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THE CONCEPT OF POTENTIATION IN HOMEOPATHIC PHARMACY.

June 9, 2024

THE CONCEPT OF POTENTIATION IN HOMEOPATHIC PHARMACY.

METHODS OF DESIGNATION OF CONCENTRATION OF ACTIVE INGREDIENTS IN VARIOUS MEDICINES.

CLASSIFICATION OF HOMEOPATHIC DILUTIONS.

TECHNOLOGY OF HOMEOPATHIC DILUTIONS BY DECIMAL AND CENTESIMAL SCALES.

Homoeopathic Dynamizations are processes by which the medicinal properties, which are latent iatural substances while in their crude state, become aroused, and then become enabled to act in an almost spiritual manner on our life; on our sensible and irritable fibre.

This development of the properties of crude natural substances (potentisation) takes place, in the case of dry substances by means of trituration in a mortar, but in the case of fluid substances, by means of shaking or succussion, which is also a trituration.

These preparations cannot be simply designated as dilutions, although every preparation of this kind, in order that it may be raised to a higher potency; in order that the medicinal properties still latent within it may be yet farther awakened and developed, must first undergo a further attenuation, in order that the trituration or succussion may enter still further into the very essence of the medicinal substance, and may thus also liberate and expose the more subtle part of the medicinal powers that lie hidden more deeply, which could not be effected by any amount of trituration and succussion of the substances in their concentrated form.

We frequently read in homoeopathic books that, in the case of one or another person in a certain case of disease, some high (dilution) dynamization of a medicine was of no use at all, but a lower potency proved effectual, while others have seen more success from higher potencies.

What prevents the preparer of the medicines (and this ought to be the homoeopathic physician himself; he himself ought to forge and whet the arms with which to fight the diseases) -what prevents him, in preparing a potency, from giving 10, 20, 50 and more successive strokes against a somewhat hard, elastic body to every vial containing one drop of the lower potency with 99 drops of alcohol, so as to obtain strong potencies? This would be vastly more effective than giving only a few nerveless succussive strokes, which will produce little more than dilutions, which ought not to be the case.

The perfection of our unique art of healing and the welfare of the patients seem to make it worthwhile for the physician to take the trouble necessary to secure the utmost efficiency in his medicines.

If, however, every potency is dynamized with the same number of succussive strokes, we obtain, even in the fiftieth potency, medicines of the most penetrating efficacy, so that every minute pellet moistened with it, after being dissolved in a quantity of water, can and must be taken in small parts, if we do not wish to produce too violent an action with sensitive patients, while we must remember that such a preparation contains almost all the properties latent in the drug now fully developed, and these can only then come into full activity.

Potentisation

With some remedies, for example Arnica or Calendula, the mother tincture may be applied directly to the skin, or it may be diluted and used as a gargle;

Crataegus mother tincture is often administered as five drops in water.

Most other mother tinctures, however, are subjected to a very special two stage process involving

dilution and

succussion.

Because it increases the therapeutic strength, this process is known as potentisation. It is also called dynamisation.

There are several methods of potentisation, of which the Hahnemannian method, devised by the Founder after a series of experiments, is the most common in the UK. Other methods are described below.

Dilution

The Hahnemannian method offers two scales of dilution:

centesimal and

decimal.

In the former, one drop of mother tincture is added to 99 (or 9) drops of diluent in a new clean screw cap glass vial (Fig. 1).

Fig. 1 The potentisation process

In modern pharmaceutical practice it is common to use a triple distilled alcohol and water system, the strength of which varies from 20 to 60%, in the preparation of homeopathic dilutions. Hahnemann in 1827 recommended good brandy as a diluent. Brandy contains a lot of accompanying substances in addition to ethanol.

For example, Lorenz compared two dilution media to investigate the diluent’s influence. Within the limitations of the test system the dilution media were as similar to good brandy as possible and like purified ethanol. Dilutions of Histamine were prepared with both media. As test system they used modified basophil activation in an in vitro cell system. The results appeared to support the hypothesis that the dilution medium may influence the effects of high dilutions. This could be of importance for homeopathic pharmaceutical practice as well as for ultra-high dilution experiments.

Traditionally a single drop of mother tincture was obtained by tipping the container and carefully manipulating a cork stopper. This required a great deal of dexterity and often lead to minute traces of cork becoming incorporated into the potencies. To ensure no such contamination occurs, a disposable glass capillary or dropper bottle is now used for this transfer. For accuracy the 99 drops are usually measured with a special calibrated glass pipette.

Succussion

The solution resulting from admixture of the two liquids is subjected to the vigorous shaking with impact known as succussion. In Hahnemann’s day the procedure was effected by striking the vial on a large leather-bound book, typically the family Bible. Nowadays, in a more secular environment, the same effect is usually obtained with a special mechanical shaker.

There are a few pharmacists who still succuss by hand, striking the vial on the heel (firma ”Heel”) of their palms. For quite some time Hahnemann could not decide on the number of succussions necessary. The extent to which the vials are shaken depends on the individual concerned and the pharmacopoeia being used – somewhere between 20 and 40 times is often quoted as being appropriate, although one British manufacturer claims to hand-succuss for 20 minutes and another machine-succusses for 10 seconds.

The French Homeopathic Pharmacopoeia of 1965 (eighth edition) sets the number at 100.

Within each manufacturing process the number of succussions remains constant.

For example, a comparative study of the merits of hand-succussion and machine-succussion has been carried out. The study used the remedy Pulsatilla at 4c and 8c potencies, known to produce an increase in the growth of yeast, and found a gradual increase in the growth response rate of yeast cultures in the remedies that had been hand-succussed up to 60 times. Above this no further enhancement was observed. Unfortunately the workers were unable to formulate a result for the mechanical potencies and so a comparison could not be made. They suggested that a wait period of around 3 minutes between successive dilutions may be advantageous. We know from clinical observations that this agitation is vitally important to the therapeutic efficacy of the remedy; dilution alone is not sufficient to produce the phenomenon.

Vithoulkas (1980) has commented on the subject as follows:

Succussion adds kinetic energy to the solution which is crucial. If one merely succusses a solution without diluting it further, a raise in level of only one potency occurs, regardless of how many times it is succussed; therefore both succussion and dilution are required. We also know that the more there is succussion and dilution, the more the therapeutic power is increased, even beyond the point of there being even one molecule of the original substance remaining.

The structure of solvent molecules may be electrochemically changed by succussion, enabling it to acquire an ability to ‘memorise’ an imprint of the original remedy. It is acknowledged that this concept is difficult for many highly trained personnel with scientific backgrounds to accept. Whether succussion imparts a certain energy or whether it merely facilitates complete mixing is, like much of homeopathy, still a topic for lively debate.

For example, adult toads, Bufo melanostictus, were administered Nux vom 30, prepared with and without succussion, on the tongue. The remedy was mixed with sterile distilled water at the rate 0.05 ml/ml water and given orally 0.05 ml/individual. The control consisted of blank ethanol solution. Nux vom 30 was prepared by successive dilution and succussion in 30 steps, Nux vom 30u was prepared by successive dilution only. Four hours after treatment, toads were given 25% ethanol i.p. at 8 g/kg body-weight. The duration of ethanol-induced sleep time was recorded for each toad. Both Nux vom 30 and Nux vom 30u significantly reduced ethanol-induced sleep time in toads as compared to their respective controls.

Electronic, infra-red and nuclear magnetic resonance spectra of Nux vom 30, Nux vom 30 u and their diluent medium (90% ethanol) show marked differences from each other. These dilutions and ethanol 30 and ethanol 30 u show marked electrochemical differences from each other. The difference has been attributed to the variation in intra– and inter-molecular association of ethanol and water.

For example, a homeopathic model was developed to study the influence of high diluted solutions on the velocity of metamorphosis of the frog Rana catesbeiana induced by their thyroid glands. In this model, thyroid glands added to the water of a basin (final concentration 10–26 by weight) slowed down by 17.1% the velocity of development of tadpoles. It was postulated that thyroid hormones, prepared according homeopathic techniques, transmit specific information to the solution. The possibility of storing information from molecules and subsequent transfer to a physiological system may opeew therapeutic and technical methods.

The structure of the active molecule imprinted on water polymers during the process of potentisation. The specifically structured water interacts with the active sites of a-amylase, modifying its activity. Ethanol molecules have large non-polar parts stabilising the water structure and thus retaining activity for a longer time.

Terminology – centesimal and decimal scales

After the initial process, successive serial dilutions follow, using fresh glass vials at each stage, until the solution reaches 12c, 30c, 200c and so on; the number refers to the number of successive (1 in 100) dilutions and the letter ‘c’ indicates the centesimal method (see Table 1).

Table 1

Centesimal potencies

Dilution

Concentration

Centesimal potency

1:100

10^–²

1c or 1cH

1:10 000

10^–⁴

2c or 2cH

1:1 000 000

10^–⁶

3c or 3cH

1:10¹²

10^–¹²

6c or 6cH

1:10³⁰

10^–³⁰

15c or 15cH

1:10⁶⁰

10^–⁶⁰

30c or 30cH

1:10⁴⁰⁰

10^–⁴⁰⁰

200c or 200cH

1:10²⁰⁰⁰

10^–²⁰⁰⁰

1000c or M

1:10^{20 000}

10^–^{20 000}

10 000c or 10M

! Some key intermediate potencies are usually preserved, so that stocks can be reconstituted without going right back to the mother tincture, while the rest are discarded.

! The letter ‘c’ is sometimes left out when describing the potency. In the absence of any letter, centesimal (and not decimal) potencies are implied.

Another variation is the addition of a letter ‘H’ after the ‘c’, which refers to the classical method of dilution attributed to Hahnemann. Very high centesimal dilutions are usually expressed with Romaumerals. They are commercially made robotically, often using Korsakovian methods.

The 1000 dilution is denoted simply by the letter ‘M’, while a 10 000 potency (i.e. a 1 in 100 dilution carried out serially 10 000 times) is denoted by 10M.

There are some ultra-high potencies – CM (10⁵), MM (10⁶) and even higher – but their use is limited.

The way in which the first potency (a 1c) is made varies according to the pharmacopoeia. This has implications for higher potencies.

In the FrHomP the 1c potency is made by adding one part of mother tincture by weight to 99 parts of 60–70% alcohol,

but commonly the 1c potency is also made by adding three parts of mother tincture to 97 parts of alcohol.

In the HAB it is made by adding two parts by weight to 98 parts of 43% alcohol,

while the HPUS directs that a 1 in 10 dilution of a 10% mother tincture be prepared in 88% alcohol.

These differences mean that remedies may differ from country to country even though the potencies appear to be the same.

The decimal dilution method (see table 2.) (attributed to American homeopath Constantine Hering) is similar, except that the process involves adding one drop to nine drops of diluent. The potencies are designated by a number with the letter ‘x’ following it.

Thus 6x represents a 1 in 10 dilution carried out serially six times, each with a burst of succussion. In some countries the ‘x’ is replaced by a letter ‘D’ before the number, signifying the number of dilutions. Thus, Euphrasia D6 is just another way of expressing the remedy Euphrasia 6x.

Table 2

Decimal potencies

Dilution

Concentration

Centesimal potency

1:10

10^–¹

1x or D1

1:100

10^–²

2x or D2

1:1000

10^–³

3x or D3

1:10000

10^–⁴

4x or D4

1:100000

10^–⁵

5x or D5

1:1000000

10^–⁶

6x or D6

1:10³⁰

10^–³⁰

30x or D30

From Tables 1 and 2 it can be seen that mathematically 6x equals 3c, both being equivalent to a dilution of 1 in 1 000 000, or 10^–⁶, but because the former involves six bursts of succussion and serial dilution, and the latter only three – they cannot be considered to be equivalent homeopathically.

! In this case the decimal dilution is considered to be the stronger therapeutically.

Dilution on a grand scale or, as some unkind critics have suggested, placing 5 ml of drug solution at the source of a river and collecting it down- stream, will not work because of the lack of succussion. Silica glass also seems to play some part in holding the power of the remedy, perhaps in surface receptor sites, and so it is necessary to use a series of carefully prepared vials. Ideally vials should not be reused, but washing with distilled water and heating in an oven at 150⁰C for 8 hours should be sufficient to destroy residual material. Problems to be averted during potentisation include crosscontamination from potency to potency or contamination from airborne chemicals.

Other methods of potentisation

Korsakovian potentisation method. General Simeon Nicolaevich Korsakov was probably the first Russian Homeopath. Although not a doctor, he was given the task of preparing Tsar Nicholas I’s remedies when he was travelling. He is known principally for his work with high potencies and for the development of the Korsakov method of potentisation in 1832.

I. A first centesimal dilution (known as 1K or 1CK) is prepared by adding a measured volume of mother tincture to an appropriate volume of diluent; the resulting solution is succussed thoroughly.

II. Rather than taking one drop of this dilution and transferring it to the next vial sequentially, the potency is removed from the vial by suction or inversion, leaving droplets of solution adhering to the wall of the container.

III. New solvent is then added, the vial agitated vigorously 100 times and the process repeated.

IV. The first three dilutions are carried out using alcohol of a strength similar to that included in the mother tincture; subsequent dilutions are in distilled water.

V. Only one vial is used for the whole potentisation process.

VI. In the case of an insoluble substance, the BHomP directs that the first three successive Korsakovian triturations are prepared in lactose. Subsequent dilutions are prepared in the liquid diluent as above.

Until the mid-1950s, more than half the potencies used in France were prepared in this way, but by the time homeopathic medicine was included in the eighth edition of the French Pharmacopoeia in 1965, the Korsakovian method and almost all potencies above 30c were made illegal. The method is still used widely in Belgium.

A variation on the method has been suggested. Here the multivial method is used up to the 200c level. Then one drop of the dilution is placed into a 5 m vial and 99 drops of 43% ethanol added. Succussion is by Hahnemann’s method using 20 succussion strokes, instead of striking the vial against a hard surface, the physician makes a figure of eight motion in the air. The vial is emptied with a vigorous downward shake leaving one drop inside, and the process repeated as required.

The commonest Korsakov potencies are 6K, 12K, 30K, 200K and 1000K (MK).

The preparation of very high potencies is an extremely time-consuming process using the laborious Hahnemannian method. It would take several months to make a very high potency by hand. These potencies can be made with the help of a robot but still take a long time and involve large amounts of alcohol and large numbers of containers.

Thus, it was designed and built a potentiser to replicate as closely as possible the action of hand-succussion and dilution using the Korsakov method. The succussion mechanism involves a stepper motor driven cam, which raises and lowers an arm holding a specially designed glass vial. The arm and vial are repeatedly bumped against a firm but elastic object as per Hahnemann’s instructions – in this case a rubber stopper. The number of succussions can be set by the user. The desired potency is set by rotating a thumbwheel switch. The system is controlled by programmable logic control.

The difference between the traditional Hahnemannian and the Korsakovian methods of preparation is a subject of controversy between homeopaths which centre’s on the accuracy and reproducibility of the Korsakovian potencies. Some practitioners acknowledge that it is possible to pass on a mixture of potencies in this method, but claim that this is unimportant. Other workers feel that homeopathy appears imprecise enough to sceptics without having the additional problem of identifying a potency correctly.

A 30K potency is sometimes said to correspond to a 5c potency, a 200K to a 7c, but in both cases the former has undergone far more bursts of succussion than the latter, which therefore cannot be considered exactly comparable to the Hahnemannian potency. Surprisingly, a 1000K is considered no better than a Hahnemannian 9c. Pharmacological activity of Korsakovian potencies has been demonstrated in the rat in 1965.

Skinner potentisation method. Another potentisation method was principally used by Boericke and Tafel in Philadelphia and Ehrhart and Karl in Chicago for very high potencies (1991s). Here potencies are made by a combination of Hahnemannian and Korsakovian methods up to M and then further potentised using a Skinner dynamisator up to 10M (1 in 100 dilution 10 000 times) and CM (1 in 100 dilution 100 000 times). With this machine, which was invented by the Scottish homeopath Thomas Skinner (1825–1906), a single vial is automatically emptied and refilled under pressure with tap water. An example of his machine is shown in Figure 2.

Fig. 2 Skinner potentising machine

Even higher potencies (e.g. MM) can be prepared using the Skinner continuous fluxion method, where a flow of tap water is run over 5 ml of potency contained at the bottom of a glass tube that is agitated. The original potency is progressively washed away to obtain the required potency. With this method it takes 75 hours and 180 litres of tap water to raise a 10M potency to a CM. There is no wonder that sceptics find it hard to believe that a medicine could possibly work at this dilution. How one works out the true final potency in Hahnemannian terms is also a matter for conjecture!

Quinquagintamillesimal potentisation method (LM). Some homeopaths use potencies based on serial dilutions of 1:50 000 at each level. These are called either 50 millesimal potencies (abbreviated to LM) or quinquagintamillesimal (thankfully abbreviated simply to Q) and became available commercially during the 1950s. This rather unusual method was suggested by Hahnemann towards the end of his life following a review of his earlier experiments with different degrees of dilution and succussion and is contained in paragraph 270 of the sixth edition of the Organon. They provided a method of lessening the aggravation caused by certain remedies. Remedies were first triturated to the 3c level with lactose, before being serially diluted on the new scale:

In order to best obtain this development of power, a small part of the substance to be dynamised (say one grain) is triturated for three hours with three time one hundred grains sugar of milk according to the method described below up to the one millionth part in powder form.

A degree of dubiety exists as to whether some LM potencies are prepared exactly as Hahnemann instructed and also whether LM and Q potencies from different manufacturers are exactly interchangeable. A modern LM1 potency is sometimes understood to represent a dilution of 1:50 000 and a LM2 a dilution of 1:2500 000 000; that is, the potencies are made directly from mother tinctures without the intervention of a 3c stage. By convention the number signifying the level of millesimal dilution follows the scale letters, to distinguish it from centesimal potencies.

Thus, 50M (rather confusingly sometimes written as LM) is a 1:100 centesimal dilution carried out 50 000 times, while a LM1 potency is a 1:50 000 millesimal dilution carried out once. Remedies prepared in this way are claimed to be more gentle, more effective, and have a longer shelf-life.

A potency prepared by one of the methods described above in a high concentration alcohol vehicle may be used in the preparation of other dose forms (when it is known as a medicating potency) or the alcohol content may be adjusted to 20–30% and the potency administered orally (when it is known as a liquid potency). In most cases topical preparations are prepared by incorporating a mother tincture in a suitable vehicle, but occasionally a potency or a trituration powder may be used instead, for example Graphites or Sulphur.

Table 3 summaries most of the remedies that are restricted to prescription in the UK. This list is not exhaustive; suppliers will advise on the up-to-date position. Such remedies are used extremely rarely; some (e.g. Aconite 1x) are potent poisons.

Table 3

Examples of homeopathic remedies classified as prescription only in the UK

Remedy

Potency below which remedy POM

(prescription-only medicines)

Aconite (and mixtures containing Aconite)

3c or 6x

Ammonium bromatum

3c or 6x

Antimonium tartaricum

3c or 6x

Arsenicum album