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.”
Boger touches upon some of the finer points of the technique of prescribing. “A single dose,” he remarks, “is given and the effect awaited. In very acute affections the response will come in a few minutes or hours. If the disease is of a more prolonged nature, from the fourth to the twelfth day it will develop a crisis and show us our bearings. In chronic cases, periods of aggravations may come and go like waves even until the sixteenth week, while the patient himself shows a gradual improvement. When, however, each of these waves is followed by increasing weakness, the case is usually hopeless.” On the appearance of new symptoms he says, “Often a new symptoms complex is only a variation of the older image and requires a repetition of the former remedy in a different potency.
Having carefully made up our mind as to the indicated remedy, we should be slow to change, always thoroughly testing the chosen medicine in the same scale of potencies as well as in the repetition of the dose, before abandoning it for another… We all know that when the constitutional remedy is finally worked out, it will cure almost any disease that may attacked him, even though these later symptoms may seem the opposite of those previously removed, for it must be remembered that these later manifestations are also, in all likelihood, alternate effects of the drug already in use; it were therefore folly to change the prescription.
It is a trouble maker and mixes up our cases.” Elsewhere he makes the pertinent statement that, “when old groups of symptoms come back, the mental are the most important and the best guide for the selection of the remedy.”
Again, in commenting on a paper by Grace Stevens, Boger says: “The cases with the feeblest aggravations are the ones that get along best- those with a mere suggestion of an aggravation. A gentle reaction leads to a more permanent cure.”
Under the heading of “Pointers” in the same volume, Boger is quoted as saying, “You can avoid an aggravation from a high potency by giving it in three doses two hours apart.”
Case has this to say about new symptoms: “If an eruption is an old symptom reproduced by the homoeopathic remedy, it will usually be cured by that prescription unless the appearance was of a chronic nature, then it may need one or more repetitions of the same remedy, at long intervals, to effect a cure. If the eruption is an entirely new symptoms, it shows that the ailment was in the system and the vital force needed help to throw it to the surface. If so, the eruption will soon reach its height, then gradually disappear. But if, on the other hand, the eruption persists or continues to increase in severity, it should be regarded as a new symptom and as the important guide to a remedy required for the cure of patient.”
Kent gives, by far, the most comprehensive treatment of our subject in his Lectures on Homoeopathic Philosophy. His teachings are based on the works of the homoeopathic school, including his own. The greater part of what follows is, in effect, a resume of his lectures, those of Close, or paragraphs 252 to 263 of The Organon and Hahnemanns work on Chronic Diseases.
All of these eminent homoeopathists, as we have seen, emphasize the absolute necessity of learning to wait on the action of the remedy, and of being able to distinguish between a genuine homoeopathic aggravation and one due to the action of the medicine or to the natural course of the disease itself.
Thus Wells says, “Those periods of time during which we are anxiously waiting, are a necessary part of cure; and chiefly during this period the drug is not necessarily inactive because the results of its action are not yet externally visible.”
And Lippe: “The most serious mistake that we, as well as others, have made [is] in not carefully following Hahnemanns third precaution. Hastiness in not allowing each dose sufficient time to develop and exhaust its action.”
Boger exclaims: “The watchword is wait, wait, while the full picture develops; then prescribe and your success will be pronounced and permanent.”
Close says that the hardest thing we have to learn is to wait.
There are, in general, eleven different phases in the reactions of the patient after the remedy has been given. They are as follows:
1. A steadily progressing amelioration of all symptoms.
This by most informed prescribers is considered the ideal of remedial action. It is positive proof that the potency was not too high, but quiet high enough to cope with the ailment from which the patient is suffering. While it is most often met with in acute cases, it is frequently observed in affections uncomplicated by the effects of previous drugging or other ill- advised treatment; it rarely occurs in chronic cases where the potency was right.
2. A Sharp, short and vigorous aggravation, followed by relief of all symptoms and an increase in the patients strength.
This type of aggravation is much to be desired. It is a positive indication that the medicine and the potency were correctly chosen and the cure will be rapid and complete. An aggravation of this sort is most often seen in patients of strong vitality and good reactive power, and who have little or no gross tissue changes in the internal organs; but it is frequently observed when the potency used was higher than it need have been. A lower dilution would have produced the gentle reaction which, Boger says, leads to a more permanent cure.
3. A long continued aggravation but final and slowly progressing improvement.
This reaction occurs when the medicine was administered in a potency too high for the reactive power of the patient, whose vitality, however, was able finally to assert itself, and in time, genuine curative action begins. It is usually and indication that the case was on the borderline of incurability, and often one where extensive pathology is present.
4. A prolonged aggravation and final decline of the patients condition.
