You are here

What potency should I take? How often?

Choosing the right remedy dosage

I teach emergency medicine at Southwest College of Naturopathic Medicine, a course in which I try to include a healthy dose of homeopathy. Just about every quarter one of the students will ask, "Dr. Dooley, once you've chosen a remedy to give a patient, how do you decide what potency to give and how often to repeat it?"
     I remember struggling with this issue when I was a student and new in practice. Choosing the remedy itself is fairly straightforward in that the goal is always to find a medicine which can cause symptoms similar to those that the patient is experiencing. After making this choice, however, it can be difficult to know the best method of dosing. Hahnemann himself, the founder of homeopathy, experimented throughout his career, and his recommendations varied at different times. To make matters more confusing, the opinions of various experts since that time sometimes seem in conflict.
     I don't think there is an absolute answer that will apply to all patients all the time. It is going to depend on the patient, the type of illness they have, and the way they are reacting to this illness. It is also going to depend on the practitioner, since, as experience grows, it becomes possible to use different approaches in similar circumstances with good results.
     I'd like to share some of the underlying principles that I have found reliable and helpful in making this decision. But first we need to discuss what is meant by the word "potency."

Potency
There is no official definition of what the word "potency" means in homeopathy. It is usually used to refer to the degree of dilution that a homeopathic remedy has undergone in its manufacturing process. This is indicated by the number and letter listed after the name of the remedy. For example, Pulsatilla 30C has undergone 30 steps of dilution, each step having been a one-to-one-hundred dilution (indicated by the letter "C" meaning centesimal).
     The usual convention in homeopathy is to refer to the higher dilutions, indicated by the larger numbers, as higher potencies and the lower dilutions, indicated by smaller numbers, as lower potencies. To those new to homeopathy, this may seem like an odd way to do business since the higher dilutions have less of the original medicinal substance. But homeopaths have long observed that the higher dilutions elicit powerful responses in patients when (and only when) they are well indicated by the similar symptoms. It is this deep homeopathic response that causes these remedies to be referred to as high potencies.
     The more commonly available and used potencies are the 6C (and sometimes 9C or 12C), 30C, 200C, 1,000C (abbreviated 1M), and 10,000C (abbreviated 10M). In most of the homeopathic world, potencies up to 30 are often referred to as low potencies and those of 200 and up are referred to as high potencies. Again, there is no official definition about this and opinions may vary (I hear that in France a 30C potency is considered quite high), but most homeopaths in my experience draw the line between high and low potency somewhere around 30C. Most certainly the potencies of 6C and 12C are considered low, and the potencies of 1M and 10M (i.e., 1,000C and 10,000C) are considered high.
     Some stores also carry the "X" potencies, such as 6X or 30X. The number still refers to the number of dilutions the remedy has undergone, but the letter "X" means that each was a one-to-ten dilution (indicated by "X" the Roman numeral for 10). Both 6X and 30X are usually considered low potencies.
     One other potency scale is the LM potency scale. In this system, each individual dilutional step is a much larger one-to-fifty-thousand dilution. These potencies are not commonly available to the public and are not further discussed in this article.

Choosing high versus low potencies
It is stated above that the higher potencies give deeper and longer responses, so why not just use them all the time? Why bother with the low potencies at all? The answer is that some patients respond too vigorously to the high potencies, becoming more ill and feeling worse before they get better. Such a response is called a homeopathic aggravation. These aggravations can be quite serious and give experienced homeopaths cause to reflect when choosing potency. At the same time, these high potencies are very useful medicines that, under the correct circumstances, can help patients recover quickly and comfortably.
     So how does one decide which potency to use? Simply stated, it depends on the health and vitality of the patient, the nature of the illness that they have, and their response to that illness. The following is a brief overview of how these factors are used in potency selection.
Consider higher potencies:
•     In those with good strength and vitality
•     In those not overly sensitive to medicines
•     In those with a history of positive responses to remedies
•     When the illness is acute or sudden
•     When the patient is responding vigorously to the illness.
Consider lower potencies:
•     In those who are sickly with poor vitality
•     In those who are over-sensitive and become ill with every medicine they take
•     In those with a history of difficult responses to remedies (such as easy aggravations)
•     When the illness is chronic or slow
•     When the patient has an indolent response to the illness.

How often to repeat the remedy
Now that you have chosen the remedy and the potency, how often should it be repeated? This is another area of conflicting opinions. It is clear, however, that there is a general principle at work when making this decision, namely that the frequency of repetition depends upon the response of the patient. Simply stated, as long as most patients are improving, it is not necessary to repeat the remedy. Please note that this applies to "most" patients. There are some where more frequent repetitions will be helpful and others where progress seems to be hampered. It depends on the patient, the type of illness they have, the potency of remedy being used. The following is an overview of some of these factors and how they relate to remedy repetition.
Consider more frequent repetitions:
•     In acutely ill or injured patients: These patients need more frequent repetitions whether the remedy is high or low potency. Don't be afraid to repeat or change remedies frequently in this situation.
•     When lower potencies are being used for chronically ill patients: Patients suffering from chronic (long-term) illness often need lower potencies repeated frequently to both obtain a good result and to avoid aggravations.
Consider less frequent repetitions:
•     When higher potencies are used to initiate treatment in chronically ill patients: This is the situation where aggravations are common. It is necessary to wait after giving a high potency to such a patient until it is clear what their response will be and how long it will last. (Chronically ill patients who start on lower potencies repeated frequently often do well with higher potencies repeated frequently as time goes by. It is not usually a good idea to start these patients with such repetitions of higher potencies.)
•     In patients with known over-sensitivity to remedies or other medications: Caution must be used repeating remedies of any potency, especially high, with these patients. An exception to this rule is that even over-sensitive patients usually tolerate repeated doses if they are acutely ill or injured.

What constitutes a "dose"?
Homeopathic remedies are typically dispensed on medicated sugar pellets. These pellets may vary in size and composition depending on the manufacturer. Remedy bottles sold in stores are most often filled
with pellets about the size of BBs, and one dose is usually two to five pellets.
     For most patients, taking five pellets will not significantly increase their response over taking two pellets. The way I usually explain this is as follows. Homeopathic remedies appear to act by giving the body a subtle stimulation to which the body responds (if it is a well-indicated remedy). An analogy can be made with an electrical outlet. If you were to directly touch the electrical outlet with one finger, you would receive a shock of 110 volts. If you touch it with two fingers, you still receive a shock of 110 volts. If you touch it with 10 fingers, you still get 110 volts.
     In a similar way, the number of pellets taken each dose doesn't seem to make a lot of difference. I usually tell people to take two of these BB-size pellets just to make sure they are getting enough to cause a response. (There is an occasional patient who is sensitive to the number of pellets they take.)
     Sometimes the pellets used by the manufacturer are much smaller than BBs. Don't be alarmed. For somewhat smaller pellets, take three or four per dose, and for the tiniest (mustard seed sized) pellets take five to ten.
     Remedies can be taken in water as well as dry under the tongue. The most common way to take them in water is to simply put a dose into a drinking glass of water. Acutely ill patients may sip or take a teaspoonful as frequently as needed, usually stirred before each dose. This is an effective way to give patients relief while also stretching the supply of the remedy.

Summary
For acutely ill or injured patients:
     These are patients with colds, flus, fevers, injuries, etc. These patients tolerate high or low potencies repeated frequently. "Frequently" means every few minutes in urgent situations and perhaps every 3 to 4 hours in less urgent situations. The frequency should taper off as the patient recovers. Even most over-sensitive patients will respond well to this kind of repetition. Don't be afraid to change remedies frequently with acutely ill or injured patients if their symptoms change or results seem inadequate.
For chronically ill patients:
     These are patients with long-term illnesses or complaints under the care of a professional. It requires a bit more experience to successfully treat these patients. In general, treatment will begin either with low potencies repeated frequently or with higher potencies repeated infrequently. What happens next depends almost entirely on how the patient responds to the initial dosing. Some patients will take a dose as infrequently as every few months whereas others will be taking higher potencies daily after awhile. Remedies should be changed infrequently.

The bottom line
Respect homeopathy but don't be afraid of it. Remember to pay attention to the patient and how they are responding, and adjust your treatment accordingly. As your experience grows you will find your confidence increasing and your results improving.

About the author:
Dr. Timothy R. Dooley is a graduate of National College of Naturopathic Medicine as well as Oregon Health Sciences University School of Medicine. He practices homeopathy in San Diego, California, and teaches at the Southwest College of Naturopathic Medicine and Health Sciences. He is the author of the easy-to-read introductory book, Homeopathy: Beyond Flat Earth Medicine. The complete text can be read on-line at http://www.beyondflatearth.com. For more information, visit http://www.drdooley.net. He can be reached at (619) 297-8641 or drdooley@drdooley.net.