Combinations and Alternation of homeopathic Remedies

Combinations and Alternation of Remedies

Q: "I've heard it said that, in his later years, Hahnemann broke from his earlier method of using only one remedy at a time, and frequently used remedies in combination or in routine alternation to improve success in healing. Is this true?"

NO.

(That's the short answer. The long answer is:)

In 1833 (While still in Köthen, 36 years after the "birth" of homeopathy, 3 years before his move to Paris, 10 years before his death, the year prior to the publication of the 5th Edition of the Organon, and prior to his development of the LM potencies) Hahnemann experimented briefly with combining 2 remedies (never 3 or more), administered simultaneously by olfaction. He abandoned these experiments within a few months (from his letters, these experiments appeared to be carried out between June and October, 1833). These experiments were abandoned as being not successful, and the note he had been preparing on this strategy (inspired by the confidence Aegidi expressed in this approach) for the 5th edition of the Organon, as a footnote to aphorism 274, was pulled from the manuscript, and replaced by stern caution against this practice.

The idea of using two remedies in combination by olfaction was proposed to Hahnemann by Aegidi, who reported that he had had some measure of success using this approach. Hahnemann initially embraced the idea, and began experimenting with it, in collaboration with Boenninghausen, who was also taken by the idea. In these days, the homoeopathic pharmacopoeia was limited. Hahnemann's remedy chest from Paris, at the time of his death - certainly the most complete such collection in Europe in 1843 - contained 205 remedies. The Materia Medica Pura, when completed in 1833, made reference to only 67 remedies. If Hahnemann felt the need for aphorism 162 in the 6th edition of the Organon, edited in the last 6 months of his life in 1843, he certainly felt this in 1833: "Because there are still only a moderate number of medicines which are exactly known as to their true, pure action, ...". The dilemma of the limited Materia Medica was certainly a driving force in his entertaining what he referred to as "double remedies", where each appeared to cover complementary portions of the totality of symptoms. The problem was, it just didn't work in practice.

Here is a letter from Hahnemann to Boenninghausen on the topic, near the close of these brief experiments (it may be found in Haehl's biography of Hahnemann, vol. 2, p. 253; the emphases were added by David Little):

Cöthen, October 16, 1833
Your eloquence would have easily persuaded me, if I had been in your position, that is, if I had been as much convinced as you are from a large experience of the possibility or even great utility of giving double remedies. *BUT FROM MANY ATTEMPTS OF THIS KIND ONLY ONE OR TWO HAVE BEEN SUCCESSFUL, which is insufficient for the incontrovertible establishment of a new rule*. I was therefore, too inexperienced in this practice to support it with full conviction. Consequently it required only a slight momentum to induce me to alter that passage in the new "Organon" which results in this, that I concede the possibility that two well chosen remedies may be given together with advantage in some cases BUT THAT THIS SEEMS TO BE A VERY DIFFICULT AND DOUBTFUL METHOD. And in this way, I believe I have done justice to truth on the one side and to any inner conviction on the other. I should be sorry if in that way I have receded too much from your wishes.
Samuel Hahnemann

Hahnemann, Boenninghausen and Aegidi all abandoned the use of double remedies at this time, 10 years before Hahnemann's death, after less than a years' experiments with them which proved this approach to their satisfaction to be ineffective and risky. The 5th edition of the Organon as published cautioned against this practice, and the 6th edition left us with the experience of Hahnemann's next 10 years telling us (aphorism 273):

In no case of cure is it necessary to employ more than a single simple medicinal substance at one time with a patient. For this reason alone, it is inadmissible to do so.

Hahnemann describes his well-considered approach to the dilemma of having all-too-few well-proved remedies in aphorisms 162-171 of his Organon. He also tells us that the growth of the materia medica from 1833 to 1843 has had a major effect on reducing this dilemma (aphorism 166: "Such a case, however, is very rare due to the recent increase in the number of medicines known according to their pure actions"). With the nearly 10-fold increase in the size of our materia medica from 1843 to the present, this should be of even less concern for the conscientious student of homeopathic art today.

Now there was a piece of historical subterfuge that adds an interesting accent to this. In 1865, on Hahnemann's birthday (32 years after the publication of the 5th edition of the Organon, 22 years after Hahnemann's death, when Melanie was still sitting on Hahnemann's 6th edition manuscript), Arthur Lutze of Köthen published what he (falsely) represented to be a 6th edition of the Organon. On the basis of Hahnemann's letters to Boenninghausen during the early portion of those 1833 experiments, Lutze included (along with several other alterations of his own) an aphorism 274 note advocating the use of "double remedies". In response to this, Aegidi wrote: "(Lutze) whilst including the mention of my name ... yet omitted to mention that ... years ago, I loudly and publicly made known my disapproval of the administration of so-called double remedies, as an abuse and mischievous proceeding." Boenninghausen responded cogently, "If consequently in our day, a homoeopathician takes it into his head to act according to experiments made thirty years ago, when our science was still in its infancy, and which were subsequently condemned by a unanimous vote, he clearly walks backward, like a crab, and shows that he has neither kept up with, nor followed the progress of science".

Hahnemann and his colleagues similarly experimented with the close alternation of two (but not more) remedies, such as the alternation of Rhus-t and Bryonia that he employed in the treatment of the typhus epidemic among the Russian soldiers chasing back Napoleon's army about Dresden in 1814, and the alternation of Poppy and Ipecacuanha in the treatment of the scarlet fever epidemic in Königlsutter in 1799. But read these accounts carefully (they are in his Lesser Writings, compiled by Dudgeon) - because, even in this early stage in the development of homeopathy, this was not routine alternation - each remedy was given based on the prevailing totality of symptoms, and we can follow the directives of the 6th edition of the Organon, aphorisms 162-184 (on treating with an inadequate stock of medicines and on treating one-sided disease) to understand his approach even before the 4th birthday of homeopathy.

There's a great letter from Hahnemann to Aegidi on this larger topic of homoeopathic polypharmacy, that should be sobering for us all:

Cöthen, January 9th, 1834
In my opinion you have proceeded somewhat too speedily in the matter of administering double remedies, since you are generally an impulsive man. I cannot and will not prevent you from talking about it in public; I don't do it myself.
You presuppose that imitators could easily find the correct Simillimum in such a case of illness not only for one part of the symptoms but also the other part and in such a way that they could always achieve good results. Ah! if most homoeopaths could or would discover only ONE remedy, exactly suitable in accurate similarity to the characteristic symptoms, we would gladly excuse them the necessity of finding the nearest suitable one!
For my part I find the discovery of the right remedy difficult and laborious in every case. Therefore I do not see how they would hit upon the first, to say nothing of the second twin remedy so easily! Pardon me for being so incredulous in this matter. However, I leave it to you to write about as you think fit - but I beg you to use only the "Archiv", as both the homoeopathic periodicals appear before the general public ... ; it will be a delight for the allopaths.
Samuel Hahnemann