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Potency problem in daily practice
(Gist of the Lecture delivered by Dr. K.S. SRINIVASAN, Madras on the 31st July 1983 at the Madras Presidency Homœopathic Association, Madras, at Kesari High School, Mylapore, Madras.)
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‘Potency’ means power, authority, influence. HAHNEMANN called potentisation as ‘dynamisation’, ‘development of power’ – that is development of the hidden medicinal powers in the medicines by succussion or trituration with an unmedicinal medium.
Paragraph 269 of the Organon: “The Homœopathic system of medicine develops for its special use, to a hitherto unheard of degree, the inner medicinal powers of the crude substances by means of a process peculiar to it and which has hitherto never been tried. Therefore they all become immeasurably and penetratingly efficacious and helpful even those that in the crude state give no evidence of the slightest medicinal power on the human body. ….”1
Let us examine the germination of this ‘peculiar process’:
1790 was the year of the Cinhona experiment of HAHNEMANN. Experiments proceeded further; and for the first time in 1796 in an article titled “Essay on a new principle for ascertaining the curative powers of drugs with a few glance at those hitherto employed”2, HAHNEMANN speaks of “small doses”. In 1797 he reported in ‘Hufeland’s Journal der praktischen Arzneikunde’, “a case of rapidly cured Colicodynia”3. In this case he gave four powders each containing four grains – one powder daily. A severe agg. came when the patient took two powsers instead of one. However, cure followed. From now on HAHNEMANN went further reducing the doses and curing.
The first indications of the theory of small doses were seen in his “cure and prevention of Scarlet Fever” published as a pamphlet in Gotha in 18014. Here he speaks of mixing a grain of Belladonna with 100 drops of common distilled water and rubbing it in a mortar and adding 200 drops of diluted alcohol and making the liquid. This was the strong solution of Bell. One drop of this mixed with 200 drops of alcohol and shaking it for a minute is the medium solution of Bell. This is the prophylactic remedy for Scarlet Fever. You will notice that all these are to ensure the smallest dose to effect a cure without agg. and does not speak of “potency” or “dynamisation”. Same year HAHNEMANN wrote in Hufeland’s Journal “On the power of small doses of medicine in general and of Belladonna in particular”5. Neither in the essay “Medicine of Experience”6 published in 1805 which was a forerunner of the Organon, nor in the First Edition of the Organon published in 1810 does he speak of potentization. In 1815 he gave one drop of strong undiluted juice of Bryonia a washerwoman;7. “Potentisation” as such had not been born although dilution had begun even in the year 1801 with reference to Belladonna in Scarlet Fever. In 1823 GOETHE was dangerously ill and Arnica decoction prescribed by Goethe’s physician, taken in small sips, saved him.8
It therefore appears that sometime after 1823 only, the “potentisation” or “dynamization” as such, was introduced by HAHNEMANN. (“How can small doses of such very attenuated medicines as Homœopathy employs still possess great power?”)9.
So much about the historical or chronological development of the theory of potentization by HAHNEMANN. We are not going to discuss at all the vexed question of the efficiency of the high potency or whether the high potencies may be reckoned as ‘scientific’ etc; or as to how much medicinal content is there in a 200th potency etc., or as to what transpires in the fauces when homœopathic medicine in potency is placed upon the tongue. We know from our everyday experience that potencies work and work efficiently. That is enough for the Practitioner. What we would like to know is the Law, if any, guiding to the suitability of certain specific potencies for specific cases. There have been and still are, Homœopaths who use exclusively high and highest potencies and those who use low and mother tinctures. However, experience would surely convince everyone that we require the mother tincture, the low potency, the high and the highest – the entire range – the artist Prescriber works so. Amongst the users of mother tinctures, Compton BURNETT used the 30th and 200 potencies. CLARKE also did so; Richard HUGHES did not use high potencies. Carrol DUNHAM was neither low nor high; he seemed to have generally prescribed the 30 and 200 and made wonderful cures. NASH generally the high and highest. LIPPE practiced the high and highest exclusively. HERING seems to have used only the medium – 30/200. The great BOENNINGHAUSEN used upto 1000 and carried out unique experiments with potencies. KENT of course as you all know, was high; however, he did use in some cases even the 12x. Margaret TYLER used all the potencies and perhaps was the wisest of all in practical Posology. BOGER too used high and low.
Now the question again: Is there any clear, authoritative and specific guideline of dicta on the Posology with regard to specific diseases? The only simple and definite Rule is “the more similar the remedy to the disease, the higher the potency” and where we find the ‘Similimum’ the higher or highest. Why so? We agree that “the quantity of medicine required to effect a cure is the least”. We have seen that HAHNEMANN arrived at the dose “gradually and after many years of very careful experiments and observation”. DUDGEON has opined that HAHNEMANN went on reducing the dose so as to be beyond the persecution by the apothecaries of Germany10. DUDGEON is also of the view that it was KORSAKOFF who first hit upon the idea of “potentisation”.11 This does not seem acceptable. Whatever be the historical reasons the fact is that Hahnemann’s principle of potentization came about as he went on latent powers of medicines were developed by potentization. The conclusion is that the proper dose is always the least dose which will effect a “cure”. In terms of curative power the mild dose is really the most powerful. “Die milde Macht ist gross”.
Out of his very many years of experience and careful experimentation BOENNINGHAUSEN gives the advantages of high potencies (200 and above). These are12:
1. The sphere of action of a medicine continually enlarges the higher the dynamization is carried. This is most striking in those remedies which in their raw state excite few symptoms. e.g., Calcarea, Silicea, Natr. mur., Aur. met., Arg. met., Alumn. met. etc. While these effect already more in their 30th potency than in their first or second trituration their powers develop further with every additional dynamization. The immediate consequence of this is that they correspond to an ever-increasing number of ailments as their homœopathic simile, and therefore in chronic ailments they hasten the cure. (The fact that the sphere of action of the higher dynamizations which no attentive observer will deny continually enlarge has been deduced by BOENNINGHAUSEN from the results observed in two different cases of cattle suffering from same ailmnent where both PULS., and NUX V. worked efficiently.13
2. In acute diseases the after-effects or curative effects appear more quickly.
3. The high potencies show themselves effective in a single dose.
4. By continual dynamization, remedies are more and more withdrawn from the laws of chemistry. HAHNEMANN calls attention to the fact that the highly dynamized medicines retain their medicinal virtues for many years unlike the crude drugs.
5. A defective diet, which especially in cities and in the higher ranks frequently spoils the best cures, always does less damage the higher the dynamization is, and least of all if a minute dose dissolved in water, and every time shaken anew, is taken several days in succession.
6. The avoidance of the first effects (primary) which are merely material, and thus the avoidance of all the dangerous concomitant symptoms, which lie outside the symptom sphere of the disease in question. Especially will it be found that only the specific dynamic powers (which in provings on healthy people generally manifest later than the others) will become active, while the gross material (poisonous and destsructive) properties are not manifested.
7. Finally, it must bse considered a particular excellence of the higher dynamizations, that they can never be used as deceptive palliative which are useless as to any real curative effects and always extremely injurious.”
Those are the advantages of the higher dynamizations. How many of us have consciously observed these advantages over the lower potencies is the question. Careful recording and comparing the cures would help us confirm these observations of the great observer Dr. BOENNINGHAUSEN.
The following should be the considerations which should influence us in the choice of dose or potency14:
1. The susceptibility of the patient.
2. The seat of the disease.
3. The nature of and the intensity of the disease.
4. The stage and duration of the disease.
5. The previous treatment of the disease. (15,16, 17, 18, 19, 20)
THE SUSCEPTIBILITY IS ONE OF THE MOST IMPORTANT GUIDE. The more similar the remedy to the symptoms, 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 therefore the higher potency required. I have found Gelsemium in 1M as more effective than any other potency in ‘flu’. All these go to show that the medicines also have their own range of efficiency.
Dr. COLEMAN has observed21: “Digitalis is homœopathic to auricular fibrillation and auricular flutter. It must be given in the tincture, or its equivalent, if we are to accomplish results. Our dear old friend, Dr. EUGENE NASH, a prescrber par excellence, who usually prescribed high potencies, told me of a case where Asafoetida was clearly indicated. He tried it high and medium with no benefit. It was not until he gave four grains of the crude drug that he obtained the results.”
If the true simillimum (which includes the correct potency) is given, the medicine need be given only once (that is, only one dose).
Listen to the practical advice of Margaret TYLER22: “in advanced disease, malignant or tuberculous, with much tissue change or lowered vitality, philosophy teaches that the most terrible you can give your patient is the indicated remedy in high potency. Give anything but that. When the disease mass is large, or the reaction poor, the most harmful drug you can give is the similimum unless very cautious and low.”
With regard to palliation in incurable cases, BOGER has advised 23: “High potencies will not palliate incurable cases, you must use the low”.
The moot point is: How high is, generally, high? Is 10M high and CM highest? Or MM, DMM the highest? Further, except as part of a series of potencies to carry-through a curative process, are the MMs and DMMs valuable? Is not 200 a high potency? Recall the case of Tabes Dorsalis cured by BOENNINGHAUSEN24 with Aluminium metallicum 200. I think a Kent would have given 10M or higher if such potentisation had been resorted to during his life; it was only upto 1000 that he went. I therefore feel that the “high” is really a matter of individual experience. It is worth pointing out that the potencies now generally used are 6, 30, 200, 1000, 10,000 and so on and no potencies between 6 and 30 or 30 and 200 or 200 and 1000 (and so on) are prescribed; does this not indicate that the potencies between these do not matter much for general curative practice? Of course a great art prescriber may use potencies between these too. For the average General Practitioner potencies 6, 30, 200, 1M and 10M would do.
One more point – and this is a practical problem – namely the stocking of the various potencies of at least the most generally called for medicines, in all the potencies from the 3rd to the CM. How many of the practitioners amongst us can stock these? Of at least about 500 remedies; the investment; let alone the investment, the availability as far as Madras is concerned! I could not obtain even good quality empty vials of required size, except in just two shops, in Madras! Unless more Homœopathic Pharmacies are opened with stock of full range of medicines and potencies it would be not possible for practice of Art of Homœopathy. Perhaps if more number of Homœopathy Practitioners come up Pharmacies too may open. I hope it will not be a day-dream.
In conclusion: from the conception of ‘Potentization’ by HAHNEMANN and development of it to ‘high’ and ‘highest’, we have discussed; some kind of ‘law’ governing the selection of the Potency laid down by the great teachers have also been discussed. It has been pointed out that we require complete range of potencies in the scale right from the mother tincture and that there cannot be a hard-and-fast rule for choice of a particular potency in a particular disease in all persons at all times; the potency depends upon the symptom-similarity and the patient-susceptibility; matching these ios an Art, which has to be developed by each individual Prescriber. For some patients in given conditions mother tincture may be the proper potency and homœopathic to the case whereas for some the 10M. The tenet of individualization is a ‘sine qua non’ in selection of the Potency also.
References:
1. HAHNEMANN, S. Organon of Medicine, VIth Edition, 1977, translation by Kurt HOCHSTETTER, F., Santiago-Chile.
2. -do- Lesser Writings, translated by R.E. DUDGEON.
3. -do- -do-
4. -do- -do-
5. -do- -do-
6. -do- -do-
7. -do- Cases illustrative of Homœopathic Practice, Lesser Writings, translated by R.E. DUDGEON.
8. SRINIVASAN, K.S. Homœopathy in the days of Goethe, Hahnemannian Gleanings, May, 1980, Hahnemann Publishing Co. Pvt. Ltd., Calcutta.
9. HAHNEMANN, S. Lesser Writings, translated by R.E. DUDGEON.
10. DUDGEON, R.E. Lectures on the Theory and Practice of Homœopathy.
11. -do- -do-
12. BOENNINGHAUSEN, The advantages of High Potencies’ -
Clemens Lesser Writings.
13. -do- ‘The value of High Potencies’,
Lesser Writings.
14. CLOSE, Stuart The Genius of Homœopathy.
15. HAHNEMANN, S. ‘Cure and Prevention of Asiatic Cholera’, Lesser Writings.
16. NASH, Eugene, B. Leaders in Homœopathic Therapeutics
17. PULFORD, A. ‘The Science and Art of Prescribing’,
Homœopathic Recorder, Jan. 1929.
18. CLOSE, Stuart The Genius of Homœopathy.
19. BOENNINGHAUSEN, ‘Concerning the relative value of Symptoms and CLEMENS something about Borax’ – Lesser Writings.
20. KENT, James Tyler ‘Use of Potencies, application of remedies to sickness’ – Lesser Writings.
21. COLEMAN Homœopathic Recorder, Nov. 1929.
22. TYLER, Margaret ‘How not to do it’, Homœopathic Physician, 1912.
23. BOGER, Cyrus M. Homœopathic Recorder, July 1929.
24. BOENNINGHAUSEN, ‘Tabes Dorsalis and Aluminium metallicum
Clemens - Lesser Writings.
[]P.S.: This ‘lecture’ was delivered in 1983, and dealt with the Centesimal Potency – During the following years the Homœopathy Practitioners woke up to the need to study the Organon VI edn. Critically, and the 50 millesimal potency came to light and at present a fairly large section of the homœopathy practitioners use the 50 millesimal scale – also known as LM Potencies or Q potencies. There are clear instructions on this in the Organon VI edition = KSS]