***IN considering the amount of medicine to be used at one time, or to answer the query, What constitutes a dose? it is very important to have some concept of the history of homoeopathy, for this throws light upon the development of the problem of dosage.
Before Hahnemann’s time, and indeed in his early work, the dose played an important part. Nothing but crude and massive doses had ever been used in the care of the sick. All physicians used these massive doses as a matter of course, and Hahnemann, being a product of the best training of that day, followed, in his early career, in the footsteps of his predecessors. Even after Hahnemann began to see the light of the ***LAW OF CURE he continued to use massive doses, and it is to be remembered that he made cures with massive doses of crude medicine, but from his close observations and continual experiments he found that he was obtaining drug effects oftener than he was making a successful cure.
When he became convinced of this, he reduced the dose, dividing and again dividing the dose, watching closely the results. He soon found that the smaller the dose, the more beneficent the results. His experiments with the divided dose did not come until after he had discovered the dynamic action of disease; then with his logical mind he must of necessity have correlated his results from the larger doses and brought his ideas of dosage in to correlation with the same concept. For if disease be dynamic in nature, the use of a remedy to cure, or even to reach the disease, must be dynamic, rather than physiological, in form and power.
The more Hahnemann became convinced of the dynamic nature of disease, the more he sought the dynamic plane in medicine, and the more beneficial he found the administration of the similia. Very, very gradually, the minimum dose, which is always a flexible measure, became ever smaller and smaller, until it has developed into the infinitesimal.
However, it has been a long road to the use of the minimum dose, and many animosities have developed, all because of the failure of many minds to grasp the idea of the dynamic nature of disease and the natural tendency to look upon material substance as the remedy and the pathological state as the disease, and the failure to see the expression of diseased states in subjective symptoms.
The gradual recognition of the power of the minimum dose is manifest even in the dominant school of medicine, and is being proven in the laboratories of modern science. As a result, gradually lessening doses are being adopted by many who have formerly derided the possibility of effectiveness from small doses. Many of the leading pharmacies have followed this road in preparing drugs for the use of the general physician. This trend is manifest in the colloidal preparations and the ductless gland therapy. Of late the physiologist has shown the power of vitamins, and as a particular instance we might point to recent experiments with Vitamin D. It has been found that one part of the crystalline form to three-trillionths has a curative action on rachitis, while one part to fifty-thousandths has a destructive action to the points of causing rickets. This again verifies Hahnemann’s dictum on the power of the small dose and the harmful effects of the more material dosage, although this proven material would be classed as infinitesimal by many.
This also demonstrates the Arndt-Schulz law of action and reaction. So we are coming to a point where we fully recognize and comprehend the soundness of Hahnemann’s deductions. Let us go to Hahnemann’s *Organon (fifth American edition) for his teaching in regard to the dose, remembering that in every edition this was plainly taught. Each edition progressed one step further in the development of the minuteness of the dose.
Paragraph 112. In older descriptions of the fatal effects of overdoses of medicines, it is often to be noticed that the close of such deplorable accidents was marked by certain effects which were of very different nature from those witnessed at the beginning of the case. These symptoms which are called forth in opposition to the primary effect, or actual operation of drugs upon the vital force of the organism, are its counter-effect, or after-effect. But these are rarely if ever perceived after moderate doses administered to healthy persons for the purpose of experiment; and they are altogether absent after minute doses. During the homoeopathic curative process, the living organism exhibits only that degree of counteraction against these minute doses, which is required to re-establish the natural state of health.
128. The most recent experiment have taught that crude medicinal substances… will not disclose the same wealth of latent powers as when they are taken in a highly attenuated state, potentiated by means of trituration and succussion. Through this simple process the powers hidden and dormant, as it were, in the crude drug, are developed, and called into activity in an incredible degree.
156. There is, however, scarcely a homoeopathic remedy which, though well selected, if not sufficiently reduced in its dose, might not call forth at least one unusual sensation, or slight new symptom during its operation on very susceptible and sensitive patients….
157. Although a homoeopathically selected remedy, by virtue of its fitness and minuteness of dose, quietly cancels or extinguishes an analogous disease…. Aggravation caused by larger doses may last for several hours, but in reality these are only drug-effects somewhat superior in intensity, and very similar to the original disease.
159. The smaller the dose of the homoeopathic remedy, so much the smaller and shorter is the apparent aggravation of the disease during the first hours.
160. The dose of a homoeopathic remedy can scarcely be reduced to such a degree of minuteness as to make it powerless to overcome, and to completely cure an analogous, natural disease of recent origin, and undisturbed by injudicious treatment. We may, therefore, readily understand why a less minute dose of a suitable homoeopathic medicine, an hour after its exhibition, may produce an appreciable, homoeopathic aggravation of this kind.
In Hahnemann’s *Chronic Disease he is equally emphatic when he says :
But when these aggravated original symptoms appear later on in the same strength as at the beginning, or even more strongly later on, this is a sign that the dose of this antipsoric remedy, although it was correctly selected, was too great, and caused the fear that no cure could be effected through it, since medicines given in so large a dose are able to establish a disease which in some respects is similar, but even greater and more troublesome, without extinguishing the old disease. This is caused by the fact that the medicine used in so large a dose also its other symptoms which nullify its similarity and thus establishes another dissimilar disease, also chronic, in place of the former.
Again he says :
This ( the large dose of medicine) finds its decision already in the first sixteen, eighteen or twenty days of the effect of the medicine given in too large a dose, as it much then be checked, either by prescribing its antidote, or when this is not known, by giving another antipsoric medicine, as suitable as possible to the symptoms then prevailing, and this in a very moderate dose, and when this is not yet sufficient for abolishing this sinister medicinal disease by prescribing a second medicine as suitable as possible at that time…. When the stormy assault of the excessive dose of even a correctly selected homoeopathic remedy has been assuaged by the following use of an antidote or the later use of some other antipsoric remedy, this remedy which had only proved injurious through its excessive strength may be used again, and indeed as it is homoeopathically indicated with the best success, only in a far smaller dose and in a far more potentized attenuation.
And still again :
No harm will be done if the dose given is even smaller than I have indicated. It can hardly be too small if only everything is avoided that might interfere with the action of the medicine or obstruct it…. they will even then do everything of good that can in general be expected of medicine, if only the antipsoric was selected correctly in all respects as to the carefully examined symptoms of the disease and was thus homoeopathic, and the patient did not by his actions disturb the medicine in its action…. On the other hand, we have the great advantage that even if in some case the selection should not have been made quite suitably, we have the great advantage that we can easily put out of the wrong medicine in its minimal dose in the manner indicated above, when the treatment can be continued with a suitable antipsoric delay.
If prescribes in general, and especially those starting on the path of homoeopathic prescribing, would take special note of this warning, they would save themselves much trouble and their patients much needless suffering. Hahnemann felt the waste of time, effort, and actual suffering needlessly caused, when he cried:
What would they have risked if they had at once heeded my words and had first made use of these small doses? Could anything worse have happened than these small doses might have proved ineffectual? They could not have injured anybody! But in their unintelligent self-willed use of large dose in homoeopathic practice they only passed again through the same roundabout route, so dangerous to their patients, which I in order to save them the trouble had already passed through with trembling, but successfully, and after doing much mischief and having wasted much time they had eventually if they wanted to cure to arrive at the only correct goal, which I had made known to them long before faithfully and openly, giving to them the reasons therefor.
That Boenninghausen also passed through this “roundabout route” is witnessed by his words in his *Lesser Writings, quoting from an earlier statement in *Homoeopathy, a Reader for the Cultivated, Non-medical Public : “Since I also, led by the almost unanimous assertions as to the untenableness of this teaching, gave, though only for a short time, larger doses and with bad success.”
Homoeopathic dosage is based upon law, as is the selection of the remedy based upon the law of similars. ***ACTION AND REACTION ARE EQUAL AND OPPOSITE : this is fundamental, and it is this law that must guide us in the application of drugs.
The so-called primary action of drugs, and the so-called secondary action of drugs, are manifest to any observer. As a common illustration we may take the nausea and vomiting of *Ipecacuanha; yet in small doses it is curative in sickness with nausea and vomiting as prominent symptoms, other symptoms agreeing. *Opium causes profound sleep when used in the ordinary manner; yet *Opium is of inestimable value when given homoeopathically, in small doses, in cases of profound coma. These instances cited are of drugs classic in massive doses, or in common parlance, physiological doses, for certain common states of sickness.
The physiological action of a drug, however, has nothing whatever to do with the curative action from the homoeopathic point of view, because homoeopathic remedies are never used in physiological doses. This may seem at first illogical because we may use them in low potencies, yet we never use them for their physiological effect.
The physiological action is toxic on nature, therefore injurious to the patient. The physiological action of a drug is not its therapeutic or curative action; it is the exact opposite of a curative action and is never employed in homoeopathic practice for curative effects. The use of the drug in physiological form is an acknowledgment of the attempt to produce drug symptoms because of their primary action, and an acknowledgment also that the physician so using the drug has never observed the secondary symptoms. Speaking of narcotic drugs, in Paragraph 113 of his *Organon, Hahnemann has this to say :
… As these (narcotic drugs) destroy sensibility and sensation, as well as irritability, in their primary effect, a heightened state both of sensibility and irritability is frequently observed in healthy persons, as an after-effect following the administration of narcotics, even in moderate doses.
*Pathogenetic is the term used by the homoeopathicians as a more correct term for the primary symptoms produced by the drug, and as a synonym for the term *toxic; in other words symptoms may be produced by massive doses or by crude drugs, but these symptoms are pathogenetic and not curative. These symptoms may show forth family likenesses as many members of a family, under certain circumstances, will often have a similar general reaction; but to apply our knowledge of the drug as a curative measure we must know definitely what its capabilities are. These capabilities cannot be manifest from the pathogenetic symptoms.
The homoeopathic cure is produced without drug effects; it is accomplished without suffering; it is mild; it is developed through growth; it is dynamic in nature, therefore it must be given on the dynamic plane and never in a way to produce drug effects. It therefore must be the minimum amount of the drug that will act upon the vital force, which, as Hahnemann says, can scarcely be too small.
We must remember, in the dividing of the dose, no matter how far this is extended there is something of the drug left. Matter is never destroyed; it may be changed in potentization, but an absolute zero is never reached.
Homoeopathic dosages required that no new symptoms shall be produced as a result of their administration, for these would be drug effects; but we may find a slight aggravation of the symptoms already present immediately following the administration of the homoeopathic remedy, which soon recedes, and improvement continues. Only the single remedy in the smallest possible dose will usher in these happy results in this way; the suffering is quickly reduced; the strength is conserved; the patient is in a state of restored health.
We must not think that the infinitesimal dose cannot produce symptoms; this is frequently found in very susceptible patients. In fact, the best provings are obtained with the high potencies on susceptible people.
When the homoeopathic drug is administered, it is so similar to the natural disease that it therefore meets with no resistance, because the sphere of its action is already invaded by the similar disease and its resistance overcome by the similar acting disease-producing agent. The affected organs and tissues are open to attack susceptibility to the similar remedy is therefore greatly increased. The homoeopathic remedy acts upon the identical tracks involved in disease states in a similar way to the disease-producing cause. In order that the suffering and distress may not be increased, it is therefore necessary to use only the smallest possible dose. For this reason the homoeopathic dose is always short of the physiological or pathogenetic dose. It must be so small as not to produce too much aggravation of the symptoms already present, and never large enough to produce new symptoms.
There is a law of dosage as well as law of cure, and when we use a homoeopathic remedy it should be based upon that law, for if homoeopathy means anything, it is that it is based upon natural law and order. This law is fixed and unchangeable. It makes no difference with the law if we do not follow it, but it does make a difference with our results. *The quantity of action necessary to effect any change in nature is the least possible : the decisive amount is always a minimum, an infinitesimal.
It can hardly fail to be plain that the same power which establishes the curative relationship between drugs and diseases, and regulates this law, should at the same time and in the same manner determine the quantity and method of this administration. This places it, not upon a notion or whim of what strength shall be used, but our interpretation of the law.
Let us elucidate this law. Let us get a clear concept of the elements of this problem. They are of two classes: those which belong to the patient, and those which are associated with the drug.
In the first, we are dealing with the perverted stimulus of the organs or functions of the body and the natural relationships are disturbed. The susceptibility of these organs to impressions from these stimuli are exalted, depressed, or extinguished. The susceptibility may be exalted in respect to some influences even to the point of intolerance, or depressed in others to the point where we have the feeblest response to impressions, while others are entirely void of response to all stimuli. These are new susceptibility to impressions from external forces not found at all, or not existing to the same degree, in the healthy. The sum of these changes forms a class of facts most important in this investigation, and gives the basis of a proper understanding of the condition of the sick.
For our present purpose it will be necessary to consider only such of these changes as have reference to impressions from drugs. In a given case of disease the patient is often over- sensitive to the smallest quantity of some drugs, while there is an equal insensibility to even large quantities of others. We find this often. The answer to this is an illustration of the expression of the law of the dose. The changes of susceptibility constitute the first class of the general elements of the problem. Those of the second belong to the drug.
These consists of the power which belongs to drugs to produce disturbances in the action of living forces, so that they no longer act in harmony which maintain that sense of well-being which is health. It is this power so to act that constitutes a drug, and it is with this power so to act upon living organs in special conditions of susceptibility that we have to do in determining the dose in a given case of disease and also to comprehend as the law which governs the dose in all cases.
After having settled the first question in prescribing-What is the remedy?-this question of special susceptibility in the organs is just that which decides the next question we must answer: How much of this remedy is required to restore the lost balance of the vital force in the particular case? In these two questions lies the whole problem of cure.
How can we know the degree of the special susceptibility to the action of the drug before its administration? Simply by the same process of inquiry that led to the choice of the true remedy; it is that which is like; it is what the drug, whose action on the healthy living organism is most like the phenomena of the lost balance of the vital energy which we call disease. Then institute this inquiry: *How much is it like? This answer determines the quantity of the drug required, and *this is in the inverse ratio of the similarity. This constitutes the basic law of the dose as to quantity and potency.
What is the like, the similarity? The like which cures is the resemblance of the characteristic symptoms of the drug to those of the disease; the characteristic symptoms of the disease and the drug are those symptoms that give to each its individual character, *not all those symptoms held in common with the general disease group or the family group of drugs.
It is the similarity of the characteristic symptoms of the drug to those of the disease; and again, how nearly similar it is to the number of characteristic symptoms, that marks the exact similitude. The greater the number of characteristic symptoms of the disease that are found to correspond to the drug, the less the quantity and the higher the potency that can be used.
The whole relationship of drugs to disease rests on the susceptibility. The power of the drug over disease is solely in its similarity; without it, it has no power except in a physiological from, and that is never curative. If in the patient there be wanting a susceptibility to its impressions, this relationship of the patient to the drug does not exist. It rests on the very similarity to those elements of the disease which show its specific nature, to those which are characteristic of the drug and according to the degree of susceptibility; it is in direct ratio to this susceptibility.
In sickness, susceptibility is markedly increased, as the avenues of diseased states are widely opened so that which would have no effect in health will be quickly grasped in disease. The resemblance of the group of symptoms is marked, therefore accordingly the very smallest possible dose will satisfy the susceptibility and therefore be curative.
A knowledge of the basic principles of this law explains why often a very high potency will cure intractable disease states where the low potencies do not even give relief. Again, the knowledge of this law necessitates a thorough knowledge of our materia medica. A knowledge of this law makes for a clearer understanding of the homoeopathic art.
Why did Hahnemann first begin to experiment with the divided dose?
Why do we believe that the remedy should be dynamic in action?
What did Hahnemann mean when he said: “… crude medicinal substances… will not disclose the same wealth of latent powers as when they are taken in a highly attenuated state”?