Posology – Hahnemannian Concept

Dr Jatin N Dhagat  

Introduction:
Basically the word Posology has originated from the Greek word Posos. The meaning of this word is how much [dose]. The word logos suggest study or discourse. So Posology means science of dosage. The terminology of dose originates from the word dose that means the quantity of a drug or other therapeutic agent to be taken or applied. On the basis of this we may say that Posology is the branch of pharmacology and therapeutics concerned with a determination of the doses of remedies; the science of dosage. Or Posology is the scientific study of drug doses.

A homoeopathic concept of Posology necessarily means selection of potency, dispensing and repetition of the dose of the medicine. Homoeopathic Posology is based on the principles of the single remedy, minimum dose and minimum intervention.

Controversy and Confusion:
Since after the death of our master Dr.Hahnemann, Posology remains a topic for controversy and confusion for beginners. After perceiving the concept of Hahnemannian Posology various stalwarts like Dr. Boenninghausen, Dr.Kent, and Dr.Boger etc have tried to express their own perception in a different manner. As a result of our misunderstanding profession has been divided in to different paths. Everyone is directly or indirectly walking on one or another path. Hahnemann had also at one stage proposed to treat all cases with the thirtieth potency.

After trying to understand the concept of stalwarts, as a beginner various confusing question should arise in our mind. They are like: whether to give a single unit dose or repeated doses? If we give one dose than when to repeat it? What will be the frequency of repetition? How far we have to wait and watch? etc. As a result of all such controversial and unsolved questions Homoeopathy is still struggling for its existence in front of modern science in the country like India. If we perceive the actual evolutionary concept of Posology given by Dr.Hahnemann in different editions of Organon of medicine we can satisfy ourselves regarding the concept of Posology. This attempt has been made in this article.

Evolution of homoeopathic Posology:
1) Before The Discovery of Homoeopathic System:
During his earlier period, Hahnemann was using massive doses, as was the practice in those days. But by his keen observation he was able to detect that large doses of medicine were causing undue aggravation. In § 621 in Lesser writings (On the nature and treatment of venereal disease) 1786 (pg 133) he says “… in very sensitive persons I have sometimes not have the occasion to use more than 1 grain of soluble mercury to cure moderate idiopathic venereal symptoms and commencing syphilis yet I have met with cases in which 60 grains were necessary”. He says that he was forced to use such large quantities of medicine, as some circumstances of the patient must have interrupted with the action of medicines. Hahnemann says that in moderately severe syphilis not more than 8 grains were required while for severe and deep-rooted cases about 12 grains were needed. After giving the first dose Hahnemann used to progressively increase the dose until the disease have disappeared. In Lesser Writings he narrates the way of increasing dose in a progressive scale from ¼ to 1/3, ½, 3/4, 11/4 grains then after an interval of 14 days again dose is increased from 11/2 to 2 grains until syphilis disappeared.

Here we can see that Hahnemann inferred that the large quantities of medicine was not the factor which helped in curing disease, but sufficient quantity just needed to excite an reaction was only needed. So Hahnemann reduced large quantities of mercury given for treatment of venereal disease to just sufficient quantity required to bring about mercurial fever. Thus Hahnemann reduced the quantity of mercury needed for the treatment of venereal diseases from 12 grains, 5 grains etc to 11/2 to 2 grains.

2) Period of discovery of homoeopathic system:
In 1790 Hahnemann on translating Cullen’s M.M came upon the fact that the curative power of cinchona was due to its astringent property which he tested upon himself and established that medicines were able to cure owing to its property of producing similar symptoms. Thus in 1796 he laid down the foundation of a new system of medicine viz. Homoeopathy. In the period 1796 – 1801 we don’t find a marked reduction in the dosage for we find him giving 4 grains of Veratrum album for a case of colicodynia, Ipecac 5 grains, Nux vom 4 grains etc.

3) Inception of infinitesimal Posology
But in 1801 in his essay ‘on the cure and prevention of Scarlet fever’, the first indication of infinitesimal Posology took its place and unto now it stands as essential and integral part of homoeopathic system. In cure and prevention of scarlet fever Hahnemann advises 1 part of opium to be taken in 20 parts of weak alcohol and keep it for one day, then one drop of it is taken and dissolved in 500 drops of alcohol and then one drop of this could be given for children and 2 drops for persons above 10 years of age.

Hahnemann says “The smallness of the dose in which the medicines acts upon the whole organism, when it is suitable to the case is incredible; at least it is incredible to my colleagues”. In his essay ‘on the power of small doses of medicine in general and belladonna in particular’ (Lesser Writings ) Hahnemann says a very hard dry pill of extract of belladonna produces no effect in a perfectly healthy man, but it may not be so if he is ill. One drop of belladonna taken in 2000 drops of water and is shaken vigorously and 1 teaspoon is given every two hours will produce violent symptoms in a strong man, if he is ill. Hahnemann says that except him no other physicians have noted this remarkable action and many physicians are ignorant of this dynamic action. Here Hahnemann was able to see that the medicines acted even in minute doses due to its dynamic action.

In Medicine of Experience (1805), which is the precursor to Organon of Medicine, he further elaborates upon his discovery, making it a doctrine and a foundation stone of homoeopathy.
In M.E Hahnemann says “… We have not only selected the right remedy but also hit upon the proper dose (for curative purpose incredible small doses suffice)…”

In the first edition of the Organon, which appeared in 1810, Hahnemann speaks much to the same effect. Here he says, “Scarcely any dose of the homeopathically selected remedy can be so small as not to be stronger than the natural disease and not capable of overcoming it”.

Thus in scarlet fever we find Hahnemann giving betwixt our 2nd and 3rd dilution. In 1814 we find him giving Bryonia and Rhus tox in a dilution equal to 15th and 16th of centesimal scale. Hyoscyamus was prescribed in 8th dilution. In 1819 on the treatment of suicidal mania we find him giving gold in 6th dilution.

In 1827 in his essay ‘How can small doses of such very attenuated medicine in homoeopathy employ still greater power’, Hahnemann says that there are various reasons why a sceptic ridicules these homoeopathic attenuations.

1) He is ignorant that by means of such triturations, the internal medicinal power is wonderfully developed and liberated from its material bonds.

2) Pure arithmetic mind believes that it sees here only an instance of enormous sub division and does not observe in this spiritualization of internal medicinal power.

3) The sceptic has no experience relative to the action of preparations of such exalted medicinal power.

4) Concept of Posology in the Fourth Edition of Organon:
In the fourth edition of Organon Hahnemann introduced the single unit dose consisting of a few poppy seed sized pellets and taught that as long there was improvement, no repetition of the remedy was allowed. Only when a definite relapse of the symptoms occurred could a remedy be repeated. [Aphorism-240, 242] The above aphorisms still are the basic principles for so many homoeopaths for their practice throughout the world. In this wait and watch method the homoeopath is totally committed to the first dose, delaying repetition in order to avoid unnecessary aggravation.

Dr.Kent was well aware of the Fifth Edition of Organon even though he kept the legacy of these aphorisms alive by practicing according to the fourth edition. He was a follower of the philosopher, Emanuel Swedenborg, one of the greatest scientists of that day. According to his theory energy is based on a fourth state of matter called the simple substance. Simple substance has no quantity but only quality in degrees of fineness. So the number of pills used in a dose makes no difference for Dr.Kent. Till today so many modern homoeopaths and followers of Dr.Kent are claiming that it never matters whether the remedy is given in water in spoonful doses or given in a few pellets dry on the tongue.

At this place in the aphorism 275 Dr.Hahnemann says: “A medicine given in too large dose, though completely homeopathic to the case and in itself of a beneficial nature, will still harm the patient by its quantity and unnecessary strong action on the vital force, and through it, because the medicine is homoeopathic on precisely those parts of the organism which are the most sensitive and have already been afflicted most by the natural disease.”

5) Concept of Posology in the Fifth Edition of Organon:
The fifth edition of Organon was published in 1833. This Edition had three major changes.
Initially Hahnemann resisted the use of higher potency for longer period of time. Stapf, Gross, and especially Boenninghausen convinced Hahnemann to conduct his own experiment and to remove the 30ch limit. So the potency limit of 30ch was removed. This was the first change of Fifth Edition.

As a part of second change Dr.Hahnemann introduced to give medicines in watery solution instead of dry doses. He had concluded that the uses of watery solutions were far superior than to give dry doses. We may find such reference in aphorism 286 in Fifth edition: “ For the same reason the effect of a homoeopathic dose of medicine increases, the greater the quantity of fluid in which it is dissolved when administered to the patient, although the actual amount of medicine it contains remains the same. For in this case, when the medicine is taken, it comes in to contact with a much larger surface of sensitive nerves responsive to the medicinal action. Although theorists may image there should be a weakening of the action of a dose of medicine by its dilution with a large quantity of liquid, experience asserts exactly the opposite, at all events when the medicines are employed homoeopathically.”

The third and very surprised suggestion given by Dr.Hahnemann in this edition was related to repetition of the dose even when improvement of the patient had set in. When we take the reference of aphorism 246, he says: “ …. If the disease is somewhat chronic, however a single dose of the appropriately chosen homoeopathic medicine does sometimes complete the good that remedy can according to its nature accomplish in the case, but slowly over a period of 40, 50, 60, or 100 days. Now for one thing, this is very rarely the case and secondly it must be a matter of great importance to the physician and to the patient to reduce this period by half or three quarters or more, if possible, so as to obtain a far more rapid cure. As the most recent and frequently verified experiments have taught me, this can be accomplished very felicitously if the following conditions are fulfilled: firstly, if the medicine is very carefully selected so that it is accurately homoeopathic, secondly, if it is highly potentized, dissolved in water and given in suitably small doses at intervals that experience has shown to be the most appropriate for the speediest possible cure…” This statement was creating a great disappointment for the followers of wait and watch method by giving dry doses in infrequent repetition. [According to Fourth Edition] Here the theme of this Para is: “suitably small doses at intervals”. At this point what was his perception regarding suitable intervals we may not say but one thing is clear that his suggestions were towards repetition for shortening the period of cure though improvement was going on. He called this path as a true middle path.

Later on in the same aphorism he says for this the nature of the different medicinal substances, corporeal constitution of the patient and the magnitude of disease must guide us. This statement guides us to understand his perception regarding repetition. We may say that Dr.Hahnemann considered such factors for the basis of repetition at suitable interval.

Here the question should arise in our mind that whether such repetition at suitable interval will produce aggravation or not? In the fourth edition Dr.Hahnemann had extensively mentioned regarding Aggravation by unnecessary repetition of similar medicine. Here in the Fifth edition he has mentioned his different view related to Aggravation than Fourth edition. In the aphorism 279 he says:” A dose of the homoeopathic selected remedy can never be prepared so small that it shall not be stronger than the natural disease, and shall not be able to overpower, extinguish and cure it, at least in part as long as it is capable of causing some, though but a slight preponderance of its own symptoms over those of the disease resembling it, [slight homoeopathic aggravation] immediately after its ingestion. This makes our understanding clear that we must expect some aggravation after using this split method suggested by Dr.Hahnemann in Fifth Edition. This concept was totally changed after introducing LM potency in the Sixth Edition of Organon.

6) After the invention of Psora theory
After his invention of Psora theory Hahnemann fixes an uniform standard for the dose of all remedies at a globule of the 30th dilution. In his essay ‘On the extreme attenuation of homoeopathic medicine’ he is found to recommend 30th dilution as standard.

Korsakoff’s statement about high Potencies:
Graf von Korsakoff’s says that he has diluted medicines up to 150th, 1000th, 1500th attenuation and he has found them to be still efficacious. Korsakoff’s says that the material division of medicinal substance attains its limit at 3rd and 6th dilution and subsequent attenuation obtain their medicinal properties by a kind of infection or communication of medicinal power after the manner of contagious disease to the non – medical vehicle. He says he communicated medicinal properties to large quantities of unmedicated globules by shaking them up with one dry medicated globule. By diluting medicines highly the primary action of the medicine or its tendency to produce homoeopathic aggravation declines, whilst the curative action of medicine continuously increases.

To this Hahnemann says that we are indebted to Korsakoff’s, who has brought the idea of contagion in communicating the power of medicine to another globule, but the supposition that dry globules, that has been impregnated with a certain degree of development of power can be further dynamized and their medicinal power increased in their bottles by shaking or carrying about in pocket is incredible.

Hahnemann says even though triturations can be carried out to any limit it is advisable in preparing all kinds of medicines not to go higher than the decillionth attenuation and dynamization (x) in order homoeopathic physicians may be able to assume themselves of uniform results in practice.

7) Directions given during the last years of his life:
At Paris, on Dec 1838, Hahnemann states that “Thus we obtain, even in the fiftieth potency (the new wiseacres have hitherto ridiculed the thirtieth potency, and made use of the lower, little developed, more massive medicinal preparations in large doses, whereby, however, they were not able to effect what our system can do), each lower one of which has been dynamized with an equal number of successions, medicines of the most penetrating efficiency, so that each of the minutest globules impregnated with it, dissolved in much water, can be taken in small portions and must be so taken in order not to produce too violent effects in sensitive patients, not to mention that such as mode of preparation develops almost all the properties that lie hid in the essential nature of the medicinal substance, which thereby done can attain any activity.

In the preface to 3rd volume of c/c disease (edition 1837) he says that when we repeat the medicine we should descend from 30th to the 24th dilution and below. In the history of 2 cases collected in lesser writings he gave medicines especially Sulphur and Mercurius in doses greatly below 30th dilution.

In the last years of life he again allowed himself a greater range of dose, chiefly by extending the scale of dilutions upwards as high as 60th, 180th and even 300th dilutions, but also downwards to the 24th and occasionally also much lower. Hahnemann however used almost all potencies from lower to 30th, 60th, 150th and 300th dilution.

8) Concept of Posology in the Sixth Edition of Organon:
History related to Sixth Edition is very interesting. Dr.Hahnemann had completed the Sixth Edition in 1842 but his dream to make aware the world with such new way of selection of dose and potency was not fulfilled because of his death on second July 1843. As a result of this his work was remained unpublished for years and later on with the financial help of Dr. William Boericke the first German edition was published in 1920. During this period there were numbers of followers of Dr.Kent in the world but Sixth Edition was published after the four years of the death of Dr.Kent. So it was very clear that Dr.Kent remained deprived of the hidden treasures of the Sixth Edition. As a result of this so many followers of Dr.Kent had raised their questions regarding the purity of this Edition by saying that Melanie made such changes after the death of Dr.Hahnemann and they were not the original work of Dr.Hahnemann. But truly speaking it was the original work of Dr.Hahnemann and we may confirm it by referring the Dr.Boericke’s translation of Sixth Edition. Overall view of aphorisms makes our concept clear regarding thinking of Dr.Hahnemann.

In the aphorism 246 in the Fifth Edition he had used the sentence “ be repeated at suitable intervals”. Here in the same aphorism he says: “ The degree of every dose deviate somewhat from the preceding and following in order that the vital principle which is to be altered to a similar medicinal disease be not aroused to untoward reactions and revolt as is always the case with unmodified and especially rapidly repeated dose.” In the foot note of this aphorism he further says: “ During the last four or five years however all these difficulties are wholly solved by my new altered but perfect method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely after the lower degree of potency has been used for one or two weeks in the treatment of chronic disease, advance is made in the same way to higher degrees.”

In the next aphorism [247] he says: “it is impractical to repeat the same unchanged dose of a remedy once, not to mention its frequent repetition. The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine to manifest themselves than those similar to the disease to be cured, because the former dose has already accomplished the expected change in the vital principle and a second dynamically wholly similar, unchanged dose of the same medicine no longer finds, therefore the same conditions of the vital force. The patient may indeed be made sick in another way by receiving other such unchanged doses. But if the succeeding dose is changed slightly every time, namely potentized somewhat higher then the vital principle may be altered without difficulty by the same medicine.”

In the aphorism 248 he says: “ For this purpose we Potentize a new medicinal solution from which we give the patient one or increasingly several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour or oftener. Thus in chronic diseases, every correctly chosen homoeopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success. If the solution is used up it is necessary to add to the next solution of the same medicine if still indicated one or several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one m ore homeopathically related medicine must be chosen in place of the last and administered in the same repeated doses, mindful, however, of modifying the solution of every dose with thorough vigorous successions, thus changing its degree of potency and increasing it some what.”

In the same aphorism regarding homoeopathic Aggravation he says: “On the other hand should there appear during almost daily repetition of the well indicated homoeopathic remedy, towards the end of the treatment of a chronic disease, so-called [aphorism161] homoeopathic aggravation by which the balance of the morbid symptoms seem to again increase somewhat [the medicinal disease, similar to the original, now alone persistently manifest it self]. This statement is totally creating contradiction of his own statement given in the Fifth Edition where the question of aggravation had been mentioned immediately after administration of homoeopathic medicine. While here homoeopathic aggravation is seen at the end while patient is on the path of cure and it is only due to presence of medicinal symptoms. In Further aphorisms he has also represented the method of preparation of the medicine according to the Lm potency and he has expressed his great trust in his LM potencies. [Aphorism-279]

In the aphorism 284 he has also mentioned the route of administration of medicine, which is also a part of Posology. He says: “Besides tongue, mouth and stomach, which are the most commonly affected by the administration of medicine, the nose and respiratory organs are receptive of the action of medicines in fluid form by means of olfaction and inhalation through the mouth.

In the footnote of the aphorism 285 he has given the proper guideline to give mild Antipsorics treatment especially with Sulphur to the pregnant women in order to protect the posterity [hereditary] in foetus. Such women have given birth to children usually more healthy and stronger.[Here the time ,where she has to take medicine and its dose is not mentioned.]

Factors that led Hahnemann to arrive at the concept of minimum dose:
Dr.Dudgeon in his Lectures and Practice of Homoeopathy says that following factors led Hahnemann to arrive at the concept of minimum dose.

a) Hahnemann observed that medicines exhibited greater strength when given in dilution than in dry state.
b) He observed the greater power of medicine when given in divided dose than given at once.
c) He observed the greater susceptibility of disease organism for the medicine having a specific homoeopathic relation to the affected parts.
d) Hahnemann observed an increasing power of medicine by a thorough admixture of vehicle by means of succession
e) Desire to evade precession of apothecaries who tried legal proceedings against Hahnemann for invading upon their privileges for dispensing medicines.
f) To avoid aggravation of disease when given in large doses.

Exception to infinitesimal dose:
Hahnemann states an exception to infinitesimal dose in §282 fn of Organon of Medicine

“….there is an exception in the treatment of three great miasm while they still efflorescence on the skin i.e. recently erupted itch, the untouched chancre and the fig warts. These not only tolerate but indeed require from the very beginning large doses at their specific remedies of ever higher and higher dynamization daily.

The reasons why we should employ only minimum or infinitesimal dose are
1) When the disease attacks the body, it overcomes the body resistance. Now the body becomes vulnerable to the action of a similarly acting disease producing agent. So this disease-producing agent via the drug need only be applied in a minimum dose just sufficient to produce a cure.

2) Disease has already rendered the parts abnormally sensitive, so if the stimuli applied are large it will produce an aggravation.

3) According to Arnold – Schutz law minimum dose stimulates medium inhibits and maximum destroys.

Stalwarts view regarding Posology: 
Stuart Close
According to Stuart Close there are three necessary requirements for the action of infinitesimal dose.
1) The development of special virtues of medicine by the process of potentisation.
2) The increased susceptibility to medicinal impression produced by the disease.
3) The selection of symptomatically similar remedy.

Gordian Knot of Homoeopathy:
Posology became a subject of much misunderstanding, discussion controversy in the earlier days of homoeopathy. On this subject the profession was divided into two opposing camps. It came to be regarded as a kind of Gordian Knot to be cut by each individual as best as he could with the instrument at his disposal.

Hahnemann at one time in despair of bringing his followers to an agreement proposed that one should treat all the cases with thirtieth potency. Later each person adopted the dosage according to his convictions. The materialistic minded restricted themselves to the crude tinctures and triturations of very low dilution ranging from 1x to 6x. Other ranged from 3 to 30 potency while some other small class inclined to metaphysical ideas, using only the highest potencies ranging from 200 to millioneth. As physicians differed in their ideas this topic came to be regarded as the Gordian Knot to be cut by each individual as best as he could with the instruments at his disposal.

Stuart Close comments that this decision should be open to every practitioner and that each man should be competent, willing and ready to use any potency or preparation of indicated remedy. If he confines himself to one or two potencies, be they low medium or high he is limiting his own usefulness and depriving the patient of valuable means of relief & cure.

H.A.Roberts:
According to H.A.Roberts the law of dosage could be summarized to 3 fundamental laws.

1) Law of least action and quantity: The quantity of action necessary to effect any change in nature is least possible. The decisive amount is always the minimum i.e. an infinitesimal.
2) Law of quantity and dose: The quantity of drug required is inverse ratio to its similarity.
3) Law of quality: The quality of action of homoeopathic medicines is determined by its quantity in its inverse ratio.

H.A.Roberts in ‘The Principles and Art of Cure of Homoeopathy’ says that infinitesimal dose is one, which is so small as not to produce too much aggravation of the symptoms already present and never large enough to produce new symptoms.

Carrol Dunham:
In his Science of Therapeutic he says that the most vigorous opposition from old school as well as chief ground of division among the homoeopaths was upon the question of infinitesimal dose. Dunham says that the question of minimum dose is manifestly an open one. He states in favor of infinitesimal dose and concludes that there are many evidences in chronic disease that many medicines have acted in very large doses.

Richard Hughes:
In his Pharmacodynamics Richard Hughes say “My own experience of such dilutions as 6th and 12th and of the 30th is such as to make me join with unquestioning acclamation in their praise. I have no practical knowledge of the 200th, but if I had no other fact before me than their constant use by scientific and successful a physician as Carroll Dunham I should be content to acknowledge their legitimacy. Richard Hughes says that reason has nothing to say in favor of high potencies.

1) We have no evidence that can be brought before us to prove that we actually develop power as we go on attenuating.
2) There is no material particle of the drug beyond 12c
3) Preparation of 1000th and beyond according to Hahnemann’s directions are simple impossibilities, for it will require lot of time, labor and cost.

James Tyler Kent:
In his lesser writings J.T.Kent says that

1. There is difference in the activities of a given remedy in the 30th and 10M upon the same constitution.
2. Very high potencies seldom require repetition in c/c disease in severe a/c disease several doses in quick succession needed.
3. It is better to begin lower and go higher and higher.
4. Medicines given in series of Octave potencies.
5. A deep acting chronic remedy should seldom be given in the midst of a paroxysm or exacerbations but at close of it.

General laws applied in Posology.
1) The Law of Dosage:
The law might be stated thus: The curative dose, like the remedy, must be similar in quantity and quality to the dose of the morbific agent, which caused the disease.

2) The Law of Quantity and Dose:
The quantity of the drug required is in inverse ratio to the similarity.

3) The Law of Quantity:
The quantity of action necessary to effect any change in nature is the least possible. The decisive amount is always a minimum, an infinitesimal.

4) The Law of Quality:
The quality of the action of a homoeopathic remedy is determined by its quality, in the inverse ratio.

5) The Law of Use:
The dose and quantity that will thoroughly permeate the organism and make its essential impress upon the vital force is that which will affect the functional sphere of the individual.

6) The Law of Repetition (for proving):
Never repeat the dose while symptoms are manifest from the dose already taken.

7) The Law of Repetition (for cure):
Never repeat your remedy so long as it continues to act.
In medical parlance dose could be defined as the quantity of particular medicine administered to a particular individual at a time.

Types of doses:
1) Physiological dose:
A dose of drug empirically selected of sufficient quantity and strength so as to produce predetermined effect or a group of symptoms. For e.g. physiological dose of belladonna is one which is sufficient to produce dilatation of pupil, dryness of mucus membrane. This is the quantity of medicine, which could be administered with safety.

2) Pathological dose:
Quantity of medicine capable of producing pathological change in the tissues of the organism i.e. bio-chemical changes, biophysical changes.
3) Toxic dose – Dose which produces toxic effects upon the organism.
4) Lethal Dose – Dose which produces deleterious effect upon the organism even death.
5) Therapeutic Dose – Least quantity of medicine required to affect a cure or palliation.
6) Minimum Dose – Minimum dose which is otherwise known as the sub physiological or homoeopathic dose can be defined as the quantity of medicine required to produce a scarcely perceptible homoeopathic aggravation. According to Stuart Close minimum dose is a dose which is not capable or producing symptoms when use therapeutically. Minimum dose is also known as the infinitesimal dose.

Homoeopathic Posology is the study of infinitesimal dose.
It involves
1) Study of the preparation of infinitesimal dose.
2) Application of infinitesimal dose.
3) Study of repetition of the dose.

I) Study of Preparation of Remedies
Study of preparation of remedies is called pharmacoproxy.
Mode of preparation of medicines includes

• 1) Decimal scale
• 2) Centesimal scale
• 3) 50 Millesimal scale
• 4) Korsakavian method
• 5) Mixed Hahnemannian & Korsakavian method
• 6) Jenichen’s potencies
• 7) Fincke’s method
• 8) Skiner’s method
• 9) Q-potency

1) Decimal Scale:
Dr.Herring introduced decimal scale. Here 1 part by weight of crude drug is taken and mixed with 9 part by weight of sugar of milk and is subjected to the process of titration for 1 hour. OR 1 part of drug is succssed with 9 part of alcohol to give the 1st potency.
2) Centesimal Scale:

2) Centesimal Scale was put forward by Hahnemann. Here one part by weight of crude drug is taken with 99 parts by weight of sugar of milk and is triturated for one hour to get the first potency. OR 1 part of drug is succussed with 99 parts of alcohol to give the 1st potency.

3) Millesimal Scale
Hahnemann introduced this scale in his 6th edition of Organon §270.
Triturate up to 3c. Then take 100mg of 3c and add to it 50 ml of a mixture of purified water with alcohol. (1 part of alcohol + 4 parts of purified water). This is the mother solution.
Pour 1 part of mother solution to 100 parts of dispensing alcohol and give 100 successions. This is the first fifty-Millesimal potency denoted as ‘0/1’.

4) Korsakovian Method:
a) Korsakovian method is a single phial system based on the following principle: When one empty a phial there remains one drop of the medicinal solution adhered to the walls of the phial and to this drop adherent to the walls alcohol is again added .Then succussion is carried out, this makes the next potency.

b) One globule, which is medicated when put in a bottle of non-medicated globules, will communicate the medicinal properties to it via a process of infection.

5) Mixed Hahnemannian and Korsakovian method
Begin with Hahnemannian mode of preparation up to 6c or 30c. Then use the single phial method.

6) Jenichen’s potencies:
As much vehicle as required to prepare 30th dilution is taken. Then one drop of mother tincture is put into it, 10 succussion given will raise the potency to 1stdilution. Sufficient succussion is given continuously for a long time until the desired potency is reached.

7) Fincke’s method:
One hundred drops of drug substance is taken in a glass jug and a stream of distilled water is allowed to flow through the same. For every dram of water entering in and coming out of the vessel, Fincke would count it as one potency. Thus for 100 drams of water entering and coming out of the vessel would raise the potency of containing drug substance to 100.

8) Skinner’s Method:
Skinner developed a method of potentisation which was somewhat similar to Fincke’s method.

9) Q- potency:
Q-potency is the term used to designate 50 Millesimal potency.

2. Application of infinitesimal dose:
Application of infinitesimal dose involves the study of:
a) Selection of potency & dose
b) Route of administration of remedy
c) Notion of quantity
d) Notion of quality

a) Selection of Potency & dose:
For determining the potency and dose one should assess the susceptibility of the patient. While assessing susceptibility one should bare in mind the modifying factors like age, habits, environment, pathological conditions, seat character & intensity of disease and previous abuse of medicine.

1) Age:
Susceptibility is greatest in young vigorous persons and in children and it diminishes with age. Children are particularly sensitive during development and most sensitive organs are those, which are being developed. So children respond more to higher potencies.

2) Constitution and Temperament:
High potencies are adapted to nervous, sanguine choleric temperament, to intelligent, intellectual persons, quick to act and react and to zealous and impulsive patients.

Lower potencies and more frequent dose correspond to torpid and phlegmatic individuals, coarse fibred, sluggish individuals of gross habits and to those of great muscular power who require powerful stimuli to excite them.

3) Habit and Environment:
Susceptibility is increased by intellectual occupation, by long sleep and effeminate life. Therefore potencies are required for them. Persons exposed to continuous influence of drugs such as tobacco workers and dealers, distillers, brewers, all connected to liquor and tobacco trade, druggist, perfumes, chemical workers etc. are less susceptible and require low potencies. Idiots, imbeciles, deaf & dumb have low susceptibility hence require low potencies.

4) Pathological Conditions:
In certain terminal conditions the power of organism to react even to indicate homoeopathic remedy is low so material doses will be needed. This may be due to existence of gross pathological lesions, long existent exhausting chronic disease or much previous treatment. If the grade of disease is low, the power of reaction is low; the remedy must be given in low potencies.

5) Seat, character and intensity of disease:
In certain malignant rapidly fatal diseases like Cholera, the susceptibility is low, so it requires material doses or low potencies. Disease characterized by diminished vital activity, torpor, collapse and deficient vital reaction require low potencies and those with increased vital action require high potencies.

6) Previous abuse of medicines:
Due to this we may find that the patient is not al all sensitive even to the indicated remedy. Then all medication has to be ceased for few days. Then carefully regulate the diet and regimen. Hahnemann recommends the administration of opium in one of the lowest potencies every 8th or 12th hour until some signs of reaction are perceptible. By this means susceptibility is increased and new symptoms of disease are brought to light. Carbo Veg, Lauro, Sulph and Thuja are other remedies, which serve to arouse the organism to reaction so that indicated remedies will act.

Types of Potencies:
1. Low Potency: Potencies below 30CH.
2. Medium Potency: 30 CH and 200 Ch are considered to be medium Potencies.
3. Higher Potencies: 1M and above potencies are considered to be higher Potencies.

Susceptibility and Remedy selection:
Conditions/personality Susceptibility Remedy and Potency
Crude medicines Low susceptibility Inspired Hahnemann for Potentisation.

Acute disease Immediate response. High Susceptibility High Potency.
Chronic disease Slow response
Moderate/Low Susceptibility Deep acting remedies.

Higher mental level affection Higher susceptibility High Potency.
Reversible Pathological changes Poor Susceptibility Lower Potency and frequent repetition.
Hysterical Persons High Susceptibility Good provers, difficult to cure and requires medium potency.
Irreversible Pathological changes Poor Susceptibility Superficial acting medicines are advisable.
Poor reaction after giving medicines. Poor Susceptibility Remedies like Sulphur, Zinc, Opium etc.
Standstill Position of a case. Poor Susceptibility Nosodes Higher Potency and less frequent repetition.
Too many symptoms may be due to over medication. Moderate Susceptibility Nux. Vomica is a good helper.
Patient is recovering from acute state. High Susceptibility Constitutional medicine.
Allergic patients. High Susceptibility Moderate Potency.

Infant and children High Susceptibility Moderate as well as Higher Potency.
Old age people Low Susceptibility Low Potency.
Addiction Suppress Susceptibility

Partial Similimum medicine Partial meets with Susceptibility Zigzag way of Cure.
Biochemic medicines Prescribed on salt deficiency so advisable to be used in decimal scale.

Time Of Administration Of Medicines:
1. Most Of the remedies are best administered at bed time.
2. Antipsorics medicines are advisable to give in the morning.
3. Medicines should never be administered immediately before and during the time aggravation. But should be given after the aggravation.
4. In diseases characterized by periodicity do not give deep acting medicines before and during the attack of paroxysms but always after the paroxysms are over. It is advisable to give superficial acting
Or Biochemic medicines at that time practically.
5. It is not advisable to give the drugs during menstrual periods. [72 hours after the flow].

b) Route of administration of medicine
Study of the route of administration of remedy is called pharmaconomy. It is written in § 284 of the 6th editions.

Besides the tongues, mouth and stomach, which are most commonly affected by the administration of medicine, the nose and respiratory organs, are receptive of the action of medicines in fluid form by means of olfaction and inhalation through the mouth. But the whole remaining skin of the body clothed with epidermis, is adapted to the action of medicinal solutions, especially if the inunction is connected with simultaneous internal administration. For infants medicines are administered by giving moderate doses to the nursing mother.

External application is not advisable § 197
Simultaneous local application along with the internal employment of the remedy in diseases whose chief symptom is a constant local affection has a great disadvantage for the premature disappearance of the local symptom if occurs.

c) Notion of quantity:
Hahnemann in § 276 says

Every dose that is too large does harm, more harm occurs if the well selected remedy is given in a large dose to a case with greater homoeopathicity and a large dose of a high potency also does more harm.

Hahnemann says about the quantity of medicine in 6th edition § 285 Foot Note:
For this purpose it is most convenient to employ sugar globules of the size of poppy seeds, one of which imbibed with medicine and put into the dispensing vehicle constitutes a medicinal dose, which contains about the three hundredth part of a drop, for three hundred such small globules will be adequately moistened by a drop of alcohol. The dose is vastly diminished by laying one such globule alone upon the tongue and giving nothing to drink. If it were necessary, in the case of a very sensitive patient to employ the smallest possible dose and to bring about most rapid result, one single olfaction will suffix.

For olfaction one globule of high potency is placed in a small dry phial, the physician allows the patient to hold the open mouth of the phial first in one nostril, and in the act of inspiration draw the air out of it then if he wish to give a stronger dose, smell with other nostril also more or less strongly accordingly to the strength it is intended it to be.

d) Notion of quality §272 of the 6th edition:
1) A single globule, crushed with sugar of milk dissolved in good deal of water when stirred well, before every administration will be more powerful. To increase quality medicine should be stirred well before every administration.

2) Quality increase, the greater the quantity of fluid in which it is dissolved. For in this case medicine will come into contact with a much larger surface of sensitive nerves responsive to medicinal action.

3) Quality of medicine is increased when the succeeding doses are changed slightly every time i.e. potentized somewhat higher on every repetition. This is because the former dose has already accomplished the expected change in vital principle and the next dose does not find similar conditions.

4) Quality of the medicine does not reduce in direct proportions to the reduction in the material quantity with every quadratic dimensions of the quantity of medicine; the action on human body will be diminished each time to only about one half. 284 § of the fifth edition.

Effect of 2 drops of M.T is not ¼th the effect of 8 drops.

Conclusion:
1. On the basis of this study of Posology we may conclude that it is necessary that each and every homeopath must thoroughly do the comparative study of 4th, 5th, 6th Edition of Organon of Medicine and Chronic disease written by Dr.Hahnemann. It is also desirable that we have to compare the concept of stalwarts with Hahnemannian concept of Posology.

2. After doing an attempt to perceive the understanding of Dr.Hahnemann we may also conclude that he has shown the superiority of LM potency. But he has also warned us regarding its action related to aggravation.

3. IT is a wrong concept that LM potency never aggravates the case. As such the high number of dilutions makes the power of the remedy very high and the remedy quickly penetrates very deeply, to the mental- emotional level. So mechanical repetition of LM without considering the instructions given by Dr.Hahnemann will cause similar aggravations and the production of accessory symptoms.

4. Principles upon which the selection of potencies depends vary according to individuals clinical experiencies.

Bibliography:

1. Cambridge- International Dictionary of English, Cambridge University Press.
2. Hahnemann S. 2002 Organon of Medicine. Sixth Edition. Translated by W.Boericke. B.Jain Pub.Ltd.
3. Little David, www.simillimum .com.
4. Schepper De Luc Achieving and Maintaining the Simillimum B.Jain Pub. Ltd.
5. Organon of Medicine – Samuel Hahnemann.
6. Lesser Writing – Dr.Hahnemann
7. The Genius of Homoeopathy – Stuart Close
8. The Principles and art of Cure by Homoeopathy – H.A.Roberts
9. The Science of Therapeutics – Caroll Dunham
10. Lectures on the Theory and Practice of Homoeopathy – R.E.Dudgeon
11. A manual of Pharmacodynamics – R.Hughes
12. The Hidden Treasures of the last Organon – P.Schmidt

 Dr Jatin N Dhagat M.D. [Hom.]
Lecturer Dept. Of Organon, Dr.V.H.Dave Homoeopathic
Medical College, Anand. Email : drjatindhagat@yahoo.co.in