The Potency Dilemma: Tailoring the Rx to Pt
NATIONAL JOURNAL OF HOMOEOPATHY 2000 Nov / Dec VOL II NO 6.
Dr Ajit Kulkarni

I have selected only precise indications for our readers.
Components Of Potency Selection:

1. Disease Potential:
   1. Nature Of Disease: Acute. Sub-acute. Chronic. Somatic. Psycho-somatic. Psychiatric
   2. Zone Of Illness: Asymptomatic / Dynamic, Post-dynamic / Pre-functional, Functional/ Symptomatic, Post-Functional / Pre-Structural, Structural / Organic, Post Structural / Sequelae, Partially developed / Fully Developed.
   3. Phase: Exacerbations, Remissions, Alternations, Relapsing, and Remittent. Intermittent etc.
   4. Tissue Changes:
      1. Physiological, Pathological, Biochemical alterations
      2. Type of pathology: Inflammation, Destruction, Degeneration, Hypertrophy, Atrophy, Induration, Thickening, Hypersensitive States etc.
      3. Reversible. Borderline. Irreversible.
   5. Pace And Duration Of Pathology: The pace with which disease pathology operates: Onset: Sudden/gradual, evolution: rapid /slow, assessment with relation to duration of pathology.
   6. Miasmatic Interpretation: Rapid appearance and disappearance - Psora and Tubercular. Slow, sluggish - Sycosis. Rapid deterioration leading to irreversibility: Syphilitic.
   7. Pattern Of Response: Periodic, Irregular, Erratic, Static, Progressive etc.
   8. Tissue Affinity: Localities, Sides, Alternating, Diagonal, Radiating etc.
      Miasms: Skin : Psora ; Glands - Sycosis, Lymphoid - Tubercle, Brain - Syphilis
   9. Expressions : The field of modalities, the field of symptoms and signs, general / particular, pathognomonic / non-pathognomonic, common , uncommon, chief/ Concomitants etc, adequate/ in adequate etc.
2. Sensitivity "At Mental and Physical (Nerves) level: | | or moderate
3. Susceptibility: Availability of characteristics expressions help appreciate the state of susceptibility, indicated as | | or moderate
4. Etiological Factors: Maintaining, precipitating and fundamental
5. Miasms
6. Similarity: Degree and Level
7. Suppression: Concept of layers, Consequences
8. Type Of The Patient: Stages of life: Childhood / Adolescence / Adulthood/ Old age, occupation, dull (Sharp, sthenic / asthenic, lean / obese etc.)
9. Nature Of Vitality (Energy Reservoir): Immunological resources available and parameters of investigations

Guidelines For Potency Selection

1. Patients with high sensitivity require high potencies in infrequent doses.
2. Patients with moderate sensitivity should be given medium potencies in infrequent repetitions.
3. Frequent repetitions of low potencies [crude drugs, including mother tinctures] should be followed in patients exhibiting low sensitivity.
4. If the susceptibility is heightened, prescribe the drug in high potency but in an infrequent manner. "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 in frequent doses for patients who exhibit low susceptibility.
7. As suppression yields a poor state of susceptibility, low to medium potencies in repetitive doses are to be preferred in patients who have sustained suppressions.
8. If the complete or total similarity is achieved by a drug, 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 diseases where the pathology has set in, use the low potencies. "High potencies will not palliate incurable cases; one must use the low" [Boger]. "Patients with advanced pathology are apt to have their sufferings 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 is to be preferred.
13. a. Psoric Miasm: High potency in an infrequent manner.
    b. Sycotic Miasm: Low to Medium potencies in frequent or infrequent doses.
    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 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.
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 the patient now shows no desired response, he can commence with low potencies again, as 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 Phosphorus] 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 ensemble of various components and not on a single factor.

When to use High Potency ?

1. In patients with increased susceptibility.
2. Extreme/ Exacting similarity between the patient and the remedy.
3. Qualified mentals being covered well by the remedy.
4. Disease in functional zone.
5. Remedies in inert state, nosodes.
6. Cases not responding to low and medium potencies.
7. Hypersensitive patients.
8. Children, young vigorous persons, intellectuals, impulsive, quick to act and react patients; sedentary occupation, an effeminate life.
9. Ample amount of characteristics.
10. Good vitality.

When to use medium potency?

1. In patients with moderate susceptibility.
2. Partial similarity between the patient and the remedy.
3. Disease in both functional and structural zone but pathology minor and reversible.
4. Remedies active in crude state.
5. If the patient has become 'immune' to low potencies.
6. Moderately sensitive patients.
7. Diseases characterized by erratic pattern.
8. A 'messed-up' case.
9. Moderate amount of characteristics.
10. Moderate sinew.

When to use Low Potency?

1. Patients with low susceptibility.
2. Inadequate correspondence between the patient and the remedy.
3. Disease predominantly in structural zone.
4. Organ remedies, partially proved remedies, narcotics.
5. When higher potencies cease their action.
6. Patients with low sensitivity; torpid, sluggish; idiots; imbeciles; deaf, dumb.
7. Diseases characterized by suppression.
8. Advanced pathological conditions: Borderline / Irreversible.
9. Absent or scanty characteristics.
10. Low ebbed vitality.

Comments On The Use Of Lm Scale Of Potencies:
I have an opinion that the increasing use and emphasis on LM scale should not lower the importance of decimal and centesimal scales. As a matter of fact, Homoeopathic profession is using decimal centesimal scales for over 200 years & 200 years is not a small span ! Thousands of Homoeopaths all over the world treating thousands of cases and reporting thousands of cases as either helped palliatively or curatively thousand times definitely weigh high.

To say that LM scale is better than D / C scales will be an injustice! Injustice to the scales and also to the serious practitioners who used them profoundly over the years. (Editor- Sorry one cannot agree. It is one thing to say that centesimal potencies are easier to handle and all Homoeopaths are familiar with it. In fact Hahnemann devised these LM potencies after noting very carefully the unnecessary aggravation caused by the centesimal potencies on his patients and now several cases of cure effected with LM potencies are being published and also instances where LM potencies cured where the centesimal potencies did not are also being published.

As Hahnemann himself advises that one should experiment on the lines given by him before coming to this sort of conclusion) The right statement, hence, will be "all scales have their own scope & limitations, to view each scale from pros and cons, from success and failure, with adequate clinical verifications will clear up many confusing ideas in this important field." Although my clinical experiences with LM scale are inadequate to give the profession some guidelines with authority, I have some suggestions to offer humbly.

1. Acute toxic, fulminating infections yield rapid results with LM scale.
2. Deep-seated, inveterate chronic diseases that have not responded to decimal or centesimal scales may respond to LM potencies.
3. The concept of intercurrent remedies if one has to follow in some cases, could be followed with LM potencies to see if results occur rapidly.
4. If treatment has to be instituted on remote causative factor like suppressed eruptions or discharges in the past, better use LM scale.
5. 'LM scale can be safely repeated' - I personally take this statement with caution.( This statement cannot be accepted= KV)
6. Intricate cases like Psychosis, Schizophrenia, Cancer, AIDS etc. should be given a fair double blind control studies using D/C & LM scales to deduce some standard conclusions.

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