infections. I can’t conceive patients dying from acute infectious diseases while having at their bedside a physician who practices genuine homeopathy and God knows that I have seen some of the worse cases with infectious diseases.

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**Q:** **What are the most common mistakes the practitioners make when taking a case?**

**A:** See the answer in [[https://www.youtube.com/watch?v=gSk6u-fogCQ|this Youtube video]].

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**Q:** **Could you please comment on proving symptoms? If somebody produces proving symptoms while taking a remedy which has improved his condition in general significantly, is the appearance of proving symptoms just a sign of a very sensitive patient, or is it a wrong chosen potency or does it express a high degree of similarity between the remedy and the patient, from where a good prognosis of the case could be expected?**

**A:** Patients can experience symptoms they never had before taking a homeopathic remedy which clearly belong to this remedy. These symptoms are called proving symptoms. Their occurrences are associated with two factors, hypersensitivity of the patient or a too high posology. These responses are really individual, as there are people who tend to be very good provers, while others are very poor provers.

I remember a patient whom I treated for about 15 years who had multiple sclerosis and lung cancer. She was an extraordinary prover of remedies. If I would prescribe a remedy that didn’t have a sufficiently high degree of similarity she would experience only a keynote symptom of that remedy for 1-2 days without any other changes. On the other hand if she received a remedy with a high degree of similarity she would still develop a keynote symptom of that remedy she never had before but she would also experience a healing response. This occurred with change of remedy or change of potency, regardless of the remedy given. I used to call her the Queen of Provers.

Once she said, “The last remedy you gave me was a really great remedy.” She recalled having had the same feeling many years before, during the month of October, when she had a severe episode of pneumonia. I looked back in the file and she was right, both times associated with that great feeling of well-being she had received a dose of Pulsatilla 50 M. In fact, each time she would receive Pulsatilla anew or in a new potency she would dream of bees for the first night only, “lots of bees, big ones, small ones, bees all over the place and in all kind of circumstances.”

Hering used to say that when patients experienced proving symptoms it is a good sign, as the healing response will soon follow. This is not always the case, as with the patient I just mentioned. The answer as to whether it is a favorable sign depends on the patient experiencing these symptoms.

Proving symptoms tend to occur very soon after taking a remedy when it is given in single doses, or they happen later from too frequent repetition. At some point every sensitive patient will develop proving symptoms if the remedy is repeated too frequently. The goal with posology is to find what is the optimal posology at each visit in order to produce a rapid and gentle recovery of the patient. The majority of patients with chronic diseases are likely to experience proving symptoms if the remedy is repeated too frequently.

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**Q:** **Could you provide some guidelines that would improve our chances in determining the correct posology (potency, frequency of repetition and way of administration of the remedy) in any particular case of acute or chronic disease?**

**A:** Here is the short answer to this question: The homeopathic physician must use every contact with a patient to determine whether posology is optimal, which means that the potency, repetition and way of administering the remedy are optimal at all times in order to assure a gentle, rapid and sure recovery. The concept of the minimal dose is fundamentally wrong, as it might be just enough to begin a healing reaction but not enough to have to sustain the ideal cure.

 The long answer to the question of posology is very complex and takes many long years of practice to master it, as many factors must be taken into account, such as the sensitivity of the patient, the ascendency and resiliency of the disease, the degree of similarity of the remedy, the undesirability of an initial aggravation, the strength of the patient, etc. This subject is better taught with illustration of hundreds of cases, each presenting its own difficulties.

Editor's note: André discusses the question of posology also in this instructive Youtube video: [[https://www.youtube.com/watch?v=Vx81dMWRQ2g]]

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**Q:** **How far can we push homeopathy when it comes to curing serious and painful teeth problems such as root abscesses or full-blown caries? I have succeeded in curing cases of abscess or toothache, but how to cure caries if there are no more symptoms to prescribe on? If the toothache caused by caries disappears and no more symptoms are present, according to Hahnemann, the patient should be cured, but in this case, I am not sure, considering the fact that caries often remains painless until an advanced stage is reached. Will the carious tooth remineralize, if we prescribe correctly?**

**A:** I always encourage patients to deal with dental abscesses with homeopathy, and discouraged them of getting any root canal. Caries of bones is easy to deal with homeopathy, however caries of teeth seem more difficult to reverse. I personally have never seen dental caries reversing with homeopathy. My teacher, Dr. Bastyr, told me he had seen it happened at least once. However, it is possible that it is because we have not found the right way of doing it.

Once I had a 23-year old man who was in late stage heart failure, and for whom conventional medicine had nothing more to offer. He was not a candidate for heart transplant, as he also had liver cirrhosis. Once he was out of heart failure and cruising along pretty well, he asked me whether something could be done for his two upper medial incisors, which had completely lost their enamel on their anterior surface. They were dark gray, eroded and without any shine to them. I asked him to apply a paste made from tablets of Calcarea fluorica 6 X mixed with water to his two incisors three times a day. Within seven weeks his teeth were looking better, and within seventeen weeks the enamel had completely returned on his upper two incisors, which had become remarkably white, like pure ivory. They were outstanding when he smiled.

Incidentally, a dental caries, even though it is painless, is a symptom by itself.

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**Q:** **How would you suggest to proceed in cases with clear pathology (such as chronic leucorrhea or eruptions on skin) but very little useful symptoms upon which to base the prescription? Let's assume the greatest care have been taken to take a complete case, the patient has been repeatedly interrogated, but there is still nothing characteristic to go about.**

**A:** A defective case can be due to a defective doctor, a defective patient or a defective disease. Let’s assume in this case that it is the disease that is defective, as there is a paucity of characteristic symptoms to come up with a sure prescription despite a most thorough examination of the patient. Many strategies can be used to help resolving such a case.

 Choosing the best strategy for each case is a complex process that depends on many factors. Hahnemann discussed the subjects of defective cases and localized diseases in paragraphs 172 to 203 of the //Organon//.

 First, the patient must be informed of the situation and made an active partner in the strategy chosen to resolve the case. One general option, which I favor in particular, is to see the patient on a regular basis without prescribing any remedy until the picture becomes clear and to recommend during this time lifestyle improvement in order to improve the patient’s general health and sense of wellbeing.

 Also during this time, persons close to the patient can be interviewed in order to obtain more objective symptoms and symptoms of the past, now long gone. It is important to notify the patient to report any acute manifestation that could develop during this waiting time, as it often holds the key of the first prescription.

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**Q:** **The old homeopaths often appear to have two categories of materia medica -- antipsoric and non antipsoric medicines -- implying that non-antipsoric remedies are to be followed by and antipsoric during treatment. Hahnemann comments on this in the treatment of mental diseases in the //Organon//. It implies a certain depth/constitutional action in antipsorics that is not apparent in other medicines. What is the difference in your view on this apparent division of materia medica? Most ‘modern’ homeopaths don’t seem to talk in these terms. Is this still a valid practice?**

**A:** As a rule, more than one remedy will be needed to complete the treatment of patients with chronic diseases. Let’s say that such a patient requires a plant remedy at the beginning of treatment, after some time—most commonly after a few years of assiduous treatment—there will be a change of picture, and there will therefore be a change of remedy, which will need to fit the newly appearing picture. Slowly but surely the disease picture of such a patient with a chronic disease will move towards one or more antipsoric remedies, and more typically towards a remedy of mineral origin as the end of treatment approaches.

Regardless of this differentiation of antipsoric and non-antipsoric remedies, the fundamental law of cure requires that in all cases of disease primarily related to an untunement of the regulating force of life, the remedy that is most similar to the totality of the characteristic symptoms of the disease must be prescribed. Often in the case of a patient with a chronic disease, this most similar remedy will not be a remedy classified by Hahnemann as being an antipsoric, such as Pulsatilla or Staphysagria.

Let’s say that we have a patient who is suffering from a typical chronic disease: rheumatoid arthritis, tiredness, depression, difficult digestion, poor sleep, dysmenorrhea, etc. If Pulsatilla is the simillimum of the case, the patient will do very well on it. Most but not all the symptoms will disappear and some new ones will slowly make there way into the case, perhaps a skin eruption or some return of old symptoms, and a new picture will eventually emerge, which will now most likely require an antipsoric remedy.

It is important to understand that the distinction between antipsoric and non-antipsoric remedies is not cut-dry and is somewhat arbitrary. For instance, Arsenicum album was considered by Hahnemann to be a non-antipsoric up to the second edition of the //Materia Medica Pura// in 1833. However, in the fifth and last volume of the second and last edition of the //Chronic Diseases// in 1839, Arsenicum album made it to the list of antipsoric remedies. It was included at the end of the volume, out of sync of the alphabetical order found in Hahnemann’s materia medica, as if it was added at the last moment. Incidentally, this presentation of Arsenicum album was Hahnemann’s the last writing on materia medica.

Even though any non-antipsoric remedy can be used to successfully treat patients with chronic diseases, and any antipsoric remedy can be called for to treat patients with acute diseases, we will still end up using antipsoric remedies to complete the cure of patients with chronic diseases.

Therefore, to answer the question whether the consideration of antipsoric and non-antipsoric remedies is a valid practice, the answer is an absolute yes, however, as long as it is considered within the context of a general understanding of the materia medica and of the other practical rules of homeopathy. To illustrate the importance of this general understanding, let’s say you have a patient who presents a chronic picture that makes you think of Nux vomica, and among the patient’s symptoms are warts, you should know right away that Nux vomica will unlikely be the simillimum in this case. However, if Nux vomica is prescribed because it is really the true simillimum, it is important to understand that it will be required for a limited time only. The physician will then need to be on the watch for a change of picture, which may occur within days, weeks, months or years, and most likely pointing towards an antipsoric remedy. 

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**Q:** **When a patient gets an acute disease almost immediately (1-3 days) following the first dose of the chronic remedy, how would you interpret this? Is it a good sign, bad sign, no sign at all (with regards to the effect of the chronic remedy)?**

**A:** There are a number of different scenarios that could be associated with the development of an acute disease after the intake of a remedy indicated for the chronic disease of a patient.

First, it could be incidental, which is the most likely scenario. For example, a patient becomes chilled just prior to taking a chronic remedy, and soon afterwards the symptoms of an acute condition begin. In such a case, the person had already lost their sensitivity to the chronic remedy at the time of taking it, and unlikely there will be any reaction to it, unless the chronic remedy addresses as well the acute condition. It is neither a good or bad sign. However, the physician must be on the alert and know when to intervene in the presence of a dissimilar disease.

Second, you will meet at times very sensitive patients who when taking //any remedy// develop always the same condition, e.g., an acute bronchial cough. In such a case, the physician must pay great attention to the bronchial cough and go back to the drawing board and see if remedy prescribed or another one has the genius of this cough as well as the rest of the case of the patient.

Third, the acute disease can be an acute indisposition, which could be related to physiological changes that were triggered by taking the chronic remedy, e.g., menarche or menopause. If the chronic remedy has a high degree of similarity, it is a good sign.

Fourth, it is the return of old symptoms (ROOS), which is less likely, as it tends to occur later in the course of treatment. ROOS tends to be a very good sign.

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**Q:** **Is it possible to remove pedunculated warts by homeopathy alone? What is your experience?**

**A:** There is no right answer for a wrong question, as homeopathy doesn’t remove anything. However, the question is likely meant to be, can we rid ourselves of pedunculated warts through homeopathic treatment?

All types of warts in all parts of the body have disappeared under homeopathic treatment. This generalization doesn’t imply that all warts will disappear once homeopathic treatment has been initiated. The remedy prescribed must be of a sufficiently high degree of similarity to the patient’s disease, and in an optimal posology.

Once these conditions are fulfilled, warts will disappeared in due time, depending on the direction of cure, i.e., //what else needs to be healed//.

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**Q:** **What is your experience with homeopathic prophylaxis? I am familiar with Hahnemann's ideas on the topic, expressed in sections 101 and 102 of the Organon, but he based his recommendations (such as the use of Belladonna in scarlet fever) on the totality of symptoms present in the epidemics already occuring. Is it possible / rational to recommend homeopathic prophylaxis in cases where the totality of symptoms is not known? For example, someone travels to a country where malaria is prevalent, but we do not know what exact kind of malaria, what symptoms are prevalent, so how do we recommend a homeopathic prophylactic remedy with any degree of confidence?**

**A:** What can be treated can also be prevented under the principles of similarity. Homeoprophylaxis is therefore not just for the prevention of infectious diseases but it can applied for any situation that can be anticipated, like it can be with physical or emotional trauma (surgery). The greater the degree of similarity between the remedy and the genius epidemicus of the incidental disease, the more successful will homeoprophylaxis be. It is often not possible to know the genius epidemicus and we therefore have to come up with the most likely possibility, e.g., remedies used in recent years in the same locality, or the most commonly used remedy through time for a particular situation or disease. It is better to try homeoprophylaxis than to wait for disease to develop. I provided in my answer to question 17 in the [[en:misc:talk-qa-schwarcz-saine#question_17|following link]] a good example of the beneficial results from being proactive with homeoprophylaxis. (http://www.legatum.sk/en:misc:talk-qa-schwarcz-saine#question_17)


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**Q:** **How and when should we use information about the remedies that "follow well", are "followed well by" or are "complementary" to other remedies, such as "Bryonia is followed well by: Alum., Ars., Kali c., Nux, Pho., Puls., Rhus, Sulph; Complementary: Alum., Rhus." What about "incompatible" remedies, such as Phosphorus and Causticum? Shouldn't we give them one after another, if indicated, despite this information? How important or clinically valuable are these remedy relationships and how did they come to be?**

**A:** The rubrics “Complements” and “Follows well after” are consulted when a patient has clearly responded well to either an acute or chronic remedy and the picture of the case is now dissimilar to the initial picture. You will then prefer to have a remedy that tends to follow well the remedy that addressed the acute disease, or a remedy that will complement the remedy given previously to address the chronic disease.

As this information on the succession of remedies is entirely based on clinical experience, it should only be considered as a possibility, not as an absolute. In all cases, we must attempt to find the most similar remedy corresponding to the genius of the disease (the totality of the characteristic symptoms), and information about the succession of remedy is then only a minor consideration.

It is said that the concept of incompatibility of remedies succeeding each other, common in allopathy, was first mentioned by Hahnemann, as //freundlich// (friendly like) and //feindlich// (enemy like). Incompatible means that a remedy given immediately after one that is known to be incompatible to itself can antidote the beneficial reaction to the previous remedy and/or the patient can as well experience new (proving) symptoms of the newly prescribe remedy, or aggravate the patient’s presenting symptoms. In other words: a messy situation. Once Mohr wanted to challenge this concept and had a patient who had reacted very well to Rhus tox. over a period of many weeks. Once the patient had become mostly asymptomatic, he gave her one dose of Apis mellifica to address last remaining symptoms. Not only all the symptoms that had disappeared under Rhus tox. returned but the remaining symptoms greatly aggravated and she also developed ovarian pain similar to the one found under Apis and which she never had before.

Mohr also recounted a case with a paronychia, whom he had unusually great difficulty curing. He looked back at his earlier prescriptions and noticed that he had prescribed Silicea and Mercurius solubilis, two incompatible remedies, in succession.

Incompatible remedies tend to have a certain degree of similarity between them, and they therefore have the capacity to antidote each other’s reaction, but at the same time they don’t mix well, like a marriage of a sister and brother, like Ignatia and Nux vomica. Hahnemann had already pointed out that the symptomatology of Nux vomica greatly resembles the one of Ignatia, but they will both be indicated in very different patients. 

Negative reactions from having prescribed incompatible remedies are not predictable, and greatly depend on the sensitivity of the patient. One strategy to avoid such reactions, if a known incompatible remedy seems now better indicated and the patient has either had no reaction or has not reacted well to the first remedy, would be to prescribe an antidote before prescribing the incompatible to the first remedy. 


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**Q:** **What strategy would you recommend in cases of eczema, when, after taking a homeopathic remedy, a terrible aggravation occurs (such as from having eczema just on hands to having it almost everywhere)? Would you wait, antidote, prescribe a new remedy on the current image or something else? Waiting seems like a tough option since the clients are usually unable to resist taking SOMETHING to suppress it, not to mention the doctors screaming hell when they see a patient in such a state. Also, there is a more shadowy option of an aggravation without a subsequent amelioration, which is a real trust breaker. Any good ideas how to manage such cases?**

**A:** First, you have to be very careful not to provoke strong aggravations with homeopathic remedies in patients suffering from eczema, asthma, psychosis, suicidal ideation, or in the ones having violent or destructive tendencies. The posology must therefore be very conservative at first in order to observe their initial reaction to the remedy, following which you can proceed step by step. I have never had any serious aggravation of skin problems with any of my own patients but I have had to advice colleagues who inadvertently triggered such unfortunate, severe aggravations.

However, if patients would develop an untoward aggravation of their eczema and particularly when it is associated with intense pruritus, you will have to intervene properly. The first thing to do is to inform the patient what is happening. Now if the patient is suffering from a very serious disease, such as cancer, this untoward and very unpleasant aggravation is most likely to be a blessing in disguise. In any case, the eczema should not be suppressed but it must be managed correctly. If the pruritus needs to be dealt with, try to find out what will mitigate it. The most commonly effective, benign, palliative approach I have found is the use of oatmeal (Avena sativa), which can be used in a cheesecloth in the water of a bath. The same wet oatmeal in a cheesecloth can also be used locally as needed in compresses. Occasionally, you will find that the pruritus is instead relieved by adding vinegar to the water of a bath, while in others relief will be found by adding baking soda to bathwater, or by using compresses soaked in a mix of water and vinegar or baking soda. With severe pruritus, particularly in children, fingernails must be cut very short, and children may have to wear gloves at night to prevent unduly scratching during sleep. In all cases, open skin must be kept clean to prevent infection, which can be done with Avena soap and warm water.

If a remedy with a high degree of similarity has been prescribed, you have to patiently wait as long as the patient is improving as a whole, and repeat the remedy as needed in the optimal posology.

If the degree of similarity of the remedy was not sufficiently high, you will need to return to the original case and ask, “If remedy A is not correct, which remedy would then be most similar?“ Oftentimes, you can get clues for a more similar remedies from the patient’s reaction to the previous wrong remedy. 

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**Q:** **When updating our repertories, I understand it is a usual practice to add remedies to rubrics (or up their grade) corresponding to symptoms cured by the remedy, **even if these were not produced in the proving**. If, for example, we take [[en:ahr:lippe-ad-importance-of-a-single-symptom-158-10559#s21|this Lippe's case]], complying with usual practice, we should add Lycopodium to all the rubrics corresponding to the cured symptoms of the case (lying on his back perfectly unconscious, his eyes wide open, glaring, fixed on the ceiling, pupils dilated, cheeks red and hot, mouth wide open, the lower jaw hanging down, tongue and lips dry, black and cracked; picking of bed coverings; rapid pulse), although the prescription was based on a very different symptom (deposit of red sand, resembling brick dust, in the urine). I find this a dubious practice which, eventually, will lead to all remedies being present in all rubrics, making the repertory a useless tool. What is your opinion on this? Or, more generally, how do you think we should consider / value symptoms produced in proving, cured but not produced and cured AND produced in proving?**((Lippe's opinion on this is quite clear from his other articles, for example, in his article "THE “SIFTING OF OUR MATERIA MEDICA:” A CLINICAL ILLUSTRATION.", he relates a case of abdominal typhus cured by Stramonium and writes "The man who rides the pathological hobby-horse will draw the deduction that Stramonium will heal sore mouth and ulcerated alimentary canals in every case of typhus fever, and he will be sadly disappointed if he leaves out “the mental symptoms,” as related in this case."))

**A:** Symptoms that make their appearance during provings, even though it is only once, must be recorded in our materia medica and repertories. Similarly, well-established symptoms that unmistakably disappear in the sick under a certain remedy must also be recorded in our materia medica and repertories as belonging under that particular remedy. Symptoms making their appearance during a proving or disappearing in the sick, particularly when they occur but one time, could all be artifacts. As Hering mentioned we can’t take a chance of excluding any of them and have to admit them all into our materia medica. If they are artifacts they will lie silent and never be confirmed. If they really belong to the remedy in question they will eventually lead another practitioner to find the indicated remedy in a sick patient, and thus they will be confirmed and will have the possibility to increase in prominence under a remedy.

This is the way the American school of homeopathy has functioned since Hering and Lippe and it has lead the world in presenting the best records in medical history. 

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**Q:** **What are the relations among miasm, immune system, vital force and pathology? Please, clarify in detail.**

**A1:** Hahnemann used the word “miasm” to designate acute or chronic contagious diseases. He used the model of syphilis to illustrate that the three chronic diseases he had identified were the result of contagions. He pointed out that all three have in common a point of entry for the contagious agent, which is followed by a prodromal stage and then by a skin eruption that makes its appearance at the point of entry, and, when this one is suppressed, a full-blown chronic disease is unleashed. I discussed in greater details Hahnemann’s concept of miasms in an interview conducted in 2001 (see http://www.homeopathy.ca/articles_det17.shtml).

The vital force is the force that animates living organisms, which have the capacity to protect themselves from inimical forces or influences and to self-repair through what is termed the immune system. Genetic and epigenetic influences and qualitative properties of the vital force will determine the susceptibility of an organism to be affected by inimical forces and influences. Being alive is being in a constant act of balance, and the vital force self-regulating capacity is therefore in a constant state of adaptation and self-repair.

When an organism is in a state of relative balance and harmony, there is an absence of symptoms and there is an overall sense of well-being, which is referred to as normal physiology or health. When this state of balance and harmony is sufficiently perturbed, signs and symptoms appear, which is referred to as abnormal physiology, illness, disease or pathology.

Both health and disease are manifestations of the self-regulating vital force, which, once the offending, maintaining causes of disease have been eliminated, should, if necessary, be the chief object of attention for medicinal treatment.

**A2:** The force animating a living organism is called the force of life or vital force. To be alive is to be sensitive, and therefore it is to be susceptible to various forces and influences, such as infectious agents. The immune system, which is at the command of the vital force, protects the living organism against these various forces and influences, and promotes adaptation to them.

For Hahnemann, a miasm is an infectious disease, either acute (e.g. measles, scarlet fever, etc.) or chronic (syphilis, sycosis (the figwart-disease), or psora (scabies)). In his conception of the nature of chronic diseases, Hahnemann made many mistakes related to pathology.

Today, with a much broader understanding of microbiology, genetics, epigenetics and pathology, we can more accurately formulate the constitutional predisposition to chronic diseases than Hahnemann could do in his time.

Susceptibility can be inherited or acquired. The combination of the genetic and epigenetic inheritances (nature) will reflect the potential of an individual, and therefore greatly determine this person’s level of susceptibility to these various forces and influences. Destiny, the expression of this susceptibility (pathology), will be shaped by lifestyle and environment.

In conclusion, as we know that inheritance and not an underlying infection determines our susceptibility to fall sick, the use of the term miasm is not necessary anymore. However, Hahnemann should be lauded for having identified that the fundamental cause of disease was constitutional. I explain this in greater details in the following interview, http://www.homeopathy.ca/articles_det17.shtml.

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**Q:** **According to Hahnemann's case books and 5<sup>th</sup> and 6<sup>th</sup> Edition of Organon, Hahnemann often used frequently-repeated (even several times daily) doses of the indicated remedy in chronic diseases (solution in water and succussed before each new dose). Reading the old American journals and cases of eminent homeopaths like Lippe, it seems to me they still preferred the "watch-and-wait" method of the 4<sup>th</sup> Edition of Organon (albeit giving them in water, instead of dry dose). Can you give any clues on the most efficient method and / or your experience with this?**

**A:** It is important to understand that for both Hahnemann and Lippe when a pellet of a remedy was stirred in water and a teaspoon was given at regular time intervals, it was still considered one dose. Hahnemann had almost every one of his patients with a chronic disease to repeat the remedy once or more daily in water. Lippe used to repeat the remedy at regular intervals, particularly in acute cases. All aspects of posology, which means potency, repetition and way of administration of the remedy, must be optimized at each visit in every patient. In other words, posology must be individualized like it is with the remedy. One aspect of the great art of homeopathy is to learn when to wait, and when to repeat the remedy, or change potency or way of administration. There are patients with serious chronic diseases who can improve for weeks and months after a single dose, while other will go to recovery only with remedies that are repeated at regular intervals. The key is to find in each patient the optimal posology.

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**Q:** **Can you recommend any literature where we can best learn what are common symptoms in various diseases or pathological states?**

**A:** It depends if the disease is one that has been known for a long time or one that has been identified lately. For the former one, I use Thomas Watson’s //Lectures on the Principles and Practice of Physic//, C. G. Raue’s //Special Pathology and Therapeutics//, and even William Osler’s //The Principles and Practice of Medicine//. For the later one, I try to find in the literature monographs and more particularly case reports of patients having that particular disease. Sometimes I will contact a specialist or a support group to ask if a certain symptom is peculiar to the individual or belong to many having that particular disease.

Sometimes you have to be resourceful to find a clear answer to this question as it could make a big difference in order to clearly understand a case and prescribe with great precision.

Once I had a patient who presented with severe [[wp>Epidermolysis_bullosa|epidermolysis bullosa]]. She would protect herself completely from light and more particularly from sunlight. No lights were ever on in her room and all her windows were heavily covered with shades to not let any sunlight in. She didn’t know if this sensitivity was only peculiar to her or it was common to others having this disease. The few monographs or case descriptions that I could find in the literature made no mention of this extreme light sensitivity.

Not satisfied I contacted the two other adults in Canada known to have the disease. Neither of them had the light sensitivity, which ended to be key for prescribing for my patient.
 
On the other hand, if the symptom had been common to many in the ones having the same disease, I would not have emphasized it in the research of the most similar remedy.

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**Q:** **Can you recommend any literature where we can learn what states are healthy / normal and what is pathological -- for example how often is a normal urge to urinate, to defecate; what sexual desire/frequency is normal; is it normal to feel nervous/restless when hungry; how soon should one fall asleep when going to sleep and many other questions of that kind?**

**A:** You should find answers about the normal functions of the human organism in textbooks of physiology. If this is not sufficient for a rare aspect of a function then the answers could be found in specific monographs and research.

Regarding human behavior the same can be done in textbooks, monographs and research papers of abnormal psychology and ethology.

A valuable alternative would be to ask a large group of people questions such as, how many of you experience some degree of shyness to urinate in large public washroom? How many would not spontaneously use an adjacent urinal from one that is already occupied if there are many available urinals? Etc.

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**Q:** **Some teachers of homeopathy teach that in chronic diseases, after prescribing a remedy in high potency, we should wait several months before considering a different remedy, __even if nothing at all seems to be happening__. What is your experience with this? Can you provide any kind of practical rule how long to wait before reevaluating the case?**

**A:** Three possibilities can happen after prescribing a high potency remedy in a patient with a chronic disease, namely it is 1) a dissimilar remedy, 2) a simile or 3) the simillimum.

  - If it is a //dissimilar// remedy, most patients with serious chronic diseases, with the exception of very sensitive patients, will not report any changes. Waiting for months would be non-sense in either case.
  - If it is a //simile//, the response to the remedy will not be satisfactory and a more similar remedy will need to be sought the sooner the better. Again, waiting for months would be non-sense.
  - If it is the //simillimum//, patients will, as a rule, experience an immediate aggravation that will be short, and which will be followed by a prolonged and marked improvement. However, if there were no change, either the posology is inadequate, and it must be readjusted right away, the remedy is not potent and it would need to be changed, or there are some interfering factors that must be acknowledged and dealt with the sooner the better. Again, waiting for months would be non-sense. By immediate aggravation, it is meant the sooner the better, which is typically within hours in a chronic case.

If there is no apparent reaction in patients with chronic diseases, a case must be re-assessed within a few days in a patient with cancer; to within about 10 days in most other cases.

One of the fundamental principles of medicine stipulates that the restoration of health must be rapid. If a patient can be restored to health in one year, why wait three or more years to achieve the same results?
 
I would be curious to know if the professed teachers of homeopathy you are referring to have ever reported patients with //relentlessly progressive, serious// chronic diseases (i.e., cancer, Parkinson Disease, muscular dystrophy, schizophrenia, etc.) who started to progressively improve after several months of waiting when nothing was happening. If the answer is positive, I would like to see some of their cases. However, I wouldn’t be at all surprised if the answer is negative, as regression to the mean without any intervention is a very common phenomenon in patients with milder complaints, but is, on the other hand, unseen in patients with relentlessly progressive, serious chronic diseases.

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**Q:** **Are there any trustworthy records of successfully curing rabies with homeopathy alone (after the symptoms appeared, not prophylactically)?**

**A:** In 2003, I began reviewing the homeopathic literature in times of epidemics.
I have so far uncovered over 7,000 references of which 2,000 have been incorporated into a comprehensive text that is now over two thousand pages long and is entitled the //Weight of Evidence//, see here: http://www.homeopathy.ca/publications_det02.shtml.

All epidemics in which homeopathy has been involved since 1797 have been included in this extensive review of the literature. I have also investigated mortality and morbidity records from boards of health, insurance companies, hospitals, prisons, mental institutions, etc. Rabies will likely be one of the most riveting chapter of this multi volumes opus, see here the current table of contents:

[[http://www.legatum.sk/_media/en:weight_of_evidence_toc_full.png|{{ :en:weight_of_evidence_toc_s.png?nolink |}}]]

So far, I have found a fair number of cases of clinical rabies, with some being very dramatic, like being on their deathbed with the homeopath being called after the priest had given the last rites. Once the remedy is administered, patients typically show signs of immediate and continual recoveries and go on to recovery without apparent long-term consequences.

The USCDC reported a few years ago that only five proven cases of rabies in humans have been documented to have survived, but no one has have ever recovered from rabies. Of these five, only one had not received pre and/or post immunization. The only known case of rabies to the USCDC to have survived rabies without immunization was a case that was hailed by the media about 8 years ago as a great achievement in medicine. It was the case of a teenage girl from Wisconsin who had developed rabies. She was given two general anesthetic agents for a period of two weeks in order to considerably slow down the activity of her brain while they were pumping her with different antiviral drugs. When she was released after a six-week stay at the ICU and hospital, she appeared on TV, having the speech and posture of someone with advanced cerebral palsy.

It is very interesting that the very advanced cases of rabies that have recovered under homeopathy have quickly responded to the remedy, the recovery being progressive, all the seizures and spasms would usually stop within about the 12 hours and the weakened patients take between 2 to 6 weeks to completely recover their strength without any apparent signs of permanent disability. 

In the 1940s, a physiologist produced experimental rabies in laboratory animals by injecting them with brain extracts of animals that had died of rabies. These injections were either intracerebral, intraocular or intralingual and/or intralabial. Hundred percent of the animals that received the intracerebral injection developed the most severe type of rabies. Hundred percent of the animals that received the introcular injection developed rabies but of a less severe type. Between 50-70 percent of the ones that received intralingual and/or intralabial injections developed rabies. 

With little knowledge of homeopathy and with no one to guide him he made various experiments with homeopathic dilutions for prophylactic and therapeutic purposes. He was able to observe complete protection from rabies in only a few animals. However, one of the most revealing outcome of his work is that out of about 300 rabid dogs, 35 were cured while all of the 158 controls, “without an exception,” died of rabies. None of the ones that received the intracerebral injection survived but 10 of the ones that received the intraocular injection were cured and 23 of the ones that received the intraligual and/or intralabial injections were cured. Two other dogs that were cured of rabies had the furious form (not the paralytic form) of rabies that they had acquired in nature.

Last week, I was at a US university and we discussed the possibility of conducting a research project that would involve treating homeopathically all animals diagnosed with rabies in an area in which it is endemic. Positive results of such a search research would likely put homeopathy on the map in a major way.

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**Q:** **When writing about Pulsatilla, Hahnemann claims the remedy is "especially adapted for slow, phlegmatic temperaments; on the other hand, it is but little suitable for persons who form their resolutions with rapidity, and are quick in their movements, even though they may appear to be good tempered." I would like to know how important do you find temperament when considering a prescription like Pulsatilla (or any other remedy)? For example, I have employed Pulsatilla in a woman with a quick, choleric, irritable temperament who, however, had such a tremendous amelioration from open air (or open window) that I simply __had to__ consider Pulsatilla and other than her temperament, symptoms seemed to match (and she improved a lot after the remedy). Do you find such cases the exception that confirm the rule or are they more common and temperament is not as important as emphasized in the books?**

**A:** Temperaments are really important for accurate prescribing, as Hahnemann said so well in paragraphs 211 and 213, that the psychic picture is often the decisive factor in any case of acute or chronic disease. When Hahnemann describes the genius of a remedy, he is right on without any exception. In the footnote to paragraph 213, he wrote, “Thus Aconitum napellus will seldom or //never// cure either quickly or permanently if the disposition is calm and undisturbed; nor will Nux vomica if it is mild and phlegmatic; nor will Pulsatilla if it is glad, cheerful, and willful; nor will Ignatia if it is steady and without fearfulness or irritability.” By writing “seldom or //never//,” Hahnemann left the door open for exceptions, but they would have to be very rare. For instance, you can administer Aconitum to a patient who has just collapsed following an intense fright. In this case, the absence of a restless disposition is not a contraindication for Aconitum. You can appreciate that Hahnemann left the door open here for exceptions but really by a tiny, tiny crack.

I am assuming that your choleric patient was sensitive to Pulsatilla and no doubt reacted well to Pulsatilla, but that Pulsatilla was not the simillimum.

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**Q:** **What specific titles of materia medica / repertory do you find most reliable and recommend them for study and practice? Do you personally use a repertory in your own practice?**

**A:** Before the advent of portable computers, whenever I had to bring only one book of materia medica (MM) for home visits or traveling, I most often chose T. F. Allen’s //Handbook of Materia Medica and Therapeutics//. However, computers with efficient search programs have greatly changed the practice of homeopathy, and portable computers have permitted homeopaths to travel with their entire library. If we want to know what remedies have a certain symptom, we can now search all the available MM on a digital library at the blink of an eye. For instance, yesterday I was quite sure that the patient required Chimaphila. This elderly lady had peed most of her adult life standing inclined forward, as “it is much easier this way.” She had also developed in the last five years prolapse of her bladder associated with much pressure. As Chimaphila was not in the repertory for prolapse of the bladder I wanted to check whether it had been reported somewhere in our MM. Such a search would have taken hours before the advent of computers. It took literally seconds to find in Lilienthal’s //Therapeutics//, “Vesical tenesmus from prolapsus or retroversion,” which was //exactly// one of this patient’s complaints.

However, when I want to study the genius of remedy, it is usually sufficient just to review its monograph in our Materia Medica Pura Project (MMPP). However, if the remedy has not yet been reviewed and updated in our project, I go to the primary MM, the ones containing the largest list of proving and clinical symptoms, principally, Hahnemann’s //Materia Medica Pura// and //Chronic Diseases//, Allen’s //Encyclopedia// and Hughes’ //Cyclopedia//, and also Hering’s //Guiding Symptoms//.

 I constantly use a repertory in practice, which is Zandvoort’s //Complete Repertory// 4.5 to which the MMPP has [[en:resources:additions-repertory-saine|added close to 50,000 additions]] in the later years. In its revision of the MM, the MMPP constantly upgrades the repertory. We were adding about 5,000 additions a year in earlier years. This last year, with increased contribution from colleagues, we were able to make 10,000 additions, and we are expecting to add between 10,000-20,000 additions every year to the repertory in the coming years..

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**Q:** **What exactly is happening when there is a strong aggravation of symptoms after the remedy, but no subsequent amelioration? Some teachers claim it is a sign the case is incurable, but I find that difficult to believe as a general principle (for example in cases of eczema).**

**A:** There could be many reasons why there is an aggravation of symptoms, e.g., the natural course of the disease, a response to a new stress, etc. However, if the aggravation happens immediately after taking a homeopathic remedy, it means that the patient is sensitive to the remedy. It is a good sign when this initial aggravation occurs soon and is short-lasting, however it must be followed by an improvement. If there is no improvement despite the absence of interfering factors, it usually means that the patient is sensitive to the remedy but the degree of similarity of the remedy is not high enough. It has nothing to do with incurability of the disease.

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**Q:** **What exactly are the "characteristic symptoms" so emphasized in the old writings (as pertaining to remedy selection) and how do they fit in the "totality of symptoms" as a basis of prescription? What makes a symptom "characteristic"?**

**A:** Characteristic symptoms are the symptoms that tend to occur rarely, and/or are very striking, peculiar, and/or unusual. After taking a case and having fully examined a patient, the physician must then ask the following question, what is most striking in this case of multiple sclerosis, schizophrenia, ulcerative colitis, etc.? To know what is most peculiar in a case, the physician must know what is common, which means having a good knowledge of the normal function of man (physiology) and of abnormal function (pathology). For instance, ascending paresthesia and paresis is common in patients with multiple sclerosis then it is not a peculiar symptom if present in the patient and should therefore not be considered highly for prescribing. Or, as hearing voices is common in schizophrenia, then you don't pay attention to such a symptom, but instead to symptoms that make you think, and make you say Ah! Ah! 

The totality of the characteristic symptoms of a disease organized in a hierarchy from the most to the less peculiar symptoms constitutes the genius of a disease. The goal of the homeopathic physician is to now find in the materia medica the remedy whose genius is most similar to the genius of the disease of the patient. The more someone has clinical experience, and knows materia medica and human nature (pathology, ethology, psychology, etc.), the easier it is to know what is most peculiar in a case and the better prescriber he/she will be. This was the strength of Lippe, who was homeopathy's best prescriber.

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**Q:** **Some homeopathic teachers believe there must **always** be aggravation after simillimum and if there is just amelioration without aggravation, they believe the remedy was not really simillimum, just simile or perhaps a palliative. I do not find this to be the case. What is your experience / opinion on this?**


**A:** For an initial aggravation (IA) to occur after taking a homeopathic remedy (HR) depends of many factors, such as 

  - the degree of similarity between the remedy and the disease of the patient (the greater the degree of similarity the more likely there will be an IA but the earlier it will occur and it will tend to be short); 
  - the sensitivity of the patient (the more sensitive is the patient the more likely there will be an IA and the more intense it will be); 
  - the potency of the remedy (the higher is the potency the more likely there will be an IA and the more intense it will be); 
  - the repetition of the remedy (the more often the remedy is repeated the more intense will be the IA); 
  - the more acute is the condition the less likely there will be an IA; 
  - if the patient is taking high doses of strong immunosuppressive drugs or of narcotics, the less likely an IA will occur and the milder it will be. 

It is usually not a good sign if patients with chronic diseases don't report any IA after the initial dose of a homeopathic remedy, unless the remedy was given in a low potency (equal or less than 30 C), or the patients took the remedy as they were going to develop an acute dissimilar disease (e.g., a flu), or they took the remedy at the same time of an acute stress (e.g., they received a very bad news that is quite distressful to them). The earlier the IA occurs after taking a HR in patients of average sensitivity is an indication that the remedy has a high degree of similarity with the disease of the patient.((In a five month study in a large clinic, it was estimated that approximately 75% of patients with chronic diseases experienced an initial aggravation after taking the simillimum homeopathic remedy. (Paterakis S, Bachas I, Vithoulkas G. Statistical data on aggravation after the simillimum. //Journal of the American Institute of Homeopathy// 1977; 70: 267-269.))u
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