|Selection of the Single Homeopathic Remedy and Potency|
Selection of the Single Homeopathic Remedy and PotencyIndex
1. Homeopathic Case Analysis and First Prescription
2. Case Analysis for the Beginner and Advanced Homeopaths
3. Selection of the Single Homeopathic Remedy and Potency
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Selection of Potency
Once a remedy is selected, the next decision facing the prescriber is the choice of potency. For this, there are no set rules, and experience and observation play a very large role. In this section, some general guidelines will be presented, but it must be fully understood that they are not designed to be adopted as "rules."
There is a tendency, particularly among beginning prescribers, to pay a lot of attention to potency selection. Strangely enough, it is more common for a homeopathic instructor to be asked why a particular potency is selected in a given case than why a particular remedy is selected. In actual fact, potency selection is secondary in importance to remedy selection. The Law of Similars is the primary law of cure, and the process of potentization is merely an accessory factor. If the correct remedy is selected, then it will act curatively in any potency, even though a correct potency will act more gently for the comfort of the patient; conversely, an incorrect remedy can be either inactive or disruptive to a case, regardless of what potency is given.
Proper guidelines for selection of potency are difficult to define, because in any given case it is impossible to say what would have happened if a different potency had been given. Suppose a patient is seen with arthritis, asthma, and anxiety about health; Arsenicum is given in a 30th potency, and a lasting cure occurs over a period of six months. One might conjecture that a 10M potency would have produced a cure in three months. This, however, cannot be proven because one cannot go back and give the 10M in order to see! In addition, one cannot really compare two cases which seem similar and then give two different potencies; no two cases are ever exactly alike, so one case cannot legitimately be compared to another. The only circumstance where such comparisons have some validity is during a virulent epidemic in which many patients require the same medicine; indeed, it is in these circumstance that the effectiveness of higher potencies can be convincingly demonstrated, but this experience cannot necessarily be transferred to chronic cases. Chronic cases involve a wide variety of factors, so any guidelines for potency selection in chronic diseases can only be considered general impressions.
There are certain types of cases in which relatively low potencies should be used — at least initially. Patients who have weak constitutions, old people, or very hypersensitive people should initially be given potencies ranging, roughly, from 12 X to 200. The reason for this is that higher potencies can overstimulate weakened defense mechanisms, resulting in unnecessarily powerful aggravations (aggravations will be discussed in the next chapter). This principle particularly applies to patients known to have specific pathology on the physical level — i.e., arteriosclerosis, can cer, coronary artery disease. When pathology has reached an advanced stage on the physical level, the constitution has likewise been relatively weakened, and administration of even the correct remedy in high potency can lead to severe sufferings. Thus in general it can be said that the more severe the state of physical pathology, the lower the potency that should be used for the initial prescription.
If a 12 X potency is decided upon, it can be given frequently over a period of time, as long as careful instructions are given to discontinue it if any dramatic aggravation or amelioration of symptoms occurs. Amongst the patients weak enough to require a 12 X potency, those with relatively greater vitality may repeat the doses three times daily for 30 days. If the patient's vitality is greatly weakened, however, this recommendation might be reduced to once daily for 20 days.
For example, suppose we have a patient who is an old man with a very enlarged prostate, which we suspect might involve cancer. If the patient has enough vitality to go about his daily activities to a reasonable degree, then a 12 X might be prescribed three times daily for 30 days, with instructions to discontinue it if any dramatic change occurs for "better or for worse." On the other hand, an old man with an enlarged prostate who is so weakened that he spends most of his time in bed would be given a 12 X (or sometimes even a 6 X) potency only daily for about 20 days, along with the same instructions for discontinuation in the event of significant change.
Oversensitive patients present a unique problem for potency selection. These are patients who are excessively "nervous," reactive to all physical and emotional stimuli, usually lean and quick in their movements, restless, sensitive to odors and noise and light, and frequently suffering strongly from exposure to chemicals in the environment or in food. Such people are very reactive both to low potencies (on the physical level) and high potencies (on the electrodynamic level). Consequently, it is better to restrict initial prescriptions to 30 or 200 in such patients; depending upon their reaction, later potencies might go higher or lower. But, initially at least, 30 or 200 are the best elections for oversensitive patients.
Children who are suffering from severe problems should generally be given low potencies. An infant with a severe eczema or psoriasis is likely to have a severe aggravation if given a high potency. Consequently, such cases might be given just a few doses (say, daily) of a 12x, or just one dose of a 30 or 200.
Generally, cases with known malignancy should not initially be given potencies above 200. If a case is merely suspected to have a malignant or premalignant condition, the initial prescription should not be higher than 1M. Again, such potency restriction is in order to avoid unnecessarily powerful physical aggravations, which require considerable experience to manage.
If a case seems relatively curable and free of physical pathology, higher initial potencies may be tried, ranging from 30 to CM. The primary guiding principle here is the degree of certainty which the homeopath has about the remedy. If the medicine seems very obvious and covers the case very well, a very high potency may be given in a person with a curable system. If the remedy is not so clear, it is better to begin with a potency closer to 30.
For example, suppose a 30-year-old woman consults you complaining of a skin eruption on the hands of three-year duration. As you take the case, you discover that she has had very few other problems, and that she is quite free in her life-expression. She is quite creative, she enjoys her work, she has enjoyed traveling in various cultures, she has deep friendships, and she is not obstructed in the sexual sphere. The homeopathic information leads to a very clear picture of Pulsatilla, and your observation of the patient confirms this impression. In such a case, you could easily prescribe Pulsatilla 50M or even CM with confidence.
On the other hand, another young person comes to you with a similar complaint, but you cannot decide whether she needs Pulsatilla or Sulphur. You finally decide upon Pulsatilla after many hours of careful study; in this instance, you would tend to give only a 30 or a 200 for the initial prescription because of the lack of clarity.
In still another case with a skin eruption, you may see clearly that Pulsatilla is indicated. Yet the patient reports that she is able to keep her skin eruption under control by using cortisone ointment "only" twice a week. Further, you observe that there are other weaknesses of the organism — a weak vitality, the patient is easily tired, easily affected by chemicals in the environment. In this type of case, you would not give a potency higher than 200; otherwise, you may witness an unnecessarily prolonged aggravation.
It is sometimes said that high potencies are for cases in whom the center of gravity is on the mental level, whereas lower potencies are reserved for cases centered on the physical plane. This point of view is false. It is true that mental symptoms are the most important in selecting a medicine; if they give a clear and obvious indication for a remedy, even though the physical symptoms may not match so perfectly, then a high potency can be given — because there is a high degree of certainty about the remedy, and not because it is a mental case. Another case with many mental symptoms which do not fit clearly into any particular remedy will be given a lower potency because the remedy is not clear.
Another mistaken idea is that no harm can be done if a beginning prescriber restricts potencies to below 30. As previously mentioned, any potency can have profound actions depending upon the similarity of the medicine to the patient. If the remedy is the simillimum, even a crude dose or a very low potency can have profound effect; indeed, if it is originally a poisonous substance and it closely matches the resonant frequency of an oversensitive patient, a lower potency can produce a severe and dangerous aggravation.
There are a few remedies which one should be cautious about giving high potencies. Medicines such as Lachesis, Aurum, and deep-acting nosodes (especially Medorrhinum) have strong tendencies toward physical pathology. For this reason, they should usually be restricted to lower potencies (30 or 200) unless the individual case is demonstrated to be quite free of physical pathology.
Finally, a few guidelines should be given for prescribing in acute cases. In general, the same principles apply, but repetition may have to be more frequent if the remedy action is quickly exhausted. In children with acute ailments (because their defense mechanisms are quite strong), it is best not to give potencies lower than 200; thus 200 to CM potencies can be given, depending upon the certainty of the medicine for the acute ailment. If the patient is elderly, chronically weakened, or even if severely weakened by the acute ailment (for example, if it has developed into a severe pneumonia), a 200 potency would be preferable for the initial prescription, even if the remedy is quite obvious.
Even in acute ailments, one dose of the remedy should be given, and then the effect observed. If a lower potency has been given, it is possible that its effect will be exhausted in a matter of a few hours, in which case another dose should be given. This should not be done routinely, however; the case should be retaken to be certain that a different remedy is not needed. It is common practice in some homeopathic circles to routinely prescribe an automatic program of repetitions in acute cases (say, one dose every hour for six doses). Although such a practice probably does little harm, it is also usually unnecessary. If the remedy is clear and a high potency can be given, one dose usually will suffice; even if a repetition is needed, the case should be retaken to determine if a new prescription is necessary.
Single Homeopathic Remedy
One of the most fundamental principles of homeopathy is that of prescribing only one remedy at a time. This is such an obvious principle that it applies to every healing practice. If more than one remedy (or therapeutic technique) is prescribed, any beneficial or adverse effects cannot possibly be evaluated with accuracy. There can be no way to decide which of the components of a combination has acted. In addition, no one can possibly predict the interactions which might occur between a combination of therapeutic influences. If a particular medicine acts in a particular manner when given singly, who can say what it might do after being altered in an unpredictable way by a combination?
Suppose a patient is given a combination of six different homeopathic remedies, and a definite deterioration ensues. What is going on? Is some kind of complex aggravation occurring? Has one remedy produced a healing crisis while another is antidoting any previous progress which might have been made? Is one remedy acting within a few days, while another is acting after a week? Is the patient unusually sensitive to one particular substance? And if so, which substance is it? If the aggravation is judged to be truly serious, how does one go about finding the next remedy that will save the patient?
Conversely, suppose a patient is given a combination of six remedies, and definite improvement occurs over a period of three months. Which medicine produced the improvement? If the improvement proves to be only temporary, how might a related follow-up remedy be chosen? Suppose the active remedy was given in a potency too low for permanent cure, how would one then decide which remedy to give in a higher potency?
There are even further questions. If remedies are proven in the context of separate, carefully-conducted provings, what would happen if they are combined? Would the resulting action be merely a mixture of the separate provings, a "sum of the parts"? Or would the result be a drastically different symptom picture? No provings have ever been conducted on combination remedies, so how can anyone predict what set of symptoms such combinations could cure?
The practice of giving combinations of remedies obviously violates all of the fundamental laws of homeopathy — and common sense as well. Nevertheless, it is common practice in some parts of the world. Some homeopaths take a case, cannot see a medicine covering the totality of symptoms, and so they create a combination of medicines, each of which (according to their estimation) covers a fragment of the case. To make matters worse, it is common practice in such circles to mix potency levels as well, and even to give certain remedies at one time of day and others at other times of day. As the reader of this book now knows very well, the process of homeopathy is to find the remedy with the vibrational frequency most closely matching the resonant frequency of the defense mechanism of the patient. Combination prescribing, in this context, would be analogous to trying to create harmony by tuning six different radios to separate stations simultaneously in the hopes of creating a symphony.
Such practice can only create complete chaos, and indeed some of the most pitiable cases in homeopathic practice are those who have undergone years of such chaotic treatment. The defense mechanism of such patients is so disturbed that it is often completely impossible to restore their health to even the level prior to such prescribing, let alone bring about a cure.
For a conscientious and knowledgeable homeopath, combination prescribing can only be forefully and vociferously deplored. Even the attitude, "Well, we have our way and they have theirs," is insufficient, because such chaotic prescribing can only contribute to the ruination of the reputation of homeopathy. If one is conscientiously attempting to utilize a therapy based on energies beyond ordinary perception, then one must necessarily conform very strictly to the specific and refined laws governing the use of such energies.