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April 2006. The Phoenix Rises: How Homeopathy Continues to Survive & Thrive (Vol. 11, #1)
Posology - Helpful Hints
Feeling confident in which potency to use for each unique situation in a homeopathic practice comes with clinical experience. Materia Medica dominates post graduate courses and seminars, but clinical posology is often left to the practitioner. There may be limited written information accessible today for determining the dose, but there are reliable guidelines, and it becomes very beneficial to hear what good homeopathic doctors have done in their practices.
Feeling confident in which potency to use for each unique situation in a homeopathic practice comes with clinical experience. Materia Medica dominates post graduate courses and seminars, but clinical posology is often left to the practitioner. There may be limited written information accessible today for determining the dose, but there are reliable guidelines, and it becomes very beneficial to hear what good homeopathic doctors have done in their practices.
In the “Organon of Medicine,” Hahnemann dedicated paragraph 246 to 256 to posology and remedy action, carefully explaining his method. The “Nature of Chronic Diseases,” 1828, shows Hahnemann’s close attention to the sensitivity of the patient, administering drops, “according to the irritability and the vital force of the patient.” It is the sensitivity of the patient that I would like to briefly discuss.
G. H. G. Jahr, in his “Clinical Guide,” published in 1869, has an excellent introduction which includes posology. Linn Boyd, in “A Study of the Simile in Medicine” in 1936, presented the development of posology with historical notes from the early prescribers. He concluded that, “individualization must take precedence over the rule,” mentioning Dr. Raue, who urged that the sensitivity of the patient is the deciding factor in posology. Jahr, noting sensitivity, stated that if there is an aggravation after the remedy is given, with a new symptom of the disease, wait! It is an artificial aggravation, not the disease progressing, and there will be an amelioration and the new symptom will disappear. This can happen more so with a sensitive person, or someone who is particularly sensitive to the remedy, or if the remedy is too strong. The sensitivity of the patient may determine a “proving,” or the emergence of a symptom relative to the disease. In severe acute disease, this may happen quickly , and be imperceptible, so we have to rely on the general improvement to know if our remedy is the correct one, especially in a sensitive person. When a new symptom or symptoms appear, and the patient is getting worse, then of course we have to retake the case by adding the new symptoms to the remaining old ones, giving the new symptoms more value.
In chronic prescribing, repeating a remedy in too high a potency, and/or too frequently, may either cause a proving or dull the sensitivity of the patient . Too low or not enough can delay the healing. We have to determine the sensitivity of the patient by asking, “How sensitive is this person?” Are they emotionally sensitive, mentally imbalanced, environmentally sensitive, or allergic to medicines or drugs? Often, sensitivity may be ascertained by simply asking, ”How sensitive are you?” It may also help the patient feel more comfortable knowing that their homeopath cares and wants to avoid an unnecessary aggravation.
Dr. H. A. Roberts, in his “Principles and Art of Cure by Homeopathy,” claimed that there is a law of dosage as well as of cure. A natural “fixed” law is: “ . . . the quantity of action necessary to effect any change in nature is the least possible: the decisive amount is always a minimum, an infinitesimal.” Therefore, it stands that the more sensitive a person, the lesser is the impetus (potency) needed to stimulate the vital force response. Likewise, in a case lacking sensitivity (ie. a long chronic incurable disease) a higher potency repeated more often might be called for, continued until a response is determined. Dr. Sankaran (the father) in “Repetition of the Dose,” presented a cured case of paraplegia of the lower limbs where Causticum had helped with the first dose, and was continued for three months: first month 1M daily, second month 10M daily, and the third month CM every other day.
That case, and many historical cases portraying successful posology, were presented by André Saine in a two-day seminar on posology as part of the Canadian School of Homeopathy. In factors determining poslogy, he listed in the following order: sensitivity of the patient, then the evolution of the disease (speed of the disease), the chronicity of the disease, understanding the aggravation, the vitality of the patient, clarity of the case, the patient’s lifestyle, the patient who doesn’t understand homeopathy, and prohylaxis or inter current prescribing.
Some brief notes about sensitivity from the seminar are:
1. The more acute the disease, the more the patient is sensitive only to the remedy they need. In a chronic disease, a sensitive patient who has been treated with low potencies, can be given high potencies in acute episodes, but be careful of treating certain chronic diseases where an aggravation could be fatal, i.e., asthma or suicidal depression.
If the patient is in a latent stage and is treated with a 1M there might be a severe aggravation, especially if the person is sensitive. However, in these cases where there is an acute flair up, the potency chosen should match the intensity of the disease to be most effective.
2. The more nervous, the more sensitive.
3. Hysterical, very sensitive.
4. Allergies: the more, the more sensitive.
5. Sensitivity to drugs
6. Sensitive to influences, very sensitive.
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More....
Give 6c once a day for sensitive people, and go to 12c one dose, when two or three of the symptoms begin to reappear, and repeat when needed, or one to two times a week.
A two hour aggravation is normal sensitivity, a two week aggravation is a sensitive patient, and the potency should be adjusted accordingly.
Remember, that even a sensitive patient can have a higher potency when there is a severe acute disease, but be cautious once treating the chronic symptoms again.
Hysterical patients are extremely sensitive, so give one dose only, or begin with a placebo.
Olfaction (Organon, paragraph 284) is especially gentle for oversensitivity. . . . . .
Today the LM potencies have been used successfully with sensitive patients. Personally I have seen and heard of substantial, perhaps unneeded, aggravations using the LM potencies in sensitive people. If this happens, it is necessary to stop the daily dosing and let the aggravation pass, before reevaluating the dosage. Also, initially after the first week of using an LM potency, there may occasionally be a confusion as to whether the remedy choice is correct. Hopefully it is, and the patient is healing with its daily influence , but a problem arises when the remedy is a simile (similar, but not the exact similimum), and the reaction is to the daily medicinal effects. Here the disease remains unaffected or coexists with the medicinal action, the two being dissimilar, (Organon, paragraph 42) and returns once the patient’s sensitivity to the medicine’s influence wanes.
With the similimum, the vital force reaction is a secondary response and curative. There is, firstly, a reaction to the proper remedy, then the vital force healing reaction (secondary). However, if the simile is given continually, there may be a primary medicinal reaction-not a curative response. In other words, the medicinal influence confuses progress, especially in sensitive people. Perhaps an approach, especially with sensitive people, would be to first discover the similimum by using a single dose prescribing with a “c” potency.
By waiting for a curative response we would more clearly observe an aggravation followed by amelioration, not influenced by daily dosing. Then the LM potencies can follow once we have confirmed the correct remedy. (The editors would be happy to review any observances from practitioners with experience using the LM potencies for the next issue.)
Still, the problem of avoiding an aggravation in the sensitive patient remains. A similar approach to diluting the potency, perhaps a little easier, and with less possibility of confusion, is using the 6c,12c, 30c, 200c, or 200D (the potency corresponding with the sensitivity of the patient and intensity of the disease), and stirring it into 4oz. of water 30 times, and giving a teaspoon. In acute cases, I save the remedy dilution and repeat in a specified time, or as needed, and stir it 30 times each dose. As a first dose in a chronic case, a teaspoon of the first dilution is enough. For an extra sensitive patient, 1 pellet diluted into 16 oz. of water, using a 6c, 12c, or 30c, and giving 1 teaspoonful. A second dilution can be made by taking one teaspoon of that dilution, stirring it into another 16 oz. of water, and giving one teaspoon from that dilution. Dr. Saine cured a case of an extremely sensitive patient who literally was forced to live in an environmental bubble. (A trailer home that was totally protected from outside allergens and was sterile on the inside.) He started with one #10 pellet of a 6c, as needed. Hahnemann used the technique of “plussing” in this nature (Organon, paragraph 246), and said that the degree of potency be “somewhat different from that of the previous,” to better stimulate the “vital principle.” “Plussing” is an excellent method of posology in acute disease and Hahnemann said that the need for “modification” of the dose was especially true in short intervals, but in chronic disease, history has shown us that the repetition of the same dose when the healing process begins to slow, or begins to reverse direction, has proven to be as beneficial, especially with the 200 potencies. (A. Saine)
Paragraph two of the Organon, “The highest ideal of therapy is to restore health rapidly, gently, permanently; to remove and destroy the whole disease in the shortest, surest, least harmful way, according to clearly comprehensible principles,” encompases the essence of homeopathy, and sets the basis for posology.