By posology (from the Greek, posos, how much) we mean the science or doctrine of *dosage.
Small doses and homoeopathy are commonly regarded as synonymous terms. If they who have such an idea of it are favorably inclined toward homoeopathy, it is as likely to be because they have heard that the medicines are “pleasant to take” as for any other reason. While such an impression, taken with what it involves, is not altogether undesirable, it is to be regretted that a broader basis of judgment has not been furnished by those whose duty it is to instruct the public in the principles of homoeopathy. Had this been done such a juvenile conception would not exist, and homoeopathy would be more widely appreciated.
It is not to be denied that the subject of the dose in homoeopathy is a very important one. The three essential elements of the system are the *principle, the *remedy and the *dose; and the three are of equal importance. Posology, and the related subject of Potentiation were the subjects of so much misunderstanding, discussion and controversy in the early days of homoeopathy that the profession, after being divided into two opposing camps, grew tired of the subject. It came to be regarded as a kind of “Gordian Knot,” to be cut by each individual as best he could with the instrument at his disposal.
Hahnemann himself at one time, almost in despair of ever being able to bring his followers to an agreement on the subject, cut the knot by proposing to treat all cases with the thirtieth potency. Following this suggestions 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 homoeopathic 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 selection of the dose is as much an integral part of the process of making a homoeopathic 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. Does as well as remedy must be adjusted to the patient’s need.
The homoeopathic 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 is another application in medicine of 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 cause 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, and 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 diarrhoea 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 homoeopathic law of posology, the use of drugs in “physiological doses” has nothing to do with their homoeopathic use, because *homoeopathic remedies are never used in *”physiological doses.” This statement is true, even in those cases where the low reacting power of the patient sometimes requires *material doses of the homoeopathic remedy. It would be more accurate to say that homoeopathic medicines are never used for *their “physiological effect.”
It is necessary to a clear understanding of the subject that a distinction be made between three terms, physiological, therapeutic, and pathogenetic, used by two schools of medicine express the nature of the action of the drugs. There is a demoralizing tendency even in the homoeopathic 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 homoeopathic practice for therapeutic purposes. The use of the word “physiological: in connection with drug action and drug dosage tends to mislead the unwary and justify the use of measures which would otherwise be regarded as illegitimate. In one word, is it a euphemism. Inasmuch as 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 the name, in order that there may be no misunderstanding.
The homoeopathic school has recognized the wisdom and justice of taking this position, and has compiled 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 homoeopathic 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 homoeopathic 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 homoeopathically the objects 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 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 homoeopathic cure is obtained without suffering, without the production of any drug symptoms, in a positive and direct manner, by the action 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. Homoeopathy 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.It is not to be understood that infinitesimal does are not capable of producing symptoms in healthy susceptible persons; for that is not true. Infinitesimal doses will produce symptoms in certain highly sensitive person, and many of our most valuable provings have been made with more or less highly potentiated 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.
In ordinary usage 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. That other effects not desired nor needed are produced incidentally, does not matter. They are left to take care of themselves, and it is not considered that they complicate or prejudice the case if they occur.
In attempting to predetermine arbitrarily 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 homoeopathic 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 reason why the dose of the medicine chosen homoeopathically 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 and 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 secretion 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 does must be large enough to overcome first, this bodily resistance; and second, to produce its characteristic symptoms.
When the similar or homoeopathic 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 drug is therefore greatly increased.
The homoeopathic 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 homoeopathic dose, therefore, is always a sub-physiological or sub-pathogenetic dose; that is, a dose so small as no 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 that the homoeopathic drug is always given singly, so that its action is complete and unmodified by other drugs.
Homoeopathists do not say, vaguely, that medicine in infinitesimal doses cure disease unconditionally. The proposition is that medicines act curatively in infinitesimal quantities, *when given in cases to which they are homoeopathic. And they still further qualify this statement by laying down three necessary requirements for such action :-
1. The development of special virtues in medicine by a peculiar process of preparation, or potentiation.
2. The increased susceptibility to medicinal impression produced by disease.
3. The selection of the symptomatically similar remedy.
They affirm and stand ready to demonstrate that an infinitesimal dose of medicine *has power and that its acts as *a force; but in order that the force should be medicinal, or curative, a condition of application is necessary; namely, that it be applied in accordance with the homoeopathic 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 homoeopathy 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 does 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, – apart of the whole let it be ever so minute? What man in his sense would deny it?
And it 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 medicine in material doses and in the usual form.His discovery of the principle of potentiation 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 be 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.
Having now a general view of the principles underlying the question of the dose, and a general standard by which to test results, it is desirable to try to formulate some rules, based upon experience, to govern us in the selection of the proper dose for a particular case.
The question seems more complex now than it was in Hahnemann’s day, but really it is not so. The same principle applies now as then. 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. Boenninghausen 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. Boenninghausen also states the Hahnemann in correspondence with him, was much interested in the experiments of Boenninghausen 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 forth coming sixth edition of the Organon., a work which fortunately never saw the light until 1922.
Since Hahnemann’s day the potency makers have been busy and we now have potencies ranging up the millionth centesimal, and even higher. Men with the confidence, courage and seal to experiment with these altitudinous preparation 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. It is not just for us to question this testimony until we have put the matter to the test. 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 and armamentarium as possible.
The great bulk of the work of the profession, however is done with the lower and medium potencies and these, if accurately prescribed and wisely managed, will give satisfactory results in the great majority of case. The third, sixth, twelfth and thirtieth potencies with a set of the two hundredths to “top off with” gives a general working range. When the young practitioner can afford to add to these a set of ***BOERICKE & TAFEL’S hand made five hundredths and one thousandths, he will be well equipped indeed. The rest is “velvet;” but if anybody should offer him a set of Fincke’s, Swan or Skinner’s fifty thousandths and one hundred thousandths, he should not let his modesty nor his prejudices prevent him from accepting and trying them. Hundreds of practitioners, including the writer, have used them with great satisfaction.
Choosing the Potency.- Now is there any teaching which will help us to choose the best potency for a given case? 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 and 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.
The series of potencies has been compared to the gamut in music, “A skilful 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 a by proper combination of all the sounds that can be elicited from his instruments.” (Guernsey.)
In general it may be stated that any curable diseases may be cured by any potency, when the indicated remedy is administered: but hat the cure may be much accelerated by selecting the potency or dose appropriate to the individual case.
Five considerations influence us in the choice of the dose:
1. 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. It is important to have some means of gauging, at least approximately, the susceptibility of a patient.
Susceptibility to medicinal action is only a part or phrase 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. Homoeopathicity 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.
The “indefatigable 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 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 potentiation.