Know Your Potency, Dose & Repetition
Homeopathic Journal :: Volume: 3, Issue: 7, May, 2010 (General Theme) - from Homeorizon.com
|Article Updated: May 08, 2010|
The selection of the appropriate drug is the 1st prerequisite - if the treatment is to be successful. The choice of the potency and the dose should correspond to the patient' s reactivity at that moment of treatment. The 'dose' i.e. the amount of substance or energy, needs to correspond with the 'Laws of Stimulant Therapy' - "the greater the irritant effect, the smaller dose; the more inert the substance, the greater the dose" . In the Homœopathy, the 'dose' means the number of minim (drop) or tablet.
When the administered substance is highly attenuated, the dose is not determined in milligram - but it is on the basis of the alternative energy, eliciting a noticeable reaction. The reactions observed in the patient calls for repetition.
The Homœopathic medicines can be selected by 'long' or 'short' route. The classical ways, is to select the medicine after proper Repertorization [selection of repertory based on the presenting case and the adaptability of the repertory] and consulting with the Materia Medica. This consultation is necessary to ensure that the drug really matches the overall reactivity of the patient. At this moment, when the final selection is to be made - some points are to be considered; and this is troublesome & confusing for majority of the beginners. The points are to be considered - are ------
Dr. Hahnemann initially used the unpotentized drugs, though his treatment was homœopathic. Adapting the potency to the patient' s sensitivity is very important. A cure can be achieved with low ( q to 6x) or medium (12x to 21x) or with high (30c & above) potencies. The choice of potency is not a matter of faith or hearsay. It is to be performed by the unbiased observation and on the experiences gained by generations of physicians.
We all know from the knowledge of toxicology that massive poisoning causes destructive tissue damages and the chronic poisoning with a smaller dose leads to functional changes. The subtle toxicology of homœopathic drug-tests yields mental symptoms.
Dr. Voisin had assessed drug-test-records to determine the interval after which particular reactions occur in the healthy human (prover) in particular potency. He formulated some sequences. His formulation provides the
1st Principle of Choice of Potency - i.e.
- Low Potency in Organic Disease.
- Medium Potency in Functional Disorders.
- High Potency for Mental Disorders.
The 2nd principle based on the medicinal quality of the drug in non-potentized form. The 2nd Principle of Choice of Potency, as done by Dr. Gerhard Kœhler, is ----
- The lowest medicinal potency for drugs with practically no medicinal properties in non-potentized form (inert substance), usually corresponds to their colloidal solubility from about 8x & above.
- Highly toxic drugs only show alternative properties above their aggressive range from about 12x potency & above.
The 3rd principle derives from the observation that there is considerable variation in the individual' s reactivity. The phenomenon of allergic or hypersentivity reactions to minimal stimulus is much greater in persons with vegetative imbalance than those with sympathetico-tonic or parasympathetico-tonic regulation.
The indications of such reaction are red or white dermographic reactions, marbled skin, patches of redness in cheeks or neck or any where in the body. These patients generally respond very well to 30c or LM potency. The highest centesimal & decimal should only administer in very small doses.
So, the 3rd Principle of Choice of Potency is -------
- Low Potency - if vegetative reaction is poor.
- Medium Potency - if Vagus & Sympathetic are imbalance.
- High Potency - with allergic / hypersensitivity / vegetative imbalance.
The 4th principle regarding the determination of choice of potency considers the patient' s vitality and the degree of agreement between the patient & drug-picture. Several stalwarts experienced that in the final stage of a disease process, when the reactive potential of the patient has been exhausted - a very high potency (perhaps above 200c) performs much better to maintain the regulatory balance. If the patient has considerable vitality and case-taking reveals wide-reaching similarity in the mental & constitutional symptoms - it is perfectly safe to use a very high dilution.
So, the 4th Principle of Choice of Potency is ---
- Good vitality of patient & good 'simile' give remarkable cure with very high potency.
- Where the drug-diagnosis is less certain, it is better to use medium or low potency.
In the introductory memorandum to volume II of Materia Medica Pura, Master Hahnemann quoted two examples - to demonstrate the essential principle of making a drug-diagnosis based on comparison of a number of symptoms. The drug-diagnosis based on comparison of symptoms requires the physician partly to have the drug-symptoms in his memory and partly to know where to find them. Then the necessity of a 'drug-index' is urgently felt by Hahnemann.
Observations made on highly sensitive patients have shown that it is possible to avoid excessive initial aggravation by reducing the dose. Many stalwarts observed marvelous result with divided / fractional doses. They administered high potencies of one drug 2 or 3 times in succession at 2 to 6 hours interval; and then allowed a long time to pass before further repetition. There are 04 observations of Dr. Gerhard Kœhler regarding potency -----
- ST Observation : One granule of a high potency is sufficient for most of the infants, debilitated young children and old persons in a reduced general state of health.
- ND Observation : Hyperactive persons with dilated pupils, positive light reflex and excitement coming to expression in their gesture need only a small dose (1 granule or 1 minim). Hyperactive allergic subjects with narrow pupil & frozen mien react with greatest gentleness to medium quantities of LM potency (perhaps 5 to 8 drops twice in a day).
- RD Observation : Low potencies with organotropic affinity may be given in larger doses & with frequent interval in acute conditions. In infectious conditions, for acute conditions, cumulative dosage in rising potency proves effective.
In § 248, Hahnemann says, " ......., we potentize anew the medicinal solution ..... from which we give the patient one or (increasingly) several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener. Thus in chronic diseases, every correctly chosen homœopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success. If the solution is used up (in seven to fifteen days) it is necessary to add to the next solution of the same medicine if still indicated one or (though rarely) several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one more homœopathically related medicine must be chosen in place of the last and administered in the same repeated doses, mindful, however, of modifying the solution of every dose with thorough vigorous succussions, thus changing its degree of potency and increasing it somewhat. On the other hand, should there appear during almost daily repetition of the well indicated homœopathic remedy, towards the end of the treatment of a chronic disease, so-called (§ 161) homœopathicaggravations by which the balance of the morbid symptoms seem to again increase somewhat (the medicinal disease, similar to the original, now alone persistently manifests itself). The doses in that case must then be reduced still further and repeated in longer intervals and possibly stopped several days, in order to see if the convalescence need no further medicinal aid. The apparent symptoms (Schein-Symptome) caused by the excess of the homoeopathic medicine will soon disappear and leave undisturbed health in its wake. If only a small vial say a dram of dilute alcohol is used in the treatment, in which is contained and dissolved through succussion one globule of the medicine which is to be used by olfaction every two, three or four days, this also must be thoroughly succussed eight to ten times before each olfaction" .
4th Observation : In chronic cases, treatment with the constitutional drug in rising potency may be helpful.
Hahnemann' s advice in § 246 of his Organon of Medicine, " Every perceptibly progressive and strikingly increasing amelioration during treatment is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hastening towards its completion. This is not infrequently the cause in acute diseases, but in more chronic diseases, on the other hand, a single dose of an appropriately selected homoeopathic remedy will at times complete even with but slowly progressive improvement and give the help which such a remedy in such a case can accomplish naturally within 40, 50, 60, 100 days. This is, however, but rarely the case; and besides, it must be a matter of great importance to the physician as well as to the patient that were it possible, this period should be diminished to one-half, one-quarter, and even still less, so that a much more rapid cure might be obtained. And this may be very happily affected, as recent and oft-repeated observations have taught me under the following conditions: firstly, if the medicine selected with the utmost care was perfectly homoeopathic; secondly, if it is highly potentized, 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 the cure but with the precaution, that the degree of every dose deviate somewhat from the preceding and following in order that the vital principle which is to be altered to a similar medicinal disease be not aroused to untoward reactions and revolt as is always the case 1 with unmodified and especially rapidly repeated doses" .REPETITION OF DOSE : -
The substitution therapy involves medication to make-up the deficit. Compensatory therapy is to be continued till the decompensated organ is in equilibrium and can be kept going with the maintenance dose.
The Homœopathy is a form of regulatory therapy. Regulatory therapy introduces a stimulus to provoke a reaction. " It is senseless to introduce further stimuli whist the desired reaction is continuing" . So, the Homœopathic medicinal therapy is based on the principle ---- " Give the drug until there is a reaction. Wait and observe the progress of the reaction. Only repeat the drug when the curative process comes to a standstill or becomes retrograde" . Master Hahnemann' s advice in § 246 " Every perceptibly progressive and strikingly increasing amelioration during treatment is a condition which, as long as it lasts, completely precludes every repetition of the administration of any medicine whatsoever, because all the good the medicine taken continues to effect is now hastening towards its completion" .
The most important thing for successful practitioner of the 'healing art' is watch and wait. Patience and observation are priceless. There is no fixed rule as to how long one should wait. Every individual, every state of illness, every drug and potency has its own laws.
The General Principles are ------
- Low Decimal Potency may be repeated more frequently.
- High Centesimal acts for several weeks or months.
- 50-millesimal Potency is flexible and they may be given daily.
- If Rising Potencies are used, the same drug may be given at increasing intervals for an extended period of time.
Conclusion : -
The choice of potency ranks below the selection of the appropriate medicine. For a long-lasting and 'gentle' cure, it is important to adapt the potency of the individual case. The term low, medium & high potency do not refer to absolute value. Being a special type of regulatory therapy, Homœopathy calls for the individualization of the case, as well as, the medicine. The toxicological sources of drugs and their 'pathogenetic tests' on healthy human show a corresponding affinity of the medicinal agents to a particular level of disorders - viz. ----
Low Potencies for Organic Lesions, Medium for Functional Disorders and High Potencies for Psycho-somatic Disorders or when 'higher functions' are affected.
This is to be kept in mind that a 'sick' react differently than that of a healthy. A tendency to over-react calls for a high & gentle potency (LM potency); whereas, poor reactors need hammering (more crude form). High potencies (above 200c) should never be given to the patients in a parlous state. Dr. Close modified Dr. G. H. G. Jahr' s advice for selection of potency and suggested - ' ...the finer, the more peculiar and more characteristic symptoms of the remedy appear in a case, the higher the degree of susceptibility and the higher the potency' . Dr. S. Close stated, 'the more acute the disease, the more susceptibility; and require higher dilution' .
There are ' Five considerations influence us in the choice of the dose' - as stated by Dr. Stuart Close ------
- 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.
So, " 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" .
Psora, Sycosis or Syphilis rarely occurs in their pure forms. Due to this, it is often necessary to consider a number of drugs in making the final choice. If the drug-diagnosis is uncertain at first and the choice is open, the decision is based on the following sequence ------
- Plant Kingdom .
- Mineral Salt.
- Metal Group.
If the drugs relate to a number of different constitutional defects or if the basic disorder cannot be clearly discerned, the sequence is -------
- Close, Stuart - The Genius of Homœopathy.
- Hahnemann, Samuel C. F. - Organon of Medicine (Translated from 6th edition by Wm Bœricke).
- Kœhler, Gerhard - The Handbook of Homœopathy: Its Principles and Practice.