Abstract: Hahnemann did not start with the idea of potency. He began with using similar medicines and that is what he did for some time (8 years), until he recognized a problem. He observed that the similar medicine cured, but at times with unnecessary suffering and it was his experiments in reducing the dose that led to the idea of potency – this process of diluting the medicine with his succussion method actually seemed to make the medicine more effective (more potent) in curing his patients. It was his continued exploration of how the medicines could be best prepared that occupied him through the rest of his life, culminating in the introduction of the LM potencies. In this talk we explore Hahnemann’s ideas about dilution and the form of remedy administration (wet, dry and slightly damp) as related to the treatment of the patient. We will also see how other homeopaths related to these factors and what their experiences were, in particular how Kent attempted to solve the same problem by looking beyond homeopathy.

Introduction
I have been in the position, as a teacher of homeopathy, to see many cases of other practitioners. I have observed the tendency, the last few years, of what I consider excessive concern about the potency and form of remedy administration in cases in which the wrong remedy is being used. In other words, in situations in which the remedy should be changed, instead the interpretation is that the remedy is correct and the way of administration is what should be adjusted. This paper addresses this issue and gives my perspective on this, based on my 30 years of experience and also the experience of other practitioners – notably Kent and Jahr.

The student of homeopathy has enough challenges, you would think. Yet, after the prescription has been made, they are often confronted with the additional challenge of having to decide among the many options that have developed of late as to how to administer the remedy. Shall we use one or several pellets? Shall the remedy be dissolved in water or given dry? If dissolved in water, should I give it once or more than once? If more than once, should it be succussed before each dose? Or diluted further? If diluted further, how much water should I use to do it? Does it matter how many times I succuss it? How about using the C potencies vs. the LM potencies? And on and on it goes.

Here is an example of an exchange between two practitioners that demonstrates the complexity and confusion that arises. In regard to advising on a case and making an assessment of the medicine being used, this advice was given:

Practitioner 1: “I agree with your assessment at this time, except for your decision to give just a single dose of the remedy. It would be hard to judge just a single dose, especially with the way he has reacted to this remedy. He does not have the kind of reaction that (shows us it is curative) but just an “inching towards better” type of reaction. So one dose will not clear up the confusion. What I would do is try daily doubly diluted doses until he clearly worsens or does not improve. Then we will be sure one way or the other and can move on if need be.”

Practitioner 2: “Thanks for your continuing help. Just to make sure I’ve got it right – you suggest going back to daily (vs EOD) dosing when his forward momentum wanes. I have been making the stock solution with 1 pellet in 8 Tbsp water and having the owner put 1 Tbsp into 1/2 cup water and give 1 cc orally. So now, she will instead take a Tbsp from the first diluted glass and put it into a 2nd glass of 1/2 cup water and then give 1 cc. Correct?”

Why has this become a topic of confusion? Why are there so many different opinions about how to give the medicine? I take this position – there is uncertainty about how to give the medicine because Hahnemann was uncertain himself in how to do it. He spent much of his active professional life trying to solve this problem – and unsuccessfully.

Two basic concepts

Let’s start with this. There are two very general concepts at the base of homeopathy and these are the use of the similar medicine and the concept of potency. The latter word, potency, refers specifically to the observation that Hahnemann made, that in preparing the medicine by dilution and succussion it appeared that the medicine became more “potent”, e.g., as in the dictionary definition “having great power, influence, or effect”. This was a clinical observation and is one that has been confirmed by other homeopaths.

There are two sides to this:

1. The medicine that is close to crude form can be too powerful in effect (not just healing effect but also aggravations of the disease).

2. The medicine diluted, succussed, and given in small dose acts more smoothly and curatively without unpleasant side-effects (thus more potent).

The remedy in crude form can act excessively.

One of the most interesting presentations of how the crude drug can have excessive effect (though still curing) is in Burnett’s 50 Reasons For Being A Homeopath, Reason no. 1.

“A number of years ago, on a dull dreary afternoon, which I had partly occupied at B Hospital with writing death certificates, I suddenly rose and felt something come over me, for the fiftieth time at that period. I hardly knew what, but it grew essentially out of my unsatisfactory clinical results. I had been an enthusiastic student of medicine originally, but an arrantly sceptic professor quite knocked the bottom out of all my faith in physic, and overmuch hospital work and responsibilities, grave beyond my age and experience, had squeezed a good deal of the enthusiasm out of me.

After pacing up and down the surgery, I threw myself back into my chair and dreamily thought myself back to the green fields and the early bird’s-nesting and fishing days of my childhood. Just then a corpse was carried by the surgery window, and I turned to the old dispenser, and enquired in a petulant tone, “Tim, who’s that dead now? ” “Little Georgie, Sir.” Now little Georgie was a waif who belonged to nobody, and we had liked him and had kept him about in odd beds, as one might keep a pet animal. Everybody liked little Georgie ; the most hardened old pauper would do him a good turn, and no one was ever more truly regretted than he. It all came about in this way : One day I wanted a bed for an acute case, and I ordered little Georgie out of his bed in a warm, snug corner, to another that was in front of a cold window ; he went to it, caught cold, had pleurisy, and Tim’s reply gives the result. Said I to myself: If I could only have stopped the initial fever that followed the chill by the window, George had probably lived. But three medical men besides myself had treated Georgie – all in unison – and all hospital men; still pleurisy followed the fever, dropsy followed the pleurisy, and poor little Georgie died. Georgie was no more, and I FELT SURE HE NEED NOT HAVE DIED, and this consciousness nearly pressed me down into the earth.

That evening a medical friend from the Royal Infirmary turned up to dinner with me, and I told him of my trouble, and of my half determination to go to America and turn farmer: at least I should be able to lead a wholesome, natural life. He persuaded me to study Homoeopathy first, and refute it, or, if apparently true, to try it in the hospital. After many doubts and fears – very much as if I were contemplating a crime – I procured Hughes’s ” Pharmacodynamics ” and ” Therapeutics,” which my friend said were a good introduction to Homoeopathy. I mastered their main points in a week or two, and came from a consideration of these to the conclusion either that Homoeopathy was a very grand thing indeed, or this Dr Hughes must be a very big ……. No, the word is unparliamentary. You don’t like the word? Well, I do, it expresses my meaning to a T ; on such an important subject there is for me no middle way, it must be either good clear God’s truth, or black lying.

I was full of fever on account of Georgie’s fate, so studied the Homoeopaths thereon, and found that they claimed to cut short simple fever with Aconite. Ah, thought I, if that be true, Aconite would have saved little Georgie if given it in time at the very onset. Well, feverish colds and chills were common enough just then, and I had, moreover, a ward where children thus taken ill were put till their diseases had declared themselves, and then they were drafted off to the various wards, for that purpose provided, with Pneumonia, Pleurisy, Rheumatism, Gastritis, Measles, as the case might be.

I had some of Fleming’s Tincture of Aconite in my surgery, and of this I put a few drops into a large bottle of water and gave it to the nurse of said children’s ward, with instructions to administer of it to all the cases on the one side of the ward as soon as they were brought in. Those on the other side were not to have the Aconite solution, but were to be treated in the authorized orthodox way, as was theretofore customary. At my next morning visit I found nearly all the youngsters on the Aconite side feverless, and mostly at play in their beds. But one had the Measles, and had to be sent to the proper ward: I found Aconite did not cure Measles. The others remained a day or two, and were then returned whence they had originally come. Those on the non-aconite orthodox side were worse, or about the same, and had to be sent into hospital – mostly with localized inflammations, or catarrhs, measles, etc. And so it went on day after day, day after day: those that got Aconite were generally convalescent in twenty-four or forty-eight hours, except in the comparatively seldom cases where the seemingly simple chill was the prodromal stage of a specific disease such as measles, scarlatina, rheumatic fever : these were barely influenced by the Aconite. But the great bulk of the cases were all genuine chills, and the Aconite cured the greater part right off, though the little folks were usually pale, and had perspired, as I subsequently learned, needlessly much.

I had told the nurse nothing about the contents of my big bottle, but she soon baptized it “Dr Burnett’s Fever Bottle.” For a little while I was simply dumbfounded, and I spent much of my nights studying homoeopathy. I had no time during the day. One day I was unable to go my usual rounds through the wards. In fact I think I was absent two days from Saturday till Tuesday, and on entering the said children’s ward the next time in the early morning, the nurse seemed rather quiet, and informed me, with a certain forced dutifulness, that all the cases might, she thought, be dismissed. “Indeed,” said I, “How’s that ? ” ” Well, Doctor, as you did not come round on Sunday and yesterday, I gave your fever medicine to them all and, indeed, I had not the heart to see you go on with your cruel experiments any longer. You are like all the young doctors that come here – you are only trying experiments! ” I merely said, “Very well, nurse, give the medicine in future to all that come in.” This was done till I left the place, and the result of this Aconite-medication for chills and febricula was usually rapid defervescence, followed by convalescence.

An interesting story and the purpose in telling it is to show how the Aconitum tincture use resulted in strong signs of reaction, reactions that were not necessary for a cure.

It was Hahnemann’s same experience that stimulated his search for the best form of the medicine and the best way to deliver it. It was clinical experience and observation that moved Hahnemann in this direction. What I suggest in this paper is that Hahnemann worked on this his entire life without solving this puzzle of the best potency and the best method of administration.

Why the dose question was of interest to Hahnemann.

Let’s summarize what prompted Hahnemann to investigate this so thoroughly.

1. The patient is as sensitive to the medicine as to the disease.

2. If the medicine is used too much or in too crude a form then we can actually make the symptoms worse, what appears to be an aggravation of the patient’s condition or what Kent referred to as an aggravation of the disease.

3. If the dose is made smaller and if it is also succussed or triturated, then the power of the medicine to heal looks to be enhanced, while at the same time the primary effect of the medicine (that part which causes excessive action) is reduced, made minimal.

When Hahnemann turned to the potency question.

It is sometimes difficult for us to realize how the work Hahnemann did unfolded over time. We read (or study) the principles of practice as if they are one integrated whole, yet it did not arise this way. The first major insight was the importance of the similar remedy in bringing back health. This was confirmed by practice and, indeed, developed and defined much more clearly as the years went by. In the last edition of the Organon it has become a major part of the book in which the emphasis is on understanding the difference between curative action and palliation or suppression (the discussions of similar vs. non-similar medicines, paragraphs 22 to 71).

Once this principle was established Hahnemann considered it completely reliable like a natural law of nature. The challenge to this was the recognition of patients with chronic disease for which the usual way of using similar medicines was not followed by success. Yet it is revealing that Hahnemann did not lose confidence in the law of similarity in spite of having these difficult patients.

His adherence to the basic principle of the similar medicine is most evident in the beginning of the book on the Chronic Diseases, in which he introduces the topic of the failure of the usual way of treating patients.

From the Chronic Diseases.

“Using the more natural treatment, Homeopathic physicians have frequently been able in a short time to remove the chronic disease which they had before them, after examining it according to all the symptoms perceptible to the senses; and the means of cure were the most suitable among the Homeopathic remedies, used in their smallest doses which had been so far proved as to their pure, true effects. And all this was done without robbing the patient of his fluids and strength, as is done by the allopathy of the common physicians; so that the patient, fully healed, could again enjoy gladsome days. These cures indeed have far excelled all that allopathists had ever -in rare cases- been able to effect by a lucky grab into their medicine chests.”

“The complaints yielded for the most part to very small doses of that remedy which had proved its ability to produce the same series of morbid symptoms in the healthy body; and, if the disease was not altogether too inveterate and had not been too much and in too great a degree mismanaged by allopathy, it often yielded for a considerable time, so that mankind had good reason to deem itself fortunate even for that much help, and, indeed, it often proclaimed its thankfulness. A patient thus treated might and often did consider himself in pretty good health, when he fairly judged of his present improved state and compared it with his far more painful condition before Homeopathy had afforded him its help”.

“Of this kind were the cures of diseases caused by a psora not yet fully developed, which had been treated by my followers with remedies which did not belong to the number of those which, later, proved to be the chief anti-psora remedies; because these remedies were not yet known. They had been merely treated with such medicines as Homeopathically best covered and temporarily removed the then apparent moderate symptoms, thus causing a kind of a cure which brought back the manifest psora into a latent condition and thus produced a kind of healthy condition, especially with young, vigorous persons, such as would appear as real health to every observer who did not examine accurately; and this state often lasted for many years. But with chronic diseases caused by a psora already fully developed, the medicines which were then known never sufficed for a complete cure, any more than these same medicines suffice at the present time.”

“Even some gross errors of diet, taking cold, the appearance of weather especially rough, wet and cold or stormy, or even the approach of autumn, if ever so mild, but, more yet, winter and a wintry spring, and then some violent exertion of the body or mind, but particularly some shock to the health caused by some severe external injury, or a very sad event that bowed down the soul, repeated fright, great grief, sorrow and continuous vexation, often caused in a weakened body the re-appearance of one or more of the ailments which seemed to have been already overcome; and this new condition was often aggravated by some quite new concomitants, which if not more threatening than the former ones which had been removed homeopathically were often just as troublesome and now more obstinate.

“This would be especially the case whenever the seemingly cured disease had for its foundation a psora which had been more fully developed. When such a relapse would take place the Homeopathic physician would give the remedy most fitting among the medicines then known, as if directed against a new disease, and this would again be attended by a pretty good success, which for the time would again bring the patient into a better state. In the former case, however, in which merely the troubles which seemed to have been removed were renewed, the remedy which had been serviceable the first time would prove less useful, and when repeated again it would help still less. Then perhaps, even under the operation of the Homeopathic remedy which seemed best adapted, and even where the mode of living had been quite correct new symptoms of disease would be added which could be removed only inadequately and imperfectly; yea, these new symptoms were at times not at all improved, especially when some of the obstacles above mentioned hindered the recovery.”

“Some joyous occurrence, or an external condition of circumstances improved by fortune, a pleasant journey, a favorable season or a dry, uniform temperature, might occasionally produce a remarkable pause of shorter or longer duration in the disease of the patient, during which the Homeopath might consider him as fairly recovered; and the patient himself, if he good-naturedly overlooked some passable moderate ailments, might consider himself as healthy. Still such a favorable pause would never be of long duration, and the return and repeated returns of the complaints in the end left even the best selected Homeopathic remedies then known, and given in the most appropriate doses, the less effective the oftener they were repeated. They served at last hardly even as weak palliatives. But usually, after repeated attempts to conquer the disease which appeared in a form always somewhat changed, residual complaints appeared which the Homeopathic medicines hitherto proved, though not few, had to leave uneradicated, yea, often undiminished. Thus there ever followed varying complaints ever more troublesome, and, as time proceeded, more threatening, and this even while the mode of living was correct and with a punctual observance of directions. The chronic disease could, despite all efforts, be but little delayed in its progress by the Homeopathic physician and grew worse from year to year.

“This was, and remained, the quicker or slower process in such treatments in all non-venereal, severe chronic diseases, even when these were treated in exact accordance with the Homeopathic, art as hitherto known. Their beginning was promising, the continuation less favorable, the outcome hopeless.”

“Nevertheless this teaching was founded upon the steadfast pillar of truth and will evermore be so (Hahnemann’s emphasis). The attestation of its excellence, yea, of its infallibility (so far as this can be predicated of human affairs), it has laid before the eyes of the world through facts.”

Hahnemann’s positions on potency.

We see from this a tremendous confidence on Hahnemann’s part as to the correctness in using similar medicines to cure. He does not appear to have deviated from that. It is quite the different story when it comes to potency and administration. In contrast to the dependancy he had on this principle of similarity he never came to the same confidence in respect to potency and dosing. We see in his writings a continued experimentation with this his entire professional life, until death finally stopped him. Hahnemann started investigating the potency problem about 8 years after discovering the principle of similarity and worked with this conundrum for decades. We could make the assumption that the last suggestion of his, the use of the LM potencies, was the one he was satisfied with but that is an unlikely conclusion. The pattern was constant tinkering – until he could experiment no more.

At first H. tried the idea of starting “high” (for him) and then working down, like starting with 15c, then 12c, and so on. Another method was to go higher, up to 30c though he was not a fan of going higher than this – waiting for Kent and others to push the envelope. Much attention in his writings is given to advice on how to manage the excessive reactions after the medicine is given – about not repeating too soon especially. Basically he found it was best not to irritate the life force by giving the medicine repeatedly so that there was too much influence, or mistuning, of the patient. If this was done, the risk was there of both unnecessary reactions and discomfort for the patient.

Without going into an exhaustive depiction of all the methods he tried, the point to make here is that he was always trying to make it better. He had the idea, and stuck with it, that the patient could be cured gently and was always trying to make this a practical clinical reality.

The final development, as described in the 6th edition of the Organon, was the LM potencies. Put simply, he changed from making a 1:100 dilution to a 1:50,000 dilution between each step of preparation. It was his idea that the “potency” was developed more gently by doing this. In addition, and an essential part of this method, was that the medicine was given in water, succussed and diluted before each dose. Again, he thought that this method would allow the life force to accept more frequent exposures to the medicine.

Note that at this point in Hahnemann’s work he is saying that the C potencies were simply too powerful in some patients and that was a factor of how they were made, the 100:1 dilution steps instead of 1:50,000.