Answering Your Patients' Questions - By David A. Johnson


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, James 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