Posology (from the Greek, posos, how much) mean the science or doctrine of dosage. Posology is the study of Law of Dosage. Dose is defined as the least quantity of substance required to effect a change in nature. In Greek Posos means How Much and Logos means Study
- Law of Dosage: The Curative dose of the remedy, must be similar in quantity and quality to the morbific agent, which caused the disease.
- Law of Quantity: The Quantity of the drug required is in inverse ratio to the similarity ( Higher the Potentisation, less is the Quantity of the drug in that preparation) and the quantity necessary to effect any change is always a minimum, an infinitesimal.
Types of Doses
- Physiological Dose: It is a dose which stimulates the normal physiology or function of the body and which could be administered with safety. The Physiological action of a drug is not its curative action. Eg : Belladonna in physiological doses produces dilatation of pupils,dryness of mucous membranes, flushing and turgescence of skin.
- Pathological Dose: It is the quantity of medicine capable of producing pathological changes in the tissues of the organism i.e bio-chemical changes, biophysical changes.
- Toxic Dose: Dose which produces toxic effects upon the organism.
- Lethal / Fatal Dose: Dose which produces deleterious effect upon the organism even Death.
- Therapeutic Dose: It is the least quantity of medicine required to effect a cure or palliation.
- Minimum/ Infinitesimal Dose: It is the smallest possible quantity of medicine required to produce a scarcely perceptible homoeopathic aggravation. According to Stuart Close minimum dose is a dose not capable of producing symptoms when used therapeutically.
The selection of the dose is as much an integral part of the process of making a homœopathic prescription as the selection of the remedy, and often quite as important. A well selected remedy may fail utterly, or even do injury, because of wrong dosage. Dose as well as remedy must be adjusted to the patient’s need.
Hahnemann himself at one time in despair bought his followers to an agreement on the subject to treat all cases with the thirtieth potency. Following this suggestion others tacitly adopted a dosage confined to one, or a very limited range of potencies. The materialistically minded restricted themselves to the crude tinctures and triturations, or the very low dilutions, ranging from 1x to 6x. Others ranged from the third to the thirtieth potencies, while another small class of metaphysical tendency used only the very high potencies, ranging from the two hundredth to the millionth, each according to his personal predilection.Such a state of affairs is unfortunate. Assuming that there is a difference in the action of the various doses of medicines, and that a series of potencies or preparations of the different medicines has been available for use; it follows that the entire series should be open to every practitioner, and that each man should be competent, willing and ready to use any potency or preparation of the remedy indicated in a given case, without prejudice. If he confines himself to one or two potencies, be they low, medium, or high, he is limiting his own usefulness and depriving his patient of valuable means of relief and cure.
Under homœopathic principles any potency may be required in any case. It is as unreasonable to expect to cure all cases with any two or three potencies as it is to expect to cure all cases with any two or three remedies. In either case, those who follow such a course are governed more by the love of ease and their prejudices than they are by their desire for efficiency.
The Homœopathic Doctrine of dosage, like the law of cure, was based upon the discovery of the opposite action of large and small doses of medicine. It’s another application of medicine,the Law of Mutual Action – the third Newtonian law of motion – “Action and Reaction are Equal and Opposite.” Every one at all acquainted with the action of drugs knows, for example, that Ipecac in large doses causes nausea and vomiting and in small doses, under certain conditions, will cure the same; that Opium in large doses will cause a deep sleep or narcosis, arid in small doses, under certain, conditions, will cure the same.
Closely allied to this is the so-called primary and secondary action of drugs, in, which we see many drugs, in the first or primary stage of their action producing one group of symptoms, and in the second stage a directly opposite set of phenomena; as when the deep sleep of the primary action of Opium is followed by a much longer lasting wakefulness; or where the diarrhea induced by a cathartic is followed by a longer lasting constipation. This applies, of course, only to drugs given in tangible form and considerable quantities, in what are called “physiological doses.”
Although the physiological antagonism between large and small doses is an illustration of the homœopathic law of posology, the use of drugs in “physiological doses” has nothing to do with their homœopathic use, because homœopathic remedies are never used in “physiological doses.” This statement is true, even in those cases where the low reacting power of the patient some-, times requires material doses of the homœopathic remedy. It would be more accurate to say that homœopathic medicines are never used for their “physiological effect.” It is necessary to have a clear understanding of the subject that a distinction be made between three terms, physiological, therapeutic, and pathogenetic, used by the two schools of medicine to express the nature of the action of the drugs. There is a demoralizing tendency even in the homœopathic school to use these terms without discrimination.The word “physiological” as currently used in medicine in relation to drug action and dosage is misleading and inaccurate, The Word has a reassuring sound, pleasantly suggestive of something normal and healthy. Its use tends to obscure, or keep in the background, the fact that the kind of drug action so designated is essentially a toxic action and therefore really painful and injurious.
The “physiological action” of a drug is not its therapeutic or curative action. It is exactly the opposite of a curative action, and is never employed in homœopathic practice for therapeutic purposes. The use of the word “physiological” in connection with drug action and drug dosage tends to mislead and justify the use of measures which would otherwise be regarded as illegitimate. Is it a alternative ,sustitute. The action of the physiological dose and the purpose for which it is given is avowedly to produce drug symptoms, in, a direct and positive manner, that fact should be clearly expressed in order that there may be no misunderstanding.
Homoeopathic School has recognized the wisdom and justice of taking this position, and has complied with the requirements of scientific accuracy in nomenclature by the adoption and use of the word “pathogenetic” (Gr., pathos, suffering, and genesis origin, “producing suffering”) as properly describing the character of such drug action. The “suffering” of the organism produced by the drug is expressed in symptoms, which are the language of disease. In homœopathic parlance, therefore, these are termed “pathogenetic symptoms,” a term which is preferable because it is accurate and truthful.
Therapeutic means curative, healing, alleviating. A pathogenetic action is never curative. The action of a drug may be pathogenetic (toxic), or therapeutic (curative), depending upon the size and strength of the dose, the susceptibility of the patient and the principle upon which it is given.
In the homœopathic treatment of disease a drug is never given for its pathogenetic action. Pathogenetic doses may be given, however, for experimental purposes to a healthy person, in making what are called provings. In treating disease homeopathically the object is not to produce symptoms but to “remove them. By means of the similar remedy in the minimum dose it is possible to do this in a direct manner without producing symptoms. It is not necessary to resort to the indirect, antipathic or allopathic method of producing drug symptoms in one part to remove a disease of the same, or any other part, and therefore it is not necessary to use “physiological” or pathogenetic doses. The homœopathic cure is obtained without suffering, without the production of any drug symptoms, in a positive and direct manner, by the action of sub-physiological or sub-pathogenetic doses; in other words, by the minimum dose, which is a dose so small that it is not capable of producing symptoms when used therapeutically. Homœopathy requires that the therapeutic dose must be capable only of producing a slight temporary aggravation or intensification of already existing symptoms, never of producing new symptoms. Only the similar remedy, in the. smallest possible dose, is capable of bringing about this highly desirable result. By this means the patient’s strength and vitality are conserved, his suffering quickly reduced to the lowest possible degree and a true cure brought about, if the case has not passed beyond the curative stage. Infinitesimal doses are not capable of producing symptoms in healthy susceptible persons it is not true. Infinitesimal doses will produce symptoms in certain highly sensitive persons, and many of our most valuable provings have been made with more or less highly potentised medicines. Indeed, no remedy can be regarded as having been thoroughly proven until it has been proven in the potencies as well as in crude form.
A Physiological dose means a dose of a drug, empirically selected, of sufficient quantity and strength to produce a definite, predetermined effect or group of symptoms. Practically it amounts to the maximum dose consistent with safety. A physiological dose of Atropine or Belladonna, for example, is one sufficient to produce dilatation of the pupils, dryness of the mucous membranes and flushing or turgescence of the skin. The action of the drug is carried to this point irrespective of any accessory symptoms that may be produced, or as to whether it is curative or otherwise. No other kind of action is looked for or expected and, as a rule, it is not recognized if it occurs. The intent is to produce a direct definite drug effect. In attempting to predetermine arbitrarily the size and strength of the physiological dose, allowance is made only for difference in the age of the patients, who are roughly divided into two classes, infants and adults. If a patient is unable to take the established or usual doses without serious results, it is considered to be a case of idiosyncrasy or hypersensitiveness and some other drug is substituted.
Unlike the homœopathic physician, the allopathic practitioner is not trained to observe the finer, more delicate action of drugs upon the living organism and he does not, therefore, recognize the symptoms expressing such actions when they occur. From this point of view such symptoms, so long as they are not serious, are of no importance and have no use.
In considering the reasons why the dose of the medicine chosen homeopathically is necessarily smaller than the physiological dose of antipathic or allopathic prescription, we meet first the fact of organic resistance.
Every living organism is endowed with an inherent, automatic power of reaction to stimuli. By means of this power the organism offers resistance to everything which tends to injure or destroy its integrity or disturb its normal functioning. Resistance is manifested by suffering pain, fever, inflammation, changed secretions and excretions, etc.
This power is displayed when drugs are administered because drugs are inimical to health, in proportion to their power and the size of the dose. In order for a dissimilar drug to produce its so-called physiological effect, therefore, the dose must be large enough to overcome first, this bodily resistance; and second, to produce its characteristic symptoms.
When the similar or homœopathic drug is administered in disease, little or no resistance is encountered because the sphere of its action has already been invaded and its resistance overcome by the similarly acting disease producing agent. The affected organs or tissues are open to attacks from without. Susceptibility to the similar drug is therefore greatly increased.
The homœopathic drug acts upon the identical tracts involved in the disease process, in a manner similar to the action of the disease producing cause itself. In order that the suffering of the affected organs may not be increased and the patient injured, a much smaller dose must be given.
The homeopathic dose, therefore, is always a sub-physiological or sub-pathogenetic dose; that is, a dose so small as not to produce pathogenetic symptoms; for we desire, not to produce more symptoms, but only to remove and obliterate symptoms already existing. It must also be given in a dose so small, as not to produce a severe aggravation of the already existing symptoms.
Another reason for the small dose lies in the fact that disease renders the affected parts abnormally sensitive, as we see in an inflamed eye, which is painfully sensitive to a degree of light to which it reacts, normally in health.
A third reason is that the homeopathic drug is always given singly, so that its action is complete and unmodified by other drugs.
Homœopathic medicines in infinitesimal doses cure disease unconditionally,when given in cases to which they are homeopathic.This statement is qualified by laying down three, necessary requirements for such action:
- The development of special virtues in medicine by a peculiar process of preparation, or potentiation.
- The increased susceptibility to medicinal impression produced by disease.
- The selection of the symptomatically similar remedy.
An infinitesimal dose of medicine has power and that it acts as a force; but in order that the force should be medicinal, or curative, a condition of application is necessary; namely, that it must be applied in accordance with the homœopathic law.Force, to be effective, must be supplied not only in proper amount, but in the proper direction and at the proper time.
The proper amount of a drug to be administered in a given case can never be settled by a priori reasoning, but only by experience; and thus it has been settled. Those who hesitate to try the infinitesimal doses of homœopathy on the ground of improbability, should be reminded that an infinitesimal quantity is a quantity. It cannot be thought of as nothing. Hear Hahnemann’s reply to those who railed at the infinitesimal dose as “Nothing,” and “Absurd.”
“How so? The smallest possible portion of a substance, is it not an integral part of the whole? Were it to be divided and redivided even to the limits of infinity, would there not still remain something,-something substantial, – a part of the whole, let it be ever so minute? What man in his senses would deny it?
And if this be in reality an integral part of the divided substance, which no man in his senses can doubt, why should this minute portion, as it is certainly something, be inactive, while the whole acted with so much violence?”
Hahnemann’s final views and practice in regard to the dose were arrived at gradually, through long years of careful experiment and observation; at first, even for some time after the promulgation of the law of similars and the method of practice based upon it, he used medicines in material doses and in the usual form. His discovery of the principle of potentization came about gradually as he experimented in the reduction of his doses, in order to arrive at a point where severe aggravations would not occur. Gradually, by experience, he learned that the latent powers of drugs were released or developed by trituration, dilution and succussion. Thus he arrived at his final conclusion that the proper dose is always the least possible dose which will effect a cure.
For the greater part of his life Hahnemann had only what we now call the lower potencies; namely from the first to the thirtieth; although in his later years he was enabled to procure and use some of the higher potencies. Bœnninghausen wrote that Hahnemann had repeatedly stated to him that he generally used the sixtieth dilution, and that he often used much higher ones with great satisfaction. Bœnninghausen also states that Hahnemann, in correspondence with him, was much interested in the experiments of Bœnninghausen and Gross with the high potencies and heartily approved of the same. It was repeatedly stated that Hahnemann would deal with this subject in the forthcoming sixth edition of the Organon, a work which unfortunately never saw the light until 1922.
Since Hahnemann’s day the potency makers have been busy and we now have potencies ranging up to the millionth centesimal, and ever higher. Men with the confidence, courage and zeal to experiment with these altitudinous preparations and publish their results have not been lacking. Physicians of unquestioned honesty, ability and experience have testified that, they obtained curative results from the use even of the very highest potencies. In the light of experience and of recent revelations in other departments of science of the power of the infinitesimal, there is nothing inherently improbable about it, and it is unquestionably to our advantage to have as large an armamentarium as possible.
Five considerations influence us in the choice of the dose:
There are little teachings but many opinions which will help us to choose the best potency for a given case. 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 patients of many agents of cure which are easily within their reach.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
- The susceptibility of the patient.
2. The seat of the disease.
3. The nature and intensity of the disease.
4. The stage and duration of the disease.
5. 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. 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.Susceptibility varies in different individuals according to age, temperament, constitution, habits, character of diseases and environment.The susceptibility of an individual to a remedy at, different times also varies. Idiosyncrasy may exist as a modifying factor. Homeopathicity must always 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.
Kent was not only an exponent of medium and high potencies but was also the preceptor of a generation of high potencists. It was because of his students that high potencies came into vogue in England. Kent is still considered the person who has influenced the use of high potencies the most among the homeopathic community. Kent has written:
He further writes: “When the similimum is found, the remedy will act curatively in a series of potencies. If the remedy is only partially similar, it will act in one or two potencies and then the symptoms will change and a new remedy will be required.”
Nash was also strongly in favor of medium and high potencies.
Jahr has very lucidly and beautifully 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 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.
In the first to the third potency, similar or related remedies like Arn, Rhus, Bry and Sulph have a great many symptoms in common; but the higher they progress in the scale of potentization 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 drastics 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 succussing,” 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.
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 which seems most similar, in a low (third to twelfth) potency. But, when most symptoms of a case clearly indicate one remedy, whose characteristic symptoms correspond closely to the characteristic symptoms of the case, we give the high potencies – thirtieth, two hundredth, thousandth, or higher.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. -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 persons.
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 whiskey, 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. In certain terminal conditions the power of the organism to react, even to the indicated homœopathic remedy, may become so low that only material doses can arouse it. A common example of this is seen in certain terminal conditions of valvular 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 be regarded as “physiological” or pathogenetic doses, the nature of the reaction in such cases is clearly not pathogenetic 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 pathogenetic dose. Quality, proportionality and the susceptibility of the patient are also factors. When power to react is very low due to the existence of gross pathological lesions, or of long existent, exhausting chronic disease and much previous treatment susceptibility is very low. 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 there are no finer symptoms. Yet the symptoms remain and the almost hopeless conditions they represent, are still within the scope of the homœopathic law; and they sometimes yield to its power, when the related law of posology is rightly understood and applied.
When Pathological symptoms exist alone and are as significant and characteristic in their way and may be as clearly indicative of a remedy, homeopathically, as the earlier, finer grades of symptoms. Whether they are as useful to the homœopathic prescriber or not depends upon the existence 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 which 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 homœopathically 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, nor 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. 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 homœopathic prescriber has to do sometimes, in the kind of cases under discussion.This does not in the least degree invalidate nor violate the principle of the minimum dose in such cases, The principle of similia as applied in the selection of both remedy and dose is eternally and universally true. It is as true in terminal conditions in chronic diseases marked by gross pathological lesions and symptoms as it is in any other kind of cases. The homœopathic physician fails and falls short of his duty if, at such a crisis, he throws tip his hands and lets his patient die or pass into other hands; or if he weakly yields, abandons the principle of similia and resorts to the routine measures of allopathic practice, based upon theoretical assumptions. Occasionally an allopathic physician is called in who gives so-called physiological doses of some common drug and restores the patient. He merely does what the homœopathic physician should have the discernment and common sense to namely give the drug that is really homeopathic to the case, but give it in the stronger doses required at that stage of the case to excite the curative reaction. He does what the homœopathic physician is perhaps too timid, too ignorant or too prejudiced to do. Result: the allopath gets the honor, the family and the emolument; the homœopath “gets the laugh;” and homœopathy “gets a black eye.” The occasional successes of allopathic physicians in such cases are nearly always accomplished with drugs which are essentially, although crudely, homœopathic. The homœopath who habitually uses high potencies is apt to forget or overlook the fact that a terminal case may reach a point where the symptoms call for material doses because the susceptibility is so low that it will react to no other, but will react to them.
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 influence 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 illnesses, 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 homœopathic doses. Contrary to what one would expect, persons who have taken many crude drugs of allopathic, homœopathic 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.
When the old “Chronics” begin to come in to see the New Doctor–“old rounders” upon whom the contents of the drug shops and the medicine cases of his tincture and low potency competitors have been exhausted in vain– “an’ he be wise” he will get out his little high potency case and prescribe from that. The results will surprise them, if it does not surprise him. It should not surprise, him because he has been told before hand.
The seat, character, and intensity of the disease has 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 minutes, with which so many thousands 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 pathogenetic 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 drugs must be antidoted and the further treatment carried on by higher potencies. These remarks apply not only to mercury and syphilis but to practically all other diseases and drugs, It is not to be inferred that mercury is the only remedy for syphilis; for in syphilis, as in all other diseases, we must individualize both case and remedy, if we expect to cure our patients.
What has been said of the use of higher potencies in cholera, after reaction has been established by camphor tincture, is applicable in many other diseases of malignant character and rapid progress. In the beginning, when torpor or collapse indicate the dangerously low vitality and deficient reaction, a few doses of a low potency may be required until reaction comes about, after which the potency should be changed to–a higher one if it is necessary to repeat the remedy. The question is entirely one of susceptibility. The higher the susceptibility, the higher the potency. We must learn how to judge the degree of susceptibility if we would-be successful as homœopathic prescribers; and this applies not only to the normal susceptibility of the patient as evidenced by his constitution, temperament, etc., but to the varying degrees of his susceptibility as modified by the character and stages of his disease and by previous treatment. At one stage he may need a low potency, as already pointed out, and at another a high potency. The man who confines himself to the use of a single potency, or two or three potencies, be they low or high, is not availing himself of all the measures of his art and will frequently fail to cure.
So the Physician must determine the degree of susceptibility of the particular patient at a given time.Thus the whole matter of the dose, like the selection of the remedy, resolves itself into a problem of individualization, which, as a principle, governs all the practical operations of homœopathy. Looking at this subject broadly and having the highest degree of success in view, it is seen that it is as necessary to individualize the dose as it is the remedy, and that the whole scale of potencies must be open to the prescriber.
Repetition of Doses. – It remains to speak of one more important matter connected with the general subject of Homœopathic 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 it? Third, if we give repeated doses, how often shall we repeat the doses and when shall we stop dosing?
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.
Young practitioners and many old ones too, for that matter, give too many doses, repeat too frequently, 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 correct 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. We need have no doubt on that score. The indicated remedy and potency, even in a single dose cannot be given without some result and the result must be good. Generally speaking, it may be taken for granted that if there is no perceptible result after a reasonable time, depending upon the nature of the case, either the remedy or the potency was wrong.
In Par. 245 Hahnemann gives this general rule: “Perceptible and continued progress of improvement in an acute or chronic disease, is a condition which, as long as it lasts, invariably counterindicates the repetition of any medicine whatever, because the beneficial effect which the medicine continues to exert is rapidly approaching its perfection. Under these circumstances every new dose of medicine would disturb the process of recovery.”
In Pars. 247-8, Hahnemann says: “These periods” (marked by the repetition of doses) “are always to be determined by the more or less acute course of the disease and by the nature of the remedy employed. The dose of the same medicine is to be repeated several times, if necessary, but only until recovery ensues, or until the remedy ceases to produce improvement; at that period the remainder of the disease, having suffered a change in its group of symptoms, requires another homœopathic medicine.” Study also Pars. 249-252.
The single dose of the indicated remedy, repeated whenever improvement ceases, as long as new or changed symptoms do not indicate a change of remedy, is adapted to all cases, but especially to chronic cases and to such acute cases as can be seen frequently and watched closely. The nature and progress of the disease will determine under this rule, how often the dose is to be repeated. Cases may present themselves, however, which cannot be watched as closely as we would like. We may not be able to visit the patient frequently, nor remain with him long enough to observe the full period of remedial action. In such cases it is permissible and indeed necessary, to order a repetition of doses at stated intervals of one, two, or three hours, until improvement is felt or seen, or perhaps until our next visit. In such cases it is well to direct that the medicine be stopped as soon as the patient is better, giving some simple instruction to the nurse as to what constitutes a reliable sign of improvement, according to the nature of the case.
If a patient is so gravely ill as to require doses at intervals of less than one hour it is the physician’s duty to remain with the patient and judge of his condition and progress for himself, unless he is absolutely sure of the remedy, or is in telephonic communication with the case.
Effect of the Remedy. – The next point to be considered under the general subject of Homeopathic Posology is: The Effect of the Remedy.
After we have selected the most similar indicated remedy and administered it in proper potency and dosage, it is our duty to observe the patient carefully in order that we may correctly note and intelligently interpret the changes that occur; for upon these changes in the patient’s condition, as revealed by the symptoms, depend our subsequent action in the further treatment of the case.