Part 10: Dose and Potency
The issue of dose and potency is one of the most confused and confusing, not to mention vexing, in the history of writings on Dr. Hahnemann’s medical system. Within this issue lies also that concerning the use of the C versus Q potency scale (often referred to as the LM-scale).
This series on Dose and Potency seeks to –
·Lay out the historical development of dose and potency
·Understand the principles behind the use of dynamised and potentised medicines
·Establish a basis for understanding the different dilution scales, in particular the Q-scale.
We will start with Part I: The Historical Development of Dose and Potency. This Part will be set out in various sub-parts given the complexity of the issue and material.
Part I: The Historical Development of Dose and Potency
A: The Beginning – Dynamization
From the start of his establishment of a true system of Western medicine, in his landmark essay of 1796, Essay on a New Principle, Hahnemann introduced the principle of the medical dose as that dose just greater in strength than the natural disease. Although this has been commonly referred to as “minimum dose,” we shall see that it would be more accurate to call it the principle of the “optimal dose.”
The cautious physician, who will go gradually to work, gives the ordinary remedy only in such a dose as will scarcely perceptibly develop the expected artificial disease, (for it acts by virtue of its power to produce such an artificial disease)… (Haehl, Vol. I, p. 265-266, footnote 3)
Hahnemann also mentions repeatedly the use of moderate doses in cure compared to the large often poisonous doses common in his day. This concern with the poisoning effects of larger doses led Hahnemann to seek to reduce the quantity by diluting the medicine in alcohol. At the same time, he undertook to thoroughly shake or succuss the dilution. Here we have the earliest mention of what came to be termed the dynamised dose.
The first hints of dilutions are to be found in the translation of the second part of the Edinburgh Dispensatorium (1798). Silver Nitrate was recommended by Boerhaave in doses of 2 grains, worked into pills with breadcrumbs and sugar. Hahnemann considered that too strong, and suggested a very diluted preparation. In the same year, in the “Apothecaries Lexicon” he recommends Sabina “in very small doses” and Hyoscyamus also “in very small doses according to my method one-sixtieth to one-thirtieth grain (0.000-0.002 gram) of the concentrated juice given in solution.” Stramonium he liked to administer only in the hundredth or even thousandth part of a grain of the concentrated juice. (Haehl. Vol. I, p. 312)
In 1800, Hahnemann stated:
As the physicians of today will not consider giving one ten millionth part [1/10,000,000] of a remedy, therefore Arsenic is not a medicine for them. (Haehl, Vol. I, p. 312)
In 1801, Hahnemann gave the first detailed description about dilution and succussion in his treatise on scarlet fever, Cure and Prevention of Scarlet Fever. Note Hahnemann’s use of the term “intimate” to describe the fact that the diluted substance still had a profound effect on the living organism, suggesting Hahnemann’s awareness of the dynamic effects of the diluted/shaken medicine on the human being.
…For internal use, I take a drop of this tincture and mix it intimately with 500 drops of diluted alcohol, and one drop of this mixture likewise with other 500 drops of diluted alcohol, shaking the whole well. Of this diluted tincture of opium (which contains in every drop one five-millionth part of a grain of opium) one drop given internally was amply sufficient in the case of a child of four years of age,* and two drops in that of a child of ten years, to remove the above state.
…The drops for internal use must be intimately mixed with from one to four tablespoons of fluid (water or beer) just before they are administered. (Lesser Writings, p. 375, footnote 3, bold added)
He gave similar directions for the other medicines for scarlet fever, Ipecacuahna and Belladonna.
In speaking of the prophylactic action of Belladonna, Hahnemann also gives us very precise directions for a serial dilution to1/24,000,000 involving this “intimate” mixing (see Lesser Writings, p. 380-381)
If we now wish to prepare from this the prophylactic remedy, we dissolve a grain of this powder …in one hundred drops of common distilled water, by rubbing it up in a small mortar; we pour the thick solution into a one-ounce bottle, and rinse the mortar and the pestle with three hundred drops of diluted alcohol (five parts of water to one of spirit), and we then add this to the solution, and render the union perfect, by diligently shaking the liquid. We label the bottle strong solution of belladonna. One drop of this is intimately mixed with three hundred drops of diluted alcohol by shaking it for a minute, and this is marked medium solution of belladonna. Of this second mixture one drop is mixed with two hundred drops of the diluted alcohol, by shaking for a minute, and marked weak solution of belladonna; and this is our prophylactic remedy for scarlet-fever, each drop of which contains the twenty-four millionth part of a grain of the dry belladonna juice. (Lesser Writings, p. 380-381, bold added)
This unprecedented dilution and “weakening” of the common doses of his time brought forth immediate criticism from his most prominent medical ally, Hufeland, editor of an influential journal. This caused Hahnemann to write a defense of his new approach in Hufeland’s medical journal in 1801, entitled, On the Power of Small Doses of Medicine in General and of Belladonna in particular.
This article has a number of important observations:
·The dry dose is weaker, the liquid dose is stronger.
·The sick person is more sensitive to the similar remedy, so the dose needs to be smaller (more diluted) to avoid an unnecessary homeopathic aggravation.
·The more acute the disease the smaller (more dilute) the dose.
·Use descending dose (that is from more dilute to less dilute) when the person is generally healthy and has only a local affection.
·The action of the diluted dose is purely “dynamical.”
·The aggravation from a small dose of the wrongly selected medicine is quickly overcome and leaves no lasting effect (a form of unintended proving).
Here Hahnemann ascribes the effect of the small dose of Belladonna to the fact that it is mixed in water (and intimately shaken) and given to a sick person (who is more sensitive to the medicine) who is or has suffered from a Belladonna-like disease. The degree of sensitivity to dose increases the greater the degree of the similitude.
A very hard dry pill of extract of belladonna produces in a robust, perfectly healthy countryman or labourer usually no effect. But from this it by no means follows that a grain of this extract would be a proper, or too weak a dose for this or a similar stout man if he was ill, or if the grain were given in solution – certainly not! On this point, let the pseudo-empiricism of the compendiums hold its tongue; let us hear what experience says. The most healthy robust thresher will be affected with the most violent and dangerous symptoms from one grain of extract of belladonna, if this grain be dissolved thoroughly in much (e.g. two pounds of) water by rubbing, the mixture (a little alcohol being added, for all vegetable solutions are rapidly decomposed) made very intimate by shaking the fluid in a bottle for five minutes, and if he be made to take it by spoonfuls within six or eight hours. Those two pounds will contain about 10,000 drops. Now if one of those drops be mixed with other [sic] 2000 drops (six oz.) of water (mixed with a little alcohol), by being vigorously shaken, one tea-spoonful (about 20 drops) of this mixture given every two hours, will produce not much less violent symptoms in a strong man, if he is ill. Such a dose contains about the millionth part of a grain. A few tea-spoonsful of this mixture, will, I assert, bring him back to the brink of the grave, if he was previously regularly ill, and if his disease was of such a description as belladonna is suitable for…
…secondly, because many physicians, ignorant of the purely dynamical action of medicines, are prevented from instituting any experiments of this nature by their invincible prejudiced incredulity [regarding the small doses]…
To the ordinary practitioner it is incredible that a given person, when sick, needs only to take a millionth part of the same drug that he swallowed when well without it having any particular effect, in order to be violently acted on; and yet this is undeniably the case…
Will medical men ever learn, how small, how infinitely small, the doses of medicines may be in order to affect the system powerfully when it is in a morbid state? …The nearer the disease approaches the acute character, the smaller are the doses of medicines (I mean of the best selected one) it requires in order to disappear. Chronic diseases also combined with debility and general derangement of the health, do not require larger ones. It is only in cases where along with a local affection, the general health seems to be good that we must proceed from the first small doses to larger ones, to the very largest however in those cases where the medicine only can act in a palliative manner…
If the appropriate medicine in solution is efficacious in such a small dose, as it assuredly is – how highly important on the other hand is it, that in the event of the remedy being improperly selected, such a small dose can seldom excite such serious symptoms (ordinarily termed aggravations of the disease) as that they shall not soon disappear spontaneously, or be readily removed by some trifling antidote. (Lesser Writings, p. 387-389,bold added).
DYNAMIZATION (VERSUS POTENTIZATION)
Between 1796 and 1801 Hahnemann developed the concept of dynamization out of his serial dilutions and succussions. Hahnemann meant by dynamization the process of imparting “spirit-like” activity to the substance, or more accurately, liberating the “spirit-like” potential of a medicinal substance. The idea of dynamization is the insight that all medicines act dynamically, an idea that is distinct from that of potentization. This means that even for a mother tincture or other relatively crude dose to act medically it must do so dynamically, for the disease itself is dynamic in nature.
In essence, Hahnemann had discovered a way in which to penetrate the veil of natura naturata, past the sensory world of appearances (chemistry) and into the supersensible world of dynamic effect (the realm of natura naturans, the Living Power or Dynamis). It is the succussion or “intimate mixing” of the liquid solution (or the process of trituration over a long period of time) that was the means to awaken the dynamic (spirit-like) power of the natural substance.
In describing, in 1837, the process of “shaking the liquid” each time a dose (usually a tablespoon) is given to the patient, Hahnemann states that this is the dynamization. Thus, the potency is not altered, as it remains the same potency by the nomenclature usually used (e.g., 30C) but the degree of dynamization is heightened.
This slight change in the degree of dynamization is even affected, if the bottle which contains the solution of one or more pellets is merely shaken five or six times, every time before taking it. (Chronic Diseases, p. 156)
We can also see that succussion alone affects the idea of dose (which is both general and specific – see below), namely through the quality of the power of the medicine.
§161.1. a]1 If the doses of the best dynamized medicine (§270) are small enough and if the dose was modified anew each time by succussion, then even medicines of long active duration can be repeated in short time periods even in chronic diseases.
Disease, being dynamic, that is, ground in the generative power of the Living Principle, requires for its destruction (cure) a dynamic agent. Hahnemann talks of taking one drop from a solution and then mixing it vigorously, a process he sees as making the solution (medicine) “intimate,” seemingly a generative term (sexual in nature). All through this article, we see without doubt that he is moving away from the idea of quantity and into the idea of quality. In fact, he sees these as being functionally related.
The next reference to dose in his writings is in 1805 in The Medicine of Experience, where he speaks of the heightened sensibility of the sick person to small doses of the similar medicine, as well as, again, to the dynamic nature of the remedies:
With the exception of these few things and the almost purely mechanical operations of surgery on the body, amputation which merely shortens the limb, and blood-letting which merely diminishes the amount of that fluid, together with some mechanically injurious and insoluble substances that may be introduced into the body – all other medicinal substances act in a purely dynamic manner, and cure without causing evacuations, without producing any violent or even perceptible revolutions.
This dynamic action of medicines, like the vitality itself, by means of which it is reflected upon the organism, is almost purely spiritual in its nature…
Almost the sole condition necessary for the full and helpful action is that the appropriate remedy should come into contact with the susceptible living fibre; but it is of little, almost no consequence how small the dose is…
If a certain small dose of diluted tincture of opium is capable of removing a certain degree of unnatural sleepiness, the hundredth or even the thousandth part of the same dose of such a solution of opium suffices almost equally well for the same end, and in this way the diminution of the dose may be carried much further without the excessively minute dose ceasing to produce the same curative result as the first…
I have said that the contact of the medicinal substance with the living, sensitive fibre is almost the only condition for its action. This dynamic property is so pervading that it is quite immaterial what sensitive part of the body is touched by the medicine in order to develop it whole action…
…Dry preparations of the medicine in powder act less powerfully through it; its solution acts more powerfully, and still more so if it be applied to a larger surface [here he is talking of external applications of medicine]…
But the diseased organism is altogether much more sensitive for the dynamic power of all medicines, so also is the skin of diseased persons… (Lesser Writings, p. 465-467, bold added)
This is confirmed in the final edition of the Organon, when speaking of the LM potency:
§270.9. g]2 It thereby becomes exceedingly probable that the material by means of such dynamizations (evolutions of its true internal, medicinal Genius) finally dissolves itself wholly into its individual spirit-like Entity and thus in its crude state could be considered only actually to consist of this spirit-like Entity. (bold added)
What we see here clearly is that the energy of the medicine comes from the Dynamis (Genius) of the medicine, a generative power, such that it has the ability to act on the disease, which is engendered by and living within the generative power of the Life Force.
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Rudi Verspoor is Dean and Chair Department of Philosophy, Hahnemann College for Heilkunst, Ottawa. He has written extensively on homeopathy and created the only college in the world offering a full program of study in Hahnemann’s complete medical system, Heilkunst.
More details on studying Heilkunst can be obtained from www.homeopathy.com.
Rudi founded the National Association of Trained Homeopaths (NUPATH) in Canada, as well as the Canadian/International Heilkunst Association (C/IHA). He has advised the Canadian government on healthcare issues, made presentations to various federal and provincial governments on homeopathy, and has written for various journals as well as lectured around the world.
His publications include: Homeopathy Renewed, A Sequential Approach to the Treatment of Chronic Illness (with Patty Smith); A Time for Healing; Homeopathy Re-examined: Beyond the Classical Paradigm (with Steven Decker); The Dynamic Legacy: Hahnemann from Homeopathy to Heilkunst (with Steven Decker)
The website at www.heilkunst. com has more articles and resources about Heilkunst.