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Date posted: April 6, 2012

Dr N Hari hara Iyer MD(Hom)

Prologue
A careful analysis of the effectiveness and efficiency of fifty mille- simal scale of potency in the treatment of sick definitely demands an in depth study on the circumstances and conditions which led Dr Hahnemann to promote and propagate this scale of potency as the ‘most perfected one’.

Various changes were made from the early days of practice of Dr Hahnemann to the time of publication of sixth edition of Organon of medicine with reference to the laws of repetition, dosage and administration of medicine not only on the theoretical point of view but on the practical aspect as well.  The study which covers the theoretical part includes an over view of the gist of dictums of repetitions and dosage dates back from the earliest writings of Dr. Hahnemann. The experimental aspect deals with the facts of experience that forced Dr Hahnemann to alter the same from time to time.  The latter is summarized as a note from the own writings of Dr Hahnemann considering the footnotes to aphorisms of Organon in an emphatic manner.

Dr Hahnemann always tried hard to satisfy his ambition of attaining the cure in a rapid, gentle and permanent manner. At last he     reached the goal through the introduction of fifty millesimal scale of  potency in the sixth edition of Organon, the most perfect of all editions.

Benchmark qualities of the LM scale of potency remarked by Dr Hahnemann is replicated in this part of work with a special reiteration to the statement that no two same potency of suitable medicine will be accepted by the Life Force. Then the last, not the least an attempt has been made to make a bird’s eye view on the observations and comments of those who nurtured and enriched this ‘most perfected’ scale of potency.

Repetition of medicine

A Prelude
The study of the evolutionary process regarding the repetition of medicine in homoeopathy is utmost important.  A clear understanding of its therapeutic value makes one sympathizes that some of the practices which are well cherished even today was once tried by Dr Hahnemann and proved its ineffectiveness especially in chronic diseases management and was declared to be discarded.  Significant to mention are the frequent repetition of unchanged potency of same medicine and prolonged wait and watch policy after the first dose.  A massive aggravation leading to a state of medicinal disease was the pitfall of the former where as unnecessarily prolonged sufferings and incomplete restoration especially in stubborn chronic ailments was the curse of the latter.

Rule of repetition of suitable medicine with reference to the writings of Hahnemann in progressive evolutionary order

From the very beginning of his career itself Dr Hahnemann keeps the idea that therapeutic action of medicine is the result of direct action or primary action.  It varies with the dosage and repetition of medicine.  Still then how long the primary effect of medicine is continued is considered as the duration of action of that remedy. So the rule of repetition in the initial years was that it should be repeated only after the primary action of the remedy is over. That is why Hahnemann said in his article ‘Essay on a new principle for ascertaining the curative power of drugs.’ “It’s (Belladona) direct action last 12, 24 and forty eight hours.  Hence a dose should not be repeated sooner than after two days”.  Likewise Dr Hahnemann fixes the duration of action of medicine and time span for repetition for the remedies whose primary action is known.  Examples are foxglove repeated only after six days, coffea two days, aconite 7-8 hours etc.

A close survey through the ‘Medicine of experience’ gives an impression that each medicine has got fixed duration of action and the particular medicine will act even after the duration of action in some cases if no hindrances comes in the way. The properly selected medicine will cure the case either in that doses itself or another one more dose of the same medicine.  But the repetition should be made only after the exhaustion of action of previous dose.  In acute case also, he says more than one dose may be required for complete restoration. On the contrary an early repetition will definitely produce hurtful influences.  He illustrates it with a case of digitalis that it should be repeated not oftener than seven days.

Views of Hahnemann from first to third edition of Organon
Repetition of medicine in small dose can be made only after the expiry of the period of action of preceding dose, in order not to disturb the improvement is the rule.  In order to completely cure a case, repetition of the chief remedy can be made in 3 or 6 months or even at longer intervals until the tendency of organism to the chronic dyscrasia has completely disappeared and is extinguished.

But aphorism 252 of third edition of Organon, the first part reads like this: “But should we find that such ever decreasing dose do not suffice to attain the desired end, and that the patient must continue to have equally large or even larger and frequently repeated doses of the still indicated homoeopathic remedy in order to avoid a relapse – in cases the original symptoms are reappearing again and again”.

Here Dr Hahnemann confirms that in order to acquire a permanent cure, repetition of medicine is necessary.  But the repetition should be made after duration and the exhaustion of action of remedy or at longer intervals.  But in cases where a relapse is usual, repetition is to be done frequently and in large dose.

Views in fourth edition of Organon

Aphorism 241
“It is more necessary to bear this in mind because we do not know with certainty the precise limits of the duration of action on healthy body of any medicine even when taken in large dose, still less in the small dose used in homoeopathy in such diverse disease and in patients with such constitution”.

Aphorism 242
“As long therefore as the progressive improvement continues from the medicine last administered so long we can take for granted does the duration of action of helpful medicine in this case at least, continue, and hence all repetition of any dose of medicine is forbidden”.

Aphorism 246
“If this improvement which has until now only gone forward but not yet attained to perfect cure, now comes to a stop, we shall then on careful investigation of what remains of the improved disease, discover some though perhaps small alteration in the group of symptoms for which a fresh dose of hither to efficacious medicine is no longer homeopathically suitable, but some other will be more appropriate for these remaining symptoms”.

Aphorism 247
If then the first dose of the best selected medicine has not been able to effect a perfect restoration of the health in the time during which its action lasts – which can do in most cases of recently developed new diseases – there is evidently nothing better to be done for the remaining though improved morbid state than to administer a dose of another medicine most homeopathically adapted for the remainder of symptoms”.

Aphorism 250
“Even in chronic disease it is very seldom or never the case that nothing better can be done especially at first, than to prescribe the same medicine twice in succession, even after the expiration of period of action of first dose, for even when it has done good the improvement effected by it must go on for some time, and usually there is no indication for the repetition of the same medicine, because what cannot be improved by the first dose, a second or larger dose is equally unable to cure”.

The main points that a careful reader can deduct regarding the repetition based on the aphorism 241 to 250 of the fourth edition of Organon is as follows: -

(1) Duration of action of medicine cannot be fixed a priori.  It depends on the nature and quantity of dose, nature of disease and constitution of a patient.

(2) Repetition or administration of new remedy is prohibited as long as the progressive improvement continues.

(3) First dose will effect the cure completely in a curable case.

(4) If the first dose has produced an improvement only and not a total cure is brought out, never repeat the same medicine.  Instead look for the remaining symptoms and new symptoms if any, and administer a new medicine based on the present symptom picture.

(5) In no case repetition of the same medicine is allowed even if it has produced a favorable response.

Views of Dr Hahnemann on fifth edition of Organon

Aphorism 246 and247 clearly gives the idea

(1) A single dose of the well-selected remedy in very minute quantity   will take a long time to produce a favorable response.

(2) A cure will not be complete and permanent by a small single dose of medicine.  Exception is to slight cases of disease particularly in young children and very excitable and delicate adults.

(3) Instead it has to be repeated at suitable intervals especially in chronic disease of long standing, allopathically mal-treated cases and serious acute diseases in order to complete a cure.

(4) But the repetition should not be too frequent or one time administration of massive dose.

(5) But the repetition should be based on the nature of medicinal substance, corporeal constitution of the patient, idiosyncratic nature of the patient, gravity or magnitude of the disease etc.  In acute disease the deciding factor is grater or lesser rapidity and nature of severity of the disease.

(6) In chronic disease the repetition for suitable intervals is fixed apriori and the medicine can be repeated 10 to 12 times giving adequate time gap.

(7) If this type of repetition is producing the symptoms of already administered medicine, it can be interpolated with another related remedy and again repetition can be continued.

(8) In chronic disease Dr.Hahnemann illustrates the above statement that remedies like sulphur can be repeated not oftener than every seven days in robust persons and 12-14 days in more delicate persons.  10-12 doses can be administered for complete cure.  If sulphur symptoms are appearing in between it should be interpolated with remedies like Hepar.Sul, Puls, Nux vomica etc.  After a gap again sulphur can be repeated

(9)  In acute diseases the medicines can be repeated several times a day.

Rule of repetition in the work “Chronic disease and its peculiar nature”.
The rule of repetition in this masterpiece is that as long as the improvement continues even if it has passed beyond the supposed time duration of action of medicine, we should not interfere with the action of previous remedy, but with one exception to the cases where the actions of remedy is exhausted.

When the original symptoms are reappeared or are aggravated, the physician can think of repeating the same remedy.   Hahnemann confirms this statement by illustrates a case of sepia.  In a case of headache, he administered sepia and it was repeated after 100 days to make the cure permanent when symptoms reappered.

In acute disease or chronic diseases that assume the nature of an acute ailment the immediate repetition of the same medicine may be necessary. This is because the action of medicine is exhausted very soon. One criterion is that the repetition is to be made with change in the degree of potency. The change can be made in two ways.  If 30th potency is given to the patient and the repetition is imminent it can be changed to 18th then to 24th etc.  This is more applicable in cases where the first does has been counter acted by errors in diet or regimen etc. Or, if the physician is sure of the specific nature of medicine it can be repeated with change in degree of potency.  This change is made with stirring the medicinal solution  so that the vital force will accept it smoothly.

In ‘The chronic disease, their peculiar nature and their Homoeopathic cure’ Hahnemann says “It is a fundamental rule in the treatment of chronic disease to let the action of the remedy, selected in a mode homeopathically appropriate to the case of disease which has been carefully investigated as to its symptoms, come to an undisturbed conclusion so long as it visibly advances the cure and the while improvement still perceptibly progresses, this method forbids any new prescription, any interruption by another medicine and forbids as well the immediate repetition of the same remedy”.

“It is only then – as a practical observer can recognize – when the peculiar symptoms of the disease to be treated, after fourteen, ten, seven and even fewer days visibly cease to diminish to that the improvement manifestly has come to a stop, without disturbance of the mind and without the appearance of any new troublesome symptoms so that the former medicine is still homoeopathically suitable, only then I say, is it useful and probably necessary to give a dose of the same medicine of a similarly small amount but most safely in a different degree of dynamic potency.  This is rare in chronic diseases but in acute diseases and in chronic diseases that rise into acute stage this is frequently the case”.

The view of Dr. Hahnemann on repetition on the preface prefixed to the Vol. III of the “Chronic disease” published in the year 1837.A preface concerning the technical part of Homoeopathy have the following ideas

Medicines should be given in solution. Medicinal solution is prepared by dissolving one pellet or pellets of medicine in 7-20 tablespoonful of water. This medicinal solution should be administered in divided dose.

In acute disease repetition is made in every six, four or two hours and in very urgent cases every hour or half an hour.

In chronic diseases repetition is to be made at least every two days or more usually every day. The vital force will not bear the same unchanged dose. Either the effects first dose of the medicine is neutralized or new medicinal symptoms appear due to cumulative effect. Vital force will accept if it is shaken to change the potency. This can be attained by shaking the bottle five or six times before each administration. If the medicinal solution is used up by frequent repetition a new medicinal solution is prepared with a low potency. For instance the medicinal solution of 30th potency is used up a new medicinal solution is prepared with 24th potency (Higher to Lower). The higher potency is administered in less quantity and at longer intervals.

The remedy is to be continued till improvement lasts. If an aggravation of existing symptoms is produced, stop the medicine for 1-2 weeks and wait for improvement. If new symptoms appear another remedy should be selected for administration. If the same medicine has to be repeated again, prepare a new solution with the same potency provided the same number of shakes should be made for this potency also which is made for earlier one. Then 5-6 shakes for subsequent does. Dr. Hahnemann concludes that this way of administration of medicine will prove beneficial especially in chronic diseases.

Views in the sixth edition of Organon

  • Medicine should be perfectly homoeopathic and given in small dose
  • It should be highly potentised.
  • It should be dissolved in water.
  • Repetition should be at definite intervals.
  • Repetition should be followed with the precaution that every dose deviate some what from the preceding and following.

Here a medicine is prepared in the 50 millesimal scale of potency where the material quantity of drug is reduced to the ratio 1: 50,000 to the dilutent.  The rate of succession is fixed as 100. This medicine in a single poppy seed sized pellet is given in water and is successed every time before each administration so as to change the degree of potency.  The medicines are used in an ascending manner of potency.

A Brief narration on the rule of repetition with a stress to the precautionary remark in the 6th editions of Organon.
It was a customary practice in Homeopathy to administer one dose well selected medicine and wait for a favorable action to exhibit in the patient.  But experience showed that this method of administration of medicine not only prolonged the desired effect to display on the patient but an annihilation of the disease in whole extent in most of the chronic ailments was made impossible. So Dr Hahnemann advised  in Organon repetition of most suitable medicines at  suitable intervals for effecting a speedy and permanent cure in the fifth edition and at definite intervals in sixth edition respectively.

But the repetition of suitable medicine at definite intervals should be made in tune with the precautionary remark set by Hahnemann in the sixth edition of Organon of medicine. It reads like this “Firstly, if the medicine selected with utmost care was perfectly Homoeopathic, secondly, if it is highly potentised, dissolved in water and given in proper small dose that experience has taught as the most suitable in definite intervals for the quickest accomplishment of cure but with the precaution, that the degree of every dose deviate some what from the preceding and following: (aph 246)

The point is that no two dose of administration should be of the same degree of potency.

A detailed and careful study and observation on the repetition of medicine in the unchanged potency was done by Hahnemann even before setting the rules of repetition in the fourth edition of Organon of medicine.

The inference obtained from such a study was that either one time administration of massive dose of medicine or frequent repetition of small dose of unmodified potency will act on the same areas of vital force that are sensitized by the disease and give strong impressions in that area, ignoring the fact that first dose of the medicine has dynamically altered the vital force. Here the dynamically changed vital force is not getting a medicinal power of that quality (a dynamically altered medicine i.e. a medicine with change in degree of potency) to continue the curative process instead a cumulative effect is produced on the vital force due to repeated and stronger impression of the same unchanged potency. The net result is production of new symptoms leading to medicinal disease. The patient in this way experience not only worsened stage of already existing symptoms for which he took medical advice but will be much annoyed by the production of new symptoms.

Hahnemann has set the maxim for the repetition in the 4th edition of Organon is that as long as the amelioration is continuing the physician should not interfere the action of present medicine either by repeating or going for a new remedy. This dictum was aired on the assertion made after various experiments that proved the harmful effects of frequent repetition of medicine in small dose and also on the one time administration of medicine in massive dose. The latter was tested on high and low dynamisations.

One reason which is firmly believed by Hahnemann was that the vital force could not quickly adapt to the transition from natural disease state to the artificial medicinally similar morbid state if medicine is administered in either of the above manner. (246 5th edition F.N Para I.)

In the case of massive dose the vital force will be suddenly and violently attacked and as a result the vital force will be weakened to low ebb and from which a secondary curative reaction will be more difficult.

Same is the case with the unchanged potency of medicine repeated frequently. The external superior drug force is acting upon the life principle in rapid succession not giving adequate time gap to make a recovery on. So the vital force cannot recover in between every dose. Instead the vital force is oppressed and overwhelmed incapacitating it to make a secondary curative action. Also the cumulative effect produced by frequent repetition ultimately giving rise to medicinal disease. (F.N. to aph 246  5th edition Para 7).

So because of the unfavourable effects produced by the rapid repetition of small dose of well selected remedy, the safe philanthropic maxim of ‘si non juvat, mod one noceat’ is “single dose at a time, that the very smallest of the carefully selected remedy to act upon the patient and moreover to exhaust its action” is the rule of repetition in the 4th edition of Organon (F.N to aph 246 Para I, 5th edition).

Hahnemann has studied and experimented on the repetition unmodified potency of well selected medicine fixing the time span a priori. The results of these experiments can be seen in the foot notes to aph. 246,247,248 of 5th edition of Organon of medicine. Hahnemann himself is explaining his inference of experiments with sulphur in psoric diseases. Sulphur was repeated every seventh day in robust patients and little bit longer in sensitive and weak patients. In order to complete cure 6-10 doses of remedy were required depending upon the nature of the case. The adequate time gap was given with an intention to set the vital force for a favourable reaction. But here also Hahnemann witnessed unfavourable reaction. This can be read from these words. “But it not in frequently happens that the vital force refuses to permit several dose of Sulphur even though they may be essential for the cure of chronic malady and are given at the intervals mentioned above, to act quietly on itself; this refusal it reveals by some though moderate Sulphur symptoms which it allow to appear in the patient during the treatment” (F.N. to aph 246 5th edition.)

So these statements clearly shows that medicinal diseases are produced after such repetition of medicine and sometimes in order to prevent this Hahnemann was forced to interpolate it with remedies like Hepar sulph, Nux vomica, and Pulsatilla etc.

Again Hahnemann made experiments with dry pellets and globules diluted in water. The repetition was made with globules dissolved in water and which was ‘standing undisturbed’. The medicinal solution was stirred only or it was again diluted for sensitive patients. Here a modification in the degree of potency was not done but only dilution or attenuation was done. All these experiments proved inefficacious due to the unfavourable reaction it produced (F.N. 247 6th edition).

At last Hahnemann with his inquisitive mind and unshattering confidence to make a cure speedy gentle and permanent has launched a method of administration of medicine in which a highly dynamised medicine preferably in water medium is used with a modification in the degree of potency before each administration as the rule.

Here according to the experience of Hahnemann from the last 4-5 years of practice of his carrier, no offense to the medicinal action is made by the vital force even if repeated daily. No medicinal disease is produced in this new altered but perfect method that was a cause of alarm in earlier methods of repetition at suitable intervals. This can clearly visualized from the words of Hahnemann. “But during the last four or five years, however all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely, after the lower degree of potency has been used for one or two weeks in the treatment of chronic disease advance has made in the same way to higher degree”. (F.N. to aph 246, 6th edition.).

Here the hypothesis corroborates the idea that the spirit like action of dynamised medicine will alter the dynamically deviated vital force by the disease agent. The next dose that is also dynamically altered by succession will find a place in the dynamically altered vital force. So by such modifications in the degree of medicine, every time the medicinal force can find place in dynamical vital force extracting wholly the disease force in a rapid and continuous manner. A saturation point is reached where there is no need for further medicinal force will be revealed by intensification of the balance of symptoms or of the original symptoms (Homoeopathic aggravations) or production of apparent symptoms of already administered drug (Schein-symptoms).

The cure is made gentle again by making the conclusions that a smooth and gradual arousal of vital force is taking place by the new preparation and so the reaction of the vital force to produce a secondary curative action will also be smooth. Not only that, as the dilution ratio is high i.e. 1:50,000 the process of cure will also be in a gentle manner.

Due to the continuous excitation of vital force and the extraction of disease upto the saturation point of medicine noted by the Homoeopathic aggravation confirms that the cure is made permanent with total annihilation of the disease in its whole extend. That is why Hahnemann aptly said “It almost seems as if the best selected, Homeopathic remedy could best extract the morbid disorder from the vital force and in chronic disease to extinguish the same on if applied in several different forms”.(aph.247,sixth edition)

Summary
In the initial years of homeopathic practice, Hahnemann believed on the primary action of medicine and set a priori time duration for the action of medicine and so also for repetition. Then he changed his idea a priory fixation of duration for repetition to repetition after exhaustion of action of medicine.  So medicine can be repeated whenever necessary is the rule up to 3rd edition of Organon.  In the 4th edition Hahnemann totally prohibit the repetition of same medicine. If remnants are present, a new medicine can be opted is the rule. This time Hahnemann was keeping the philosophical idea of unconditional and superior power of drug substance compared to the conditional inferior power of disease force, according to Dudgeon.

We can perceive a sea change in the 5th edition. No repetition of same medicine at any cost in the 4th edition to repetition after fixing the time duration a priori based on the peculiarities of a patient and drug in 5th edition.  In the 5th edition Hahnemann started to share a firm belief and conviction out of his experience acquired that not only to accelerate the favorable response of the medicine to utmost rapidity but also to armor and facilitate the vital force to flush out the inimical forces completely so as to ensure a permanent restoration in all types of diseases, repetition of well selected medicine in minimum dose at suitable intervals is a must and necessity. From this time Hahnemann never relinquished the view that more than one dose is required for a complete cure. (Dudgeon after closely watching the views of Hahnemann making a statement that this was the time when Europe was on the grip of cholera. The grave disease was not amenable to one dose of indicated medicine. Perhaps this may be one reason of shift of ideas on repetition of 4th edition to frequent repetition in fifth edition.)

 In the textbook ‘Chronic disease’ Hahnemann favors repetition but repetition with a change in the degree of potency just by stirring. In the article published as the preface to chronic disease as the ‘technical part of Homeopathy’, Hahnemann makes a number of changes in the rule of repetition. Here he introduces the new theory with firmness that the vital force will not bear the same unchanged dose more than once. So a change in potency is necessary before each administration and medicine should be given in water. He hints about the Homeopathic aggravation at the end of treatment etc. In the 6th edition  Hahnemann for the first time introduced the 50 millesimal scale of potency.  He confirmed in this that medicines should be repeated in an ascending order of potency. The number of shakes in between administration to change the degree of potency is fixed at least as eight, and the dissolving water to prepare medicinal solution is fixed at least as eight table spoon. Set parameters in drug administration for sensitive and highly sensitive patients.  Hahnemann was more careful about the dynamis of life principle and dynamisation of drugs.  So he introduced a method of preparation of Spirit like drug substance which can reach the level of spiritual life principle.

This is a brief narration of the progressive evolutionary idea of Hahnemann with reference to the repetition of medicine.

Dose
Introduction
The idea of dose can only be explained and interpreted in homoeopathic therapeutics based on the following tetralogue:-

  1. The material quantity present in the drug substance.
  2. Volume of drug administered to the patient at a time.
  3. The strength or power of drug substance
  4. Quantitative medicine needed to produce complete restoration.

The evolutionary history of Hahnemannian concept of dosage not only revolves and rotates on the points mentioned above but it includes  a peep in to the positive experience which curtailed Hahnemann from committing the same mistakes of old school with crude drugs. By 1827 Hahnemann introduced the dynamisation theory and there by the strength and power of medicine was increased by succession and triturition.  In the final edition of Organon of medicine Hahnemann  reduced the medicinal substance  in the ratio of 1 in 50,000 thereby the material quantity was reduced incredibly but raised the succession rate by 100 times to elevate the medicinal power into spirit like ‘conceptual essence’.

Dosage Proper
In the initial years of his practice and also two years before the cinchona bark experiment, he announced the world through the article “Instruction to surgeons respecting venereal disease” (1789), in the chapter treatment of simple chancre, that “In order to cure chancre radically, the soluble mercury must be given in increasing doses until the mercurial fever that supervene has completely cured the chancre without the employment of the slightest topical application.”

In the essay ‘On a new principle for ascertaining the curative powers of the drug’(1796) we can perceive that in a case of cramps in leg, five drops of chamomilla was given.  Like dose of medicine in crude substance was mentioned about cinchona, arnica etc. Four grains of veratrum alb as one dose in four successive days was the quantity of medicine in ‘a case of rapidly cured colicodynia’.

In the year about 1801, we can ascertain that Hahnemann started reducing the material quantity by diluting the medicine.  For scarlet fever he prepared a medicinal solution of one grain of Belladona to a mixture of 100 drops of distilled water and 300 drops of alcohol. Quantity of medicine was fixed as two to sixteen drops from the medicinal solution according to the age.  There were different preparations for treatment and preventive purpose.

In 1813, on the essay ‘Spirit of Homoeopathic doctrine’ he announced that medicine should be administered in dynamic nature and in small quantity as he pioleted nature’s law of cure in that article.

Then from the simple dilution and shaking in order to reduce the material quantity in medicine, Hahnemann has progressively elevated to dynamisation in order to make medicine powerful also.  This can be seen in the article “How can small dose of such very attenuated medicine as Homoeopathy employs still possess great power”? Published in 1827. By the process of friction and intimate mixture of drug substance with non-medicinal substance he released the spirit like power of drug substance “as in a note to thuja in Materia Medica Pura”.

In the fifth edition of Organon, Hahnemann reduced the material quantity of drug substance in the ratio of 1:100, and power is increased by making two successions in each preparation of potency. (Earlier it was used ten successions but he reduced to two because of massive aggravations). Volume of administration was reduced to minimum instead of drop doses.  In this context, Hahnemann saying that one drop can moisten 300 poppy seed sized globule and one globule either dry or dissolved in water can be taken as the quantity at a time.

As to the quantitative dose, Hahnemann reserves his opinion that it cannot be set a priori but only through experience and observation we can arrive at a conclusion. In short a curative dose should be:-

(1) Stronger than natural disease.

(2) Should be able to over power and extinguish the natural disease from vital force.

(3) Shall be able to produce preponderance to natural disease so that it shall produce a slight Homoeopathic aggravation immediately after its ingestion.

In the preface to Vol. III of the text book ‘Chronic disease’ published in 1837, Hahnemann shares the views on Dose that ratio between medicine and dilutent is 1:100 and the number of succession is again raised to ten in order to prepare a new potency as medicine is administered in water so as to dilute it thereby reduce the chance aggravation. The quantity at a time should be a spoon full dose from the medicinal solution, in which one no. 10 pellet is dissolved in 7-20 table spoonful of water.  The quantitative dose to ensure a complete cure is repetition of dose in chronic disease up to the saturation point with that potency of medicine indicating a Homoeopathic aggravation at the end of treatment.

In the sixth perfected edition of Organon the ratio of material drug substance to dilutent is 1:50,000.  This shows that the material content is very very low. The drug strength is made superior and elevated to the rank of spirit like power by making 100 successions. Dose at a time is made small to the level that a teaspoonful from the solution of a mixture of one poppy seed sized globule of indicated medicine with eight table spoonful of water.  The quantitative dosage is up to the saturation point of producing a Homoeopathic aggravation.

So the sum and substance of the dosage is that Hahnemann started with massive dose of crude medicinal substances and then he shifted his concepts on dosage based on the observations obtained from his experience. At last he arrived at a conclusion in the sixth edition of Organon as   to the material quantity present in the drug is to be reduced to one in 50,000 part of mother solution.  Volume of drug to be taken by the patient ranges from one poppy seed sized pellet in moderate case to one teaspoonful from the mixture of one poppy seed sized pellet with at least 120 cc of water. The strength of drug is elevated to the level of spirit like power through 100 successions in the preparation of each potency and at least 8 succession in between each administration, to be accepted by the life force.  The quantitative medicine required is to ensure a homoeopathic aggravation at the end of treatment to reach at the point the therapeutic saturation.

A note on the administration of medicine in water.
Hahnemann reiterates the merits of administration of medicine in water in aphorism 269 of fourth edition 286, 287 and 288 of fifth edition and 272 and 247 of sixth edition.

 There are two ways of mixing a medicine with a non-medicinal fluid substance. A medicinal solution is prepared in an intimate and uniform mixture by the process of succession. Another method is the preparation of medicinal solution by mixing the medicine with non-medicinal fluid in a superficial and imperfect manner. The former is the process used in dynamisation and the latter comes under the designation of mere dilution.  In the former, the power and drug strength is increased where as in the second process the material quantity of drug substance is reduced with no awakening in power.

Advantage of dissolving medicinal globule in water for administration
The power of medicine is released to the diluting water and medicine will act in a spirit like manner. The water potency ensures the affection of medicine in all nerve ending it touches. So a speedy and uniform dynamic action is obtained. As the dilution causes a reduction in material quantity, chance of an aggravation is reduced to minimum. It can be used as a medium for olfaction and inhalation. So it is safe to use in sensitive and highly sensitive patients. The dose can be adjusted properly. A succession or stirring can be made so as to change the degree of potency. The power of penetration of the life principle is made more uniform. It enhanced the effectiveness of delivery since it can touch many nerve endings than tiny pill. It allows a single dose to split in to many administrations. Plus method can safely used in the case of centesimal scale.Even though the material quantity is reduced the power of medicine is preserved.

Disadvantage
Preservation for a number of days is not possible unless some alcohol or charcoal is added. It is not user friendly. But on the contrary, Hahnemann says medicinal globules can retain their medicinal virtues for several years if protected from sunlight and heat

A short study on the various aspects of ‘new altered but perfected method’ of Dr Hahnemann with reference to the sixth edition of Organon of Medicine

Contents
I. A prelude to new altered but perfected method.

II. Preparation of 50 millesimal scale.

III. Duration of medicinal efficiency.

IV. Methods of dispensing medicine to the patients

V. Preparation of medicinal solution

          (a) to patients of normal constitution

          (b) to sensitive patients.

          (c) to highly sensitive patients.

VI. Medium of administration of medicine.

VII. Routes of administration of medicine.

VIII. Repetition in 50 millesimal scale

      (a)  period of repetition

      (b)  repetition of same medicine

      (c)   repetition at longer intervals

      (d)  repetition with higher dynamisation

IX. Dose

  (a)   ideal dose

  (b)  quantity at a time

  (c)   qualitative dose

  (d)  Exceptions to the rule of dosage in chronic miasm.

X. Homoeopathic aggravation

          (a) Acute disease

          (b) Chronic disease

          (c) Due to large dose

          (d) Schein symptoms

XI. Cure with 50 millesimal scale of potency.

XII. Significance of new altered but perfected potency.

A prelude to the ‘new altered but perfected method’.
50 millesimal scale of potency is a new scale of dynamisation in which crude substance is raised in to medicines of highest development of power at the same time mildest in its action. The former state is attained by hundred progressive successions and the latter by attenuating the medicinal substance to the dilutent at the ratio of 1:50,000. The high- tent medicinal power and frequent repetition of the same in modified degree of potency is capable of extracting the disease force from the sick person quickly and permanently and at the same time gently by its low material content. So the real fence of a speedy and gentle cure due to the pitfalls in dosage and potency are surpassed by this new perfected method.

Preparation of LM scale
Homoeopathic system of medicine uses the inner medicinal powers of crude substances for its therapeutic use. Substances in the crude state sometimes will not show any evidence of medicinal power. But the peculiar process owned to Homoeopathy called dynamisation or potentisation develops the inner medicinal virtues of crude substance in to dynamical powers efficiently making it for therapeutic use. This is effected by the process of intense friction of fixed quantity of medicinal substance with un-medicinal substance either by the process of rubbing in the case of dry substances or by shaking (succession) in the case of fluid substances.

There are different scales of dynamisation. Out of this Hahnemann says the best development of power is attained by the method 50 millesimal scale. Preparation of LM scale is detailed in aph.270 of sixth edition of Organon.

Duration of medicinal efficiency.
The medicinal globule will retain their medicinal virtues for many years, if protected from sunlight and heat.

The method of dispensing the medicine to patient
A globule of high potency is crushed in a few grains of sugar of milk which       the patient can put in a vial and be dissolved in requisite quantity of water. (F.N to aph. 248).  It can also be dispensed by the physician after making a medicinal solution.

Preparation of medicinal solution.

Normal constitution.
Medicinal solution can be prepared in 40,30,20,15, 8 table spoonful of water. But to avoid the inconvenience of large quantity of water it is always better to prepare the medicinal solution in a vial which contains 7-8 tablespoonful of water. Put one globule of highly potentised medicine in that vial. In order to preserve the medicinal solution from decay as it has to be used for longer days some alcohol or charcoal can be added. If charcoal is used as a preservative, it has to be suspended by a thread and remove it whenever succession is made. The vial which contains the medicinal solution should be successed thoroughly 8, 10 or 12 times. After this procedure take one tablespoon and put it in a glass which contains 7-8 table spoonful of water. Stir it well. From this solution give one dose to the patient. For the second dose the original solution should be successed 8, 10, or 12 times and then from which one table spoon is taken and dissolved in a glass containing 7-8 spoonful of water stir it.  From this solution one tea spoon is given as a dose.

Preparation of medicinal solution to the sensitive patient.
Take 7-8 table spoonful of water in a vial and add one globule of high dynamisation. Thoroughly successes the solution for 8, 10 or 12 times. Take one table spoon of medicinal solution from it and add in a glass, which contain 7-8 table spoonful of water. This is stirred thoroughly. From this solution take again one table spoonful and add in a glass, which contain 7-8 table spoonful of water. Stir it well. From this one dose can be given to a sensitive patient.

Preparation of medicinal solution to highly sensitive patient.
The preparational procedures done for sensitive patients are diluted one more glass and stirred for more sensitive patients.

The high light of this method is that the original medicinal solution is successed and change in the degree of potency is made before each administration. A close scrutiny will expose the fact that in sensitive and highly sensitive patients, Hahnemann is trying to reduce the harmful effects of suitable medicines by reducing the material quantity by diluting before each administration. (F.N to aph.248)

Medium of administration of medicine
It  may be administered as dry globule in moderate and recent cases of illness. It can also be administered through water medium.

Route of administration
The main method of administration is by oral route either in dry globules or in liquid form.

In sensitive patients, in order to avoid aggravation Dr Hahnemann also resorts to either olfaction or inhalation. Here dry globule or globules, dissolved in alcohol, and are used for the process.

Medicine can be used through external parts by rubbing on it. The parts subjected to pain, spasm, skin eruption, denuded surface are avoided.

Repetition in 50 millesimal scale
Repetition of medicine should be made with the precaution that every dose deviate some what in degree of potency from the preceding dose. Then only the vital force will accept the medicine in a proper manner. This is applicable in all types of repetition in 50 millesimal scale.

(a) Period of repetition
In long lasting chronic cases, repetition can be made daily or every second day, in acute diseases every two to six hours. In very urgent cases every hour or oftener can be repeated. In acute fever small dose of lowest dynamisation can be repeated at shorter intervals though the medicine possesses long duration of action.

(b) Repetition of same medicine in same potency.
The medicine that acts without producing new troublesome symptoms is to be continued while gradually ascending (of the same potency but modified ) so long as the patient with general improvement.

(c) Repetition at longer intervals
After administration of suitable medicine in modified potency, a state will appear where with the general improvement of the condition of the patient, there will be intensification or reappearance of one or more of the original complaints. This is indicative of Homoeopathic aggravation. The saturation point of medicine in that particular potency has reached in that particular patient. In that circumstance medicine repetition should be restricted to longer intervals.

(d) Repetition with higher dynamisation.
If a case demands prolonged administration of medicine, after using the already prepared medicinal solution of lower dynamisation, the physician can proceed to higher dynamisation, if he finds it is necessary for a complete restoration.

Another situation calling higher dynamisation is that during the course of treatment there will be intensification or reappearance of one or several old original complaints. If after adequate waiting the above symptoms are not vanished, it is indicative of remnants of disease in that particular patient. Here a high potency has to be started administering in place of lower dynamisation earlier used.

‘In very rare cases, notwithstanding almost full recovery of health and with good vital strength, an old annoying local trouble continuing undisturbed, it is wholly permitted and even indispensably necessary to administer in increasing doses the homoeopathic remedy that has proved itself efficacious but potentised to a very high degree by means of succession by hand.’

One precautionary remark Dr Hahnemann making when going to higher potency is that the ascending should be gradual and slow especially in sensitive and irritable patients compared to less susceptible patients.

(e) Repetition with new remedy.
In the course of treatment, it is natural that sometimes new symptoms or complaints will appear after administration of suitable remedy. In that circumstance, one new Homoeopathic remedy which covers the new symptoms should be selected for administration.

Dose
The ideal dose for moderate and recent case is a poppy seed sized globule which is placed directly on tongue. (Aph272)

A poppy sized globule dissolved in water is a method which gives more powerful action.

Quantity at a time

A medicinal solution is prepared usually at least in eight table spoonful of water.  From this medicinal solution one or (increasingly) several tea spoons can be taken as a dose at a time.

Quantitative dose
The ideal dose for a particular patient can only be ascertained based on pure experience and experiment. It can be determined by observing the sensitiveness of individual patient also. In all cases acute or chronic, except in cases where a deterioration of an improvement viscus is identified, the dose should be stronger than the natural disease that is able to over power, extinguish the sensation of natural disease from life force. This can be attained by continuation of medicine gradually ascending in degree of potency till the patient is feeling a general improvement.

 It can be continued with ascending degree of potency till the patient experiences the reappearance of one or several original complaints. This is an indication that the life principle is not now on the grip of natural disease, but is controlled by the already administered medicine. This is the stage of Homoeopathic aggravation in 50 millesimal scale of potency due to the primary action of medicine. As this is a sure sign that natural disease force is eliminated and medicinal force has taken charge of vital force, repetition of medicine is no longer required. So naturally medicine has to be stopped for 8, 10, or 15 days. It is to confirm the stage as a real curative stage or medicinal aggravation. If it is a true homoeopathic aggravation, the symptoms will disappear within a short period without much disturbance to the patient.

The dose required to complete a cure in the above manner is considered as the quantitative dose.

On the contrary, if the original symptoms are persisting and slightly increasing, then it is a clear indication for higher potency of the same remedy. In order to extinguish the remnants of disease completely higher dynamisation of the same medicine should be opted for administration with change in degree of potency every time. Then, with the higher dynamisations a Homoeopathic aggravation will appear and that dose is considered as the ideal qualitative dose for that particular patient.

Dr.N.Hari hara Iyer.MD(Hom)
Dept. of Organon.
Dr.Padiar memorial Homoeopathic Medical College. Ernakulam.

Read Part II : http://www.similima.com/50-millesimal-scale-potency-a-critical-study-part-ii

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