Does the Size of the Dose Really Matter?

While working in a molecular biology lab almost twenty-eight years ago, I learned how sensitive animal cells are to dose. We were studying cell surface receptors using tissue cultures of mouse pancreatic cells (the insulin receptor was one of our objects of study).

Cells can be grown in single layers attached to a petri dish as long as they are provided with the correct nutrients and micro-environment. Even a difference of a nanomole (.000000001 or 1 billionth of 1 mole of the substance) would make the difference between life and death of the cells.

Ten years later, while practicing as a holistic (though allopathic) veterinarian, I had several clients who found that their pets responded best to “sub-therapeutic” doses of certain drugs. Whenever I was able to convince them to employ the commonly used higher doses, their pets would experience side-effects and get sicker instead of better. Yet at one half, one quarter, or sometimes less of the standard dose the disease symptoms would resolve and the animals would recover.

In part because of these experiences, I was confused by some discussions concerning posology when I first started practicing homeopathy. It seemed that some homeopathic clinicians were equating the sub-molecular remedy strength (potency) with the molecular quantity (dose). I didn’t understand how  one dry pellet could have the same effect as five (or ten, or…). Most of my reading list from those days consisted of the writings of Hahnemann and I remembered seeing many pertinent references by him concerning this topic

For example, in ¶ 275 from the Kunzli translation of the sixth edition of the Organon Hahnemann says: “The correctness of a medicine for a given case of disease depends not only on its accurate homoeopathic selection but also on the correct size (or rather smallness) of the dose. Medicine given in too large a dose, though completely homoeopathic to the case and in itself of a beneficial nature, will still harm the patient by its quantity and unnecessarily strong action on the vital force, and through it, because medicine is homoeopathic, and precisely those parts of the organism which are most sensitive and have already been afflicted most by the natural disease.” (author’s emphasis)

Now this made sense to me and explained my observations of the exquisite sensitiveness of cell cultures as well as the sensitivity of some patients to certain drugs. Since homeopathic remedies work at a much deeper level than allopathically or antipathically prescribed drugs (which are usually required in gross chemical quantities to achieve a physiologic response), over-dosages of homeopathically selected medicines should have even greater consequences.

This point was made by  Hahnemann in ¶ 276: “For this reason a medicine, although homeopathic to the case, does harm when is given in overdose. In strong doses the more homeopathic the medicine and the higher  its potency the more harm it does:  indeed it is far more harmful then equally large doses of unhomoeopathic medicine, an allopathic one unrelated to the disease condition. Excessively large doses of an accurately selected homoeopathic medicine, especially if frequently repeated, are, as a rule very destructive…”

It is also important to note from this paragraph that Hahnemann considered dose and potency to be two distinct entities.

In a footnote in Chronic Disease (pg. 120) Hahnemann also says: “I have myself experienced this accident, which is very obstructive to a cure and cannot be avoided too carefully. Still ignorant of the strength of the medicinal power, I gave sepia in too large a dose. This trouble was still more manifest when I gave lycopodium and silicea potentized to the one-billionth degree, giving four to six pellets, though only as large as poppy seeds. Discite moniti!”

Discite monitii. DON’T DO THIS!

Hahnemann, the quintessential scientist and experimenter, after years of practice and close observation of his many patients emphatically requests his readers to benefit from his experience. OK. So now I knew what NOT to do. Fortunately the Master is also quite clear in his directions for determining the correct dose to use.

In ¶ 278 he writes-“Now the question arises what this ideal degree of smallness is, the degree that is certain and gentle in its remedial effect: how small should the dose of a given correctly chosen homeopathic medicine be to cure a case of disease in the best way?  To solve this problem, to determine for a given medicine used in homoeopathic practice what dose would be sufficient and at the same time small enough to effect the gentlest, quickest cure, is not a matter of theoretical conjecture, as one can easily understand. Theorizing and specious sophistry cannot enlighten us on this subject, nor can every possible eventuality be tabulated in advance. Only pure experiment, the meticulous observation of the sensitivity of each patient, and sound experience can determine this in each individual case…” (author’s emphasis)

Ahhh. Individualize. Now that makes sense. After all, homeopathy is the ultimate individualized system of medicine.

¶277: “For the same reason and since, if the dose is appropriately small, a well-dynamized medicine becomes increasingly curative…it must become increasingly beneficial as its dose approaches the ideal degree of smallness for gentle action.” (author’s emphasis)

In ¶278 Hahnemann continues: “It would be foolish to disregard what pure experience teaches us about the smallness of the dose necessary for homeopathic cure and to favor the large doses of the inappropriate (allopathic) medicines of the old school, which do not homeopathically effect the sick part of the organism, but only attack the part that the disease has not taken hold of.”

Wow!  Now I feel much better prepared to “restore health rapidly, gently and permanently…”

Let’s see how important dosing correctly is in practice.

Daisy is a beautiful and energetic five year old Golden Retriever. She eats a wide variety of fresh food but never has vomiting or diarrhea. She is even tempered in all situations, has no fears and can be taken anywhere. Her ears are spotless and she doesn’t itch or have other skin problems. She has no evidence of the early onset arthritis commonly seen in others of her breed. She lives in a Lyme and Anaplasma hot bed in CT yet has never been affected by an infectious dis-ease.

Soon after Daisy was adopted as a puppy she started manifesting signs of latent psora. She developed waxy inflamed ears, runny eyes, and excessive licking of her vulva after urination. I assessed her otherwise as having a strong Vital Force. I based this on my assessment including the fact she was a young dog, was minimally vaccinated, got plenty of outdoor activity, was on a fresh food meat-based diet, appeared to have superficial symptoms and had never had suppressive therapies. I decided to give her a single teaspoon dose of Sulphur 1M (The dose was prepared by dissolving one poppy seed sized pellet in water as Hahnemann directs throughout his writings).

Unfortunately I did not heed his advice given in ¶ 278. I relied instead on my “theorizing” about Daisy’s strong Vital Force and elected to give her a high potency remedy. Note that although the physical quantity (1 teaspoonful from a 4 ounce medicinal solution) was small, it soon became apparent that the initial dose was still too highly dynamized for this individual.

Within a week this poor puppy suffered a medicinal aggravation consisting of a high fever and generalized pains such that she had to be carried into my office for an emergency visit. Fortunately I had learned Hahnemann’s Advanced Methods as described in the Sixth Organon and was able to successfully manage her case with infrequent doses of LM remedies given “as needed” (see Organon ¶ 246). She quickly recovered from the medicinal aggravation, continued to respond in a curative manner and has had no problems of any kind since then.

This case exemplifies the importance of testing the sensitivity of every patient in deciding the dose of medicine to use.

Currently my patients initially receive one (or less) teaspoons from a 30c solution, or one dose of an LM 0/1. Subsequent doses can then be adjusted based on the sensitivity of the patient to the test dose.

Tuli is a Nova Scotia Duck Tolling Retriever. The chief complaints at our initial consultation were excessive bleeding during heat and recurrent false pregnancies. She also had excessive reactivity to noises and movement, some lethargy (“depression”) and was picky about her food.

She did very well after her first remedy dose which was given as a double-diluted medicinal solution (one teaspoon of the initially diluted remedy was transferred into a second dilution glass from which 1 teaspoon was given). There was minimal bleeding during her next heat and Tuli seemed happier, more energetic, and less reactive to both noise and movement. Over the next few months some new symptoms emerged that guided me to the next prescription. Now this is where the situation got interesting. The first dose of the new remedy (also diluted in the same way) facilitated amazing improvement in Tuli’s overall state. Her mood, energy, appetite, reactivity, etc. were all better by the next day along with development of increased itching and discharge, sign of exteriorization of the disease.

This wonderful response continued for one month, at which time there was an increase in her reactivity to noise and motion as well as in her capricious appetite. Although her energy was still very high and her other symptoms were still better, I considered this a partial relapse. I recommended a re-dose of the same remedy, but using a smaller dose than I had prescribed in the previous administration (I continued with the same potency). This time however, there was no perceived response after the administration of the remedy.

If I hadn’t known how important it was to match the dose – not only the remedy – to the patient I might have thought that this was the wrong remedy, a remedy that had merely palliated with the first dose. Based on that incorrect assumption, I might therefore have chosen a new remedy. Instead, keeping the idea of individualized dose in mind, I increased the dose of the previously administered remedy without changing anything else. She again had an immediate appropriate response – a response which lasted four months.

Seven months after the initial double-diluted dose, Tuli continues to do well and in many ways is better than ever. At our last follow-up, there was some evidence that she may soon need a re-dose of the double-diluted 30c. We will continue using the same dose as long as she continues to respond in a curative manner and as long as there is nothing to indicate the need for a change in prescription.

What do these cases illustrate?

First, just because an animal is young and apparently vital doesn’t mean that a high potency is indicated; even in patients with mental and emotional components to their dis-eases.

Second, it really is essential to test the sensitivity to the remedy of every patient with chronic disease and when time allows in acute disease.

Third, curing our patients involves both choosing a simillimum and managing the case correctly; that is, by giving the correct dose at the appropriate time during treatment.

The best source for learning correct posology is right from the Master’s mouth: the Sixth edition of the Organon.

David Little’s online course and library at http://www.simillimum.com/ (and books which are due out in early 2008) and Dr. Luc De Schepper’s books offer some wonderful commentary on Hahnemann’s posology directions.

In conclusion, a reminder from ¶ 279: …”the dose of the highly potentized homeopathic remedy beginning the treatment of a significant (chronic) disease can, as a rule, not be made so small

that it is not stronger than the natural disease

that it cannot at least partially overcome it…

that it cannot start the process of cure.”

And from ¶ 282: “If during treatment, especially of a chronic disease, the first doses already produce a so-called homeopathic aggravation, i.e., a noticeable heightening of the disease symptoms originally observed, even though each repeated dose was somewhat modified (more highly dynamized) by succussion (par.247) then this is a sure sign that the doses were too large.” (author’s emphasis)

Finally, some prescient advice from the preface of the first edition of Chronic Diseases: “…What would men have risked if they had at once followed my directions in the beginning, and had made use of just these small doses from the first ? Could anything worse have happened than that these doses might have proved inefficient? They surely could do no harm!…”

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Jeffrey Feinman, BA, VMD, CVH, holds both molecular biology and veterinary degrees from the University of Pennsylvania. His training in homeopathy began with reading many of the works of the Masters and then progressed to study with Dr. Richard Pitcairn in both his Professional and Advanced courses and subsequent years of study with David Little, Paul Herscu, and Andre Saine. He became the first Certified Veterinary Homeopath in the state of Connecticut in 2000. Member: Past President of The Academy of Veterinary Homeopathy and Chairman of its Education Committee, member, American Holistic Veterinary Medical Association • Veterinary Honor Society (Phi Zeta): Inducted 1985.