POSOLOGY
Dr.Sailendra Kumar.G.N.
Etymology
The term posology originates from the Greek, ‘posos’ meaning how much and ‘logos’ meaning study or discourse
Definition of Posology
Posology means the doctrine of doses of medicine. The terminology of ‘dose’ derived from the word ‘dosis’ which means the quantity of a drug or other therapeutic agent to be taken or applied all at a time or in fractional amounts within a stated period. (Ref. Stedman’s Medical Dictionary).’
Definition of Homoeopathic Posology
A homoeopathic ‘dose’ means the particular preparation of medicine used, the quantity and form of that preparation as well as the number of administration of the medicine. In short, homoeopathic ‘dose’ includes potency, quantity, form and number of administration of the medicine.
The study of the doctrine of these doses is known as ‘posology’.
Difference between Homoeopathic and Allopathic concept of Doses
Allopathic concept of dose:
In allopathy ‘dose’ means so many drops by measure or so many grains by weight – enough to produce the direct, positive, or physiological effect and not enough to endanger the patient. Allopath relates the word ‘dose’ to the material quantity of the medicine used
Homoeopathic concept of dose:
In common speech a homoeopathic ‘dose’ of anything means an infinitesimal dose.
i) In the first place, the ‘dose’ related to the particular preparation of medicine used.
E.g. In constipation opium mother tincture or the 6th, 12th or the 30th potency. .
ii) In the second place, the ‘dose’ related to the quantity of that preparation and the form of that preparation
E.g. opium 30 was given.’ It may have been given the one drop liquid under the tongue, one or two globules, one drop liquid is dispensed with purified water or sugar of milk.
iii) In the third place, the ‘dose’ related to the number of administration of the medicine – repetition.
E.g. opium 30, it may be a single dose or may be repeated every 4 hours or every week according to the condition of the patient.
Selection of Potency
The selection of proper potency is the next important step after the remedy has been selected.
It has been shown experimentally that inspite of the correctly selected medicine on the basis of totality of symptoms; it will not act curatively unless it is given in proper potency.
There are different opinions in this regard as to which potency one should prescribe, though there is consensus over the broad division of potency, namely
- Law: Potencies below 30.
- Medium: Potencies below 30, 200 and IM
- High: Potencies above IM.
Voisin has clearly state
- Low potencies are organotropic,
- Medium potencies influence function.
- Higher potencies the psyche.
This scale provides the basis for the selection of potency.
- Low: in organic disease.
- Medium: for functional disorders.
- High: ‘for mental symptoms.
Factors responsible for the selection of potency.
1.The susceptibility of the patient
Susceptibility of the patient is the most important guide in the selection of the potency.
The general rule is – more the susceptibility less will be the medicinal quantity, higher will be the potency.
This susceptibility is again modified by several factors which are as follows
(a) Age: Normally, susceptibility tends to be maximum in a child who has to develop immunity and build up its body but decreases continuously with age at a slower pace till youth and then at an increasing pace till death, because it has to fight the catabolism of advancing age, i.e. gradual decay of the body which includes its organs and their functions.
Susceptibility is nil in a dead person.
Therefore, the medicines which have a peculiar affinity for those organs in children should be given in the medium or higher potencies.
(b) Constitution and temperament (Dr. Stuart Close’s view)
Higher potencies are best adapted to
- Sensitive persons of the nervous, Sanguine or choleric temperament.
- Intelligent, intellectual persons, quick to act and react.
- Zealous and impulsive persons.
Lower potencies and large and more frequent doses correspond better to
- Torpid and phlegmatic individuals dull of comprehension and slow to act.
- Coarse fibred, sluggish individuals of gross habits.
- Those who possess great muscular power but who require a powerful stimulus to excite them.
Dr. E. Wrights view
Medium potencies are best adapted to
Oversensitive patients: Certain persons are oversensitive (often owing to improper’ homoeopathic treatment) and they will prove any remedy you give them; they require therefore, medium low potencies.
Idiosyncratic patients: Some individuals have idiosyncrasies even to homoeopathic potencies of certain substance. In extreme idiosyncrasy, medium potencies should be preferred.
Note: Selection of potency on the basis of Van Grauvogl’s constitution (especially. for Biochemic Remedies)
- Hydrogenoid Constitution – lower potency up to 12x, but foremost 3X – 6X.
- Oxygenoid constitution – will mostly be the field for 20X – 30X, seldom going as low as 12X
- Carbonitrogenoid constitution can be treated only by high potencies; this means 30th centesimal and higher potencies.
(c) Habit and environment (Ref. Dr. Stuart Close)
Higher potencies are best adapted to
- Intellectual occupation.
- Excitement of the imagination and emotions
- Sedentary occupations.
- Long sleep.
- An effeminate life.
Lower potencies are best adapted to
- People who are accustomed to long and severe labour out of doors.
- Who sleep little.
- Whose food is coarse.
- Persons exposed to the continual influence of drugs, such as tobacco workers and dealers. . .
- Distillers and brewers and all connected with the liquor and tobacco trade.
- Druggists, perfumers, chemical workers etc.
- Idiots, imbeciles and the deaf and. dumb.
But where their illness is directly caused by some particular drug influence, a high potency of the same or a similar drug may pro-ye to be the best antidote.
(d) Pathological conditions.
In certain terminal conditions, due to the existence of gross pathological lesions or of long existent, exhausting chronic disease and much previous treatment the power of organ: ism to react, even to the indicated homoeopathic remedy may become so low that only material doses can arouse it. Here dynamic medicine will not act. The disease reaches the stage of organic pathology. Massive dose of crude medicine is to be administered in these cases.
2. Nature of the disease
(a) Seat of the disease
Where an important viscus i.e., an internal organ has been considerably deteriorated, material doses of the medicine are necessary to check it. This naturally belongs to chronic cases.
E.g. In chronic valvular heart disease: Crateguse, 10-15 drops doses may be used.
(b) Nature and intensity of disease (As per Elizabeth Wright)
In functional diseases –
- In general, the symptoms are subjective or physiological; where the vital force is tactile, respond well to high potencies and the organic conditions to lower ones.
In acute diseases –
- Here susceptibility generally remains high. Because, no organic change is usually affected in such a case and if it occurs, it is temporary in nature.
- Acute crisis on chronic trouble - Medium or lower potencies are to be given.
In chronic diseases –
- In chronic diseases with no organic change – In chronic prescribing, it is a safe rule to begin with the 200th centesimal potency unless this is dangerous because of the nature of the remedy, the degree of the pathology or the depth of the miasm.
- In chronic diseases with organic charge - The lower preparations should be used in chronic diseases with tendency to disorganization of tissues.
- Mental disease: Higher potency.
(c) The stage and duration of the disease
- Incurable chronic disease: Lower and medium potency.
- Terminal stage of chronic disease: Very high potency.
(d) The previous treatment of the disease
Patients who have taken many crude drug~ of allopathic or homoeopathic often requires higher potency for their use.
APPROXIMATE DOSE OF HOMOEOPATHIC PHARMACY
| Forms |
Adult |
Child |
|
Infant |
|
|
(Above |
(3 to |
|
(Up to |
|
|
14 years) |
14 years) |
|
2 years) |
| Globules |
Four |
two |
one |
|
| Powders |
grain |
1 |
1 |
|
|
| “2 gram |
4″ grain. |
|
| Tablets |
two |
one |
half |
|
| Tinctures |
one d.rop |
1 |
1 |
|
|
| “2 drop |
“2 drop. |
|
| or |
|
|
| Solutions |
|
|
|
|
|
VARIOUS KINDS OF DOSES
A. Maximum dose
It is the maximum or largest possible amount of medicine, which can be taken at a time by an adult, not harmful to human life.
B. Lethal or fatal dose
It is also known as toxicological or narcotic dose. It is such amount of dose which can cause death of living being. The fatal dose of different substances may be different, which depend upon their toxicity.
‘Minimal lethal dose’ is the smallest dose that has been recorded as fatal to a healthy person.
C. Booster dose
A subsequent dose given to enhance the action of initial dose.
D. Fractional or refractive or divided dose
It is the fraction of a full dose which is to be taken at short intervals.
E. Physiological dose
Physiological doses are those which, stimulates the normal physiology or functions of the different organs or systems of our body and hence the symptoms thus appearing are known as physiological symptoms.
F. Minimum dose
1. Definition
It is that dose which is sufficient to overpower and annihilate the disease and capable of producing slight homoeopathic aggravation scarcely observable after its ingestion (Aphor. 280).
It is that amount of medicine which is though smallest in quantity produces the least possible excitation of the vital force, and yet sufficient, to effect the necessary changes in it. (Aphor 246).
2. Evolution of concept of, minimum dose
Hahnemann at the beginning used large doses of medicine like allopathic system.
- 1786: He uses large and repeated doses of mercury for Lues Venerea.
- 1796: He prescribed several grains of Arnica root for dysentery and three grains of Veratrum Album every morning for 4 weeks in severe spasmodic asthma. ‘
- 1797: He prescribed 4 grains Veratrum, once daily for colic. He also prescribes 5 grains Ipecac, 4 grains Nux, vom, and 11/2drachm of Cinchona Bark in different cases.
- 1801: Here we get the first indication of ‘infinitesimal doses’.
- 1813: He stated that the smallest dose is sufficient to cure disease-and there may have been severe’ aggravation following large doses of medicine.
To avoid excessive aggravation, he decided to diminish the dose which results after ingestion of medicinal dose.
In this way, our master Hahnemann reaches to the concept of minimum dose.
3. Reasons behind the application of minimum dose
In homoeopathy uses of minute dose has certain advantage. On the other hand application of large dose has some disadvantages. Due to these reasons homoeopathy advocates minimum dose of medicine in practice.
Disadvantages of using large dose
(a) Too strong a dose of medicine though quite homoeopathic, inspite of its remedial nature, will produce an injurious effect by its mere magnitude. Its qualities as well as its homoeopathic similitude will produce un-necessary, too strong impression upon the vital force, which, in its turn, acts upon the most sensitive parts of the organism, already most seriously affected by the natural disease. (Aphor. 275).
For this reason, a medicine even homoeopathically suited to the case of disease does harm in every dose that is too large. It does more harm, the greater the homoeopathicity is and the higher the potency selected. It does much more injury than aq equality large doses of an allopathic medicine that is un-homoeopathic and in no respect adapted to the morbid state (Aphor. 276).
In that case, the so called homoeopathic aggravation (i.e. the artificial and similar drug disease, called fourth in the diseased parts of the body by the excessively large dose, and the reaching vital force, Aphor. 157.160) will rise to an injurious height. But the same similar drug disease, if of appropriate intensity would have gently effected a cure (Aphor. 276).
(b) Produces violent medicinal disease
Too large doses of an accurately choosen homoeopathic medicine, and especially when frequently repeated, bring about much trouble as a rule. They put the patient not seldom in danger of’ life or make his disease almost incurable.
They indeed extinguish the natural disease, so far as the sensation of the life principle is concerned. The patient will no longer suffer from the original disease which had been homoeopathically cured, yet he will have to suffer from the excessively violent medicinal disease which is most difficult to destroy. (Aphor. 276, 6th edition)
Advantages of minimum dose
(a) In order to act really in conformity with nature, the true physician will prescribe his well selected medicine in minute dose which is exactly as small as will just be sufficient- to overcome and extinguish the disease.
But as human skill and caution sometimes fail in the selection of the remedy, the injury arises from small dose of wrongly selected inappropriate medicine will be insignificant.
Moreover harm dose by the smallest possible dose is so slight, that it may be immediately extinguished, or repaired by the natural vital powers, as well as by the speedy administration of an equally small dose of a more suitably selected similar remedy (Aphor. 283)
(b) A medicine whose selection has been accurately homoeopathic must be all the more salutary; the more its dose is reduced to the degree of minuteness appropriate for a gentle remedial effect.
(c) By applying minimum dose unwanted aggravation can be avoided.
(d) The specific dynamic action which produces uncommon, characteristic, distinguishing symptoms of the drug is produced by the minimum quantity of the drug.
(e) The smallness of the dose not allows the drug to do any organic damage nor there is any medium doses paralyse and large doses kill’ risk of ‘drug addiction and drug-effects.
(f) To taken the full advantage of finer and finest curative property of the remedies, they should be administered in minimum dose.
(g) In order to maintain the similarity of the sequence of the disease and the drug, minimum dose is suitable.
(h) The concept of minimum dose is verified by Arndt-Schultz law-‘Small doses stimulate,medium dose paralyse and large does kil’
Repetition of Dose of Medicine
A. Hahnemann’s instructions of repetition of doses as per the 5th edition of Organon .”
In repetition of dose the following factors should be considered.
- Condition and progress of the patient.
- Nature of the disease.
- Nature of the remedy.
Condition and progress of the patient
(a) Perceptible and continued progress of improvement contraindicates repetition (Aphor. 245).
Perceptible and continued progress of improvement in an acute or chronic: disease- contraindicates the repetition of any medicine; because the beneficial effect which the medicine continues to exert is rapidly approaching its perfection. Under these circumstances every new dose of any medicine even of the last one that proved beneficial, would disturb the process of recovery.
(b) Repeat the dose only when improvement ceases.
To allow a dose, or remedy to act as long .as the improvement produced by it is sustained is .a good practice. But to attempt to fix .arbitrary limits to the action of medicine, as some have done, is contrary to experience.
(c) Repetition may be continued till either recovery ensues or different groups of symptoms arise and thus demands different remedy (Aphor. 248)
The dose of the same medicine’ may he -repeated several times if necessary, until recovery ensues, or until the same medicine ceases to do well. At that period, the rest of the disease presenting a different group of symptoms demands another homoeopathic remedy.
Nature of the disease
(a) Chronic .diseases-The medicine may be repeated at intervals of fourteen, twelve, ten, eight, or seven days.
(b) Chronic diseases assuming an acute form at still shorter intervals.
Discussion
i) Repetition of higher potency – A single dose of higher potency is administered and then a wait follows till its action is over.
ii) Repetition of lower potency – frequent repetition of lower potency in chronic diseases acceptable.
(c) Acute diseases – at very shorter period every twenty four, twelve, eight, or four hours.
In the most acute diseases, every hour, up to as often as every five minutes.
Nature of remedy
(a) Potency:
- Higher potency: Not frequently repeated.
(b) Duration of action of remedy
- Short acting remedy: Repeated at short intervals.
- Deep acting remedy: less frequently repeated.
(c) Medicines having alternating action (Aphor. ,251)
There are some medicines (e.g., Ignatia Amara, also Bryonia and Rhus rad. and sometimes Belladonna) whose power of altering man’s health consists chiefly in alternating actions – a kind of primary action. Symptoms that are in part opposed to each other. If after prescribing one 6f these remedies, on strict homoeopathic principles, no improvement follows, this will soon be obtained (even within few hours in acute diseases) by repeating a fresh and equally small dose of the same medicine.
B. Hahnemann’s instructions of repetition of doses as per the 6th edition of Organon
– Vide chapter “Different scales of preparations of drugs” – 50 millesimal scale.
C. Kent’s instructions of repetition of doses.
Dr. J. T. Kent has given clear instructions about the rules of repetition in the second prescription as follows
The first medicine should be repeated
- When improvement remains standstill.
- When the original symptoms return after a temporary disappearance having the same general and particulars as formerly (Kent’s 11th observation)
Repetition of the same medicine
When the original symptoms return after a temporary disappearance having the same, general and particulars as formerly.
When improvement symptoms return after remains standstill – Wait a long-time – If no outward symptoms have appeared during this waiting period, repetition of the previous medicine may help to complete the cure.
REASONS OF APPLYING ONLY SINGLE SIMPLE MEDICINAL SUBSTANCE AT A TIME
- In the treatment of diseases, only one simple .medicinal substance should be used at a time. (Aphor. 72)
- It is wrong to attempt to employ complex means when simple means suffice. (Aphor.273)
- Some physicians have tried the plan of administering two medicines at a time, or nearly so, in cases where one of the remedies seemed to be homoeopathic to one portion of the symptoms of the diseases, and where a second remedy appeared adapted to the other portion. Master Hahnemann warned seriously against such an attempt, which will never be necessary even if it should seem proper (Aphor. 272 F.N.)
- 4. A simple medicinal substance when used in diseases, the totality of whose symptoms is accurately known, renders efficient aid by itself alone, if it be homoeopathically selected. (Aphor. 274)
- If more than one remedy be used, the physician-cannot know which element was curative and one source of future guidance is therefore obscured.
- If more than one remedy be used, the possibility of synergistic action cannot be ruled out, but it cannot be argued that the effect will be the sum total of the effects of the separate drugs.
- The disappearance of symptoms following poly-pharmacy will bring a few more confusion regarding the second prescription because of which the symptoms are removed by what medicine will not be clearly known.
- The dynamic vital force i~ a single substance. So the medicine intended to correct its disturbance and disharmony should be prescribed only singly, one at a time.
- If poly-pharmacy is continued for a prolonged period it may produce drug disease.
- The homoeopathic medicines were proved singly and the Materia Medica was built up on the observed effects of drugs given singly, either in planned provings or in accidental proving.
EVA Homoeopathy 