Homoeopathic Posology through the eyes of Dr. S.P. Koppikar

This post brings out two important segments on the –one potency selection and the other repetition.
The summary is based entirely on Dr Koppikar’s book “Clinical Experience of 70 Years in Homoeopathy”. What he says is not mere theorizing but comes as a result of ‘diligent’ experience; an experience of 70 years is definitely taking serous note of…
It would have been easier to scan and upload the pages but then it would be unjust to the labor of the author.  The bold markings are my emphasis.  Brackets (     ) and italics are my words.
11.  In the chapter ‘How I learnt About Doses’
a.       He talks about Anaphylaxis or Allergic Shock as a result of single dose (unchanged) repeated on the 10th day. When his own case met with disaster he then avoided repeating dose early.
b.       He then refers to Dr. Margaret Tyler who used to give 1M potency daily for 4 days and stop, with good effect.
c.       The opposite action of high and low potencies – he narrates his verified experience where Calcarea high (200, 1M) cured diarrhea and in 6th potency cured constipation; use of digitalis in jaundice – high (30,200) when the pulse was slow and 3x or 3 or even 6th when the pulse rate was fast… (A point worth delving on). He goes on to say “Now it is Hahnemann who has explained the peculiar and seemingly opposite symptoms appearing in the proving.  He has called them primary and secondary.  But where a seeming secondary symptoms appears first (in later periods of proving), he calls this alternating action. This does not depend upon the dose but we make use of this dual action for selecting potency, low or high…”
22.  The chapter ‘Hair Splitting Posology’
a.       He says that ‘In spite of going to infinitesimal doses Hahnemann still seemed to fear aggravation FROM A BIGGER DOSE OR A NUMBER OF GLOBULES PER DOSE.  Minimum dose for him was one pilule, the size of a poppy seed. This was in the fifth edition of Organon. In the sixth edition, which came to light much later, he had come to the still more delicate method of potentising on the fifty millesimal scale and that too in dilute solution of water.’
b.       He recounts his holiday spent with a scholarly amateur homeopath, Mr. T. S. Iyer from Bangalore South India who had high officials and society leaders as his patient whom he treated only by correspondence. Mr. Iyer he says never used more than ONE PELLET of size 10 mixed in sugar of milk as powder and posted to the patient.  When Mr. T.S. Iyer was asked if he found any aggravation from giving more than one pellet, he said he never ventured giving more than one pellet so he does not know. ( J smilesmile Imagine the level of confidence in that single pellet…do we have it today!)
c.       Today we have globules no.20, 30, 40 etc. sold by Kilos. Are these globules not working satisfactorily?...this and few other postures are put forward by the late Veteran.
33. A chapter has been devoted to ‘Anaphylaxis in Homoeopathy’ which was also published in The Homoeopathic Heritage, December 1982. A very uncomfortable subject hence not spoken of much and still rarely acknowledged or reported.  Here he gain talks about the 10th day aggravations he experienced by repeating unchanged dose around that time. This chapter needs to be read in its entirety as it has reference to Hahnemann, Kent’s Philosophy.
a.       He says he has stopped using single dose for any case. Instead, he gives on the first day two or three doses at interval of three or four hours followed by placebo, if necessary, from the next day. He says that Kent and others also used this method, which is ‘single collective dose’. “I have never seen any upset by subsequent repetition in such cases, and I find this an absolutely safe method,” he concludes. He also refers to the ‘plus dosage’ used mostly in chronic cases which avoids severe aggravation or ‘anaphylactic shock by repetition.
44.  ‘Repetition Of The Same Low Potency For Years’
a.       He gives examples of his cases who continued taking Aurum mur. nat 6x for 4 years, Sulphur 6 once daily for 10-12 years and Carbo-Veg 30 daily for 6-7 years with good effect.  He did not ask his patients to do so but were told to take it on and off if needed. And when they visited him again after all these years he learnt about it…but it did them good. The first a lady (born with ‘Infantile Uterus) conceived after 15 years of marriage, the second – sulfur a case of rheumatism where all major joints being affected looked younger and the third suffering from arterial blockage of circulation to extremities was back to health.
b.       He concludes the chapter by “If millesimal potency repetition is permitted, why not of the ordinary potencies?”
55.  In the Chapter on ‘Homoeopathic Posology’ he gives 16 cases drawing to the reasoning led the doctor to the selection of the appropriate potency.
a.       Here he says that we must make full use of the full range of potencies from mother tincture to the very highest ones, we have the extremes of therapeutic resources open.  He further adds that he has researched the writings of Hahnemann, Boenninghausen, Dunham, Wells, Hering, Lippe, Allen, down to Roberts and other luminaries…and they do not suggest low potencies for acute and high for chronic cases.
b.       Here he refers to the chapter on ‘Homoeopathic Posology’ in the great work “Genius of Homeopathy” by Dr. Stuart Close and the five factors written therein:
                                                               i.      The susceptibility of the patient.
                                                             ii.      The seat of the disease.
                                                           iii.      The nature and intensity of the disease.
                                                           iv.      The stage and duration of the disease.
                                                             v.      Previous treatment of the disease.
“The more similar the remedy, the more clearly and positively the symptoms of the patients take on the peculiar and characteristic form of the remedy, the greater the susceptibility to that remedy and the higher the potency required.”  As we know, the fine characteristic symptoms of remedies are developed in higher potencies only, whereas the crude durgs only show gross changes.  In cases where only pathological changes are prominent, low potencies are required; or in any case where three or four remedies seem equally indicated, it means that finer indications are wanting and only lower potencies are indicated.
Young, vigorous people are more susceptible; they need higher potencies than old people. Similarly, delicate, sensitive, nervous, intellectual people need high potencies. Coarse, torpid phlegmatic people need lower doses.

Terminal conditions deaden reaction. Only large doses can produce some reaction. If the grade of disease is low and the power of reaction is low, the remedy must be given low.  In these cases finer shades of symptoms are absent. So, in terminal conditions or in gross pathological changes, resort to the crude drug and increase the dose to the point of reaction.

Environments and habits of life also should be considered in selecting the dose….Idiots and dull witted persons need lower potencies.

The seat, character and intensity of the disease must be considered. Rapidly fatal cases require large doses to start with. Low vital action requires lower potencies; increased vital action requires higher potencies.

Dr. Koppikar adds one point to the above which is omitted by Dr. Stuart Close. “The susceptibility increases as the remedy becomes more and more similar, and is the highest to the “Similimum”. If we apply this rule, it means “the more accurate our prescription become the higher we can go,” with extremely gratifying results. Conversely, when in doubt about the prescription, give low first to see the reaction.

6.       In another place Dr. Koppikar refers to a study done by Boenninghausen where the direct disciple of Hahnemann tried 30C for all patients for one year. The next year, he tried only 200 on all patients and all the remedies. He maintained a meticulous records and he found 200 to be superior and quicker.  With this he made a unique discovery that high potency also, most probably increases the range of action. His article –in his ‘Lesser Writings’ is worth a gold mine. There he mentions a peculiar epizootic affecting the horses, on the farm in the next village. On indications of stools etc., he thought that either Nux vom or Puls. Might be the indicated remedy; as he could not differentiate more, he gave the servant one dose of Nux V 200 and Puls 200 and asked to try Nux Vom first and if after 24 hours the horse did not improve, to try Pulsatilla. The next day the servant reported that the first dose cured the first horse and the second dose cured the second horse, which got infected with the same symptoms.  Here were two distinctly differing remedies curing same symptoms. Most probably they could tackle symptoms beyond their own symptomatology. This sort of things happened especially when he used high potency.
This subject on Posology cannot be treated with  a rule of thumb approach and calls for diligent attention and study and is an important aspect that has to be part of ‘responsible prescribing’ for every homoeopathic practitioner.
Writing this synopsis has proved therapeutic on me, I would exhort readers not to rely on what is put down here but to read this book for a more complete understanding on the topic and then delve into the writings of masters that come up as reference work whilst reading this book.