The Myth of 'High' and 'Low' Potency Homeopathic Medicines

Abstract:

In homeopathy, ideal patient management occurs when the optimum potency and dose of the curative medicine is given, so that a rapid, gentle and permanent restoration of health follows[1] in accord with the Direction of Cure.[2] A Homeopathic Pharmacopoeia pragmatically offers a range of possibilities for preparing the optimum potency of a curative medicine, individualised for each patient. Serial dilution makes the starting medicinal substance weaker, and so more gentle, while intercurrent succussion (shaking) makes it stronger, and so more rapid. A ‘low’ potency medicine has been arbitrarily designated as one preceding the Avogadro Limit (before 12C, 24X, and Q4 potencies), whereas a ‘high’ potency medicine has arbitrarily been designated as one after the Avogadro Limit. These rhetorical terms of ‘low’ and ‘high’ potency medicines will be deconstructed as half-truths, and half non-truths. The range of possibilities of an individualised optimal potency for each patient can be found between the peaks and troughs of a regular periodic (sine) wave, demonstrating the regular varying biological effects that are available at different potencies along each of the three potency scales.

Keywords:

Homeopathic Pharmacopoeia, potentisation, intercurrent succussion, serial dilution, ultra-dilution, potency, Avogadro Limit.

Introduction

Mechanistic critics of homeopathy believe that, despite the range of ordinary material medicines that are available, it is the range of extraordinary ultra-dilute medicines that have inappropriately brought the whole edifice of homeopathy into disrepute. There really are no genuine arguments against the therapeutic application of the Law of Similars (simila), the use of one medicine at a time (simplex), or even the aspiration to use the optimum amount of medicine (minima). It is the clinical use of these ultra-dilute medicines alone, those that are beyond the Avogadro Limit, that are argued by these critics to not contain any molecules of the mother tincture from which they were derived, that are both the ‘Achilles heel’ and the ‘prestige’ of homeopathy. These ultra-dilute medicines are also known as ‘infinitesimal remedies’, and are criticised as having no genuine biological action beyond possible placebo and nocebo effects, and perhaps some consequences of quantum entanglement. These mechanistic critics claim – incorrectly, in this writer’s view - that they have solved the ‘mystery’ of the ‘clinical magic’ performed by these ultra-dilute medicines simply by disproving their efficacy[3] through the arithmetic of the Avogadro Limit (a dilution of 6.02214199 x 10 E -23). They then proceed to wrongly deduce that everything else about the world’s second most widely utilised system of medicine, homeopathy, must also have a false basis.

Unfortunately, homeopathic practitioners have incorrectly been led to believe that the range of their ordinary material medicines that precede the Avogadro Limit are ‘low’ potencies; and the range of extraordinary ultra-dilute medicines that come after the Avogadro Limit are ‘high’ potencies. The relevance of the Avogadro Limit to these two different ranges of medicines is that, if a process of serial dilution and intercurrent succussion is applied, there are alleged to be no more molecules remaining of the original medicine beyond this dilution limit that were definitely present at the beginning.

Critics are bothered by the extent to which the principle of giving the optimum potency and dose (minima) is taken, as the choices that are available to homeopaths include both the material and these ultra-dilute medicines. These critics are usually scientists committed to the dogma of materialism, who share the delusion that mechanistic medicines are the only kind that work.[4]

Gentle

To select and dispense the optimum potency and dose is misunderstood by some homeopaths as a conservative exercise in frugality – let’s see how little medicine you can actually give to your patient to generate a curative response. Problematically, what is an optimum potency and dose for one patient may be sub-optimal for another, or supra-optimal for the next. Therefore, careful individuation of an optimum potency and dose is required for every new patient, and for their every subsequent prescription. Optimum potency and dose are as important as the selection of a curative medicine. Hahnemann affirmed this, in that ‘the suitableness of a medicine for any given case of disease does not depend on its accurate homeopathic selection alone, but likewise on the proper size, or rather smallness, of the dose’.[5] Homeopaths have to do at least these two things correctly - select the curative medicine for the patient, and select the optimum potency and dose. Some homoeopaths have gone on record to differ. For example, Vithoulkas[6] has – erroneously, in this writer’s view - suggested that:

"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."

In his quest for ideal patient management, Hahnemann began by dispensing varying drop doses of the mother tinctures of his homeopathic medicines. Occasionally, he had patients for whom even one drop of the mother tincture was still too strong a dose, so he conscientiously diluted even a one-drop dose, to diminish the effects of that dose by effectively giving only a fraction of a drop, in his search for the optimum dose of this tincture. Such conscientious steps of continued serial diluting alone, with the admirable intention of doing no harm, ultimately resulted in doses with no clinical medicinal effect. We now understand that this phenomenon occurs at the Avogadro Limit. Diluting alone certainly served Hahnemann’s conscientious purpose of making a dose gentler, and importantly doing no harm, but it ultimately fails in its therapeutic purpose when the dilution process alone is taken too far.

Rapid

An optimum potency and dose need to be not only gentle but also rapid in delivering a permanent curative outcome. One disputed theory has been proposed: that as a consequence of Hahnemann carrying his liquid medicines in saddlebags on horseback when travelling to consult his patients at their private residences, a serendipitous solution to the dilution dilemma occurred. Due to the jostling and shaking of his diluted medicines while they were in transit, they spontaneously experienced the ‘magical’ process of the Homeopathic Pharmacopoeia – succussion. The problem with this splendid theory is that for most of Hahnemann’s life, especially before his move from K?then in Germany to Paris in 1835, at 80 years of age, he was too poor to have owned a horse.[7] It is more likely that as a consequence of his earlier apothecary experience Hahnemann added this ‘magic’ process of intercurrent succussion as a standard procedural step, between each serial dilution.

Carefully consider the following procedure, introduced by Hahnemann for a future Homeopathic Pharmacopoeia, that he termed potentisation (or dynamisation). Begin with one drop of a mother tincture of a medicine, which is added to 99 drops of diluted alcohol in a new glass vial, and then stoppered with a new cork. To a chemist like Hahnemann, this stoppered vial just begs to be shaken - to mix the solute with the diluent. How could he resist? We whisk, beat, grind and stir in our kitchens every day. Hahnemann instructs that this stoppered vial is then succussed (shaken) ten times before another step of serial dilution is again repeated. Succussion is the ‘magical’ process of the Homeopathic Pharmacopeia, as we will see that the addition of the kinetic energy involved in this friction procedure, as with trituration (grinding), is essential to potentisation by making medicines increasingly stronger and rapid, solving the issue of the diminishing gentle effects of serial dilutions.[8]

Gentle and Rapid

Homeopathic potentisation critically involves two processes – serial dilution alternated with intercurrent succussion. The dilution factor first used by Hahnemann was one part in one hundred, to prepare Centesimal (C) preparations. Constantine Hering (1800-1880) introduced a different dilution factor of one part in ten to prepare Decimal (D or X) preparations. The last dilution factor Hahnemann developed was one part in fifty thousand, to prepare Quinquaginta millesimal (Q or LM) preparations. These, and any other possible serial dilution factors, contribute the ‘gentle’ variable to potentisation. It is intercurrent succussion that contributes the ‘rapid’ variable. We know this comes from Hahnemann’s empirical experience:

Only after this bar of steel is dynamised, rubbing it with a dull file in one direction, will it become a true active powerful magnet ... In the same way will triturating a medicinal substance and shaking of its solution (dynamisation, potentisation) develop the medicinal powers hidden within and manifest them more and more or if one may say so, spiritualises the material substance itself.[9]

The intercurrent succussion factor is usually ten for C preparations, ten for D/X preparations, and one hundred for Q/LM preparations. The variation of the ratios between the serial dilution factor and the number of intercurrent succussions in these three different scales simply represents pragmatic aspirations to finding the very best ratio between these two variables, to be able to deliver both as gentle and as rapid a curative effect as possible.

Myth

An unfortunate consequence of this potentisation process of medicines has been the emergence of the rhetorical terms ‘low’ and ‘high’ potencies. This was an attempt to note the difference between those potentised medicines closest to the mother tincture, termed ‘low’ - and relatively weaker, from those potentised medicines furthest away from the mother tincture, termed ‘high’ - and relatively stronger. So here is a rhetorical question for you. Do you believe that potentised remedies prepared in any scale get stronger the more that they are subjected to serial dilution with intercurrent succussion? Or more explicitly stated, do you believe that there is a direct linear increase in the potential biological effects of remedies used by homeopaths (exceptions may occur here with inert substances, known poisons and narcotics), starting with the mother tincture, and the first potencies of the three most commonly used scales (1C, 1X, Q1), onwards, passing through the Avogadro Limit (just before 12C, 24X, Q4), through to the last commercially available potencies of these three scales (CMM, 200X, Q30)? If you said yes, then you are definitely not alone. This is a common shared belief among the international homeopathic community, and is the myth that I would like to now deconstruct.

The current consensus is that, for example, a 3C potency is a ‘low’ potency medicine before the Avogadro Limit; while a CM (100,000C) potency is a ‘high’ potency medicine after the Avogadro Limit. All homeopaths would agree that these are two very different potencies, even if they were derived from the same source substance, and they would be expected to have very different clinical effects when appropriately prescribed. Or are they really so different? Certainly, a 3C medicine and a CM medicine are very different potencies in terms of the degree of serial dilution and intercurrent succussion that went into their preparation, but the difference that matters the most to our patients is not so theoretical, or even rhetorical, but more pragmatic, that is, whether the potency and dose (of the curative medicine) selected for them are the optimum ones, or not. That is, whether their curative journey in the Direction of Cure towards the permanent restoration of their health is both as gentle and as rapid as can be. If this quest for ideal patient management could possibly be generated with the appropriate dosing of either a 3C potency, or a CM potency of their curative medicine, are these two potencies really so empirically different from a patient’s perspective?

Reality

Let us begin on our quest for the optimum potency and dose (assuming we have selected the curative medicine). What is this to be for a new patient? We don’t know before having set a precedent to review, therefore no potency and dose is truly safe, unless it is the optimum potency and dose for this new patient’s individual needs. Conversely, no potency and dose is truly dangerous if it is the required optimum potency and dose for that unique patient. Even so, the Australian Therapeutic Goods Administration (TGA) limits the potencies and remedies that are available to homeopaths who don’t have legal access to substances on the Poisons Schedule.

If the process of dilution alone is accepted as a general technique for ‘diminishing’ a potential therapeutic stimulus, and conversely, if succussion alone is accepted as a technique for ‘increasing’ a potential therapeutic stimulus, then in preparing a range of different potentised medicines from an appropriate starting point (usually a mother tincture), the potential therapeutic stimulus is paradoxically, simultaneously ‘diminished’ as it is serially diluted, and ‘increased’ with intercurrent succussions, as the process of potentising progresses from the starting point onwards to the end point of any of these three scales. The biological effect of the potentised medicine taken at, or near to, the starting point would have had both the least ‘diminishing’ effect that could be had from serial dilutions, and the least ‘increasing’ effect from intercurrent succussions. Conversely, a potentised medicine taken at, or near the end of, any of these three scales would have had both the greatest ‘diminishing’ effect from the cumulative serial dilutions, and the greatest ‘increasing’ effect from the cumulative intercurrent succussions. (The obvious exceptions are mother tinctures of the poisonous, inert and narcotic substances, and their subsequent potencies within each scale, up to 11C, 23X and Q3).

Therefore, it is impossible to accurately proclaim that a potency chosen from near the beginning of any scale is any stronger or weaker than another potency taken from near the end of the same scale – they are both just very different in a non-linear way. These paradoxical issues are also potentially complicated by other ‘low’ potency medicine issues, like hormesis;[10] the presence of nanoparticles;[11] biphasic drug action and the Arndt-Schulz Law;[12] and the Law of Mass Action[13] and Monotonicity.[14] In contrast, the evidence provided by Benveniste[15], and Jones and Jenkins[16] both show the reality of a periodic sine wave of differing biological effects, at differing potencies, across the same potency scale. This sine wave explains why the potencies of both 3C and CM of the same medicine could possibly deliver the same therapeutic outcome if they both were at the same relative positions on the same sine wave.

More extraordinary evidence of ultra-dilutions has been shown by Schulte and Endler.[17] Instead of using the degranulation of basophils, or the sprouting of wheat as their biological system, they used the rate of metamorphosis of tadpoles to frogs, and showed that this rate could not only be stimulated, but also inhibited, with different potencies of Thyroxin.

Pragmatism

To know where to begin within the spectrum of possible potencies offered across the breadth of each scale, individualising the unique needs of a new patient in the search for their optimum potency and dose, is the next pragmatic challenge.

The reality is that there is no linearity of ‘low’ to ‘high’ potencies (and vice versa) from the beginning through to the end of any scale, but rather a regular periodic sine wave of biological effects at different potencies. Somewhere in between (or including) any maximum peak and the next minimum trough, either to the left or to the right of wherever you began, the optimum potency may now be found. The previous axis of up and down for ‘high’ and ‘low’ potencies can now be replaced with a less intimidating axis of ‘a little to the left’, or ‘a little to the right’ of wherever a potency precedent was clinically first set.

Conclusion

A novice prescriber could also do well to review the Appendix in Hughes[18] brief history of Hahnemann’s posological experiences from 1796 to 1842, and see how Hahnemann began particularly gently, though over time he ultimately perfected the rapid variable too.

The confusion about ‘low’ and ‘high’ potencies still exists, as illustrated in the interview noted between two homeopaths, Michelle Shine[19] and Ian Watson, though this can now be resolved by understanding the paradoxical reality I have presented. 

References

[1] Hahnemann S. Organon of medicine. In R. E. Dudgeon & W. Boericke (Trans. from the 5th & 6th Edition), New Delhi, India: B. Jain Publishers, 1988, Aphorism 3, p.31.

[2] Saine A. Hering's Law: Law, Rule or Dogma? https://www.homeopathy.ca/articles_det12.shtml

[3] Chalmers AF. What is this thing called science? An assessment of the nature and status of science and its methods. St. Lucia, Australia: University of Queensland Press, 1999, p.38.

[4] Sheldrake R. The science delusion: Freeing the spirit of enquiry. London, United Kingdom: Coronet, 2012, Chapter 10

[5] Hahnemann S. Organon of medicine. In R. E. Dudgeon & W. Boericke (Trans. from the 5th & 6th Edition), New Delhi, India: B. Jain Publishers, 1988, Aphorism 275, p.140.

[6] Vithoulkas G. The science of homeopathy. New York, NY: Grove Press, 1980, p.213.

[7] Winston J. Homoeopathic myths (first in a series). Homoeopathy NewZ 2005; April:8-10.

[8] Jones RL & Jenkins MD. Plant responses to homoeopathic remedies. The British Homoeopathic Journal 1981;70(3):120-128.

[9] Hahnemann S. Organon of medicine. In R. E. Dudgeon & W. Boericke (Trans. from the 5th & 6th Edition), New Delhi, India: B. Jain Publishers, 1988, footnote to Aphorism 269, p.134.

[10] Endler PC & Schulte J. Ultra high dilution. Physiology and physics. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1994.

[11] Chikramane PS, Suresh AK, Bellare JR & Kane SG. Extreme homeopathic dilutions retain starting materials: A nanoparticulate perspective. Homeopathy 2010;99,231-242. 

[12] Coulter HL. Homoeopathic science and modern medicine: The physics of healing with microdoses. Richmond, CA: North Atlantic Books, 1980, p.34.

[13] Rang HP, Dale MM & Ritter JM. Pharmacology. Edinburgh, United Kingdom: Churchill Livingstone, 1995, p.7.

[14] Aronson JK, & Ferner RE. The law of mass action and the pharmacological concentration-effect curve: resolving the paradox of apparently non-dose-related adverse drug reactions. British journal of clinical pharmacology 2016;81(1),56–61.

[15] Davenas E, Beauvais F, Amara J, Oberbaum M, Robinzon B, Miadonnai A, Tedeschi A, Pomeranz B, Fortner P, Belon P, Sainte-Laudy J, Poitevin B & Benveniste J. Human basophil degranulation triggered by very dilute antiserum against IgE. Nature 1988;333(6176),816-818.

16. Jones RL & Jenkins MD. Plant responses to homoeopathic remedies. The British Homoeopathic Journal 1981;70(3),120-128.

[17] Schulte J, & Endler, PC. Fundamental research in ultra high dilution and homoeopathy. Dordrecht, The Netherlands: Kluwer Academic Publishers, 1998, p.155.

[18] Hughes R. A manual of pharmacodynamics. London, United Kingdom: Leath and Ross, 1886, pp.930-939.

19. Shine M. What about the potency? A comprehensive guide to homeopathic potency and dosage. London, United Kingdom: Food For Thought Publications, 2004, p.181.