The words dose and dosage implicitly carry the idea of quantity; and when we refer to the “minimum dose,” we are speaking of quantity in the smallest possible amount. This, which holds true when speaking on general terms, can well be exemplified with the daily prescribing of drugs by our confreres of the Old School: physiological dose, dose of greatest tolerance, toxic and lethal doses, all these are classifications as to quantity.
But if the actual amount of a drug used for a single prescription, or for a course of treatment, actually determines, in allopathic therapeutics, the dose in which a remedial agent should be used, this is not true when we speak in terms of our very won Hahnemannian language in discussing what is the most appropriate dose for a homoeopathic remedy, or rather, for a homoeopathic prescription. And allow me to emphasize the preference for the expression. And allow me to emphasize the preference for the expression “homoeopathic prescription” instead of “homoeopathic remedy”.
In allopathic prescribing, if the remedy is to be given in liquid form, the dose is specified in Minims, Cubic Centimeters, Fluid Drachms, Fluid Ounces, and so forth. If it is a powder, Grains Drachms, Fluid Ounces, and so forth. If it is a powder, Grains Or Grams will determine the dose; if in Tablets or Pills, so many tablets or so many pills will establish the corresponding dose. if dealing with not very highly toxic remedies, the index of tolerance, as shown by the patients reaction, is the key-note for the determination of the dose. In other words, a remedy must be used in the largest possible amount that the patient may tolerate with out showing symptoms of intoxication.
We may well say that in homoeopathic practice we invert the concept of dosage, in as much as we try always to use the least possible amount of drug in a remedy; it does not matter how small the amount, if it is capable of producing a favorable reaction, manifested by the amelioration of symptoms; but without producing the so called physiological effect, which will mean an intensification of the symptoms if the remedy has been prescribed according to the Law of Similars. As our remedy, or therapeutic agent, will be acting on a direct line of the already present spontaneous reaction of the sick organism, we are not expecting to get any chemical, physiological effect of the drug itself; but, rather, an indirect, physical, dynamic effect which can only be obtained with a greatly diminished dosage.
In order to obtain, therefore, the desired action of a homoeopathic remedy, the dose thus selected will have to be an infinitesimal amount to avoid the direct, physiological action which will handicap or even obliterate Natures own efforts in effecting the cure. But not only because of that reason, the dose should be very small for we are endeavoring ONLY to produce with our remedy the starting point of a reaction which will actually cure the patient. This starting effect, once produced, will actually cure the patient. This starting effect, once produced, will tell us that all medication should be stopped right then, at least for the time being, or permanently, should this first “impulse” keep up its “stimulus” in the right way to recovery.
It is easy and very simple to know when to start medication of a patient; but the hardest and most difficult task is to intelligently determine when to discontinue it or entirely to stop it. To carry on medication beyond the “dose” needed, even by repeating the same one previously used, may mean complete failure. The greatest and most frequent mistakes of our daily practice ar due to OVERDOSAGE.
There is no question in my mind that radium and X-ray radiations may cure certain cases of cancer, as these two agents are, at times, causative of cancer, if they were only used in compliance with the law of similarity and in very small, infinitesimal, “instantaneous” applications, never to be repeated until the effect of the first administration fades away and signs of amelioration stop.
But, on the contrary, these therapeutic agents are overused to the point in which cancerous cells and tissues are burned to death. usually meaning also the death of the patient. To satisfy oneself with burning off diseased tissues and cells, even at the expense of the patients life, is far from Hahnemanns ideal when he said that “the physicians highest and only calling is to restore health to the sick, which is called healing,” and that “the highest aim of healing is the speedy, gentle and permanent restitution of health, or alleviation or obliteration of disease in its entire extent, in the shortest, most reliable and safest manner, according to clearly intelligible reasons”.
The dose, then, homoeopathically speaking, does not refer to the amount of the drug used; it more refers to the repetition of the administered remedy, which should never occur until necessary. This occurrence may present itself in a matter of a few minutes, like in some instances when Camphora may be repeated in a very acute case of a choleriform diarrhea with the symptoms of collapse pertaining to the remedy; it may not be needed for weeks, or even months, in a chronic case in which the use of an anti-miasmatic remedy is imperative.
Too frequent repetition may cause overdosage just as much as too great an amount of any drug would.
To me, and this is an illustration I have very often used with my patients, a sick organism is like a “stalled” automobile on the middle of the road because of a weak battery. Along comes another car (therapeutic agent) and gives it an impulse which will start the “stalled” engine. if the impulse thus given and so received is the appropriate one, just with the required power and effected by the exact application of the corresponding matching parts of both elements (the cars), the impulse being exerted in the right direction, which will be indicated by the stalled” automobile (the patient) itself, and “intelligently” used by the latter, with no interference whatever, this primary impulse should prove sufficient for the desired result. But, on the other hand, if the car behind keeps on “pushing” by repeated impacts, it may damage or even demolish the “stalled” car which it tried to help.
The example can well be applied to the administration of a homoeopathic remedy, or of any therapeutic agent: First, it should “go” in the same direction the other element (sick organism) is “going”; second, it should match or, may we say, should bear a resemblance, or better yet, a similarity, as to action, to the other element (similar symptoms); it must have just power enough to start it “going” on the road to recovery (minimum dose); and fourth, it should never be repeated when unnecessary. A new “stalling” on the road will be the call for a new impulse (repetition of the dose), or for a more convenient one, which in our case will mean a new remedy.
How can we, then, establish a rule to determine the “minimum dose”? To do so would be to fall into a routine procedure, which will never do. If a routine is advisable for laboratory work, or when examining patients for diagnostic purposes, or in a hospital for clinical care of a number of sick persons, it should never be used in treating a patient. The word “routine” must entirely be prescribed from the field of therapeutics, for treatment requires always individualization in the determination of the appropriate dose. To follow routine procedures, or previously established rules, at this most important function of medical practice, the application of the therapeutic agent, will mean failure.
Medicine is a science as well as an art. Science in all of the aspects of medical training; but an art in the manner in which all that medical knowledge is brought into actual practice at the moment when the physician must exercise his “highest and ONLY calling.” which is to restore health to the sick.
A physician, then, must be a scientific man, with all the attributes of a highly trained mind, capable of assimilating all possible medical knowledge; but, most essentially, in my humble opinion, he must be an artist, with the temperamental sensitiveness of an artist, when it comes to the actual application of his knowledge in his effort to restore the impaired health of his patient.
The higher his artistic temperament, the more successful he will be in identifying the most minute, apparently trivial, details of his patients reactions, which usually show those peculiar, characteristic symptoms so important in the selection of the remedy. Like the musician does with his violin, he must make his instrument (the remedy) vibrate in the proper key-tone to produce the harmonious effect he is seeking. This explains to me why some men are more successful than others in prescribing when the same “instruments” are accessible to all. The like remedy is the appropriate instrument for every particular case; the minimum dose, the note that will reestablish the desired harmony.