Chapter 39 Homeopathy
Homeopathy is a highly systematized method of medical therapeutics and clinical evaluation. The term “homeopathy” is derived from the Greek words “homeos,” meaning “similar,” and “pathos,” meaning “suffering.” The medicines used in this system of therapeutics are chosen according to the Law of Similars (the concept of like curing like), a fundamental homeopathic principle based on the observed relationship between a medicine’s ability to produce a specific constellation of signs and symptoms in a healthy individual and the same medicine’s ability to cure a sick patient with similar signs and symptoms. This principle was first recognized by Hippocrates, who noticed that herbs given in low doses tended to cure the same symptoms they produced when given in toxic doses.
Homeopathic medicines are derived from a wide variety of plant, mineral, and chemical substances. They are prepared according to standards of the U.S. Homeopathic Pharmacopoeia, a revised version of which has been approved by the U.S. Food and Drug Administration and U.S. Congress.
The homeopathic school of medicine was founded by a German physician, Samuel Hahnemann. He had already gained a reputation in chemistry and medicine, having formulated a soluble form of mercury and developed a safer method for its use, and having written a number of works on pharmacology, hygiene and public health, industrial toxicology, and psychiatry. His treatise on arsenic poisoning (1786) is still considered authoritative. A prolific writer, Hahnemann collected, compiled, revised, and edited the existing pharmacologic knowledge. The work was well received by the medical profession of the time. Hahnemann was one of the most learned men of his generation in medicine, chemistry, and pharmacology, making his later criticisms of medicine all the more significant.1
Disillusioned with the theories and practice of eighteenth century medicine, Hahnemann retired from practice in 1782 and spent the next 14 years earning a meager living doing chemical research; writing; and translating English, French, Italian, and Latin works. He wrote of his time of practice:
It was painful for me to grope in the dark, guided only by books in the treatment of the sick. To prescribe according to this or that (fanciful) view of the nature of diseases, substances that only owed to mere opinion their place in the materia medica; I had conscientious scruples about treating unknown morbid states in my suffering fellow creatures with these unknown medicines which, being powerful substances, may, if they were not exactly suitable (and how could the physician know whether they were suitable or not, seeing that their peculiar special actions were not yet elucidated) easily change life into death, or produce new affections and chronic ailments, which are often more difficult to remove than the original disease.
In his struggle to determine a reliable basis for therapeutics, he was distressed by his inability to provide medical care for the acute illnesses of even his own growing family. In 1790, during his translation of William Cullen’s (a Scottish physician) Materia Medica, he added a footnote disagreeing with Cullen’s conclusions that the basis of cinchona bark’s effectiveness was its bitter and astringent qualities. Cinchona officinalis (peruvian bark), from which the drug quinine is derived, was known to be clinically effective in malaria and intermittent fevers (then called ague). He argued that there were several drugs in common usage that, in smaller doses, had greater bitter and astringent qualities yet had no specific action on fevers. As an experiment, Hahnemann took four drachms of cinchona twice daily and soon developed the paroxysmal symptoms characteristic of intermittent fevers.
Although homeopathy offers a profoundly deep and unified evaluation in the treatment of chronic diseases (see the section on “Follow-Up and Case Evaluation”), it had gained most of its early reputation in the treatment of acute and epidemic diseases. An uproar was caused in Cincinnati in 1849, when two immigrant German homeopaths, treating cholera with camphor and other homeopathically prescribed remedies, published statistics in newspapers indicating that only 35 of their 1116 treated cases had died. During the nineteenth century, 33% to 50% of patients with cholera who were given standard medical care died. In the 1879 epidemic of yellow fever, New Orleans homeopaths treated 1945 cases with a mortality rate of 5.6%, whereas standard medical doctors were losing 16% of patients. These and similar statistics had a profound effect on Congress and public opinion.2
Over time, homeopaths established their own network of treatment facilities. By 1892, in the United States, they controlled 110 hospitals, 145 dispensaries, 62 orphan asylums and retirement homes, more than 30 nursing homes and sanatoria, and 16 insane asylums.
Constantine Hering established the first homeopathic medical school in the United States in 1835. It later moved from its original site in Allentown, Pennsylvania, to Philadelphia, where it remains today as an orthodox medical school: the Hahnemann Medical College and Hospital. Hering’s promotion of homeopathy and development of the materia medica was equaled only by Hahnemann himself. His 10-volume work, The Guiding Symptoms of Our Materia Medica, remains a definitive work on the clinical verifications of the homeopathic approach. Unfortunately, of the many medicines introduced by Hering, only nitroglycerine remains in orthodox medical practice as a tribute to his medical genius.
Throughout the world, homeopathy has maintained a consistent tradition. Frederick Harvey Foster Quinn introduced it to England in the 1840s. It has since become a postgraduate medical specialty, recognized by the Department of Health by virtue of an Act of Parliament. Homeopathic hospitals and outpatient clinics are part of England’s national health system. Homeopaths have been engaged as personal physicians to the Royal family for the past four generations.
Hahnemann defined his method of testing medicines on healthy people as “provings.” He expanded his investigations to include a wide range of substances, using his family, friends, and associates as experimental subjects.
Historically, Hahnemann was not the first to use this methodology. In 1760, Anton Stoerck reported testing stramonium (datura) by rubbing it on the skin, inhaling the vapors of the freshly crushed leaves, and, finally, ingesting the fresh extract. He theorized that if stramonium disturbs the senses and produces mental derangements in healthy people, it might be administered to maniacs for the purpose of restoring the senses by effecting a change of ideas.
Medical literature contains examples of inadvertent provings: in 1983 a study in the New England Journal of Medicine reported that pyridoxine (vitamin B6), which is used in the treatment of some types of peripheral neuropathy, was also capable of producing neuropathies when given in large doses.3 In 1796, Hahnemann published, in Hufeland’s Journal, the fruit of his investigations in an article, “Essay on a New Principle for Ascertaining the Curative Power of Drugs, with a Few Glances at Those Hitherto Employed.”
Hahnemann also recognized the tendency of a natural disease to have a “homeopathic effect” (i.e., a preventive or therapeutic effect) on other diseases with similar symptomatology. Although he ascribed this to the stimulation of the organism to eradicate the disease, he felt the deliberate induction of a disease to be difficult, uncertain, and dangerous.4 This concept has many parallels in modern medical science. Descriptions of viral interference under natural conditions were described in 1937 by G. Findlely and F. MacCallum, who found that monkeys infected with the Raft Valley fever virus were protected from the more fatal yellow fever virus. They adopted the term “virus interference” and believed that when one virus infects a group of cells, a second virus is somehow excluded.5 This eventually led to the discovery of interferon in 1957 by Alick Isaacs and Jean Lindenmann. These methods of inducing self-regulation are critical in enhancing the ability for the body to recognize and resolve illness.
In 1799, Hahnemann gained increased professional acceptance of his ideas by the successful application of atropa belladonna (deadly nightshade) in the prevention and treatment of scarlet fever (which had at that time reached epidemic proportions). In 1860, it was recommended as the treatment of choice in the National Dispensatory, which stated: “As long as persons are under the influence of belladonna the liability to contract scarlatina is very much diminished.”6
In 1810, Hahnemann published his Organon of Medicine, a book that, through six editions, formed the foundation and definition of the homeopathic practice of medicine. It contains the philosophy, observations, and clinical applications of homeopathy, as well as citations from the historical and current literature of the time. Hahnemann challenged the reductionistic and mechanistic practices of his time, stating that the nature of disease is dynamic and could not be defined by isolating processes, grasping for an explanation. He further asserted that the cause of disease could not be known and that the categorization of disease states and attempts to manipulate physiology were insufficient, because they did not address the integrity and complexity of organization of the organism as a whole.
Disease is therefore addressed descriptively in the context of the whole patient, with the patient’s unique symptoms being indicative of that individual’s vital response to the condition. For any given disease there may be a long list of remedies that have been clinically effective, but it is the individualization and differentiation among medicines, based on the patient’s unique indications, that leads to a successful homeopathic prescription.
Disease, in the homeopathic model, is thought to arise from inherent or developed weaknesses in the patient’s defense mechanisms, creating a susceptibility to “morbific influences” (e.g., toxic factors in the environment, bacteria, psychological stresses). This viewpoint is considered “vitalistic” (see Chapter 3, Hierarchy of Healing, and Chapter 5, Philosophy of Naturopathic Medicine, for further discussion) and, although it does not deny a corporeal reality, considers pathology to be but a singular focus in a complex net of interactions.
We must admit, however unwillingly, that we seldom or never really know the cause of anything. Many a beautiful idea has been slain by ugly fact. We merely note a constant association with one thing always following another. We say that the tubercle bacillus is the cause of tuberculosis. That is merely another way of saying that the bacillus is associated with a constant type of lesion; it is no explanation of how the lesions are produced by the bacillus. Nor does it explain why some persons and animals are susceptible to the infection while others are immune.
Vitalism can be better understood in the context of Hahnemann’s time, when theories of the causation of disease and its treatment abounded, such as Galen’s doctrine that the secondary quality of a medicine (i.e., its action on the disease) could be determined from its primary qualities, such as its taste or smell; the evaluation of medicines by the study of their interactions when mixed with human blood in a jar; iatrochemistry, which had been reduced from the Paracelsian application of spagyric tinctures or oils of metals to dangerous toxic doses; the classification of drugs according to the Dioscoridian approach, which was based on the physiologic action (e.g., diuresis, diaphoresis) and chemical composition; and the “doctrine of signatures,” which held that the outer form and color of a plant revealed its inner archetypal action.8,9
Although some studies of the effects of medicinal agents were done with animals, Hahnemann observed that they had different effects on humans; pigs could safely eat nux vomica in quantities that would immediately kill humans. Dogs could eat aconitum napellus, a deadly poison to humans, without injury. He also rejected the method of testing drugs by studying their effects on the sick as haphazard and unreliable, particularly because the results being sought were often only symptomatic relief rather than eradication of the disease state.
Hahnemann defined the application of medicines whose purpose was to alter physiology or act as an antagonist to disease as the practice of “allopathy” (“allo,” meaning “contrary” in Greek). The current dominant medical system is heavily influenced by the causalistic and allopathic paradigms. This results in the diagnosis being the focal point of practice, without which appropriate therapy cannot be instituted. The pharmacologic approach is limited to the end results of disease rather than the origins of pathogenesis. Subsequent problems are classified as unwanted side effects, because only the primary action of the pharmaceutic agent is used for treating a specific disease state. By focusing on only the primary effects of a drug, a diverse remaining range of physiologic, as well as psychological effects, are ignored.
In the homeopathic model, the side effects are an important part of the agent’s action and the body’s response to them, and by ignoring them, a drug’s range of usefulness is greatly limited, whereas its toxicity is increased. Hahnemann’s empiric investigations not only led to new applications of medicines but provided a method for integrating the physical, mental, and emotional effects of a drug. This allowed the treatment of the totality of a patient’s symptoms as a dynamic pattern of interaction.
Vitalists stress the teleologic behavior of organisms (i.e., the goal directedness and design in biological phenomena). Disease is therefore regarded as a positive expression of the organism’s self-regulatory process in response to environmental or other stresses. Disease is not accidental but is rather the effort of the organism to ward off deeper or more internal disorganization. It is the natural wisdom of the body, the vis medicatrix naturae, or, using current scientific terminology, the tendency of the body to maintain homeostasis. Medical intervention often acts in conflict with these vital intracellular and extracellular regulatory functions.
I believe that clinicians have come to think more and more in terms of a disturbance in the total economics of the personality, a temporary overwhelming of the efforts of the organism to maintain a continuous internal and external adaptation to continuously changing relationships, threats, pressures, instinctive needs and reality demands … It is the imbalance, the organismic disequilibrium, which is the real pathology, and when that imbalance reaches a degree or duration that threatens the comfort or survival of the individual, it may correctly be denoted disease.
Homeopathy is a method of specific induction of nonspecific resistance that stimulates the body’s inherent defense and self-regulatory mechanisms, rather than by taking over a function of the body, initiating dependency on the medicine itself.
The homeopathic clinical and therapeutic process consists of three interrelated processes: case taking, evaluation, and prescribing. The process is comprehensive and engages the observations of the patient, as well as those of the doctor. Hahnemann described the process in paragraphs 84 to 103 of the Organon and stressed the importance of distinguishing between chronic and acute, or self-limiting, disease.
The initial history of complaints is elicited from the patient with as little interruption as possible (as long as the patient does not digress unduly), so that the patient’s train of thought is not disrupted or directed along lines imposed by the physician’s biases. According to Hahnemann:
The physician elicits further particulars about each of the patient’s statements without ever putting words in his mouth, or asking a question that can be answered only by yes or no, which induces the patient to affirm something untrue or half true or else deny something really there to avoid discomfort or out of desire to please, thereby giving a wrong picture of the disease, which would lead to the wrong treatment.
An entire review of symptoms is recorded in descriptive detail, taking into consideration all modalities that affect a symptom. Hahnemann emphasized the general symptoms (i.e., those affecting the entire organism), as the leading indications for the remedy. These key symptoms include mental and emotional affects, the metabolism and its reactions to environmental stimuli, sleep positions, food cravings and aversions, thirst, body type, and all manifestations of unconscious and autonomic regulation.
Unique characteristic symptoms, particularly those regarded as “strange, rare, and peculiar,” are important considerations in the selection of the remedy. These might be the expression of a paradoxic or unusual relationship, such as pain ameliorated by pressure or the sensation of the legs being made of wood or glass. The association of the start of a disease or symptom complex with an environmental or emotional event can be key and emphasizes the importance of an accurate and extensive interview.
In chronic diseases in women one should pay particular attention to such things as pregnancy, infertility, sexual desire, confinement, miscarriages, nursing, vaginal discharges, and the condition of the monthly flow, especially noting whether it recurs at intervals that are too short or too long, how many days it lasts, whether or not it is interrupted, the quantity, how dark with color, any leukorrhea before or after the flow. If there is leukorrhea, what it is like, what symptoms accompany it, what is its quantity, under what conditions does it appear, what brings it on?
Because the patient’s symptoms are the expressions of the body’s attempts to heal itself, symptomatic treatment (i.e., many allopathic therapies) can impair the physician’s ability to obtain vital information and complicate the taking of the case. This problem has also been recognized by some medical authors, such as Boyd, who stated: “We recognize that the pattern of disease has changed out of recognition during the last 30 to 40 years owing to modern drugs, particularly the antibiotics.”7
Considering the vitalistic and holistic perspective of the homeopathic approach, a clear definition of cure is necessary to establish the treatment goal. Mere palliation or suppression of symptoms at the cost of the overall vitality and function of the individual is considered negligent by the homeopathic practitioner. For example, if a patient’s skin disease is treated and appears to resolve but is followed by asthma, fatigue, and confusion, the treatment is evaluated as having been suppressive. If, upon proper treatment, the more serious lung and systemic disruptions are alleviated and the previous skin lesions return, the patient is considered as progressing toward a cure. When further appropriate therapy results in final alleviation of the skin disease, without any undue stress to the patient, it is then considered a true cure.
This evaluative procedure is part of Hering’s Law of Cure, an observation of the principles of curative responses that can be applied to any healing process, regardless of the school of thought. In true healing, according to this set of observations, symptoms follow these patterns:
Homeopathy holds that the disease first affects the vital force and is manifested first by a change in the patient’s well-being, long before any objective changes can be observed. Illness is usually first recognized when the patient becomes aware of the early manifestations of the disease.
Disease and cure must also be considered in the context of the belief system and culture of the patient. Much of what we call disease arises from the individual’s inability to find meaning and purpose. Many forms of healing are capable of enabling the person to integrate into the fabric of daily life and of providing ways to help the person address personal needs for fulfillment.
In his study of disease, Hahnemann noted that there were inherited predispositions to disease, which he related to the improper treatment, and therefore suppression, of skin eruptions and venereal disease. He called these predispositions miasmas and, in 1828, published his findings in Chronic Diseases: Their Nature and Homeopathic Cure. He observed that many people, despite apparently healthy lifestyles, develop degenerative diseases. These often become established in childhood and continue to plague the person throughout life, despite medical treatment. He described three miasmas: psora, which represents a fundamental flaw in human ability to eradicate disease related to the suppression of skin disease; syphilis; and sycosis, which is caused by the suppression of the figwort, or what is now known as human papilloma virus. Hahnemann described the chronic effects of bacterial and viral diseases in his explanation of miasmas. In his discussion of viral diseases such as smallpox and other epidemic diseases, Hahnemann’s descriptions of the nature of viruses and their treatment predate their discovery by 50 years. He was a contemporary of Edward Jenner and supported his use of smallpox vaccination.
More recently, George Vithoulkas, a contemporary homeopathic author and teacher, defined health on three levels: mental, emotional, and physical. The mind should be capable of functioning with clarity, rationality, coherence, and logical sequence. It should be capable of engaging in creative service for the good of others, as well as for the good of oneself, demonstrating a freedom from selfishness and possessiveness. On the emotional level, there should be a state of serenity free from excessive passion, a state that should not be confused with lack of emotional response generated as a protection against emotional vulnerability. Finally, on the physical level, there should be freedom from pain. The healing person should experience a subjective sense of well-being and a progressive increase in vitality.12
Because homeopathy is oriented toward the administration of a single medicine at a time, careful prescribing is important. It is through the application of single medicines that homeopathic physicians have been able to record clinical verification of the provings and amass an impressive body of literature.
The process of selecting the correct remedy involves both careful study of the patient’s symptomatology and medical history and matching these with the appropriate remedy. This requires a sound understanding of the homeopathic materia medica (see section on “The Study of the Materia Medica”).
As Hahnemann began his research, he found that when treating patients according to the Law of Similars there was an initial aggravation of the symptoms, the “healing crisis,” when using the high dosages typical of that era. He empirically tried using progressive dilutions of the medicines, beginning with tinctures from plants and titurations with milk sugar for metals and salts. He made the dilutions serially by mixing 1 drop of the tincture to 100 drops of alcohol, which were then “succussed” (shaken by pounding against a resilient surface) vigorously. He found that, with increasing dilution, the severity of the aggravation lessened while the patient continued to improve, often with deeper and more enduring results. He called these diluted remedies “potentized.” As an analytic chemist, he was aware of Avogadro’s theories (they were contemporaries), but he persisted in evaluating dilutions beyond the point where chemical activity could be detected.
This challenge to the present understanding of therapeutic mechanism has been addressed by recent workers, who have suggested that the therapeutic properties of the remedy lie in the energetic impression they make on the diluting vehicle (typically alcohol and water or lactose). Various techniques have been used to determine if there is a physical difference between the potentized dilution and the unmodified vehicle. These studies have used ultraviolet spectroscopy, conductivity measurements, infrared spectroscopy, surface tension measurements, Ranian-Laser spectroscopy, nuclear magnetic resonance, and other methods. Much of this work has shown regular peaks and troughs in activity with progressive dilutions, and Heintz claimed that the peaks corresponded to the maximum effects found in the biological studies he reported (see section on “Basic Research”).13
To date there is no conclusive understanding of the mechanism of action of the potentizing process. However, this has not inhibited the use of potencies, which have been diluted by a factor of 100 up to 100,000 times (10200,000). At this time, most explanations for the mechanism of homeopathic high potencies are provisional (such as the postulate that the remedies act in resonance with the magnetic fields of the body, or that the physiochemical properties of water can be modified by a solute and remain so even in the absence of the solute).14
This has not affected clinical practice or demonstration of efficacy in clinical trials any more than the use of aspirin did, despite the fact that the discovery of its mechanism of action through modulation of prostaglandins did not occur until the 1980s. There are many forces whose nature can only be recognized by their results (e.g., gravity). These observations of relationships, confirmations of experience, are the basis of an empiric system. Medicine remains an art in the field of science.
Interestingly, a group operating in the Hematology Department of the School of Pharmacy in Bordeaux, France, tested both the effect of common aspirin and homeopathic preparations on the vascular walls of rats. Aspirin at high concentrations (100 mg/kg) induced a decrease in platelet aggregation (amplitude and speed), as well as a decrease in the area of the thrombi (arterial and venous) and the number of emboli (arterials and venous).
Aspirin at ultra-low doses (9, 15, 30 CH) induced an increase in platelet aggregation (amplitude and speed), as well as an increase in the area of thrombi (arterial and venous) and the number of emboli (arterial and venous). The antiaggregation and antithrombotic action of aspirin at high concentrations (100 mg/kg) was inhibited by the concomitant injection of aspirin 15 CH.15
This confirmed Hahnemann’s observations of the primary and secondary effects of medicines mentioned in the Organon.16 Bellavite described these effects as “biologically active compounds (which) may cause inverse or paradoxical effects on a complex homeostatic system when either the doses of the compound, or the methods of preparation and of administering, or the sensitivity of the target system are changed.”17,18
Research into both the pharmacologic effects of homeopathic preparations and the paradoxic effects of orthodox drugs that confirm the Law of Similars’ underlying homeopathic prescribing are a growing body of literature. Certain pharmacologic substances when tested in high dilutions act on the same biological systems.19–25
Paradoxic effects of medicines are the basis of the Arndt-Schulz Law in pharmacology and hormesis. The Arndt-Schulz law states that weak stimuli slightly accelerate vital activity, medium strong stimuli raise it, strong ones suppress it, and strong ones arrest it.30
Southam and Erlich31 reported the stimulatory effect of an antifungal agent when used at low doses and proposed the term “hormesis.” Hormesis is defined as “the stimulatory effect of subinhibitory concentrations of any toxic substance on any organism.”32 Hormesis is considered a nonspecific phenomenon that increases the resistance and growth of the treated organism. It exists in all living organisms. This “action–reaction” model shows the efficacy of the “vital activity” in fighting the poison in a nonspecific way, although specific defense molecules are also synthetized.33–38 A modern and important pathologic model showed that a single dose of an antitumoral immunosuppressive substance (cisplatin) induced increased lymphokine-activated killer activity.39 Wagner and colleagues demonstrated that low doses of cytostatic agents stimulated human granulocyte and lymphocyte growth.40
The goals and methods of homeopathic pharmacy have their roots in earlier Paracelsian and spagyric medical systems. The challenge remains to define homeopathic empiric science in the context of a modern science. It may be that homeopathy presents a challenge to science itself that will bring forth new models for pharmacology. The more central challenge is for homeopathy to discover how it can apply its own critical methods to develop a more effective health care service.
The assumption that we can find substances in nature that can alter disease underlies the history of medicine and pharmacology, yet healing remains a mystery. Further studies are necessary to confirm and develop the understanding of the mechanisms and validity of homeopathic medicines.