Evolution of Hahnemannian Posology

INTRODUCTION:

Posology is described as the science of dosage. The Hahnemannian concept of homoeopathic posology stands for selection of potency, quantity of dose and repetition of the dose, based on the principles of the single remedy, minimum dose and minimum intervention.

In Hahnemann’s era all physicians were using 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. From that 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 reducing the dose did not come until  he had discovered the dynamic action of disease; then with his logical mind he correlated his results from the larger doses and brought his ideas of infinitesimal dynamic dosage into 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.

HISTORY OF EVOLUTION OF HOMOEOPATHIC POSOLOGY:

When a correct remedy has been chosen according to the law of similia, only one half of the difficulty of homoeopathic treatment has been overcome. It is often more difficult to decide what quantity of the suitable remedy will be most adaptable to the sick organism. Hahnemann devoted more than fifty years of his life to the solution of this problem.

Before discovering the law of similia Hahnemann’s medicinal treatment of his patients differed very slightly from that of other physicians. By his university training he was equipped with nothing different from the rest. In the young physician’s publications of the seventies’ and eighties’ his prescriptions correspond in composition, weight and quantities with those of his contemporaries. In the “Directions for the cure of old sores and ulcers” (1784) he still recommends 5-50 grains (.25-2.5 grams) of crude pulverised antimony to be taken daily for the purification of the blood etc. But with his deep insight and warm philanthropic tendencies, the failures of these prescriptions based upon unscientific, casual, and thoughtless imitation must have soon sobered him. So, for many long years he abandoned medical practice.

In 1796, he first made known the principles of homoeopathy in “Essay On A New Principle…”. He frequently recommended the administration of “small doses”, but did not then say what he meant by “small”. From then onwards he selected his remedies from the standpoint of similarity, still administering fairly large doses.  In 1797, he prescribed 4 powders of veratrum album, each containing 4 grains in a “case of rapidly cured colicodynia”.

Inception of the small dose

In 1799, he announced very small infinitesimal doses. Most probably it is to be assumed that the unwelcome homoeopathic aggravations and secondary effects which followed upon the remedies prescribed according to the law of similia induced this keen and careful observer to decrease the doses more and more.

In 1800, he says in the “Treasury of Medicine”: As the physicians of to-day will not consider giving one ten millionth part of a remedy, therefore Arsenic is not a medicine for them.

Inception of serial dilution and drop dose:

In 1801, the first detailed statements about dilution were made in “Cure and Prevention of Scarlet Fever”, where he states, “for internal use I used one drop of the tincture thoroughly mixed with 500 drops of very dilute spirits of wine, and of this mixture I took one drop again carefully mixed with 500 drops of spirits of wine likewise much diluted. Of this diluted tincture of poppy juice (which contains in every drop a five millionth of a grain of poppy juice) one drop for a child of about 4 years and two drops for a child of 10, given internally were more than sufficient to cure the disease. These doses will not have to be repeated before 4-8 hours, sometimes only every 24 hours, and at times only occasionally during the whole fever, according to the more frequent or more seldom occurrence of the (previously mentioned) symptoms.”

In speaking of the prophylactic action of Belladonna, He also gives us very precise directions for a serial dilution that leads to a dilution of 1/24,000,000. In 1805, in “Medicine of Experience” he mentioned the 100th, 1,000th, or 1,000,000th part of a medicinal dose, where he says for curative purposes incredibly small doses are sufficient. “If instead of smaller and smaller doses, increasingly large one were given, then there arise merely medicinal symptoms, a kind of artificial and unnecessary disease.” Hahnemann is still groping and experimenting without making his decision. This is the impression made by the entries in the patients’ registers of these years. But he was standing firmly on the ground of the similarity between disease and remedy, and he only prescribed one medicine at a time.

In 1809, in the “Information concerning the prevailing fever”, he recommends Nux vomica trillionth part (corresponding to 9c) and Arsenicum sextillionth part (18c) as curative agents for a fever.

Inception of dynamic and infinitesimal Posology:

In 1813, “Spirit of the New Theory of Healing”, states: “The spiritual power of the medicine attains its purpose not by quantity but by quality (dynamic suitability)”.

Definite statements about the use of small quantities of medicine are to be found in 1814, in the article : “The treatment of Typhus fever” . He used Bryonia and Rhus Tox  in the 12 C and Hyos in 8C.

In 1816, in “M. M. P.” 2^nd volume, he has given instructions for each individual remedy concerning dilution and size of dose. For example, one drop of the original is recommended in the 12th, 18th and 30th dilution; Ignatia is said to be particularly efficacious in the 9th and 12th potency, Puls the 12th, with Rhus tox the 12th or 15th, and with Bryonia the 18th potency.

In 1818, in the 4^th volume of “M.M.P.” he described 12 medicines and gave exact instructions about the doses. E.g.-  Hyos was preferred in the 12th, 15th, or 18th dilution; Dig in the 15th; Aur-met is to be used in the 1^st and 2nd trituration.

In 1819, the 5^th volume of “M.M.P.” states that Thuja is administered in very small doses of the 30C, Spig  and Staph are recommended in 30C.

Inception of medicated globules:

In 1821, in the 6^th volume of the “M. M. P.” There appears the expression “the smallest part of a drop”. Now Hahnemann was starting to adopt the use of globules, whereby the small fraction of a drop could be administered more easily.

Inception of higher potency:

During 1824 to 1827, from the 2^nd edition of the “M.M.P.” and Hahnemann’s correspondence, particularly with his friend and colleague Stapf, he gradually increased the dilution of remedies. He recommends Thuja in the 60C for treating gonorrhoea.

1828 : “The Chronic Diseases”. For Sycosis he recommends chiefly Thuja 30C and Nitric acid 6 C; for Syphilis, Merc sol 6 C and for recent itch a globule saturated with Sul Q.

Up to this time Hahnemann had made use of the most varied degrees of dilution, from the original tincture or the viscous juice up to the 30th centesimal dilution. But even then there existed a small body of over-zealous students, anxious to out step the Master in potentising. The 30th potency was by no means high enough for them and so they produced a 90th, a 200th and finally even a 1,500th potency. Among these enthusiasts the principal part was played by Dr. Gross in Jütterbogk, Dr. Schréter in Lemberg and General Korsakoff in Russia.

Inception of optimum potency:

In1829, he felt the necessity of a limit in potentising and declared the ultimate degree of dilution to be the 30th centesimal potency. He wrote a letter to Dr. Schréter of Lemberg stating “I do not approve of your potentising medicines higher than to 36 and 66, there must be a limit to the matter, it cannot go on indefinitely.” In 1829 Hahnemann came upon the strange idea of setting up a kind of standard dose for all curative remedies used in homoeopathy. This was to be the 30C.

Inception of olfaction dose:

From 1829 onwards Hahnemann’s was no content with administering a few globules of the 30C as a dose; he began now to restrict himself to letting the patient smell a single globule the size of a poppy seed of the 30C. This smelling of the medicine is first mentioned by Hahnemann in his preface to Boenninghausen’s “Repertory of the anti-psoric medicines”

Inception of single dose:

In the 1^st to 4^th editions of Organon of Medicine, he recommended the wait and watch method, which was totally committed to the first dose. If the case comes to a stand-still after some improvement, he recommended not to repeat a 2^nd dose of previous medicine but do a fresh case-taking and give a dose of new similar remedy after expiry of duration of the previous one. (201-214)^1st , (241-247)^4th

Inception of repetition of dose:

In 1833, in the “5^th edition of Organon he recommended the repetition of a dose (in slowly progressive amelioration) at suitable intervals for much more rapid cure.

Dr. Breyfogle’s correspondence regarding potency use by Hahnemann in his later years:

Dr. Breyfogle wrote a letter asking Madame Hahnemann for information about the degrees of potency, which Hahnemann employed during the last years of his life. The answer was:- “Your enquiry as to whether Hahnemann altered his views about potencies in the last period of his life and whether he made use only of high potencies, I can answer in this way. Hahnemann used all degrees of dilution, low as well as high, as the individual case required. I saw him give the third trituration, but I also know that he used the 200th or even the 1,000th potency whenever he considered it necessary”.

Regarding 50 Millesimal scale:

In the period from 1841-43, he discovered a new scale of potency which he prescribed not only in daily doses, but also increasing ones, when for example, he dissolved a powder (containing globules) in 15 to 18 tablespoonfuls of water and some spirits of wines, gave the mixture 12 succussions, put a teaspoonful in a glass of water to be stirred and of this ordered at first one teaspoonful to be taken daily and later two teaspoonfuls each day. This medicinal water had to be prepared fresh every day and after taking the prescribed number of teaspoonfuls the remainder had to be poured away.

In the 6^th edition of the “Organon”, Hahnemann abandoned his instructions, formerly so definitely expressed, of giving only one dose of the well-chosen remedy in chronic diseases and then allowing it to act for weeks and even months. He now prescribed the continuous taking of the same correct medicine every day for months, in ascending potency, gradually from lower dilutions at the beginning to higher ones. By this means the diseases are made to yield more speedily.

Final Instruction by Hahnemann regarding posology:

In the 6^th Organon, the 50-millesimal scale is said to be the perfect method, yet it is also evident that there are uses for the centesimal scale, which he used also, during his last years of life. So with the following directions these two Hahnemannian scales should be prescribed:

• One single simple and similar medicine should be prescribed at a time. (272^5th,273^6th)
• Suitableness of a medicine for a given case does not depend only on accurate homoeopathic selection but also on proper (smallness) dose of suitable potency. (25, 275)^6th
• Only internal medicine is allowed except in case of untreated long standing fig wart where a similar medicine may be applied externally simultaneous with internal medication. (194-204, 282^n.)^6th
• Route of administration of medicine may be tongue, mouth, interior of nose, respiratory organ, skin (wound free), rectum and genital. (290^5th ,284^6th )
• Time of administration :-
• Best time for antipsoric medicine is early morning while fasting.
• After taking the medicine, the patient should keep himself quiet at least 1 hr but not sleeping, because sleep delays the beginning of action of the medicine. During this hour, the patient must avoid any excitement, mental strain from reading, writing, computing or meditation.
• A dose of antipsoric must not be given to a female before and during menses. It should be given 96 hrs (4 days) after menses sets in. But in case of premature, too profuse or too long-lasting menses, an olfaction dose of Nux v. should be given on 4^th day and then following the 4^th or 6^th day an antipsoric is to be given. (T.CD.^{pg 137-138})

1. CENTESIMAL POTENCY:
2. A. General rules for repetition:
3. Every perceptibly progressive and striking amelioration contraindicates repetition. (245)^5th
4. In case of slowly progressive amelioration, dose should be repeated for much more rapid cure at suitable intervals (246)^5th guided by the following points:

(a) Nature of medicine

(b) Corporeal constitution of patient.

(c) Magnitude of disease.(246 ^f.n.)^5th.

3. Dose of another similar medicine should be administered when a previous remedy ceases to do good and the case presents a different group of symptoms.( 248)^5th
4. B. Particular rules for repetition:

(a). According to the nature of the medicine:

(i). In every case a dose may be repeated in proportion to action of                     medicines. (247^f.n.)^5th

(ii).In the case of medicine prescribed having alternating action, if no   improvement follows, an equal dose should be repeated, which become curative soon in most cases.(251) ^5th

(b). According to the corporeal constitution:

(i). In robust patients suffering from chronic diseases, the dose may be repeated in not less than 7 days.

(ii).In weaker and excitable patient suffering from chronic diseases, thge dose may be repeated at some long interval on every 9, 12 or 14 days.(246^f.n.) ^5th

(c). According to the magnitude of diseases:

(i). In very acute diseases: Dose may be repeated from every 1hr up to 5minutes.

(ii). In acute diseases:  Dose may be repeated at interval of 24, 12, 8, or 4 hrs.

(iii). In chronic diseases: Dose may be repeated at interval of 14,12,8 or 4 days.(247) ^5th

1. C. Potency selection: 30C is recommended as the best potency for acute and chronic cases both. (246^n.)^5th
2. D. Quantity of medicine to be used for a dose: 1 medicated poppy seed size globule. During medication, 300 poppy seed size globules should be moistened with 1 drop of medicinal potency. (285^n.)^5th
3. E. Dispensing and administration of dose:

Action and effect of the same dose (1 medicated poppy         seed sized globule) altered according to its administration. We can regulate the desired effect through its administration with the following rule:

(i). Dry dose:

(a). 1 such globule should given on tongue and thereafter nothing should be given to drink. Such dose is considered as a vastly diminished dose.

(b).When diminished effect is desired, such 1 globule should be put into the dispensing vehicle which will have weaker power because with such smaller volume of dose only few nerves can be touched.(285 ^{ê f.n.}) ^5th

(ii).Wet dose: If we want to increase the action and effect of the same dose, a  wet dose should be administered. Here 1 globule should be dissolved in a larger quantity of water just before ingestion. The action of such dose is increased due to coming in contact with the larger surface of sensitive nerves.(286,287) ^5th

(iii). Olfaction dose: For this 1 medicated globule should be placed in a dry vial and patient allowed to inspire from vial through nostril.

(a). Patient is allowed to inspire air out of vial in one nostril. If you wish to give a stronger dose do similarly with the other nostril. (288 ^f.n.) ^5th

(b). But when a most rapid result is necessary in case of a very sensitive patient one single olfaction (through one nostril) is to be given as smallest possible dose. (285 ^f.n.) ^5th

1. 50-Millesimal potency:
2. A. General rules for repetition:
3. Every perceptibly progressive and striking amelioration contraindicates repetition. (246) ^6th
4. In cases of slowly progressive amelioration, dose should be repeated for more rapid cure at definite intervals (246) ^6th guided by the following points:

(a). Degree of potency of each dose should deviate somewhat from the preceding  and following potency.

(b). Nature of medicine.

(c). Magnitude of disease.

1. B. Particular rules for repetition:

(a).Degree of potency of each dose should deviate somewhat from the preceding and following potency.

(i). A medicine should used in gradually ascending potency because vital force does not accept same potency. (247,248, 280)^6th

(ii). A single potency solution may be used for 7-15 days. If such a solution is used up then next solution of higher potency should continue as long as patient improves and symptoms indicate the same medicine. But if another group of symptoms appear, then a more similar medicine should be administered in the same repeated doses. (248) ^6th

  (b). According to magnitude of diseases:

(i). In very acutest diseases: Dose may be repeated every 1hr or even more frequently.

(ii). In acute diseases:  Dose may be repeated at interval of every 2-6 hrs.

(iii).In chronic diseases: Dose may be repeated daily or every second day for months with ever increasing success. (248) ^6th

(c). Accoridng to action of medicine: Even long acting medicine can be repeated in acute diseases in lowest potency. (270 ^f.n.)^6th

1. C. Potency selection: In treatment of chronic diseases, it is best to begin with lowest 50- millesimal potency and go higher as demanding.(270^n.)^6th
2. D. Quantity of medicine to be used for a dose: only 1 globule of desired potency.(248^n.) ^6th
3. E. Dispensing and administration of dose:

(i). Wet dose: This is most common dispensing method in 50- millesimal potency. This is administered in divided dose:

Dispensing-Take 1globule of desired potency- crushed it in a few grains of sugar of milk and put it into a bottle –pour in 7 to 8 tablespoonful of water and add some drops of alcohol.

Administration-Give 8,10 or 12 succussions-take 1 tablespoonful of it into a glass containing 7 to 8 tablespoonfuls water and stir well- ingest 1 (or more) tablespoonful doses and throw away the rest- but if patient is greatly sensitive, 3^rd or 4^th glass should prepared in a similar way and give 1 tablespoonful of it. Each such prepared glass must be made fresh daily.(248^f.n.) ^6th

(iii). Olfaction dose: If medicine is to be administered by olfaction then it should be dispensed as follows:

Take 1 globule of desired potency and dissolve it in 1 dram dilute alcohol- it may be used with 8 to 10 succussions each time before inspiring every 1, 3, or 4 days. (248) ^6th

Conclusion

On the basis of this study of posology we may conclude that it is necessary that  homoeopath do comparative study of all the writings, of every Edition of Organon of Medicine and Chronic disease written by Dr. Hahnemann to grasp the exact concept of Hahnemannian Posology.

BIBLIOGRAPHY

1. Haehl R.; Samuel Hahnemann His Life and Works, volumes1;11^TH Impression; Jain Publishers Pvt. Ltd., New Delhi-110 055;2013
2. Hahnemann S.; Organon of Medicine, 5^th and 6^th edition, First Corrected, Re-translated and Redacted edition translated by Dr. Mahendra Singh and Dr. Subhas Singh; Homoeopathic Publications: Second edition: 1, Raj Narayan Street, Kolkata- 700009: 2015.
3. Hahnemann S.; Organon of the Medical Art; 6^th edition, translated by Steven Decker , edited and annotated by Wenda B. O’ Reilly; First Indian edition, 2^nd Impression; Jain Publishers Pvt. Ltd., New Delhi-110 055;2013
4. Flores francois D. F.; Samuel Hahnemann His Life and Memory; first edition ; Jain Publishers Pvt. Ltd., New Delhi-110 055; 2007.