Homeopathy Papers

Questions Patients Ask-2 (More on Dosing and Potency)

Last modified on February 15th, 2014

Elaine continues to answer patients’ questions about homeopathic treatment.

What’s the Deal with Potency?

(“My Homeopath Gives Almost Every Remedy in 200C”)

Well, I’m back again; because as always, there are questions and more questions! Here we have the interminable question about potency! What potency should I take? Why does my homeopath only prescribe the 200C? Is that good or bad?

Some of you will be surprised to hear that Hahnemann was actually serious about that “rapid and GENTLE” cure thing he mentions as being the physician’s highest calling. How we went from there to “Aggravations are a good sign, keep it up!” I don’t know, but I can tell you that Hahnemann would be outraged! Don’t believe me? Look at what he says here in Aphorism 253 of The Organon (my “translation” is in red):

§ 253

Among the signs that, in all diseases, especially in such as are of an acute nature, inform us of a slight commencement of amelioration or aggravation that is not perceptible to every one, the state of mind and the whole demeanor of the patient are the most certain and instructive.

Hahnemann is saying, if you want to know if a remedy is aggravating or ameliorating, just look at the demeanor of the patient.

In the case of ever so slight an improvement we observe a greater degree of comfort, increased calmness and freedom of the mind, higher spirits and a kind of return of the natural state.

If the remedy is ameliorating, you will observe that the patient feels calm, natural and comfortable.

In the case of ever so small a commencement of aggravation we have, on the contrary, the exact opposite of this: a constrained helpless, pitiable state of the disposition, of the mind, of the whole demeanor, and of all gestures, postures and actions, which may be easily perceived on close observation, but cannot be described in words.1

If a remedy is aggravating, you can surely tell just by observing the demeanor, the gestures, posture, etc.

1 The signs of improvement in the disposition and mind, however, may be expected only soon after the medicine has been taken when the dose has been sufficiently minute (i.e., as small as possible),

You will only see amelioration soon after the remedy’s been given if the dose has been as small as possible. Remember homeopathy’s motto, “the minimum dose”? (Now, what is “dose”, exactly? It is the potency, the size, and frequency of repetition of the remedy. The proper dose is always relative to the patient’s sensitivity and what the problem is. So, minimum dose means: using only the force that’s necessary and nothing more.)

an unnecessary large dose of even the most suitable homoeopathic medicine acts too violently, and at first produces too great and too lasting a disturbance of the mind and disposition to allow us soon to perceive the improvement in them.

If the dose is too large–unnecessarily large–the remedy acts violently, causing a disturbance in the mind and disposition.

I must here observe that this so essential rule is chiefly transgressed by presumptuous tyros in homoeopathy,

It is arrogant beginners who constantly make this blunder of causing aggravations with the highest potencies and unnecessary repetitions, thinking this will get the person better faster.

and by physicians who are converted to homoeopathy from the ranks of the old school.

And former MD’s who think side effects and other worsenings are normal and to be expected.

From old prejudices these persons abhor the smallest doses of the lowest dilutions of medicine in such cases,

They won’t use the lower potencies out of habit and a prejudice against them.

and hence they fail to experience the great advantages and blessings of that mode of proceeding which a thousandfold experience has shown to be the most salutary;

So they cause more harm than good. How does deliberately causing aggravations with unnecessarily high potencies and repetitions fit in with the Organon’s philosophy of rapid and gentle? I try to prescribe according to the 6th edition of The Organon. A very hypersensitive patient came to me recently from a “200C-for-all” prescriber, suffering from aggravations and proving symptoms and I prescribed for her a 6C, single dose, of the indicated remedy in a large bottle of water, and in less than one day, all the SIGNS OF HEALTH were there!  Who would believe it?  A 6C?  One dose?  In a large bottle of water?  Where did this idea of 200C-for-all come from?  I don’t know!   What are the SIGNS OF HEALTH? Being able to sleep, decrease in pain, return of appetite and all the things Hahnemann mentions above: calm demeanor, comfort and lifting of spirits. When do you repeat the remedy? At the first sign of relapse.

they cannot effect all that homoeopathy is capable of doing, and hence they have no claim to be considered its adherents.

They don’t deserve to be called homeopaths.

***

How to summarize this…. Your potency selection has to be based on:

1. What’s wrong

and

2. How sensitive is your patient?

Is your patient robust or is he sensitive to everything? This has to be part of the consideration in chosing potency. Is the complaint recent and intense, like an injury? Or is the complaint of long duration?

A robust person comes down with the flu. He’s dizzy, sleepy, droopy and dull. What’s your prescription? Gelsemium 200C, one dose, wait to see results. If no change comes about soon, in an hour or 2, let’s say, no change at all, retake your case. Gelsemium 200C or 1M should act quickly if it’s the right remedy.  If you gave a 30C or 200C and it didn’t work and you’re convinced you had the right remedy, try the next higher potency.  Sometimes, the next higher potency is the same potency in water!  If a change for the better is observed, repeat the dose at the first sign of a relapse or if the case stalls.  Put a few pellets in a bottle of water and succuss five times before each dose.  (See my previous article “Why Do We Have To Put the Remedy in Water?” in last month’s issue.)

A weak and sensitive person has arthritis that is worse for first movement, better for continued movement, and better for hot showers, what’s the prescription?  Rhus tox 6C, one pellet, in a medium bottle of water, one sip, wait 24 hours to make sure no aggravation occurs.  If no aggravation occurs, Rhus tox 6C, 5 succussions before each dose, twice a day, if patient gets worse, stop dosing. When patient recovers, cut back to once a day and 3 succussions. If patient makes a striking improvement, stop dosing. Start again at first sign of relapse.

The homeopath’s job is to “shadow” the vital force of the patient. If the patient changes, you change! What tools do you have at your disposal to keep pace with the patient?

1. increasing or decreasing the number of succussions

2. increasing or decreasing the frequency of dosing

3. increasing or decreasing the size of the dose (from a sip to a swallow, from teaspoon to tablespoon, etc. or increasing the size of the bottle.)

4. increasing the potency (plussing your bottle–and by that I mean, dumping out bottle almost entirely, refilling half way, succussing 40 times, and now your potency is one degree higher)

What are you looking for after a remedy to evaluate whether it’s correct or not? The Signs Of Health! If you get the signs of health but don’t see an improvement in the physical case, what do you do, change the remedy?  No!  If you see The Signs of Health, stay with the remedy, the rest will come around in due time!

You can probably tell from aph. 253 that Hahnemann abhored aggravations. He said that if you cause aggravations deliberately, you don’t deserve to be called a homeopath. Think about it: If you cause aggravations deliberately and you’re not inclined to stop them because you think “they’re a good sign”, what’s going to happen? Not only will you lose your patient, but what does this do to our reputation?  What is your patien going to say about homeopathy? “Don’t try homeopathy, whatever you do, it’s really dangerous!”  Now, when the aggravation wears off and the patient gets better, who’s going to get the credit for that?  Certainly not you, the homeopath!

How do you stop an aggravation? Diane Fuller and I wrote an article about that called “The Aggravation Zapper”, and here it is now:

https://hpathy.com/homeopathy-papers/the-aggravation-zapper/

Now, you might ask, when is it appropriate to use the highest potencies?  It is all relative! You could give Cactus 1M for a heart attack, and you should have gone higher, or, you can give a 10M and be UNDER-dosing because you didn’t give it often enough! The patient was fine for 15 minutes and then relapsed, and instead of repeating the remedy, you said, “I guess Cactus didn’t work….” Again, you have to “shadow” your patient and meet force with force.

In general, think of the high potencies for acutes, and the low potencies for chronics (repeated daily, if need be, in water with succussions before each dose). But again, remember: meet force with force, and shadow your patient.

I hope that makes sense. See you again next time!

About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at LEWRA@aol.com
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at:
https://elainelewis.hpathy.com/ and TheSilhouettes.org

25 Comments

  • As always, great article! thanx. just confused bout how to make a remedy bottle…from your article I understand that you take a few pellets and put it in a large bottle of water and then the patient is to be given doses from this bottle directly.Am I right? I think I have read in ezine that u put a pellet or two in a 6 oz bottle..fill it up and leave 1/4th space for succussions.Then succuss it 6 times(or whatever times,that depends),put 1 teaspoon in a 6 oz dilutin glass, stir it and then give one teaspoon from this glass..so plz tell me whether both procedures are different or equally effective? Thank you

  • Dr Lewis
    As always, you are the best teacher.
    How one tries to thank you for the excellent service you’re providing to Homeopathy, is something
    worth mentioning and holding in high esteem.
    Wish you long and happy life so that we all can benefit from your great teaching.
    Many thanks,
    Ravi

  • Elaine,
    You are superb, as usual and you hit the nail when you say, “The homeopath’s job is to “shadow” the vital force of the patient.” If only ALL homeopaths do this, they will do the world a big favor. God bless you. Keep up the good work.
    Nisar

  • your article is very nice and educative but i have a small doubt during the normal prescription if the patient comes with viral fever of cold how to tell the patient about the dose we can not observe them every 6 hourly most of the patients dont have the time to visit the doctor then how can we assess their situation because they will come only if there if severe aggravation.on a daily practice is it practical to educate the patient about the water potency?

  • “As always, great article! thanx. just confused about how to make a remedy bottle…from your article I understand that you take a few pellets…”

    Elaine replies: Actually, in this case, one pellet–because she was hypersensitive. And that was the reason for the 6C and the large bottle as well.

    “… and put it in a large bottle of water and then the patient is to be given doses from this bottle directly. Am I right? I think I have read in ezine that u put a pellet or two in a 6 oz bottle..fill it up and leave 1/4th space for succussions. Then succuss it 6 times(or whatever times,that depends),put 1 teaspoon in a 6 oz dilutin glass…”

    Elaine replies: Well, wait. That is only necessary if you have a hypersensitive patient. Your average patient can take a sip from the bottle. And I get nervous when you say “dilution glass” because if you let people think they can use the family glassware to take their remedy, people are going to be dosing on remedies every time they sit down to dinner! The remedies stick to whatever they’re in! I always say to use disposable-everything when working with remedies.

  • Oy! Dr. T, if your patient’s got your typical cold/virus, with or without fever, and he won’t keep in touch with you and won’t let you monitor his case and will only come in for the initial visit and that’s it, then one can only hope that the dose of Belladonna 200C or the Gelsemium 1M you gave in the office completes the case!

    You can certainly say, “If there’s an initial worsening, don’t panic! Sometimes a case has to get a bit worse before it gets better after a remedy. It’s usually short-lived and can be a good sign. If, after an initial improvement, you seem to be sliding backwards again, take another dose of the remedy. Don’t take another dose WHILE you’re improving because that dose could antidote the one that’s working and you’ll be right back to square-one again! Repeat the remedy only when you suspect you’re starting to relapse.”

    So, there’s at least that much case-management you can do; however, I have observed that occasionally the acute presentation changes after the remedy: The gelsemium patient, let’s say, turns into Belladonna (a healthier state). You can tell your patient, “If, after the remedy, your presentation changes; for example, if you break out in a fever where before you didn’t have one; this does not mean you’re getting worse! A healthier immune system puts out a fever and burns up those pathogens that are making you sick. All it means is that now you need a different remedy; so, you must come back right away and I will give you the appropriate remedy if that should happen. In fact, if there’s any sort of change after the remedy that you have questions about, please let me know! However, if the ‘change’ is accompanied a renewed sense of well-being, improved energy and appetite, do not worry about any change taking place on the physical plane. Chances are that it will work itself out in short order.”

  • Thank you so much for sharing your wisdom with the homoeopathic world. You have once more refreshed my own knowing, and defined prescribing in a way that is clear, easy to remember and of course makes perfect sense. Shadowing my patients vital force is a beautiful way of remembering exactly what i do best.

    Long life, health and happiness,
    Michelle Burns.

  • Oh, and Michelle? I really don’t want to live that long; so, maybe you could refine your wish to something like: “sort-of long life with the caveat that at some point, enough is enough!”

  • DEAR DR,
    YOUR ARTICLE IS VERY USEFUL, BUT IN THE LAST PARA OF YOUR ARTICLE YOU HAVE STATED THAT IN ACUTE CASES THINK OF THE HIGHER POTENCY AND IN CHRONIC USE LOWER POTENCY AND REPEAT THE SAME WHERE AS FROM THE BOOKS AND IN OUR PRACTICE WE ARE DOING REVERSE OF IT EG WE USE LOWER POTENCY IN ACUTE AND HIGHER IN CHRONIC. PL LET ME KNOW WHAT IS THE EXACT METHOD OF USING THE MEDICINE IN ACUTE AND CHRONIC CASES. I AM EAGERLY WAITING FOR YOUR QUICK REPLY ON MY EMAIL
    REGARDS
    DR SHEKHAR

  • Dear Dr. Shekhar,

    I welcome the chance to straighten out this misunderstanding! I believe it stems from the principle that physical complaints or pathology requires low potency repeated daily or every other day or third day. This is generally true. The reason for this is, if something has existed for years, the condition is no longer “fluid”, it has calcified, hardened, only by steadily chipping away at it are you going to get rid of it; taking a bat and swinging real hard at it, as if to hit a home run, isn’t going to budge it (but may cause the patient aggravations). So, having agreed to the plausibility of this principle, what has happened is that some have postulated that since acutes are on the physical plane–usually–this same principle must apply, that they should be treated with low potency.

    Well, acutes are entirely different! They may be physical but that’s where the similarity ends! They are not hardened, they are not calcified; they are very fluid and you can swing a bat hard at them and knock them right out of the park!

    Doesn’t it make sense that we want to meet force with force? If we see a presentation that’s very intense, do we want to give a 6C to this person, or a 200C? Think of a child with a chamomilla ear ache, what do we want to give to this child, a 6C or a 200C?

    Now, don’t get me wrong, I’ll bet there are acute cases where the 6C works just fine! And you can always go up in potency if the lower one doesn’t work. But you know what? Now that I think of it, I ate at a salad bar today and after some time I began getting stomach pains. I reached for the Arsenicum 200C. Almost immediately I felt a change for the better; but do you know that even with the 200C I had to repeat the remedy two more times because of two relapses coming after roughly 15 minutes–meaning the 200C only lasted that long? What it means is that the complaint must have been very energetic to make a 200C relapse in so short a time! What would a 6C have done if 200C was only holding for 15 minutes? I’m guessing the 6C would have done nothing at all!

    So this is the idea–meeting force with force. “Recent and Intense” would lead one to prefer high potencies. “Chronic and dull” would lead one closer to low potencies repeated daily. (But again, no rote prescribing! Start with once or twice a day, observe to make sure the patient isn’t aggravating and know that your potency will have to be raised at some point going forward, and perhaps raised numerous times, even if just a few degrees, to keep the case from stalling or relapsing.)

    Also, there is this belief that an acute, usually on the physical plane, is very “shallow”. It is not “deep” like a psychological problem. Because it is “shallow”, it deserves a “shallow” remedy like a 6C! Well, all I have to say is, if you think you can get rid of a Belladonna fever with a 6C, more power to you! Me? I’d prefer to have at least a 200C on hand for that–it’s only common sense!

  • Dear Elaine Lewis,
    Your article is very much informative. Here I would like to share my views with U
    1. HIGH POTENCY: is generally used
    a. When mental symptoms are more stricking and with good state of vitality in the case
    b. when Lower potency has worked, but still indicated.
    2. LOW POTENCY: Mostly 6C is given
    a. When vitality is low,
    b. when gross pathology is observed.
    c. when no stricking mental symptoms are elicited.
    d. when using less proved drugs
    e. In Idiosyncratic individual
    f. In the acute exacerbation of chronic diseases without disturbing the indicated medicine’s action
    3. SIZE OR QUANTITY OF ADMINISTRATION: as per Homoeopathic principle a dose is defined as “any quantity of medicine taken at a time “ I have personally verified and found correct
    4. PLUS POTENCY : Here I shall mention my case where BRYONIA 200 was given to a case of viral fever with headache, body pain, and patient was thirsty very irritable and cross. Bryonia 200 has decrease the symptoms to 50% but still indicated, I have tried plus potency but found no relief. When BRYONIA 1M was given. There was total improvement. This improvement helps us to say that plus potency are weaker.
    I shall be eagerly waiting for your replay .

    • Hello Dr. Baig,

      Thank you for reading my article and taking the time to comment. I think you did the right thing with the Bryonia case you cited above; that’s exactly what I would have done: Bryonia 200C for the flu-like symptoms that matched Bryonia. Then when it only worked partially, and you’re still convinced it’s Bryonia, you went up to 1M. You tried plussing first but nothing happened. (All we can conclude from that is that a certain potency was needed; 1M was it, and lower potencies–plussed or not plussed–lacked the power to overcome the disease.)

      But now let’s look at some of your other observations. You say that a healthy person with mental problems needs a high potency. Again, I think we need to get away from the notion that there is something “deep” about mental problems, while physical problems are “shallow”. In fact, Dr. Baig, we don’t even “know” where the mental “plane” is, per se! Yes, I know, Hering’s Law!!! But, all that tells us is that the body prizes the mentals above all else and will protect the mentals at all costs, allowing the physicals to fall by the way before it will allow the “mentals” to go. But does that mean that the mental symptoms are “deep”, thus requiring a strong “force” to blast them out? Words like “deep” are abstract and not literal or observable.

      Again, I would submit that the crucial question here is:

      Is this complaint recent and intense? Or is it chronic and dull?

      A recent, strong occurrence–whether mental or physical–would require at least a 30C, more likely a 200C, possibly a 1M, and even possibly a 10M or higher depending on just how serious this complaint is. (Think about snake bites, pneumonia, car accidents, etc.)

      A dull, chronic presentation–whether mental or physical–is more appropriately dealt with by a 30C or under, repeated at suitable intervals. Why? Because a potency is nothing more than a measure of force. Potency is punch! It should match the “punch” of the complaint.

      Now, even having said that, there are going to anomalies. You’ll give a big strong man a remedy in a 30C and he’ll aggravate, and you’ll say, “What? Why did that happen, that makes no sense, he’s perfectly healthy!” So, what we are talking about here are guidelines, every person is not going to fit neatly into these confines; but, it’s something to go on at least.

      You say we have to go low when there are no mentals in the case. Well, again, a Belladonna fever or earache or mastitis, with nothing but the red color and heat and thirstlessness and congestion and aggravation from a jar, with no mentals, is enough to merit Belladonna 200C. Why? Because of the intensity of almost all Belladonna complaints.

      Low potency when vitality is low: That sounds reasonable, and maybe you have a point there; but, who looks weaker than the poor Gelsemium patient with the flu? His eyes are droopy, he’s dizzy, he can’t even speak; all he says is, “Huh?” He might want to eat or drink but can’t summon up the stamina to sit up so he can do it! What’s the potency? Gelsemium 200C or 1M! Give him Gels. 1M and he’ll pick right up!

      Now, this one:

      (Low potency required…)
      f. In the acute exacerbation of chronic diseases without disturbing the indicated medicine’s action

      In fact, I would submit to you that just the opposite should be the case! I understand what you’re saying: Patient has been given a 200C (you see, this is the problem right here, because he probably should have been on a 12C once or twice a day, given that this is a chronic disease) and now along comes a fever, which is a good sign. Again, you’re going to give a 6C for a Belladonna fever???? No way! You see, it’s just the opposite. The patient is on, let’s say, Anacardium 12C once a day, he is improving when all of a sudden, out comes a fever which he hasn’t had in decades! What does he need now? Belladonna 200C! By all rights, the chronic disease should be over now, that should be the end of it.

      I hope this helps and makes sense.

  • A very informative and useful artcle of questions and answers.This clarifies some misunderstandings.However,the present life style patients do not have patience and want immediate relief.Now,if a patient has aggrevation he seldom informs the doctor about it and switches to allopathy. This fact must be accepted and patient should be informed of possibility of aggravation and should be asked to report.

  • Dear P.D. Bhatt,

    Yes, patients really do want immediate relief–and that’s the great thing about homeopathy because homeopathy, alone, is capable of doing this! Within minutes of the right remedy, a child’s earache can stop, a baby’s colic, a child’s upset stomach, symptoms of head injury can subside…miracles abound–pretty much with homeopathy alone!

    Now, what you said about patients switching to allopathy after an aggravation; wow, that’s quite a long-lasting aggravation then if the patient has time to schedule an appt. with an allopath and the aggravation is still present! I would suggest that whatever potency was used was REALLY inappropriate for that to still be going on. Or perhaps it was the number of repetitions “unsuccussed-before-each-dose” that caused it, or multiple remedies given all at once in high potency; in any case, we’re supposed to know better than this; but, you should tell your patients the following:

    “Here is your Belladonna 200C. Sometimes the right remedy aggravates briefly, for a short period of time, then an amelioration follows. If this doesn’t happen, if you get worse and don’t get better, call me and I will tell you how to antidote the remedy. Also, the right remedy sometimes results in “discharging”–generally there will be a feeling of calm and relaxation, followed by some kind of discharge–don’t be alarmed at all if this happens, it usually signals the end of the complaint; plus, it doesn’t always happen, I’m just giving you a heads-up of all the possibilities that can occur after a remedy. Then also, after a remedy, it’s possible that the case will ‘roll back’ the way it came! Don’t be alarmed if this happens, it usually doesn’t last long. And, lastly, after the right remedy, a fever or other example of a healthier state may come up–because a healthy person is able to put out a fever! Let me know and I will give you another remedy for that.”

    To learn how to antidote aggravations, see Diane’s and my article:
    “The Aggravation Zapper”. Google it or find it on my website:
    http://www.ElaineLewis.hpathy.com

  • in chronic conditions——— 6c water dosing repeated daily will still heal???????? it will not palliate only?????

    just want to make sure i just read a lot and some places says that in chronic conditions higher potencies must be used to actually cure??????? like one dose high potency.

    is this so or i think what this article shows is that 6c repeated and actually lower potencies repeated are better from chronic conditions???????

    • Essentially, what you’re asking is for me to repeat everything I’ve just said! It’s like you’re saying, “Did you really mean all those things you said?” YES! Maybe you need to go back and read them again.

  • if a person receives constitutional remedy in an unchanged dose the remedy gives negative effect to the individual as I have seen in a case the lady was Nat mur and she receives a dose of Nat mur daily for 10 days after a month she becomes bulky and she has goitre in throat that was not before she is in a bad condition since from 2 years with terrible headaches everyday with pain in legs and swollen face all Nat mur proving symptoms.I have employed aggravation Zapper method with higher potency but does not cure. every remedy is not working on her I.e she has changed iodium constitution but does not.what is your suggestion how to recover this case.

  • As always, Elaine, thank you for being so open and generous with all this helpful information!

    I came down with bronchitis last winter and was reaching for the phone to call my allopathic doc when it dawned on me that I owned some Bacillinum 200c. So I took a dose and miraculously, within a couple of hours, my cough was mostly gone! A couple of days later, I took another 200c. My cough suddenly became worse, and now I know it’s because I antidoted the first dose!

    From now on, I’m going to always have a bottle of water handy so I can make my own liquid doses (without having to buy the LM remedies) and can succuss each dose so that each one is slightly more potent than the last.

    Yay! The fog is beginning to clear and I’m starting to understand homeopathy.

    • Yes, Linda, it does sound like, with your second dose of Bac. 200C, you antidoted the first dose and therefore, you relapsed. I know it’s hard, but, if you’re improving on your last dose of a remedy, don’t repeat it, because you take a risk that all you will accomplish is antidoting it! Make sure that there’s truly a need to repeat a remedy that’s already working.

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