Homeopathy: A Brief Overview with Examples
By Edward Shalts, MD, DHt, Dr. Shalts is in private practice and is a member of the faculty at the Center for Health and Healing, Beth Israel Medical Center, New York, NY; he is a trustee of the American Institute of Homeopathy and vice president of the National Center for Homeopathy; he reports no consultant, stockholder, speaker's bureau, research, or other financial relationships with companies having ties to this field of study.
The general public has been utilizing homeopathic preparations at an astoundingly high rate.1 Despite evidence of the efficacy of homeopathic preparations shown in well-designed studies2-9 and high demand by patients, the majority of conventional physicians remain opposed to the very possibility of homeopathy being a plausible therapeutic approach.10 One of the most recent examples of such opposition has been well analyzed in peer-reviewed publications.11-13
Throughout the years a number of double-blind placebo-controlled trials have been published in which the researchers found no benefit from the homeopathic intervention.14-17 Methodologically sound research in the field of homeopathy must be performed with the understanding, however, that a double-blind, placebo-controlled study is not well designed if it does not take into the account the core principles of homeopathy and excludes experienced homeopaths from both the design and execution of the study.12,18 This is indeed a very large and complex topic, well-addressed by Iris Bell, MD, PhD, in a recent publication.12
The purpose of this article is to introduce the main ideas of homeopathic theory and practice using the language of modern biomedical science. Some simple homeopathic solutions for common ailments will also be offered. More detailed, in depth discussions of these principles can be found elsewhere.19-21
Homeopathy: Its History and Principles
Homeopathy is based on four basic tenets: the Principle of Similars, provings, minimal dose, and high dilutions.
Principle of Similars. Homeopathy (from the Greek "omeos" meaning similar and "pathos" meaning suffering) is a system of medicine whose main tenet is the Principle of Similars: A substance that can cause symptoms in a healthy person, can stimulate self-healing in a person presenting with a similar constellation of symptoms (both physical and emotional).
For example, a patient suffering from seasonal allergies who presents with increased lacrimation, irritating, burning nasal discharge, pain at the root of the nose, and a general feeling of dullness may benefit from a homeopathic preparation of Allium cepa (onion) because it produces a similar constellation of symptoms in healthy individuals. Another patient with seasonal allergies characterized by irritating discharge from the eyes and bland, non-irritating nasal discharge may benefit from a homeopathic preparation of euphrasia (eyebright) because it produces similar symptoms in healthy volunteers.
Proving. Homeopathy was developed as a system of medicine in the 19th century by the German physician and chemist Samuel Hahnemann. From its inception, homeopathy sparked controversy, particularly because of Hahnemann's strong opposition to the barbaric treatment methods employed by mainstream medical practitioners of his time (e.g., blistering, phlebotomy, purging) and polypharmacy. Hahnemann also refused to accept the theory of signatures that dominated medicine of the 18th and 19th centuries. For example, onion was considered beneficial in the treatment of prostate problems because it resembles a prostate gland. Medicinal qualities of Cinchona officinalis (Peruvian bark), which was successfully employed in the treatment of malaria, were attributed to its sour, astringent taste.
Hahnemann's desire for a scientific medical practice based on unbiased experimental data eventually led him to take significant doses of Cinchona officinalis in an attempt to understand its mechanism of curative action in patients with malaria. After a few doses he developed symptoms similar to the symptoms to those characteristic of patients suffering from malaria. Subsequent to reproducing this experiment a few times with consistently comparable results and researching the available medical literature of the time, Hahnemann formulated the Principle of Similars. At the same time, he recognized the process of finding medicinal characteristics of various substances by administering them to healthy volunteers as a valid method of creating homeopathic pharmacological records. He named this process "proving" (from the German "Prüfung," meaning test and experiment). Further provings were performed by Hahnemann on himself, his family members, and students (later to be called provers). Eventually, a group of 50 doctors constituted the pool of provers that worked closely with Hahnemann and described characteristics of approximately 100 substances of mineral, herbal, and animal origin. Currently, homeopathic pharmacological books (called Materia Medica) list around 3,000 remedies.
Provings, essentially Phase 1 pharmacological studies, are performed according to a strict protocol. While conventional researchers look for physiologic tolerance in healthy individuals without too many side effects, homeopaths look for as many side effects as they can find. They use these side effects to develop prescriptions; however, different people may react to the same substance in slightly different ways.
Minimal dose. Homeopaths employ as few doses of the remedy as necessary to produce a healing response. In many cases the administration of one to three doses of the remedy is sufficient. Although this notion seems highly unusual (if not flatly counter-intuitive) in the model of conventional medicine, homeopaths and their patients have been utilizing and benefiting from the principle of minimal dose for more than 200 years.
High dilution. Initially, Hahnemann prescribed remedies in the accepted (i.e., pharmacologic) dosages of the time. Many skeptics of homeopathy today incorrectly assume that Hahnemann and homeopathy were first decried for recommending doses of medicine too small to have any therapeutic benefit. However, for the first 20 years of Hahnemann's practice he primarily used medicinal doses that were only slightly diluted, commonly using the tincture of an herb or a 1:10 plant or mineral dose diluted two or three times. He found that although patients improved in many cases, the drug often caused a severe initial aggravation of the symptoms. Such aggravation was to be expected since the drug itself was producing symptoms similar to those that had initially brought the patient to treatment. Still, it was understandably uncomfortable and alarming for the patients, and it precluded Hahnemann's ability to test (prove) some of the extremely toxic drugs in common use at that time, such as mercury and arsenic.
In response, he began reducing the doses by one-tenth and, as his patients continued to respond favorably even as their initial aggravations decreased in severity, Hahnemann continued to experiment with further 1:10 dilutions of previously diluted medicines. If there was a match within the framework of the Principle of Similars, the patient would be specifically sensitive to the remedy itself. As such, the doses necessary and sufficient to obtain a curative reaction were much lower than those needed to cause symptoms in healthy subjects and, as he continued to strive for subtler, less heroic healing action, Hahnemann observed that progressive dilutions not only were less toxic but, paradoxically, more potent.
The early dilution procedures included vigorous shaking or "succussing" by hand to effect complete homogenous dilution of the homeopathic medicine. Contemporary experimental data suggest that succussion is an important step in the preservation of biological activity of a highly diluted substance.22 The interested reader is referred to a book chapter providing a more detailed description of homeopathic pharmacology.23
Scientific Assessment of Homeopathy's Basic Tenets
The Principle of Similars can be restated in common biomedical terms as follows: A given concentration (or homeopathic dilution) of a substance may have opposite (not just different) effects if physiologic conditions are different (e.g., healthy vs. ill organism). There also can be two different concentrations (or homeopathic dilutions) of a given substance that have opposite effects in a given physiologic state of a living system.1 A detailed analysis of this issue is presented in recent publications by Eskinazi1 and Merrell and Shalts.19
Provings have been recently subjected to double-blind placebo-controlled studies to ascertain validity of the premise that biologically active substances in homeopathic concentration 30C (10-60) can produce consistent symptoms in healthy volunteers. Preliminary data show a significant positive trend in the consistency of symptoms.24-30 Interestingly, they correspond to descriptions in original provings performed by Hahnemann and his team.
Biological effects of high dilutions have been thoroughly investigated and described in scientific publications.1,31 However, there is no understanding of the exact mechanism of action of high dilutions at this time.
Clinical Applications
Significant clinical success in the treatment of children during the 1801 epidemic of scarlet fever in Germany made Hahnemann and homeopathy famous. Hahnemann emphasized a holistic approach with the individualization of treatment, pioneering the concept of differential therapeutics. This approach required a significant amount of effort and time. It also required a shift from the existing theoretical paradigm based on pathology and theory of signatures to the holistic approach addressing the entirety of psychosomatic changes characteristic to the illness in a particular individual. For this reason, almost since the very inception of homeopathy in the beginning of the 19th century, a significant number of physicians rooted in the conventional practice of polypharmacy and invasive methods of treatment insisted on using combinations of various homeopathic remedies for the treatment of particular diseases, both as an alternative to and adjunct treatment in combination with conventional medical practice. The very same concept that Hahnemann fought in all his major writings was brought back under the flag of homeopathy.
A homeopathic physician bases a prescription on unique characteristics of symptoms present in the particular individual. For example, two patients with tonsillitis might receive two different medications if one has diffusely erythematous tonsils while the other has a unilateral pustular presentation.
The homeopathic interview is structured to provide data necessary to match a unique symptomatological picture of the patient with the characteristics of an available remedy. The single most important factor in the evaluation is the chief complaint and the circumstances around it. Key points of the homeopathic interview are not dissimilar to a conventional history, but provide much more detail. There is an emphasis on:
Concomitant Symptoms. What else is happening at the same time the other symptom is occurring? This information is essential for a homeopath, as it provides information that is unique to a particular patient.
Modalities. What makes the sensation occur, become worse or better (includes temperature, position, food or lack thereof, and time of day)?
After taking the list of complaints as well as addressing characteristics of the personality, lifestyle, and reactivity to emotional and physical events, the case then is evaluated in its entirety. Frequently, the emerging clinical picture readily corresponds with the toxicological picture of one of the common remedies (in homeopathic parlance they are called "polychrests"). In the example with the homeopathic remedy belladonna provided below, the core symptoms of the patient match exactly symptoms observed during accidental poisonings with and provings of belladonna.
When an easy match does not happen, the homeopath repertorises the case. Symptoms and physical findings graded according to the level of importance and severity are cross-referenced using either print or computerized versions of the repertory. This analysis yields a list of remedies whose toxicological pictures closely correspond to the case presented. A homeopath, using knowledge of homeopathic toxicology and, when necessary, consulting any one of numerous reference sources, then makes a final decision on the remedy to prescribe.
The use of homeopathic preparations for the treatment of fever is illustrative. The homeopathic remedy aconitum is indicated when there is sudden onset of fever or chills followed by fever with tremendous anxiety, agitation, fear, restlessness, thirst, and contracted pupils. On the other hand, a patient who could benefit from the homeopathic remedy belladonna will present with the feeling of dry, burning heat without chills. The face and body will be warm to the touch with icy cold extremities. The person may be somewhat delirious and have photophobia, sometimes with twitching of the face, and/or seizures. In this situation, the pupils are dilated. Certainly, conventional medical evaluation and treatment in this situation would be warranted as well.
Homeopathic Treatment of Acute Diarrhea
Treatment of acute diarrhea is one well-researched area in clinical homeopathy.7-9 Combined analysis of three double-blind placebo-controlled studies9 shows duration of diarrhea to be 3.3 days in patients treated with homeopathy as compared with 4.1 days for those receiving placebo (P = 0.008). The meta-analysis shows a consistent effect-size difference of approximately 0.66 days (P = 0.008).
The response to homeopathic remedies is usually prompt and can be appreciated within 15-60 minutes after the administration of a correctly chosen remedy. Remedies should be used in homeopathic concentration 30C. A dose consists of three pellets administered under the tongue with an inter-dose interval of 15 minutes. The remedy should be discontinued at the sign of at least 50% improvement of the target symptom or after three doses regardless of the effect. Lack of response indicates that the remedy was chosen incorrectly. Although another attempt with a second remedy is acceptable, if the second remedy fails, further attempts at treatment with homeopathic remedies are discouraged.
Homeopathic Remedies for Acute Diarrhea
Important differentiating symptoms for major homeopathic remedies are presented in Table 1.
Podophyllum (May apple) is considered one of the primary choices for the treatment of diarrhea. People who need podophyllum do not show a lot of anxiety; they are simply exhausted from having diarrhea. One well-regarded homeopath writes: "The efficacy of podophyllum in acute diarrhea is so marked that our thoughts turn automatically to this remedy in such a condition, and must be forced by symptoms to look elsewhere."
To make the differentiation between this remedy and Arsenicum album, the rule of thumb is to consider podophyllum first in cases of severe diarrhea, while primarily considering arsenicum in cases of food poisoning. Other remedies are only prescribed when you can see their most prominent symptoms, or if you cannot find clear symptoms consistent with either podophyllum or arsenicum.
Dosage and Administration
Homeopathic remedies can be purchased in health food stores or on-line.
Homeopathic medications have been incorporated into the Food, Drug and Cosmetic Act (FDCA) since its inception in 1938. The Homeopathic Pharmacopoeia of the United States was added to the list of official Compendia at the original writing of the act. Thus, homeopathic products are officially recognized as "drugs" within the meaning of the FDCA, 21 U.S.C. paragraph 321 (g)(1)(A), 351(b), and 352 (e) and (g). Currently, homeopathic remedies are regulated as over-the-counter (OTC) medications and there are more than 2,500 remedies available.
The main producers and suppliers in the United States are 1-800 HOMEOPATHY (MA), Hahnemann Laboratories (CA), Washington Homeopathic Products (WV), and Boiron (France). Main homeopathic remedies are carried by the majority of health food stores, Amazon.com, and many pharmacies.
The core process of production of homeopathic remedies is achieved by serial dilutions with vigorous shaking (succussions, in homeopathic parlance) at each step. The minimum requirement is 10 succussions at each dilution step. A detailed, easy to understand description of this process can be found in readily accessible sources.21,23 Important information about homeopathic concentrations is provided in Table 2.
Homeopathic dilution 12C exceeds Avogadro's number (6.022 x 1023). Dilutions above 12C are traditionally called ultramolecular as they most probably do not contain any detectable amount of the original substance.
There are two basic types of homeopathic dilutions. The first is 1:10 at each step marked with a Latin numeral X (decimal means 10). In some cases you may also see the letter D (for decimal). Another, popular in the United States and many other countries, is dilution 1:100 marked with a Latin numeral C (centecimal means 100), or CK (K stands for Korsakoff, a homeopath who modified the process of dilution). The most frequently employed dilutions in clinical practice are 6C, 12C, 30C, and 200C. According to homeopathic theory and experience, the higher the dilution, the quicker and deeper the action of the remedy. Historically, the most common homeopathic dilution used for acute conditions has been 30C. Most homeopaths find that the effect of remedies in this concentration is very quick. On the other hand, the remedy is highly diluted and will not affect the person negatively if chosen incorrectly.
Homeopathic remedies are labeled similarly to other OTC products. The label contains the Latin name of the substance, its homeopathic concentration, dosing instructions, indications for use, and the expiration date. However, the list of self-limiting conditions allowed to be stated on the labels of OTC products is very limited, leading to frequent inconsistencies between a homeopath's recommendations and the content of the label. For example, a label of Apis mellifica (honey bee) used successfully for bee and other small insect stings accompanied by redness and edema reads "edema of skin," which in some cases could be misleading.
Dosing instructions usually advise taking 3-5 pellets three times a day.
Safety and Quality Control
Homeopathic remedies have been in continuous use since the early 1800s. Throughout the entire period, there have been no reliable reports of poisonings. A thorough literature search using Medline yields no reports of toxicity caused by homeopathic preparations that were correctly used according to the standards of homeopathic practice. There are only two reports of complications due to homeopathic preparations used incorrectly. One of these incidents occurred in India when someone used Arsenicum album in homeopathic concentration 1X.32 This concentration (dilution 1:10) is a material dose, rather than a highly diluted dose of arsenic.
According to the Homeopathic Pharmacopoeia of the United States, Arsenicum album (trioxide of arsenic) must not be used in potencies lower than 4C or 8X, a concentration equal to 10 parts per billion, equivalent to 10 nanograms (10-8 of a gram) per gram of the final product. By way of comparison, public health regulations allow our drinking water to contain 50 parts of arsenic per billion.
The other report comes from Mexico.33 An infant with diaper rash, a mild respiratory infection, and diarrhea was treated with mercurius 6X (dilution 10-6). According to this report, the infant became seriously ill with an exacerbation and spreading of the rash, as well as irritability and protein in the urine. Conventional treatment resolved the issue. Again, the use of such a highly concentrated preparation made from mercury is unusual. By accepted international standards of conventional homeopathic practice mercury should not have been used on a baby in a concentration lower than 6C (10-12 dilution).
Interestingly, there are reports of well-designed animal studies in which homeopathy was shown to prevent and treat both arsenic and mercury toxicity.34,35
It is important to note that frequent repetition of a 30C remedy may cause a homeopathic proving with worsening of the patient's condition, which is why it is strongly advised not to repeat the dose of the remedy more than three times a day. Remedies also should be kept away from children, as pellets are sweet and very attractive to toddlers and older children.
Conclusion
Homeopathic remedies have been safely and effectively used for more than 200 years. The growing popularity of homeopathy mandates access to basic education for conventional physicians about core principles and research data available on this subject. Homeopathy can be used very safely not only as an alternative, but also as an adjunct treatment for many acute and chronic conditions. Developing a better understanding of homeopathy will help physicians establish enhanced rapport with a growing population of patients choosing to employ CAM therapies.
Recommendation
The National Center for Homeopathy offers courses for medical professionals. Physicians deciding to explore homeopathy should study a comprehensive textbook on the subject21,36,37 and can begin using remedies for uncomplicated acute conditions when confident of their ability to identify indications for the remedy.
For treatment of diarrhea, first consider Arsenicum album and podophyllum, the most popular remedies for this condition. Of these, Arsenicum album is a good choice if there is a component of anxiety or emotional reaction, or when food poisoning is suspected. In cases of uncomplicated diarrhea, podophyllum frequently is the better choice.
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