An aggravation is the temporary appearance of new symptoms, or a temporary intensification of existing symptoms, following a dose of a homeopathic remedy.
Aggravations are harmless, usually mild, and short-lived. They sometimes occur following the first dose of a remedy as part of the initial rebalancing effect, or when the remedy has been taken more often than needed, or if the person is unusually sensitive to that particular remedy.
If person’s existing symptoms intensify, it is called a similar aggravation and means the remedy selection is correct and improvement will follow but don’t redose until improvement stalls or symptoms return. If the aggravation involves new and different symptoms (while original symptoms remain unchanged), it is known as a dissimilar aggravation and indicates that the remedy choice is wrong and a new remedy needs to be selected.
If the person is unusually sensitive and experiences an aggravation on each dose of the remedy, the dose should be adjusted to suit their sensitivity.
Aggravation means the increase of intensity or degree of suffering. Each aggravation of symptoms or the appearance of new symptoms, when nothing untoward has occurred in the mental or physical regimen, invariably proves the unsuitability of the given medicine, either the remedy itself or its potency or dose.
This homeopathic aggravation involves the generative power.
Ø Modality Aggravation
Modalities are circumstances that modify a particular or general symptom, either appearing artificially induced during provings, or as experienced by the patient suffering from the natural disease. Modalities can make a symptom better or worse.
Each remedy has its own mode of action and acts best under certain conditions. Thus, modalities belong to the distinguishing features that help differentiating remedies. Especially, if they are strange, rare or peculiar they highly individualize a case and assist in choosing the homeopathic remedy.
Modalities can be classified as physical, temperature, time, climate, dietary modalities, localized modalities (lateralities) and miscellaneous modalities.
Similar, homeopathic aggravation
A similar aggravation occurs when the original symptoms of the patient increase temporarily at the beginning of treatment. This is a sign that the remedy is correct but that the potency was too high, or the dose too large or repeated too frequently.
A homeopathic aggravation is often appreciated by the homeopath, especially the forth or fifth Organon prescribers, as indicating that the chosen remedy is correct and working. However, an aggravation is neither necessary to know that the remedy works, nor for cure. Any aggravation delays or might even prevent cure if the primary action of the remedy is too strong and suppresses the secondary, curative response of the vital force. Hahnemann just wrote, that a slight homeopathic aggravation is a very good prognostic that the acute disease will most probably yield to the first dose!
The intensity and duration of the similar aggravation gives us a clue about the correctness of the chosen remedy, the patient’s vital force, prognosis, and for case management.
A quick and short similar aggravation followed by improvement indicates that the remedy was chosen correctly. Improvement will be long lasting. The patient has a strong vitality and good reactive power. Organic changes are unlikely or only present in non-vital organs. The case is curable, the prognosis is very good.
A long continued aggravation but eventual and slowly progressing improvement indicates that the patient is on the borderline of incurability. The vital force is struggling to start a secondary curative reaction. Pathology is likely to be present. Prognosis is uncertain. The patient may recover if treated properly and the vital force strong enough to initiate and maintain the healing process.
A prolonged aggravation and slow decline either indicates the incurability of the case due to irreversible organic pathology and a too weak vital force, and/or, that the vital force has been overwhelmed by a too high potency or dose and is unable to start a healing reaction.
Hypersensitive patients may react to and aggravate on every remedy. High potencies are to be avoided.
Ø Accessory symptoms
As it is almost impossible that the symptoms of the remedy and the symptoms of the patient’s disease cover each other exactly, “there is hardly any homeopathic medicine, which during it‘s action does not bring about some very slight unaccustomed complaint or small new symptom”.
Accessory symptoms of the correctly chosen remedy may also appear when the dose was too large, the remedy repeated too frequently, and/or the potency too high, so that medicinal symptoms of the remedy which were not experienced before, are displayed. This may especially appear in oversensitive patients who prove remedies easily.
If the accessory symptoms are troublesome, the remedy will not be capable of effecting real improvement. A medicine, although homeopathic to the case, does harm in every dose that is too large. The greater its homeopathicity the greater the harm of the remedy in too large doses as the patient‘s susceptibility is increased. The danger lies in establishing an artificial, medicinal disease with new and more severe symptoms, without extinguishing the old, natural disease.
What are we to do?
1. If the aggravation is trifling or not dangerous the action of the medicine should not be interrupted. Wait till the aggravation wears off and amelioration follows. If repetition is necessary, repeat the remedy in a more suitable potency and/or reduced dose, or repeat less frequently. When remedies are applied in watery solution the dose can be easily adjusted to avoid aggravations.
2. If the aggravation is of burdensome intensity it should not be endured. Either repeat the same remedy in a lower dose or potency, or in descending potencies to decrease the intensity of the remedy’s action, until the aggravation subsides. Check whether the remedy is truly indicated.
3. If the aggravation is very severe or even life-threatening the action of the remedy should be interrupted by giving an antidote. Apply a remedy which is known to antidote the previously given remedy and which is most similar to the new troublesome symptoms. Let it act until the symptoms subside, then return to prescribing, adjusting potency and dose. Check whether the remedy is truly indicated.
4. If the homeopathic aggravation appears towards the end of treatment the doses must be reduced further and/or repeated at longer intervals, or even stopped for several days, to see whether no more medicine is necessary for cure. If no further medicine is necessary the symptoms caused by the excess of the remedy will soon disappear and leave undisturbed health.
Ø Dissimilar aggravation
A dissimilar aggravation occurs when an incorrectly chosen remedy produces new, persisting and possibly troublesome symptoms which the patient had never experienced before. With the wrong remedy the patient does not feel better in general apart from the palliative relief of some superficial symptoms. If the remedy is allowed to act the internal disease will be intensified, new ailments will develop, and an artificial, medicinal disease might be produced that suspends the natural disease. Beware to think the patient’s original disease has improved and another, old layer is coming to the surface!
What are we to do?
1. If the remedy is similar enough to remove a considerable part of the disease without causing too many or severe accessory symptoms, the treatment is to continue.
2. Don’t repeat the remedy if it causes too many new and troublesome symptoms due to insufficient homeopathicity.
3. If there appear symptoms of some moment, don‘t allow the dose to exhaust it‘s action but take corrective measures.
4. If the new symptoms are not severe, a better indicated remedy should be given immediately.
5. If the new symptoms are troublesome or even dangerous, the action of the remedy should be stopped by an antidote before giving a better chosen remedy. Chose an antidote that is known to antidote the action of the previously given remedy and which is similar to the new, troublesome symptoms.
6. To chose a better remedy the remainder of the original symptoms and the newly developed symptoms are to combine in a grand totality, as the new symptoms are of such a nature as the disease itself was capable of producing.
Ø Disease aggravation
An aggravation of the patient’s disease occurs if treatment is inadequate and the natural disease and pathology progresses. Inadequate treatment is the prescription of a wrong remedy as well as the improper application of the homeopathically correctly chosen remedy. Maintaining causes may also attribute to a continued diseases aggravation and should always be investigated. Intervention is necessary by retaking the case and adjusting treatment and lifestyle.
Cure and the reappearance of old symptoms
True cure means to restore the sick to health and includes the normalization of all vital processes and increased resistance against all sick making forces. This can never be reached through the suppression of symptoms or mere removal of pathology.
When following Hering‘s direction of cure a decrease of the most recent complaints and the return of old symptoms is part of the reversal of the disease timeline and indicates that the correct remedy is working deeply and towards cure. Reappearing, old symptoms should be less severe than the original incident and pass off quickly, unless the potency or dose were too large or the remedy repeated too frequently. They should resolve within a short time and be followed by a subsequent improvement in health. Their reappearance should be accompanied by an increase of well being and an amelioration on the general plane. These symptoms should not be treated by changing the remedy or using allopathic medicine.
Apart from the reappearance of old symptoms, an aggravation of symptoms as experienced before the beginning of treatment may still occur. Cure needs time and not all symptoms are going to ameliorate immediately.
Elimination symptoms
The truly indicated, homeopathic remedy balances the vital force, stimulates the defense system and supports proper desintoxication so that increased discharges from the skin, mucous and serous membranes, kidneys, bowels, lungs or skin may appear. This elimination of residuals through channels is a positive sign of the vital force throwing off the disease. Related symptoms are transitory and pass off soon whilst the patient feels better and his symptoms ameliorate.
Conclusion
The different forms of aggravation demonstrate that the correct choice of the remedy, potency and dose are important in the treatment of patients. Any aggravation is to be avoided, as it delays or even prevents the cure. Ideally, the patient does not aggravate, or experiences only a slight homeopathic aggravation, followed by steady improvement that follows Hering´s rule. In practice this is not always possible to achieve. However, correct prescription and case management are only possible if the reactions of the patients and different forms of aggravations are properly understood.