PRESCRIBING : POTENCY SELECTION.
After thoroughly digesting the first six lectures of this brief course and doing wide collateral reading and studying one should be able to select the most similar remedy. The most similar remedy, however, does not become the simillimum until the potency is adjusted to the plane of the individual during his or her illness at the time of prescribing.
Our philosophy teaches us that pathology, and even bacteria, at ultimates of disease and that the true cause is far deeper and less material than these. in order truly wipe out the cause of a so called disease one must administer the remedy on or near the plane of the cause. It follows that for mental distresses and disease of manifestly psychic origin the high potencies (10M and upward) would be employed, other things being equal; and that for grossly material conditions, such as marked organic and pathologic changes, the lower or medium potencies would be selected.
In general, then, functional diseases, where the symptoms are subjective or physiological, where the vital force is tactile, respond well to high potencies; and the organic conditions to lower ones. It makes some difference whether the conditions be acute or chronic. For instance, diphtheria has marked pathology, as has pneumonia, yet the pathology is recent and swift in pace, and the high potencies are suitable.
In general, acute diseases respond well to high potencies, especially of acute remedies (high potencies of deep acting chronic remedies, when these are indicated in an acute condition, may be dangerous). Certain acute crises, based on chronic trouble, such as cardiac asthma, would have to be treated with medium or low potencies because the high potency would stir up more than the vital force could cope with in the face of the advanced chronic pathology.
In chronic prescribing it is a safe rule to begin with the 200th centesimal unless this is dangerous because of the nature of the remedy, the degree of the pathology, or the depth of the miasm. One great object in starting at the 200th in chronic cases is that you then have an ascending series of potencies to use as treatment progresses. The Kentian ideal being to exhaust the action of one potency (see section of Repetition below) and then to step up to the next, exhaust that, and so on, if no change of remedy is indicated to the highest potency.
(Hahnemann places the upper limit of potencies suitable at the end of a series in any given case at the last potency which will produce a very slight aggravation of the symptoms. In our experience you can usually use the highest known potency of the true simillimum and still get action, although at times action will cease with, say, the CM potency). When the top of the series has been exhausted and the same remedy is still called for you begin again at the 200th and repeat the ascending series.
Series of homoeopathic potencies have been made by many famous persons, either by hand, as in the case of the Jenichen potencies, or by various machines. As a general rule it is best to stick to the potencies made by one man as you go up the series in any one case, as for instance, Kents 200th, 1M, 10M, CM, etc. On the other hand, if a jolt is needed, although the same remedy is called for, a change from, say the Skinner to the Fincke potencies may whip up the case.
For those who understand rhythms and cycles it may be well, after a patient has been through a curse (ascending series) of a remedy from one source to change to one of the irregular potencies of the remedy from another source, for instance, we have seen Skinners Lyc. 2M beneficial instead of Kents 1M, or Finches 43M in place of a 50M. This change seems to start a new rhythm or cycle, it is as though the vital force became bored with the decimal system and responded with a renewed spurt to the alternation of potency. The is advanced doctrine.
In desperately ill cases, where the fight for life is active, in acute disease, the high potencies are indicated; also where the desperate illness is the terminal stage of chronic disease the very high potencies induce euthanasia. In chronically incurable cases, unless the vitality is very good and the pathology not yet too extreme, low or medium potencies are suitable, and usually the deep acting simillimum must here be avoided and a palliative drug given. If such a palliative be not too searching a remedy, Sang., Rumex, Puls., etc., it may be given even to incurables in a fairly high potency.
The problem of potency selection to acute disease incident to chronic treatment is another snag. Patients long under correct chronic prescribing show less and less acute diseases, in other words their susceptibility is eradicated; however, explosions of latent psora do occur sometimes particularly when the vigor is increased by the proper chronic remedy, as a sort of vent or effort on the part of the vital force toward house-cleaning.
The first problem for the prescriber in this connection is to determine whether the acute symptoms arising during chronic treatment are an aggravation following the remedy, and if so, whether they are an aggravation due to the reactive curative power of the body or a remedy aggravation due to over sensitivity or to wrong potency. If either of these be the case and the aggravation is not too severe no remedy should be given, merely Placebo.
If the aggravation threatens life or is unbearably painful (this may have to be an antidote) or for some social reason, particularly intolerable for the moment, an acute remedy may be given in the medium low potencies, preferably the 30th or 200th, and this will probably not interfere with the action of the chronic remedy. In acute exacerbations or explosions of active chronic disease you can often give the acute complement or cognate of your chronic remedy. In this case also the chronic remedy may continue to act undisturbed.
In very severe acute diseases during the course of chronic treatment it will sometimes be better to give the acute remedy high and after the acute condition has subsided retake the chronic case which will often show a new picture. The new prescription takes into account the original chronic symptoms but lays more stress on the recent developments.
In many conditions with marked tissue change, such as adhesions, chronic cardiac decompensation, very low potencies, even tinctures may be useful. Potencies as low as the 12th or even the 6th are occasionally invaluable in single dosage in such grave conditions as tuberculosis where even a 30th or a 200th of such a remedy as Phos. or Sil. might set the economy on the down grade.
From this brief outline of the possibilities of potency it will be seen that we uphold the use of the high potencies mostly. The question of Potency is the most moot point in all homoeopathy and even in our ranks today many strict homoeopaths are so-called low potency men. These follow Hughes and are more pathological in their prescribing. The strict Kentians, almost without exception, are preponderantly high potency.
The degree of susceptibility of our patient also influences potency selection. Certain persons are over-sensitive (often owing to improper homoeopathic treatment) and they will prove any remedy you give them; they require, therefore, medium low potencies. Other patients are very sluggish (often owing to much allopathic drugging). These will often take a very high potency to get any action at all or they may need a low potency repeated every few hours until favourable reaction sets in.
A third type of patient is the feeble one where the vital force can easily be overwhelmed. Repetition is the greatest danger here. Acutely sick, robust patients will stand repetition of high potencies until favourable reaction commences, although the ideal is the single dose. Children take high potencies particularly well, and in general the very aged require medium potencies except for euthanasia. Some individuals have idiosyncrasies even to homoeopathic potencies of certain substances.
Some degree of idiosyncrasy to a remedy must be present or the patient will not be sensitive enough to be cured, but where this is extreme the law of medium potencies should be preferred. Where patients are habitually poisoned by a crude substance, as a general rule it is not advisable to give that substance in very high potency, it is better to give an antidotal substance high. For instance, patients long dosed with calomel are not relieved by high potencies of Mercurius but may be by Hepar. On the other hand exceptions to this occur as in chronic susceptibility to Rhus poisoning, Thus tox. CM may eradicate the tendency.
If not, a deeper antipsoric in accordance with the totality of the symptoms is indicated. Certain remedies are noted for their power to restore order after chronic poisoning with crude drugs, as Natrum Mur. after the misuse of quinine or silver nitrate. The very low potencies, such as the 3 and 6x are very dangerous in the hands of accurate prescribers. This may be mainly due to the customary repetition.
