Achieving Maintaining Simillimum

Review

Reviewed by Francis Treuherz

I believe that when homeopaths adopt short cuts like putting more than one remedy into the same pill, or different remedies in the same day or week, before evaluation, for a chronically ill patient, it is because they have not been able to grasp the homeopathic method. Our colleges teach theories but perhaps insufficient methodology so that we misunderstand the philosophy. They are happy to teach the latest ideas which are as yet unproven over time, and adopt titles like 'practical' or 'contemporary' which signify modernity and imply something pejorative, or downgrade the idea of 'classical'. Electronic machinery is used for diagnosis, biofeedback, allergy testing, and even the simulation of remedies which have until now been prepared by pharmacies. It is the allopaths who have to make antiques of their textbooks every 5 years. Ours can and should last longer than that. Inexpensive reprints from India are there for most of our classics, with a few gaps which I shall mention.

Continuing professional development (CPD) seems increasingly to focus on counselling and psychological techniques for unravelling the practitioner / patient relationship rather than unravel the reactions of the patient in the light of homeopathic methods. There is also a focus on attending seminars and meetings as the best way to fulfil CPD.

Here is a wondrous new book which will at once become the best basic textbook of methodology for students of homeopathy, and the best CPD for even the most experienced practitioner. If Dr Luc's earlier book, Hahnemann Revisited, presented the science of homeopathy this book presents the art. The author has painstakingly analysed Hahnemann's later works, and then analysed the work of his most famous and influential followers whether long gone like Lippe or Kent, or recent like Vithoulkas or Sankaran, in the light of his discoveries. How Hahnemann really selected and managed potency between the 4th, 5th and 6th editions , is explored in detail, between different editions of the Organon; the implication is that many of us, including Vithoulkas, are actually using the methods of Hahnemann's 4th Organon (1828) not even the 5th (1833) or 6th (posthumous - 1922 / 1982 /1996).

Let me elaborate on this statement:
Firstly Dr Luc may make remarks about other homeopaths as I have quoted but they are definitely not ad hominem, they are not in any way personal attacks, they are observations on practice methods.

Secondly it is not only potency, but a long list of topics which are analysed:
Similar and Dissimilar Diseases;
Primary and Secondary Action;
Potency Selection in Chronic Diseases;
The Significances of Accessory Symptoms and Related Problems;
External Symptoms or Local Diseases - The Problem of Suppression;
Modern Homeopathic Myths and Misconceptions;
Lifestyle and Other Obstructions to the Cure;
Acute Intercurrent or Intermediate Remedies, and Chronic Intercurrent Remedies or Nosodes in Chronic Diseases;
The Second Prescription - Different Scenarios for the Second and Subsequent Prescriptions in the Management of Chronic Diseases;
Complementary Remedies and Remedies That Follow Well Compatible Remedies;
Clinical Examples of Management;
Hahnemann's Paris Casebooks (1835-1843);
Responses After the Test Dose;
Sample Remedy Instructions

Thirdly the book is clear and very readable, this look at theory in practice could be very heavy but the text is broken up with questions and answers, with cases, with references to short quotations, especially of aphorisms from the Organon. There are many diagrams.

Fourthly there are many details, too many for this short review, such as an analysis of the origins of the classic 19c 'wait and watch' single dose method and ideas on how to avoid disastrous results for the patient.

There are some flaws, (not many) but I am sure if the author agrees with me, he will correct them in the second edition, as I am sure that there will have to be one. And I shall help him if he asks me. I do not wish to appear disputatious, but to exemplify how conscientious Dr Luc has been in his research; he has studied papers from the Hahnemann archive in Stuttgart, and worked hard to disentangle a complex web of ideas.

There is a disclaimer at the start that there are many references to reprinted editions of old books, and the true dates are in the bibliography. The bibliography actually refers to the modern reprints on which most readers will have to reply. But the flaws in our practice originate in our lack of knowledge of the epistemology of our own subject. As an example, the 4th Organon of 1828 was translated in 1833 in Dublin and as a reprint became the first (and 2nd and 3rd and 4th) American editions and the one upon which Hering and Kent relied. The 1833 Organon was translated by Dudgeon in 1849 in London, and 1875 in America by Wesselhoeft. So it was reliance on earlier work of Hahnemann that has led us astray, and which Dr Luc is here correcting. The science of the transmission of our knowledge would be clearer with accurate publication dates, even a chronology of editions. There is a great one in French by the late Jacques Baur Un Livre Sans Frontieres, Histoire et Metamorphoses de l'Organon de Hahnemann, (Lyon 1991).

Dr Luc refers elegantly to Hering's Set of Observations, often taught as Hering's Law. Once again the story of editions is needed. He refers to the 1896 Tafel translation of Hahnemann's 1833 edition of Chronic Diseases. But it is in the 1845 Hempel translation of the 1828 Chronic Diseases that Hering's Observations are published in full as a preface. I published them in The Homeopath in 1987 and I have made them available at www.homeoint.org/cazalet/hering/chronicdiseases.htm . Tafel had ignored them and so they have been forgotten by most of us; read them and ponder what we have been missing.

Many of us think we know of Hahnemann's miasms, but we overlook his fourth one, and I know not why. The rabies miasm is Hahnemann's half acute miasm, where onset is delayed (rabies does not always manifest until some time after the bite), and the manifestation may be violent. This is different from modern attempts to create more (and to my mind not essential) miasms.

My personal preference is that references to traditional Chinese medicine are confusing unless we are already familiar with this, as is Dr Luc, and I have not grasped how the comparisons with yin and yang, and with the temperaments, enhance our understanding of homeopathy. I made a conscious choice 30 years ago to stick to homeopathy as I could not cope with TCM. I shall have to re read this book and see if I understand these references.

So I hope that I have given the right impression. This is a very rich, multi layered and scholarly book, dealing clearly with controversial and overlooked problems on our methodology. I must go and reopen some failed cases. When some colleagues complain that they do not earn enough suggest that they read this book in order to improve their practice. Cured patients will refer their sick friends, and this book will help us cure more patients, rapidly, gently, and using a clear comprehensible methodology.

Francis Treuherz MA RSHom FSHom
Registered Homeopath
2 Exeter Road
London NW2 4SP

+44(0) 208 450 6564 Phone & Fax +44(0) 795 845 9446 Mobile

www.homeopathyhelpline.com

 

This book review is reprinted from Volume 10, 2004 Edition of The American Homeopath with permission from The American Homeopath.
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Reviewed by Melanie Grimes, RSHom (NA), CCH

This extensive work covers homeopathic philosophy from potency selection, to case management, to clinical examples. Much of the research is taken from De Schepper's clinical experience, as well as Hahnemann's Paris Casebooks (1835-1843), and various editions of Hahnemann's Organon and Chronic Disease.

Part One contains information about the vital force and remedy selection, taken from the 4th, 5th and 6th editions of the Organon.

Part Two discusses topics as second prescription, layered cases, acute vs. chronic remedies, provings, LM potencies, and complementary and compatible remedies.

Part Three, entitled "Management Inquiries," is written in a question-and-answer format, and very useful, as questions are asked such as, "I have heard some say that Hahnemannian prescribing has nothing to do with prescribing on the basis of the constitution." With answers taken from the Organon itself, this is a very useful chapter to both practitioners and students.

Part Four, the clinical examples, are well described and easy to follow.

The book lists an extensive three page bibliography, and an index, a quarter of which is devoted to its first listing, Aphorisms.

Though intended as an advanced textbook, because it is easy to follow, this book could easily be read by a student with some background in homeopathic philosophy, though one would want to have read the Organon at least once to appreciate De Schepper's insights, interpretation and extrapolation.

This book is a useful tool for case management, a guide for practitioners, as well as a useful text for advanced students.

 

This review is reprinted from Volume 25, Number 5, September/October 2005 edition of Homeopathy Today with permission from the National Center for Homeopathy.


Reviewed by Edith Malin, BFA, CMT, CABT

This most recent book by Luc De Schepper, distinguished practitioner, author, and teacher, is a major contribution to furthering the science of homeopathy and the art of case management.

If the myriad mistunements of a person's life force are as diverse as a forest, and the many factors to consider in homeopathy are a lake, then the meeting of the two is a swamp which we slog through in order to resolve a case. Achieving and Maintaining the Simillimum is a map of the dry paths and a field guide to the sights of the swampland, both of which help speed the way to the destination - Hahnemann's ultimate objective - a quick, gentle, and permanent cure.

The intended audience is the intermediate to advanced student and the professional, although the first two chapters are valuable for anyone who picks up a vial of pellets or seeks homeopathic care. Chapter 1 begins with Hahnemann's experimentation confirming the law that "like cures like," explains the premise that disease is a mistuned Vital Force, and sets forth reasons why allopathic drugs appear to work but must be taken for a lifetime to maintain the appearance of good health. Chapter 2 discusses the primary and secondary actions of substances taken into the body and how homeopathy cures.

A finely woven cloth

The book is easy to understand, well organized, and written in a personal style. De Schepper weaves together the history and evolution of Hahnemann's methods with the insights of his experience and makes connections that might have obscured the Gestalt of the book from being understandable at all; instead, the result is a finely woven cloth.

De Schepper quotes Hahnemann's Organon of Medicine and Chronic Diseases, along with many old masters of homeopathy, including Kent, Hering, and von Boenninghausen. He explains their wisdom in a clear and uncomplicated way, illustrating concepts with examples and simple diagrams. Hahnemann's observations and guidance are borne out in the examples of actual stalled or confused cases which move forward again when one follows the principles discovered and tested by Hahnemann, lost by time, and then dusted off by De Schepper. The goal is to perfect the individualization-making the dose, the potency, and the indicated remedy fit the patient like a custom-made suit-and, even more importantly, to identify a poor fit, why it is poor, and how to correct it.

The book is divided into five sections: Potencies, Management, Management Inquiries, Clinical Examples of Management, and Hahnemann's Paris Casebooks. Chapters 3 through 5 recount the evolution of Hahnemann's understanding of how the body heals and how best to help it, as documented in the fourth, fifth, and sixth editions of the Organon of Medicine and in Chronic Diseases. De Schepper touches on the developments leading to the fourth edition of the Organon, then proceeds with the evolution beyond the fourth edition, explaining why Hahnemann abandoned dry doses in favor of watery solutions. He then compares Hahnemann's methods from each edition of the Organon and Chronic Diseases in order to spotlight the evolution of Hahnemann's nascent science. He quotes specific aphorisms which clarify and underscore improvements of the fifth and sixth editions of the Organon, in which Hahnemann describes how to achieve a quicker, gentler, permanent cure.

Minimum dose, myths, and misconceptions

De Schepper explains where Kent went wrong in believing the size of the dose doesn't matter. He cites chapter and verse in which Hahnemann explained the importance of the smallness of the dose, the repercussions of too large a dose, and why potentizing every dose is essential. Included are instructions for when and how to use fifth and sixth edition methods. A helpful chart of potency selection based on the patient's sensitivity appears in the addendum to Chapter 5. Throughout the book one finds many tips for working with hypersensitive patients, those whom Kent once declared incurable.

Chapter 6 discusses accessory symptoms: from the simillimum, during acute diseases, from the close simile, and from the distant simile. Changing symptom pictures, cases with a paucity of symptoms, and recognizing the simillimum are also covered.

Chapter 7 describes necessary surgery, situations that suppress and their consequences, and local diseases. Chapter 8 shows that modern homeopathic myths and misconceptions are based on Hahnemann's abandoned experiments and ruled-out hypotheses. The author has tracked down the original context and quotations, restoring Hahnemann's insights to their proper place in the evolution of his work. Chapter 9, of interest to patient and homeopath alike, discusses obstacles to achieving the cure despite having found the simillimum, such as problems of the patient's lifestyle or the homeopath's attentiveness.

Intercurrent remedies and more

Chapters 10 and 11 explain how to decide when acute cases and chronic cases require an intercurrent remedy or nosode. Chapter 12 covers 12 scenarios that can arise after the second or subsequent prescriptions. This is an expansion on Kent's scenarios in which only one reason for each was proffered. De Schepper gives additional reasons why such situations may arise. Each chart shows the progress of fourth, fifth, and sixth edition Organon dosing, demonstrating how cases progress more quickly and more gently with fifth and sixth edition methods (i.e., using watery solutions) compared to fourth edition dry dosing. De Schepper's scenarios also identify incurable cases and miasmatic blocks.

Chapter 13 points out helpful connections that may speed one's search for the next simillimum. These include remedies in series, complementary remedies, antidotes and inimical remedies, and the pattern in which other miasms tend to become active after one miasm has been subdued.

Applying the information

Part 3, the Management Inquiries section, is a bit of a jumble of miscellaneous questions with answers. Although the information is valuable, searching for something here is tricky. In Part 4, Clinical Examples of Management, 26 actual cases are presented. The attending homeopath's record of the case is interspersed with De Schepper's assessments as each case progresses. This gives a practical application of the information in the book and demonstrates when a case is being managed properly and when it is not. Appendix A is the flow chart of possible responses after giving the first test dose, and how to adjust the treatment. Appendix B is a sample of a handout to give the patient, which describes how to take the remedy.

Hahnemann in Paris

Part 5, Hahnemann's Paris Casebooks, provides a sampling of Hahnemann's case notes from 1835 to 1843. They make an enigmatic first impression, and one must use imagination to connect Hahnemann's dots.

Out of the swamp

This book is a joy to read-well made, sturdy, with soft-white, pleasantly thick pages. It is bound in such a way that it lies flat before the reader. The book has minimal problems; only a few typographical errors were found in its 369 pages, and none are critical. Since the book will be a valuable reference for anyone seriously practicing homeopathy, the index could have used many more entries and subheadings.

For its clear and abundant guidance through the case management landscape, the book's price of $75 is very reasonable, as it likely covers no fewer than 60 hours of classroom time.

De Schepper's mission is not only to get the fifth and sixth edition Organon methods off the dusty shelves and into widespread use in order to truly cure as many people as possible, but also to dispel the misconceptions that caused them to remain on the shelf until recently. He makes it his mission to explain other misconceptions he has encountered in order to increase the greater understanding of how homeopathy really works.

Comprehending the Gestalt of homeopathy is an enormous task. This author's dismantling of misconceptions fits fragmented knowledge into place. Homeopaths deserve the assistance that this book can provide to get out of the swamp and into a place where they can see the landscape as well as the details. This book should join another title by its author, Hahnemann Revisited, as foundational textbooks for the serious student.

 

This book review was emailed to us from Luc De Schepper and is from Homeopathic Times

Reviewed by Geraldine Petch

Why should the homeopath who has read Hahnemann Revisited need to read Achieving and Maintaining the Simillimum ? Hahnemann Revisited "represented the Science of Homeopathy: Laws, case taking and finding the simillimum". Achieving and Maintaining the Simillimum "is the other side of the coin - The Art of Homeopathy". De Schepper asks the reader in the introduction to the book " Do you want to treat the most chronically ill with their strong miasmatic background.? Do you want to prevent unneeded similar aggravation? Do you want to treat the most sensitive patients ? Do you want to speed up the time to cure by a half, a quarter or less the time that it takes with a dry dose? Do you want to be successful with heavily suppressed cases and with illnesses deemed 'incurable'? Do you want to use Hahnemann's most advanced methods and walk in his footsteps? If you do then this book is for you".

In Achieving and Maintaining the Simillimum Dr De Schepper sets out to document and teach the advanced methods of Samuel Hahnemann. He draws from years of research into the 4th 5th and 6th editions of the Organon, several editions of Chronic Diseases, Hahnemann's Paris casebooks and the works of von Boenninghausen, Dudgeon, Kent and several other Old Masters of homeopathy. De Schepper's underlying belief is that it is "fruitful for us to study what really is in the Organon" and he sets out to assist his readers on the path of understanding Hahnemann's advanced teachings. He leads the reader through Hahnemann's writings as only a scholar who has immersed himself deeply in such works can. He entices us to learn more about Hahnemann's advandced methods and he writes with enthusiasm and practical knowledge gleaned from years dedicated to implementing Hahnemann's advanced methods.

The author undertakes the arduous task of explaining to the reader the advanced methods of the Organon while acknowledging that the methods are artistic ones that "must be individualised to the patient… No preconceived schedules or protocols can guide the practitioner..the practitioner must be guided by his individual judgement based on the advanced methods that Hahnemann taught".

De Schepper in his opening pages of the book notes that Hahnemann was "one of the world's most creative geniuses..an exceptional scientist - 200 years ahead of his time" and , one that "we may have to wait for centuries for a 'Hahnemann' to come again and lead us to the completion of the work he left us. So far no one has been able to pick up where he left.

In PART 1 of the book [ POTENCIES] De Schepper explains in detail Hahnemann's understanding of the Vital Force and devotes a chapter to the primary and secondary action of the potentisied remedy medicine on the vital force. In this way he lays a foundation for further discussions throughout the remainder of the book on treatment plans, doses and potencies.

Separate chapters are assigned to the subject of potency selection and management of each of the final three editions of the Organon. The author traces the development of Hahnemann's thinking in the 4th 5th and 6th editions of the Organon and points out that because of the influence of Kent on the generations of homeopaths who have come after him "it is as if homeopathy froze in time around 1828 as most of the techniques used in modern practice are from this period [the 4th edition Organon according to which Kent practiced].

As De Schepper notes almost all "true homeopaths… call themselves classical homeopaths - indeed they are since they try to follow the rules and regulations outlined by Hahnemann in the Organon... The question needs to be posed however "classical according to which edition of the Organon"? ...90% follow the 4th edition...Even now, stuck in the 4th edition, many poorly trained homeopaths fail to grasp the evolution of the Organon through six distinct phases".

It is De Schepper's hope that "every homeopath in the world will go over to using the watery solution guidelines described in the 5th and 6th editions of the Organon. He asks homeopaths "Doesn't it make sense to start your cases with the smallest doses of the lowest effective potency in adjustable aqueous solutions and proceed to increase the potencies and amounts as needed.? And he advises "Begin as conservatively as possible, just as Hahnemann did and believe in the maximum effect of the minimum dose!"

To help guide the homeopath in the selection of potency for patients, Dr De Schepper has created a useful table of guidelines for choosing potency , based on the sensitivity of the patient [he advises using the table with common sense always bearing in mind the individual case.]

PART 2 [MANAGEMENT] is a guide to the homeopath on management of the case, although as De Schepper points out "Many management problems could be avoided if Hahnemann's rules as outlined in the previous chapters were known in the first place and strictly adhered to in the second". As De Schepper notes in this section of the book the quest to find the simillimum is "difficult enough in and of itself" but when we have found the simillimum we are " only halfway to the cure. We must know how to follow up the case properly or we'll get lost". De Schepper gives the homeopath practical guidelines for assessing patient response to the homeopathic remedy. He discusses the significance of accessory symptoms and related problems and the problem of suppression.

A chapter deals with modern homeopathic myths and misconceptions in which there are lively discussions on some controversial aspects of homeopathic practice. De Schepper outlines the logical reasons for rejecting mixing several homeopathic remedies. He discusses the use of intercurrent remedies and alternation of remedies. The author examines some "misstatements" and "assertions made by leading homeopaths" who in making such statements "show their ignorance of the most important work in homeopathy". Once again De Schepper reminds us that lest we throw the baby out with the bathwater we have "yet to discover a newer and better method than what Hahnemann outlined in the last two editions of the Organon. The problem is that 90% of all homeopaths do not know or correctly apply these advanced methods".

When he comes to discussing the list of obstructions to the cure in the next chapter, De Schepper wryly notes that there are so many obstacles to cure "it seems surprising that anyone can be cured". The "biggest and most frequent obstruction to cure", in the author's opinion, can be the practicing homeopath A homeopath may lack the necessary love of humanity and sympathy which is "akin to intuition and instinct". The author states that "much of the art of prescribing lies in the quality of sympathy". He goes on to discuss the other qualities that are necessary to be a homeopath including objectivity, discipline, concentration, patience, supreme concern with mastery of the art and above all else a love of homeopathy and people. The remainder of the chapter outlines in detail the obstacles to cure homeopaths will have heard of before, with several pages devoted to a discussion of errors in diet and lifestyle including an exploration of Hahnemann's insistence that the patient abstain from coffee.

The chapter on acute intercurrent or intermediate remedies in chronic diseases opens with De Scheppers observation that "modern homeopaths no longer understand how to use an acute intercurrent remedy". He notes that the "skillful use of intercurrents is an essential method in classical homeopathy an aspect of complete case management" and he outlines what Hahnemann, Kent, von Boenninghausen said about the use of acute intercurrents. De Schepper outlines what acute events need an intercurrent remedy.

The next chapter deals with the use of chronic intercurrent remedies or nosodes in chronic diseases, and discusses the special role of nosodes as chronic intercurrent remedies. Indications for the use of nosodes are clearly outlined and advice is given about how to administer nosodes, and how to assess progress when a nosode has been administered. Two nosodes - Carcinosin and Streptococcium are discussed in particular detail, including two charts differentiating carcinosin with medorrhinum .

The chapter entitled 'the Second Prescription - Different Scenarios for the Second and Subsequent Prescriptions in the Management of Chronic Disease" presents twelve different scenarios and for each scenario, possible questions the homeopath might ask follow with an analysis by the author. For each scenario De Schepper gives the path that might be followed by a prescriber from each edition of the Organon. Much can be learned from the presentation of scenarios, and Dr De Schepper's gifted insights in the subsequent analysis of each scenario. There is little doubt that on studying the different scenarios the limitations of prescribing according to the 4th edition of the Organon become glaringly obvious. In fact De Schepper says "the following scenarios..should encourage anyone to abandon the 4th edition and move onto the 5th/6th editions of the Organon". Examples of scenarios include Scenario #1 "Immediate improvement of mental, emotional and physical levels without any observable similar or dissimilar aggravation" ; scenario #4 "Quick, short similar aggravation followed by improvement and increase of patient's strength"; scenario #10 "long-term improvement over weeks or months, then sudden similar aggravation".

The final chapter in the second part of the book discusses complementary remedies and remedies that follow well, including paragraphs on complementary miasmatic states, antidotes and inimical remedies.

PART 3 [MANAGEMENT INQUIRIES ] is a collection of questions and answers which the author considers pertinent, some of which he found in the writings of the Old Masters and some from his own "inquisitive mind". Questions posed and answered include "If the simillimum is given in the perfect potency will the patient experience an aggravation";/ "What is the difference between a disease aggravation and a remedy aggravation";/ "How do we differentiate between old returning symptoms and the symptoms of similar aggravation?"/ "When do we use a 'small' remedy?./ "How do you treat head, body and crab lice?"/ "Is it true that lower potencies antidote higher ones and if so why?"

PART 4 [CLINICAL EXAMPLES OF MANAGEMENT] as its title suggests outline clinical examples of management with case examples chosen to help the reader understand the follow -up visits after the first prescription. Throughout the case examples and assessment of the cases De Schepper emphasises the importance of understanding of the laws and principles of case management as taught by Hahnemann.. Throughout the author's comments he quotes from Hahnemann's writings and several of the Old Masters.

In PART 5 [HAHNEMANN'S PARIS CASEBOOKS] the author gives us a "glimpse into the monumental work" of studying Hahnemann's Paris casebooks in a chapter entitled 'The Later Years of Hahnemann - Theory and Techniques' . De Schepper notes that "Whatever symptoms he chose as a basis for his prescription mental, emotional, physical, pathological and general or particular- they always related to Aphorism 153:they were always peculiar and individual to his patient and equally peculiar to the chosen remedy. And he always had firmly in place the changes he advanced in his 5th edition- using watery solutions and more frequent repetitions of the remedy".

The hard cover book contains over 360 pages, and is divided into 5 parts with 13 chapters, two appendices, an epilogue, detailed bibliography and an index. The two appendices include [A] a clear and useful diagram of possible responses after the test dose and [B] sample instructions to the patient for taking the LM remedy.

The book completes with an epilogue which recognises the principle founders of homeopathy as Samuel Hahnemann, von Boenninghausen Constantine Hering, Adolph Lippe,.

De Schepper acknowledges in the epilogue that the "advanced solution methods. ..are not easier to use than the dry dose method…these methods demand more experience and artistry than the dry dose", however he encourages the homeopath to "take the time to master the basics as the rewards will be tenfold". His parting words to the reader are "Try out these advanced methods for yourself, gain experience with them, and you will become a true classical Hahnemannian homeopath, beloved by all patients".