Dr Mohd Furqan Aamer
The term posology originates from the Greek, posos meaning how much and logos meaning study or discourse.
Definition of Posology:
Posology means the doctrine of doses of medicine. The terminology of ‘dose’ derived from the word ‘dosis’ which means the quantity of a drug or other therapeutic agent to be taken or applied all at a time or in fractional amounts within a stated period. (Ref. Stedman’s Medical Dictionary).
Definition of Homoeopathic Posology:
A homoeopathic ‘dose’ means the particular preparation of medicine used, the quantity and form of that preparation as well as the number of administration of the medicine. In short, homoeopathic ‘dose’ includes potency, quantity, form and number of administration of the medicine.
The study of the doctrine of these doses is known as ‘Posology’.
Difference between Homoeopathic and Allopathic concept of Doses:
Allopathic concept of dose – In allopathy ‘dose’ means so many drops by measures or so many grains by weight – enough to produce the direct, positive, or physiological effect and not enough to endanger the patient. Allopath relates the word ‘dose’ to the material quantity of the medicine used.
Example: In constipation recommended dose is 1 to 3 grains.
Homoeopathic concept of dose:
In common speech a homoeopathic ‘dose’ of anything means an infinitesimal dose.
i) In the first place, the ‘dose’ related to the particular preparation of medicine used. E.g. In constipation opium mother tincture or the 6th, 12th or the 30th potency.
ii) In the second place, the ‘dose’ related to the quantity of that preparation and the form of that preparation e.g. opium 30 was given. It may have been given the one drop liquid under the tongue, one or two globules, one drop liquid is dispensed with purified water or sugar of milk.
iii) In the third place, the ‘dose’ related to the number of administration of the medicine – repetition. E.g. opium 30, it may be a single dose or may be repeated every 4 hourly or every week according to the condition of the patient.
Approximate dose of Homoeopathic Pharmacy: -
Forms Adult (above 14years) Child (3-14years) Infants (upto 2years)
Globules Four Two One
Powers 1 grain ½ grain ¼ grain
Tablets two one half
Tinctures one-drop ½ drop ½ drop.
Various kinds of doses:
1. Maximum dose:-It is the maximum or largest possible amount of medicine, which can be taken at a time by an adult, not harmful to human life.
2. Lethal or fatal dose: – It is also known as toxicological or narcotic dose. It is such amount of dose, which can cause death of living being. The fatal dose of different substances may be different, which depend upon their toxicity.
3. Booster dose: – A subsequent dose given to enhance the action of initial dose.
4. Fractional or refractive or divided dose: – It is fraction of a full dose, which is to be taken at short intervals.
5. Physiological dose: – Physiological doses are those which stimulates the normal physiology or functions of the different organs or systems of our body and hence the symptoms thus appearing are known as physiological symptoms.
6. Minimum dose: – “ It is that dose which is sufficient to overpower and annihilate the disease and capable of producing slight homoeopathic aggravation scarely observable after its ingestion.” (Apho.280)
It is that amount of medicine, which is though smallest in quantity produces the least possible excitation of the vital force, and yet sufficient to effect the necessary changes in it (Apho.246).
Homoeopathic posology represents the accumulated clinical experiences and interpretation of all careful prescribers since the times of Hahnemann. A proper understanding of the dynamic concept of disease of susceptibility and of remedy reaction is essential for an intelligent grasp of this most important aspect of homoeopathic practice. The ever-changing kaleidoscopic picture presented by homeopathic posology contrast well with the firm application of the law of Similars. The latter represent s the fundamental unalterable principles i.e. the former the rules that have been evolved out of the accumulated clinical experience, ever subject to modification in the light of subsequence experience. A perusal of the organon through its additions enables one to understand how even Hahnemann was all the time modifying and changing his ideas of posology in the light of its clinical experience.
The old school believes in administration crude medicines, which do more harm than good. In an address, delivered by Sir Jagdish Bose FRS and published in British Homeopathic Journel of Oct 1926, the distinguished scientist says that India has a system of Medicine which is two or three thousand years old and that the modern followers of the ancient system believe that every poison has two opposite effect, a good and bad.
Two German scientists, Prof. Arndt an eminent biologist and Prof. Schulz, a leading pharmacologist, have studied the opposite effects of drugs and have laid down their finding in what is called Arndt- Schulz law of Pharmacological action. According that ‘law’ “ small stimuli encourage life activity, strong stimuli tend to impede it and very strong stimuli are apt to stop or destroy it.”
The opposite action of drug s is well known to us. Our strongest poisons are Strychnine, Arsenic, Phosphorous etc. when given in large doses, but if given in small doses these are most valuable tonics. A very large no. Of our most valuable medicine are virulent poisons.
Dr. Hahnemann was originator of the science of Attenuation of drugs. After having learnt the effect of crude drugs described on irrational basis in the treatment of diseases, he found out the truth in medicine. His experiment with Peruvian bark led him to enunciate famous action, “ Similia Similibus Curenter” He found that crude drug applied on the law of Similars resulted in violent reactions. His ever-searching mind thought that of reducing the drug substance. This gave him surprising result. Encouraged by this experiment, he established his theory of minimum dose and drug dynamisation.
The fundamentals of Homoeopathic posology are represented in the trinity of
- A single remedy,
- Minimum dose and
- Minimum repetition.
1) Single remedy: -
The fundamental principle of Homoeopathic practice is selection of a remedy according to the Law of Similars. It is obvious that at a given point of observation out of a number of similar remedies only one remedy can be exactly similar to the case.
There are prescribers who advocate a combination of remedies on the plea that the Homoeopathic materia medica is not rich enough to cover adequately all the varied clinical states in practice through the single remedy for a case. They further claim to get over the difficulties of finding a single remedy out of the many as exactly similar to the case. They submit that it is possible to surmise the properties of the mixture from the known effects of its constituents. They thus proceeds to administer the combination on the basis of these supposed indications. This specious argument lures many.
The assumption that the properties of a mixture can be predicted from the known properties of its constituents is wrong on fundamental considerations. A mixture can never act as a homogeneous substance. Its constituents will act individually on the subject and produce their own effects varying according to the different susceptibilities they meet. These effects, further, will acts on each other. The final picture, therefore, cannot be predicted but will be known only after an experiment. Since the mixture acts as a heterogeneous substance, even a well-conducted proving will fail to bring out any consistent pathogenesis, which will serve later as indication for its clinical use. The advocates of such mixtures, therefore, have really no case and merit peremptory dismissal.
The same could be said of the routine’ alternators’ prescribers who use one remedy now and another next and continue them in the same sequence. Alternation of remedies could be considered as sound Homoeopathic practice only when the symptom group tends to alternate, e.g. Bryonia and Rhustoxicodendron in Enteric fever. But, in a chronic case, alternation of symptoms itself becomes a characteristic feature which should be covered by a single remedy.
2) Minimum dose:
Hahnemann in his initial application of the Law of Similars employed remedies in crude state and in large doses. When he found that severe aggravation invariably preceded amelioration, he embarked on the classical experiment of progressive reduction in the dose, according to a certain plan in which adequate dispersal of a drug was ensured by succession of trituration at every step of dilution employing an inert medium like alcohol or Lactose. This led to the chance discovery of potentization which has enabled the release of potential drug-energy in a form suited to cure.
We have also observed that minimum force is sufficient to disturb as well as to restore the lost balance. A Homoeopathic physician, therefore, employs a minimum dose and has little use for maximum tolerated one. The latter is very often employed by the physician all set to assault according to the law of dissimilar.
The minimum dose, therefore, should not be confused with the infinitesimal dose. Under certain circumstances like low susceptibility, the minimum dose may partake of material characteristics as in the use of tinctures. The practice of Homoeopathic therapeutics rest not on the small infinitesimal dose but on the selection in accordance with the Law of Similars. The infinitesimal dose has come to stay in Homoeopathic practice as a result of clinical experience for well over a century but we should not identify it with Homoeopathy.
We have indicated that a Homoeopathic physician has to accurately assess the susceptibility in a patient before he selects the right potency. Any error in this is immediately reflected either in a poor response or in an exaggerated response even though the remedy has been correctly selected.
We could formulate certain general guidelines:
- The closer the similarity a remedy bears to the picture presented by the patient, the higher is the potency, provided no specific contra-dictions to the use of high potencies exist in the case.
- A prescription that is predominantly determined by the mentals in a case, gives best results when higher potencies are employed.
- With remedies that are inert in the crude state, higher potencies give better results.
- A potency, which has helped a patient in the past, should not be lightly changed; otherwise, a needless aggravation may be precipitated.
- In chronic cases when the highest potencies have been tried with progressively decreasing responses, the 30th potency repeated to the point of reaction works satisfactorily.
- When an allergic patient reports with the same old symptomatology after a long remission from a constitutional remedy in a high potency, the use of the same potency might this time precipitate a severe aggravation. A careful Homoeopathic physician will go back to the medium range and observe the response carefully and regulate further repetition accordingly.
- When a remedy is prescribed on poor indications or only for a particular effect, the potency that acts best is the one in the lower range, at times even the mother tincture. For this purpose, potencies beyond 30 should not ordinarily be used.
- In acute illnesses affecting vital organs a differing response is seen according to the potency employed:
- a. High potencies frequently repeated lead to a crisis.
- b. Medium or low potencies with frequent repetition lead to a lysis.
We shall now consider some of the specific indications and contra-dictions for the use of high, low and, medium potencies and the special applications of ascending potencies.
i) High potency:
This range comprises all the potencies in the centesimal scale, commencing with 1000.
The following are the contradiction:
1. Advanced pathological changes in the vital organs (which also contra-indicate the use of deep-acting constitutional remedies). This state is signified by the predominance of the symptoms of the disease, the individual symptoms pointing to the remedy being scanty. Physical examination and special examinations furnish the necessary evidence. The ’Killer’ type of Homoeopathic aggravation results if a deep-acting constitutional remedy in high potency is administered in this condition.
2. Hypersensitive patients tend to prove practically every remedy administered to them. They respond best to the 30 and 200 potencies. Persons with skin allergy should be included in this category.
The following are the indication:
- 1. Extremely close correspondence of a remedy to the picture as presented by the patient.
- 2. Predominant mentals in a case.
- 3. Acute illness with change in vital organs and poor response to the medium range of potencies although the remedy is indicated unmistakably. Under these circumstances the remedy is repeated frequently till a definite response is seen and continued for about 12 hours after defervescene, otherwise there is a relapse.
- 4. Allergy to chemical or drugs. Such cases are known to respond dramatically to the same chemical or drug administered in high potency.
- 5. Cases no longer respond to lower potencies, indications remaining the same.
- 6. Reaction, poor. If it is decided to prefer a Nosode for this state, then a high potency, repeated infrequently, is employed.
ii) Low potency:
Potencies below the 30th centesimal are termed low potencies. The following are the contra-indications:
- Hypersensitive patients who show a tendency to come down with medicinal aggravation.
- Remedies that are highly active in the crude state like Phosphorous are not tolerated in the lower potencies; the 30th is the safest to employ.
- Cases with predominantly mental symptomatology will not respond to the lower range.
The following are the indications:
1. Cases in which symptoms of the disease predominate, indicating gross advanced pathological changes in the tissues and organs.
2. Organ remedies which are not properly proved and are generally employed for particular effects in a definite sphere, e.g. Thlaspi Bursa Pastoris, Chelone glabra, Pereira brava, etc.
3. Remedies in Biochemic practice are generally administered on coarse indications. The fine indications given in Homoeopathic materia medica interest the Biochemic practitioner little. These remedies, therefore, are generally administered in the lower range in the decimal scale. When these remedies are administered for greater specificity, however, medium or higher potencies are employed.
It is a common mistake to presume that the selection of lower potencies exempts prescribers from exercising causation in repeating a remedy. Thus, Mercurius corrosives is very often employed in acute dysentery in lower potencies – 3 or 6. An initial good response may be obtained only to be replaced later by what appears to be a setback for which more frequent doses of the remedy do little good; on the contrarily, the condition of the patient worsens, with the patient still manifesting the classical indications of the remedy. A careful re-evaluation of the case enables the following rational interpretation: The initial response indicated amelioration, which should have led to a reduction in the frequency of the dose. Through oversight, the remedy continued to be administered with the same initial high frequency and this, in course of time, proved too much for the patient’s state of susceptibility. Consequently, the remedy started proving itself and this was denoted by an exacerbation, which was misinterpreted as progress of the disease. This misinterpretation led to still more repetition with further deterioration in the patient. The extremely important point of the symptomatology still pointing to Mercurius corrosives enables the diagnosis of medicinal aggravation, which according to Kent can prove fatal. If the deterioration has not progressed much, mere withholding the remedy will prove curative; otherwise, an antidote to Mercurius corrosives will have to be administered according to the relationship of remedies.
iii) Medium Potency:
The mediums are the only potencies that can safely be employed in the hypersensitive type of patients. It should be a general rule to commence the treatment with the 30th potency, if one entertains any doubts about the accuracy of the prescription or about the probability of an aggravation. It is least likely to prove damaging. In some of the skin allergies it is a good practice to call the patient every day to note the effects of the previous single dose of a remedy like Sulphur 30 and to repeat till either definite amelioration is seen or a slight aggravation makes its appearance. By following this plan a severe aggravation can be avoided.
Tuberculinum Bovinum is best not employed below the 200 potency as the lower potency may lead to an aggravation of the medicinal type.
iv) Ascending Potencies:
In some instances a reaction fails to ensue even after repeated doses of the same potency. A restudy of the case confirms the same remedy. Under these circumstances, especially in mental cases, the indicated medicine could be administered with advantage in an ascending scale of potencies, viz., 30 / 200 / 1000, 200 / 1000 / 10M; 1M / 10M / 50M; etc. a single dose of each potency being repeated on consecutive days to the point of reaction: as soon as reaction is observed, further stimulation is stopped. This is the scheme recommended by Margaret Tyler for some of the resistant cases.
Time of administration
This is an important consideration in practice to which very often-adequate thought is not given. We can avoid unnecessary aggravation or failure to obtain the best possible response to the remedy if we take into account the following guidelines.
1. Most remedies are best given at bedtime.
2. Sulphur is best given on an empty stomach in the morning. If Sulphur is given at night to a case not having insomnia, it is said to give rise to it; however, if the patient has insomnia, then it will put him to sleep.
3. A remedy should not be administered either before or during the period of aggravation; it should be administered after the period of aggravation. Thus, Natrum Muriaticum should not be given in the morning, but preferably at bedtime; Lycopodium is preferred at bedtime or early morning.
4. In disease characterized by periodicity, a deep-acting remedy should not be administered just before or during a paroxysm. A superficial remedy may be administered during if necessary. Thus, in a case of Natrum Muriaticum, Bryonia may be administered during an acute phase to be followed up later by Natrum Muriaticum.
Failure to observe this precaution is known to have precipitated severe paroxysms of Malaria, which in an infant can prove easily fatal.
5. In a chronic case, an acute phase often precludes a constitutional remedy for fear of precipitating an aggravation. A related superficial remedy often works best, controlling the acute exacerbation and preparing the ground for the constitutional remedy.
6. When prescribing for Menstrual troubles, the remedy very often has to be selected on constitutional grounds and is best administered immediately after the menses so that sufficient time is allowed for the remedy to take hold of the patient. For relief of pain of menstrual colic, some superficial remedy like Nux vomica, Colocynth, Magnesia phosphorica may have to be administered during the menses.
4.In asthmatic states, the constitutional remedy is best administered after every attack is treated with a related superficially acting remedy. An anti-sycotic remedy will have to be administered some time in the course when the indications pointing to the same are seen. In cases treated in this fashion, progressively longer periods of remission are observed, prior to final disappearance.
8.Tuberculinum is best administered in the quiescent state.
3) Repetition of potency
The following general rules could be laid down about repetition:
- a) As soon as an adequate response is observed further repetition is stopped.
- b) As long as the response continues, the remedy is not repeated.
- c) Cessation of progress is not to be taken as an indication for repetition.
- d) The only indication for repetition is the return of the symptoms that have disappeared under the action of the remedy.
These rules are modified according to special circumstances as under:
1. Acute Cases: The action of a remedy is known to exhaust early; therefore, frequent repetitions are indicated. As the response is obtained, the frequency is cut down progressively so that the dose tapers gradually. Premature cessation of the remedy is known to promote a relapse.
2. Chronic Cases: Single dose stimulation should be the rule. Multiple dose stimulation – either on the same day or on consecutive days – should be reserved for cases in which single-dose stimulation has failed or is considered to be insufficient. However, as soon as adequate response is obtained, the further stimulation should be suspended. It should be remembered that a borderline case in which a deep-acting constitutional remedy like Phosphorous is indicated, does not bear frequent repetitions well. The action of a single dose may continue for months if not interfered with. Finally, before changing potency, multiple dose stimulation should be tried; otherwise a needless aggravation is precipitated. The special situation presented by a return of the old symptoms as per Hering’s Law of Direction of Cure has been discussed already. As regards the specialized form of repetition of Tuberculinum Bovinum for prophylaxis. Kent has given detailed instructions in his Lectures on Homoeopathic Materia Medica.
Classification of potency
After having come to know about various methods of drug dynamisation, the question arises as to which potency should be given to the patient and whether low or high. The practitioners know that potencies such as 0,1,3,6,12,30,100,200,500,1000, 10M, 50M, CM and MM are generally used. We may classify these into 6 categories namely:
- Low potencies: – 0,1,3,6,30
- Medium potencies: – 200.
- High potencies: – 1000. (1M)
- Higher potencies: – 10,000. (10M)
- Very high potencies: 50,000 and above.
The classification as given above May however, is different in some of the books but we have adopted this classification for our convenience only.
The potency question has been solved not-withstanding all endeavors of homoeopaths. Therefore, many popular books on homoeopathy leave the question of potency to the judgment of the practitioners. Like others I have also tried to solve this problem and accordingly divided this problem into 4 categories enumerated below i.e.
- Skill and Knowledge of the physician
- Nature of the patient
- Nature of the medicine.
1) Skill and Knowledge of the Physician: -
Hippocrates once remarked that in medical matter experience and common sense are far more valuable than scientific theories, however plausible. These remarks also hold good in the selection of potency. The ability, experience and the knowledge of a physician play an important role in the selection of potency. There are physicians who play well with the high potency on the basis of their experience and there are others who are afraid of even giving medicine above 30 potency. The physicians who have faith in the administration of low potencies are of the opinion that the high potencies do not contain any material substance in them, hence do not have medicinal value. But this belief is not correct. We must remember, that in the division of a dose, no matter how far this is extended, there is something of the drug left.
Matter is never destroyed; it may be changed in potentization, but an absolute zero is never reached. The high potencies where administered have shown their results. Both low and high potencies are of immense value at different physicians. Beginners in homoeopathy generally start with material doses because of lack of practical knowledge in them. According to the homoeopathic teachings very high potencies, the infinitely small doses are most powerful and may be dangerous if wrongly given. Of course much depends on the sensitiveness of the individual. A physician should know that no one potency deserves the preference in all cases and secondly that all potencies cure diseases but that not every potency cures every disease.
Some of the Opinions of Eminent Homoeopaths
Prof. J. H. P. Frost stated in the Hahnemannian Monthly of 1873 that Dr.Hahnemann taught that the right remedy would act in almost any strength or potency but that the wrong remedy will be inoperative whatever strength is selected.
Dr. Jahr writes in his Pocket Dictionary written for professional men and layman: -
“ In spite of the careful attention with which I have either-to followed the discussions relative to that subjects, I have not yet been able to decide whether the higher or the lower attenuations are the weaker or stronger doses. I have known one drop of the pure tincture to act for weeks precisely in the same manner as the 30th attenuation has been supposed to do; I have seen violent effects from the 30th as well as from the 2nd or 3rd, and on the other hand, I have effected speedy cures, without any previous aggravations by means of the tincture, and the 1st, 2nd or 3rd attenuation as well as with the 30th. I have observed similar effects from the 100th up to the 3000th and 8000th potency. We know that from the 4th attenuation upwards the medicines act dynamically than chemically but what the real difference is between the first and thousandth attenuation, is as yet impossible to say. It is my belief that the attenuation, if carried up to certain degree, acts more speedily and more positively than the lower preparations, and that a spoonful of a solution of a few pellets is a milder dose than a drop of an alcoholic attenuation, but I am unable to offer any proof in favor of my belief what I know positively is that we do not yet know that limit how far the attenuating process can be carried without destroying the power of the medicine, and that under proper circumstances, a pellet of the 8000th potency act as well as a pellet of the 30th or 3rd .”
Boenninghausen, one of Hahnemann’s favorite pupils states in his Lesser Writings: –
“In paragraph 287 of the Organon (5th ed.) At the conclusion there is a remark, in which we find the following words:” The higher the attenuation by means of potentizing is carried the more quickly and penetrating the preparation seems to transform the vital force. The swifter and more penetrative the action of the higher and highest dynamisation, here so expressly emphasized, has shown itself most decidedly during the 15 years during which I have used them almost exclusively. The quick alleviation of wounds from burning by the use of Arsenicum 200th, and of the pains resulting from contusions by Arnica 200th, borders on the marvelous, and can never be so fully attained by the use of lower dynamisation nor so completely.”
Dr. Elbert Guernsey wrote in his Homoeopathic Domestic practice,” In domestic practice the lower attenuations may be used with much greater safety than the higher.” But a word of warning given by Dr. Shepherd is not out of place to mention here “ Let me impress on the lay people that the high potencies are not for them to play with. Knowledge of metaphysics, mental philosophy and logic is necessary before one can hope even humbly to understand their action from a distance. I have been horrified at some people who after reading a book or two on Materia Medica while they are still in a state of mental indigestion, start to throw their weight about and begin to treat their friends and acquaintances with repeated doses of high potencies, frequently changing the remedies every few days in their foolish ignorance and vain glory. They do more harm to the cause of Homoeopathy than they kept to the ordinary run of house hold remedies.” (Dr. D. Shepherd – Magic of the minimum Doses).
Further, I may quote two statements of two great authors about low or high potency. Dr. Nash writes in his Leaders in Homoeopathic Therapeutics,” Of course low potencies will often cure, and that in spite of alteration, over-dosing and frequent repetition. But they will often fail, and, in the great majority of cases will not accomplish anything like the satisfactory results of true similimum, the single remedy, and the minimum dose.”
Dr. Kent writes in Lectures on Materia Medica, “ It is well to realize that you are dealing with razor when dealing with high potencies.” On the other hand while dealing with Calc. Carb; he writes,” You do not build mole thrills out of our high patencies; they simply establish a state of order, so that digestion and assimilation go on; order is established and tissues are improved”. The above two statements appear to be quite contradictory and give two idea that Dr. Kent was afraid of giving low potency. This thinking is basically incorrect. If Dr. Nash was supporter of high potencies only, why then he advised to give Senega q in asthma and as well as he remarked that there is no success with high potency. Similarly he used Digitalis in second potency, Picric acid in 6th trituration, Cal.Sulph in 12x, and Jalapa in 12th and regarding few other remedies his remarks are very important.
So I wish to tell the readers that if they have read Nash, try to understand him. The two statements of Dr. Nash and Dr. Kent were given by them into different contexts, basing their decision in the light of two different actions of the medicine in low and high potency, which we are going to discuss under the remaining three factors. The knowledge of physician about the use of medicine, its action in low and high potency, his experience and skill are very important and guiding factors in the selection of potency. It should be clearly understood that the first factor is not independent of the remaining three factors. All are interrelated and we are dealing with them fewer than three different headings for the sake of convenience only.
The knowledge of the Physician is that which he derives from his experiments on his patients and which he learns from the experience of the others. In some cases, even the most experienced homoeopathic physician may have to experiment on his patients in order to find out the whether a high or a very high or a low potency will cure.
2) Nature of the patient: -
One of the guiding factors for selection of potency is degree of susceptibility of the patient. Much depends on the sensitiveness of an individual taking homoeopathic medicine. No two people react alike. Persons oversensitive may even be due to improper homoeopathic treatment required low potency. The sluggish patients, owing too much allopathic drugging, will require a very high potency to get any reaction at all or low potency repeated every few hours until favorable reaction commences. In case of feeble patient where the vital force can easily be overwhelmed repetition of medicine is full of dangers. Actually sick robust patients will stand repetition of high potencies until favorable reaction sets in.
Children can tolerate high potencies well and generally the very aged persons require medium potencies except for euthanasia.
Thirty potency has special affinity for fair sex (Clark – The Prescriber). Unintelligent patient require medicine in low potencies while in highly intelligent person high potencies act better.
Some patients Proves every remedy they get. Such patients have an idiosyncrasy to every thing and these oversensitive patients are often incurable. Such patients are good provers; they will prove the highest potencies. Such provers be given medicine in higher potencies, go back to the 30th and 200th potencies. Their acute diseases can often be cured by 30th and 200th potencies and chronic by 30th, 200th, and 500th potencies. (Kent – Lectures on materia medica)
In fact in such cases 50 Millesimal potencies are most useful.
When a patient a patient is hypersensitive, you must avoid the use of the CM and other very high potencies, which will make; your patient sick, and use instead the 30th and 200th. In cases where the remedies are indicated such potencies will work quickly (Kent – Lecturers on Materia Medica).
All the lower animals are more easily cured by Similia Similibus Curenter than human beings – Dr. Thomas Skinner.
Animals require high potency. Boenninghausen became extraordinarily successful physician and had an enormous practice. He was a prominent advocate of high potencies having convinced him by the treatment of animals.
“All objections to high potencies are at once cut off by the homoeopathic cures of animals………….. He further writes that lieutenant Von Grueter of the Eleventh Regiment of Hussars had an English horse suffering from affections of larynx, coughed much there being rattling and croaking in the throat and short breath at the slightest exertion, it was cured by Hepar sulph 200 followed by Spongia 200. In another case he writes that when a cow distended from eating wet clovers, receives, three drops of Colchicum 3rd it recovers but it rarely requires less than two hours before it is entirely restored but after taking Colchicum 200th this takes place in half an hour. The fatal white diarrhoea of young pigs, which with Merc 3rd unusually drags along for two days, is cured by Mercuriues 200th in five to six hours.” (Lesser writings- Boenninghausen)
3) Nature of the disease:
In general acute diseases respond well to high potencies especially of acute remedies. But certain acute cases based on chronic troubles such as cardiac asthma would have to be treated with medium or low potencies, because the high potency would aggravate more chronic pathology.
In obstetrics emergencies high potencies are required. (YINGLING).
In bad hearts high potency may give a bad re-action. It may be necessary to use the tincture. (Grimmer).
In chronic cases, it is safe to begin with 200th centesimal unless it is dangerous because of the nature of the remedy, the degree of the pathology or the depth of the Miasms. The object behind using 200th potency is that you have then ascending series of potencies to use as treatment progresses (Kent).
In serious chronic cases the physician should take utmost care in the selection of potency of certain very deep acting medicines such as SULPHUR, SILICEA, TUBERCULINUM, or PHOSPHORUS in tuberculosis, KALI CARB in gout, PSORINUM in asthma and ARSENICUM and LACHESIS in many conditions. In these cases 30th potency may be very useful.
In mental diseases and disease of manifestly psychic origin the high potency 10M and upward is to be used and that for grossly material condition i.e., marked organic pathological changes, lower or medium potencies would be selected.
Dr. B. Bhattacharya in his book Tridosha and Homoeopathy writes that, “in working out this problem it is found for instances that
Obesity asks for C.M. potency. Oedema 1M. Ottorrhoea200
Paralysis 1M. Piles 200. Plague 500. Pleurisy 12
Pneumonia 30 and so forth - Anthracinum 200 has raised up several patients suffering from Bone T.B. which made them bed ridden for number of years. Three or four doses of this wonder medicine were enough to produce this result.
In incurable and doubtful cases give no higher than the 30th or 200th potency and observe whether the aggravation is going too deep or too prolonged. There are many signs in the chest in such cases to make a physician doubt whether he will begin in such cases with moderately low potency and 30th is low enough for anybody or anything (Kent). This view has also been held by Dr. Underhill when he advocates for the use of low potency in cases where cure is impossible and only palliation is required as in cancer.
Susceptibility and it’s relation to the potency selection
Stuart Close in his book “ The Genius of Homoeopathy” writes about the choosing the potency there is little teaching but many opinions. Practitioners, who publicly boast of their liberality on this subject, will too often be found, on more intimate acquaintance, to practice an obstinate exclusivism in the use of some particular potency; generally a very low or a very high one; and to harshly criticize those who differ with them. This is unfortunate, because such practitioners undoubtedly deprive themselves and their reach.
The series of potencies has been compared to the gamut in music,” A skillful artist may indeed construct a harmony with the various vibrations of the same chord; but what a more beautiful and perfect harmony might he construct by a proper combination of all the sound that can be elicited from his instrument.” (Guernsey- keynotes.)
In general it may be stated that any curable diseases may be cured by any potency, when the indicated remedy is administered; but that the cure may be much accelerated by selecting the potency or dose appropriate to the individual case.
Five considerations influence in the choice of the dose:
- The susceptibility of the patient.
- The seat of the disease.
- The nature and intensity of the disease.
- The stage and duration of the disease.
- The previous treatment of the disease.
Susceptibility of the patient: – This is generally and rightly regarded as the most important guide in the selection of the dose. It is important to have some means of gauging, at least approximately, the susceptibility of the patient.
Susceptibility to medicinal action is only a part or phase of the general susceptibility of the organism to all stimuli. By analogy, as well as by experience, we are led to a consideration of the main factors, which modify and express susceptibility in general.
The susceptibility of an individual to a remedy at different times also varies. Idiosyncrasy may exist as a modifying factor. Homoeopathicity must be considered.
The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy, and the higher the potency required.
The ‘Indefatigable Jahr’ has very lucidly and positively illustrated this point. He remarks an essential difference between the action of the low and high potencies, which consists, not in their strength or weakness, but in the development of the peculiarities of the remedy, as we rise in the scale of potencies. This is based on the well known fact that provings of the tincture and lowest potencies of a drug, as a rule, produce only the more common and general symptoms of the drug, not very sharply differentiated from other drugs of its class. It is in the provings of the medium and higher potencies that the special and peculiar character of the drug is revealed by its finer and most characteristic symptoms. Jahr illustrates this by a geometrical figure, consisting of a number of concentric circles, with radii drawn to represent remedies in different stages of potentization. In the first to the third potency, as shown in the innermost circle where the radii lie close together, similar or related remedies like Ars, Rhus, Bry, and Sulph, have a great many symptoms in common; but the higher they progress in the scale of potentization the more radii recede from each other, so that each appears more and more distinctly in its peculiar and characteristic features.
All narcotics, like Bell. Stram, or Opium, for example, in crude and massive doses act in a manner equally stupefying, causing death by apoplexy or paralysis; all drastic produce vomiting and purging, etc. it is only in small or potentiated doses that their most characteristic differences of action become apparent.
“By continual diluting and successing,” says Jahr,” remedies get neither stronger nor weaker, but their individual peculiarities become more and more developed:” in other words, their sphere of action is enlarged, as represented by the concentric circles.
The practical bearing of this on the selection of the potency or dose, according to Jahr, is as follows: – In a given case, where the symptoms are not clearly developed and there is an absence or scarcity of characteristic features; or where two or three remedies seem about equally indicated, susceptibility and reaction may be regarded as low. We give, therefore, the remedy, whose characteristic symptoms correspond closely to the characteristic symptoms of the case, we give the high potencies – thirtieth, two hundredth, thousandth, or higher, according to the prescribers degree of confidence and the contents of his medicine case.
We may slightly modify Jahr’s advice by suggesting; the clearer and more positively the finer, more peculiar and more characteristic symptoms of the remedy appear in a case, the higher the degree of susceptibility and the higher the potency.
Susceptibility is Modified by Age: – Generally speaking, susceptibility is greatest in children and young, vigorous persons, and diminishes with age. Children are particularly sensitive during development, and the most sensitive organs are those, which are being developed. Therefore the medicines, which have a peculiar affinity for those organs, should be given in the medium or higher potencies.
Susceptibility is Modified by Constitution and Temperament: – The higher potencies are best adapted to sensitive persons of the nervous, sanguine or choleric temperament; to intelligent, intellectual persons, quick to act and react; to zealous and impulsive.
Lower potencies and larger and more frequent doses correspond better to torpid and phlegmatic individuals, dull of comprehension and slow to act; to coarse fibered, sluggish individuals of gross habits; to those who possess great muscular power but who require a powerful stimulus to excite them. Such persons can take with seeming impunity large amounts of stimulants like whisky, and show little effect from it. When ill they often require low potencies or even, sometimes, material doses.
Susceptibility is Modified by Habit and Environment: – It is increased by
intellectual occupation, by excitement of the imagination and emotions, by sedentary occupations, by long sleep, by an effeminate life. Such persons require high potencies.
Susceptibility is Modified by Pathological Conditions or Disease: – In certain terminal conditions the power of the organism to react, even to the indicated homoeopathic remedy, may become so low that only material doses can arouse it. A common example of this is seen in certain terminal conditions of vulvular heart disease, where Digitalis is the indicated remedy, but no effect is produced by any potency. The patient will respond, however, to tangible doses of the pure tincture or a fresh infusion of Digitalis and sometimes make a good recovery from a condition that seems hopeless. Although such doses, judged only by their amount might regarded as “physiological” or pathogentic doses, the nature of the reaction in such cases is clearly not pathogentic but dynamic and curative, as many have witnessed. The form of the reaction complies perfectly with the requirements of cure as to order and direction of the disappearance of the symptoms and nature of the result.
Quantity alone does not constitute a pathogentic dose. Quality, proportionality and the susceptibility of the patient are also factors. What would be a large, injurious or perhaps dangerous dose for a highly susceptible patient, would have no effect whatever upon one whose power to react was very low by reason of the existence of gross pathological lesions, or of long existent, exhausting chronic disease and much previous treatment. It is solely a question of approximating the quality and quantity of the dose to the grade or plane of the disease, according to the law of Similars. If the grade of the disease is low, and the power of reaction low, the remedy must be given low. Thus we find, in such cases, that the symptoms of the patient are usually of a low order; common, pathological symptoms; organ symptoms; gross terminal symptoms; symptoms that correspond to the effects of crude drugs in massive toxic doses. The finer shadings of symptoms belonging to acute conditions, in vigorous sensitive patients, do not appear. Potentiated medicines will not act. The case has passed beyond that stage, and the finer symptoms with it. Yet the symptoms remain and the almost hopeless conditions they represent are still within the scope of the homoeopathic law; and they sometimes yield to its power, when the related law of posology is rightly understood and applied.
So-called “pathological symptoms” when they exist alone, are as significant and characteristic in their way and way be as clearly indicative of a remedy, homoeopathically, as the earlier, finer grades of symptoms. Whether they are as useful to the homoeopathic prescribers or not depends upon the existences of similar symptoms in the Materia Medica. We can only prescribe for symptoms, which have a counterpart in the Materia Medica. From the records of poisonings, over-dosing, and some extreme provings, as well as from clinical experience, we have knowledge of some drugs whose symptoms thus derived, correspond very closely to the class of pathological symptoms under discussion. In the list of such drugs we may find one that fits our case. If that is not possible a study of the early symptoms from the history of the case, if they can be elicited, may lead directly or by analogy, to the remedy needed. When a case has reached a stage where none but gross pathological or organ symptoms are present, it is usually incurable; but it is not necessarily beyond help by medicines homoeopathically selected, even if no results follow the use of the ordinary small doses or potentiated medicines.
In terminal conditions, therefore, when the patient does not react to well selected remedies, not to intercurrent reaction remedies, given in potentiated form and small doses, resort to the crude drug and increase the dose to the point of reaction.
When reasonably sure of the remedy give the tincture, or a low trituration, first in moderate, then in increasing doses until the dosage is found to which the patient will react, eve if it be the “maximum dose” as set down in the books. The “maximum dose” may be the “minimum dose” necessary to bring about reaction sometimes. It takes more power to drive an automobile up a hill than it does on the level; and if the hill is very steep the driver may have to go backward on the road a ways and take ‘a running start’ in order to gain momentum enough to carry him up. When he gets to the top of the hill he can shut off power and “coast” down the other side. That is what the homoeopathic prescribers have to do sometimes, in the kind of cases under discussion.
Susceptibility is Modified by Habit and Environment: -
People who are accustomed to long and severe labor out-of-doors, who sleep little and whose food is coarse, are less susceptible.
Persons exposed to the continual influences of drugs, such as tobacco workers and dealers; distillers and brewers and all connected with the liquor and tobacco trade; druggists, perfumers, chemical workers, etc., often possess little susceptibility to medicines and usually require low potencies in the illness, except where their illness is directly caused by some particular drug influence, when a high potency of the same or a similar drug may prove to be the best antidote.
Idiots, imbeciles and the deaf and dumb have a low degree of susceptibility as a rule.
“There is no rule without its exceptions.” And this is especially true in this matter of the homoeopathic doses. Contrary to what one would expect, persons who have taken many crude drugs of allopathic, homoeopathic or “bargain counter” prescription often require high potencies for their cure. Their susceptibility to crude drugs and low potencies has been exhausted and even massive doses seem to have no effect; as where cathartics or anodynes have been used until there is no reaction to them. Such cases will often respond at once to high potencies of the indicated remedy; in fact they often require the high potency as an antidote. The high potency is effective because it acts on virgin soil, invades new territory, as it were.
The seat, character, and intensity of the disease have some bearing upon the question of the dose.
Certain malignant and rapidly fatal diseases like cholera may require material doses or low potencies of the indicated drug. Hahnemann’s famous prescription of Camphor in drop doses of the strong tincture, given every five or ten minute, with which so many thousand of lives have been saved, is an illustration. Later, after reaction has been established and other remedies, corresponding to the symptoms of later stages of the disease come into view, the higher potencies are required.
Generally speaking, diseases characterized by diminished vital action require the lower potencies; while diseases characterized by increased vital action respond better to high potencies; but this again is modified by the temperament and constitution of the patient. Uncomplicated, typical syphilis, in its primary stage, the chancre still being existent, may be cured speedily by Mercury in medium or high potencies, if the patient is of the nervous or sanguine temperament, and especially if he has not already received treatment. If he is of the sluggish type, however, Mercury in the second or third trituration will probably be required. If the patient presents himself later, having already received the conventional large doses of mercury and potash until the characteristic dynamic and pathogentic symptoms of those drugs have been produced, low potencies will be of no avail. Either susceptibility has been exhausted or a drug idiosyncrasy has been developed. The drug must be antidoted and the further treatment carried on by higher potencies. These remarks apply not only to mercury and Syphillis but also to practically all other diseases and drugs. It is not to be inferred that mercury is the only remedy for Syphillis; for in Syphillis, as in all other diseases, we must individualize both case and remedy, if we expect to cure our patient.
Susceptibility and Cure: -
The processes of adaptation, which maintain health and prevent disease, restore a diseased individual to health. An intelligent physician will promote these activities and process of recovery and do nothing that will impede them. He will definitely not do away with the signposts that indicate the remedy and the abnormal susceptibility at the same time. Restoration to normal susceptibility therefore is a prerequisite to cure.
When the process of cure has set in, a definite pattern will make itself manifest:
- The ‘cleansing-up’ will progress from within without
- Vital mechanisms will be set right first to aid further adjustment.
- Direction will be from above downwards, and
- The ‘ old skeletons’ and ‘ the dirty linen’ long stored out of sight will be brought out of for cleansing prior to final disposal.
This definite pattern was detected by Hering and is known as Hering’s law of Direction of Cure. Naturally, this ‘Operation Cleansing’ might prove distressing to the patient but no true order can be set up in a deranged economy without such upheavals, especially in a case, which has long been suffering.
Any deviation from this pattern will indicate a red light to a Homoeopathic physician who will have to take immediate measures to save the situation.
Susceptibility and Drugs: -
Drugs are capable of influencing the organism because of its susceptibility. Examples of a total lack of susceptibility in animals to certain poisons are well known. The acquired lessening of susceptibility seen in drug-tolerance as well as the remarkable instances in which previous contact with the drug has promoted extreme susceptibility manifested through idiosyncrasy are also well known. What is not widely known is the fact that certain substances, inert in crude state, acquire remarkable powers to influence susceptibility when they are prepared as per directions in the Homoeopathic Pharmacopoeia and administered according to a definite plan as has been done in well conducted provings. The claim that Homoeopathic drugs have a capacity to influence mental processes was laughed a till very recently when the psychotropic drugs were announced with a beat of drums.
Once we accept that drugs can affect susceptibility and thereby lead to a train of symptoms, to limit these to the physical sphere alone would be highly illogical; they will also appear in other two spheres. The specific capacity of the drug to affect health acts on the susceptibility in a power to give rise to the final picture in a drug proving. As susceptibility is reflected in the constitutional type of a prover, a properly conducted drug proving has to ensure that the provers are drawn from the various constitutional types.
The total picture that develops in a drug-proving can be considered under the following categories:
- Common Symptoms in a large majority of Provers: they indicate a general response to the specific capacity of a drug, but are of little use from the standpoint of identification of the drug.
- Characteristic Symptoms in a large majority of Provers: They indicate the specific capacity of a drug and establish its identification and hence are all-important.
- Characteristic Symptoms in a few Provers only: This group may be further subdivided as under:
a) Characteristic Symptoms experienced for the first time by the Provers:
These symptoms represent a highly susceptible prover and if confirmed furnish reliable evidence of the specific capacity of the drug. If they cannot be confirmed by their occurrence in other provers, they are rated low provided the person in charge of the proving is sure of their veracity.
b) Characteristic Symptoms experienced previously by the Provers either when diseased or in another Proving: These symptoms do not indicate the specific capacity of a drug, but the peculiar susceptibility in the provers themselves. So they should be excluded from the final record.
4) Characteristic Symptoms in isolated instances only: They may represent cases of idiosyncrasy and are of doubtful value, but, all the same, must be entered in the final record for confirmation and re-evaluation. At times extremely valuable data, which can be clinically confirmed later, may be obtained only in this manner.
When we try to group and classify the provers who have responded best to a drug, we are struck by the similarities in somato-types and we conclude the persons with those characteristics are more susceptible to the form of energy released by the drug. And we try to identify this type with the record of the drug proving. Therein lies our mistake. The type furnishes an indirect form of evidence while symptoms a direct form. No extended argument is necessary to prove the superiority of the direct form of evidence. As a matter of fact, if the symptomatology of a drug were to be seen in an altogether different somato-type, it will be a very peculiar circumstance meriting special attention from the standpoint of prescribing.
In a proving, a drug is administered till it meets the susceptibility and evokes the response. Further stimulation is then suspended; otherwise, the clarity of response tends to get blurred.
Not all provers manifest susceptibility to lower potencies. Some of the finer indications have been obtained by provings conducted with the 30th potency and beyond. Experience indicates that with the increasing potency, the capacity of a drug to affect susceptibility progressively widens to operate more and more in the mental sphere.
General experience indicates that a sensitive and gracile subject is extremely susceptible; whereas; the coarse type requires repeated stimulations through the lower potencies. Inert substances require considerable releases of energy through 30th potency and beyond before they affect susceptibility. Poisonings represents mass onslaught and furnish only coarse data. Such frontal attacks never produce fine characteristic indications.
Susceptibility and Remedies: -
The invariable aggravation that preceded the amelioration when Hahnemann started employing remedies selected on the Law of Similars, but in the crude doses then prevailing, led him to postulate the maximum susceptibility is exhibited by a host to the Similimum. This observation with its correct interpretation led him to the great discovery of Potentization – the release of drug energy.
An acute and explosive onset of disease indicates a robust constitution with high susceptibility and, therefore, responds best to the remedy administered in the higher potencies. On the other hand an insidious onset indicates poor susceptibility so often seen in individuals in poor condition. This may call for deep acting remedies and or Nosodes.
A well-defined characteristic picture of a remedy, especially in the mental sphere, indicates a high level of susceptibility and therefore, call for the similimum in high potencies. In the advanced stage of disease, when pathological states have taken over, the characteristic features show a tendency to recede and all that one sees are the signs and symptoms diagnostic of these. This nondescript picture indicates poor susceptibility and calls for lower potencies or even material doses with frequent repetition to the point of reaction.
Sensitive subjects with a plethora of symptoms, especially of the hysterical type, indicate extreme susceptibility and call for caution in the use of both high and low potencies; only the medium range of 30 and 200 suits them, if at all. These unfortunate individuals – so difficult to cure- make good provers.
An advanced case with characteristic indications pointing to deep-acting remedies like Sulphur, Silica, Kali carbonicum, signifies extreme susceptibility to that particular similar force and which, if satisfied, lead to that stormy downhill course with violent reaction and misery which Kent has vividly described. A prior knowledge of the explosive situation helps one top steer clear by administering some superficially acting related remedies like Sanguinaria and Pulsatilla, which comfort these unfortunate patients in their terminal illnesses.
A borderline case, by contrast, weathers the storm and gradually makes a comeback. However, this storm can be averted by judicious prior preparation with related superficial remedies till the patient has turned the corner.
A patient with poor symptomatology or acute exanthemata where eruptions not come out and the nervous system gets involved, indicates poor susceptibility and calls for prompt exhibition of the appropriate strong remedies like Sulphur, Psorinum, Zincum, Lachesis, Opium, etc. These remedies are listed under the rubrics, ‘Reaction, poor’ and ‘ Discharges > Suppressions <’ in the repertories.
Similarly, a patient who cannot move further and has got stuck indicates poor susceptibility consequent upon detrimental miasmatic influences calling for an appropriate remedy, usually a Nosode.
A patient exhibiting bizarre symptomatology which does not fit any single remedy from the Homoeopathic Materia Medica indicates the morbid type of susceptibility – a result of abuse after abuse heaped on him by indiscriminate prescribers Homoeopathic as well as non-Homoeopathic. Experience indicates Nux vomica as a good helper in satisfying this morbid susceptibility and thereby creating a semblance of order out of this chaos. A patient who is just recovering from an acute illness presents a sort of virgin soil and is in a high state of susceptibility. He, therefore, presents to a discerning physician and array of symptoms, which unmistakably point to the constitutional remedy, a prompt administration of which completes the cure and effectively cuts short the convalescence.
A woman during pregnancy and after delivery is also in a similar condition and affords a Homoeopathic physician an unrivalled opportunity for constitutional prescribing. All allergic patients, especially those with skin allergy, have extreme susceptibility. This should caution prescribers against indiscriminate administration in higher potencies and injudicious repetitions, which can precipitate quite a severe form of aggravation.
The susceptibility to the subsequent administration of the same potency tends to fall gradually and this is reflected in progressively decreasing response as evidenced by shorter remission. This can be offset by changing the potency. Roberts in his book ‘Principles and Practice of Homoeopathy’ suggests that the potency should not be readily changed as long as it helps the patient; otherwise, a needless aggravation may precipitate. Kent, however in his ‘Lecturers on Materia Medica’ views that the same potency should not be repeated more than twice. Our personal preference is for Roberts. Hahnemann himself, in his later years, was experimenting with a schedule in which every subsequent dose was of a slightly higher dynamisation and he expresses himself in favour of this innovation. But, subsequent prescribers have not much to record on this interesting aspect of posology.
We very often try to offset a decreasing response to potency by
i) A frequent repetition on the same day, e.g. 3 doses 2 hourly, avoiding the characteristic time or period of aggravation or
ii) Repetition of the dose every day till reaction is roused.
This procedure is preferred when changing the potency is likely to lead to an aggravation, which the nature of the complaint deems inadvisable.
In some instances, susceptibility is dormant and no reaction follows the administration of the similimum. We have seen this repeatedly in patients who have been subjected to Electro-Convulsive-Therapy, Cortisone and ACTH Therapy, Prednisone, heavy sedation and similar suppressive measures. Under these circumstances, at times, a response may be effected by resorting to the ascending scales of potencies, 30 / 200 /1000; 200 / 1000 / 10 m; 1000 / 10 m / 50 m, and so on one dose of each on consecutive days till the reaction is observed.
It is worth remembering that when the highest potencies are exhausted and satisfactory response no longer obtainable, susceptibility to potencies in the lower range is very often restored and we can commence again from the 30th potency.
Another point worth remembering is that when a patient reports after a gap of a few months for a relapse of the same complaint and the last potency administered was beyond 200, he may exhibit marked susceptibility to the same potency and experience a flare-up, especially if he has some allergic disorder. In such circumstances, we should be cautious and recommence the treatment with a dose in the 30th potency, repeated to the point of reaction.
Infants and children are in general highly susceptible and react well to medium and higher potencies. In old age, the lower range with more frequent repetitions proves more satisfying. Addictions may suppress susceptibility and thereby interfere with action of the remedies. Certain foods and drinks known to aggravate a specific drug type, if consumed by the patient who is under treatment with that specific remedy, are known to interfere with the smooth action of the remedy and may terminate its action much earlier. This is on account of the suppression of susceptibility affected by the food or drink in question, e.g. the use of vegetable acids in a patient on Sepia.
The Relationship of Remedies indicates indirectly a probable sequence of changes in susceptibility. This particular fund of knowledge we owe to Boenninghausen whose critical study of symptomatology in Homoeopathic materia medica and widespread clinical experience are reflected in the Section of Relationship in the ‘Therapeutic Pocket Book’. This knowledge has grown with additions made subsequently by Hering, Kent, Miller, Boger and others. It should be understood that their interpretations and prognostications are ever subject to change in the light of accumulating experience.
A remedy, which is quite out of tune with a patient, will not meet with the requisite susceptibility and, therefore, will fail to evoke any response. This is the case with remedies far removed from the Similimum; the remedy with a partial resemblance to the totality meets the susceptibility partially and evokes only a partial response. Thus even a poor prescriber is able to zigzag his case to cure by utilizing such partial responses as stepping-stones.
Repetition of doses
It remains to speak of one more important matter connected with the general subject of Homoeopathic Posology – the repetition of the dose. The management of the remedy in regard to potency and dosage is almost as important as the selection of the remedy itself. The selection of the remedy can hardly be said to be finished until the potency and dosage have been decided upon. These three factors, remedy, potency and dosage, are necessarily involved in the operation of prescribing. Not one of them is a matter of indifference and not one of them can be disregarded.
The first question, which confronts us, is whether to give one dose or repeated doses. The second question is, if we give one dose when shall we repeat the doses and when shall we stop dosing?
Many expert prescribers begin the treatment of practically all cases by giving a single dose of the indicated remedy and awaiting reaction. This is an almost ideal method – for expert prescribers. Of course we all expect to become expert prescribers and will therefore accept that as our ideal!
Hahnemann’s usual teaching, the outcome of his long and rich experience, was to give a single dose and await its full action. The wisdom of this teaching has been amply confirmed since his day by many of his followers. The duration of action of a remedy which acts (and no other counts) varies, of course, with the nature and rate of progress of the disease. In a disease of such violence and rapid tendency toward death as cholera, for example, the action of the indicated remedy might be exhausted in five or ten minutes and another dose be required at the end of that time. In a slowly progressing chronic disease, like tuberculosis the action of a dose of a curative remedy might continue for two or three months. Between these two extremes are all degrees of variation.
The only rule, which can be laid down with safety, is to repeat the dose only when improvement ceases. To allow a dose, or a remedy, to act as long as the improvement produced by it is sustained, is good practice; but to attempt to fix arbitrary limits to the action of medicine, as some have done, is contrary to experience.
Young practitioners and many old ones too, for that matter, give too many doses, repeat too frequently, and change remedies too often. They give no time for reaction. They get doubtful, or hurried, or careless and presently they get “rattled” if the case is serious. Then it is “all up with them,” until or unless they come to their senses and corrects their mistakes. Sometimes such mistakes cannot be corrected and a patient pays the penalty with his life. It pays to be careful and “go slow” in the beginning; then there will not be so many mistakes to correct. We should examine our case carefully and systematically, select our first remedy and potency with care, give our first dose, if the single dose is decided upon and then watch results. If the remedy and dose are right there will be results.
Dr Mohd Furqan Aamer M.D(Hom)
DKMM HMC, AURANGABAD (M.S)