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Achieving and Maintaining the Simillimum:
Strategic Case Management for Successful Homeopathic Prescribing by Luc De Schepper, MD, PhD

Reviewed by George Guess, MD, DH

What a marvelous time for homeopathic literature it is! Whether authors are inspired by the controversy between our more conservative Hah-nemannian colleagues and, what I will term,"New Age' homeopathic advocates or not, surely they are inspired. And we, the rank and file, have only to sit back, turn freshly printed pages, and absorb the wisdom oi their labors. Surely'tis a fate to embrace.

And embrace I did the most pleasurable educational experience of reading Achieving and Maintaining the Simillimum: Strategic Case Management for Successful Homeopathic Prescribing, a book that reconstitutes in readily comprehensible and most detailed terms the many-lessons that Hahhemann, were he alive today would still be trying to instill in our heads. I never cease to be amazed at just how much of what Hahnemann had to impart to us almost 200 years ago remains true and relevant today - basically everything! And Dr. De Schepper has labored impressively to remind us of that fact. Additionally, he has provided many of his own insights in clinical case management from his extensive experience. In essence, this volume comprises an ode to the liquid dilutions, both centesimal and LM, of the fifth and sixth editions of the Organon. I confess my own hesitation, wrought, I believe, of habit and past teaching, to adopt these potencies for a long time. Now that I have, I readily appreciate their immense value. And some interesting observations have followed. For example. I had earlier on occasion heard a patient, who was at the time taking frequent doses of a low potency remedy, comment that if he took five pellets of the remedy instead of the two pellets he had been taking, he experienced a better reaction to the remedy i had always been prone to dismiss such observations, believing, as 1 had been taught, that the physical size of dose was not significant, that our remedies were immaterial energy and that frequency of repetition, not size of dose, was the only critical factor influencing patient response. I had read, several times, Hahnemann's discussion of the importance of size of dose in the Organon. Somehow, though, 1 continually misconstrued his comments, believing that he was referring to potency only, not the material quantity of dose.. .. and I was not alone. Now, 1 have had the benefit of De Schepper's treatment of this topic and my own experience at varying the size (and number of succussions) of liquid doses, and, believe me. they do most certainly matter, especially in the case of hypersensitive patients. This is but one example of the many benefits that accrue after a thorough reconsideration of Hahnemann's, and De Schepper's, observations.

Achieving and Maintaining the Simillimum begins with a discussion of the action,primary and secondary of homeopathic remedies; then follows with the most detailed explication of potency selection and management,relative to the fourth,fifth and sixth editions of the Organon, that I have ever encountered. Ever mindful of the pragmatics of homeopathic practice, De Schepper provides detailed protocols (including information to provide to patients) for employing liquid centesimal and LM potencies. Subsequent chapters read like a series of thorough essays on ail aspects of clinical homeopathic practice, including: the significance of accessory symptoms, the problem of ¦suppression, modem myths and misconceptions, obstructions to cure, treating acute illnesses during chronic case management and the use of intercurrent remedies; the use of and indications for nosodes,and valuable advice on the utility of complementary remedies.

Chapter 12 is invaluable - a lengthy chapter on the second prescription, it contains very detailed analyses of the varied patterns of response to the first prescription, together with graphical representations of same, quite similar to the analyses that George Vithoulkas provided in The Science of Homeopathy- The difference here is that De Schepper contrasts the responses to single, dry doses of remedy with the responses, at times quite different, to liquid centesimal and LM doses. One quibble 1 have with this chapter is that, in some instances, 1 find the graphical representations to be quite confusing, hard to interpret; fortunately, De Schepper's written explanations are clear.

Most interesting to me was Scenario #2 in this chapter, which deals with the case that displays no reaction at all to the prescribed remedy Now, with the fourth edition,single dry dose method, the practitioner, with some few exceptions, would most likely interpret such a lack of response as indicating that an incorrect remedy (or, occasionally, too low a potency) had been given. Not so when repetitive doses of liquid dilutions are employed, says De Schepper. He contends, again with some exceptions, that if an incorrect remedy is prescribed and taken in gradually ascending potencies (as is the case with properly administered liquid dilutions),some new,previously unexperienced symptoms will be produced. If absolutely no reaction is the result, we must consider other options: a higher potency is required (usually automatically addressed with liquid dilutions), an obstacle to cure or strong miasmatic obstruction is involved, a new acute event supervened,a strong psychological block is impairing patient response, or, rarefy, the patient is hyposensitive.

Part Three of the book, entitled "Management Inquiries." consists of a lengthy recounting of the many questions about practice methodology put to De Schepper by his students and his detailed replies.

Part Four provides many edited case histories illustrating the practical application of the lessons contained in the book, helping to cement the author's lessons in the readers mind.

Part Five consists of the authors preliminary review and commentary on Hahnemann's Paris casebooks, the subject of a planned future book by Dr. De Schepper.

The book is hardbound in an attractive cover; the typeface is large and easy to read; the book is peppered with useful charts and illustrations; and there is a comprehensive index.

Achieving and Maintaining the Simillimum is an excellent book that will deepen and broaden any homeopath's understanding of our discipline, especially in relation to the application of liquid remedy dilutions according to the fifth and sixth editions of the Organon. I would recommend that this book be required reading in all serious homeopathic educational curricula.

About the Reviewer: George Guess, MD, DHt, practices homeopathy in Charlottesvilk, Virginia.