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Complex Homoeopathy

Samuel Hahnemann, a German physician, began to develop the major principles of homoeopathy some 200 years ago, although there is some suggestion that the concept of "like cures like" may well have been an observation made by the father of medicine, Hippocrates. The oft quoted and classical beginning of homoeopathy is Hahnemann's observations in relation to quinine.

About the Author

Dr George Lewith MA, DM, MRCP, MRCGP Hon Clinical Senior Lecturer School of Medicine University of Southampton.

The history of homoeopathy

Samuel Hahnemann, a German physician, began to develop the major principles of homoeopathy some 200 years ago, although there is some suggestion that the concept of "like cures like" may well have been an observation made by the father of medicine, Hippocrates. The oft quoted and classical beginning of homoeopathy is Hahnemann's observations in relation to quinine.

Quinine given on its own appeared to produce symptoms similar to tertian fever; every three days while taking quinine, the individual experienced a pyrexia; similar to that experienced by those suffering from malaria, an endemic disease in both southern and central Europe some 200 years ago. Giving malaria sufferers quinine in low (infinitesimal) doses seemed to have a positive therapeutic effect on the illness.

It was through this observation that two of Hahnemann's major principles of homoeopathic prescribing were established. The first is that a remedy given to a healthy patient "proves". This effectively means that an individual can write down "a remedy picture" while taking it in homoeopathic potency and then recording the symptoms in some detail for the ensuing two or three weeks. Thus, proving a remedy on a number of healthy individuals allowed a remedy picture to be established which could then be matched with a patient's symptoms when they presented with an illness. Hahnemann's second major concept, "like cures like" was then employed to treat the patient by utilising the illness picture that matched the proving.

The political debate

As Hahnemann was establishing the principles of homoeopathic prescribing some 200 years ago, two schools of thought in relation to the manufacture and prescribing of homoeopathic medicine began to emerge. The first was the classical Kentian approach in which only a single remedy was used at any one time. Kent was an American homoeopath and the use of Kent's materia medica revolved solely around the prescription of single remedies, often in very high potencies (that is very dilute remedies) largely prescribed on the basis of the individual's constitutional type. Simultaneously, in both the German and French speaking countries of central Europe, there were those among Hahnemann's disciples who began to use homoeopathic mixtures or complexes to treat illnesses in situations where they were unsure about exactly which remedy would be best, or indeed in situations where perhaps two or more remedies might be indicated based on the provings. Some of Hahnemann's original manuscripts also suggest that the use of mixed homoeopathic remedies was a perfectly valid and frequently clinically indicated mechanism through which to approach illness.

To some extent an artificial division has emerged within the homoeopathic world. Those who appear to support the use of a Kentian approached based exclusively on single remedies and those who prescribe homoeopathic complexes or mixtures of more than two remedies in order to treat a specific problem. In effect, many homoeopaths in both continental Europe and North America will tend to use both singles and complexes depending on the specific indication and presenting symptoms. In England the vast majority of homoeopaths adhere to the Kentian school of prescribing singles, largely directed at the individual's constitutional type. In essence, complex homoeopathy is defined as the use of two or more homoeopathic remedies in a single preparation, frequently with varying potencies.

Homoeopathic prescribing

Homoeopathic prescribing can be divided into three main areas. Remedies are prescribed for acute conditions; 200 years ago most illnesses tended to be acute, frequently involving acute infections. The prescription of homoeopathic remedies in these situations centres around the use of relatively low potencies given frequently, the usual potencies involved those which can be bought in most health food stores such as a C6 dilution. The second major area of homoeopathic prescription involves single remedies prescribed for a particular constitutional type. For instance, dark haired females who frequently suffer from menstrual problems, headaches and are drawn to tears easily will fit the picture of a "Sepia constitution". Therefore the prescription of Sepia can be used to treat the constitution and thereby hopefully improve any illness by dealing with the person's constitutional weaknesses through the use of a high potency remedy given infrequently. In such situations a potency of at least C30 and frequently C200 or 1M may be used. In spite of this a Sepia constitutional type who may develop an acute urinary infection would be given Cantharis in a C6 potency every hour or two in order to deal with the acute illness. It is, however, in the treatment of chronic illness that the third system, the use of complex remedies comes to the fore. Frequently individuals with multiple symptoms will develop complicated and, in homoeopathic terms, frequently confusing remedy pictures. As a consequence the prescription of complexes or mixtures gained many disciples in the early days of homoeopathy and is still practised largely by both French and German homoeopaths.

Modern homoeopathy

As the pattern of illness has changed over the last 2 centuries, many homoeopaths have adapted their prescribing in order to respond to the challenge of chronic illness and pollution that is unfortunately part of our modern western society. The first change is the use of nosodes, an approach unknown and unrecognised in Hahnemann's time. One of the first individuals to utilise nosodes coherently was Dr Edward Bach, who also developed the Bach Flower Remedies. He noted that many individuals with persistent digestive problems appeared to be experiencing low grade chronic infections of the intestine. As a consequence he developed the bowel nosodes which are in themselves complexes. These involve mixtures of bacterial preparations and bowel tissue given in potency in order to treat underlying digestive complaints. Abnormal digestive fermentation, or dysbiosis, has been recognised as the basis of much pathology by naturopaths, homoeopaths and those practicing within the field of nutritional medicine. A modern Western diet, high in refined foods and sugar, has only served to exacerbate this problem and the epidemic of "candida" is just one such example of the problems that may occur when an abnormal fermentation process is present in either the large or small intestine. Complex remedies such as the bowel nosodes can frequently be used to approach these problems as part of an appropriate treatment regime involving diet, and frequently combined with some herbal remedies and nutritional supplements in order to normalise gut fermentation.

Exposure to chemicals, such as pesticides, herbicides and organophosphates can also be treated by the use of appropriate nosodes. These remedies contain homoeopathic doses of toxins which, when given to patients who have been chemically poisoned, appear to trigger an acute reaction which in turn seems to mimic the original poisoning episode. Therefore, by employing the simple principle of "like cures like", chemical mixtures in homoeopathic potency can be given to those suffering from chemical exposure in order to detoxify their tissues and treat their symptoms.

The use of isopathy or homoeopathic immunotherapy (HIT) has received much publicity recently, particularly in relation to David Reilly's work in this field1. It is clear from this work that if an individual is suffering from hay fever, a potency of pollens may prove to be effective in their treatment. If an individual suffers from asthma, triggered possibly by house dust mite, house dust, cat hair, dog hair and feathers, then those who utilise the principles of homoeopathic immunotherapy will frequently prescribe mixtures involving potencies of each of these items. They will therefore be prescribing a complex remedy in order to treat an individual's allergic symptoms. It is interesting to note that this "modern approach to homoeopathy" does not involve a classical symptom picture, but utilises remedies based solely on conventional medical knowledge and the individual's allergic profile.

Many of the complex remedies currently used in Germany have, to some extent, moved away completely from classical homoeopathic prescribing and their indications are based solely on the patient's presenting symptoms and diagnosis. An excellent recent review published in the British Medical Journal by Linde et al2 indicated that there were a large number of clinical trials looking at the use of Hypericum (St John's Wort) in the treatment of depression. Hypericum was frequently used in material amounts as a herbal remedy, and the studies indicated that good arguments are beginning to emerge for the use of Hypericum in mild depressive states. Not only do the preliminary clinical trials suggest quite a defined effect on mood, but they also imply that there are far fewer side effects from the use of Hypericum than there would be from the regular use of conventional anti-depressant remedies.

Hypericum is frequently prescribed as part of a complex remedy. For instance, Neurapas, a product produced by Pascoe, one of the German pharmaceutical houses, contains not only Hypericum but also other remedies such as Passiflora and Valerian. It is registered and licensed in Germany under its trade name, Neuropas (Extr. Herb. Hyperici [aquos. sicc. 6:1] 80.0 mg, Extr. Rad. Valeriannae [spir. sicc. 4:1] 40.0 mg, Extr. Herb. Passiflorae [spir. sicc. 6:1] 40.0 mg, Rhiz. Corydalidis cavae 40.0 mg, Herb. Eschscholtziae californ. 40.0 mg, Cicuta virosa D2 0.1 mg). Neurapas represents a typical example of a modern complex remedy involving mixtures of a variety of homoeopathic products balanced within one product and targeted at a specific symptom. Valerian is prescribed to help the sleep disturbance often associated with depression and the Passiflora to help symptoms of anxiety, again frequently associated with depressive illness. Not only is Neurapas as a complex remedy specifically targeted at depressive illness, but modern homoeopathy is also beginning to establish itself by increasingly exposing its treatments to properly controlled clinical trials. Such studies suggest that Neuropas is at least as good as conventional antidepressants in mild depression, and furthermore appears to cause fewer adverse reactions and seems to be far less addictive than some of the powerful chemical agents used to treat this condition3.

Echinaceae, a well-known immune stimulant, is also a major component of many complex remedies designed to treat viral and bacterial infections. Pascotox contains not only a herbal extract of Echinaceae, but also many accompanying homoeopathic remedies frequently utilised in acute viral and bacterial infections such as Bryonia and Ferrum Phos (Extr. Rad. Echinaceae ang. sicc. 90 mg, Baptisia D4 16 mg, Bryonia D1 16 mg, Eupator. Perfol. D2 16 mg, Arnica D3 16 mg, Ferrum phosphoric D8 16 mg, Thuja D4 16 mg, China D3 16 mg, Lachesis D8 16 mg, Lachesis D 15 16 mg, Cuprum sulfuric D4 16 mg). Again, this remedy has been exposed to appropriate clinical trials and shown to be effective in the treatment of acute viral infections4.

Conclusion

Complex remedies are not new but have their foundations firmly rooted in the origins of homoeopathic prescribing. While in the past there have been many vitriolic battles between those who adhere only to the single homoeopathic approach and those who espoused complexes, the reality is that many modern homoeopaths use combinations of both singles and mixed homoeopathic remedies. These are particularly valuable in the treatment of chronic illness. The use of modern homoeopathic complexes has evolved so that they can be simply and effectively applied in the treatment of common, often chronic, conditions. Their indications, as we have implied with the evidence provided for two such remedies, are much simpler and more direct than the process involved in taking a prolonged classical homoeopathic history. It is quite clear that there is an important place for both homoeopathic complexes and the prescription of classical single remedies in the treatment of a whole variety of different complaints. The detailed prescription will inevitably depend on the patient's presenting symptoms and response to treatment, as well as the homoeopath's experience. It is also apparent that homoeopathy, like any branch of medicine, must continue to develop and evolve, and it is gratifying to see areas that involve complexes, such as homoeopathic immunotherapy, developing into an essential part of homoeopathic prescribing while being firmly grounded in the principles of conventional allergy.

References

1. Reilly D, Taylor M, Beattie G, Campbell J, McSharry C, Aitchinson T et al. Is evidence for homoeopathy reproducible? Lancet, 1994; 2: 881-6.

2. Linde K, Ramirez G, Mulrow CD, Pauls A, Weidenhammer W, Melchart D. St John's Wort for depression - an overview and meta-analysis of randomised clinical trials. BMJ, 1996; 313:253-258.

3. Ditzle K, Gessner B, Schatton WFH, Willems M. Clinical trial on Neurapas versus placebo in patients with mild to moderate depressive symptoms: a placebo- controlled, randomised double-blind study. Complementary Therapies in Medicine, 1994; 2: 5-13.

4. Dorn M, Knick E, Lewith G. Placebo controlled double blind study of Echinaceae Pallidae Radix in upper respiratory tract infections. Complementary Therapies in Medicine (in press)

         

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