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Demystifying the Implausible
A number of years ago, a friend invited us to contribute a homeopathy chapter to a book on holistic pediatric care that she was coauthoring with two medical doctors. In an attempt to make the concepts of homeopathy more palatable to mainstream parents, she addressed up front the notion that the more homeopathic medicines are diluted, the stronger they become. This concept, she warned, stretched the bounds of logic.

It is this counterintuitive premise, in part, that has made homeopathy the controversial modality that it is. Proponents argue that, because there is only energetic, rather than material, substance in the medicines over the 30C potency (higher than Avogadro's number), homeopathic medicines are safe and without side effects. Opponents counter that homeopathic medicines are ineffective because, plain and simple, there is nothing in them. There have, in fact, been many scientific studies corroborating the effectiveness of homeopathy. (Visit www.homeopathiceducationalservices.com, where you can view or download a number of studies. Editor note: Now at Homeopathic.com) But rather than get into a debate as to whether or how homeopathic medicines work, the purpose of this article is to share how we use which potencies in our clinical practice.

The Nuts and Bolts of Homeopathic Potencies
The other day we ran into an acquaintance in the small Whidbey Island town where we live. She has worked in the local natural products store for some years and is still bewildered about which homeopathic potencies to recommend. We suggested that she take us out to lunch and we'd simplify the topic for her so that it would no longer be confusing. She is not alone. It was that encounter that inspired us to write this article, though we may be sacrificing that free meal in the process!

[The following four paragraphs are excerpted from our book Homeopathic Self-Care: The Quick and Easy Guide for the Whole Family. New York: Three Rivers Press, 1997, soon to be republished by Picnic Point Press.)

Homeopathic medicines are prepared on one of two scales: a decimal scale or, more frequently, a centesimal scale. In a decimal preparation, one part of the original mother tincture of the substance, which is prepared in a specific and standardized way, is mixed with nine parts of water or alcohol. This is called a "X" preparation or potency. In a 6X potency, which is widely available in pharmacies or health food stores, one part of the 1X has been mixed again with nine parts of water or alcohol, and this process has been repeated a total of six times. Each time a dilution is made, the substance is vigorously shaken in order to distribute the material thoroughly. This shaking, called succussion, also seems to alter the energy of the substance.

Lay people self-treating with homeopathy often use the decimal potencies, such as 6X, or, from the centesimal scale, 6C, 12C, or 30C medicines. The lower the potency, the more frequently the medicine typically needs to be readministered.

Professional homeopaths frequently use the potencies from the centesimal scale. In a centesimal preparation, 1 part of the original substance is mixed with 99 parts of water or alcohol to form a "1C" medicine. This process is repeated a number of times. Each time the medicine is diluted and shaken, it actually becomes stronger, rather than weaker. Dilutions of various strengths are inoculated onto sugar pellets.

Potencies of 30C or lower are called low-potency remedies or medicines, and potencies of 200C or higher are considered high-potency medicines. When using the C potencies, professional homeopaths most often use 30C (diluted 30 times), 200C (diluted 200 times), 1M (1000 dilutions), and 10M (10,000 dilutions). A single dose of a high-potency medicine may last for weeks or months, occasionally for years.

A third scale that may be new to some readers: LM potencies. LM is the Roman numeral for 50,000. An LM1 potency, for example, has been diluted to a factor of 1 to 50,000, rather then 1 to 10 or 1 to 100. Whereas the C and X potencies most often come in the form of medicated sugar pellets, the LM medicines are prepared by homeopathic pharmacies in liquid form, then diluted by the patient and taken frequently, often daily.

Acute Care: Self-Treatment and Professional
Although in our Homeopathic Self-Care book, we provide instructions for dosing with a variety of potencies, most home medicine kits, including ours, use 30C potencies. The reason is that it is a high enough potency to last for a day or so, but low enough to be used comfortably by those with very little knowledge of homeopathy. Self-treatment can be quite effective for first aid and acute conditions, 70 of which we discuss in our book.

When we treat ourselves or patients for acute complaints, we typically use a 1M potency, if it is at hand. We do this for several reasons. First, we have a high level of confidence that the chosen medicine is correct. Second, the 1M potency will act quickly and powerfully. Third, typically a single dose will take care of the acute problem and repetition is usually unnecessary.

Topical homeopathic preparations, often in combination, are also widely available and displayed alongside the pellets. These have become very popular with the public for a variety of conditions, including lacerations and abrasions, poison ivy and oak, burns, and musculoskeletal injuries. They may be used instead of or as an adjunct to the oral homeopathic medicines.

The Old Days
In our initial homeopathic training in naturopathic medical school, we were taught, largely under the influence of the Greek homeopath George Vithoulkas, to use, fairly exclusively, single doses of medicines ranging from the 200C to the 10M potencies. We most often began treatment with a 200C, increasing in potency only when the previous one was no longer effective in producing positive results in the patient. On rare occasions, with longstanding patients, this would require the use of a 50M (the equivalent of a 500C, a term not used in homeopathy) or, rarely, CM (the equivalent of a 1000C). A dose consists of approximately eight to ten tiny pellets, though they are really too small to count. This is surprising to some of our patients who were previously accustomed to purchasing their homeopathic medicines over the counter in tubes. These tubes actually contain many doses, even though the label might give instructions to take the entire contents of the tube. We were originally taught that certain antidoting factors, including coffee; aromatics such as eucalyptus, camphor, and menthol; and electric blankets should be avoided.

A few years into our practice, we studied under the tutelage of a distinguished and well-respected Argentine homeopathic doctor, Francisco Eizayaga. His method of choosing potencies consisted of beginning with a dry dose of 6C pellets administered three times a day. When the potency needed to be raised, the patient graduated to a 12C twice a day, then a 30C once a day. Over time, the repeated dosing became cumbersome and the daily dosing didn't appear to us to be much of an improvement over single doses, so we gave it up.

Daily Doses Become Necessary
Until 10 to 15 years ago, avoiding coffee, electric blankets, and strong aromatics didn't seem to be much of an issue for our patients. Taking single doses was simple for babies, children, and adults alike, and there was no need for them to remember to take the medicine at home. Then the espresso epidemic hit Seattle big time. Around the same time, aromatherapy became ubiquitous. Particularly for our women patients, it seemed impossible to avoid lavender oil wafting in the air, Aveda hair products, and tea tree oil in everything from laundry detergent to dental floss. Between the exposure to the Frappuccinos and lattes and the intensely aromatic fragrances, single-dose medicines were no longer a realistic option for many of our patients. Although some homeopaths insist that none of those substances interfere with the effectiveness of the medicines, many of them do not use single doses of high-potency medicines, and their conclusions have often not been borne out in our clinical experience. Though we have patients on infrequent, high-potency medicines who drink coffee whenever they please with no ill effect, we have witnessed a number of antidotes.

It was around this time that the LM (50,000 dilutions, as mentioned earlier) potency became quite popular in the US. In fact, a new breed of homeopaths claimed that Dr. Samuel Hahnemann, in his last years of practice, used this potency exclusively. Adherents of the LM theory warned that the same potency should never be repeated and that the stirring of the water-based LM medicines slightly raised the potency prior to each dose. They touted the benefits of LMs, including that they were gentle, did not produce aggravations, and allowed the patient to take them as needed. So, seeking a solution to the coffee/aromatherapy wave, we used the LM medicines with many of our patients, beginning with LM1 and gradually going up to LM10 or so over time. We found that they worked well for some patients and, despite what we had been told, created significant aggravations for others. So common, in fact, were the aggravations that the overly sensitive patients, for whom the LMs were supposedly ideal, often needed to further dilute the preparation to 2, 3, 4, or even more glasses. We found this process to be painstaking, time-consuming, and often extremely confusing, especially finding the right frequency of dosing and number of glasses to offer the optimal benefit.

In an attempt to find a simpler alternative for those needing repeated doses, we began using the water-administration method of the 12C and 30C potencies with some of our patients, with a technique called "plussing." We followed the precise instructions given to us by the respected pharmacy Hahnemann Homeopathic Laboratories. With plussed medicines, we have our patients shake the bottle vigorously ten times, then place five drops of the liquid under the tongue. This is a much less complicated procedure than preparing LM medicines.

The Importance of Flexibility
While a number of our colleagues have settled on one or another style of potency administration, we prefer to have them all in our tool kit. These are the basic criteria that we use in our potency selection:

Ease – By far the easiest way to take a homeopathic medicine is in a single dose. When we see patients in person, we place the medicine under the tongue or, if they prefer to wait, dispense it as pellets in a small paper envelope protected by a small plastic zipper storage bag. The small pellets are easily tolerated, and often enjoyed, by infants, young children, and animals, as well as adults.

Patient Preference – We often let our patients choose whether they prefer a single-dose medicine or frequent dosing. If they choose to drink coffee, use recreational drugs, or engage in an occupation that exposes them to antidoting substances, we use repeated doses. Whether coffee, for example, will compromise the effectiveness of homeopathic treatment depends not on the type of coffee bean or frequency of ingestion, but rather on the sensitivity of that particular patient to the coffee.

Compliance – How well a patient complies with homeopathic treatment varies. There are some individuals who will never remember to take repeated doses and respond better to single doses. There are others who feel much more secure when they take the homeopathic medicine on a regular basis and don't have to be concerned about avoiding certain substances. We do have patients on single-dose medicines who drink coffee, but we have found it best if they avoid coffee at least for a month so that, if there is not a curative response, we will not mistake interference by coffee with interpreting the medicine to be an incorrect match.

Sensitivity of the Patient – When we are treating very sensitive patients, we usually use low-potency, repeated medicines, in part to avoid an aggravation or temporary worsening of the existing symptoms after taking the medicine. In this way, the patient can be in charge of taking the medicine when needed, and also of using as many glasses as necessary to dilute the LM or plussed medicine to avoid any unpleasant reaction.

Conventional Medications – Many of our patients, children as well as adults, are taking pharmaceutical medications when they first come to see us. Often they are able to discontinue the medications, depending on the situation, as they respond well to the homeopathy. We tend to use repeated doses just in case the medications interfere with the homeopathy, though this it is not absolutely necessary, mainly a precaution.

Age of the Patient and Strength of the Vital Force – We tend to use lower potencies, either in single or repeated doses, with babies, with patients who are depleted and weak, and in treating our pets. That said, in cases of severe acute illnesses, or if the lower potencies have been exhausted already, we may use high-potency medicines in these cases. The decision often depends on the clarity of the symptom picture, severity of the symptoms, and compliance.

The various possibilities of dosing provide tremendous flexibility to prescribers and to patients. Not only is homeopathy the safest type of medicine we have ever encountered, but there is a mode of administration to suit anyone's needs. This flexibility, along with its effectiveness, allows it to be used as a stand-alone form of medicine, or in combination with other drugs or therapies.

Judyth Reichenberg-Ullman and Robert Ullman are licensed naturopathic physicians, board certified in homeopathy, and live on Whidbey Island, Washington, and in Pucon, Chile. Their books include A Drug-Free Approach to Asperger Syndrome and Autism, Ritalin-Free Kids, Rage-Free Kids, Prozac Free, Homeopathic Self-Care: The Quick and Easy Guide for the Whole Family, Whole Woman Homeopathy, The Patient's Guide to Homeopathic Medicine, and Mystics, Masters, Saints and Sages: Stories of Enlightenment. They teach and lecture internationally and practice at the Northwest Center for Homeopathic Medicine in Edmonds, Washington. They treat patients by phone and videoconference as well as in person, and can be reached at 425-774-5599; drreichenberg@gmail.com or drbobullman@gmail.com; or www.healthyhomeopathy.com.