Homeopathy

Homeopathy (also spelled hom?opathy or homoeopathy) from the Greek words ??????, hómoios (similar) and ?????, páthos (suffering), is a system of alternative medicine, notable for its controversial practice of prescribing water-based solutions that in many cases do not contain chemically active ingredients. The theory of homeopathy was developed by the Saxon physician Samuel Hahnemann (1755–1843) and first published in 1796. It is growing in popularity in some areas where it is practiced today, but neither its empirical nor its theoretical foundation meets minimum scientific standards.

Basic principles

Theory of disease

The conventional theory of disease in Hahnemann's time was based on the four humours. Mainstream medicine focused on restoring the balance in the humours, either by attempting to remove an excess of a humour (by such methods as bloodletting and purging, the use of laxatives, enemas and nauseous substances that made patients vomit) or by suppressing symptoms associated with the humours causing trouble, such as giving feverish (and so hot and wet) patients substances associated with cold and dry.

Related Topics:
Four humours - Bloodletting - Laxative - Enema - Vomit

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The late 18th century was a time of intense exploration, with many new diseases being identified, and the model of internal humours was proving inadequate. For example, many new diseases were clearly associated with certain geographic regions, which was difficult to explain through entirely internal mechanisms. Scientists were considering a model of external causes, and Hahnemann was lead to speculate on such causes of disease.

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Beginning with his early work, Hahnemann rejected the prevailing physical model, in favour of a view of disease as more dynamic or spirit-like. He came to consider the spiritual factors as the root cause of all disease, in what he termed the "highest disease." Most later homeopaths, in particular James Tyler Kent, have tended to put even more emphasis on spiritual factors.

Related Topics:
Physical - Spiritual - James Tyler Kent

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Vitalism had been a part of mainstream science through the 18th century. Whereas modern medicine sees bacteria and viruses as the causes of many diseases, some modern homeopaths regard them as effects, not causes, of disease. Others have to some extent adapted to the views of modern medicine by referring to disturbances in, and stimulation of, the immune system, rather than the vital force.

Related Topics:
Vitalism - 18th century - Bacteria - Virus - The causes of many diseases

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Scientific medicine has discarded vitalism and its associated beliefs in favour of the germ theory of disease, as part of a physiological model based on the work of scientists like Louis Pasteur, Alexander Fleming, and Joseph Lister. Moreover, following Avogadro's discovery it has firmly rejected the possibility of most homeopathic preparations having any medicinal action.

Related Topics:
Louis Pasteur - Alexander Fleming - Joseph Lister - Avogadro's

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The law of similars

Homeopathy rests on a principle known as the 'law of similars'. Hahnemann first expressed it as the exhortation similia similibus curentur or "let likes cure likes." The idea did not originate with Hahnemann, but he was the first to use it as the basis of a system of medicine. The law of similars is generally considered by homeopaths as a law of nature. Following this principle, the appropriate homeopathic substance for treating a disease is one which induces similar symptoms in a healthy person.

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The relation of similarity is primarily determined through provings, in which relatively healthy volunteers who are given a substance in homeopathic form record changes in their physical, mental, emotional, and spiritual symptoms. This information is subsequenly compiled and presented remedy-by-remedy in a Materia Medica. Subsequent versions of the Materia Medica additionally incorporate symptoms observed to have been cured by the remedy. A homeopathic repertory is an index of the Materia Medica, namely a listing of symptoms, followed by remedies reputed to cure them. With the growth of information on remedies such an index has become an indispensable tool for narrowing down the range of possibilities of appropriate remedy for a given case, although it is still properly treated as an adjunct to the Materia Medica.

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At first, Hahnemann proved substances known to him as poisons or as remedies. Hahnemann's findings from provings were first recorded in his Materia Medica Pura. Kent's Lectures on Homoeopathic Materia Medica (1905) lists 217 remedies, and modern drugs and chemicals are being added continually to contemporary versions. As a result, homeopathy uses a wide variety of animal, plant, mineral, and chemical substances of natural or synthetic origin. Examples include Natrum muriaticum (sodium chloride or table salt),lachesis muta (the venom of the bushmaster snake), Opium, and Thyroidinum (thyroid hormone). Other homeopaths during and after Hahnemann's time, notably Hering and Lux, developed remedies called nosodes, which are homeopathic dilutions of the agent or the product of the disease in question. Rabies nosode, for example, is made by potentizing the saliva of a rabid dog. Some homeopaths also use a number of more esoteric substances, known as imponderables because the prepartions do not originate from a material substance but from electromagnetic or electrical energy presumed to have been captured by direct exposure (X-ray, Sol (sunlight), Positronium, and Electricitas (electricity)) or through the use of a telescope (Polaris). Recent ventures by individual homeopaths into the realm of esoteric substances include Tempesta (thunderstorm), and Berlin wall.

Related Topics:
Materia Medica Pura - Kent's - 1905 - Sodium chloride - Lachesis muta - Bushmaster - Snake - Opium - Thyroid hormone - Nosode - Rabies - X-ray - Polaris

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Today, about 3000 remedies are used in homeopathy, of which approximately 300 are used based on comprehensive Materia Medica information, a further 1500-or-so on relatively fragmentary knowledge, and the rest are used experimentally in difficult clinical situations based on the law of similars, either without empirical knowledge of their homeopathic properties or through purely empirical knowledge independent of the law of similars. Examples include: the use of an isopathic (disease causing) agent as a first prescription in a 'stuck' case, when the beginning of disease can be traced to a specific event such as vaccination; the use of a biologically or chemically related substance when a remedy fails to act yet seems well-indicated; and more recently, the use of substances based on their place in the natural classification of their respective kingdoms (the periodic table or relevant biological taxonomy). This last approach is considered very promising by progressives in the homeopathic community, because it allows for grouping remedies and classifying the ever-burgeoning Materia Medica, but is rejected by many purists because it involves speculation about remedy action in the absence of proper provings.

Related Topics:
Periodic table - Taxonomy

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The law of similars is the guiding principle in homeopathy, but calling it a "law" is misleading. It is, rather, an axiom or postulate which forms the foundation of the homeopathic system and through the application of which homeopaths arrive at their diagnosis. As it cannot be disproved scientifically (since a failure to cure homeopathically can always be attributed to incorrect selection of a remedy), the law of similars derives its justification from its contribution to the clinical results that homeopaths claim. The application of this principle, however, is not straightforward: there exist multiple methodologies for determining the most-similar remedy (the simillimum), and homeopaths will often disagree on the diagnosis. This is due in part to the complexity of the idea of 'totality of symptoms' to which the law refers, as homeopaths will not use all the symptoms of a patient, but will decide which are the most characteristic; this evaluation of the gathered clinical data is the aspect of diagnosis requiring the most knowledge and experience. Finally, the remedy picture as found in entries of the Materia Medica is always more comprehensive than the symptomatology that a single individual can ever exhibit. These confounding factors mean that a homeopathic diagnosis remains presumptive until it is verified through testing the effect of the remedy on the patient.

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See also: List of common homeopathic remedies

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The theory of infinitesimals

The most characteristic—and controversial—principle of homeopathy is that the potency of a remedy can be enhanced (and side effects diminished) by dilution in a particular procedure known as dynamization or potentization. Liquids are successively diluted (with water or occasionally alcohol) and shaken by 10 hard strikes against an elastic body, a process called succussion. Insoluble solids are diluted by grinding them with lactose, a process known as trituration. Homeopathic practitioners believe the vigorous agitation following each dilution transfers some of the "essential property" of the substance to the water, which fits in with the concept of disease as a disturbance in the "vital force" of the patient. The dilution factor at each stage is traditionally 1:10 (D or X potencies) or 1:100 (C potencies). Hahnemann advocated the use of 30C dilutions for most purposes, i.e. dilution by a factor of 10030 = 1060. Critics point out that since Avogadro's number is only 6.022 × 1023 particles/mole the chance that even one molecule of the original would be present in a 15C solution is small and the chance of one molecule of the original being present in a 30C solution is infinitesimal.

Related Topics:
Lactose - Trituration - Avogadro's number

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Some later homeopaths, in particular Kent, advocated the use of much higher potencies, whose manufacture could no longer be practically achieved by the traditional methods, but required succussion without dilution (Jenichen), higher dilution factors (LM potencies are diluted by a factor of 50,000), or machines which in some way integrate dilution and succussion into a continuous process (Korsakoff). Higher dilutions are generally considered stronger and 'deep-acting'. This is in contrast to pharmacology and biochemistry, which hold that the effects of a substance are always due to its physical or biochemical activity in the patient's body, and therefore that generally the more of an active ingredient is present in a drug, the more effect (whether positive, negative, or both) it will have.

Related Topics:
Pharmacology - Biochemistry

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The choice of potency will depend on a number of factors. These include how deep-seated the disease appears to be; whether the disease is primarily physical or more mental/emotional; the patient's sensitivity based on the practitioner's intuitive assessment or previous reactions to remedies; and the desired dosing regimen based on patient-compliance considerations (e.g., low potency repeated often vs. high potency repeated seldom). There are many theories and traditions of potency use. For example, as a general rule French and German homeopaths use lower potencies than their American counterparts. What most homeopaths agree on is that the choice of potency is secondary to the choice of remedy: a well chosen remedy will act in a variety of potencies, but an approximately matched remedy might act only in certain potencies.

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Chronic disease

Although homeopathy is often used for the treatment of acute illness, there are several distinctive theoretical principles that apply mainly to the homeopathic treatment of chronic disease:

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Suppression

A prominent role in the homeopathic theory of disease belongs to the notion of suppression. Its initial meaning consisted of the belief that there are diseases whose external manifestations prevent development of inner symptoms of the same disease. In his Chronic Diseases Hahnemann argued that mistreatment of diseases of the skin leads to disease 'deeper' in the organism, listing numerous cases in support. Present-day homeopaths invoke this notion in their claim that symptoms are not in themselves the disease, but rather represent an underlying disturbance of the organism's vitality. As they seek to address this underlying disease, homeopaths do not automatically regard the disappearance of a symptom (whether spontaneous or in response to some treatment) as a favorable event: under some cases this could instead indicate a weakening of the organism's ability to express the symptom, and because the underlying disturbance is still present, sooner or later it is expressed as a symptom elsewhere in the organism. They further claim that the tendency of past skin manifestations to reappear transiently following successful homeopathic prescribing is considered evidence in support of the this notion. It is maintained that although suppression is sometimes necessary for the patient's welfare or may even be life saving, it is regarded unfavorably in the context of long-term prognosis. In the modern context the issue arises mainly with respect to the use of corticosteroid treatment for skin disease, allergies, and asthma, and the use of chemotherapy, as homeopathic treatment is claimed to be significantly less effective under immune-system suppression.

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Critics point out that the notion of suppression is deeply flawed, being based on erroneous intepretation of some clinical facts Hahnemann adduced in support of the theory. This is illustrated by Hahnemann's reasoning about the development of symptoms of syphilis{{fn|21}}: Physicians of his time regularly tried but failed to stop the progression of the disease by destroying the chancre that manifests early on. Hahnemann saw a non-existent causal relation between these events, arguing that the removal of the chancre was the cause of the disease's progression, writing that syphilis

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:"...can only proceed from the uncured indwelling veneral disease, whose external substitute and suppresser (the chancre, which, as long as it exists undisturbed, prevents the outbreak of the syphilis) has been destroyed locally by the physician, and can consequently no longer hinder its outbreak."

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But since the clinical course of untreated syphilis involves the spontaneous disappearance of the primary chancre only to be followed by more extensive skin and systemic manifestations some time later, Hahnemann was wrong both in his observations (that the chancre remained indefinitely when untreated) and theory (that localized treatment of the chancre was the cause of later symptoms).

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Direction of cure

Hahnemann's protégé Constantine Hering systematized Hahnemann's observations concerning the relation between symptoms by noting that homeopathic treatment often brought back previously suppressed symptoms of the patient (known as "return of old symptoms"), with cure tending to proceed:

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• from more vital to less vital organs;
• from the interior to the surface; and (when applicable)
• from the head and torso to the extremities.

Thus, as an example, a patient originally treated with medicinal ointments for a body-wide rash, later became asthmatic, and was now being treated homeopathically for suicidal depression, would tend first to recover emotionally while experiencing transient asthma symptoms and the reappearance of his skin rash, which would leave the core of his body first and his extremities last. Although this set of observations later became known as "Hering's Law of Direction of Cure", it is not a strict law but a clinical pattern whose presence indicates a high likelihood that deep cure has taken place and that recurrence is unlikely.

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Homeopathic aggravation

The phenomenon of existing symptoms worsening in response to homeopathic treatment is termed homeopathic aggravation. The idea of aggravation can be considered a consequence of the law of similars, whereby a remedy acts by accentuating the disease symptoms, thus prompting the organism's healing response. Some homeopaths regard a quick aggravation as an indication of strong vitality and tend to be encouraged by its presence, while others strive to avoid aggravations in favor of the patient's comfort throughout treatment.

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Constitutional treatment

Although Hahnemann himself did not have an explicit theory of physical constitution or psychological disposition, he did observe that general symptoms pertaining to the whole organism (e.g., reactions to weather, perspiration and sleep patterns) plus the patient's disposition were of special importance both diagnostically and for case management. Later homeopaths, notably James Tyler Kent, increasingly used overall disposition as a basis for determining the remedy and assessing the patient's vitality in response to treatment. Such treatment, which was applied in cases of chronic illness, became known as constitutional prescribing. Recent developments in the understanding of remedies and the homeopathic process, such as George Vithoulkas' essence prescribing and Rajan Sankaran's concept of central delusion, are continuations of this trend.

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Because in the present social context classical homeopaths are usually seen for chronic complaints, these principles feature prominently in current homeopathic education and practice. In accordance with this view of disease, classical homeopathic treatment of chronic disease requires a long interview, often longer than an hour, to determine the totality of the patient's symptoms: a thorough history is taken, including childhood and physically or psychologically traumatic or memorable events; important or recurrent dreams are elicited; and a unified understanding of the person's unique perception of the world is sought.

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Miasms

Although nowadays homeopathy is especially known for its treatment of chronic diseases, Hahnemann recognized already early on that homeopathy, like conventional medicine, had more difficulty with these than with acute illness. In response, in his later years he developed the concept of miasms, an idea that is still as complex as it ever was, and which remains contentious. After some years of homeopathic experience Hahnemann began noticing that many of his chronic patients tended to relapse even after prolonged homeopathic treatment: though they responded to remedies, over time their symptoms would tend to shift around without a fundamental improvement in their state. This led to his hypothesizing that health was not only determined by the person's present vitality, but also related to historical factors in the person's own life, as well as that of immediate ancestors; what he called miasm (from the Greek for taint). These factors had to be addressed before the patient could experience satisfactory improvement of the symptoms, while in cases where the miasmatic load was heavy only partial improvement was to be expected.

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Hahnemann described three types of miasm in his Chronic Diseases (vol. 1):

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• Psora (possibly from Greek for itch): This was associated with cutaneous manifestations such as scabies, as well as diseases that tended to present as constantly irritating or distracting yet completely reversible (e.g. eczema, mild asthma, recurring infections). Hahnemann considered this the primordial miasm, arguing that improper treatment of such manifestations throughout history was what led to chronic disease and the other miasms.
• Sycosis (from the Greek for fig-wart): This was associated with genital infections such as fig-wart (today recognized as HPV) and gonorrhea. These infections and diseases such as cutaneous warts, benign tumors, and psychological neuroses had the shared quality of being relatively fixed yet non life-threatening. Psychologically such states were associated with the need to accept the problem as an irremediable defect.
• Syphilis (from the disease name) was associated with syphilis and other manifestations such as bone ulcers, organic heart disease, and dementia that had the shared tendency of producing irreversible tissue destruction.

Later in the nineteenth century the following miasms, which are considered intermediate in severity between sycosis and syphilis, were further delineated:

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• Tuberculosis: Associated with the infection as well as with life-threatening yet reversible asthma or pneumonia and (psychologically) with constant dissatisfaction and desire for change;
• Cancer: Associated with malignant states as well as Obsessive-Compulsive Disorder and psychological traits of perfectionism, and excessive responsibility or ambition.

More recently, the highly influential Rajan Sankaran has further developed the understanding of the psychological qualities of miasms, and has made miasms an integral aspect of his diagnostic approach. He further expanded the list of miasms by largely supplanting Psora in favor of several, more specific miasms previously subsumed under it:

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• Acute: Diseases (whether acute of chronic) that present with a pattern of recover (with no ill effects) or succumb;
• Typhus (after the clinical pattern of the infection): Enormous, short-term struggle followed by recovery;
• Ringworm (after the clinical pattern of the infection): Cyclical recovery followed by likely recurrence;
• Malaria (after the clinical pattern of the infection): Low-grade, fixed illness (similar to a sycotic manifestation) punctuated by acute exacerbations.

He further added a miasm between cancer and syphilis:

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• Leprosy (after the clinical pattern of the infection): Destructive, irreversible, yet not necessarily life-threatening manifestations such as leprosy and other disfigurements and AIDS that lead to both physical and social disability.

Miasms are determined through careful inquiry into the patient's personal and family medical history in search for previous infections (especially ones that from which recovery was incomplete) such as tuberculosis or diseases such as cancer. The presence of such manifestations can influence the choice of remedy beyond the presenting symptoms, and also provides a prognostic measure in a similar way as familial inheritance influences prognosis in conventional medicine.

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The acceptance of miasms varies within the homeopathic community. Some homeopaths find the concept unhelpful or otherwise unacceptable; others will make occasional use of it; while other yet strive in every case to determine the miasmatic nature of the illness in order to facilitate prescribing (since remedy selection can be assisted by knowledge of the miasm). Of the latter two groups some regard miasms as objective features of the disease, while others view them merely as clinically useful categorizations.

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