The Single Dose. William Yingling

 

After properly “taking the case”, and the selection of the simillimum, the true Hahnemannian, holds in importance the exhibition of the remedy. Shall the remedy be given, in a single dose or, without reason, in a multitude of repetitions ? That is a most important consideration whether the potency be low or high, as either the high or low potency will cure, or do great injury when improperly administered. Its determination will materially influence the curative action of the remedy- From this reason the question of dose should occupy a higher plane in the minds of all prescribers, and be determined with care and reason.

There is a misapprehension on the part of many regarding the exhibition of single dose. Some suppose it to mean that each individual patient is to receive one, and only dose of the given remedy, and no more. This is erroneous. The single dose does not apply to the case alone, but directly to the prescription. Each prescription is to be of a single dose, unless there are very strong reasons for a repetition arising out of the nature of the acute case, or the similarity of the remedy, which will be but seldom with careful prescribers, and then only until the drug shows an action. If a well selected drug does not show an action within a reasonable time, reason tells us to repeat it. But under such a circumstance the reasoning would be the same as a new prescription, and the repetition upon reason would be the same as a single dose with each prescription. To repeat without reason would be guessing, and hence censurable if not criminal. With but very few patients can the repetition be submitted to their judgements. If you say. Repeat till better, then stop, the patient will reason that if one dose does good, another will do more good, and hence will continue to repeat to the detriment of the case. It is seldom that more than one dose is needed in a single prescription, occasionally two or even three doses may be required to effect the vital force, and make a change in the case. Following this, the next dose may be of an entirely different remedy. To give a remedy when another is indicated may do harm and complicate matters to such an extent that great trouble, even danger to the patient’s life may arise. The only safe plan is to follow the directions of the Master.

This plan is not incompatible with a large practice, as our remedies act for hours and days in acute diseases and for weeks and months in chronic cases. A very critical case necessarily must be seen frequently, and in such a case it would be the height of folly to submit the all-important question of repetition to the judgement and decision of the panic-stricken friends or to the incompetency of the nurse. To return in six or twelve hours would be wiser and safer than to repeat on a guess without reason. In emergency cases, like haemorrhage, convulsions, etc.. the physician is expected to remain till the remedy shows an ameliorative action, and then to see or to hear from the case within a reasonable time.

In chronic cases there is no danger in writing on a single dose, and it frequently requires days, or even weeks before a change may be noticed ; but when undisturbed, always followed by a happy action of the true remedy. In chronic cases the skill of the physician is gauged to a very large extent by his ability to intelligently wait on the action of the remedy. He must know the nature of the disease and the indications of the favorable action of his remedy. If the disease goes from within outward, from above downward, from the more important to the less important organs, he may rest assured that his remedy is favorably acting and that a repetition of the dose is not called for.

There are persons so constituted as to be uninfluenced by a single dose of remedy, but I feel free to say that the vast majority of such uninfluenced cases arise from a wrong selection of the remedy. It is plain to be seen that a similar remedy will require more repetition than the simillimum. There may be several similar remedies to a given case, but there can be but one simillimum. The similar will lack something, thus not striking the vital force properly and requiring a repetition and more time to effect a cure.

The simillimum exactly fits the case, its action goes right to the centre of the mark, and the cure is the most speedy, pleasant and effective. The simillimum seldom needs repetition ; the similar most always needs it, and the farther it is from the one simillimum the more need there will be for the repetition. Either may cure ; only the simillimum is sure of a cure in all curable cases. I believe that if a simillimum to the entire state of the patient is found, one dose of a high potency is sufficient, either in chronic or acute cases’, but when the medicine does not fully correspond as may often happen through the deficiencies of even our large Materia Medica, the dose may have to be repeated, the want of a complete similarity hindering the curative action of the drug, and in these cases the more acute the disease the more frequent must be the repetition, because the action of the drug then becomes more speedily exhausted, unless it is sufficiently homoeopathic to subdue the disease at once. This view is in accordance with the teaching of Hahnemann. One thing is certain, that when the curative effect has set in we should let the medicine act undisturbed till its effect has entirely ceased.

Again, in certain cases a frequent repetition may be needed to effect a cure. This applies to those cases where several doses have been given of the same remedy ; the symptoms remaining the same ; each dose has had a favorable result, but with a lessening effect. Then a lower potency should be given in water and frequently repeated till a very decided result has been obtained. Or as Dr. Ad. Lippe remarks, “If a dose administered has acted for a long time, in acute diseases, for days in chronic diseases for weeks or months, we may reasonably judge that it would be best to again administer one more single dose ; but if the action of the dose lasted only a comparatively short time, has been rapidly exhausted, especially in acute diseases, and a repetition appears still advisable, then it would almost always be better to dissolve a single dose of the remedy now to be repeated in some few ounces of water and continue its administration in broken doses till it becomes evident that the action of the dose in this manner administered has fully set in, and the symptoms for which it was given are yielding to it, becoming lessened in every respect. The greatest care should be taken never to repeat the dose, or administer another remedy till the effects of the dose last taken have been exhausted.”

The rule should be to carefully “take the case”, by comparison select the remedy, covering the totality of the symptoms, the simillimum, and then exhibit it in a single dose of some potency whether high or low, according to the faith and practice of the prescriber.

The single dose is no new doctrine, but one as old as the school of Homoeopathy. This may be seen from a careful study of the Organon and other writing of Hahnemann. He says in article 158 of the Organon : “This slight homoeopathic aggravation during the first hours, is quite in order and in case of an acute diseases, generally serves as an excellent indication that it will yield to the very first dose. “Also in his remarks upon article 246 he elaborately elucidates this subject. Among other things he says, “In the former edition of the Organon. I have recommended that a single dose of a well selected Homoeopathic remedy should be allowed to terminate its operation before the same or a new remedy is repeated, a doctrine derived from the same certain experience that the greatest amount of good can scarcely ever be accomplished, particularly in chronic diseases, by a large dose of medicine (a retrogressive measure recently proposed) however well selected, or what amounts to the same thing, by several small doses administered in rapid succession, because a procedure of this kind, will not permit the vital force to undergo imperceptibly the change from the natural disease to the similar drug disease.

On the contrary, it is usually excited to violent repulsive action by one large dose, or by the quick succession of a several smaller doses, so that the reaction of the vital force, in most cases, is anything but beneficial, doing more harm than good. Therefore, while it was impossible to discover a more salutary method than the one proposed by me, it was necessary to obey the philanthropic rule of precaution : “Sinon juvat modo se noceat” in accordance with which maxim, the homoeopathic physician considering human welfare to be his highest aim, was to administer but one most minute dose at a time, of a carefully selected medicine in a case of disease to allow this dose to act upon the patient and to terminate its action. I say most minute, since it holds good, and will continue to hold good as an incontrovertible homoeopathic rule of cure that the best dose of correctly selected medicine will always be the smallest in one of the high potencies for chronic as well as for acute diseases.

“A quick number of small doses, repeated for the same purpose in quick succession will accumulate in the organism till they constitute as it were, one large dose, and will produce the same evil result, except in some rare instances. The vital force, unable to recover during the interval even between small doses, is over tasked and overpowered, incapacitated to begin curative reaction and compelled to continue passively the predominant drug disease forced upon it. This process is similar to that produced by the large and accumulating allopathic doses of the drug, resulting in protracted injury to the patient, an event we are called upon daily to witness.”

The following letter from Hahnemann to a patient is to be the point. This letter is in the possession of Dr. J. C. Burnett :

“My dear Post Master, … You have done well to inquire of me whether, in case of obvious (striking) amelioration of your salivary fistula, you should nevertheless take a new medicament ? I answer No. Continue so long entirely without medicine, living regularly, until the gland has been again getting worse for seven days. Then only begin with the new medicine.

“It is impossible in the various constitutions of the body to determine how long a given anti-psoric drug may continue to act. This much, however, is certain, that its action lasts as long as it does good, and the disease does not again continuously increase”

Now that you may plainly see that Hahnemann and his coadjutors relied on the single dose, I have every hope that you wilt also put to test Hahnemann’s golden rules and enjoy the best results !

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