DOSE,DILUTIONandtheLMPOTENCIES byJohnMorganM.R.Pharm.S.,R.S.

Hom
HahnemanncompletedthefiftheditionoftheOrganonin1833andthesixthedition bytheendof1841.Hewrotealetterdated20thFebruary,1842,toSchwabe,hispublisherin Dusseldorf sayingthat' Ihave nowafter18monthsofwork finishedthesixtheditionofmy Organon,themostnearlyperfectofall .'Afterstatinghispreferenceastotypeandpaperhe asked Schwabe if he would publish it, but before the negotiations were completed Hahnemann died on 2nd July 1843. His wife Melanie was pressed by Boenninghausen, HeringandotherstudentsofHahnemanntopublishthedocumentafterhisdeath,butshe wouldnotreleasethemanuscripteitherbecauseofadesiretoprotecthisnameorbecause ofherdesireformoney!AlthoughmostwritersfavourMelanie'savariceasthecauseofthe delay,thisisunlikely,asthemanuscriptwasnotreleased,eventhoughshewasover80 whenshedied,andhergreedwasthusleftunsatisfied.Hahnemanndescribedherashis besteverstudentandherdeeploveforhimsurelywithheldthemanuscripttodenyhis criticstheopportunityofjudgingthe6theditionevenmoreeccentricthanthe5th.Itwas only released to the world, after translation, in 1921 when Richard Haehl procured the manuscript from Hahnemann's ancestors by which time there had been a great establishmentofhomopathybyJ.T.Kentandthosewhofollowedhim.Itisironicthat Kent,suchadevotedfollowerofhismaster,shouldhaveonlyhadthefifthedition,andnot the 'most nearly perfect of all' onwhich tobase his teaching. Hadthe 6th edition been availabletohim,thewholeevolutionofhomopathywouldsurelyhavebeendifferent. Kent's contribution to the development of the high potencies established an extensiontoremedypreparationbasedontheguidelinesgivenbyHahnemanninthe5th edition(publishedin1833),namelythecentessimalpotencyscale.By1921,5years after Kent'sdeath,AmericaandEuropewerewellestablishedindecimalandcentessimalremedy philosophysothediscovery,inthe6thedition,ofanewmethodofpotentisingremedies, theLMpotencies,didnot,atthetime,startarevolutiontowardstheiruse.Infactitwasa further 33 years, in 1954, that Dr.Pierre Schmidt of Geneva published essays about his experiencesusingtheLMscale.SincethenonlyafewhavecarriedtheflameinEuropeand India,butrecentlytheworldwidegrowthofhomopathyhasstartedtolookagainatthe LMpotencieswhichHahnemanndescribes,inafootnoteto270asbeing "themostpowerful andatthesametimemildestinactioni.e.asthemostperfected" TheevolutionofthepreparationandapplicationofHahnemann'sremediespassed throughseveralphases.Hisearlyuseofremedies(from1784)weresmallcrudedoses,ofthe drug, in powder or tincture form given according to the homopathic principle. There were,ofcourse,sideeffectsespeciallywiththepoisonousremediessuchasArsenicum,and the desire to eliminate these toxic effects led him to develop, in 1815, the method of trituration and subsequent liquid dilution and succussion, we know as the centessimal potencies.From1815heusedpotentisedremediesforthetoxicandinsolubleinertmaterials suchasSilica,CarboVegetc.anddoseddirectlywithdropsofthelesspoisonousmother tincturessuchasBryonia,Pulsatilla,RhusTox.By1834hewasusingallhisremediesina potentisedform,givingtheappropriatepotencyandtheminimumdose(i.e.quantity)ofhis medicines topatientsbymeansofthesmallestsugargranules available.Thesesocalled 'pellet'dosagesaredescribedinChronicDiseasesp151as 'thefinest,ofthesizeofpoppyseeds, ofwhichabout200(moreorless)weighagrain' andjustoneofthesetinygranules,givendry onthetongue,remainedHahnemann'sstandardsoliddoserightupto1837. Itseemsthattheevolutionofhisremedypreparationwasfuelledbythedesireto create, not only, a highly dynamised remedy but also to give it in the smallest dose (quantity)possibletoeffectacurativeresponse. Hahnemann'swritingsclearlyshowthathedifferentiatesbetweenthelevelofpotencyand

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smallnessofthedosei.e.thequantitygiven. Forexample, Organon 5thedition (1833) 276 "A medicine, eventhough it may be homopathically suitedtothecase,doesharmineverydosethatistoolarge,themoreharmthelargerthedose,andby the magnitude of the dose it does more harm the greater its homopathicityand the higher the potencyselected". Organon5thEdition(1833)246footnote"Now,incaseswherehewasconvincedofthe correctnessofhischoiceofthehomopathicmedicine,inordertoobtainmorebenefitforthepatient thathewasabletogethithertofromprescribingasinglesmalldose,theideaoftennaturallystruck himtoincreasethedose.......and,forinstance,inplaceofgivingasingleveryminute globule moistenedwiththemedicineinthehighestdynamization,toadministersix,sevenoreightofthemat once,andevenahalforawholedrop. Buttheresultwasalmostalwayslessfavourablethanit shouldhavebeen;itwasoftenactuallyunfavourable,oftenevenverybadaninjurythat,ina patientsotreated,itisdifficulttorepair. These days we tend to regard the size of a dose of a centessimal remedy as irrelevant. One tablet or ten tablets taken as one dose still only gives one dose of the potency,doesn'tit? Butthereareunansweredquestions.Forexample,whydowenot nowadaysextensivelyseeremediescausing'moreharmthelargerthedose'?Afterall,the averagedosefromatabletusedtodayisapproximately50timesthedoseofHahnemann's smallgranule.Alsohowfarcanaremedybedilutedbeforetheremedyisinactive?Ifwe dissolveatabletinabathofwaterwillateaspoonfuldosehavethesameeffectastakingthe tablet itself? Why should olfaction of a remedy be more suitable to sensitives? Is this becausetheytakeinasmallerquantityofvapourortabletdust?Andhowfardoesthevial havetobefromthenosebeforethedoseisinactive?Asweshallseemanagementofcases using the LM scale is based on the quantity of medicine the patient takes. Its as if Hahnemanntakesitforgrantedthatweallunderstandtheimportanceofquantity,aswell as potency, when administering a remedy, but this seems almost a revolutionary new concept to us as we rarely consider this factor when using both low and high potency centessimalremedies. Anotherinterestingconcept,whichHahnemannconsistentlyrefersto,istheability ofanincreasednumberofsuccussionstocontinuallystrengthenorintensifythepotency withoutfurtherdilution. Inthe5theditionwefindthefollowingfootnoteto270 "Inorder tomaintaina fixedandmeasuredstandardfordevelopingthepower ofliquid medicines,multipliedexperienceandcarefulobservationhaveledmetoadopttwosuccussionsfor eachphial,inpreferencetothegreaternumberformerlyemployed(bywhichthemedicinesweretoo highlypotentised).Thereare,however,homeopathistswhocarryaboutwiththemontheirvisitsto patientsthehomopathicmedicinesinthefluidstate,andwhoyetassertthattheydonotbecome morehighlypotentisedinthecourseoftime,buttheytherebyshowtheirwantofabilitytoobserve correctly.Idissolvedagrainofsodainhalfanounceofwatermixedwithalcoholinaphial,which wastherebyfilledtwothirdsfull,andshookthissolutioncontinuouslyforhalfanhour,andthis fluidwasinpotencyandenergyequaltothethirtiethdevelopmentofpower." Itismorelikelythat,ratherthananincreaseinpotencylevelitself,thelargenumber of succussions produce a lateral intensification or energising of the solution within the confinesofthedilutionfactoraconceptupheldbytheLMmethod.Iftherewasnota 'ceiling'topotencylevelthenserialdilutionwouldnotbeneededtomakearemedy,one couldsimplyshakeanydilutionfordifferentlengthsoftimeasintheexamplegivenabove.
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Alsothelowerpotenciesareverylimitedbythephysicalmolecularpresenceoftheremedy soitisimpossibletomakea30cifthereismaterialpresenceaspotenciesabove12chaveno moleculesoftheoriginalsubstanceleft. Thequestionremains,however,astowhenapotencylevelisactuallyreachedand howmanysuccussionsareneededtoreachitandalsowhetherdifferentdilutionfactors needdifferentamounts.Forexampleifonesuccussionwillturna29cintoa30cthenextra succussionswillsimplyintensifyonthe30clevel.Ifmoreshakesareneededthenagradual increase in potency occurs until a saturation point arrives and presumably only intensificationtakesplace.InthesixtheditionHahnemanndescribesthedailysuccussionof theLMsolutionsas 'alteringandslightlyincreasingthedegree ofpotency'248 suggestinga gradualalmostexponentialcurveofincreasingpotencywhichneveractuallyreachesthe nextdegreeuntilafurtherdilutionstepistaken. Hahnemann'sthoughtsareshowninthefollowingextracts, Materia Medica Pura (1827) p46 ....... we must act with moderation in order to avoid increasingthepowersofthemedicinestoanundueextentbysuchtrituration.AdropofDroserain the30thdilutionsuccussedwith20stokesofthearmateachdilution,givenasadosetoachild sufferingfromwhoopingcough,endangerslife,whereas,ifthedilutionphialsaresuccussedonly twice,aglobulethesizeofapoppyseedmoistenedwiththelastdilutioncuresitreadily. Organon6thEdition(1842)270footnote ......withsosmalldilutingmediumas100to1ofthe medicine,ifmanysuccussionsbymeansofapowerfulmachineareforcedintoit,medicinesarethen developedwhich,especiallyinthehigherdegreesofdynamisation,actalmostimmediately,butwith furious even dangerous, violence, especially in weakly patients, without having a lasting, mild reactionofthevitalprinciple. OnthesubjectofrepetitionofacentessimaldoseofthesamepotencyHahnemann showsanimportantchangeofmindbetweenthe2editions.Inthe5thedition246footnote headvocatesthat "......asingledoseofawellselectedhomopathicmedicineshouldalwaysbe allowedfirsttofullyextenditsactionbeforeanewmedicineisgivenorthesameonerepeated.", then continues in this long footnote to give details of certain chronic and serious acute conditionswhenitisactuallynecessarytorepeatthedoseseveraltimestoeffectacure, althoughheadvisescautionas"hehasfrequentlyexperiencednoadvantage,butmostfrequently, decideddisadvantage" Whereas in the 6th edition the rewritten 246 dismisses the above as " all my experiencepermittedmetosayatthetime.." andthathisresearchofthepreviousfiveyears hadwhollysolvedthedifficultiesofrepetition. 247clearlystateshisrenewedposition "Itisimpracticaltorepeatthesameunchangeddoseofaremedyonce,nottomentionits frequentrepetition(andatshortintervalsinordernottodelaythecure).Thevitalprincipledoesnot acceptsuchunchangeddoseswithoutresistance,thatis,withoutothersymptomsofthemedicineto manifestthemselvesthanthosesimilartothediseasetobecured,becausetheformerdosehasalready accomplishedtheexpectedchangeinthevitalprincipleandaseconddynamicallywhollysimilar, unchangeddoseofthesamemedicinenolongerfinds,therefore,thesameconditionsofthevitalforce. Thepatientmayindeedbemadesickinanotherwaybyreceivingothersuchunchangeddoses,even sickerthanhewas,fornowonlythosesymptomsofthegivenremedyremainactivewhichwerenot homopathictotheoriginaldisease,hencenosteptowardscurecanfollow,onlyatrueaggravation oftheconditionofthepatient." After many years of continued experimentation, Hahnemann published new procedures,whichsolvedsomeoftheproblemsofdoseandrepetition.Theyformedthe basisoftheLMmethod,whichwastofollowafteranotherfiveyearspainstakingwork. Thisfirstbreakthroughcomesin1837whenthechapterinChronicDiseasescalled 'Concerning the technical part of Homopathy' describes the new plussing method for
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administering centessimal potencies. He is lead to changes of the dosing of remedies becausethe"varietyamongpatientsastotheirirritability,age,spiritualandbodilydevelopment necessitateagreatvarietyintheirtreatmentandadministrationtothemofthedosesofmedicines". Hahnemannfeltthatthe'singledoseandwait'philosophylefttoolongaperiodofinaction andthespeedofcureoftentooslowasthepractitionercoulddonothingbutwaitforthe remedy to complete it curative curve. Also, from his many comments about violent reactions to remedies, the sensitive patients he saw were producing undesirable aggravations,whichheconstantlysoughttoescapefrom. Hefirstly introducesthegreaterbeneficialeffectsofadministeringremediesalways inliquidform,thereasonforthisbeingthatthemedicine "comesincontactwithamuch larger surface of sensitive nerves responsive to the medicinal action" (5th edition 286) and becauseofthistheeffectoftheremedyincreases.Oneofthegranulesofhighdynamisation (herefersmostlytothe30c)isdissolvedin720tablespoonsofwaterwithalittlealcohol added. The patient then takes, directly from the bottle, a tablespoon of the liquid (a teaspoonorcoffeespoonfulsforchildren)two,fourorsixhourlyforacutes,dailyorevery other day for chronics. The choice of how many tablespoons tomake the solution with 1 dependsonhowmuchofthegranuleisrequiredineachtablespoondosei.e. / thgranule 7 1 (7tablespoons) / th(20tablespoons),aswellasforhowmanydaystheremedyistobe 20 given.Thedifferingamountofsolutiontobemadeupgivesflexibilityforeachpatients needs and infers that the remedy action is different (weaker) in its 'intensity' the more diluted the original granule becomes. Additionally, before each dose is taken " a slight changeinthedegreeofdynamisationiseffectedifthebottle,containingthesolutionofoneormore pellets,ismerelywellshakenfiveorsixtimes,everytimebeforetakingitThus eachdaysdosage remainshomopathictothecaseastheslightincreaseinthehealthofthevitalforceis matchedwiththeslightincreaseinpotencycausedbythefiveorsixshakesofthebottle. The regular stimulus of the remedy, which is homopathic both in pathogenesis and potency,isthekeytothespeediercure. ThesamechapterinChronicDiseaseshighlightsthisthus "Intakingoneandthesame medicinerepeatedly(whichisindispensabletosecurethecureofaseriouschronicdisease),ifthedose isineverycasevariedandmodifiedonlyalittleinitsdegreeofdynamisation,thenthevitalforceof thepatientwillcalmly,andasitwerewillinglyreceivethesamemedicineevenatbriefintervalsvery manytimesinsuccessionwiththebestresults,everytimeincreasingthewellbeingofthepatient." Anothermethodfordosing "carefulpatients isalsosuggestedinthesamechapter wherebythepelletisdissolvedin200(approx.8ml),300(12ml)or400drops(16ml)ofa50% brandysolution,dependingonwhetheritistobeweakerorstronger,andone,two,threeor severaldrops,accordingtotheirritabilityofthepatient,aredroppedintoacupcontaininga tablespoonofwater.Thiswellstirredthentakenallasonedoseoronlyhalfistakenif "specialcareisnecessaryThe 'stock'bottleisshakenassuggestedinthemethodabove. Soherewehaveasexampleofreducingthedosefurtherbyusingdropsratherthan tablespoonssoastonotoverstimulatethesensitiveor'careful'patient.I.e.thesmallerthe quantity of the pellet received in the dose the less its undesirable effects. There is an optimumdosage,whichsuitseachpatientasthedilutingweakensthepotencysoitdoesn't overstimulate.Theoptimumdoseindividualforeachcaseisthesmallestamountneeded for a gentle but certain remedial effect. These are also the principles on which the LM methodisbased. LastlyHahnemannpavesthewayforthefinalstep,intohismostperfectmethod,witha famousparagraphconcerningthenumberofsuccussionsgiventothevialwhenpreparing centessimal remedies. The homopathic Pharmacopoeias officially advocate ten succussions as the number to use when preparing C potencies, but I believe they have missed a small point when interpreting Hahnemanns reasons for change. In Chronic
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Diseaseswearetoldthatwhengivingremediesinsolidformi.e.granulesorpowdersdry onthetongue,Hahnemannfoundthatremediespreparedwithmorethantwoshakeswere toostrongsostayedwithtwostrokesforconsistency;but "duringthelastyearssinceIhave beengivingeverydoseofmedicineinasolution,dividedoverfifteen,twentyorthirtydaysandeven more, nopotentisinginanattenuatingvialisfoundtoostrong, andagainIusetenstrokes. In otherwordsaslongasthedoseisinliquidform,andcanberegulatedastotheoptimum sizeandrepetition,thennomatterhowmanysuccussionsareusedtopreparetheoriginal remedyitwillnotbetoomuchforthepatient.Thisalsoconfirmstheideathattheintense actionofahighlysuccussedremedyisdiminishedbydilution. THELMPOTENCIES From18371843,asfarasisknown,allHahnemann'sadministrationofremedieswas doneinliquidformusingvariationsontheabovethemes.Thefinaldevelopmenttocreatea morehighlydynamisedremedywasthechangeofthedilutionfactorfrom1:100to1:50,000. The3ctriturationpowder(detailsofthepreparationofthisarein270)isthestartingpoint forthepreparationoftheLMscalebecauseallremediesaresolubleinwateratthispoint;so anyremedycanbeutilisedeventheinsolublematerialssuchasCarboVeg,Aurumetc.A graininweight(0.06gm)ofthispowderisdissolvedin500drops(30ml)of20%alcohol makinga1:500dilutionofthe0.06gmof3c,andonedropofthissolutionisthenfurther dilutedin99dropsof95%alcohol,fillingtwothirdsofaglassvial,givinga(1in500x100= 50,000)solutionofthe3cpowder.Thistubeisthensuccussed100timesagainstafirmbut elastic object (the famous leather bound bible) to create the LM 1 medicating liquid. Hahnemann'scommentsonthisnewmethodarefoundinthe6thEdition270 " .... meticulous experiments have convinced me that this ratio (1:100) between the quantity of diluentandthatofthemedicinebeingdynamisedisfartoolowtodevelopthemedicinalsubstance properlyandtoahighdegreewithalargenumberofsuccussionsunlessforceisused......Whereasin this much higher ratio (1:50,000), between diluent and medicinal substance, a large number of succussionsofthevialfilledtwothirdswithwinespiritcanbringaboutafargreaterdevelopmentof power." TheLM1liquidisthenpouredontosomepoppyseedgranulesofwhichahundredweigh 1 grain (0.06gm). Although this size is larger than those granules advocated in Chronic Diseases(200toagrain)theyarestillsosmallthatonedropofthealcoholicLM1liquidcan completelywetatleast500ofthem.Thusjustonegranuleabsorbsatleasta500thofadrop. Whenthisgranuleisdissolvedinadropofwater,and99dropsofalcoholareaddedtoit, thenextLM2solutioncontainsa1/500thx100=1/50,000thofthepreviousLM1liquid. The LM2liquidisthensuccussed100timesalso.The processiscontinuedinthisway simplyusingthegranuleastheintermediarytotransfera500thofadropinsteadofthe directadditionofawholedrop,asisthecasewiththecentessimal1:100ratio.Hahnemann's practicalsimplicityismasterfulasthesmallgranulesnotonlyprovideatiny,manageable dose,forusingwithpatients,butalsothesmallestpracticalunittoeffectsuchlargedilution ratio.Onecouldtheoreticallydilutewithonedropto50,000drops(100dropsof95%alcohol =3.6mls)butthebottletobesuccussed100timeswouldthencontain1.75litresofalcohol. Notaneconomicorpracticalsizefortheaveragehumanbeingtoworkwith! Althoughthenatureofthe1:50,000potencycreatedisdifferentfromthatcreatedby a1:100ratio (...mynewmethodproducesmedicinesofthehighestpowerandthemildestaction ...270) itisinterestingtonotethetheoreticalrelationshipwiththecentessimalscale.Each stepof1:50,000isariseofapproximately2.5Csothatconsideringwestartedwitha3Ca LM1isjustover5C,LM6=17C,LM12=31C,LM30=73C(allapproximatefigures) Sothegranulesarewettedwiththesolutionandlefttodryafterwhichtheyarebottledand labelledwiththeappropriatenomenclaturee.g.LM1,LM2orLM0/1,LM0/2etc.thezero signifyingthegranule,theforminwhichthefinalmedicineisstored.
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Nowwehavethishighlydynamisedremedyourcriteriaforhowtousethemare differentfromthoseofthecentesimalscale.Obviouslytheindicatedsimilarremedyisstill chosenonthesameprinciplesasbeforebutchoiceofpotency,uptonowourmainvariable factorforcontrollingtheresponsetotheremedy,isnotsuchasissuewhenusingtheLM's. Hahnemann'srecommendationistoalwaysstartwiththe lowestdegrees(246). Although notspecificallymentioned,thissuggestsalwaysstartingwithLM1,butisofteninterpreted, by experienced users of LM's, as between LM 1 and LM 6. The choice is based on the health/vitality level, degree of pathology, suppression, sensitivity etc. and provides a variableonwhichwecanindividualize. Withthedissolvinginliquid,andsubsequentshakingofthebottlebeforeeachdose,the potency is gradually raised, expanded, and intensified to continually stimulate the vital forceatregularintervals.Thenextpotencylevelisgivenwhenthebottleoftheprevious potencyisfinished.Noleapsinpotencyarerecommended(246)andifonestartswithLM 1,forexample,thenLM2followsandsoon.Unlesswedissolveagranuledirectlyin1.75 litresofwaterwewillneveractuallyreachthenextLMlevelbutsimplycontinuetowards thepotencyleveldeterminedbythedilutionfactor. AfterwehavechosentheappropriateremedytogiveinLMform,thefirstchoice, afterthepotency,ishowmuchofthegranuleisthepatienttotakei.e.thedose,howoftenit istoberepeatedandforhowmanydaysaretheytobeonthatparticularpotency.Theseare the areas where the difficulties of the LM's lie and, as Hahnemann tells us in 278, theorizingisnotenoughtotelluswhattheidealdegreeofsmallnessofthedoseistoeffect agentlecure,andthat"Onlypureexperiment,themeticulousobservationofthesensitivityofeach patient,andsoundexperiencecandeterminethisineachindividualcase". Control of the dosage is very similar to the centessimal 'plussing' technique but usingtheLMgranule,insteadofa30c,dissolvedinliquid.Thedirectionsformakingupthe solutionsforpatientusearedefinedquiteclearlyinthe6thedition248footnote.Hestates thatonerarelyneedsmorethanonegranulealthoughtwoorthreecanobviouslybeusedif astrongersolutionisrequired.Thegranuleisdissolvedinforty,thirty,twenty,fifteenor eighttablespoonsofwaterwiththeadditionofalittlealcoholtopreserveit;10%isagood guideforsolutionsdesignedtolastuptotwomonths.Thepatienttakes directlyfromthe 'stock'bottle"oneor,increasingprogressively,morecoffeeorteaspoonsofthisasfollows:inchronic diseases,dailyoreveryotherday;inacutediseaseseverysix,four,threeortwohours...." Eight, ten, or twelve succussions are given to the bottle before each dose. Again we have here a variable,whichwecanusetoregulateindividualneedsifrequired,twelveshakesgivinga slightlysharperdailyriseinpotencythaneight.Alsonotethewording' oneorincreasing progressivelymoreteaspoons' which,ifappropriatetothecase,canspeedupcurebygiving increasedstimulusfromthelargerdoseaswellastakingthepatientthroughthehigher potenciesmorerapidly. Tohelpusdecidehowmuchliquidtomakeupletuslookattheappropriatedosagesfor eachofHahnemann'ssuggestions. Atablespoonisconsidereda20mlmeasure,ateaspoon5ml,andacoffeespoonful2.5ml,so agranuledissolvedin: 1 1 40tablespoons=800ml= / thgranule/mlsoa5mldosecontainsa / thofagranule. 800 160 (160dayssupply) 1 30tablespoons=600ml= / thofagranuleper5mldose(120dayssupply) 120 1 20tablespoons=400ml= / thofagranuleper5mldose(80dayssupply) 80 1 15tablespoons=300ml= / thofagranuleper5mldose(60dayssupply) 60

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1 8tablespoons=160ml= /

thofagranuleper5mldose(32dayssupply) 32 Acoffeespoonfulwillrepresentadosagetwiceassmallastheabovei.e.40tablespoons= 1 / thofagranuleper2.5mldose. 320 Asbottlesabove300mlsarenotverypracticalforpatientstouseHahnemann'spracticality introducestheuseofadrinkingglasstofurtherdilutethesolutionandobviatetheneedfor alargeamountofwater.Themethodisgivenindetailin248.Onegranuleisdissolvedin sevenoreighttablespoonsofwaterandaftersuccussionatablespoonfulisputintoaglass containingeighttotentablespoonsofwater.Aftervigorousstirringateaspoonorcoffee spoonfuldoseisthentakenfromtheglass.Thennextdoseispreparedinexactlythesame wayusingafreshglassofwater.Thismethodrepresentsthefollowingdose, 1 1 8tablespoons(160ml)= / thgranule/tablespoon(20ml)dilutedx10= / thper20mlsoa 8 80 1 5mldose= / thgranulewhichistheweakestdoseHahnemannrecommendsbuttakes 320 thepatientonly810daystofinishandbereadyforthenextpotencyup. DrPierreSchmidtusedonegranule in100mlsofwaterandacoffeespoonfulasadose 1 whichrepresented / thofagranuleper2.5mldose(40dayssupply). 40 DrRobertShoreandDrHChoudhurybothdosewithonegranulein110mlwaterputting 1 onetablespoonfulinaglassof110mlsofwaterwhichrepresents / thofagranuleper 160 5mldose(6dayssupply). Othercommonlyusedmethods,forpreparingweakersolutions,include, Onegranulein150mlstockbottleanda5mlspoonfulinapprox.100mlswaterintheglass, 1 soone5ml= / thgranuleper5mldose(30dayssupply). 600 1 Onegranulein10mlswaterthen10dropsin100mlswaterinaglass= / thgranuleper 260 5mldose(20dayssupply). Verysensitivepatientswhoquicklybecomeoverstimulatedbyorprovetheremedywhen giveninthestandarddosecanreduceit,nexttime,bydilutingateaspoonfulfromthefirst glassinasecondglassofwaterthusreducingthedosebyafactorofabout20foreachglass used. The variations mentioned above provide much flexibility with different combinations of dose and speeds of potency increase reaffirming the importance of 'meticulousobservationofthesensitivityofeachpatient.' 278 CasespublishedshowHahnemannusedmostoftentheeighttablespoonstockbottle andglassmethodin248fordosingpatients.Thisprovidesaweaksolutionbuttakesthe patientthroughtothenextpotencylevelinonly78days.Itisimportanttorememberthat the Organon gives many possibilities to tailor dosing to the needs of the patient and experiencewillshowuswhatismostappropriate.ThebeautyoftheversatileLMmethodis thatwecanalsojustchooseoneortwomethodstogainthatexperiencewhilestillgiving ourpatientsthegentlebutspeedyimprovementtheydesire. CASEMANAGEMENT ManypractitionerscometouseLMpotencieswhentreatingcaseswhichneedmore carebecauseofrisksofaggravatione.g.patientswhoareverysensitivetoremedies,those withverylowvitality,caseswithseverepathology,historyofsuppressivetreatmentsetc.

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Butintheoryallcaseswhetheracuteorchronic,showingpathologyornotcanbetreated withLM'sandtherearemanypractitionerswhousetheseremediesexclusively.Inpractise, however,somepatientsmayneedthequalitiesofthecentessimalremediestoawakentheir selfhealingprocess.TheLM'sgiveusyetanothervaluablestringtoourbowtobechosen appropriately. Alternating periods of treatment with LM's and C's are also possible rememberingthatthelowestdegreesofpotencyaretobeusedwitheachnewLMeventhe lastremedywasahighcentessimalofthesameremedye.g.Sulphur10misfollowedbythe lowestLM(SulphurLM1) Management of cases with LM potencies is quite simple as long as patient complianceisgoodandifafewsimpleguidelinesarefollowed. Afterasuitablesolutionhasbeenchosenthepatientcontinuestodoseappropriately i.e.daily,oreveryotherdayetc.,whilethereisimprovementtothecaseandthepatient doesnotshowanynewsymptoms248.Eachdosestimulatesareactiontothevitalforce, whichmovesupalevelinhealthonlytobefurtherstimulatedbythefollowingdose,which matches the favourable change in the patient and remains completely homopathic as regards symptoms and potency level. The intensity of the potency, determined by the quantityofdosegiven,isalsoregulatedtotheoptimumespeciallyifthedosesareincreased progressivelyasissuggested.e.g.anextra5mlspoonfuleachweek.Howeverasnodose caneverbetoosmallthenanydosinglevelwillhavesomeeffect. Ifthereisnoimprovementafterafewdaysthenitiseithernottheappropriateremedyor therearesomeenvironmentalmaintainingcausesblockingtheremedyaction252. Ifnewsymptomspreviouslynotseenbeforeappear,thentheremedyisnotthebestchoice, becausethesymptomsarenotbeingcuredbytheremedy,sodosingisstopped.Thenew picture is then assessed and another remedy given starting at the lowest degrees of dynamisation(LM1)regardlessofwhatpotencylevelthepreviousremedyhadreached. AlthoughLMpotenciesarethemosthighlydynamisedremediestheyaremuchmilderthan thecentessimalsinaction.Howeveraggravationsstilldooccurandareusefulguidesto remedyreactionastheyarewiththeCscale.TheLMaggravationcomestowardstheendof treatmentandisareturnofoldsymptomsstimulatedbytheremedyitself.Asthecurative curveofaparticularremedycomestoanend,thevitalforcehasonlytheexcessartificial diseasestimulusoftheremedytorespondtosusceptibilityhavingbeensatisfied. The remedyisstopped.Ifthesymptomsdisappearinafewdaysnomoremedicineisneeded, butifthesymptomspersistdosingcontinuesasbeforetocompletethecure281. Anaggravationofsymptomsatthebeginningoftreatment,i.e.withlowpotencies,isasign ofoverstimulation(toomuchintensity)andindicatesthedosewastoohigh.Toalleviate this the amount taken from the stock bottle is reduced to a level, which creates no discomfort,andtheremedyiscontinuedusingthatdosageroutineuntilanincreaseindose isappropriate282.Inpractisetheuseofsuccessivedilutionsusingthedrinkingglassisthe mostusefulmethodtoeffectthisorbysimplyreducingthedosegivenfromthestockbottle e.g.ahalfteaspoonfulinsteadofafulloneifthemedicineisbeingdoseddirectlywithout theuseofglasses.Reductionofdoseissimilarlyusedforsocalledsensitivecasesthatare immediately over stimulated or prove the remedy during the first days, or hours, of treatment.Iftreatmentisstartedwithhigherpotenciese.g.LM3andabove,theninitial aggravationscouldalsobeduetoatoohigherpotencyaswiththecentessimalpotencies. ASUMMARYOFHAHNEMANN'SDIRECTIONSfortheuseofLMpotencies. 1. Theremedymustbehomopathic246 2. Theremedymustbehighlypotentisedi.e.preparedbytheLMmethod246 3. Theremedymustbegiveninsmalldosesi.e.dissolvedinwaterbeforeadministrationto thepatient246

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4. Theremedymustberepeatedatsuitableintervals246 5. The potency must be altered before each dose i.e. raised by succussion 246. The solutionistobesuccussed8,10,12timesbeforetakingone, or(increasingprogressively) morecoffeeorteaspoonsdailyoreveryotherday(forchroniccases),2,3,4,or6hoursfor acutes.248 6. Potencymuststartwiththelowerdegrees(LM16?)andproceedtothehigherlevels 246footnote 7. Evenlongactingremediescanberepeated248 8. Dosing is continued while there is steady improvement and the patient does not experienceasymptomhehasnothadbefore.248 9. Ifanew setof differentsymptoms are seen,thenanothermore appropriate remedy mustbelookedfor.248 10. Ifanaggravationoccursi.e.anintensificationoftheoriginalsymptoms,attheendof treatment,thenthedosesmustbereducedinquantityandrepeatedatlongerintervals,or stopped altogether to see if the symptoms will continue to disappear by themselves. In whichcaseeithernomoremedicinewillbeneededorcontinuationoftheremedyif,aftera certainperiod,symptomscontinue.248 11. Nodoseofahighlypotentisedremedycanbetoosmallthatitcannotbestrongerthan thenaturaldisease,thatitcannotatleastpartiallyovercomeitandthatitcannotstartthe processofcure.279 12. Ifoneissurethattheremedyiscorrect,andthereisnoimprovementthenitislikelythat amaintainingcauseinthepatient'swayoflifeorenvironmentisinfluencinghisprogress. Thismustberemovedtobringaboutapermanentcure.252 13. Aggravationsorameliorationsofthepsychicconditionsandgeneraldemeanourofthe patientareagoodindicationastotheprogressoftheremedy.253 14. Ifthepatientdevelopssomesignificantnewsymptomsorsymptomsoftheremedythen thisisanunfavourableresponse.256 15. Donotmakefavouritesofcertainremedies,asthesmallerlesserusedremedies,which mightbemorehelpful,willbeoverlooked.257 16. Itisnotnecessarytogiveapatientmorethanoneremedyatatime.273 17. Iftheremedyishomopathicallyaccuratethenitbecomesincreasinglybeneficialasits doseapproachestheidealdegreeofsmallnessforgentleaction.277 18. Itisonlybyexperiment,experienceandobservationofthesensitivityofeachpatient thatcandeterminetheoptimumsizeofdosetogive.278 19. Dosingcontinues,increasingitprogressively,untilthepatient,whilefeelinggenerally better,beginstomanifestoneormoreoftheold,originalsymptoms.280 20. Return of old symptoms is a good sign and the medicine is stopped, as this is an indicationthatnomoreisneededasthesymptomsareoftheremedy.Toverifythisthe remedyisstoppedforaweekortwo.Ifthesymptomsareoftheremedytheywilldisappear inafewdaysandnomoremedicinemaybeneeded.Iftracesoftheoriginalcomplaint remainthendosingshouldbecontinuedfromwhereitwasleftoff.281 21. A homopathic aggravation i.e. an intensification of the original complaint, at the beginning of treatment, is a sure sign that the dose (i.e. the quantity of the dissolved granule)istoolargeandmustbereduced.282 22. Ifthesmallestdosesaregiventheeveniftheremedyisinappropriatetheharmdoneis insignificantandtheappropriateremedyquicklyputsthecaseinorder.283 23. Verychronicproblemscanbespeededupbyapplyingthesamesolutionasthattaken bymouth,externallytotheback,thighsandlowerlegs. This article hasbeen anattempt touse Hahnemann's writings tounderstand the dynamicsofpotencyand,inparticular,theLMpotencies.Itisinterestingtonotethattheir

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evolutionwasalongandgradualoneandnotsucharevolutionarynewconceptbutsimply anextensionofwherewearenowi.e.incentessimalpotency(5thedition)philosophy. Theirwideflexibilityandsafetyleavesilentmanyoftheoldargumentsaboutrepetitionand potencychoice,allowingusallaveryfreeandindividualapproachtotheiruse.Itisalsoa factthatalthough6theditionphilosophyistaughtandrevered,thepracticalmethodsgiven toapply this teachinghave been, over theyears, sadly neglected. Thankfully the recent revivalhasgeneratedanewenthusiasmfortheuseofLMpotenciesgivingusafeelingthat, atlast,theirtimehascome.

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Possible observations after giving the remedy 1. 2. 3. 4. 5. 6. 7. No change - how long must we wait, how long does a dose take to act? Very slight change - nothing much, how long to go on for. 2 weeks? Good start then acute Aggravation at the start - acute and chronics 6/8/10 days? Good start then relapse. Sensitive patient - becomes over stimulated or proves everything feels speedy, queer, quick changes. Generally better but some symptoms remain. OK to increase the dose?

8. OK but shows some symptoms of the remedy - reduce the dose or increase interval between them. 9. 10. Symptoms but generally worse, no improvement. a. continue a bit longer or b, partial remedy. Aggravation comes at the end of 3-4 weeks after improvement.

11. New symptoms come up not of the remedy with no change generally - new remedy needed. 12. As above but feeling better, change remedy if picture changes

13. Good improvement but slowing down after 3 weeks. Increase dose or raise potency to see what happens. 14. Remedy aggravates initially and remains aggravated. Antidote with new remedy or low potency of same remedy.

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Helios Homopathic Pharmacy

97, Camden Road, Tunbridge Wells, Kent, TN1 2QR
0892 537254/536393

DOSAGE INTRUCTIONS FOR TAKING LM POTENCIES From the stock bottle take................ teaspoon /tablespoonful and put it in a clean glass containing eight tablespoonfuls of water (spring water is best). Stir the glass vigorously and take ............ teaspoon/tablespoonful dose, holding it in the mouth for a few seconds before swallowing. Discard the remainder of liquid in the glass. Carry out this procedure ........................................................................ Using a fresh glass of water but SHAKE THE STOCK BOTTLE ON A BOOK OR THE PALM OF YOUR HAND 8 to 12 TIMES before putting the dose into the glass.

Helios Homopathic Pharmacy

97, Camden Road, Tunbridge Wells, Kent, TN1 2QR
0892 537254/536393

DOSAGE INTRUCTIONS FOR TAKING LM POTENCIES From the stock bottle take ONE teaspoonful and put it in a clean glass containing eight tablespoonfuls of water (spring water is best). Stir the glass vigorously and take ONE teaspoonful dose, holding it in the mouth for a few seconds before swallowing. Discard the remainder of liquid in the glass. Carry out this procedure ONCE A DAY Using a fresh glass of water but SHAKE THE STOCK BOTTLE ON A BOOK OR THE PALM OF YOUR HAND 8 to 12 TIMES before putting the dose into the glass.

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