PRESCRIBING : POTENCY SELECTION.
After thoroughly digesting the first six lectures of this brief course and doing wide collateral reading and studying one should be able to select the most similar remedy. The most similar remedy, however, does not become the simillimum until the potency is adjusted to the plane of the individual during his or her illness at the time of prescribing.
Our philosophy teaches us that pathology, and even bacteria, at ultimates of disease and that the true cause is far deeper and less material than these. in order truly wipe out the cause of a so called disease one must administer the remedy on or near the plane of the cause. It follows that for mental distresses and disease of manifestly psychic origin the high potencies (10M and upward) would be employed, other things being equal; and that for grossly material conditions, such as marked organic and pathologic changes, the lower or medium potencies would be selected.
In general, then, functional diseases, where the symptoms are subjective or physiological, where the vital force is tactile, respond well to high potencies; and the organic conditions to lower ones. It makes some difference whether the conditions be acute or chronic. For instance, diphtheria has marked pathology, as has pneumonia, yet the pathology is recent and swift in pace, and the high potencies are suitable.
In general, acute diseases respond well to high potencies, especially of acute remedies (high potencies of deep acting chronic remedies, when these are indicated in an acute condition, may be dangerous). Certain acute crises, based on chronic trouble, such as cardiac asthma, would have to be treated with medium or low potencies because the high potency would stir up more than the vital force could cope with in the face of the advanced chronic pathology.
In chronic prescribing it is a safe rule to begin with the 200th centesimal unless this is dangerous because of the nature of the remedy, the degree of the pathology, or the depth of the miasm. One great object in starting at the 200th in chronic cases is that you then have an ascending series of potencies to use as treatment progresses. The Kentian ideal being to exhaust the action of one potency (see section of Repetition below) and then to step up to the next, exhaust that, and so on, if no change of remedy is indicated to the highest potency.
(Hahnemann places the upper limit of potencies suitable at the end of a series in any given case at the last potency which will produce a very slight aggravation of the symptoms. In our experience you can usually use the highest known potency of the true simillimum and still get action, although at times action will cease with, say, the CM potency). When the top of the series has been exhausted and the same remedy is still called for you begin again at the 200th and repeat the ascending series.
Series of homoeopathic potencies have been made by many famous persons, either by hand, as in the case of the Jenichen potencies, or by various machines. As a general rule it is best to stick to the potencies made by one man as you go up the series in any one case, as for instance, Kents 200th, 1M, 10M, CM, etc. On the other hand, if a jolt is needed, although the same remedy is called for, a change from, say the Skinner to the Fincke potencies may whip up the case.
For those who understand rhythms and cycles it may be well, after a patient has been through a curse (ascending series) of a remedy from one source to change to one of the irregular potencies of the remedy from another source, for instance, we have seen Skinners Lyc. 2M beneficial instead of Kents 1M, or Finches 43M in place of a 50M. This change seems to start a new rhythm or cycle, it is as though the vital force became bored with the decimal system and responded with a renewed spurt to the alternation of potency. The is advanced doctrine.
In desperately ill cases, where the fight for life is active, in acute disease, the high potencies are indicated; also where the desperate illness is the terminal stage of chronic disease the very high potencies induce euthanasia. In chronically incurable cases, unless the vitality is very good and the pathology not yet too extreme, low or medium potencies are suitable, and usually the deep acting simillimum must here be avoided and a palliative drug given. If such a palliative be not too searching a remedy, Sang., Rumex, Puls., etc., it may be given even to incurables in a fairly high potency.
The problem of potency selection to acute disease incident to chronic treatment is another snag. Patients long under correct chronic prescribing show less and less acute diseases, in other words their susceptibility is eradicated; however, explosions of latent psora do occur sometimes particularly when the vigor is increased by the proper chronic remedy, as a sort of vent or effort on the part of the vital force toward house-cleaning.
The first problem for the prescriber in this connection is to determine whether the acute symptoms arising during chronic treatment are an aggravation following the remedy, and if so, whether they are an aggravation due to the reactive curative power of the body or a remedy aggravation due to over sensitivity or to wrong potency. If either of these be the case and the aggravation is not too severe no remedy should be given, merely Placebo.
If the aggravation threatens life or is unbearably painful (this may have to be an antidote) or for some social reason, particularly intolerable for the moment, an acute remedy may be given in the medium low potencies, preferably the 30th or 200th, and this will probably not interfere with the action of the chronic remedy. In acute exacerbations or explosions of active chronic disease you can often give the acute complement or cognate of your chronic remedy. In this case also the chronic remedy may continue to act undisturbed.
In very severe acute diseases during the course of chronic treatment it will sometimes be better to give the acute remedy high and after the acute condition has subsided retake the chronic case which will often show a new picture. The new prescription takes into account the original chronic symptoms but lays more stress on the recent developments.
In many conditions with marked tissue change, such as adhesions, chronic cardiac decompensation, very low potencies, even tinctures may be useful. Potencies as low as the 12th or even the 6th are occasionally invaluable in single dosage in such grave conditions as tuberculosis where even a 30th or a 200th of such a remedy as Phos. or Sil. might set the economy on the down grade.
From this brief outline of the possibilities of potency it will be seen that we uphold the use of the high potencies mostly. The question of Potency is the most moot point in all homoeopathy and even in our ranks today many strict homoeopaths are so-called low potency men. These follow Hughes and are more pathological in their prescribing. The strict Kentians, almost without exception, are preponderantly high potency.
The degree of susceptibility of our patient also influences potency selection. Certain persons are over-sensitive (often owing to improper homoeopathic treatment) and they will prove any remedy you give them; they require, therefore, medium low potencies. Other patients are very sluggish (often owing to much allopathic drugging). These will often take a very high potency to get any action at all or they may need a low potency repeated every few hours until favourable reaction sets in.
A third type of patient is the feeble one where the vital force can easily be overwhelmed. Repetition is the greatest danger here. Acutely sick, robust patients will stand repetition of high potencies until favourable reaction commences, although the ideal is the single dose. Children take high potencies particularly well, and in general the very aged require medium potencies except for euthanasia. Some individuals have idiosyncrasies even to homoeopathic potencies of certain substances.
Some degree of idiosyncrasy to a remedy must be present or the patient will not be sensitive enough to be cured, but where this is extreme the law of medium potencies should be preferred. Where patients are habitually poisoned by a crude substance, as a general rule it is not advisable to give that substance in very high potency, it is better to give an antidotal substance high. For instance, patients long dosed with calomel are not relieved by high potencies of Mercurius but may be by Hepar. On the other hand exceptions to this occur as in chronic susceptibility to Rhus poisoning, Thus tox. CM may eradicate the tendency.
If not, a deeper antipsoric in accordance with the totality of the symptoms is indicated. Certain remedies are noted for their power to restore order after chronic poisoning with crude drugs, as Natrum Mur. after the misuse of quinine or silver nitrate. The very low potencies, such as the 3 and 6x are very dangerous in the hands of accurate prescribers. This may be mainly due to the customary repetition.
Great care must be taken in potency selection of certain very deep acting remedies in serious chronic cases. For instance, Kali carb. in gout, Sulph., Sil., Tub., or Phos. in tuberculosis; psor. in asthma; and Arsenicum and Lachesis in many conditions. These remedies should be carried in the 30th potency even by those who give almost entirely the higher degrees.
The single remedy is the third member of the essential homoeopathic trilogy. The reason for this is obvious: only one remedy can be the most similar at any given time with the condition of any given patient. If the physician can not decide between two remedies he has not gotten the totality of the symptoms, or the remedies which he has chosen are merely superficially akin to fragments or aspects of the case. Furthermore, the simillimum is a personality having a rhythm, one might almost say a permeating aura of its own, and in the fleeting instant of its administration it takes complete possession of the patient, thereby buoying up the vital force so that it can carry on the restorative process.
To have two or more remedies would be to introduce two separate rhythms, partial and disharmonious factors. Moreover, if more than one remedy be used the doctor cannot know which element was curative and one source of future guidance is thereby obscured. Lastly, since only one remedy can possibly be proved at a time, so only one can cure at a given moment. Some mongrel homoeopaths when in doubt give mixed prescriptions. This means that they are merely prescribing symptomatically, one remedy for one symptom or organ, and another for another.
Each of these if homoeopathically chosen may wipe out the fragmentary illness at which it was aimed but that which is profound, total, and primal, of which all these symptoms are but manifestations and will remain untouched and simply crop out through other channels as subsequent symptoms. Other half-hearted homoeopaths, and even some with a wide knowledge of the materia medica but a relatively feeble grasp of the philosophy alternate remedies. This practice can not be too strongly condemned as it seesaws the patient into temporary ups without real progress.
Many modern French homoeopaths give a main deep acting remedy and one or more so-called drainage remedies with it, the chronic remedy in high potency and the drainage remedies in low potency, the idea being that the drainage remedy opens up an outlet for the exodus of the disease. These drainage remedies aim at the production of a discharge or the stimulation of the secretory organs, etc. This is a recent variant and does not appear in Hahnemann, the old masters, or Kent, and the self-styled purists of today do not approve of it.
The subject of the intercurrent remedy may well be mentioned here. Many pure Kentians hold that there is, or should be, no such thing, and that when, after a series of potencies of the same remedy, a new remedy is called for to stir up or develop the case, this is not an intercurrent but at that moment the simillimum.
There is some division of practice as to whether the single remedy should be given in one or more doses. The high potencies favour the single dose, although two, three or more doses of a high potency may be given at short intervals every four, eight or twelve hours especially in very acute cases with fever as the increased metabolism, so to speak, eats up the remedy fast. in such slow diseases as typhoid high potencies may also be repeated close together, but in every instance it is an absolute rule that when favourable reaction sets in the administration of the remedy must cease.
So long as improvement is visible in the patient himself the remedy should not be repeated. Not only there is no need of “more of a good thing” but a repetition of a remedy which is still acting successfully defeats itself and actually hinders cure. Very occasionally, however, we have found that when a certain potency is aiding somewhat a higher potency of the same remedy will lift the case to speedier cure. In this connection it is of interest to mention the theory of double dosage recently promulgated by Gordon of Edinburgh.
Gordon gives his remedy in two doses, eight hours apart, the first dose of a lower and the second of a higher potency of the same remedy. For instance,Phos. 200 at bedtime and Phos. 1M on rising. This has not yet been sufficiently tried out for unqualified acceptance. Some of the masters use a lower potency after a higher one and claim good results. This seems in accord with the order of the progress of disease, from within and above, outward and downward. This has been even less used than the other method and we have no statistics as to whether these cases would have done as well or better on the lower potency originally.
Another method of multiple dosage which almost amounts to divided single doses is that of plussing. “Plussing” means dissolving your dose in a third of a glass of water, taking two teaspoonfuls, throwing away most of the rest, adding water up to the original quantity, stirring and succussing and again taking two teaspoonfuls as the second dose and so on. This raises the potency very slightly between each of the doses, gives somewhat wider range or plane, and is particularly indicated in stubborn and refractory cases.
If very low potencies are used in ordinary acute illness, repeated doses are necessary until improvement sets in in most cases, for instance, a decompensated cardiac case calling for Crataegus might need two drops of tincture in water night and morning for a week. Where there is more pathology than vitality this might open the case better than a single high potency dose of Crataegus, although this latter might follow later.
Bryonia 3x should be given as pellets or in water at intervals of one to four hours according to the pace of the case, in acute cases calling for Bryonia, by low potency men. We would whole-heartedly advocate a single dose of Bryonia high under the same conditions. So much for the administration of the first dose or doses prior to the setting in of a favourable reaction.
Next comes the problem of when to prescribe again. The rule here is never repeat or change the remedy while the patient himself is improving When the improvement has apparently ceased in acute diseases you may need to repeat the same remedy in the same or a higher potency or, if your remedy was not a true simillimum, you may need another remedy to round out the cure.
You must be sure that the cessation of improvement is not due to the emotional mechanical or hygienic cause or merely to the aggravation or out- cropping of single symptoms. In chronic work you should wait some time, from three or four days to two or three weeks or more, as the vital force has cycles even on the upward grade, and true curative action must not be interrupted until it is certain that the reactive force is exhausted. Kent admirably stresses this in his injunction “to watch and wait”.
As to the interval between repetition or prescriptions this may vary from a few minutes to a year or more and is entirely dependent on the general amelioration of the patient. When you have had true improvement and particularly, if, in chronic cases, you have observed the working of Herings law of cure, sit tight. More cases are bungled by too frequent repetition then by anything else. In this connection it is of course necessary to know which are the long acting remedies, although we have known of the good effect of Bryonia 30 one dose continuing two years in a chronic condition.
Every student should own the little pamphlet by R. Gibson Miller on The Relationship of Remedies which gives approximate duration of action, but the only true guide to the duration of action of any remedy in a given potency on any patient is the cessation of the patients general sense of well being. in general, if you are a good prescriber, one dose, single or divided as above, should cope with brief acute diseases to be followed at the termination of the disease with a chronic to set the economy in order. If a change of remedy is indicated in acute disease there will often be a reversion or return towards the close of the disease to the primary remedy.
The subject of the second prescription and of aggravations will be taken up in the next lecture. It remains only to say a word here about the place of Placebo in prescribing. A famous doctor said that “Sac. lac. is the second best remedy.” Patients who understand homoeopathy deeply may often be content with a single dose at long intervals without Placebo, but it is good policy to give even these a single powder of Placebo at every visit.
Most patients require medicine often, not only so that they feel that something is being done but so that they may have powders for emergencies and it is not only honorable but necessary to give plentiful Placebo. It is wise to train the patients to take powders or pellets as Placebo which are similar in appearance to the actual remedies, and not to give them the tempting brown, pink and green blank tablets.
Complicated as these elementary rules sound they are but the beginning of homoeopathic wisdom. Every student should own and read at least once a year Kents Lectures on Homoeopathic Philosophy and should also be conversant with the writings of Stuart Close, Gibson Miller, John Weir. as well as the Lectures on Therapeutics by Dunham and by Joslin and, of curse, with that keystone of our art-Hahnemanns Organon.