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Classical homeopathy is a 200-year-old system of healing utilized by the national health care systems of England, France and Norway, and is a recognized medical specialty in India and Brazil. An
ancient Sanskrit poem stated "It has been heard of old time in the
world, that poison is the remedy for poison", and Hippocrates wrote
"Disease is born of like things, and by the attack of like things
people are healed." (1) By using minute, non-toxic preparations of
substances which create specific symptoms in healthy people,
homeopaths address those same problems in people who are sick.
Examples of this paradox are seen in conventional medicine's
treatment of hyperactive children with Ritalin, heart conditions
with digitalis (digoxin), cancer with radiation, or gout with
colchicine.
The History of Homeopathy
Homeopathy occupies a unique place in the history of U.S. medical
practice. Founded by the German physician Samuel Hahnemann in the
late 1700's, it was brought to the U.S. in 1825. The American
Institute of Homeopathy (AIH) was founded in 1844 , and the American
Medical Association (AMA) was founded two years later. Americans
Constantine Hering, J ames Tyler Kent and Elizabeth Hubbard-Wright
eventually became names known to homeopaths around the world. Samuel Hahnemann, who never set foot in the United States, also had a
Washington, D.C. monument built in his honor. (2)
From their inception to the early 1900's the AIH and AMA were in
opposition, with one of the AMA's stated goals being the abolishment
of homeopathy. In the 1870's the U.S. was the leading country for
the study of homeopathy, and by the turn of the century there were
22 homeopathic medical schools, over 100 homeopathic hospitals,
greater than 1,000 homeopathic pharmacies, and 15% of physicians
considered themselves homeopaths. After the early 1900's, however,
homeopathic practice in the U.S. gradually declined, and homeopaths
worked in relative obscurity for over fifty years.
How and
why did this occur?
Significant differences in philosophy and practice existed between
U.S. homeopaths in the late 1800's, and they lacked the necessary
group unity to maintain a strong political presence. The AMA
subsequently offered membership to homeopathic physicians on the
condition they did not call themselves homeopaths nor advertise as
such. Large numbers of homeopaths accepted this offer, and the AMA
was promoted as the organization which represented all U.S.
physicians. New standards for medical school funding based on the
Flexner Report were also developed, effectively closing nearly all
homeopathic medical schools and departments by 1925. Only the
Hahnemann Medical College of Philadelphia continued cursory
homeopathic instruction into the 1950's. (3)
Hahnemann
As mentioned above, the historical roots of systematized homeopathic
practice began with the German physician Samuel Hahnemann.
Disillusioned with the medical practices of his day, he began
translating medical texts for his living. During the translation of
William Cullen's Materia Medica,
 Hahnemann came across the statement
that the bitter properties of cinchona (also known as Peruvian bark,
or china, and possessing quinine) made it useful in the treatment of
malarial symptoms. Because Hahnemann was familiar with other bitter
substances which were not useful for malaria, he wrote a strong
dissenting footnote in his translation. Familiar with the concept of
"like curing like", Hahnemann subsequently began self-experimention
with small quantities of cinchona.
His ingestion of cinchona resulted in palpitations and intermittent
fever, and Hahnemann postulated that cinchona could be used for
malarial symptoms because of a homeopathic treatment effect. He went
on to experiment with lower doses in the hope of maintaining
therapeutic efficacy while reducing side effects. Using a process of
serial dilutions and shaking (succussions) which he termed
potentization, he eventually recorded clinical effects at
sub-molecular dilutions before the determination of 'Avagadro's
number'. Today of course, physiological doses of the alkaloid
quinine and its analogues are used conventionally for the treatment
of malaria, and 'potentized' cinchona is used homeopathically for
intermittent fevers and fluid losses from malaria or other causes.
Questions of dilution
Hahnemann perceived that primary drug effects are followed by
secondary drug reactions, and the relationship between the primary
and secondary symptoms are related to drug size. More specifically,
if a small dose of a drug is administered, the primary drug effect
is minimal and the secondary physiological reaction is directed
towards recovery. Alternately, if a large dose of a drug is given,
the primary effect on the organism is too strong and the secondary
physiological reaction is impaired. The Arndt-Schulz Law confirmed
Hahnemann's observation by showing that physiological activity is
increased by weak stimuli, impaired by medium stimuli, and halted by
strong stimuli.
Yet controversy over whether the higher dilution remedies could
exert effects created a schism between 'high-dilution' and
'low-dilution' homeopathic practitioners, and has been a
long-standing obstacle to homeopathy's full acceptance as a
conventional therapeutic modality. Nevertheless, numerous studies
have demonstrated effects of homeopathic medicines even when there
is no measureable amount of the original substance in the
preparation. Two independent meta-analyses of well-designed
homeopathic trials both concluded that clinical results had occurred
at a statistically significant rate--ie., at a rate greater than
that of placebo. (4,5)
At the present time it is not understood why higher dilution
homeopathic medicines are capable of exerting effects. One
hypothesis relates to the "memory of water"--the idea that dipolar
water molecules align themselves with bioelectric fields of
substances they're exposed to. In the process of preparing a
homeopathic remedy, the repeated dilutions and succussions add
kinetic energy to potentiate the original substance's field within
the solution. The potentiated field both matches and expands the
chemical and therapeutic effect of the original solute without the
risk of side-effects.
In any case, the fact that the mechanism of action of homeopathic
remedies is not understood is not unique to homeopathy. As Goodman,
one of the co-authors of The Pharmacological Basis of Therapeutics
has written, "There are few drugs, if any, for which we know the
basic mechanism of action. Drug action is not drug effect." Even a
cursory look through the Physician's Desk Reference supports this
observation.
Homeopathic philosophy
Modern science recognizes that an organism's response to stress
occurs in a highly organized and interrelated manner. In homeopathy
the concept of homeostatic balance on physical levels is expanded to
include the mental and emotional realms as well. In other words,
one's body, mind and emotions are viewed as always working to
maintain a relative degree of homeostasis or balance. Because the
body, mind and emotions respond in unity to stress, the homeopathic
approach to understanding disease is holistic. This means an attempt
is made to evaluate any problem in the context of the whole
person--physically, mentally and emotionally--and to understand how
the person is limited.
From a homeopathic perspective, disease tends to occur in the
following way: when faced with a stressor (physical, mental or
emotional), the body and mind respond by adopting a temporary
'defensive posture'. Under normal circumstances a relative
homeostasis or balance will return after the stress has passed. This
is similar to Hans Selye's descriptions of the person's biphasic
response to stress, which is that there is a primary effect or
damage from stress followed by a stimulated physiological response.
When a stress is too strong or too prolonged, or when there's a
strong hereditary/genetic susceptibility--the body and mind get
'stuck' in a state of imbalance, disease and limitation. Physical,
mental and emotional realms are unable to maintain their previous
state of balance, and a unique constellation of symptoms are
experienced. For example, a person involved in a life-threatening
situation may react with a 'fight or flight' response. In a minor
car accident, for instance, the person may be a bit 'shook-up', but
in a few days the incident is nearly forgotten. After a more serious
accident, however, the person may feel anxious with driving, develop
sleep problems, or experience problems with concentration. Perhaps
they begin having physical problems with tension headaches, upset
stomach, etc. Here the stress was too strong, and the person has
become 'stuck' in the adaptive response necessary at the time of the
stress.
In a broader sense, any time a person's system is working to
overcome a stressor, they can become stuck in that response, and
symptoms of disease are produced. An important corollary to the
above is that the symptoms of illness are also recognized as the
person's 'best effort' to protect themselves against stress and
further limitation. Therefore, addressing individual
symptoms--without attention to the whole--will not ease the broader
and more integrated stress response and susceptibility which are
producing those symptoms.
The homeopathic approach does not combat disease symptoms in the
same manner as one would in conventional practice. Instead,
homeopathic philosophy states that if the organism is brought back
into balance, the symptoms of disease (imbalance) will resolve
accordingly. The homeopathic means to this end is unique to each
person; therefore, whereas a conventional diagnosis is based on a
defined set of common symptoms, and will be treated conventionally
with common treatments, a homeopath looks for a broad and unique
picture of imbalance specific to each person.
An example of this difference between conventional and homeopathic
practice can be made by looking at how each would approach an
inflammatory condition. Conventional practitioners might view a
chronic inflammatory disease as the result of an overly-aggressive
immune system, and could make a diagnosis based upon a pattern of
common symptoms. They could then choose from any number of
anti-inflammatory or immune-modulating agents, hoping to suppress
the problem.
For a homeopath, the signs and symptoms of inflammation are just the
starting point for understanding the full breadth of disease. The
common signs of inflammation--'rubor, calor, dolor and tumor'--are
simply the tip of the iceberg. A conventional diagnosis would not be
specific enough for selection of a remedy, and one would need to
consider other broader or unique expressions of disease.
The effort to target inflammation alone is also be viewed by
homeopaths as 'suppressive', meaning that although the most obvious
symptoms of imbalance (eg., inflammation) may be quelled, the
underlying stress and imbalance from which this problem arose have
not changed. Therefore, a person with a chronic inflammatory
condition is treated but not cured. Homeopaths also view the effort
to suppress symptoms as one which occurs at the expense of the rest
of the organism. That is, if the organism works as an integrated
whole, one cannot single out and combat individual symptoms without
the battle spilling over in effects on the whole.
Steroid medications, for example, are some of the most potent anti-inflammatories
available, and their ability to suppress inflammation in acute
situations has saved countless lives. However, their use--whether in
acute or chronic situations--is also accompanied by a variety of
potential complications: adrenocortical suppression, fatigue, and
even psychosis. From a homeopathic point of view, even if the
steroids are sometimes necessary in treatment, their suppressive
properties, especially with chronic use, may force the roots of
disease to be expressed in other potentially more harmful ways. What
may be conventionally recognized as a 'complication' of therapy may from
a homeopathic point of view reflect a deepening of the original
problem and a further lowering of one's vitality.
Therefore, to rid a person of their chief complaint is not enough in
homeopathy. The improvement must also be in line with a general
'direction of cure'--if a person's chief complaint is resolved, one
should not see a subsequent problem develop at a deeper or more
vital level of function.
Homeopathic Remedies
The 'gestalt' of an individual homeopathic remedy includes a
constellation of physical, mental and emotional indications. These
unique indications are discovered through provings, eg., experiments
in which homeopathic remedies are given to a group of relatively
healthy individuals. After a number of days of placebo and recorded
'baseline' symptoms, the actual remedy is introduced in a
double-blind manner. A few individuals in the group will be
sensitive to the remedy and experience new signs and symptoms.
(After the remedy is discontinued, these signs and symptoms quickly
resolve). The entire spectrum of new signs and symptoms is then
collated into a 'remedy picture', which expands through continued
clinical experience.
In practice, the remedy picture is matched to similar complaints in
a sick patient, and if well chosen will assist the person in
returning to their previous state of health. By matching and
amplifying their response against disease, the remedy appears to
bolster defenses such that symptoms resolve accordingly. There are
only remedies for individuals, individuals who are displaying any
unique expression of disease. Therefore, there are few successful
double-blind studies which use only one individual remedy for a
particular diagnosis, because each individual with a common
diagnosis nevertheless needs to be treated with a unique individual
remedy.
Homeopathic remedies are sold either over-the-counter or by
prescription, and are regulated by the FDA. Most remedies are
derived from plant, mineral or animal sources. Since 1938 they've
been classified as drugs through their recognition in the Federal
Food, Drug and Cosmetic Act (FDCA), the primary law regulating drugs
in this country. The FDCA recognizes the Homeopathic Pharmacopoeia
of the United States (HPUS) as an Official Compendium, or reference
book, for homeopathic medicines in this country. This is a book of
technical standards written and edited by the Homeopathic
Pharmacopoeia Convention of the United States (HPCUS), a group of
experts in the field of homeopathy.
A homeopathic medicine is included in the HPUS as an official drug,
and must have been determined to be safe and effective. A
homeopathic medicine can be sold as an over-the-counter product only
if it meets the following criteria: 1) it is non-toxic in the
potency in question, 2) it is claimed for a medical condition that
would resolve itself without medical intervention, 3) it is for a
condition which does not require medical diagnosis, and 4) it is
used for a condition that does not require medical monitoring. (6)
The name of a homeopathic medicine is always followed by a number
and letter--eg., 6X or 6C, 12X or 12C, 30X or 30C. This is a
designation of potency, ie., the degree to which the medicine has
undergone serial dilutions and shakings. A remedy may be diluted 1:9
("X" scale) or 1:99 ("C" scale), and the number of times this has
taken place precedes the X or C (usually 6, 12 or 30 times when sold
over the counter). Also listed is an indication for the medicine, in
accordance with FDA regulations. Ironically, the listed indication
can be misleading, as any one remedy has many potential indications.
Whether a remedy is used for an acute or chronic condition, the
individual's unique constellation of symptoms must be matched as
closely as possible to the properties of a specific homeopathic
remedy. Homeopathically speaking, this alone is the most important
determinant for whether a remedy will be efficacious for the
individual. This individualized approach to treatment complicates
double-blind research into classical homeopathy, as a person with a
common chronic problem may be treated with any one of several
hundreds of different homeopathic remedies.
Application
Most conventionally trained clinicians who now incorporate
homeopathy in their practice will recall their initial scepticism
regarding these highly dilute substances. As if overcoming their
doubts wasn't enough of an obstacle, they also had to adapt their
diagnostic skills to a new paradigm and learn the very specific
indications for hundreds of remedies. The specific remedy
indications must be matched as closely as possible to each
individual presentation of disease, and one must be able to
interpret the response to remedies throughout the course of disease.
Laypersons and clinicians alike can use homeopathic remedies for
acute, self-limited conditions, and clinicians well trained in
homeopathy can use them for chronic conditions as well. It is
easiest to use homeopathic remedies for acute self-limited or
first-aid conditions. For instance, a person complaining of a sore
throat may complain that their throat pain feels burning and is
relieved with hot drinks. They may feel thirsty for small sips, feel
very restless and chilly, and have a general aggravation of symptoms
between midnight and 2 AM. They may also feel anxious and desire
some kind of company--especially for the security it provides. This
group of symptoms is easily recognized by homeopaths as the
constellation matching Arsenicum album--and after one or two doses
most individuals with these symptoms will begin to feel better.
Even easier to use is Arnica montana--indicated for traumatic
injuries with extravasation of blood--ie., contusions of all kinds.
It is known to resolve swelling and bruising more quickly than the
body is capable of on its own. The easiest remedy of all is
Calendula ointment, which is bacteriostatic and works excellently
for skin scrapes or lacerations.
OTC homeopathic drugs are also commonly available in combination
products--a number of remedies known to help a specific condition
are included in a preparation and then marketed according to the
indication, eg., "homeopathic remedy for sinusitis". The combined
remedies are commonly at low potency, meaning they will generally
not work as deeply. Although this simplifies the selection process
for the consumer, this approach is also less precise because the
remedy selection is not made according to other unique indications,
and it complicates knowing which particular remedy is responsible
for alleviating symptoms.
Questions
If a patient asks about homeopathy, a few good introductory books
include "Everybody's Guide to Homeopathy" by Ullmann, "Homeopathic
Self-Care: The Quick and Easy Guide for the Whole Family" by Ullman
and Ullman, and "Healing With Homeopathy--The Doctor's Guide" by
Jacobs and Jonas. The main risks of a patient using over-the-counter
remedies would be for a serious problem to be overlooked, when
conventional treatment would be preferred. Although remedies need to
be very specifically matched to the symptoms in question, and are
somewhat unforgiving in that regard, an incorrectly chosen remedy is
forgiving insofar as side effects are concerned. Within homeopathic
circles there are dosing regimens which are considered
inappropriate, but this is related mainly to long-term repetition of
higher potency homeopathic remedies which are not readily available
to the general public.
Again, although homeopathic remedies do not have side-effects per
se, they can be used in an inappropriate manner (particularly for
chronic illnesses) which makes subsequent homeopathic care more
difficult. These situations are theoretical and beyond the scope of
this discussion, but do underscore the importance of working with a
person who has had extensive training and who consults with peers.
Of course, remedies do not reverse frank tissue changes nor do they
correct anatomical problems requiring surgery. They should not be
relied on when the risk of harm is too great relative to the
difficulty of choosing a correct remedy, nor should they be a reason
for delaying evaluation of a potentially life-threatening problem.
Most homeopathic practitioners are aware of the need to supplement
homeopathy with conventional therapy in severe cases or situations
calling for emergent intervention.
The ideal, of course, is greater communication between conventional
and homeopathic clinicians, so that a greater appreciation of each
system's strengths can be recognized, and for the ultimate benefit
of those seeking care. There are times when conventional and
homeopathic approaches can complement each other, and times when
they conflict. Practitioners who understand the fundamental
philosophy and practice of each system will better understand how
the greatest strengths of each system can be realized.
References:
1) Hippocrates,
“On the Place of Things Which Regard Man”; Basel: Froben, 1538, p.
72
2) Bittinger, B “Historic Sketch of the Monument Erected in
Washington City to the Honor of Samuel Hahnemann, In the Presence of
the President of the United States”; American Institute of
Homeopathy 1900
3) Rogers, N “An Alternative Path: The Making and Remaking of Hahnemann Medical College and Hospital of Philadelphia”; Rutgers
1998
4) Kleijnen, J, et al. "Clinical Trials of Homeopathy" British
Medical Journal 1991; 302: 316-323
5) Linde, K, et al. "Are the Clinical Effects of Homeopathy Placebo
Effects? A Meta-Analysis of Placebo-Controlled Trials"; Lancet
1997; 350(9081): 834-843
6) Borneman, J "The Regulation of Homeopathic Medicines"; Technical
Bulletin-Standard Homeopathic 1995
Other Books on the History of Homeopathy and
US Medicine:
»
Winston,
“The Faces of Homoeopathy; An Illustrated History of the First
200 Years”;
Great Auk 1999
»
Coulter,
“Divided Legacy: A History of the Schism in Medical Thought”;
Weehawken 1973
»
Rothstein,
“American Physicians in the 19th Century”;
Johns Hopkins 1972
»
Kaufman,
“Homoeopathy in America: The Rise and Fall of a Medical Heresy”;
Johns Hopkins 1971
»
Nicholls,
“Homoeopathy and the Medical Profession”;
Croom Helm 1988
Other Journal Articles and Books on Research in Homeopathy:
»
Gibson, et al.
"Homeopathic Therapy in Rheumatoid Arthritis: Evaluation by
Double-Blind Clinical Therapeutic Trial"
British Journal of Clinical Pharmacology 1980; 9: 453-459
»
Fisher, et al.
"Effect of Homeopathic Treatment in Fibrositis"
British Medical Journal 1989; 299: 365-366
»
Reilly, et al.
"Is the Evidence for Homeopathy Reproducible?"
Lancet, 1994, 344: 1601-1606
»
Jacobs, et al.
"Treatment of Acute Childhood Diarrhea With Homeopathic Medicine:
A Randomized Clinical Trial in Nicaragua"
Pediatrics 1994; 93,5: 719-725
»
Friese, et al.
"The Homeopathic Treatment of Otitis Media in
Children--Comparisons With Conventional Therapy"
International Journal of Clinical Pharmacology and Therapeutics
1997; 35,79: 296-301
»
Ilia, et al.
"Thermodynamics of Extremely Diluted Aqueous Solutions",
Annals of the New York Academy of Sciences, 1999; 827: 241-248
»
Jacobs, et al. "
Homeopathic Treatment of Acute Otitis Media in Children: A
Preliminary Randomized Placebo-Controlled Trial", Pediatric
Infectious Disease Journal 2001; 20,2: 177-183
»
Homoeopathic Science and Modern Medicine: The Physics of Healing
With Micodoses
by Coulter; Berkeley: North Atlantic, 1980.
»
Ultra High Dilution: Physiology and Physics ed.
by Endler and Schulte; Dordrecht, Kluwer Academic, 1994.
»
Homeopathy:
A Frontier in Medical Science
by Bellavite and Signorini; Berkeley: North Atlantic, 1995.
David Johnson, PA-C, RSHom (NA),
CCH
Classical Homeopathy, LLC
Quarry Arts Bldg; Ste 110
715 Hill St.
Madison, WI 53705
Ph:608-233-6000
E-mail:
daj@chorus.net
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