[Read in part before the 97th annual convention of the Ill Hom. Med. Assn., May 13. 1952. Adapted from one of three chapters by the writers for a 500 page book now being edited for publication].
Journal of the Amer. Isti. of Homoeo. November, 1954.
The accurate interpretation of the changes occurring after the remedy has been given is, in some respects, more important than the selection of the right remedy and the repetition of the dose. As Jahr so wisely remarks. “The physicians, be he ever so well acquainted with the remedies at his command, is unable to tell absolutely that his remedy is right. Jahr speaks with authority, for at the time he penned these words, he had practised according to the law of similars for more than forty years. His logical mind and long years of experience had taught him that, no matter how carefully he had chosen his remedy, he could not be sure in the majority of cases how the patient would react to it.
Kent  goes even farther when he says, “The whole future of the patient may depend upon the conclusions that the physician arrives at after the remedy has been administered.”
Roberts  adds his testimony regarding this phase of the art of prescribing. He says, It is upon the development of the reaction of the vital energy to the remedy, that successful prescribing largely depends.”
The correct evaluation of symptoms is peculiar to the Homoeopathic School. It is an absolute essential for the differentiation of remedies and the selection of the similimum. Nevertheless, it is sadly neglected by many of those physicians who call themselves homoeopathists. For this reason, the instructions given in this paper will mean little to the prescriber who persists in using only low potencies, repeats his doses over a long period of his patients.
The consequence is that normal reactions are interrupted or entirely obliterated by the long series of primary effects thus produced; the advocate of this method seldom sees them or if by chance they are able to manifest themselves, he is usually unaware of their significance. While there can be no doubt but that his results, especially in acute affections, are far better than those obtained by the antibiotics and palliative drugs of the dominant school, he fails to cure many deep-seated, chronic diseases that are amenable to correct homoeopathic prescribing.
During his thirty-three years of experience, from 1796 to 1829, when he published The Chronic Diseases. Hahnemann learned much concerning the reactions following the administration of the remedy and their interpretation. In the several essays he published during this period and in The Organon, he lays the foundation upon which the act of prescribing homoeopathically is based.
Those of his disciples who observed his instructions to the letter were the most successful prescribers in the history of our School, especially in the treatment of chronic diseases, as proved by the vast number of cures they have recorded in our literature of the past century and a half.
So eminently practical were Hahnemanns instructions that they could not be improved upon. All that these physicians could do was to define more clearly their application in the treatment of diseases and add a few rules for the use of the very high potencies. This can be readily understood. Hahnemann  published the first exposition of his new system of therapeutics only after six years of painstaking, methodical experimentation and research.
He wrote his famous “Essay on a New Principle for Ascertaining the Curative Powers of Drugs” in 1796. In it he give little more than an outline of the results of his labors. Another ten years elapsed before he felt that he could venture a more complete presentation. This he gives in an essay entitled. “The Medicine of Experience.”  which appeared in Hufelands Journal in 1805. The first edition of his crowning work, The Organon of Medicine, was not published until 1810.
This alone should have won the attention of all conscientious physicians who were looking for something better than they had. But prejudice, slavish adherence to tradition and the dicta of so-called authorities prevented any general acceptance of Hahnemanns revolutionary doctrines.
Moreover, since all who were concerted to Homoeopathy at that time came from the old school, it was quite natural that many, who were unable to divest themselves of their preconceived notions and what they were taught in college, would not accept Hahnemanns teachings in their entirety.
Thus it was that, soon after the publication of The Organon, a controversy arose which was to grow more bitter as the years rolled by and to split the ranks of the homoeopathic fraternity into two factions-one composed of those who were not content with differing with the views of the “Master,” but who criticised him for what they called “his despotism and desire to rule the opinions of other,” and condemned many of his teachings as theoretical, superfluous or unscientific; the other made up of those who followed Hahnemann implicity.
It was in the nature of a revolution, which, in 1835, assumed a more definite form in the so-called “Natural Scientific Movement of Homoeopathy in Germany,” originated by Moritz Muller and defined by the eighteen thesis of Paul Wolf. Haehl  is of the opinion that the basic conceptions of these thesis is of the greatest historical importance and is acknowledged by many at this day.
This explains why the majority of the early homoeopaths- and indeed those of later years-have little to say on our subject. They observed only a few of the changed resulting from the action of the remedy, such as amelioration, aggravation or not change at all.
In general, the change that are observed after the remedy has been given are:
1. Amelioration of symptoms.
2. Aggravation of symptoms.
3. Changes in the order of the appearance or disappearance of symptoms.
4. The appearance of new symptoms.
5. The return of old symptoms.
6. No change in the symptoms.
Each one of these reactions has a definite meaning to the physician who knows how to interpret it. From these observations he may determine not only the accuracy of his choice of remedy and potency, and of the repetition of the dose, but also something concerning the prognosis of the case.
Only a few of the more advanced thinkers deal with the finer points pertaining to the interpretation of the reactions when the remedy has begun to act. In the general discussion, the “homoeopathic aggravation” seems to have received the most aggravation. While many of the earlier writers admit that it may occur, the majority of them are apt to minimize its importance; some deny that it is a reality.
Among more recent authors, Boyd, in his The Simile in Medicine, presumes to give the history of its development in a chapter of two pages; and in his concluding paragraph says: “In later years the homoeopathic aggravation played a minor role: in general it was appreciated that it might occur, but that it was not essential. The literature indicated that it was most often reported by the high potentists.”
Hahnemann laid the foundation and covered all the salient points in his writings, from the first essay in 1796 to the sixth edition of The Organon. As intimated above, the keener minds among his successors, men like Jahr, Boenninghausen, Hering, Lippe, Wells, Close, Kent, Boger, Case and Roberts, amplified his instructions and added new suggestions for their application, especially for the use of the very high potencies. While much valuable information may be gleaned from their essays and reports of clinical cases, only Kent and Roberts treat the subject with any degree of completeness.
In the Medicine of Experience, Hahnemann says: “If the medicine we have chosen for the positive (curative) treatment excites almost no suffering previously unfelt by the patient, produces no new symptom, it is the appropriate medicament and will certainly cure the original malady, even though the patient and his friends should not admit that any amendment has resulted from the commencing doses.”
“Every aggravation, as it is called, of a disease the occurs during the use of a medicine (in doses repeated before or immediately after the expiration of its term of action) in the form of new symptoms not hitherto proper to the disease, is owing solely to the medicine employed, if there have taken place no important error of regimen, no outbreak of violent passions, no irresistible evolution of the course of nature by the occurrence or cessation of the menstrual function, by puberty, conception or parturition); these symptoms are always the effect of the medicine action which, as an unsuitably chosen positive remedy, either ill selected or given for too long a time, and [in] too large doses, develops them by its peculiar mode of action… The aggravation alluded to,” he says, “bears no resemblance to the increase of the original symptoms of the disease.
However, there is no positive remedy, be it ever so well selected, which may not produce at least one slight, unusual symptom, unusual suffering, during the employment in very irritable, sensitive patients, for it is impossible that the medicine and disease should correspond as accurately in their symptoms as two triangles of equal angles and sides, resembling each other. But this unimportant difference is (in a favorable cases) more than compensated by the inherent energy of the vitality.”
On another page, Hahnemann gives the most certain indication that the remedy is acting curatively when he says: “In favorable cases, the strength of the patient returns immediately and lingering period of convalescence, usual under other modes of treatment, is not met with.”
In paragraphs 155, 160, 161 and elsewhere in The Organon, similar instructions are given. He says in paragraph 161 that when he limits the homoeopathic aggravation to the first few hours, he refers especially to its occurrence in acute diseases of recent origin, but, “where medicines of long action have to combat a malady of considerable or very long standing, where no such apparent increase of the original disease ought to appear during treatment and it does not so appear if the accurately chosen medicine was given in proper, small, gradually higher doses.” He then refers the reader to paragraphs 247, where he describes his “new altered but perfected method of repeating the dose” in chronic cases, raising the potency slightly with each dose.
But in paragraphs 280 and 281, he warns the physician against continuing to repeat in chronic cases, when, after it has been accompanied by general improvement, the “patient begins to feel in a mild degree, the return of one or several old, original complaints. This” he says, “indicates that the similar medicinal disease in order to lose the sensation of the natural disease. It indicates that the life principle now free from the natural disease, begins to suffer something of the medicinal disease, hitherto known as the homoeopathic aggravation.
In order to be convinced of this, the patient is left without any medication for eight, ten or fifteen days meanwhile giving him only some powders of sugar of milk. If the few last complaints are due to the medicine stimulating the original disease symptoms, then these complaints will disappear in a few days or hours. If, during these days without medicine, while continuing good hygienic regulations and nothing more of the original disease is seen, he is probably cured.”
In paragraph 263 the author amplifies a statement, made in The Medicine of Experience, that in the best cases the strength of the patient returns immediately after the administration of the medicine by saying that “among the signs that, in all diseases, especially in such as are of the acute nature, inform us of a slight commencement of amelioration or aggravation that is not perceptible to everyone, the state of mind and the whole demeanor of the patient are most certain and instructive.
In the case of ever so slight an improvement, we observe a greater degree of calmness of the mind, higher spirits- a kind of return of the natural state.” In other words he lays the basis for that most important tenet of homoeopathy, that cure is from within outward or from above downward.
Although Hahnemann gives some instructions in The Organon as to the management of cases in which there is an underlying taint or miasm,” he is more explicit in his work on the Chronic Diseases.  Speaking of the suppression of the external manifestation of psora in the form of an eruption on the skin, he says that in some vigorous itch patient, the vital force, following the law of nature on which it rests (“her instinct showing more wisdom than the intelligence of her destroyers”), after some weeks, drives back to the skin the eruption suppressed by ointments and purgatives, the patient returns to the hospital and the mischievous destruction of the eruption by means of ointments or lotions in repeated.
In its complete state i.e., so long as the original eruption is still on the skin, so as to assuage, the internal malady, the entire disease of the psora may be cured easily, quickly and surely. But when by the destruction of this original cutaneous eruption which acts vicariously for the internal malady, it has been robbed, then the psora has been put in the unnatural position of dominating, in a merely one-sided manner, the internal finer parts of the whole organism, thus of being compelled to develop its secondary symptoms, which are in effect, “all chronic functional and organic, non-venereal diseases, and which, when complicated by numerous artificial drug diseases, is exceedingly difficult to cure…”
If, Hahnemann continues, [when] the well-chosen antipsoric remedy is still acting, a slight headache, a sore throat, a diarrhea or a moderate pain should arise in one part or another, the physician should not, at once, give another remedy, but should allow the one that has been given to finish it course without interruption.
“For, if the symptoms occurring during the action of the remedy have occurred in a similar manner some weeks or some months before.. they are a sign that this medicine is acting deeply into the very essence of the disease and that, consequently, it will be more effective in the future… But if these aggravated original symptoms appear on subsequent days, still of the same strength as in the beginning or even with increased severity, it is a sign that the dose of this antipsoric remedy, properly selected according to homoeopathic principles, was too large.”
“Now if we consider the great changes which must be effected by “the medicine in many variously composite and incredibly delicate parts of our living organism before a chronic miasm so deeply rooted and, as it were, parasitically interwoven with the economy of our life as psora is, can be eradicated; then it may well be seen how natural it is that, during the long continued action of a dose of an antipsoric medicine assaults may be made at various periods on the organism, as it were in undulating fluctuations during this long continued disease.”
“As a rule, the antipsoric medicines in chronic diseases continue their action the longer, the more tedious the diseases are… Whoever can restrain his impatience as to this point will reach his object the more quickly and the more certainly.”
The direction of the curative action of the remedy is illustrated on page 135 of The Organon, where Hahnemann says, “The latest symptoms that have been added to a chronic disease which has been left to itself (and thus not aggravated by medical mismanagement) are always the first to yield to antipsoric treatment; the oldest ailments, among which are the constant local ailments, are the last to give way.”
Even before Hahnemann re-discovered the law similia, he recognized the deterring effects of the patients habits of eating, drinking and other factors that are apt to hinder the action of the medicine prescribed. It is not surprising, therefore, that in a note to paragraph 260 of The Organon, he gives a long list of foods and drinks that will interfere with the treatment. He forbids the use of tea and coffee entirely. In the work on chronic diseases, he is equally emphatic in his warnings, saying that when the medicine fails to yield results, the physician should inquire into the patients habits and the “mishaps,” as he calls them, before selecting a new remedy.
It is not essential that the student of homoeopathy accept Hahnemanns theory of the chronic miasms in toto, provided he recognize the basic principle therein involved. Few will question the ill-effects of suppression in acute as well as in chronic affections, for it is a fundamental tenet of homoeopathic therapeutics. For this reason he should read with care Hahnemanns instructions regarding the treatment of “mixed miasms,” on page 93 to 95 of The Chronic Diseases and familiarize himself with the symptoms which characterize the several miasmatic taints. Including the materia medica of anti-psoric remedies, they comprise almost nine-tenths of this great work.
Probably most chronic patients are burdened with two miasms, and occasionally with all three. When the symptoms of psora are in evidence, an anti-psoric remedy is given and repeated until they disappears. In that event, the symptoms of one of the other taints manifest themselves, and the suitable anti-miasmatic remedy must be administered. When it has run its course, the third miasm will take the field. If psora has not been entirely eradicated, the reappearance of its characteristics will confirm the fact, and the same or another anti-psoric must be given which, as a rule, completes the cure.
As previously stated, the majority of the early writers have little to say on our subject. Schron, for instance, says that if we take into consideration the fact that what were supposed to have been medicinal aggravations are generally to be ascribed to the natural course of the diseases and that an occasional aggravation is not to be avoided, though we use the smallest doses; it is not easy to see why we should waste precious time by the administration of the smallest doses which sometimes have no effect whatsoever. He says that he has never witnessed any -so- called homoeopathic aggravations.
Kampfer attempts to explain the apparent paradox that medicinal aggravations may occur from the use of small doses, while none are observed after the employment of larger ones, by stating that the same dose of the same medicine, in the same disease but under different circumstances, may produce quite different, even opposite results, and in very different doses, identically the same results.
Rummel asserts that the homoeopathic aggravation seldom occurs, and often the increase in the symptoms following the administration of a remedy, is an exacerbation in the natural course of the disease.
Griesselich evidently had no fear of homoeopathic aggravations. He says that, in dangerous acute diseases, it is always safer to give a little too much of the medicine than too little. Such is the susceptibility of the organism in his opinion, and such its power of neutralizing any excess of the remedial agent, that the range of dosage applicable for any disease is much greater than is commonly supposed. He thinks that there is too great a tendency among homoeopaths to attribute everything to the action of the remedy, and that the imagination of the patient is an important factor, especially with regard to the so-called homoeopathic aggravation.
Arnold contends that aggravations following any potency are rare and of no special significance.
Aegidi follows almost to the letter the teachings of Hahnemann as do Rau and Trinks.
Gross says that, according to his experience, aggravations are of two types, one which appears early and lasts but a short time and is due to doses that were too small; the other occurring later, caused by doses that were too large.
Boenninghausen is in entire agreement with the precepts of The Organon.
Jahr, as could be anticipated, discusses the subject of the reactions to the remedy with his usual thoroughness and relates some confirmatory cases. The same may be said of Lippe, Wells and others of the so-called high-potentists.
Lippe was a master of homoeopathic technique. The majority of his suggestions for the prescriber, clinical hints and methods of procedure in difficult situation are scattered throughout his numerous papers and essays. Much may be gleaned from his reports of clinical cases, for he usually explained why he gave such and such a remedy or his reason for changing it.
In a notable paper dealing with the “second prescription,” he contributes some valuable information on our subject. Speaking of acute diseases he says: “When a well chosen remedy has been administered in a single dose (which was his usual custom), and when the improvement is of short duration, the symptoms may be the same as before or they have changed, so that the same remedy is no longer indicated, the second dose becomes imperatively necessary; if the same remedy is still indicated, it will generally be best to repeat it in a watery solution and to administer it by spoonful at shorter or longer intervals still a decided improvement begins; this whether it be in a high or a low potency.
But if another remedy is called for, it is best to administer this carefully chosen remedy in a single dose and carefully note the results, never repeating it till the action is fully exhausted. If the effects are of short duration, it is time enough to repeat it, but in a different potency than the one first given… When, in a grave case, repeated doses of various remedies have been administered may still follow when a well selected remedy is given in a high potency.”