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Achieving and Maintaining the Simillimum
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Strategic Case Management for Successful Homeopathic Prescribing
This book documents and teaches Hahnemann's advanced methods, unknown to 90% of practitioners in the world.
This long awaited companion book to Hahnemann Revisited is a must for every homeopath. Dr Luc has devoted years researching the 4th, 5th and 6th editions of the Organon, all editions of Chronic Diseases, Hahnemann's Paris Case Books, and many lesser known works of von Boenninghausen, Dudgeon, Kent and other great masters.
This new book will help homeopaths become better prescribers and better case managers. More importantly, studying this book will help you restore health to your clients in the most rapid, gentle and permanent way - our highest ideal of therapy (aphorism 2).
- Author: Luc De Schepper
- ISBN: 9780942501148
- 370 pages
- Hardback
- Published in 1995
- Printed in United States
Reprinted with the permission of The Homeopathic Links, Volume 18, Spring 2005. Reviewed by Francis Treuherz, UK.
I believe that when homeopaths adopt shortcuts like putting more than one remedy into the same pill, or prescribing different remedies in the same day or week, before evaluation, for a chronically ill patient, it is because they have not been able to grasp the homeopathic method. Our colleges teach theories but perhaps insufficient methodology so that we misunderstand the philosophy. They are happy to teach the latest ideas which are as yet un-proven over time, and adopt titles like 'practical' or 'contemporary' which signify modernity and imply something pejorative about, or downgrade the idea of, 'classical'. Electronic machinery is used for diagnosis, biofeedback, allergy testing, and even the simulation of remedies which have until now been mostly prepared by pharmacies. It is the allopaths who have to make antiques of their textbooks every five years. Ours can and should last longer than that. Inexpensive reprints from India are there for most of our classics, with a few gaps which I shall mention.
Continuing professional development (CPD) seems increasingly to focus on counselling and psychological techniques for unravelling the practitioner/patient relationship rather than on unravelling the reactions of the patient in the light of homeopathic methods. There is also a focus on attending seminars and meetings as the best way to fulfil CPD.
Here is a wondrous new book which will at once become the best basic textbook of methodology for students of homeopathy, and the best CPD for even the most experienced practitioner. If Dr Luc's earlier book, Hahnemann Revisited, presented the science of homeopathy, this book presents the art. The author has painstakingly analysed Hahnemann's later works, and then analysed the work of his most famous and influential followers whether long gone like Lippe or Kent, or recent like Vithoulkas or Sankaran, in the light of his discoveries. How Hahnemann really selected and managed potency between the 4th, 5th and 6th editions is explored in detail, between different editions of the Organon; the implication is that many of us, including Vithoulkas, are actually using the methods of Hahnemann's 4th Organon (1828) not even the 5th (1833) or 6th (posthumous - 1922/ 1982/1996).
Let me elaborate on this statement:
Firstly, Dr Luc may make remarks about other homeopaths as I have quoted but they are definitely not ad hominem; they are not in any way personal attacks, but observations on practice methods.
Secondly, it is not only potency but a long list of topics which are analysed:
- Similar and Dissimilar Diseases;
- Primary and Secondary Action;
- Potency Selection in Chronic Diseases;
- The Significances of Accessory Symptoms and Related Problems;
- External Symptoms or Local Diseases -The Problem of Suppression;
- Modern Homeopathic Myths and Misconceptions;
- Lifestyle and Other Obstructions to the Cure;
- Acute Intercurrent or Intermediate Remedies, and Chronic Intercurrent Remedies or Nosodes in Chronic Diseases;
- The Second Prescription - Different Scenarios for the Second and Subsequent Prescriptions in the Management of Chronic Diseases;
- Complementary Remedies and Remedies That Follow Well Compatible Remedies;
- Clinical Examples of Management;
- Hahnemann's Paris Casebooks (1835-1843);
- Responses After the Test Dose;
- Sample Remedy Instructions.
Thirdly, the book is clear and very readable. This look at theory in practice could have been very heavy but the text is broken down into questions and answers, with cases, with references to short quotations and especially with aphorisms from the Organon. There are many diagrams.
Fourthly, there are many details, (too many for this short review) such as an analysis of the origins of the classic 19th century 'wait and watch' single dose method and ideas on how to avoid disastrous results for the patient.
There are a few flaws, but I am sure that if the author agrees with me he will correct them in the second edition, as I am sure that there will have to be one. And I shall help him if he asks me. I do not wish to appear disputatious, but rather to exemplify how conscientious Dr Luc has been in his research; he has studied papers from the Hahnemann archive in Stuttgart, and worked hard to disentangle a complex web of ideas.
There is a disclaimer at the start to the effect that there are many references to reprinted editions of old books, and the true dates are in the bibliography. The bibliography actually refers to the modern reprints on which most readers will have to rely. But the flaws in our practice originate in our lack of knowledge of the epistemology of our own subject. As an example, the 4th Organon of 1828 was translated in 1833 in Dublin and as a reprint became the first (and 2nd and 3rd and 4th) American editions and the one upon which Hering and Kent relied. The 1833 Organon was translated by Dudgeon in 1849 in London, and in 1875 in America by Wesselhoeft. So it was reliance on the earlier work of Hahnemann that has led us astray, and which Dr Luc is here correcting. The science of the transmission of our knowledge would be clearer with accurate publication dates, even a chronology of editions. There is a great one in French by the late Jacques Baur Un Livre Sans Frontieres, Histoire et Metamorphoses de I'Organon de Hahnemann, (Lyon 1991).
Dr Luc refers elegantly to Hering's Set of Observations, often taught as Hering's Law. Once again the question of editions is relevant. He refers to the 1896 Tafel translation of Hahnemann's 1833 edition of Chronic Diseases. But it is in the 1845 Hempel translation of the 1828 Chronic Diseases that Hering's Observations are published in full as a preface. I published them in The Homeopath in 1987 and I have made them available at www.homeoint.org/cazalet/hering/chronicdiseases.htm. Tafel had ignored them and so they have been forgotten by most of us; read them and ponder what we have been missing.
Many of us think we know of Hahnemann's miasms, but we overlook his fourth one, and I don't know why. The rabies miasm is Hahnemann's half-acute miasm, where onset is delayed (rabies does not always manifest itself until some time after the bite), and the manifestation may be violent. This is different from modern attempts to create more (and to my mind not essential) miasms.
My personal view is that references to traditional Chinese medicine are confusing unless we are already familiar with this, as Dr Luc is, and I have not grasped how the comparisons with yin and yang, and with the temperaments, enhance our understanding of homeopathy.
I made a conscious choice 30 years ago to stick to homeopathy as I could not cope with TCM. I shall have to re-read this book and see if I understand these references.
So I hope that I have given the right impression. This is a very rich, multi-layered and scholarly work, dealing clearly with controversial and overlooked issues on our methodology. I must go and reopen some failed cases. When some colleagues complain that they do not earn enough, I suggest that they read this book in order to improve their practice. Cured patients will refer their sick friends, and this book will help us cure more patients, rapidly, gently, and using a clear comprehensible methodology.
Second review - Reprinted with the permission of The ARH (from 'Homeopathy in Practice' journal, Summer 2005 edition). Reviewed by Ernest Roberts.
It is impossible in a short review to do full justice to all that Dr Luc covers in this long and comprehensive book, which gives clear sources from the Organon, Chronic Diseases and other classical works.
Chapters 1-2 give a learned account of the nature of homeopathy, beginning with chapter one, Similar and Dissimilar Diseases, then chapter two, Primary and Secondary Action.
Chapters 3-5 illustrate potency selection and how Hahnemann developed it over the Organon, Edition 4 (ch 3), Edition 5 (ch 4), Organon 6 (ch 5). These chapters are scholarly and will especially appeal to those of academic bent, not least medical doctors anxious to verify the scientific validity of homeopathy.
Chapter six deals with 'accessory symptoms', i.e. those appearing as part of the reaction to a remedy and how to interpret them, including an interpretation of aggravations. Dr Luc distinguishes between the effects of the similimum and a simile (a partially homeopathic remedy), and discussion includes 'sensitive' patients and complex cases. This chapter also offers good advice on how to treat various reactions, aggravations and changing symptom pictures both in acute and chronic states. For example:
to give the chronic remedy in an acute crisis is a grave mistake because it runs the risk of disrupting the natural symptom pattern
and:
during an acute crisis the remedy of choice is the acute 'intercurrent', that remedy indicated by the acute state. Dr Luc emphasises the importance of knowing 'acute to chronic' relationships, saying that it is not always necessary to prescribe a chronic after an acute unless it is heavily indicated and needed.
Dr Luc's advice on the second prescription - famously the most critical, and where most mistakes are made - is essential understanding, especially his explanation of the difference between the reaction after a similimum and a simile, and on why and how long to wait.
Chapter seven deals with suppression.
Chapter eight, Modern Myths and Misconceptions, is close to my heart. Here, Dr Luc refutes arguments which try to justify various alternative uses of potencies outside the principles of homeopathy.
Chapter nine deals with obstacles to cure and maintaining causes, including difficult patients and how to handle them. It also comments on homeopaths with the wrong motives and attitude. Dr Luc gives six principles required to establish the state of the 'unprejudiced observer': Sympathy, objectivity, discipline, concentration, patience and concern with the mastery of their art.
Dr Luc gives sound guidance on diet and lifestyle. He also considers the question of antidoting remedies, concluding that the probability of antidote depends on the following factors: Vitality, sensitivity (general and specific), quantity and frequency of contact, and the accuracy of the prescription. This is a particularly valuable chapter.
An acute intercurrent is the remedy indicated by an acute disease which comes on during chronic treatment, and chapter ten deals with various kinds of acutes. Some homeopaths prescribe the chronic remedy for acutes even when the acute picture is different from the chronic, and Dr Luc convincingly shows the folly of this, with references from Hahnemann and Von Bonninghausen.
Chapter 11 gives an introduction to nosodes, their origin and development and shows how chronic intercurrent remedies can be used to treat 'miasmatic blocks, suppression and obstacles to cure', 'that an indicated remedy is always preferred over the nosode', and that ... nosodes are truly curative only when they are administered, based on the totality of the characteristic symptoms like any other remedy.
He also discusses how to use nosodes as chronic intercurrents, how to identify and remove a blockage, and when a nosode is appropriate. The casual use of nosodes confuses many cases, and Dr Luc explains how a nosode prescribed after two or three failed remedies often cures because it was the indicated remedy from the start, and that blockage theory is often used as an easy way out.
He gives ten situations when a nosode may be correctly prescribed, and I was pleased to see that these carefully argued cases correspond to the pages on this subject in my own textbook {Homoeopathy Principles and Practice, 2001). There is a valuable description of Carcinosin with a comparison with Medorrhinum, then a similar description of Streptococcinum, with several excellent illustrative cases.
In chapter 12, The Second Prescription and the Management of Chronic Diseases he explores the discussion of chronic intercurrents and nosodes with possible scenarios following a first prescription.
Chapter 13 concerns relationships of remedies: complementary, related, and cycles (series or triads).
In part 3, Management Enquiries, Dr Luc poses and answers a variety of questions likely to come up in practice, drawing on the teaching given in chapters ten to 13. Part 4 gives clinical case studies illustrating issues raised previously.
Part 5 is a fascinating account of Hahnemann's Paris Casebooks. Here is an important quotation: The idea that Hahnemann's private practice was completely different from his published works is a mistake derived from not understanding his methods in a practical sense, nor how they evolved over the years. Due to this misunderstanding, some claim that what he practised in private was different from what he preached in public, and therefore we don't need to follow the Organon. Others have used such misunderstandings to rationalise using combination remedies, alternating remedies, and frequently changing prescriptions.
Dr Luc often refers to frequent changes as 'intercurrents', prescribed hurriedly to cover any remaining symptoms where the first prescription was doing well and waiting would probably have seen a complete cure, or eventually, a clear and stable new remedy picture. To combat this tendency, I myself reverted to using Farrington's definition of 'intercurrent' as being required only in patients who show a lack of reaction to indicated remedies.
This book is a milestone in the teaching of foundations of homeopathy. In fact, it is three books in one. I am particularly grateful to Dr Luc for his clear use of the terms 'acute' and 'chronic' intercurrents. I can strongly recommend this book to all who are 'concerned with the mastery of their art'.