In this paper it is pointed out that some very specific issues have to be considered in treatment of patients with severe chronic conditions, as well as elderly chronic patients. The Law of minimum dose is the corner stone of any form of treatment in this group of patients, not only in Homeopathy, but in general. To illustrate this we have described some situations we have come across in our homeopathic clinical practice with chronic and elderly patients and, also, a very dark moment in history that can lead us to the same conclusions.
The chronic and elderly patients are basically limited to palliation in allopathic and homeopathic medicine, unless the patient is prescribed with Simillimum. Finding the Simillimum is the only real chance for a severe chronic patient to significantly improve his condition or restore the state of health, if the Vital force is strong enough.
Samuel Hahnemann – Organon: From Aphorism §51
“The dose of which he can diminish to such a degree that they shall remain only slightly stronger than the similar natural disease they are employed to cure;”
The human organism can endure in almost unimaginably difficult situations, but then again lives are often lost by some cause that seems to be minute. When a person is on the edge a slightest amount of force may push one to death, or pull back to life. This is especially true in chronic cases, where a Homeopath must always bare on mind the Hahnemann’s words “slightly stronger” in Aphorism §51 – about the Law of minimum dose. Working with young and basically healthy individuals may leave a homeopath unaware that the Law of minimum dose is not just about aggravation – it may be the matter of life and death. Life and death are also the one of the deepest pair of opposites in nature, both present at any given time – always in struggle, without a winner.
The Law of minimum dose beyond Homeopathy
The Law of minimum dose is not just a law of Homeopathy, but also a law of nature – even the entire theory of evolution is based on it, with the slight and graduate changes in order to adapt. Examples are many, but the following one is a cautionary tale in many ways. There is one less known aspect of Holocaust that teaches us how important is to make small steps and graduate advancement in treatment of severe chronic cases. During the first weeks of liberation, tens of thousands of survivors in Nazi death camps died of over-eating, epidemics and exhaustion. In Bergen-Belsen 14,000 people died in the first weeks of liberation, from disease and because after prolonged starvation their stomachs and bodies just could not take normal quantities of food. In this period around 250 survivors a day died in Dachau. There was a story about how one of the liberators said he gave a little girl a chocolate bar and she died in about 18 hours. My neighbor was one of the survivors in Dachau. He was telling how most of those who started eating much more when the liberators came have perished in a few days, because their bodies could not take it. Only than the medical staff realized all the aspects of this terrible situation, so then he was given just a few spoons of soup a day, and then gradually more, little by little, in next few months. It took years for him to get well enough for an average meal, but thanks to this gradual and patient approach in this first period after the liberation, he had recovered quite well and lived to a very old age. Elie Wiesel described this period from his own experience in his novel Night. Here is the passage on what happened after liberation: “Our first act as free men was to throw ourselves onto the provisions. That’s all we thought about…Three days after the liberation of Buchenwald, I became very ill: some form of poisoning. I was transferred to a hospital and spent two weeks between life and death.”
Anything but taking slightly more food, a graduate increase, was a drop that spills the glass – the fact that the medical staff of the liberators was unaware of Law of minimum dose has led to so many deaths of those who have survived the unimaginable, in the first few weeks after liberation, along with other causes, of course. Giving starving people the opposite – lots of food, may sound like a logical thing to do, but that was not hunger like for someone who hasn’t ate for a few days – it was a chronic condition. The results of this contrast following the concept of “Contraria contraribus curentur” were devastating in these situations, while continuing the intake of very small quantities of food, similar to those they had before liberation, in a prolonged period of time, with gradual increase was the only possible cure – “Similia similibus curantur”. This shows us, once again, how important it is to follow the Law of Similar and the Law of minimum dose in severe chronic cases.
About Homeopathic approach to chronic conditions
The chronic conditions in general are the expression of the patients constitution, so only the constitutional remedy – Simillimum, may bring the patient back to the state of health, if the vital force is strong enough. Symptomatic treatment with homeopathic remedies, without taking the constitution into the account, is just palliation and the chances to restore the chronic patient’s health this way is almost nonexistent.
Helping a patient to find strength to keep on trying in severe chronicle conditions is also very important, as well as to advise them on diet and lifestyle. The chances for the long term recovery of a patient without “raison d’être” are slim to none, unless that changes during the illness.
A chronic patient is becoming aware of more and more limitation as the illness progresses and that awareness slowly lowers their self a steam. Any kind of too ambitious or intensive attempt of rehabilitation, that may easily end in failure, usually just lowers the self a steam of the patient and deteriorate the general condition, even more.
An example how an ill managed acute condition may become chronical
A chronic case are often a consequence of an inadequately treated acute condition.
For example we’ve had a case of a 30 year old woman with spiral fracture of the femur, to whom we have prescribed Arnica montana, followed by Calcarea phosphorica and after that Symphytum, all in low potency, as acute remedies. When the x-ray was taken again after 4 weeks, to check her progress, the bone looked so much better as if 10 weeks have past and not just 4, since injury. The doctors were fascinated with her progress, so the cast was removed immediately and she was sent to the department of Physical Medicine and Rehabilitation. There she was given the intensive program of exercises, again based on the x-rays. She didn’t tell the doctors that she was taking homeopathic remedies, so her progress was misinterpreted as the result of the apparently astonishing regenerative abilities of her body.
We have seen this kind of results on the x-ray, after prescribing homeopathic remedies for fractures many times, but this does not mean that this gift should be abused by ambition and haste. Thanks to the homeopathic remedies the bone structure gets reorganized amazingly fast, but the bonds in the newly formed bone structure, take some more time to strengthen and mature, to be able for normal function.
After two weeks of these forced and premature exercises the pain was getting worse and worse and on a new x-ray not only that the fractures have reappeared but the fragments have shifted, so the only option was the surgery with external fixation and 6 more weeks in the cast. Then followed a very long rehabilitation, but even when the fracture has finally healed, on a change of weather some sensations occur in the region where the fracture was, sometimes even pain.
Injury like fracture of an extremity is, in essence, a condition usually easy to treat, and even it may end up in a chronic condition. Also, this clearly illustrates how even the best results in initial stages of treatment may be ruined by ill managed later stages, because of bad judgment, haste, or basically doing too much, too early. If the steps in the treatment are of a slightly more intense than the natural pace, it leads to recovery of the patient in most cases and, just as important, these little successes are building the patient’s self a steam. This applies to any disease and condition, acute and chronic.
A chronic case with gradual progression to health
One of our oncological patients was diagnosed with large intestine carcinoma nine years ago, that was surgically removed, and treated with chemo. Than a year later she was diagnosed with metastasis on the liver, also treated with chemo. A few years later the metastasis on bones were visible on the x-ray. A year before the pain became so intense that only morphine patches could help, but after a year of using them pain couldn’t be relived with patches anymore. She could hardly walk because of this pain and she has lost a lot of weight. That is when she came to our practice, 4 years ago, for homeopathic treatment as one last try and she decided to stop taking all allopathic drugs including morphine patches. After administering her Simillimum – Theridon curassavicum, we had to deal with acute pain and a form of apstinential crisis. After a week of daily visits with gradual changes in dose and potency of homeopathic remedy Opium given for palliation, the pain wasn’t unbearable anymore and the iatrogenic symptoms were also much better, so we could continue with the strict Simillimum treatment. After two months of Simillimum treatment the pain was so much better that she could go for a short walk, and her appetite was much better and she has gained weight for the first time after years of losing weight in this illness. After two years of constitutional – Simillimum homeopathic treatment the pain was completely gone and she was having long walks every day, and only then she could sleep well again. A few months later she felt well enough to go on vacation to her hometown 700km away, by bus.
The first months of constitutionl treatment have shown that we were on the right track, because of the great improvement in the patient’s condition, but for recovery years of patience are needed, with very gradual improvement of the patient’s condition, with frequent supervision in follow-ups and repeating the Simillimum, when necessary. It is very important not to repeat the remedy before it is necessary.
Knowing the Simillimum of a chronic patient is not only important for the course of homeopathic treatment, but also in order to be able to give advices for the patient’s diet and lifestyle suitable for the constitution. Knowing the nature of the remedy, the Simillimum, gives us an insight into the personality, as well as situations and substances that aggravate or ameliorate the patient’s condition.
For severe chronic conditions lots of patience, understanding and compassion is needed, and since the vital force is often quite weak the potencies that are high for a particular homeopathic remedy are out of the question, until the patient gets much better. Too high potency often leads to aggravation in chronic and elderly patients, as well as exhausting activities both physically and emotionally. We have seen cases when an elderly patient, with a serious chronic condition, is starting to get better on Simillimum treatment, brought back from the edge – but a sad event, death of a loved one, or some other stress with exhaustion, was too much. These are fragile conditions, especially in the first months of treatment, with a very low Vital force, that gets completely drained in such difficult situations, and the patient may die within days.
There is another difficulty in treating chronic patients. Most of them are taking lots of allopathic drugs, and it may be very difficult to see the Simillimum, because the patients symptoms are mixed with the symptoms caused by these drugs. Even if the Simillimum is prescribed it’s action may be diminished by the action of allopathic drugs, but to quit taking them at once may also be a problem because the functioning of the organism is adjusted to the presence of those allopathic drugs. Gradual reduction of allopathic drugs for life threatening conditions, like drugs for hart conditions, epilepsy, diabetes etc, with the Simillimum treatment, is usually the right way to go in this kind of situations.
Since allopathic medicine and drugs are primarily focused on acute conditions, the chronic conditions are mostly treated as long lasting acute ones. This approach may stabilize a chronic patient and, in best case scenario, makes it bearable for a patient to live with it, while it is slowly but certainly getting worse or being suppressed, causing an even more serious condition. A well managed Simillimum homeopathic treatment, on the other hand, gives the chronic patient a chance to significantly improve the quality of life, or to restore the state of health, if the Vital force is strong enough and if the damage to the organs is not too big. Giving a patient a chance to restore the state of health, instead of offering a life with a chronic condition as the only option, makes a huge difference for the patient’s future quality of life. Once again we have to repeat the importance of taking small steps in the course of treatment of these cases and that finding the Simillimum is conditio sine qua non to be able to restore patient’s state of health.
 Holocaust Survivors. In Yad Vashem. Retrieved January 5,2015, from http://www.yadvashem.org/yv/en/holocaust/resource_center/item.asp?gate=1-13
 What did the Allies find?. In The Holocaust Explained. Retrieved January 5,2015, from http://www.theholocaustexplained.org/ks3/survival-and-legacy/liberation-the-survivors/what-did-the-allies-find/#.VKnsjCuG-So
 Wiesel E. Night. 1st ed. New York: Hill and Wang, A division of Farrar, Straus and Giroux; 2006. Retrieved January 5,2015, from http://www.scslschool.com/Documents/TeacherFiles/ElieWiesel-NightFULLTEXT_3_26_2014_3_23_04_PM.pdf