EFFECT OF LM POTENCY IN HOMOEOPATHIC GENERAL PRACTICE DR. SUMANTH.B.L DOCTOR OF MEDICINE ORGANON AND HOMOEOPATHIC PHILOSOPHY

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1 EFFECT OF LM POTENCY IN HOMOEOPATHIC GENERAL PRACTICE By DR. SUMANTH.B.L Dissertation Submitted To the Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore. In partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE In ORGANON AND HOMOEOPATHIC PHILOSOPHY Under the guidance of DR. G.C. HIREMATH M.D (Hom.) DEPARTMENT OF ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY DR. B.D.JATTI HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL, AND POST-GRADUATE RESEARCH CENTRE, DHARWAD.

2 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE. DECLARATION I hereby declare that this dissertation entitled EFFECT OF LM POTENCY IN HOMOEOPATHIC GENERAL PRACTICE is a bonafide and genuine research work carried out by me under the guidance of DR. G.C. HIREMATH. M.D (Hom), Guide, Professor & HOD, Department of Organon of Medicine and Homoeopathic Philosophy of Dr. B.D. Jatti Homoeopathic Medical College and Hospital and Post-Graduate Research centre, Dharwad. Date: Place: Dharwad DR. SUMANTH.B.L

3 CERTIFICATE This is to certify that the dissertation entitled EFFECT OF LM POTENCY IN HOMOEOPATHIC GENERAL PRACTICE is a bonafide research work done by DR. SUMANTH.B.L., in partial fulfillment of the requirement for the degree of DOCTOR OF MEDICINE IN HOMOEOPATHY in ORGANON AND HOMOEOPATHIC PHILOSOPHY. Date: DR. G.C. HIREMATH M.D. (Hom) Prof, H.O.D. & GUIDE Place: Dharwad Department of Organon and Homoeopathic Philosophy, Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post-Graduate Research centre, Dharwad-1

4 ENDORSEMENT This is to certify that the dissertation entitled EFFECT OF LM POTENCY IN HOMOEOPATHIC GENERAL PRACTICE is a bonafide research work done by DR. SUMANTH.B.L. under the guidance of DR. G.C. HIREMATH, Prof., HOD Department of Organon and Homoeopathic Philosophy, Dr. B.D. Jatti Homoeopathic Medical College and Hospital and Post- Graduate Research centre, Dharwad. DR. G.C. HIREMATH M.D(HOM) DR. ANAND KULKARNI M.D(HOM) Prof. & HOD Dept. of Organon & Homoeopathic Philosophy Principal Dr. B.D. Jatti Homoeopathic Medical College, Hospital, Post-Graduate Research Centre, Dharwad Date: Place: Dharwad Date: Place: Dharwad

5 COPYRIGHT I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka shall have the right to preserve, use and disseminate this dissertation in print or electronic format for academic / research purpose. Date: Place: Dharwad DR. SUMANTH.B.L Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

6 ACKNOWLEDGEMENT I thank the Almighty God for his blessings in making this work possible and whose grace strengthened me throughout my course. To begin with it gives me immense gratitude and privilege to thank my guide Dr.G.C.HIREMATH. M.D(Hom), HOD,Department of Organon of Medicine and Homoeopathic Philosophy, Dr. B. D. Jatti Homoeopathic medical college, Hospital and Post- Graduate Research Centre, Dharwad for his valuable advice, righteous guidance, expert supervision and immense encouragement throughout the course of this study. I feel happy to express my hearty thanks to Dr.Anand.A.kulkarni. M.D (Hom), Principal, Dr B. D. Jatti Homoeopathic Medical College, Hospital and Post-Graduate research centre, Dharwad for his support and encouragement to acquire varied knowledge in this study. I would like to thank Dr.M.H.M.Vijaykumar, Dr.R.C.Hiremath, professor and Dr.Vaishnavi. D.Satish, P.G.Co-ordinator for their support and encouragement in this study. I am also very thankful to all my teachers for their support throughout the course. My special thanks to my cousin Dr.B.M.sudhindra for always being with me and for his valuable guidance.

7 My special thanks to my dear friends Dr.Amit rolli, Dr. Vishwanath Kolurmath, Dr. Pramod, Dr. Nagraj havalada, Dr. Seetharam, Dr. Doddamani, for always being with me. It is my immense pleasure to express my special thanks to all my colleagues and friends who had helped me directly or indirectly during my period of study. I thank them all from the core of my heart and regret for not mentioning individually by name because their number is quiet large. I also thank all the patients who co-operated with me during the treatment course. It is my privilege to thank the office staff, O.P.D staff and Library staff for their help and Co-operation. Last but not the least I thank all the beloved members of my family for their unconditional love and support. I thank the almighty for helping me and giving me such wonderful people who were there always for me, whenever I was in need. Date: Place: Dharwad DR. SUMANTH.B.L.

8 This work is heartily Dedicated to My parents B.N.lakshmi narayana rao And S.B.Annapurna

9 LIST OF ABBREVIATIONS USED (In alphabetical order) < Aggravation > Amelioration C/o DM F F/H HTN Lt M mths O.A Complaints of Diabetes mellitus Female Family History Hypertension Left Male Months Osteoarthritis + Positive P/H Pt. Rt Past History Patient Right

10 ABSTRACT Dr. Hahnemann wanted to rapid the time of cure with the more gentle way with less aggravation without harming the patient to achieve that he conducted the experiments the result of which is the process of potentisation, he introduced the centisimal scale first, but he was not satisfied with the results with centisimal scale, because of following reasons firstly the potencies were not acting sufficiently rapid, secondly, they often tended to produce violent medicinal aggravations, especially among the more sensitive patients. Third the period of cure took quite long time. Fourth, the duration and frequency of remedies were difficult to ascertain correctly, so he further experimented on potentisation the result of that is the LM or Q potency, he told that this is the most perfect method. The term Q means here is quinquagintamillesimal, Hahnemann observed that the aggravations are more with the centisimal scale potency as compared to that of LM scale, and he also observed that the cure has became much more faster with the LM scale compared to centisimal scale, but unfortunately most of the homoeopathic physicians are not aware of this scale of potency, because of long delay in the publication of the sixth edition of Organon, by that time most of the homoeopathic physicians were using centisimal scale potencies and got results from that, here I am trying to make the study on the efficacy of the LM scale potencies in our day to day practice and interpreting the results comparing to that the cases treated with centisimal scale potencies. For the present study the patients who visited to Dr.B.D. Jatti homoeopathic medical college and Hospital, Dharwad, and Rural O.P.D s were selected on the inclusion and exclusion criteria s. Totally 60 patients were selected for this study. In which 30 of them were given the centisimal scale potency, and 30 of them were given the LM scale potency

11 At the end of the study it was observed that, out of 30 patients those who are given centisimal scale potencies, nine patients recovered, sixteen improved, and five patients had not improved but they showed the aggravation of symptoms. The 30 patient those who were given LM scale potencies out of which 15 cases recovered, 10 cases improved and 5 patients discontinued the treatment. Hence I conclude by this study that the LM potencies are much more rapid and effective than centisimal scale potencies with less aggravation in treating the cases in day to day practice. Key Words: LM scale potencies, Efficacy, general practice

12 TABLE OF CONTENTS S. No. Particulars Page No. 1. Introduction Objectives Review of Literature Methodology Results Discussion Summary Conclusion Bibliography Annexure I Case Proforma i-xiii 11. Annexure II Graphs xiv-xviii 12. Annexure III Synopsis of Cases xix-xxxiii 13. Annexure IV Master Chart xxxiv-xli

13 LIST OF TABLES S. No. CONTENTS Page No. 1. Results of Treatment of cases treated with centesimal scale potency 2. Results of Treatment of cases treated with LM scale potency 3. Different cases treated with centisimal scale potency and LM scale potencies 4. Time duration taken for treating acute cases in centisimal scale potency 5. Time duration taken for treating acute cases in LM scale potency 6. Time duration taken for treating chronic cases in centisimal scale potency 7. Time duration taken for treating chronic cases in LM scale potency

14 LIST OF FIGURES Sl. No. Content Page No 1 Standardized vial for LM 24 potency 2 samples of globules used in the 26 preparation of LM dilutions in Brazil at the end of the 80s (left) and our standardized globules 3 Magisterial dilution of a LM potency Time line for Hahnemann s development 27 of potency and 50 millesimal scale 5. Diagrammatic representation of LM scale 49 preparation 6. Making LM2 50

15 TABLE OF GRAPHS Sl. No. Content Page No 1 Differect cases treatd with LM as well as centisimil xv scale potency 2 Time taken for treating the case group A LM potency compared with group B centisimal scale in duration of action in different cases xv 3 Aggravation rate compare to with Group A LM scale and Group B centisimil scale potency xvi 4. Time taken for treating different chronic cases with group A LM scale compared with group B centisimal scale: xvi 5. Time duration taken for treating different acute diseases with group A LM scale compared with group B centisimal scale: xvii 6. Cases treated with centisimal scale potency both acute and chronic case: xvii 7 Cases treated with LM scale potencies both acute and chronic cases: xviii

16 1 INTRODUCTION According to the testimony of all ages, no occupation is more unanimously declared to be a conjectural art then medicine. Dr.Samuel Hahnemann

17 2 INTRODUCTION Medicine is not only a science, it is also an art. It does not of compound pills and plasters, it deals with the very process of life, which must be understood before they must be guided Paracelsus. Sickness in man is like a heritage to him, it has not struck mankind randomly like a thief but certain types of people at certain points in their lives have come down with different kind of ailments. To take hold of such a situation the search for both healing art and medicine is equally old as inheritance of diseases. From time immemorial man has laid down his life in coming out with a healing touch. The Saga and apenance of Charka, Hypocrites and the like had made an epic of medicine. There is no other better sacrifice made than this where Dr. Hahnemann also joined them, even though a little later, but only to bring a solace for the suffering sick with only an aim to eradicate the pain and agony. Such an attempt in order to bring a medical science as a healing art and faced several twists and turns, victories and defeats. The modern physicians base their treatment on a more materialistic concept of disease. The constitutional trade responsible for appearance or recurrence of the disease is forgotten and the sufferer remains open or susceptible for further attack. Patients and their attendants throng the physicians with high expectations for a better alternative system of medicine with frustration on the most dominating medical science. It is an understood fact that such suffers seek a ray of hope in the better rating alternative system of medicine Homoeopathy. The art of medicine consists in amusing the patient while nature cures the disease said a Physician by name Voltaire. So does homoeopathy which is based on nature s law of cure.

18 3 Homoeopathy the benevolent science treats man and not the disease. The practice of this system is that it emphasizes on an unbiased and problems based approach to the entire range of clinical decision making process. This makes the physician a practitioner with cognitive ability to perceive the incidence, interpret their implication, decide on the best possible solution and clarify the out comes. The physician s high and only mission is to restore the sick to health, to Cure, as it is termed. - Dr. Hahnemann In accordance with those words of our master the aim, of each one of us to give a total relief leading to cure to the sick. The topic considered here, The efficacy of L.M. potencies in the day to day practice of physician. It has been estimated that 60% of the cases what we get is acute cases and around 40% is chronic cases. In 60 % of the acute cases around 50% of the cases are fevers, and other 50% comprises of various other disorders like diarrheas, acute exabrations of chronic diseases like bronchial asthma, allergic rhinitis, etc, There are many treatment are available for the above said conditions, but each of them has got their own side effects. The efficacy of treatment consists in removing all the symptoms of whatever the disease condition with no recurrence and to induce lifelong immunity. Homoeopathic approach towards treating the diseases is safer and does not have any side effects; even in the long term treatment this study is an attempt to understand the essential nature of acute and chronic diseases and effectiveness of the homoeopathic treatment with fifty millisimal potency and centesimal potency. The very foundation of Homeopathic practice considers not just a disease but an individual, as a whole.

19 4 The homoeopathic system presented to this world by our master was a boon to the whole mankind. His final thoughts regarding the use of fifty millesimal scale presented in his sixth edition of Organon was new to the Homoeopathic profession and hence controversial for many physicians. So this study attempts to clarify on those controversial thoughts and the efficacy of fifty millesimal potency. Out of 60 cases that were taken for this study, thirty cases acute cases, and thirty cases are chronic cases. In thirty acute cases 15 of them were given fifty-millesimal potency and 15 cases were given only centesimal potencies. In thirty chronic cases 15 were given fiftymillesimal potencies and 15 were give only centesimal potencies. The results were compared using stastical interpretations. Present study is undertaken in the DBHP s DR.B.D.Jatti Homoeopathic Medical College, Hospital P.G. Research centre IPD, OPD s and rural OPD s during the period of December 2009to Nov 2011

20 5 OBJECTIVES Highest ideal of cure is rapid, gentle and permanent. Dr. Samuel Hahnemann

21 6 Aim and Objectives To determine the efficacy of indicated homoeopathic medicines in the management of both acute and chronic disorders. To compare the efficacy of 50 Millisimal with centesimal potencies in the management of both acute and chronic cases. OBJECTIVES The study aims to study the History of L.M.Potencines. Preparation of L.M.Potencines. To access the utility of the L.M.Potencines in day to day practice, in various disease conditions. Prescribing methods of L.M. potencies

22 7 REVIEW OF LITERATURE

23 8 REVIEW OF LITERATURE: 1... by means of this method of dynamisation ( the preparations thus produced, i have found after many laborious experiments, to be the most powerful and at the same time mildest in action, i.e., as the most perfected) the material part of the medicine is lessened with each degree of dynamisation 50,000 times, yet incredibly increased in power... 2 The immortal Hahnemann, whose talent really looks sometimes like an inspiration from above, had, in the last years of his life, arrived at a profound conviction of the efficacy of high attenuations, and had accordingly for some time followed, in the preparation of his remedies and in his doses, a method different from that which he had recommended to the public in his former works; the modifications then introduced he intended to publish to the world in the last edition of Organon. This edition has, unfortunately, never appeared, though I know, from several letters of Hahnemann, to a certainity, that he had completed the work, and that the MS. Was ready for the printer, when death struck him. The world knows well by whose means the publication of that most important work has been prevented. But from the same letters of the great master, with which he honored and rejoiced me during a period of more than fourteen years, and of which the last was dictated scarce two months before his death, and signed with already trembling hand, I know pretty well what he thought of high dynamisations, and that he unreservedly approved of the notions and proceedings in this matter of myself and of my friends (stapf and gross). 3 D little says In the 5th and 6th editions of The Organon of the Healing Art (1833 and c. 1843), Samuel Hahnemann claimed his new revised techniques could speed the time of homeopathic cure to more or less, the time it took with the methods

24 9 of the 4th Organon (1829.) What could have led the Old Master to make such a profound statement? What is the difference between the methods of the 4th, 5th, and 6th editions of the Organon, and what innovations did the Founder introduce during the last 10 years of his life? One of the major changes was the replacement of the ordinary dry pellet dose with a succussed aqueous solution. Hahnemann used a full range of potencies from 6c to 200c with his liquid delivery system and introduced a completely new potency range called the 50 millesimal remedies (LM.) The LM potencies are made with a 1 to 50,000 dilution ratio and are administered in gradually ascending potencies marked LM 0/1, 0/2, 0/3, up to 0/30. These new methods greatly expand the therapeutic range of homeopathy by offering a new, flexible posology system which is applied to two complementary potency ranges (Cs and LMs.) For these, and other reasons, I have always found the last 10 years of Hahnemann's life and works fascinating. 4 the LM/Q series is said to be gentle, adaptable and having less aggravations; indeed it is, and a very useful technique with sensitive patients; yet it is nothing but a linear increase in potencies, modified by variable adaptations within each potency ( multiple dilution glasses, multiple successions, drop doses, spoon doses, variable timing, etc,...); but in the end, as you can see in the graph, it is a straight, slow, linear progression. 5 I have renamed the LM/Q progression the meandering potency. It is very time consuming and has again that nagging question: what is LM1 or any other LM in terms of potency? Admittedly, it is a system on its own, and a formidably effective one at that, but to be told that LM1 is as gentle as a 6C but as deep as a 200C. In the sixth edition of the Organon, Hahnemann presents us with what he himself called the most perfected method which promises to overcome the

25 10 difficulties still observed by him in the 5 th edition of Organon, principally regarding the undesirable reactions of the vital force which appeared during the repetition of the homoeopathic medicines in centesimal potencies. According to Hahnemann, the principles of his most perfected method are: 1. Perfectly homoeopathic medication, selected with greatest care; 2. Highly potentised medicine ( through the new dynamisation process, today called fifty millesimal); 3. Medication diluted in water and administered: 3.1. In small dose adequate enough for performing a brief cure 3.2. In repeated doses for as long as necessary 3.3. Initiating the treatment with the lower potencies 3.4. Gradually raising the potency every 7 or 14 days 3.5. Slightly altering the dynamisation before each dose, through successions applied to the medicinal solution phial. 6 As a rule, homeopathic doctrine is based on Samuel Hahnemann s written legacy: his Published methodological writings, provings, and principles. In the case of quinquagintamillesimal (50,000) potencies, usually known as q-potencies in the German speaking world, and LM in English, a delay of nearly 80 years in the publication of Hahnemann s last work not only prevented its contemporary reception among his followers but allowed another tradition to rise, spread, and prevail until today. Since, throughout his life Hahnemann referred to and recommended c- potencies only, it was quite natural for his disciples to follow and extend this apparently ultimate and authorized path. Hence, for instance Clemens von Boenninghausen and Carroll Dunham advocated the 200c, while James Tyler Kent introduced a scale of ultra-high

26 11 millesimal potencies: m, xm, lm, cm, dm, mm, etc. Adherents of low potencies like Richard Hughes opposed this kind of development, but virtually all of them referred to the same ratio of potentization (1:100), ie c-potencies apart from some German homeopathic pharmacists who developed a modified scale of potentization (d- or x- potencies, 1:10). This common denominator did not change even when Richard Haehl1 in 1921 and William Boericke2 in 1922 published, in German and English respectively, for the first time, the sixth edition of Hahnemann s Organon of Medicine, whose manuscript had been completed in It contained Hahnemann s last legacy: the description of 50,000 potencies which, in the last 5 years of his life, he had found to be the strongest and mildest, ie most perfect preparations. Only in the 1950s did the Swiss homeopathic doctors, Rudolf Flury, Adolf Voegeli, Pierre Schmidt, And Jost Kunzli von Fimmelsberg, start to draw the attention of their colleagues to the 50,000 potencies which from now on were called LM- or q-potencies.4 Considering the predominance of the more than a hundred years old tradition of c-potencies, the echo within the homeopathic community was very weak. After all, acknowledgement of Hahnemann s unheard directions would have meant a significant change to practice with a completely new set of remedies. A simple way of escaping the dilemma was to question the authenticity of Haehl s edition, which was based only on a transcript of Hahnemann s manuscript. It would be interesting to know how and when Hahnemann actually administered q-potencies in his own practice instead of just having to rely on his statements in the Organon. The answer to this Question, however, is hidden behind a host of difficulties including the time, capacity, and energy to read and analyze thousands of handwritten pages of Hahnemann s German French case books of his

27 12 last years in Paris. As it turns out, even there q-potencies cannot be easily identified by one distinguishing mark or label, but have to be traced like a detective by means of assumptions, reflections, and hypotheses. Up to now, three different approaches have been suggested: (1) Rima Handley (1990, 1997) supposed that the sign of a small circle (O) indicates a q-potency;6 (2) Ubiratan Adler (1994) introduced clinical pharmaceutical criteria (low potencies in a sequence of gradually ascending degrees) to locate 681 prescriptions of q-potencies in Hahnemann s case books;7 and (3) Luise Kunkle (2001) developed a theory according to which fractions like 1/190, 1/191, 1/192, etc would be ciphers for q1, q2, q3, etc. 7 In 1997, Rima Handley published a study about Hahnemann s practice in Paris, with interesting historical data about the first patients treated by the illustrious homoeopath. Handley used the notation o as the criterion to identify a fifty millesimal prescription in Hahnemann s manuscripts, kept in the library of the institute for history of medicine of the Robert Bosch foundation. According to Handley, the o sign would be an indication from Hahnemann for using a globule instead of a drop in successive dilutions of the fifty millesimal preparations. Handley claims to have observed only 12 medicines prescribed in this scale, the first being a case of sulphur 10LM, prescribed in In india and Bangladesh, the potency prepared by this scale is designated as 0/1,0/2,0/3,0/4 and M/1,M/2,M/3,M/4 etc. In the west it is designated as 1/0,2/0,3/0 etc. Master Hahnemann used to write 0/1,0/2,0/3 etc. some authors have suggested, LM/1, LM/2, LM/3, etc where L stands for 50 and M for millesimal. The numerator 0 representing symbolically the poppy- sized globule employed in each dynamisation.

28 13 9 lack of popularity: Hahnemann wrote the preface of the 6 th edition of Organon in February He could not finalize the negotiations with his printers for the publication and died on 2 nd june 1843 without this new edition appearing in print. After a gap of 77 yrs, Dr.Hael of Germany managed to get hold of the original manuscript in the early part of 1920 with the financial assistance of Dr. Boericke. Twice this manuscript of Hahnemann was in danger of being lost, once during the siege of paris in the Franco prusian war of and once during the military over running of Westphalia during World war I of In 1922 Dr. Boericke published the English translation of this edition. This long delay is one reason for the unpopularity of this scale. As the last and sixth edition of Organon did not see the light of the day till 1920, the homoeopathic profession and pharmacists were ignorant of this method of preparation of potencies. some of Hahnemann s colleagues and followers started using these high potencies, even before Hahnemann had laid down instructions about this new method. But Hering, Kent, Dunham, and Nash advocated the practice of using high potencies like 200, 1M, 10M, 50M, CM, MM and claimed better therapeutic results in many cases that didnot respond satisfactorily with thirtieth and lower potencies. With the absence of the new directions and the popularity of the high potencies for about ninety years, sufficient experience was gained with the high potencies. When the 6 th edition of Organon was available for the profession, it found some reluctance amongst the profession also due its authenticity. 10 The sixth edition of Organon was published by William boericke in December 1921, about 80 years after discovery of 50 millesimal scale potencies. During this period homoeopaths were using centesimal scale potencies Drs. Hering, Kent, EE. Case, C.M. Boger, Adolph Lippe, and other pioneers of homoeopathy

29 14 achieved marvellous results from centesimal scales of potencies, hence even now majority of homoeopaths all over the world are using centesimal scale potencies. Even after the publication of the 6 th edition of the Organon in which Hahnemann has advocated preparation, use and value of 50 millesimal scale of potencies nobody paid much importance to this new scale of potencies as the influence of Dr.J.T. Kent was still holding the top ranking homoeopath of England and USA. Dr. Pierre Schmidt of Geneva, Dr.Kunzli and Charles pahud of lusanne, Switzerland, were among the pioneers of homoeopathy who used 50 millesimal potencies in treating their cases and publishing their results. In India Dr. Ramanlal. P. Patel was the first to write my experience with 50 millesimal scale of potency in a booklet form in Dr.S.M.Bhattacharya of Berhampur, P.Shankaran of Bombay and other pioneers of homoeopathy in India are using this potency but still this scale of potency is not so popular as it should be. 11 The Q potencies as they are called now were mentioned for the first time by name: divisions infinetesemales (infinitesimal dilutions). The name Q potency, which is used today, was introduced by JOST KUNZLI VON FIMMELSBERG ( ). Rudolf Flury ( ) had preferred the abbreviation LM would denote the number 950 rather than 50,000. This is why Will Klunker ( ) and other classical homoeopaths always supported Q as the only legitimate abbreviation for the 50 millesimal potencies (lat.quinquagintamilia). 10 Dr.R.P.Patel is of opinion which he has given in the fifth annual report of 50 millesimal scale of potencies conducted at A.H. Medical college research department: 1. The 50 millesimal scale of potencies give equally good results when given in globule form, powder form, or in the form of mixture.

30 15 2. The 50 millesimal scale of potencies cannot be compared with centesimal scale of potencies nor they should be substituted one for other on the basis of calculation because the scales are altogether different in order and cannot be interchanged. 3. The medicine should not be stopped in case the patient says he is better but repeated in the next higher potency of the same remedy at longer intervals and slowly withdrawn in acute cases. 4. In chronic cases if most of the symptoms are removed and you are repeating the remedy and by chance the former symptoms reappear or a few remaining symptoms become worse you have to stop drugging otherwise you shall waste your remedy and the patient will suffer. 5. Dr.Hahnemann has advised the 50 millesimal scale from 0/1 to 0/30, but he finds that certain remedies are useful upto 0/50 potency specially Nux vom and sulphur. 6. Certain remedies like Kali phos, Arg Nit, Dulcamara and China are found to be tardy in action when given in 50 millesimal scale. They are useful when given in the centesimal scale. 7. In certain cases he finds that 0/30 potencies do not act though indicated, but when they are given in 0/1 and 0/3 they have good results. 12 Hahnemann introduced LM potency in the aph , 270,271 and 278 0f the sixth edition of Organon of medicine. Gradually in the 1940 s 50 s with R. Flury and Pierre Schmidt, mathias dorsci and later H. Farrington, Charles pahud, Robert schore, h. Choudary, kunzli, R.P. Patel and others carried out research on this latest potency method of Hahnemann.

31 16 The inspiration for the Lm potency have come from Dr. Constantine herring in a letter to the editorial he wrote for a journal archive fur die homoopathische heilkunst to the then editor and long time student of dr. Hahnemann, Earnst stapf. In the sixth edition of Organon, Hahnemann recommended dissolving single pellet of appropriate Q- potency in a vial of water, and succussing the vial about 8 12 between doses, and administering it to the patient every day or every other day. It can be repeated in 2-6 hrs in acute cases. To avoid large doses he advises that each dose should be a teaspoonful of liquid. 13 Hahnemann spent the last decade of his life developing 50 millesimal (LM) potencies specifically to avoid the aggravations aroused by centesimal potencies, which he felt caused too much suffering for the patient. He developed a technique for making the remedies deeper and faster acting while at the same time more gentle. The LM potencies are made by diluting the remedy in a ratio of 1 to at each step instead of 1 in 100, while limiting the successions to 100. The high number of dilutions raises the power of the remedy very high, while the relatively low number of successions keeps the aggravations low. The result is that LMs act deeply and quickly: deep to the mental emotional level and far back in the patient's timeline, leading to a cure in a fraction of the time of Hahnemann's previous centesimal method. LMs are also known as Q potencies, both of which represent the Roman numerals for the 1 in dilution. They are also called 0=1, 0=2 or 1=0, 2=0 etc. in which the 0 stands for the tiny poppy seed granules on which they are prepared. The patient takes one poppy seed pellet and places it in a 4 oz. (100 ml approximately) standard pharmacy bottle, then fills the bottle to the base of the neck with purified water and adds 15 drops of ethanol.

32 17 LM potencies cannot be compared with a 3C or 6C potency, as many practitioners believe. LM potencies have a much deeper action than the C scale. LMs give us the best of both worlds: they are as gentle as the low potencies and as powerful as the highest centesimals. In his Lesser Writings Von Boenninghausen spoke of the nature of LM potencies. (Hahnemann wrote his last letter to Von Boenninghausen on this subject two months before he died.) Von Boenninghausen said about the LM's, `the peculiar preparation of which is known to me and which requires less trouble and time essentially presents our high and highest potencies.' He meant the 200C and higher (which were already available at that time)! Far from being a low potency, the LM1 has actions equivalent to a higher potency even though it is the lowest end of the LM scale. It is a much higher potency than 30 C. I have often seen in practice that a hypersensitive patient would not react to 30C but would have an initial aggravation to a dose of LM1 (of course we have many ways of adjusting an LM, tailoring the remedy to the patient, as discussed later on). 14 The so-called LM, or more correctly Q-potency, comes from the Latin Quinquagiesmillesima = 50,000. The LM is produced by diluting 3c potency at a ratio of 1:50,000. Potencies are increased in the usual way with the same ratio. 15 Hahnemann aimed to develop a technique which would restore health rapidly, gently and permanently by removing and destroying the Disease in the shortest, surest and least harmful way. By the end of Hahnemann's life, he believed that his new method of dynamization known as LM potencies had achieved this goal. However, the current use of this technique has been limited, as a direct result of the delay in publication of the 6th edition of the Organon until 78 years after Hahnemann's death.

33 18 Ironically, this has led to the dominance of centesimal potencies in contemporary homoeopathic practice whilst leaving to history the later and more advanced technique of LM potencies. The use of LM potencies provides many Positive benefits, these include: ± Regulation of homoeopathic aggravations by varying the potency with each dose ± shortening the healing process ± resolving the problem of choosing the correct potency ± The similimum can be found in the shortest amount of time ± The effect of incorrect remedies will be mild ± Standardisation of procedures and results LM potencies are succussed before each Dose to avoid developing the symptoms of the remedy. 16 Hahnemann used a full range of potencies from 6c to 200c with his liquid delivery system and introduced a completely new potency range called the 50 millesimal remedies (LM.) The LM potencies are made with a 1 to 50,000 dilution ratio and are administered in gradually ascending potencies marked LM 0/1, 0/2, 0/3, up to 0/30. These new methods greatly expand the therapeutic range of homeopathy by offering a new, flexible posology system which is applied to two complementary potency ranges (Cs and LMs.) For these, and other reasons, I have always found the last 10 years of Hahnemann's life and works fascinating. The Founder introduced the liquid delivery system in aph. 286, 287, and 288 of the 5th edition (1833), well before he went to Paris with Melanie in He first discussed the method of olfaction in the introduction to Böenninghausen's repertory (1832), and the most detailed explanation of olfaction is found in the 5th Organon. All of Hahnemann's revised methods depend on the correct use of the medicinal solution. The last time Hahnemann recommended the use of the single unit dry dose

34 19 was in aph. 242 of the 4th Organon. If the homeopath is still using the dry pellet dose, they must abide by the rules of the 4th Organon (1829) and the first edition of The Chronic Diseases (1828.) I call this the 'single dose wait and watch' method. This is the most common form of classical homeopathy. In the 5th Organon, the Old Homeopath proposed a *new posology method which utilizes a single dose when there is a striking remedy response ( 245), and the repetition of the remedy at suitable intervals to speed the cure in slowly or moderately improving cases ( 246.) He called his **new posology the "middle path" because it represents the balance point between the exclusive single dose and the systematic repetition of homeopathic remedies. Hahnemann called the centesimal potencies "medicament au la goutte" (medicines of the drop) in juxtaposition to the LM potency which he called "medicament au globule" (medicines of the pellet.) In the 5th and 6th Organon (1833 and 1843), Samuel Hahnemann claimed his revised methods could speed the time of homeopathic cure to more or less, the time it took with the methods of the 4th Organon (1829.) It is for classical homeopaths who have mastered the 4th Organon methods to take up the challenge and begin new experiments. Only they have the background and depth of experience necessary to really test Hahnemann's "new methods" in the field. 17 I last addressed the public concerning our healing art, I have had among other things also the opportunity to gain experience as to the best possible mode of administering the doses of the medicines to the patients, and i herewith communicate what i have found best in this respect. Experience has shown me, as it has no doubt also shown to most of my followers, that it is most useful in diseases of any magnitude (not excepting even the most acute, and still more so in the half- acute, in the tedious and most tedious) to give to the patient the powerful homoeopathic pellet

35 20 or pellets only in solution, and this solution in divided doses. In chronic diseases I have found it best to give a dose (eg: a spoonful) of a solution of the suitable medicine at least every two days, more usually every day. Now in preparing the solutions from this and in bringing the medicines thus potentised one million fold, into fluid form, ( so that their dynamisation may be still further continued), we are aided by the property of all medicinal substances, that when brought to the potency 1, they are soluble in water and alcohol; this property is still unknown chemistry. When standing exposed to the air in the dark, is only feebly luminous and has but a slight odour. It is put into a well stoppered vial and marked phosphorus 1/100 the other two triturations 1/10000 and 1/mill are prepared like those from other dry medicinal substances. 18 As a rule, homeopathic doctrine is based on Samuel Hahnemann s written legacy: his published methodological writings, provings, and principles. In the case of quinquagintamillesimal (50,000) potencies, usually known as q-potencies in the German speaking world, and LM in English, a delay of nearly 80 years in the publication of Hahnemann s last work not only prevented its contemporary reception among his followers but allowed another tradition to rise, spread, and prevail until today. Richard Haehl1 in 1921 and William Boericke2 in 1922 published, in German and English respectively, for the first time, the sixth edition of Hahnemann s Organon of Medicine, whose manuscript had been Completed in It contained Hahnemann s last legacy: the description of 50,000 potencies which, in the last 5 years of his life, he had found to be the strongest and mildest, ie most perfect preparations.

36 21 Only in the 1950s did the Swiss homeopathic doctors, Rudolf Flury, Adolf Voegeli, Pierre Schmidt, And Jost Kunzli von Fimmelsberg, start to draw the attention of their colleagues to the 50,000 potencies which from now on were called LM- or q-potencies. Three different approaches have been suggested: (1) Rima Handley (1990, 1997) supposed that the sign of a small circle (J) indicates a q-potency. (2) Ubiratan Adler (1994) introduced clinical pharmaceutical criteria (low potencies in a sequence of gradually ascending degrees) to locate 681 Prescriptions of q-potencies in Hahnemann s case books and (3) Luise Kunkle (2001) developed a Theory according to which fractions like 1/190, 1/191, 1/192, etc would be ciphers for q1, q2, q3, etc. Prompted by a criticism by Kunkle of Adler s criteria according to which Hahnemann would have tried out not more than 27 prescriptions of q-potencies before completing his Organon manuscript in February 1842, Adler revised his initial criteria to include the J sign (as proposed by Handley), too. 19 Hahnemann expounds: a) New ideas on medicamental dispersion, associating dilution or simple dispersion of the substance, with dynamisation or potentization of latent medicinal properties by friction, tritutation or succession. Homoeopathic remedies are not inert substances whose matter is divided in the extreme. They are products which have been rendered essentially efficient by reinforcing their latent and highly disintegrated properties through a mechanical treatment which confers upon them new, active and efficient properties (aph 269). b) Duration of the medicamental efficacy of homoeopathic remedies. In his last edition, Hahnemann asserts that these remedies may be kept for many years, provided they are shelters from light and heat.

37 22 c) Scales of concordances: as you all know, Hahnemann in the 5 th edition, anticipating Mr Berne of paris, had already attempted to shake a medicament for half an hour, believing thus to have multiplied by 30 the strength of the first centisimal dilution. When, however, he realized that he had been mistaken, he cancelled his former statement and replaced it by explanatory notes in aph 270, where he describes the preparation of 50 millesimal, uniting the notions of quantity and quality. A major variation to the administration of medicines and to the succession process was described in the preface to the 1837 publication of Part 3 of Hahnemann s Chronic Diseases. Instead of the single administration of a single dry pilule, Hahnemann now advocated the use of liquid preparations which could be split into multiple doses which could therefore be taken more often. Prior to the administration of each dose, the solution must every time be briskly shaken five or six times. This was further developed in his 6th edition of The Organon. In this, his final version, Hahnemann introduced a new manufacturing method, for what is now known as the fifty millesimal potency this method increased the number of succussions at each attenuation from the two suggested in the previous edition of The Organon, to one hundred. At the same time, it increased later dilution ratios to 1:50,000, thus making the mix both more dilute and more often attenuated. Administration of the fifty millesimal (LM) potency has similar ties to the split dose method of the previous edition whereby the patient further successes the medicine prior to each dose.

38 23 27 The manufacture of fifty-millesimal remedies, described by Hahnemann as his most perfected method, is somewhat different. The substance is first triturated to the level of 1 part in a million, that is, the 3rd centesimal potency. One grain (0.06 gram) of this trituration is then mixed with 500 drops of 20% alcohol: water solution. This is the mother tincture. One drop from this stage is then mixed with one hundred drops of alcohol and succussed one hundred times to form the 1st degree of potency and labelled LM1. With the fifty millesimal method, the patient successes the bottle prior to each dose. A comparison of concentrations at the 30th dilution clearly shows the difference between preparations. The centesimal preparation is shown as twice the decimal dilution whilst the fifty millesimal solution is approximately 2.5 times greater than the centesimal equivalent. Given that each preparation is subjected to one hundred successions at each dilution stage, it is also clear that the fifty millesimal preparations have the greatest dilution factor for the same amount of successions, although the fifty millesimal preparation is succussed a further 2-8 times at each point of dosage. A brief comparison of the concentrations at selected dilution stages for the decimal, centesimal and fifty millesimal potencies is illustrated. In Hahnemann s own words. The higher their [the homoeopathic preparations] dynamisation is carried, the more penetrating and rapid does their operation become. 3 He was interested to find the opportunity to prepare such homeopathic medications, which could have a profound and at the same time gentle effect on the patient organism. After making a lot of attempts in 1840, he created a

39 24 new dilution system called LM-potency. He considered this system to be the most perfect method for quick, gentle and final recovery. LM-potencies have some peculiar features. Notwithstanding the amount of a dissolvent there are always molecules of a dissolved substance present in the solution and the dissolving level cannot reach CH12 potency. The molecules present in the solution are carriers of electromagnetic (information) waves with parameters characteristic for them. As a matter of fact LM-potencies correspond to low (decimal and initial centesimal) homeopathic dilutions and have a graduated succession beginning with LM1, LM2, LM3 and up to LM30. These dilutions differ in the quantity of dissolved substance molecules per one unit of a dissolvent; it leads to the decrease of electromagnetic wave voltage and, therefore, reduces the information potency of a medication. In LM-potencies there is a small amount of dissolved substance molecules, which have little Information power and, therefore, a gentle effect on the organism. It gives a slow, without homeopathic exacerbation, recovering. Standardized vial for LM dilutions:

40 25 23 Clinical use of LM dilutions is simple. A course of treatment begins by the lowest dilutions, taken by the patient once daily or in alternate days in chronic cases, or several times a day in acute conditions. Each dose is systematically preceded by succession of the vial for this reason, medicines are dispensed in solution. In chronic cases, a same dilution is kept as long as it elicits an improvement in the totality of symptoms of the patient provided no new significant symptom appears. Dilutions must be periodically increased, one degree at a time, as abrupt changes favour the appearance of homeopathic aggravation ( 276 [1]), here understood as a sign of excessive dose and that, thus, must be treated by increasing the interval between doses and/or increasing the dilution. In order to make transportation and use of medicines simpler, also the vial was standardized to volume 30 ml, containing 20 ml of 30% hydro-alcoholic solution of 1 globule of the prescribed LM dilution. Figure 2 illustrates the practical advantage of the standardized vial. Repeated and agitated LM potencies is the main therapeutic innovation in the 6th edition of the Organon, however there are further clinical principles that characterize Hahnemann s homeopathy and that must be taken into account when standardizing a therapeutic method, such as: selection of the guiding symptoms of the patient (characteristic symptoms); choice of medicine grounded on the most reliable sources, namely, pure Materia Medica sources.

41 26 samples of globules used in the preparation of LM dilutions in Brazil at the end of the 80s (left) and our standardized globules Magisterial dilution of a LM potency

42 27

43 28 25 Features Of LM Potency article by - Dr. Srikanta Choudhury: Disadvantage of C' scale This Lower potencies are not adequate to stimulate a healing reaction. This potency takes long time in curing disease. So, rapid cure is not possible with this potency. Higher potency brings undesirable medicinal aggravation. Single dose of high potency continues to act for a period of several weeks to months. So, the physician has waited to have positive outcome. If the result is negative, then he is to prescribe new medicine. In the meantime patient may suffer severely and may loss faith in homoeopathy. Will not be possible to repeat the dose, even if there exist the remnants of symptoms of disease. Controversy and confusion in the administration of dose and potency. Terminology In the footnote no. 132 of the aphorism 246 Master Hahnemann denotes the new method new dynamization method, new, altered but perfected method. In Aphorism 161 he termed as renewed dynamisation. Dr. Pierre Schmidt of Geneva termed this new scale as 50 Millesimal. Dr. S. Rawson described it as succussed dilution (Hahnemannian Gleanings, volume XLIII, 1976). In eastern region, some of homoeopaths indicate it as new method ' and western countries as LM method '. Significance of the term 50 Millesimal' or LM'

44 29 No 10 globules are required for saturation of medicine in LM potency. 100 globules are equivalent to 1 grain (i.e. 65 mg). 500 globules to be soaked in one drop of previous potency. One such medicated globule is required for next degree of dynamisation in LM scale. Hence 1/500 th of a drop instead of one full drop is used in LM potency. The material part of the medicine is reduced by (1/500 x 1/100 = 1/50,000) 50,000 times for each degree of dynamisation and at the same time the curative power of the medicine increases tremendously. Therefore, the terminology used for denoting this potency 50 Millesimal or LM potency is justified. Sign and symbol Hahnemann used to write it as 0/1, 0/2, 0/3 etc. In western countries the homoeopaths used to write 1/0, 2/0, 3/0 etc. At present new style of writing is LM/1, LM/2, LM/3 etc. which is more scientific. In this subcontinent the homoeopaths write as 0/1, 0/2, 0/3 or M/1, M/2, M/3 etc. This new method of dynamization is denoted by prefixing 0', which representing symbolically the poppy size globules to be used or by capital letters LM', where L' stand for '50' and M' for Millesimal'. 24 In footnote f to aphorism 270 of the 6th Organon (O'Reilly edition) Hahnemann suggests the following: "In earlier instructions, I specified that a whole drop of a liquid in a given potency be added to 100 drops of wine spirit for higher potentization. But meticulous experiments have convinced me that this proportion of the dilution medium to the medicine being dynamized (100:1) is much too narrowly limited to develop the

45 30 powers of the medicinal substance properly and to a high degree, by means of a large number of succussions, unless one uses great force. Whereas if a single globule (100 of which weigh a grain) is used instead of a whole drop of liquid, and this is dynamised with 100 drops of wine spirit, then the ratio of the medicine becomes 50,000:1, indeed higher than that, because 500 of such globules cannot completely absorb 1 drop. In this much higher ratio of the dilution medium of the medicine, many successions of the vial filled to two thirds with wine spirit can bring about a far greater development of power. With a ratio of the dilution medium to the medicine as low as 100:1 very many impacts by means of a powerful machine, as it were, are forced in. as a result, medicines arise that, especially in the higher degrees of dynamisation, almost instantaneously but with stormy--- indeed dangerous intensity, impinge on patients (especially delicate ones) without bringing about an enduring, gentle counter action of life principle. On the other hand, my new method endangers a medicine of the highest development of power and the gentlest action which, if well chosen, curatively touches all sick points. 26 The Founder realized that continuing to increase the number of dilutions and succussions of the centesimal potency did not fill the desired therapeutic lacuna in his new healing art. He came to see that the 1 to 100 dilution ratio is limited by its smaller dilution factor so he began to experiment with new larger dilution ratios rather than raising the C potency to higher and higher degrees. He also noticed that when strong succussions were used in such a small dilution medium as the centesimal 1 to 100 ratio it makes aggressive medicines prone to quick aggravation and unproductive secondary curative effects in the long run.

46 31 42 "With a ratio of the dilution medium to the medicine as low as 100:1, very many impacts by means of a powerful machine, as it were, are forced in. As a result, medicines arise that, especially in the higher degree of dynamization, almost instantaneously but with stormy - indeed dangerous - intensity, impinge on patients (especially the delicate ones) without bringing about an enduring, gentle counteraction of the life-principle." Once again we see the importance of the balance of the primary action of the remedy and curative response of the vital force. When too many dilutions and strong succussions have been forced into the higher centesimal potencies it makes medicines that are prone to aggressive primary actions and strong aggravations that do not produce an "enduring gentle counter action of the life principle". Such furious or prolonged aggravations are to be avoided at all cost as they disrupt the natural symptom pattern, waste vitality, and complicate the cure. The LM potency, on the other hand, is given in the smallest liquid dose so it produces a mild primary effect and a long enduring gentle counter action of the vital principle. During the period of the 5th Organon (1833) Hahnemann used the unmodified liquid dose made up each time from 1 or 2 poppy seed size pellets. In aphorism 29 of the 5th Organon Hahnemann described how the centesimal method works. He wrote that the similar homoeopathic remedy "pushed into the place of the weaker natural disease" against which the instinctive vital force was "compelled to direct an increased amount of energy". The idea of pushing into place and compelling the vital force to increase its energy against the remedy is based on the phenomena of the homoeopathic aggravation. The methods of the 4th and 5th Organon are based on a crisis-like aggravation in contrast to the gentle medicinal solution and the noninvasive LM method.

47 32 28 Hahnemann one of the master pharmacists of his era, came up with a simple and ingenous solution for increasing the dilution, thus making the remedies ever safer (especially considering that some were made from poisons) while holding back on the successions, thus keeping the energy at a gentler level. Instead of successing 10 times for each1 1n 100 dilution, the LM s are only successes 100 times for each 1 in 50,000 dilution. Administered in water (a development of 5 th edition as we have seen), the LM s became a truly revolutionary tool within a healing system which was revolutionary in itself for healing at a deep level while controlling aggravations. Putting the remedies in water accomplished several things at once: 1. It enhanced the effectiveness of delivery, since the teaspoon of water could touch many more nerve endings than a tiny pellet. 2. It allowed a single dose to be spit into many administrations; a single pellet of potency would be spreadout into entire bottle. 3. Successing the bottle allowed minute upward adjustments of the potency ( finer tuning than the 10 successions between centesimal potencies) in keeping with Hahnemann s 6 th edition dictum never to give the same potency twice. 4. It thus allowed for highly refined adjustments to respond to aggravations and to the individual temperament. 29 A summery for Hahnemann s directions for the use of LM potencies. 1. The remedy must be homoeopathic The remedy must be highly potentised i.e. prepared by the LM method The remedy must be given in small doses i.e. dissolved in water before administration to the patient 246

48 33 4. The remedy must be repeated at suitable intervals The potency must be altered before each dose i.e. raised by succussion 246 The solution is to be succussed 8, 10, 12 times before taking one. or (increasing progressively) more coffee or tea-spoons daily or every other day (for chronic cases), 2, 3, 4, or 6 hours for acutes Potency must start with the lower degrees (LM 1-6?) and proceed to the higher levels 246 footnote 7. Even long acting remedies can be repeated Dosing is continued while there is steady improvement and the patient does not experience a symptom he has not had before If a new set of different symptoms are seen, then another more appropriate remedy must be looked for If an aggravation occurs i.e. an intensification of the original symptoms, at the end of treatment, then the doses must be reduced in quantity and repeated at longer intervals, or stopped altogether to see if the symptoms will continue to disappear by themselves. In which case either no more medicine will be needed or continuation of the remedy if, after a certain period, symptoms continue No dose of a highly potentised remedy can be too small that it cannot be stronger than the natural disease, that it cannot at least partially overcome it and that it cannot start the process of cure. 279

49 If one is sure that the remedy is correct! and there is no improvement then it is likely that a maintaining cause in the patient's way of life or environment is influencing his progress. This must be removed to bring about a permanent cure Aggravations or ameliorations of the psychic conditions and general demeanour of the Patients are a good indication as to the progress of the remedy If the patient develops some significant new symptoms or symptoms of the remedy then this is an unfavourable response Do not make favourites of certain remedies as the smaller lesser used remedies which might be more helpful will be overlooked It is not necessary to give a patient more than one remedy at a time If the remedy is homoeopathically accurate then it becomes increasingly beneficial as its dose approaches the ideal degree of smallness for gentle action It is only by experiment, experience and observation of the sensitivity of each patient that can determine the optimum size of dose to give Dosing continues, increasing it progressively, until the patient, while feeling generally better, begins to manifest one or more of the old, original symptoms Return of old symptoms is a good sign and the medicine is stopped as this is an indication that no more is needed as the symptoms are of the remedy. To verify this the remedy is stopped for a week or two. If the symptoms are of the remedy they will disappear in a few days and no more medicine may be needed. If traces of the original complaint remain then dosing should be continued from where it was left off. 281

50 A homoeopathic aggravation i.e. an intensification of the original complaint, at the beginning of treatment,is a sure sign that the dose (i.e. the quantity of the dissolved granule) are too large and must be reduced If the smallest doses are given the even if the remedy is inappropriate the harm done is insignificant and the appropriate remedy quickly puts the case in order Very chronic problems can be speeded up by applying the same solution as that taken by mouth, externally to the back, thighs and lower legs. 22 It becomes clear that the results of the treatment with the help of medicinal solutions, which have centesimal potencies not always satisfied S. Hahnemann. It especially concerned the patients with chronic miasmatic diseases. In some cases low potencies were unable to stimulate a curative reaction, whereas high potencies aggravated the patient state. He was interested to find the opportunity to prepare such homeopathic medications, which could have a profound and at the same time gentle effect on the patient organism. (4) After making a lot of attempts in 1840, he created a new dilution system called LM-potency. He considered this system to be the most perfect method for quick, gentle and final recovery (7). LM-potencies have some peculiar features. Notwithstanding the amount of a dissolvent there are always molecules of a dissolved substance present in the solution and the dissolving level cannot reach CH12 potency. The molecules present in the solution are carriers of electromagnetic (information) waves with parameters characteristic for them. As a matter of fact LM-potencies correspond to low (decimal and initial centesimal) Homeopathic dilutions and have a graduated succession beginning with LM1, LM2, LM3 and up to LM30. These dilutions differ in the quantity of dissolved

51 36 substance molecules per one unit of a dissolvent; it leads to the decrease of electromagnetic wave voltage and, therefore, reduces the information potency of a medication. Information power and, therefore, a gentle effect on the organism. It gives a slow, without homeopathic exacerbation, recovering. Preparation of 50 millesimal scale 8 one milliliter (0.1 ml) of the first fifty millesimal attenuation (1LM) represents 4.0*10-9 g of dry crude medicinal substance. One milliliter (1.0 ml) of the second fifty millesimal attenuation (2LM) represents 8.0*10-4 g of dry crude medicinal substance. method of manufacture: 1. For solid substances, proceed according to the centisimal scale to the 3C trituration. Initially, for liquid substances, impregnate the lactose in a proportion of 1 to 100 beginning with the liquid substance. The second and third triturations are carried out in the same way as when starting with solid products. 2. Take 0.062g of the 3c trituration, add 500 drops of a mixture composed of 1 part 95%v/v alcohol and 4 parts distilled water. 3. Add 1 drop from the result of step 2 to 2.0 ml. of 95%v/v alcohol succus. The result is 1LM. 4. Pour 1 drop of 1LM on 0.575g. #10 pellets (500 #10 pellets). Take 1 pellet and add to 2.0 ml. of 95% v/v alcohol. Succus. The result is 2LM. 5. Pour 1 drop of the 2LM on 0.575g. >#10 pellets (500#10 pellets). Take 1 pellet and add 2.0ml. of 95% v/v alcohol. Succus. The result is 3LM. 6. Repeat the step 5 until the 30LM is obtained.

52 37 27 In this scale the first potency should contain 1/50,000 the part of original drug, the second potency will contain 1/50,000 the part of first potency and so on. Potency in this scale is denoted by 0/1,0/2,0/3,0/4,0/5 etc. As in this scale the proportion of medicine to alcohol will be 1/50,000 (1/5000*100), so this scale of potency is called as fifty millesimal scale. Triturate the crude drug substance in the usual manner with the milk sugar in the proportion of 100 mg. of dry drug substance or 0.01 ml. of liquid drug substance with 10 gm. Of milk sugar. Triturate the first potency thus prepared again in the usual manner, taking 100 mg of the first potency with 10 gm of milk sugar; next triturate the second potency thus obtained with the same proportion and manner to prepare the subsequent third potency. To prepare a solution of the third potency by mixing 100 mg of the third potency with 50 ml of a mixture of purified and dispensing alcohol. This mixture is prepared by adding one part of dispensing alcohol to four parts of purified water. To make the solution properly, firstly dissolving 100 mg of the third potency, in 40 ml of purified water and then add 10 ml of dispensing alcohol; call it the mother solution. Pour one part of this mother solution to 100 parts of dispensing alcohol, and give100 strong successions. This makes the first fifty millesimal potency, denoted as 0/1. For the preparations of each subsequent potency, take few globules of nearly uniform size, 100 globules of which will weigh 65 mg., then pour a drop of the preceeding potency upon these globules and dry them, take one globule and dissolve it in a drop of purified water in a new clean phial, add 100 drops of dispensing alcohol to it and give 100 strong successions. The needed potency is now ready.

53 38 19 The preparation of remedies (aph ). Here Hahnemann expounds his absolutely new theory for preparation of the 50 millesimals as well as the technique of their application. I had, in fact, already read years ago in the BJH, an article on the plus method. I had even applied it and it had been a dead failure. Since then none of our papers have ever mentioned it. It showed, however, how important it was to have the Organon translated, as no one had ever applied the method in the proper way. Even today, I occasionally read in homoeopathic journals about cures affected by 50 millesimals in globules. This is positive proof that the prescribers of such doses have not understood the new method at all, as the remedy ought to be administered in liquid form only (271). 29 we should prepare three successive tribulations (i.e., 1 st, 2 nd and 3 rd trituration) from the original substance (or mother substance). The ratio of each will be 1:100. Take one grain from 3 rd trituration and dissolve it (by necessary shaking) in 500 drops of a solution having 100 drops of alcohol and 400 drops of distilled water. This is the 4 th stratum. We call this stage, the mother potency of the new method. The ratio is 1:500. One drop from this 4 th stage is to be mixed with 100 drops of alcohol. This is to be successes 100 times. This is the first potency (or M/1, or 0/1, or LM/1, etc) of the new method. Proportion is 1:50,000. With one drop of this first potency (ie., LM/1) 500 globules (of which 100 weigh one grain, ie., No-10 globules) are to be soaked. Then put one such medicated in a one drachm vial and put 100 drops of alcohol in the vial and success it 100 times. This is the second potency (ie., LM/2) of the new method. The ratio is 1/50,000 or more. In this way the dilution may be raised from LM/3 to LM/30 or as needed. 33 In this new process of potentisation or dynamisation six steps are to be crossed from original substance to LM/2.

54 39 1 st : original substance 1 drop (1 grain)+ 100 grains of sugar of milk+1 hour trituration by grinding, pounding,scraping etc. This is first trituration= 1/100 2 nd : 1 st trituration 1gr+100gr. Sugar of milk+1 hour trituration= 2 nd trituration = 1/100 *1/100 =1/10,000 3 rd : 2 nd trituration 1gr +100gr. Sugar of milk + 1hour trituration= 3 rd trituration = 1/10,000 * 1/100 = 1/10, 00,000 4 th : 3 rd trituration 1gr drops of the solution (100 drops alcohol and 400 drops distilled water). = 1/10,00,000 * 1/500 = 1/50,00,00,000 We call it mother power of new potency. 5 th : 1 drop of the 4 th solution drops of alcohol succussions = LM/1, the 1 st potency = 1/50,00,00,000 *1/100 = 1/50,00,00,00,000 6 th : one No-10 globule soaked with LM/1+ 1 drop of distilled water+100 drops of alcohol+100 successions= 2 nd potency or LM/2 = 1/50,00,00,00,000 * 1/50,000 = 1/ 2,50,00,00,00,00,00,000 In this way, LM/3 onwards will have to be prepared and potentised. 20 In aph 270 in order to best obtain this development of power, a small part of the substance to be dynamized, say one grain, is triturated for three hours with three times one hundred grains of sugar of milk according to the method described below, upto one millionth part in powder form. For reasons given below one grain of powder is dissolved in 500 drops of a mixture of one part of alcohol and 4 parts of distilled water, ( this is the LM/0) of which one drop is put in a vial. To this are added 100 drops of pure alcohol and given hundred strong successions with the hand against a

55 40 hard but elastic body. This is the medicine in the first degree of dynamisation (LM/1) with which small sugar globules may be moistened and quickly spread on bloating paper to dry and kept in a well corked vial with the sign of (LM/1) degree of potency. Only one globule of this is taken for further dynamisation, put in a second new vial ( with a drop of water in order to dissolve it) and then with 100 drops of good alcohol and dynamized in the same way with 100 powerful successions. With this alcoholic medicinal fluid globules are again moistened, spread upon blotting paper and dried quickly, put into a well stoppered vial and protected from heat and sunlight and given the sign (II) (LM2) of the second potency. And in this way the process is continued until the twenty ninth (LM/29) is reached. Then with 100 drops of alcohol by means of 100 successions, an alcoholic medicinal fluid is formed with which the thirtieth dynamisation degree (LM/30) is given to properly moistened and dried sugar globules. By means of this manipulation of crude drugs are produced preparations which only in this way reach the full capacity to forcibly influence the suffering parts of the sick organism. In this way, by means of a similar artificial morbid affection, the influence of the natural disease on the life principle present within is neutralized. By means of this mechanical procedure, provided it is carried out regularly according to the above teaching, a change is effected in the given drug, which in its crude shows itself only as material, as times as unmedicinal material but by means of such higher and higher dynamisation, it is changed and subtilized as last into spirit like medicinal power, which, indeed, in itself does not fall within our senses but for which the medicinally prepared globule, dry, but more so when dissolved in water, become the carrier, and in this condition, manifests the healing power of this invisible force in the sick body.

56 41 30 finally some homoeopaths are using potencies based on serial dilutions of 1/50,000 at each level. These are called 50 millesimal potencies, but common parlance refers to them simply as millesimals. This unusual dilution factor was suggested by Hahnemann late in his life, based on preliminary experimentations with different degrees of dilution and succession. For eg, a 1m potency is a dilution of 1/50,000 and a 3m potency represents a dilution of 1/125,000,000,000,000 (1/50,000 * 1/50,000 * 1/50,000). 10 In the year 1840, the preparation of potencies was modified again and the 50 millesimal scale of preparing the potencies was evolved about 3-4 years before the death of Hahnemann. For preparing 50 millesimal scale potencies 3c of the centesimal scale is taken as the mother tincture for next higher potency. In one drop of this mother tincture add 500 drops of dilutent containing alcohol and water in the proportion of 1:4 are added. Hence the strength of the mother tincture is 1/500,000,000 ie., 50 millesimal potency. In preparing further potencies poppy sized globules saturated and dried are used to prepare higher potencies. Dissolve one globule of first millesimal potency in 100 minims of 90% alcohol and give 100 successions. Add one minim of this solution to 500 globules of sugar of milk and dry them off on a blotting paper. These globules form the second 50 millesimal potency written as 0/2. Thus each time a globule is taken for the preparation of the next higher potency. The preparation thus made were called medicament la globule. 32 Material part of new dynamisation medicines: 1. The material part of the medicine is lessened with each degree of dynamisation 50,000 times and yet incredibly increased in power, so that the further dynamisation of 125 and 18 ciphers reaches only the 3 rd degree of

57 42 dynamisation (3 rd potency = 125, ). The 30 th, thus progressively prepared, would give a fraction almost impossible to be expressed in numbers. 2. Trituration 1 st degree contains: medicinal substance. 3. New dynamisation mother solution contains: 1/10 6 *1/500 = 1/10 6 *1/5* 10 2 = 1/5* st degree contains: 1/5*10 8 *1/100 = 1/5* 10 8 *1/10 2 = 1/5* All subsequent potencies are expressible in terms of: 1/50,000= 1/5*10,000 = 1/5* rd degree contains: 1/5*10 10 *[1/5*10 4 ] 2 = 1/5*10 10 *1/5 2 *10 8 = 1/5 3 *10 18 = 1/125* = 125 and 18 ciphers th degree contains: 1/10*10 10 *[1/5*10 4 ] 29 1/5*10 10 * 1/5 29 * = 1/5 30 * c triturate 1 part of 2c in 99 parts of lactose. LM1---- take 1 grain (0.062 grams) of 3c and add 500 drops of mixture composed of 1 part of alcohol and 4 parts of distilled water (ie., 100 drops of alcohol and 400 drops of water). Take one drop and put it in 2ml of alcohol, success 100 times. Now you have LM1 stock bottle. Pour 1 drop from LM1 stock bottle onto 500 poppy seed pellets (#10 pellets). These are our LM1 pellets, which you will use to make your patient s remedy bottle.

58 43 LM2--- take one pellet of LM1 and dissolve in one drop of water. Add 99 drops of alcohol.succuss 100 times. Now you have LM2 stock bottle. Pour 1 drop from your LM2 stock bottle onto 500 #10 pellets. These are your LM2 pellets. LM3--- take 1 pellet of LM2 and dissolve in one drop of water. Add 99 drops of alcohol. Success 100 times. Now you have the LM3 stock bottle. Pour 1 drop from your LM3 stock bottle onto 500 #10 pellets. These are your LM3 pellets. The tedious part is of this process is making LM1. Practitioners usually purchase an LM1 kit and make the LM2, LM3 etc. By hand as patients need them. Making the higher LM s only takes a few minutes to make enough to last for years. If your 500 pellets run out you just use a drop from the appropriate LM stock bottle to impregnate another 500 pellets. 29 The final development to create a more highly dynamised remedy was the change of the dilution factor from 1:100 to 1:50,000. The 3c trituration powder (details of the preparation of this are in 270) is the starting point for the preparation of the LM scale because all remedies are soluble in water at this point; so any remedy can be utilised even the insoluble materials such as Carbo Veg, Aurum etc. A grain in weight (0.06gm) of this powder is dissolved in 500 drops (30ml) of 20% alcohol making a 1:500 dilution of the 0.06gm of 3c, and one drop of this solution is then further diluted in 99 drops of 95% alcohol, filling two thirds of a glass vial, giving a (1 in 500 x 100 = 50,000) solution of the 3c powder. This tube is then succussed 100 times against a firm but elastic object (the famous leather bound bible) to create the LM 1 medicating liquid. 1 Hahnemann's comments on this new method are found in the 6th Edition 270"... Meticulous experiments have convinced me that this ratio (1:100) between the

59 44 quantity of diluent and that of the medicine being dynamized is far too low to develop the medicinal substance properly and to a high degree with a large number of succussions unless force is used....whereas in this much higher ratio (1:50,000), between diluent and medicinal substance, a large number of succussions of the vial filled two-thirds with wine spirit can bring about a far greater development of power." 27 The LM 1 liquid is then poured onto some poppy-seed granules of which a hundred weigh 1 grain (0.06gm). Although this size is larger than those granules advocated in Chronic Diseases (200 to a grain) they are still so small that one drop of the alcoholic LM 1 liquid Can completely wet at least 500 of them. Thus just one granule absorbs at least a 500th of a drop. When this granule is dissolved in a drop of water, and 99 drops of alcohol are added to it, the next LM 2 solution contains a 1/500th x 100 = 1/50,000th of the previous LM 1 liquid. The LM 2 liquid is then succussed 100 times also. The process is continued in this way simply using the granule as the intermediary to transfer a 500th of a drop instead of the direct addition of a whole drop as is the case with the centessimal 1:100 ratio. Hahnemann's practical simplicity is masterful as the small granules not only provide a tiny, manageable dose, for using with patients, but also the smallest practical unit to effect such large dilution ratio. One could theoretically dilute with one drop to 50,000 drops (100 drops of 95% alcohol = 3.6mls) but the bottle to be succussed 100 times would then contain 1.75 litres of alcohol. Not an economic or practical size for the average human being to work with! Although the nature of the 1:50,000 potency created is different from that created by a 1;100 ratio (... my new method produces medicines of the highest power and the mildest action ) it is interesting to note the theoretical relationship with the

60 45 centessimal scale. Each step of 1:50,000 is a rise of approximately 2.5C so that considering we started with a 3C a LM1 is just over 5C, LM 6 = 17C, LM 12 = 31C, LM 30 = 73C (all approximate figures) So the granules are wetted with the solution and left to dry after which they are bottled and labelled with the appropriate nomenclature e.g. LM 1, LM 2 or LM 0/1, LM 0/2 etc. The zero signifying the granule, the form in which the final medicine is stored. Now we have this highly dynamized remedy our criteria for how to use them are different from those of the centesimal scale. Obviously the indicated similar remedy is still chosen on the same principles as before but choice of potency, up to now our main variable factor for controlling the response to the remedy, is not such as issue when using the LM's. Hahnemann's recommendation is to always start with the lowest degrees ( 246) Although not specifically mentioned, this suggests always starting with LM 1, but is often interpreted, by experienced users of LM's, as between LM 1 and LM 6. The choice is based on the Health/vitality level, degree of pathology, suppression, sensitivity etc. and provides a variable on which we can individualize. With the dissolving in liquid, and subsequent shaking of the bottle before each dose, the potency is gradually raised, expanded, and intensified to continually stimulate the vital force at regular intervals. The next potency level is given when the bottle of the previous potency is finished. No leaps in potency are recommended ( 246) and if one starts with LM1, for example, then LM 2 follows and so on. Unless we dissolve a granule directly in 1.75 litres of water we will never actually reach the next LM level but simply continue towards the potency level determined by the dilution factor. After we have chosen the appropriate remedy to give in LM form, the first choice, after the potency, is how much of the granule is the patient to take i.e. the dose, how

61 46 often it is to be repeated and for how many days they to be on that particular potency are. These are the areas where the difficulties of the LM's lie and, as Hahnemann tells us in 278, theorizing is not enough to tell us what the ideal degree of smallness of the dose is to effect a gentle cure, and that "Only pure experiment, the meticulous observation of the sensitivity of each patient, and sound experience can determine this in each individual case". Control of the dosage is very similar to the centessimal 'plussing' technique but using the LM granule, instead of a 30c, dissolved in liquid. The directions for making up the solutions for patient use are defined quite clearly in the 6th edition 248 footnote. He states that one rarely needs more than one granule although two or three can obviously be used if a stronger solution is required. The granule is dissolved in forty, thirty, twenty, fifteen or eight tablespoons of water with the addition of a little alcohol to preserve it; 10% is a good guide for solutions designed to last up to two months. The patient takes directly from the 'stock' bottle" one or, increasing progressively, more coffee or teaspoons of this as follows: in chronic diseases, daily or every other day; in acute diseases every six, four, three or two hours..." Eight, ten, or twelve succussions are given to the bottle before each dose. Again we have here a variable which we can use to regulate individual needs if required, twelve shakes giving a slightly sharper daily rise in potency than eight. Also note the wording 'one or increasing progressively more teaspoons' which, if appropriate to the case, can speed up cure by giving increased stimulus from the larger dose as well as taking the patient through the higher potencies more rapidly. To help us decide how much liquid to make up let us look at the appropriate dosages for each of Hahnemann's suggestions.

62 47 A tablespoon is considered a 20ml measure, a teaspoon 5ml, and a coffee-spoonful 2.5ml, so a granule dissolved in :- 40 tablespoons = 800ml = 1/800th granule/ml so a 5ml dose contains a 1/160th of a granule. (160 days supply) 30 tablespoons = 600ml = 1/120th of a granule per 5ml dose (120 days supply) 20 tablespoons = 400ml = 1/80th of a granule per 5ml dose (80 days supply) 15 tablespoons = 300ml = 1/60th of a granule per 5ml dose (60 days supply) 8 tablespoons = 160ml = 1/32th of a granule per 5ml dose (32 days supply) A coffee spoonful will represent a dosage twice as small as the above i.e. 40 tablespoons = 1/320th of a granule per 2.5ml dose. 31 Preparation of 1 st potency (0/1): one drop of above mentioned mother tincture is put in a suitable vial of neutral glass and 100 drops of pure alcohol are added so that the vial is filled 2/3 rd full. This is to be successed 100 times by hand against a hard but elastic body. This is the first degree of dynamisation of first potency (M/1 or 0/1 or LM/1 potency). The drug strength will be: 1/5*10 8 *1/100 = 1/5*1/10 10 =1/5*10x =1/5*5C [1/10 10 =10x;10x = 5c] Conversion in form of globules --- the small poppy sized globules (100 weighing 1 grain) are moistened with it and spread quickly on a piece of blotting paper to dry it. Then they are kept in a well corked glass phial protected from heat and sunlight with mark 0/1 on it. It is found that 500 standard globules of poppy seed sized can hardly absorb one drop of alcohol for their saturation. Preparation of 2 nd potency (0/2): only one globule of the first potency is put in a second new glass phial and one drop of purified water is added to dissolve it. To it

63 drops of pure alcohol (95%) is added and dynamised with 100 powerful successions as before. Conversion in form of globules with this alcoholic fluid globules are again moistened, spread upon blotting paper and dried quickly. These are put into well stoppered phial and protected from heat and sunlight giving the sign (0/2) of the 2 nd potency. Preparation of next higher potencies the above mentioned process is repeated with one globule of previous potency to increase it to next potency. Th process is continued up to thirtieth potency and each potency contains 1/50,000 part of previous potency.

64 49 42 Diagramatic representation of LM scale preparation: 34 Robin Murphy: the LMs are classically described as 1 to 50,000 dilution, which is not really true. Basically all LMs are made from 3c potencies. You take one drop or one pellet of 3c and you put that in 500 drops. And in those 500 drops, you have 400 drops of water and 100 drops of alcohol. You succus that and that becomes your LM0 or LM mother tincture. From that you take one drop and put it in 100 drops (this is where people make the mistake when they start fooling around with the LMs--- they

65 50 think its 1 to 500 each time. Its only 1 to 500 from 3c to LM0. That s the only time you do that. Then its 1 to 100). Then you success it and that becomes LM1.You take 1 drop of that, put it in another 100 drops and success it and the becomes LM2.

66 51 35 How to make an LM potency from 3C trituration: 1. 1 grain of 3C potency diluted in 500 drops ( 100 drops alcohol and 400 drops water) = LM/ drop of LM/ drops of alcohol +100 successions = LM/1 potency 1 drop of LM/1 is put on 500 granules of milk sugar (#10 pellets) 3. 1 granule of LM/1 is dissolved in one drop of water +100 drops of alcohol +100 successions = LM/2 potency 1 drop of LM/2 is put on 500 granules of milk sugar (#10 pellets) 4. 1 granule of LM/2 dissolved in one drop of water +100 drops of alcohol +100 successions = LM/3 potency (continue this process upto the LM/30 potency) 16 pharmaceutical standardising: at the end of the 80,s decade, the approximately ten homoeopathic pharmacies in the city of sao Paulo had available irregular yellowy inert microglobules and medications in the 50 millesimal scale, of Mexican origin. The medications had been distributed in the 7 and 31 LM potencies and the pharmacies dispenced the 8 and 32 LM potencies. Thus it went on for some time, until the following potencies were prepared, namely, the 9,10,11,e a 33,34,35 and so forth. Doctors to begin with prescribed the 8 LM and after the 32 LM. As time elapsed they began prescribing 8 to 9, to 10LM etc, and when there were no more potencies ready available, they went on to the 32, to 33 to 34LM. To more readily meet this demand, some pharmaceuticals started changing the intermediates that they had dynamized. New inert microglobules of argentine origin appeared in the market, however, their weight was above that standardized by Hahnemann and of irregular shape. That was the LM medications existent situation in our inventory when a group of doctors, coordinated by Dr. Ubiratan Adler, contacted our pharmacy asking if they were in a position to prepare medications, considering that they had already studied

67 52 the 6 th edition in detail and continued having aggravation of illness problems with their patients. We then became conscientious of the importance of the standardized globule for the dynamics of the fifty millesimal and of the quality control of the ground raw materials. We then began to recreate our inventory, from the mineral origin antiserum relying on the help of chemical engineer Antonio Sacco Neto. We soon realised that other stages of the preparation also required to be standardised; the grinding had to be performed with strength, however not so intense as to not allow for the scraping to be effected in form 3 to 4 minutes; the manual successions would have to be performed with strong, ample and rhythmic movements. The standardising of the globules demanded a lot of work. We learned that minor humidity, temperature, granulation of the sugar, and other variations, alter the size, weight and aspect of globules. We managed that a cellulose derivative used as an aggregative by the producer be removed, in order that the globules would come to only contain saccharine and starch, as documented by Hahnemann. As we did not have fresh vegetables to be ground available, we opted on purchasing them from Nelson an English pharmacy, influenced by the citation found in pathel. We received various medications in the LM1 potency and we went ahead with the dynamisation of these pills, work done by the pharmacist ilza Marcia Anelli. Some years later we became acquainted with german researcher, peter barthel, who at that time performaed grinding of fresh materials, from their natural habitat. We accompanied barthel on his trips to brazil looking for plants to be ground and were able to observe the quality in the preparation of freshly collected material, which led us to opt for this method of grinding product from fresh plants.

68 53 METHODS OF PRESCRIBING: 3 Dr Hahnemann: explained in aph 272 about the way of administering the scale he says, Such a globule placed dry upon the tongue, is one of the smallest doses for a moderate recent case of illness. Here but few nerves are touched by medicine. a similar globule, crushed with some sugar of milk and dissolved in a good deal of water and stir well before every administration will produce a far more powerful medicine for the use of several days. Every dose no matter how minute touches on the contrary, many nerves. 1. DRY: how many globules? One Where must the globules be placed? On the tongue. In this way one of the smallest dose is prescribed. In which kind of disease this dry method used? In recent moderate diseases. What other qualities does dry administering have? The medicine will touch few nerves Hahnemann gives a relavant importance to the nervous system in the process of health and disease. 2. IN WATER: the second way of prescribing the medicine is in water. This way of prescribing includes three steps: 2.1 one globule is taken and triturated with sugar of milk: one or two of these small globules are placed on a paper with 2 or 18 centigrams of sugar of milk. These globules are then crushed with a spatula or with the thumb. 2.2 then the mixture is dissolved in water. 37 prescribing the medicine in acute diseases: aph- 248 in acute diseases every two to six hours and in very urgent cases every hour or oftener only those who have not thoroughly read this aphorism may be alarmed with this instruction in acute

69 54 diseases. In case of heart attack, anaphylactic shock, intoxications for instance, the medicine mus be given every 30 minutes, 5 minutes or with the necessary frequency; without forgetting to modify the dynamisation degree every time. prescribing the medicine in chronic disease: aph- 248 we give the patientone or ( increasingly) several teaspoon doses, in long lasting diseases daily or every second day In the paragraph 248 there is a detailed procedure of administering a medicine in LM potency for chronic diseases, let us analyse it by parts. 1. Give to the patient, one or increasingly several teaspoonful doses: note that it is stated one or increasingly several teaspoonfuls, ( prescribed in some time). The dose is of 5cc which a teaspoonful contains. 2. Daily or every second day: it may be given daily, at night, one hour after the last meal, and then staying awake for one hour according to Hahnemann s instructions. Or the medicine might be given on every second day, twice a week, once a week, as required. 3. May be repeated daily for months with ever increasing success: again the instruction to prescribe the medicine even for months, if the individual case thus requires it. Note: with ever increasing success. This instruction preceeds a statement by Hahnemann... every correctly chosen homoeopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success... It might be thought that only short acting medicines can be repeated daily, precisely due to their short action, but I think that the given explanation does not need any additional commentary.

70 55 Advantages and superiority of new dynamisation over centisimal scale: 32 1.With the disproportionate higher ratio between medicine and diluting medium, (1:50,000) many successive strokes of the vial filled two thirds with alcohol can produce a much greater development of power. But with so small a diluting medium as 100 to 1 of the medicine, if any successions by means of a powerful machine are forced into it, medicines are then developed which especially in the higher degrees of dynamisation, act almost immediately, but with furious, even dangerous, violence, especially in weakly patients, without having lasting, mild reaction of the vital principle. ---FN 155 to sec The new method described by me (new dynamisation) on the contrary, produces medicines of highest development of power and mildest action, which, however, if well chosen, touches all suffering parts curatively--- FN.155 to sec In acute fevers, the small doses of the lowest dynamistion degrees of these thus perfected medicinal preparations, even of medicines of long continued action (for instance Belladonna) may be repeated in short intervals. In treatment of chronic diseases, it is best to begin with lowest degrees of dynamisation and when necessary advance to higher, ever more powerful but mildly acting degrees--- FN 155 to sec In a very rare cases, not withstanding almost full recovery of health and with good vital strength, an old annoying local trouble continuing undisturbed, it is wholly permitted and even indispensably necessary, to administer in inceasing doses the homoeopathic remedy that has proved itself efficacious but potentised to

71 56 a very high degree by means of many successions by hand. Such a local disease will often disappear in a wonderful way- Asterisk (*) note to FN 155 to sec It is the most perfected method of potentisation what I (Hahnemann) have found after many laborious experiments and counter experiments, to be the most powerful and at the same time mildest in action. FN 156 to sec Material part of medicine is lessened with each degree of dynamisation 50,000 times and yet incredibly increased in power. FN 156 to sec By this process of dynamisation, true inner medicinal essence is developed. --- FN 156 to sec The material part by means of this dynamisation dissolves into its individual spirit like (conceptual) essence. In its crude state therefore, it may be considered to consist really only of this undeveloped conceptual essence. ---FN 156 to sec By means of this potentisation, the crude drugs reach the full capacity to forcibly influence the suffering parts of the sick organism. aph By means of such higher and higher dynamisation, crude medicine is changed and subtilised at last into spirit like medicinal power, which indeed in itself does not fall within our senses but for which the medicinally prepared globule, dry, but more so when dissolved in water, becomes the carrier, and in this condition, manifests the healing power of this invisible force in the sick body.- -- aph During the last four or five years, however, all these difficulties are wholly solved by my new altered but perfected method. The same carefully selected medicine may now be given daily and for months, if necessary in this way, namely, after the lower degree of potency has been used for one or two weeks

72 57 in the treatment of chronic diseases, advance is made in the same way to higher degrees, (beginning according to the new dynamisation method, thought herewith with the use of the lowest degrees).---fn 132 to sec Though modification of every dose in its dynamisation degree there exists no offense, even of the doses be repeated more frequently, even if the medicine be ever so highly potentised with ever so many successions. It almost seems as if the best- selected homoeopathic remedy could be extract the morbid disorder from the vital force and in chronic diseases to extinguish the same only if applied in several different forms. FN 133 to sec The 50 millesimal scale of potencies differ from the centesimal scale in the following ways: 1. The mother tincture in the centesimal scale is a drop of the drug or one grain in weight according to liquid or solid form of drug taken for potentisation. Whereas the mother tincture in the 50 millesimal scale of potencies in the solution of 1 grain of 3c of the medicine in 500 drops of dilutent containing alcohol and water in the proportion of 1:4. Hence the strength of the mother tincture is 1/500,00,00,00 ie, millesimal potency. 2. In preparing further potencies in the centesimal scale a drop of previous potency mixed with 99 drops of pure alcohol to keep the ratio 100:1. Hence it is called the drop method of preparing potencies, whereas in preparing 50 millesimal scale of potencies poppy seed sized globules saturated and dried are used to prepare further potencies. Hence it is called globule method of preparing the 50 millesimal scale potencies, as one globule represents 1/500 th of a drop of the centesimal dilution, we arrive at 500*100= 50,000.

73 58 3. In preparing the centesimal scale potencies only 10 strong strokes or successions are given. Whereas in preparing 50 millesimal potencies 100 strong strokes or successions are given. 4. Many glass methods ie, for each potency a fresh bottle and fresh stopper is taken and succession is carried out in 50 millesimal scale while in centisimal scale after 30 or 200 potency usually single glass method is followed. 40 In earlier instructions, I specified that a whole drop of a liquid in a given potency be added to 100 drops of wine Importance of 50 milesimals: 41 Hahnemann had no other alternative but to revise his Organon, fifth edition mainly for the following reasons: 1. To hasten the process of cure. Gentle and rapid ideal of cure is not possible by medicine of centisimal scale or it takes a long time in many cases. 2. To avoid medicinal aggravation. The undesirable medicinal aggravation comes even after the well selected medicine is applied especially in weak patients, regarding which Hahnemann stated,...furious, even dangerous, violence. 3. Even single dose of high potency continues to act for a long time. 4. Repetition of doses is not possible even if there are remanant of symptoms of disease in consequence of which the patient suffers for a long time. 5. The problems of application of doses and potencies still create chaos and confusion throughout the homoeopathic world. 6. If the selection of medicine is wrong, then after application of high potency of centesimal scale the disease condition becomes more worse.

74 59 7. So, the highest ideal of cure according to aphorism 2 of the Organon could not be properly materialized with centesimal potency. 33 important hints regarding the appropriate appliance of Q- potencies: let me finally point to a couple of hints concerning the choice of potency and dosage. Given the precise indications supplied by Hahnemann himself, I shall limit myself to extensive quotations. The first issue is the one of the choice of potency. We should start treatment with the lowest possible degrees of Q potencies, for instance Q1, Q1 or Q3 ( annotation 132 to aph 246). Moreover, as regards the question of dosage and repetition, he asks ( ) how small must be the dose of each individual medicine, homeopathically selected for a case of disease, to effect the best cure? Hahnemann claims that this is not the work of theoretical speculation. Rather, pure experiment, careful observation of the sensitiveness of each patient, and accurate experience can alone determine this in each individual case (aph 278). More specifically we potentize a new the medicinal solution (with perhaps 8, 10,12 successions) from which we give the patient one or several teaspoonful doses, in long lasting diseases daily or every second day, in acute diseases every two to six hours and in very urgent cases every hour of oftener. Thus in chronic diseases, every correctly chosen homoeopathic medicine may be repeated daily for months with ever increasing success. If the solution is used up it is necessary to add to the next solution of the same medicine if still indicated one or several pellets of a higher potency with which we continue so long as the patient experiences continued improvement without encountering one or another complaint that he never had before in his life. For if this happens, if the balance of the disease appears in a group of altered symptoms then another, one more homeopathically related medicine must be chosen in place of the last and administered in the same repeated doses (aph 248).

75 60 METHODOLOGY The purest and highest method of applying the great treatment to humanity the law of similaris Dr. E.A. Farrington

76 61 METHODOLOGY: Study consists of 60 different cases who attended DR.B.D.Jatti homoeopathic medical college and hospital and its rural OPD cases selected on the basis of inclusion and exclusion criteria. In this 30 cases are treated with centisimal scale potency is considered and 30 cases treated with LM scale potency is considered. INCLUSION CRITERIA: Patients of age group ranging from 20 to 45 yrs of all socio economic status will be considered. Patients will be selected on the basis of inclusion criteria, history and clinical findings. Detailed case history as per Proforma will be taken. EXCLUSION CRITERIA: 1. Cases with complication and pathological changes. 2. Old age people and pediatric cases. Result of treatment: The result of treatment was interpreted of those cases, whose follow up was obtained till the end of the study. The following criteria s were fixed to know the results of treatment, depending upon the type of response from different subjects. i. Recovered: Feeling of mental and physical well being and no recurrence of the complaints for a period of 6 months. ii. Improved:

77 62 Feeling of mental and physical well being along with disappearance of the complaints and occasional recurrence of symptoms within 6 months. iii. Not improved: No response or just improved but not reduction in the frequency of attacks of complaints, after treating within period of time

78 63 RESULTS

79 64 Table No 1 Results of Treatment of cases treated with centesimal scale potency S. No. Results No. of Cases Percentage 1. Recovered % 2. Improved % 3. Not improved 09 30% In this study out of 30 cases treated with centisimal scale potency 11 (36.67%) of cases recovered, 10 cases (33.33%) were improved and 09 cases (30%) cases not improved

80 65 Table No 2 Results of Treatment of cases treated with LM scale potency: S. No. Results No. of Cases Percentage 1. Recovered % 2. Improved % 3. Not improved % In this study out of 30 cases treated with LM scale potency 11 cases were recovered ( 36.67%), 11 cases (36.67%) were improved and 08 cases (26.66%) cases were not improved

81 66 Table 3 Different cases treated with centisimal scale potency and LM scale potencies: Sl. No Cases Percentage 1. Headache 23% 2. Skin complaints 20% 3. arthritis 10% 4 Haemorrhoids 07% 5. Respiratory complaints 10% 6. Gastritis 10% 7. Fever 20%

82 67 Table 4 Time duration taken for treating acute cases in centisimal scale potency: Sl.no Cases No of days 1 Fever 5 2 Coryza Headache 2 4. Acute gastritis 4 5. Haemorrhoids 12

83 68 Table 5 Time duration taken for treating acute cases in LM scale potency: Sl.no Cases No of days 1 Fever 3 2 Coryza 2 3 Headache Acute gastritis 2 5 Haemorrhoids 8

84 69 Table 6 Time duration taken for treating chronic cases in centisimal scale potency: Sl.no Cases No of days 1 Arthritis Chronic gastritis 80 3 Psoriasis Hemorrhoids 60 5 Bronchitis 75

85 70 Table 7 Time duration taken for treating chronic cases in LM scale potency: Sl.no Cases No of days 1 Arthritis Chronic gastritis 60 3 Psoriasis Hemorrhoids 45 5 Bronchitis 60.

86 71 DISCUSSION

87 72 Discussion: This study was aimed at managing the cases belonging to both acute and chronic with L.M.potencies, and the approach followed in the treatment and selection of the potency was on accordance to homoeopathic principles. The Study was tried to rationalize the efficacy of the L.M. Potencies as compared to C.M. potencies. It has helped to analyze that the L.M. potencies were more suitable to bring about the recovery at the earliest. The approach usually is to begin with decimal, centesimal and later on to step in to L.M potencies. The finding from this study substantiates and agrees that the L.M. potencies were more effective in bringing about the recovery within a shortest span of duration as compared to the C.M. potencies (200, 1m). Selection of cases: The cases selected for the study work were both acute and chronic cases, that frequented in OPD and hence to common cases are coryza, skin complaints, osteoarthritis, fever, headache and gastritis ( both acute and chronic) were taken into consideration. Out of cases treated with centisimal scale potency 60% of cases showed the initial aggravation of the symptoms and the case treated with LM scale potency 40% of cases showed the initial aggravation of symptoms. And the time duration taken for treating the cases in LM scale potency is more lesser compared to that of centisimal scale potency. Result of treatment:

88 73 The results of treatment observed at the end of study under the guidelines of criteria (vide methodology) adopted for it are given below. This study shows cases treated with centesimal scale potency nine subjects had recovered (30.00%), sixteen subjects had improved (53.33%) and five subjects had not improved or dropped out. Out of case treated with LM scale potency 15 subjects were recovered (50%), nine subjects were improved( 37.03%) and six cases not improved or dropped out. From above all results and discussions it is clear that, the LM potency is more effective and safer than compared to the centisimal scale potency medicines. So i conclude that the LM potency is more efficacious than compared to that of centisimal scale potency as said by our stalwarts.

89 74 SUMMARY

90 75 Summary: Study was taken up for the study of efficacy of LM potency medicine in homoeopathic general practice. Here we are treated about 30 cases with centisimal scale potency and 30 cases treated with LM scale potency, out of 30 cases treated with centisimal scale potency 60% cases shows marked aggravation in the symptoms and it took quite a long time for treating the cases. But in cases treated with LM potency only 40% cases shows slight aggravation of symptoms initially and the time duration taken in treating the cases was markedly reduced in intensity. By this study we came to know that the medicines given in LM scale potency will help in treating the cases more rapidly and gently compared to that of centisimal scale as said by Dr. Samuel Hahnemann in his aphorism no 2. Thus by this study we came to know that the LM scale potency is more efficacious than compared to that of centesimal scale. Thus we came to know that LM scale help us to bring the rapid cure to the patient as told in aph 2.

91 76 CONCLUSION

92 77 CONCLUSION: In this study different cases treated with centisimal scale as well as LM scale is considered, in which it showed me that the aggravation rate is more in centisimal scale potency compared to that of LM scale potency, and the time duration taken for treating the cases is much more reduced in LM scale compared to that of centisimal scale potency. In this study I took different cases like osteoarthritis, skin complaints, fever, allergic rhinitis, headache, gastritis were considered. In cases treated with centisimal scale potency 30% of the cases were recovered, 53.33% cases improved and 16.67% cases are not improved. In cases treated with LM scale potency 50% cases were recovered, 37.03% cases were improved and 12.97% cases were not improved. Thus after the detail study I came to a conclusion that the LM scale potency is more efficacious compared to centisimal scale potency in treating the cases. As told by Dr. Hahnemann (6 th edition of Organon) LM scale is the most perfected method in treating the cases to avoid unwanted Homoeopathic aggravation.

93 78 BIBLIOGRAPHY

94 79 Bibilography: 1. Dr. Samuel Hahnemann: Organon of medicine 6 th edition, translated with preface by Dr. William Boericke MD, Indian books and periodicals publisher, New Delhi. 2. Bradford Lindsley Thomas : The lesser writings of C.M.F. von Boenninghausen, B Jain Publishers, New Delhi, Reprint edition 2003 pp A review of Rima Handley's in search of the later Hahnemann Published by beaconsfield publishers, ltd, beaconsfield, bucks, uk By David little an article published in American homoeopath 1999 taken from 4. Rozencwiajg Joe: The potency published by Emryss publishers 5. LM or Q potencies: retrospection of its use during 15 yrs in Brazil, taken from homoeopathic links 2005, 2(18): Q/LM potencies: Historical reasons for the long delay in their recognition Homeopathy (2006) Hahnemann s experiments and counter experiments with 50 millesimal potencies a further review of his casebooks from journal homoeopathy Banerjee.D.D: Augmented textbook of Homoeopathic pharmacy, second edition, B Jain publishers, New Delhi, reprint edition 2006 pp-304, Goel Sumit: Fifty millesimal scale LM potency taken from www. Homoeopathyinstitute.in. 10. Dr. K.N.Mathur: Principles of prescribing collected from clinical experiences of pioneers of homoeopathy, B Jain publishers, New Delhi, reprint edition 2008

95 The LM potencies in homoeopathy from their beginning to the present day by Robert jutte, 12. Dr. Farukh.j. Master and Dr. Natasha Fernandes: understanding posology in classical homoeopathy published and printed by Remedium Kft. 13. LM potencies: one of the hidden treasures of the sixth edition of Organon, article taken from British homoeopathic journal 1999 vol Homoeopathy pocket by Almut Brandl 15. LM potencies 12 years experience, article taken from British homoeopathic journal Oct 1998, vol American Homoeopath 1998, article named Dosage and potency according to Organon (D.Little). 17. Dr.Samuel Hahnemann: The chronic diseases, translated from the 2 nd enlarged German edition of 1835 by Prof. Louis H. Taffel, with annotations by Richard Hughes MD, B Jain publishers, New Delhi, reprint edition Schmidt. P: The Hidden treasures of the last Organon, B Jain publishers, New Delhi reprint edition M.P.Arya: A study of Hahnemann s Organon of medicine, based on English translation of the 6 th edition by Dr.william Boericke, M.D., B Jain Publishers, New Delhi first edition Don G. Baker: A research model for the scientific investigation of homoeopathy PhD thesis, Southern Cross University, Lismore, New south Wales, e- publications Southern Cross university.

96 THE SIGNIFICANCE AND COMPLEXITY OF POTENTIATION IN HOMEOPATHY Professor, doctor for medical sciences Komissarenko A.A., Doctor for medical sciences Salycheva L.V. Doctor for veterinary Novossadjuk T.V. Saint Petersburg, Russia 23. From pharmaceutical standardizing to clinical research: 20 years of experience with fifty-millesimal potencies taken from Int J High Dilution Res 2009; 8(29). 24. time line for Hahnemann s development of potency and 50 millesimal scale prepared from keran Johnson from Features Of LM Potency article by - Dr. Srikanta Choudhury 26. Comparison of C and LM potency 5 th and 6 th Organon by David Little taken form website as per Thombre.P.B: Gems of Organon with psychology, B Jain Publishers, New Delhi, revised second edition 2008 pp Luc DE Schipper: Hahnemannian textbook of classical homoeopathy for the professional, B Jain publishers, New Delhi. 29. John Morgan: article on Dose, dilution and the LM Potency. 30. H. Choudhary: 50 millesimal scale in theory and practice, B jain publishers, New Delhi 31. George Vithoulkas: The science of homoeopathy with forward by William A. Tiller, B jain publishers, New Delhi Indian edition encyclopedia of Hahnemann s Organon of medicine with a comparative and critical study of fifth and sixth edition by Dr. Prabhat Kumar Bhattacheryay MD (Hom), B jain publishers, new Delhi.

97 Mandal and Mandal: textbook of homoeopathic pharmacy, reprinted 2002, new central book agency pvt.ltd. 34. Robin Murphy: case analysis and prescribing techniques, B Jain publishers, New Delhi, edition Homoeopathic pharmacy terminology from Little David: Awen Homoeopathy introduction to homoeopathy 37. Vllalva flores Fernando: LM scale 50 millesimal potencies, B Jain publishers, New Delhi reprint edition 2007, pp Dr. Rajeev saxena: ABC of fifty millesimal potency, first edition may 2007; Indian books and periodicals publishers, New Delhi. 39. Dr.Ramanlal.P.Patel: my experiments with 50 millesimal scale potencies, fifth edition, Hahnemann homoeopathic pharmacy, Hahnemann house, college road, kottayam, Kerala. 40. Dankert Bernd: Experiences with Hahnemanns Q potencies, historical aspects, special application. 41. Dr. Harimohan Choudhury: indications of miasms, second edition, B Jain publishers New Delhi, reprint edition Wenda Brewster O Reilly: Organon of the medical art by Dr Samuel Hahnemann B Jain Publishers New Delhi, 1 st Indian edition pp Dimitriadis George: Homoeopathic posology evalution of Hahnemann s new altered but perfect method, lecture given at Hahnemann institute Sydney, for the graduate diploma of homoeopathic medicine, july 1993

98 i ANNEXURES-I Homoeopathy is this healing art,which had hitherto been sought for in vain,its fundamental principles teach,its performance prove Dr.Samuel Hahnemann

99 ii DBHPS S DR. B. D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & POST-GRADUATE RESEARCH CENTRE, DHARWAD. CASE PROFORMA (BY DR. SUMANTH.B.L UNDER THE GUIDANCE OF DR. G. C. HIREMATH) Name of the Patient: Age: Sex: Religion: Marital status: Occupation: Address: Phone no: Date of consultation : Diagnosis: Miasmatic Diagnosis:

100 iii Remedy: Constitutional remedy: Results: Recovered / Improved / Not improved Signature of Guide :

101 iv I. CHIEF COMPLAINTS: II. HISTORY OF CHIEF COMPLAINTS: III. PAST HISTORY: Whether suffered from similar complaints before: Disease Suffered from Approximate Age Duration Whether Completely Recovered Medicine & Treatment Taken Remarks *Any extra remarks or information IV. FAMILY HISTORY

102 v V. PERSONAL HISTORY: Disposition Changed disposition Diet: Appetite: Bowels: Thirst: Micturition: Desires: Aversions: Sleep: Dreams: Perspiration:

103 vi Habits: Relation with heat and cold: Menstrual history: Gynaec and obstetric history: Mental disposition: V. LIFE SPACE INVESTIGATION:

104 vii VI. GENERAL PHYSICAL EXAMINATION: VII. VITAL DATA Respiratory Rate: Temperature: Pulse Rate: Blood Pressure: Weight: Height: VIII. SYSTEMATIC EXAMINATION 1. PER ABDOMEN;

105 viii 2. CENTRAL NERVOUS SYSTEM: 3. CARDIOVASCULAR SYSTEM: 4. RESPIRATORY SYSTEM:

106 ix IX) LOCAL EXAMINATION: X) INVESTIGATIONS:

107 x Differential diagnosis: Clinical diagnosis: Analysis of symptoms: Evaluation of symptoms:

108 xi Selection of symptoms for Repertorisation: Repertorial analysis: Repertorial Result: Miasmatic diagnosis:

109 xii Remedial analysis: Potency selection: Management:

110 xiii TREATMENT Date Follow up Remedy

111 xiv ANNEXURES-II

112 xv Different cases treated with LM millesimal scale as well as centisimal scale haemorrhoids, 7% respiratory complaints, 10% headache, 23% skin complaints, 20% gastritis, 10% fever, 20% arthritis, 10% Time taken for treating the case group A LM potency compared with group B centisimal scale in duration of action in different cases

113 xvi M 0/1 0/1 0/2 0/1 0/4 0/3 1 0 potency Time taken for treating different chronic cases with group A LM scale compared with group B centisimal scale:

114 xvii Time duration taken for treating different acute diseases with group A LM scale compared with group B centisimal scale: Cases treated with centisimal scale potency both acute and chronic case:

115 xviii Cases treated with LM scale potencies both acute and chronic cases: