Monika Müller-Amenitsch, Homöopathie & Bowen-Therapie für Erwachsene und Kinder
Posology: Q/LM/C potencies - repeated and modified dose or single dry dose?
Abstract: In Homeopathy there are many different opinions and methods concerning posology. Hahnemann, the founder of homeopathy, changed his opinion concerning the administration of doses. From the “watch and wait method” (1829) with dry C potencies that are diluted 1:100 in the form of globules that are not to be repeated as long as the case is in progress he moved to the administration of C potencies that are modified by dilution and succussion and that are to be repeated during the healing process (Hahnemann, 1833). His experiences resulted in his newest and last method: The prescription of Q potencies that are diluted 1:50.000 (Hahnemann, 1992). Hahnemann described this last method as the quickest and most gentle one since aggravations can almost be avoided. When studying homeopathy I have learned the “watch and wait method” with dry C potencies and the method with Q potencies. Therefore both methods had and have an impact on my practice and my aim is to critically examine if Hahnemann’s newest method is really superior to the prior one or if there is a gap between rhetoric and reality? Can all cases be treated with Q potencies or are there cases when it is better to prescribe dry and single C potencies? Is there an almost perfect or ideal method of posology or is this assumption a sacred cow? Why do so many contemporary homeopaths still stick to the old method? I will discuss advantages, uncertainties and disadvantages of both methods and will write down some of my own experiences as well as some of those I have found in published homeopathic literature.
Key words: Posology, potencies, aggravations, dry and single dose, repeated and modified dose.
Introduction: In § 242 of the 4th edition of the Organon Hahnemann (1829) forbade to repeat a dose as long as the healing process is going on. In the 5th edition of the Organon Hahnemann (1833) introduced to administer C potencies in diluted water and to modify and repeat them even though the healing process is progressing. Hahnemann abolished an order that is very important in my opinion. Many contemporary homeopaths work successfully with this “old method”, as for example George Vithoulkas (2000) and Vassilis Ghegas (1994, 1999). In my own practice I experienced strong aggravations when especially C potencies were repeated too early. Through the repetition of diluted and modified C potencies some patients had strong aggravations especially on the emotional level. Therefore I became very cautious with this method. Hahnemann made a lot of experiments with dilutions and succussions. He searched for a new way for patients with a low vital force due to a serious illness or cancer since these patients could not endure C potencies (Wurster, 2006). In 1842 Hahnemann completed the manuscripft of the 6th and last edition of the Organon (1992) and there he introduced in § 270 Q potencies that are diluted 1:50.000 and are administered in modified form by dilution and succession while the case is in progress. This manuscript remained unpublished for 79 years (Schmidt, 1994). After its German publication in 1921 by Richard Haehl and its English publication in 1922 by William Boericke according to Schmidt (1994) Hahnemann’s new posology was at first completely ignored by the homeopathic community. In the 1950s the Swiss homeopathic doctors Rudolf Flury, Adolf Voegeli, Pierre Schmidt and Jost Künzli von Fimmelsberg started to draw the attention to the new potencies which from then on were called Q or LM potencies. But the new method was adopted very reluctantly. In the German speaking countries one of the main reasons for this was that Haehl’s edition of the Organon was questioned since it was based only on a transcript of Hahnemann’s manuscript (Schmidt, 2006). Since 1992 this edition is proved to be authentic (Schmidt, 1994). Probably because of this especially German practitioners started only in the 1990s to apply Q or LM potencies. So experiences with Q or LM potencies are of a shorter duration than those with C potencies and we find more literature on C potencies than on Q potencies. Q potencies are a relative new field. Hahnemann described his last method as the quickest and most gentle one as aggravations can almost be avoided. On the following pages I will reflect on advantages and disadvantages of Q potencies, on their schematic administration as well as on LM potencies that are also diluted 1:50.000 and that are administered and manufactured differently.
Q potencies and their advantages
The common method with Q potencies is to start with a Q1 and to continue with Q2, Q3, etc. A Q2 is made as follows: One globule of a Q1 is diluted in a drop of water. Then 100 drops of alcohol are added and afterwards the dilution is dynamized by 100 strong succussions. Dry globules moistened with this dilution are a Q2. A Q3 is made out of a Q2 in the same way. Through this method sudden potency jumps are avoided (De Schepper, 2006). The increase of potency by continuous dilution and succussion is carried out very gently and the vital force is not overstrained. In § 246 Hahnemann (1992) wrote that with Q potencies the healing process is accelerated and in § 161 (1992) he wrote that aggravations can almost be avoided in old chronic cases and that aggravations might only arise at the end of a cure when the healing process has almost or completely taken place. So Q potencies can be considered as a solution to the problem of repeating potencies to accelerate the healing process and to avoid aggravations nevertheless (Schmidt, 1994). Since with Q potencies aggravations can almost be avoided they are very good for patients having experienced a lot of suppressions (De Schepper, 2006). Suppressions take place when diseases, rashs or discharges are stopped but not healed with for example antibiotics or cortisone. I know from my own practice that patients with a lot of suppressions in their history often have profuse excretions or reactions after C potencies. Some patients like that because they feel that their general condition improves. But there are on the other hand sensitive patients who feel uncertain by such a process even though the practitioner has explained them the advantages of such a reaction. For those patients Q potencies might be a solution. As with Q potencies aggravations can almost be avoided they are the ideal potencies in palliative medicine as well as for cases with very severe pathologies (De Schepper, 2006). Meyer-König was one of the first practitioners in Germany working with Q potencies. He found out that Q potencies are good for melancholic and phlegmatic patients since their reactions to changes of their surrounding are sluggish (Meyer-König, 1995). According to him this type of patient has a tendency to develop chronic degenarative diseases. He is not in a position to react quickly on a C potency. Therefore its power has vanished before the organism has absorbed the energy. Meyer-König (1995) experienced that it is good for these patients to start with a daily administration of Q potencies for a period of one to two weeks. By this method their organism can adjust slowly to the repeated impulse of the potency and give rise to a gradual healing process. When the reaction improves the repetition of the dose can be adjusted. So Q potencies are appropriate for patients who are weak in their reactions and who are not in a position to take up the strong impulse of a C potency. Wurster (2007) works a lot with patients having cancer and he has achieved good results with Q potencies. He made the experience that the vital force of this group of patients is too weak for C potencies and that their symptoms can easily be suppressed with C potencies when they are repeated too often. De Schepper (2006), however, wrote that cases with advanced pathologies as cancer should absolutely be started with very low potencies. He normally started these cases with a C6 in diluted and modified form before he continued with Q potencies.
LM potencies compared to Q potencies
In Germany Q and LM potencies are not identical. LM potencies are also diluted 1:50.000 but they are not exactly manufactured according to §270, 6th edition of the Organon. Meyer-König (1995) wrote that in the case of LM potencies the size of the globules is not as demanded in the prior mentioned paragraph and if it is a remedy made out of plants it is not the fresh plant that is used. In Q potencies the quality control of the raw materials is better. LM potencies are produced industrially while Q potencies, since they are produced exactly according to §270, 6th edition of the Organon, are handmade. That is a reason why Q potencies are stronger and they are more likely to produce quick reactions. In LM potencies you make potency jumps from 6 to 12, 18, etc. and you adjust the potency to the case. Besides C potencies I also work with LM potencies and I experienced most of the time good results. But sometimes it turned out that patients that I judged to be very sensitive did not bear the repeated dosage. They needed LM potencies like C potencies: The dose was repeated only after the improvement had decreased. Ghegas (1994) warned not to give a remedy while the patient feels good. He only worked with C potencies. But this rule is sometimes also valid for LM or Q potencies.
Q potencies and their uncertainties
In § 281, 6th edition of the Organon Hahnemann (1992) wrote that the first small doses must be gradually raised higher if a cure is to follow after having stopped the remedy. In § 280 of the same edition he wrote too that the dose of the medicine that helps is to be continued while gradually ascending until old symptoms arise. Practitioners working with Q potencies schematically start with a Q1 to continue with a Q2, etc. When working with C or LM potencies you adjust the potency according to the case. A chronic case is good to start with a lower potency like a C30 or C200 (Saine, 2004) since then you can go up the potency scale. My experience is that especially in acute cases for example a C200 did not work but the C1000 of the same remedy did. Of course I was sure that the chosen remedy was the right one. Here it turned out to be good to make a potency jump. Saine (2004) even recommended to start an acute and clear case with a very high potency like a C50.000 or C100.000. He recommended this because in acute cases it is good to give a strong impulse and you normally do not need the whole potency scale. When applying LM potencies it is usual to start chronic cases with LM12 or LM 18 and then to continue with LM24, 30 etc. But why does it make sense in the case of Q potencies to always start with a Q1? Meyer-König (1995) wrote that Hahnemann gave in the above mentioned paragraphs the clear advice to start all acute and chronic cases with the Q1. But I cannot find this statement in these paragraphs. Maybe Hahnemann meant to gradually ascend the smallest dose according to the case? This issue is something that is not absolutely clear to me and in my opinion § 280 and § 281 of the 6th edition of the Organon do not give a clear instruction to always start with the Q1. Maybe these paragraphs are not interpreted correctly. In § 161 of the 6th edition of the Organon Hahnemann (1992) wrote that aggravations might only arise at the end of a cure when the healing process has almost or completely taken place. Concerning this matter Beijering (2007) had a very interesting point of view. In his opinion the end aggravation could be seen as a proving and an end aggravation takes place when the wrong potency or frequency has been chosen. In a proving a homeopathic remedy is taken daily until physical, emotional or mental symtoms are produced. These symptoms are exactly recorded by the provers since they make up the picture of the remedy. Beijering (2007) even wrote that when during a cure with LM potencies a restoration of health has taken place the intensity of the disease is getting less and for him the next logical step was to administer a lower potency. And he experienced good results by doing so without end aggravations.
Q potencies and their disadvantages
When applying Q potencies the compliance of the patients is very important to avoid overdosing. As soon as they experience an aggravation they have to stop taking the remedy and they should contact their homeopath. When they do not do this there is the danger that a proving is going to take place. So patients need clear instructions by their practitioners and they have to follow them. But it is also important that patients pay more attention to their symptoms and many patients are too busy for this or it is too difficult for them (De Schepper, 2006). In the beginning of my practice I experienced that patients overdosed themselves since they did not take me serious. They were used to allopathic drugs and they thought more helps more. So when an aggravation set in they thought that the remedy had to be taken more often. Fortunately this happened only a few times. I think it is important not to underestimate the power of Q potencies since they are handmade, administered diluted and in repeated doses. In § 272 in the 6th edition of the Organon Hahnemann (1992) wrote that homeopathic globules diluted in water and stirred before every administration are much more powerful than dry globules given directly on the tongue since the dilution touches many nerves. De Schepper (2006) wrote that patients treated with Q potencies produce much quicker reactions and that they need much more support by their homeopath than patients treated with C potencies. Ghegas (1999) warned not to repeat remedies made out of poisons like Lachesis, Conium or Arsenicum album in too short intervals since strong aggravations might be produced. I would be cautious to prescribe those remedies in repeated standardized doses.
C potencies and their advantages
C potencies give a strong impulse and produce clear reactions. After having administered a C30 or C200 or a higher potency at least twice and the patient does not produce any reactions I can be sure that I have chosen the wrong remedy and I administer a new one. Meyer-König (1995) wrote that patients with sluggish reactions or who have chronic diseases sometimes feel an improvement of their symptoms only when they already take a Q2 or Q3. In Q potencies the standardized way is to give the next potency after having taken the prior one eight times (Meyer-König, 1995). So it might take some time to be sure if the remedy chosen is the right one. Little (n.d.) has compared C potencies with Q potencies for fourteen years and he found out that C potencies suit best when treating acute illnesses, crisis, miasms and acute aggravations of chronic diseases. These conditions are similar to the quick and direct nature of C potencies (Little, n.d.). Little (n.d.) studied Hahnemann’s Pariser Krankenjournale and found out that Hahnemann used until his death C potencies for acute illnesses, acute crisis and as acute intermediate remedies during an interruption of a chronic treatment with Q potencies. De Schepper (2006) also stated that Hahnemann applied from 1840 until 1843 Q and C potencies in diluted form. De Schepper (2006) wrote that for very sensitive patients or for very advanced pathologies it is better to start the cure with a C6 and to gradually go up until C24 in diluted and modified form. Afterwards these patients can bear Q potencies! De Schepper (2006) wrote that Hahnemann applied the same method during his last years in Paris. Bhatia (2009) wrote that master homeopaths of the past and the present have been able to use the full range of potencies depending on the case. An advantage of C potencies administered in dry single doses is that the practitioner is able to exactly observe the reaction of the vital force having received one clear impulse and having time to react. Genneper and Wegener (2004) recommended this method for patients not being able to cooperate and to take the remedy exactly according to the instructions. With one single dose there are hardly possibilities for making mistakes. With dry single doses there is no danger of making a proving or of overdosing. Worldwide there are more experiences with the whole scale of C potencies (Genneper & Wegener, 2004).
C potencies, their uncertainties and disadvantages
Hahnemann was not absolutely satisfied with C potencies. He searched for further possibilities with a reduced danger of aggravations and finally found the solution in Q potencies. Patients who tend to produce aggravations or who should not experience aggravations due to their illness should avoid C potencies (Genneper & Wegener, 2004). For patients taking allopathic drugs during the homeopathic treatment a single impulse of a C potency might not be enough. They can achieve better results with the repeated impulse of Q potencies (Genneper & Wegener, 2004). In the homeopathic community there are different opinions concerning aggravations. Should they be avoided at all means? Vithoulkas (2000) explained that the remedy stimulates the defense system and for a time an increased exacerbation of the symptoms is created. They are the only visible proof that the defense system is in action and therefore especially in chronic cases homeopathic aggravations are desirable. According to Vithoulkas (2000) in the majority of the patients the homeopathic aggravation cannot be considered harmful. But aggravations can be dangerous when a not well indicated remedy is repeated or in serious pathological cases with a weakened constitution (Vithoulkas, 2000). For the last mentioned case Vithoulkas (2000) recommended to prescribe quickly the correct remedy at the appropriate moment. And this needs a lot of experience. Vithoulkas is a world-wide known practitioner who applied successfully the full range of C potencies in dry doses. So it is not absolutely clear if aggravations are to be avoided or if they are desirable since the organism purifies itself and the practitioner knows that the administered remedy works. I personally have experienced aggravations with dry single C potencies when the remedy was repeated too early. That happened when impatient patients pressurized me to accelerate the healing process. Concerning C potencies I prefer single doses either diluted or dry. Hahnemann (1833) introduced in the 5th edition of the Organon C potencies that are repeated, diluted and modified. But I hardly can find evidence in the homeopathic literature of those who applied this system. Kent (1985) for example worked with dry and single doses and applied the whole scale of C potencies. He recommended to wait for months when a standstill of the healing process has set in (Kent, 1985). I have tried to work with repeated and modified C potencies and have experienced strong aggravations. I will not use this system any more. For repeated doses I prefer LM potencies.
In a footnote of §270 in the 6th edition of the Organon Hahnemann (1992) wrote that Q potencies are the most perfect ones. And in a footnote of § 246 of the same edition he wrote that he had 4 or 5 years of experience in the use of Q potencies. But as already mentioned in the paragraph “C potencies and their advantages” we know from Little (n.d.) and De Schepper (2006) that Hahnemann applied until his death C and Q potencies. In this assignment I have critically reflected on C, LM and Q potencies and I think that we need all of them in our homeopathic practice. Good homeopaths should be able to use all potencies according to the case. You never know in advance how a patient reacts on any potency and you cannot exactly know in advance if a patient reacts sluggish or oversensitive. When experiencing aggravations with Q potencies it is easier to adjust the dose. I personally work with LM and C potencies. I have experienced that LM potencies are very good for patients with psychological problems or who live in very stressful situations. Maybe the repeated dosage also gives them some support on the mental level or they quickly use up the remedy. But I also like the watch and wait method with C potencies very much since you give a clear, single impulse and you can observe in the following weeks how the remedy is working. I personally do not wait like Kent for months after a clear standstill but for one to two weeks and made good experiences. I think homeopaths should restrain from standardized potency selection or from favourite potencies. In Q potencies many practitioners like Meyer-König (1995) start with the Q1 and after eight times of repetition they give the Q2, etc. But I know practitioners who start with a higher Q or LM potency and only go up the scale when the potency does not work any more or after the end aggravation. I made good experiences with giving the same LM potency for a longer period of time and have several patients who took successfully the same LM potency for a year or more. Why should the potency be changed as long as it is showing effects? Since I have analyzed advantages, uncertainties and disadvantages of C, Q and LM potencies I now feel more encouraged to apply all of them. I have become open to prescribe them even in one and the same case as Hahnemann did in Paris.
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Bhatia, M. (2009). Homeopathic potency selection. Retrieved from http://hpathy.com/organon-philosophy-homeopathic-potency-selection/
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Article written by Monika Müller-Amenitsch, Heilpraktikerin, Kosleckweg 6, 12109 Berlin, Tel. 030-70131057
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