The Potency Dilemma
NATIONAL JOURNAL OF HOMOEOPATHY 1998 May / Jun VOL VII NO 4.
Dr Ajit Kulkarni
Editor:
This is a continuation of the article which we began in the previous issue - Diabetes issue pg198
Guidelines for Potency Selection:
4] If the susceptibility is heightened, prescribe the drug in high potency but infrequently. "The more similar the remedy, the more clearly and positively the symptoms of the patient take on the peculiar, finer and characteristic form of the remedy, the greater the susceptibility to that remedy and the higher the potency required."
5] For moderate susceptibility: medium potency in infrequent repetitions.
6] Low potencies: frequent doses. In patients who exhibit low susceptibility.
7] As suppression yields a poor state of susceptibility, low to medium potencies in repetitive doses are preferred in patients who have sustained suppressions.
8] If a drug achieves complete or total similarity, it should be given in high potency with infrequent repetitions. Where similarity is partial or superficial, it is better to prescribe low or medium potency infrequently.
9] In a patient with a predominantly functional zone of disease medium or high potencies, in infrequent repetitions are preferred.
10] Preponderance of structural zone of illness lowers the state of susceptibility and calls for low potencies frequently. One should be cautious in repeating the constitutional remedy in a case that presents with irreversible/advanced pathology. Rather, avoidance of constitutional deep acting remedies and using superficially acting remedies could be thought of, if the objective is palliation.
11] In organic disease where the pathology has set in, use low potencies. "High potencies will not palliate incurable cases; one must use the low" [Boger] Patients with advanced pathology are apt to have their suffering increased and the end hastened by the highest potencies. They do better under low potencies.
12] If the sinew is good, infrequent doses of high potency should be administered. If the vitality is low, frequent repetition of low potencies are to be preferred.
13]
a] Psoric Miasm: High potency infrequently.
b] Sycotic Miasm: Low to medium potencies infrequently.
c]Tubercular Miasm: Low to medium potencies infrequently.
d]Syphilitic miasm: Low potencies in frequent or infrequent doses [depending on other criteria]
14] Diseases characterized by an erratic pattern should be approached with medium potencies in infrequent repetition schedule to avoid aggravations.
15] If the conceptual image of a remedy is not clear owing to a mess up, it is better to prescribe an intercurrent remedy, usually a nosode, in medium or high potency as a single dose. The same applies to status quo patients. This will clear the picture.
16] It is a common experience in practice that a person becomes immune to the same potency and does not exhibit the progressive desired response. In such cases, it is better to go to the ascending scale of potency.
17] If a physician has gone upto CM potencies and now the patient shows no desired response, he can commence with low potencies again, as the susceptibility to the low potencies is restored.
18] If a physician's aim in a terminal case is to induce euthanasia, high potencies should be administered frequently.
19] Unless otherwise indicated: nosodes and inert substances should be used in high potencies. The remedies that are highly active in the crude state eg Phos should be used in medium potencies. Low potencies should be preferred in organ remedies. Partially proved remedies, narcotics and deep-acting remedies in serious chronic cases.
20] The final choice of the potency is to be made on the basis of an assemble of various components and not on a single factor.
When To Use High Potency?
- In patients with increased susceptibility
- Extreme/ Exacting similarity between the patient and the remedy
- Qualified mentals being covered well by the remedy
- Disease in functional zone
- Remedies in inert state: nosodes
- Cases not responding to low and medium potencies
- Hypersensitive patients
- Children, young vigorous persons, intellectuals, impulsive, quick to act and react patients; sedentary occupation and effeminate life
- Ample amount of characteristics.
- Good Sinew
- Patients with moderate susceptibility
- Partial similarity between the patient and the remedy
- Disease in both functional and structural zone but pathology: minor, reversible
- Remedies active in crude state
- If the patient has become immune to low potencies
- Diseases characterized by erratic pattern
- A messed up case
- Moderate amount of characteristics
- Moderate Sinew
- Patients with low susceptibility
- Poor correspondence: patient and remedy
- Disease predominantly in structural zone
- Organ remedies, partially proved remedies, narcotics
- When higher potencies cease their action
- Patients with low sensitivity; torpid, sluggish, idiots, imbeciles, deaf, dumb.
- Diseases characterized by suppression
- Advanced pathology: Borderline / Irreversible
- Absent or scanty characteristics
- Low ebbed vitality
Case 1 A married woman aged 32 years consulted for acne pustulosum; AGG menses before, summer, painful, AMEL cold application, AGG oils, meat. She was also suffering from migraine since 5 years; < noise, light, sun, night-watching > binding tightly, darkness.
Mind: hurt easily. Broods over past, disagreeable incidences. Anger, <slightest contradiction < consolation. Egoistic.
Past History - not contributory.
Family History - Diabetes Mellitus, Asthma, Rheumatoid arthritis.
Discussion:
The patient has heightened susceptibility and sensitivity as evidenced by multiple stimuli, availability of characteristics both at the level of mind and body. The dominant and fundamental miasm is Sycosis. Suppression - absent. General vitality - good. Pace - gradual. Similarity - good. Hence infrequent repetition of Nat-carbonicum 200 was resorted to. He was given 3 doses of Nat-carb 200 within the span of 2 years. The sector susceptibility at the level of headache was also heightened. Hence migraine attacks were dealt with Glonoine 200. Frequently repeated to the point of reaction. She showed improvement in all respects.
Case 2 A boy, aged 10 years, was suffering from mental retardation with epilepsy. He was on antiepileptics since 6 years. On the basis of totality, he was put on Bufo 30 - 3 with frequent repetitions, then it was stepped to 200. There was some improvement in mental functioning. His seizures stopped after Bufo.
Discussion:
Epilepsy denotes hyperactivity of the brain; mental retardation denotes hypoactivity. However, the overall assessment is low in view of an absence of characteristics, hypoactivity and long term anti-epileptic treatment. Hence 30 potency was given repeatedly in the initial phase. Recrude ascence showed that 30 potency ceased to register its action, thus 200 potency was then administered.
Case 3 A man of 39 years was diagnosed as having Malaria. He had severe chills followed by heat and sweat, < 2 am to 5 am. Shuddering chills with anxiety, restlessness, tossing in bed. Thirst increased throughout. He was put on Ars-alb 1M 2 hourly which cured him. He had profound post malarial prostration that was treated with Carbo-veg 200 given frequently.
The patient came down with an 'intensified' form, denoting increased susceptibility. To meet it, high potency in infrequent doses was mandatory. The recuperative state also denoted high susceptibility. Hence frequent doses of Carbo-veg were administered.
Case 4 A primipara with labour pains. In spite of two days labour, no progress. The pains were irregular, erratic; at times weak or strong. The patient was exhausted with dose. One female longing for open air. She complained of suffocation and asked the windows and doors to be opened. The attending Homoeopath had given her Puls 200 TDS. I was called, as there was no progress. The parents were thinking of transferring the patient from the village to the city. The totality pointed to Puls again and 10M potency was given every half hour. She delivered within 2 hours.
Discussion:
Heightened susceptibility and good correspondence pointed to higher potencies to be repeated frequently. This yielded the result.
Case 5 An old man aged 69 years. A diagnosed case of malignancy with metastasis in the abdomen. The primary source could not be found. The patient showed a typical Lyco presentation. There were horizontal furrows on the forehead, chronic tympanitis, eructation and flatulence. Easy satiety, burning pain in the abdomen, > lying on abdomen. Vomiting after every meal. Anorexia ++; Cachectic. All symptoms were < from 6 pm to 8 pm. Declared inoperable and unfit for chemotherapy.
A young physician referred this case to me. He gave a single dose of Lyco 1M. Patient got severe, rather killer aggravation on the same day. He was subsequently treated with Acetic-acid 30, 3 hourly along with Hydrastis Q3 mother tincture, which gave him some relief. He succumbed within a fortnight.
Discussion: The vitality was at its lowest. The pathology was advanced and irreversible. The Preponderant miasm was syphilitic. The characteristic particulars were scanty. The disease was in the structural zone. Susceptibility: poor. Although the similarity to Lyco was good, the patient had no capacity to withstand the impact of the constitutional remedy. It was impossible to modify the state of susceptibility. Hence avoidance of the deep acting, constitutional remedy and giving palliative treatment was the aim. Here Acetic-acid was selected on the basis of
i] violent causes [< induced by Lyco]
ii] chronic athrepsia iii]cachexia
iv]pain, burning in the abdomen, > lying on it v]vomiting after every meal
vi] debility [being common to all acids] and vii] toxicological data "The only drug known to have developed a typical cancer cell"
Case 6 Female aged 46 years. Diagnosed as rheumatoid arthritis since 10 years. Deformities were present and the patient was chilly. A past history of eczema at the age of 15 years was elicited which had been suppressed. Operated for tonsils. Steroids and quinine treatment had been taken. Also took gold derivative and yograj guggul over a long period. There was a family history of diabetes mellitus, cancer, and asthma.
Mind. Anxious3. Attachment3. Active conflict at home. Husband as alcoholic, quarrelsome, and abusive. Maintaining cause ++ Kali-carb 30 - 3 then 200 and 1M with intercurrent. Thuja 1M was given.
Result: deformities lessened. The treatment gave 80% relief within 2 years.
Discussion: The stepped in pathology compensated for the remedy's frequent stimuli. It was necessary that the drug's action reach issue level. Susceptibility moderate. Sensitivity suppression+. Dominant miasm - sycotic.
Hence repeated doses were given. No aggravation occurred in this case.
Conclusion: We have journeyed to the present through the past. The past literature is replete with low potency successes; the present one with both low and high potencies. We have already seen that both low and high potency users claim success in their practice. Unfortunately clinical reports that are published in Hom books and journals contain more successes, failures are usually not presented. This affects the feedback mechanism. However an unbiased evaluation of the literature, application of logic to every case is reported to help us arrive at the conclusion. If the drug is right, it will decisively help the patient. Let us be aware that at least the onus of selecting the right drug falls upon the Hom physicians but let us remember that a Hom physician should not be satisfied only by selection of the most similar remedy. He has to select the similimum ie the right drug in the right potency. He must remember that the potential action of the remedy must meet the requisite susceptibility. If the potency is not matched properly, one is likely to get a partial response, as the susceptibility will be met partially. When the patient exhibits maximum susceptibility to the similimum, it will evoke the response of an adequate type and this is the need of both the patient and the physician to steer towards palliation or cure as the case demands.
Repetition of doses - low or high- has been on the increase, is an observation put forward by some physicians. Probably due to an enormous increase in allopathic drugging; the suppression occurring from various sources altering the susceptibility and making it moderate to poor; the system in consequence needs frequent stimuli of the drug force. However, this should not be taken as an excuse to give doses in frequent repetitions.
We reiterate that the potency of a drug is to be selected on the basis of an assemble of various components and not on a single factor. It is the relative and not the isolated consideration of components; it is the integrated consideration of all components in totality. The concept of totality is rather indispensable for a Hom physician; every action of a Hom physician has the basis of a totality. Action and totality in other words are inseparable.
The present article is presented with the view that it is possible to give an accurate potency to the patient in proportion to the hom????? Of that drug to a given data. It is presented also with the expectation that a Hom physician should strive for perfectionism, for delivering excellence to patients. The author of this paper will feel contented if the above writing stimulates the thinking process necessary for right action. The area of potency selection is not a grazing land for chewing the cud. Many aspects still need clarification. However, a Hom physician will not flog a dead horse if the article is imbibed in its totality!
Bibliography:
1] The principles and practice of Homoeopathy - Dr M L Dhawale
2] The potency problem - Dr P Sankaran
3] A select Hom Materia Medica Part I - Dr P I Tarkas, Dr Ajit Kulkarni
4] Diseases of the heart and arteries - Dr J H Clarke
5] Organon of medicine 6th edition - Dr Samuel Hahnemann
6] Principles and Practice of Hom - Dr R Hughes
7] Therapeutic Guide - Forty years practice - Dr G H G Jahr
8] Lectures on Hom Philosophy - Dr J T Kent
9] The testimony of clinic - Dr E B Nash
10] Homoeopathic Reminiscences - Dr Sarabhai Kapadia.
11] Materia Medica with Repertory with Indian medicines, 9th edition.
12] Current issues of
i] Indian Journal of Hom medicine
ii] Hom links, Mumbai
iii] National Journal of Hom, Mumbai
iv] Hom clinical case recorder, Ambajogai.
