Affinity Laboratory




Homeopathy - Real or Imagined?

 

Bizarre chemical discovery gives homeopathic hint

By Andy Coghlan
New Scientist
07  November  01
http://www.newscientist.com/news/news.jsp?id=ns99991532

It is a chance discovery so unexpected it defies belief and threatens to reignite debate about whether there is a scientific basis for thinking homeopathic medicines really work.

A team in South Korea has discovered a whole new dimension to just about the simplest chemical reaction in the book - what happens when you dissolve a substance in water and then add more water.

Conventional wisdom says that the dissolved molecules simply spread further and further apart as a solution is diluted. But two chemists have found that some do the opposite: they clump together, first as clusters of molecules, then as bigger aggregates of those clusters. Far from drifting apart from their neighbours, they got closer together.

The discovery has stunned chemists, and could provide the first scientific insight into how some homeopathic remedies work. Homeopaths repeatedly dilute medications, believing that the higher the dilution, the more potent the remedy becomes.

Some dilute to "infinity" until no molecules of the remedy remain. They believe that water holds a memory, or "imprint" of the active ingredient which is more potent than the ingredient itself. But others use less dilute solutions - often diluting a remedy six-fold. The Korean findings might at last go some way to reconciling the potency of these less dilute solutions with orthodox science.

Completely counterintuitive

German chemist Kurt Geckeler and his colleague Shashadhar Samal stumbled on the effect while investigating fullerenes at their lab in the Kwangju Institute of Science and Technology in South Korea. They found that the football-shaped buckyball molecules kept forming untidy aggregates in solution, and Geckler asked Samal to look for ways to control how these clumps formed.

What he discovered was a phenomenon new to chemistry. "When he diluted the solution, the size of the fullerene particles increased," says Geckeler. "It was completely counterintuitive," he says.

Further work showed it was no fluke. To make the otherwise insoluble buckyball dissolve in water, the chemists had mixed it with a circular sugar-like molecule called a cyclodextrin. When they did the same experiments with just cyclodextrin molecules, they found they behaved the same way. So did the organic molecule sodium guanosine monophosphate, DNA and plain old sodium chloride.

Dilution typically made the molecules cluster into aggregates five to 10 times as big as those in the original solutions. The growth was not linear, and it depended on the concentration of the original.

"The history of the solution is important. The more dilute it starts, the larger the aggregates," says Geckeler. Also, it only worked in polar solvents like water, in which one end of the molecule has a pronounced positive charge while the other end is negative.

Biologically active

But the finding may provide a mechanism for how some homeopathic medicines work - something that has defied scientific explanation till now. Diluting a remedy may increase the size of the particles to the point when they become biologically active.

It also echoes the controversial claims of French immunologist Jacques Benveniste. In 1988, Benveniste claimed in a Nature paper that a solution that had once contained antibodies still activated human white blood cells. Benveniste claimed the solution still worked because it contained ghostly "imprints" in the water structure where the antibodies had been.

Other researchers failed to reproduce Benveniste's experiments, but homeopaths still believe he may have been onto something. Benveniste himself does not think the new findings explain his results because the solutions were not dilute enough. "This [phenomenon] cannot apply to high dilution," he says.

Fred Pearce of University College London, who tried to repeat Benveniste's experiments, agrees. But it could offer some clues as to why other less dilute homeopathic remedies work, he says. Large clusters and aggregates might interact more easily with biological tissue.

Double-check

Chemist Jan Enberts of the University of Groningen in the Netherlands is more cautious. "It's still a totally open question," he says. "To say the phenomenon has biological significance is pure speculation." But he has no doubt Samal and Geckeler have discovered something new. "It's surprising and worrying," he says.

The two chemists were at pains to double-check their astonishing results. Initially they had used the scattering of a laser to reveal the size and distribution of the dissolved particles. To check, they used a scanning electron microscope to photograph films of the solutions spread over slides. This, too, showed that dissolved substances cluster together as dilution increased.

"It doesn't prove homeopathy, but it's congruent with what we think and is very encouraging," says Peter Fisher, director of medical research at the Royal London Homeopathic Hospital.

"The whole idea of high-dilution homeopathy hangs on the idea that water has properties which are not understood," he says. "The fact that the new effect happens with a variety of substances suggests it's the solvent that's responsible. It's in line with what many homeopaths say, that you can only make homeopathic medicines in polar solvents."

Geckeler and Samal are now anxious that other researchers follow up their work. "We want people to repeat it," says Geckeler. "If it's confirmed it will be groundbreaking".

Journal reference: Chemical Communications (2001, p 2224)

Correspondence about this story should be directed to latestnews@newscientist.com.

An Introduction to Homeopathy

June E. Riedlinger, R.Ph., Pharm.D.
Assistant Professor of Clinical Pharmacy,
Massachusetts College of Pharmacy
and Health Sciences, Boston, MA

US Pharmacist, Vol. 25:3 Issue date: March 2000

http://www.uspharmacist.com/NewLook/DisplayArticle.cfm?item_num=484

Part one of this two-part series discusses the inception, philosophy, and some common terms and accreditations used in homeopathy

Homeopathy has been cited by the World Health Organization as one of the systems of traditional medicine that should be integrated with conventional medicine to ensure adequate global healthcare.1 Eisenberg et al.’s national follow-up survey from 1990 to 1997 found that the use of homeopathy increased significantly in the general population (0.7% to 3.4%; p � 0.001).2 With more patients looking for alternatives to conventional therapies, homeopathy is likely to get more public attention. The pharmacist may be called upon to assess a homeopathic product. Homeopathy is a complicated system, wrought with controversy.3,4 In order to better address these controversies, the reader must have an adequate understanding of the principles, philosophies and practice of homeopathy.

Historical Perspective

Samuel Hahnemann developed the therapeutic approach of homeopathy more than 200 years ago. In 1779, Hahnemann was awarded his doctorate in medicine from the University of Erlangen. He practiced medicine for five years. He found that therapies he had been taught to use—such as bloodletting, cathartics, leeches, and the use of toxic chemicals—were too harsh and did more harm than good. He coined the term allopathy from the Greek word “allo,” meaning “other than” and “pathy,” meaning “disease,” to describe the suppressive effects of the medicines of his day. Discouraged by the practice of medicine at the time, Hahnemann made his living translating medical tests instead of practicing conventional medicine. He was also able to continue his own experiments with medicinal substances and continued to develop other innovative methods to treat his patients.

While translating an edition of Dr. William Cullen’s Materia Medica, he read a 20-page dissertation describing the use of cinchona bark to treat malaria, attributing its effectiveness to its bitter principles. Hahnemann did not think this was a reasonable explanation for the bark’s success in alleviating symptoms of malaria, since other herbs with bitter principles were not effective anti-malarial agents. He decided to search for a more reasonable explanation for the fundamental principle underlying the therapeutics of cinchona bark (also called China). He began with self-experimentation and discovered that, after taking “twice a day, four drachms of good China,” he experienced the symptoms of malaria.5 Once more, being in good health before each China challenge, he returned to good health after a period of time, when ingestion was discontinued. His experience with cinchona led him to the Hippocratic principle, “similia similibus curantur” or, “Like are cured by likes.” Some examples of Hippocrates’ principle are aspirin, which lowers fever but causes fever in toxic doses; digoxin, used to treat cardiac arrhythmias but causes arrhythmias in toxic doses; and nitroglycerin, treats angina but causes angina in toxic doses.

By expanding on this principle, Hahnemann developed one of the most important dogmas of homeopathy—the Law of Similars. Simply stated, distinct alterations (symptoms) that occur in the healthy individual when he or she is given a substance in toxicological amounts reveal the substance’s picture of illness (POI) and, thereby, its curative power. The cure is demonstrated when the patient’s symptoms disappear following a minimal dose of the substance that has a toxicology profile matching the symptoms the patient displays.

Hahnemann developed a system for documenting and cataloging the toxicological profile or POI of substances from reports in the medical, chemical and toxicology literature. He also developed strict protocols for controlled trials, or provings, to discover and document the POI of a substance. The collective results of these endeavors, produced by Hahnemann and other homeopathic physicians, are published in homeopathic Materia Medicas6,7 and Repertories8,9 which are the cornerstones of any good homeopathic practice. The Materia Medica (MM) describes the POI “proven” for each substance in monograph format. The substance’s official homeopathic or remedy name is listed along with the common and usually Latin name(s) of the substance. The symptomatic information described in the MM is organized into categories representing anatomical areas, physiological processes (e.g., fever, sleep, perspiration), gender and modalities (that which makes symptoms better or worse), and compatibility with other remedies.

The information in the Repertory is cataloged in chapters that coincide with the category system used in the MM described above. In each chapter symptoms are listed alphabetically. The name of each remedy associated with therapeutic effects for a symptom follow the symptom. The unit of the symptom and its therapeutic remedies is referred to as a rubric. The Repertory can be used to find remedies that match all of the patient’s symptomatology and the Materia Medica to determine how close a patient’s POI coincides with a given remedy’s POI profile.

The practice of homeopathy as taught by Hahnemann included adhering to a lifestyle of moderation and emphasized the importance of mental and spiritual health.

Hahnemann knew that any given substance’s healing potential was dependent not only on correctly matching the POI of a substance with that of the patient, but also on the amount of substance used. Too much, and toxic symptoms occurred; too little, and healing effects were lost. Therefore, he developed the method of attenuation which he believed produced remedies that were safe and effective. The process of attenuation, or potentization, involves the serial, or repetitive, dilution of a substance with shaking and impact (succussion), which is performed between each dilutional step. Hahnemann discovered that by increasing the number of dilution/succussion steps in the production of a homeopathic remedy, the strength of the substance’s healing capacity increased without eliciting the usual toxic side effects. The theory he proposed to explain the paradoxical increase in healing strength of a substance as it was made more dilute was that the vigorous shaking with impact or succussion of the substance in solution released into the solution or diluent an energy imprint or resonance of the original substance. This energy imprint then stimulates the healing force within the body to re-establish normal psychological and physiological function. In the case of insoluble substances, the initial attenuations are triturated in the potentization process.

The practice of homeopathy as taught by Hahnemann included adhering to a lifestyle of moderation and emphasized the importance of mental and spiritual health. The Organon of the Art of Healing, first published in 1810, was followed by five editions (last edition written just before his death in 1843), and contains Hahnemann’s theories regarding illness and the healing process, principles of practice, therapeutics, and preparation of homeopathic medicine.10

Current Regulation and Manufacturing of Homeopathic Products in the U.S.

Although homeopathy is considered an alternative/complementary therapy, homeopathic remedies are not regulated under the Dietary Supplement Health and Education Act (DSHEA), even if they are derived from herbal or mineral substances. The sale and manufacture of homeopathic products are regulated by the Food and Drug Administration (FDA) under the Federal Food, Drug and Cosmetic Act of 1938 (FFDCA). Their status as drugs is described in FFDCA, 21 U.S.C. §§ 321 (g) (1)(A), 351(b), 352 (e) and (g). Because the manufacture of homeopathic products differs so greatly from that of conventional medicines, the FDA developed the Compliance Policy Guide (CPG) in May of 1988 to regulate the marketing of homeopathic drugs. The FDA’s present policy does not require homeopathic medicines to go through the New Drug Application process, nor can most individual remedies be patented, since they are primarily derived from natural substances.

Homeopathic medicines have official compendial status in the U.S. The Homeopathic Pharmacopoeia of the U.S./Revision Service (HPRS) is recognized as the official compendium of homeopathy. This updated HPRS is published by the Homeopathic Pharmacopoeia Convention of the U.S. (HPCUS), which is comprised of physicians, pharmacists, homeopaths, lawyers, biochemists, and botanists.11 The resource contains over 1,300 monographs on homeopathic ingredients that have been determined safe and effective by the HPCUS. HPRS’s monographs provide information pertaining to a remedy’s nomenclature, origin, chemical or botanical description and classification, preparation requirements, and dilutional requirements for nonprescription and prescription status. Quality control tests are being added to the monographs as part of the ongoing revision process.

Homeopathic products come in many different dosage forms, strengths or potencies, and in various combinations. Unlike conventional drugs and supplements, whose strengths are commonly designated in microgram to gram unit; the potency of homeopathic remedies is based on the attenuation process of the remedy. The potency of a remedy is designated by at least one capital letter, representing the dilutional scale used, preceded by a number that represents the number of dilution/succession steps performed in making the product. The capital H (Hahnemannian method) or K (Korsakovian method) is used to indicate which of two different production techniques was used to manufacture a product. The Hahnemann method uses a different container for every dilution step, while the Korsakov method employs the same flask for all the dilutional steps and commonly involves potencies of 200C or greater.

 

Selected Titles awarded by certification organizations (u.s.)

For MDs and DOs
The American Board of Homeotherapeutics12 awards the Diplomate in Homeotherapeutics, DHt; Arizona Board of Homeopathic Medical Examiners13 awards the Homeopathic Medical Doctor, MD(H), title to MDs and the Homeopathic Doctor of Osteopathy DO, MD(H) title to ODs; Nevada State Board of Homeopathic Medical Examiners14 awards Homeopathic Medical Doctor (HMD) title.

For naturopathic physicians, NDs
The Homeopathic Academy of Naturopathic Physicians15 awards the title of Diplomate of the Homeopathic Academy of Naturopathic Physicians, DHANP.
For one able to demonstrate competency in homeopathic practice
The Council for Homeopathic Certification16 awards the title of Certified in Classical Homeopathy, CCH; and the National Board of Homeopathic Examiners17 awards the title of Diplomate of the National Board of Homeopathic Examiners, DNBHE.


There are many other title designations for homeopathic practitioners, including titles from other countries (e.g., England and India). They are listed in the directory published by the National Center for Homeopathy (NCH) in Alexandria, VA.18

 

The practicing retail, community or hospital pharmacist in America today is most likely to encounter remedies in potencies of X or D and C in their practices. The decimal potency scale X or (D in Europe) represents products made by serial dilutions of 1:10; for the centesimal scale (C), serial dilutions of 1:100 are used. The remedy’s potency increases as the dilutional scale and number of dilutions/succussion steps increase. For example, 12C would be slightly more potent than 12X, and 12X would be more potent than 6X. Remedies lower or equal to 12C are considered low potency and potencies greater than or equal to 200C are considered high potency.

Homeopathic dosage forms on the market today include creams, ointments, lotions, tinctures, globules or pellets, tablets, capsules, lozenges, gum, syrups, nasal sprays, eye drops, suppositories and injectables. The pharmacist in the retail setting will most often be encountering a combination homeopathic product. The combination products are typically tablets that contain 4–5 remedies in potencies ranging between 3X and 30C. They are generally formulated for the treatment of self-limiting conditions recognizable by consumers, e.g., cold, flu, headache, fatigue, and nausea. Single remedies are typically globules or pellets.

According to Good Manufacturing Practices standards as discussed above, package labeling requirements for homeopathic products include the name and place of business of the manufacturer; the ingredients, listed by their compendial name; the potencies, or strengths, of all active ingredients; adequate directions for use; and indications. Prescription homeopathic products must have “Rx only” printed on their labels, and expiration dates are not required, but many manufacturers include one on the label. The pharmacist should be aware that the indications for combination products are specific to a self-limiting condition and are intended for use by consumers. On the other hand, single remedies are best used when therapy has been individualized for a particular patient. Usually only one or two of a single remedy’s many indications are listed on the product label. Therefore, these listed indications should not be used as a sole reference, and a Materia Medica should be checked to make sure the patient’s POI matches the remedy’s.

Certification and Training

A diploma or certificate from any homeopathic school or program by itself is not recognized as a license to practice homeopathy in the U.S. However, healthcare professionals—including medical doctors (MDs) and osteopathic doctors (DOs), nurse practitioners, physician assistants, dentists, pharmacists, veterinarians, chiropractors, licensed acupuncturists, nurse midwives and podiatrists who are allowed to diagnose and treat illness—are permitted to use homeopathy within the scope of their licenses, depending on the laws of the state in which they practice. Therefore, recommending homeopathic OTC products certainly falls under a pharmacist’s scope of practice, and it may be argued that pharmacists are obligated to apply the pharmaceutical care process to include homeopathic medicines.

Several states (AK, AZ, CT, FL, HI, ME, MT, NH, OR, UT, WA) and Washington, DC, license naturopathic physicians who receive formal course work in homeopathy as part of their academic training. In the U.S., only three states actually have homeopathic licensing laws: Arizona, Connecticut, and Nevada. There are many training programs in the U.S. and abroad that prepare the homeopathically trained clinician for certification of competency in the practice of homeopathy. Each has its own set of standards, which typically includes completion of a minimum number of hours of training and passing an examination. The Council on Homeopathic Education (CHE),10 formed in 1982, monitors and approves the quality of courses offered for licensed professionals and oversees the programs offered by those organizations listed above. In 1997 over 20 training programs and five naturopathic medical schools offered homeopathic educational opportunities for interested practitioners.12 These organizations offer detailed information on the requirements for certification and training programs.

The basic tools of the homeopath are the Materia Medica and Repertory. There are many versions and editions of these reference books. There are also computer databases that contain materia medicas and repertories with the capability to repertorize or analyze patient information (rubrics) to find the right remedy. The Homeopathic Educational Resource Center20 is an excellent source of homeopathic references and resources.

For basic principles, philosophies and practice of homeopathy, George Vitthoulkas’ text, The Science of Homeopathy5 provides a good solid overview. Another good reference for both conventional medical practitioners and consumers is Ullman’s The Consumer’s Guide to Homeopathy,21 which serves as a resource for understanding homeopathic medicine and its application. Many of the older texts in homeopathy are written using medical terminology of Hahnemann’s times; thus, a good homeopathic dictionary is essential to interpret the language used. Jay Yasgur’s Homeopathic Dictionary and Holistic Health Reference,22 is an excellent resource for homeopathic terminology.

The homeopathic profession has its own journals, which publish information pertaining to homeopathic philosophy, therapeutics, research, and educational opportunities. The homeopathically untrained reader will find much of the material contained in these journals a challenge to interpret, as they are written for the most part in homeopathic language. Nonetheless, the pharmacist should be able to incorporate materials from these resources. Journals that can be obtained easily in the U.S. are: Homeopathy Today, Journal of the National Center for Homeopathy;18 Simillimum, Journal of the Homeopathic Academy of Naturopathic Physicians;15 The American Homeopath, Journal of the North American Society of Homeopaths;23 and The New England Journal of Homeopathy, Journal of the Foundation for Homeopathic Education, New England School of Homeopathy.24

 

An Introduction to Homeopathy—Part 2

Begabati Lennihan, R.N.
Renaissance Institute of Classical Homeopathy
Cambridge, MA

June Riedlinger, R.Ph., Pharm.D.
Assistant Professor of Clinical Pharmacy
Massachusetts College of Pharmacy and Health Sciences
Boston, MA

US Pharmacist, Vol. 25:6 Issue date: June 2000

Homeopathy is a system of medicine developed in Germany 200 years ago, as described in Part 1 (March edition). While the high dilutions involved in making the remedies strain the bounds of credibility, and while homeopaths have yet to provide a satisfactory mechanism of action for their therapeutic effects, homeopathy's worldwide success rests on its great strengths: its reputation for a high level of efficacy, its cost-effectiveness, and its safety.1 Side effects, drug interactions, tolerance, and addiction are unknown among users of homeopathic medicines. The remedies, however, can occasionally cause a reaction called an aggravation, usually mild and transient, that is described later in this article.

At the heart of homeopathy is the concept of individualization­that two patients with the same complaint may need very different remedies.

As described in Part 1, homeopathic remedies are so highly diluted in the process of manufacture that few if any molecules of the original substance remain in the final product. Centesimal potencies, a common OTC potency, are diluted serially in a 1:100 ratio. It is easy to see that the successive dilutions quickly add up to the point that not a single molecule of the remedy substance remains. Avogadro's number (6.023 x 1023) defines the number of molecules in a mole. A homeopathic remedy diluted to a final concentration of 10-24 would have less than one molecule of the remedy substance per mole. This would be equivalent to a 24X (representing 24 successive dilutions of the 1:10 ratio used to make an X or decimal potency) or a 12C (representing 12 successive dilutions of 1:100 used to make a C or centesimal potency).2 12C is a relatively low potency in homeopathy; 15C and 30C are common OTC potencies. These latter potencies are more dilute than Avogadro's number by a factor of trillions.

It seems obvious on the face of it that homeopathic remedies cannot possibly work if they do not contain even a single molecule of the original remedy substance. The fact that they do reflects the visionary genius of Samuel Hahnemann, the founder of homeopathy, who anticipated by a century Einstein's discovery that matter is ultimately energy. Hahnemann, one of the master pharmacists of his era, experimented for decades to discover an effective method of making medicines safer than the blood-letting, vomiting and harsh laxatives of his era. He discovered the secret in what he called "succussions"--for not only were the remedy substances diluted at each step in the manufacturing process, they were also succussed (shaken with impact). In his early 19th century language, Hahnemann said that this shaking process released the "dynamic energy" of the remedy substance.3 The dilution process ensured that no material substance of the remedy remained, hence preventing side effects and adverse reactions. The succussions added energy to the system and somehow seemed to store the information from the remedy substance in much the same way that a computer chip or cassette tape stores information.

Although Hahnemann and many succeeding generations of homeopaths were unable to explain how the substrate could store information about the remedy substance, recent advances in physics have brought homeopaths closer to a mechanism of action for the remedies. Water molecules stimulated by a "seed substance" such as sodium chloride (Natrum muriaticum or Nat. mur. in homeopathic terminology) and shaken with impact or succussed form lattice-like structures similar to ice crystals but existing in liquid water and in above-zero temperatures. Different seed substances form different crystalline structures, predictably and reproducibly. Apparently the succussions add kinetic energy to the system and this energy is stored in the form of a higher degree of organization, or--to put it another way--as information about the remedy substance. Recent advances in physics supporting this concept of the "memory of water"--including electromagnetic wave theory, chaos and fractal theory--are beyond the scope of this article and are well documented elsewhere.4

Not only does each "seed substance" or remedy material form a distinctive pattern in the substrate, it also conveys a unique pattern of information to the body's healing energy. Each homeopathic remedy is known to be associated with a cluster of physical, mental, emotional and behavioral symptoms--ones which have been cured by the remedy in the past, and for which the remedy can be prescribed. Sometimes these symptoms seem unrelated, while in other instances they cluster around a particular theme. For example Natrum muriaticum, (the homeopathic remedy prepared from sodium chloride) is associated with a craving for salt and a tendency to retain water on the physical level (not surprisingly, considering the effects of salt on water retention); with a tendency to retain memories and to dwell over past events on the mental level; with feelings of unresolved long-distant grief and unshed tears (like the retained water) on the emotional level; and with a tendency to distance oneself, as a way of protecting against further hurt, on a behavioral level. For Hahnemann discovered that releasing the "dynamic energy" of the substance through the process of "potentization" (dilution and succussion) brought out subtle curative aspects of a substance which, like sodium chloride, had no such mental or emotional effects in material doses (i.e. when physical substance is present).

The issue of placebo effects is bound to arise considering the lack of molecules in the diluted remedies. Evidence of homeopathy's effectiveness in treating infants and animals indicates that the remedies have efficacy beyond the placebo effect.6 Further, a recent meta-analysis of controlled trials in humans suggests that they "do not support the hypothesis that all clinical effects of homoeopathic interventions can be attributed to placebo."5 The issue is a complicated one with many aspects to consider for conventional as well as alternative medicine.6

Dosage Forms

Most homeopathic remedies in the U.S. are sold in the form of lactose globules (pellets) and tablets, with a few being available in liquid form in a water/alcohol base. In Europe, remedies are commonly available in liquid form, and pharmacists with a cosmopolitan clientele may receive requests for remedies in liquid forms, but they are unavailable in this country except for a few proprietary formulas. Almost all homeopathic remedies are more effective when taken internally. A few remedies (notably Calendula, Hypericum, and Arnica) which address skin conditions are also available in lotions, sprays, ointments and gels. Calendula lotion, for example, which stimulates healing, can be applied to a cut, abrasion or diaper rash, while Arnica ointment for pain and swelling can be rubbed into a bruise, pulled muscle or sprained ankle, but should never be applied to broken skin.7

Typical OTC potencies are 6C, 12C, 15C and 30C. Some stores sell 6X, 12X, 15X and 30X; these are slightly less potent than the corresponding centesimal potencies. These potencies are safe for OTC use even among clients unfamiliar with homeopathy. Higher potencies such as 200C or 1M (i.e. 1000C) are occasionally available in retail stores but are not advisable for OTC sale because they can cause aggravations if not used properly. They would be appropriate to stock in an area where patients come in seeking them based on the recommendation of a professional homeopath. They should be kept behind the counter and dispensed only when requested. In other words, pharmacists should treat potencies higher than 30C as prescription items even though legally they have OTC status. The LM potency is rarely stocked in a retail store, although the pharmacist may occasionally have customers asking for it. LMs are based on a much higher dilution ratio (1:50,000, hence the Roman numerals for 50 and for 1000) and need to be prepared using a special process.

While there are many disagreements among homeopaths about potency, certain basic guidelines are fairly universal. Higher numbers represent higher potencies; although these remedies are more dilute, they are stronger energetically because of the greater number of succussions. In general, those who are already familiar with homeopathy and its principles of remedy action can safely use higher potencies such as 200C. Lower potencies like 12X, 12C, 15X and 15C are more appropriate for neophytes, with the proviso that if the remedy does not seem to be working, a higher potency can be tried. 30C is safe to stock as an OTC potency for all but the most sensitive clients; however, if asked, a pharmacist should advise a neophyte to use a potency below 30C. Each person responds well to a certain range of potencies, depending on her/his sensitivity level; once a client has established what potency s/he responds to for acute situations, s/he can safely use the same potency in future acute situations.

 
Serial dilutions of 1:10 (designated by X) and 1:100 (designated by C) along with subsequent succussions add energy to the homeopathic system.

The potency needed is also determined by how acute the condition is; for example, a sudden high fever will require a higher potency than mild and occasional cough lingering for several weeks after flu. Potency and dosage do not at all depend on body weight; in fact, they depend on the client's energetic strength. Thus an active and vigorous child is likely to benefit from a higher potency than the average sedentary adult, who in turn will benefit from a higher potency than a debilitated elder, even if the latter is obese.

  Single and Combination Remedies

Stocking single remedies in a 12C and 30C potency will certainly cover most conditions suitable for individualized self-medication, in areas where a highly educated clientele requests them. However, combination remedies are recommended for most pharmacies because they are much easier to self-prescribe. These products combine several individual remedies indicated for a particular condition like colds, sore throats, or PMS. For each condition there are many possible remedies, and a professional homeopath would individualize the remedy to the client, recommending the particular remedy which matches the client not only in the chief complaint but in a wide range of factors including etiology, the client's emotional makeup, and behavioral changes since the onset of illness. For example, two toddlers with ear infections may have similar symptoms but one may be weepy and clingy, wanting to sit in her mother's lap for kisses, hugs and consolation, while the other may be cranky and irritable, demanding toys or food and then throwing the requested object on the floor, to the mother's despair. The first child would be given Pulsatilla, the latter Chamomilla, as explained in the section on case-taking and repertorization.

Ideally, according to the laws and principles of classical homeopathy, a client is given only one remedy, the single remedy that matches her overall mental, emotional, behavioral and physical symptoms the best. Since most Americans do not have an ongoing relationship with a professional homeopath who can prescribe for acute illnesses, combination remedies seem to be a good compromise. The concept is to combine the most common remedies prescribed for a particular condition, and label it as such (Cycl-Ease for PMS or Pollinosan for hay fever) which is permissible under FDA regulations. Then the consumer who is unfamiliar with homeopathy has a reasonable likelihood of consuming the correct remedy among all the remedies included in the formula.

Professional homeopaths object to combination remedies, on the basis that taking many remedies at once blurs the information being conveyed and confuses the body's healing energy. As discussed earlier, the remedies function on an energetic and informational plane rather than on a physical, biochemical plane. Taking 10 remedies at once has been compared to having 10 sopranos in a small room, each singing her favorite aria; the effect of each is blurred by the vibration of the others.

Homeopathy seeks to cure not an illness but a patient with an illness... what sounds like a verbal quibble actually represents a fundamentally different approach to healing.

On a practical level, however, the great majority of homeopathic remedies sold in this country are combination remedies. They are easily accessible to the public, since their labels clearly indicate their purpose. Repeat sales and anecdotal reports as well as a few studies indicate their effectiveness. Combination remedies are the first introduction to homeopathy for most people, even those who later consult a professional homeopath or learn to prescribe single remedies for themselves.

As customers become more educated in homeopathy, pharmacists can expect to see an increasing demand for the single remedies like Natrum muriaticum, Pulsatilla and Chamomilla discussed in this article. Customers who take the time to educate themselves in the use of these single remedies report greater benefits in terms of overall mental, emotional and behavioral improvement than with the combination remedies.

Case-taking and Repertorization

At the heart of the homeopathic paradigm is the concept of individualization--the idea that two patients with the same chief complaint may need very different remedies depending on factors ranging from their emotional state and the reason they became ill to the minutiae of what makes them feel better or worse (hot or cold applications, moving around or lying still, etc.) In addressing a patient with a chronic condition, the professional homeopath usually spends an hour or more asking questions on a wide variety of topics, including emotional traumas, childhood memories, dreams, fears, food preferences, and patterns of waking and sleeping as well as obvious topics like past medical history and current diagnosis.

Homeopathy seeks to cure not an illness but a patient with an illness; what sounds like a verbal quibble actually represents a fundamentally different approach to healing. While conventional medicine addresses symptoms such as a fever and tries to remove these symptoms with a medication (in this case, an antipyretic), homeopathy sees symptoms as the body's healthy attempts to restore balance to a system which has been unbalanced on a deeper level. Homeopaths believe that by removing a particular symptom, conventional medicine pulls the rug out from under the body's attempts to restore balance and thereby in the long run contributes to a further unbalancing. Homeopaths often see chronic disease arising in response to a trauma such as a loss or grief (heartbreak, death of a loved one, even a significant loss in career advancement, finances or sports) or an experience of abuse or humiliation. Of course the trauma can also occur on the physical level via a car accident, for example.

In any case, the body's healing energy attempts to restore order by throwing the disorder to the surface, from the emotional level to the physical level (in physical symptoms), from the deeper physical level (internal organs) to the superficial (skin). While it is impossible to prove this theory, it certainly is borne out in clinical practice: homeopaths often treat patients for anxiety or depression, for example, and find that the patients break out in a rash at the same time as the emotional suffering is lifted; if the patients suppress the rash with cortisone cream, the psychological symptoms return in step with the disappearance of the rash.8

Thus the homeopath must consider the whole person in determining the correct homeopathic remedy for a particular patient. The homeopath must deeply understand the answers to three questions: who is this person? What trauma is s/he suffering from? How is the body choosing to express this imbalance (through what symptoms, tissues or organ systems)? The answer to each question will lead the homeopath to a certain group of remedies; in the intersection of the three sets is likely to lie the unique remedy, which will permanently cure the patient.

One of homeopathy's most fundamental reference books, the Repertory, provides an organized system for compiling this information.19,10 Once the homeopath has interviewed the patient, s/he selects a few of the most significant, unusual and/or outstanding elements of the case to look up in the Repertory. Information in the Repertory is listed in the form of rubrics (short descriptive phrases) followed by remedies that are known to create these symptoms in provings (described in Part 1) or to cure them clinically. The homeopath then sees which remedy or remedies appear in most or all of these rubrics. She then reads about the most frequently-appearing remedies in the Materia Medica, where a full-length description of each remedy picture is available, to see which one best matches the client.11,12 A highly simplified example follows, in the case of a child with an ear infection with a yellowish discharge, accompanied by a high fever yet a surprising lack of thirst.

Ear, inflammation, media: Calcarea, Chamomilla, Lycopodium, Mercury, Pulsatilla, Silica, Sulphur.

Ear, discharges, yellow: Kali bromatum, Kali sulphuricum, Pulsatilla.

Fever, intense heat: Aconite, Arnica, Arsenicum, Belladonna, Gelsemium, Pulsatilla, Rhus tox.

Stomach, thirstless: Apis, China, Gelsemium, Helleboris, Phosphoric acid, Pulsatilla.

In this simplified case, Pulsatilla is likely to be the correct remedy, since it is the only one that appears in all four rubrics. In real life the choice is rarely so easy, and usually the homeopath would read about the top remedies to see which one fits the child: is she clinging to her mother and wanting hugs and kisses (Pulsatilla) or timid and shy, overly focused on details, and complaining about drafts (Silica) or so tired she can hardly keep her eyes open (Gelsemium)? The correct remedy can possibly alleviate the need for antibiotics as well as strengthening the child on an emotional and energetic level. Further, it can help to prevent recurrence of the ear infections in a way that antibiotics cannot.13

  Patient Counseling

Typical questions from clients include "How do I take a homeopathic remedy?" "Will it interact with my medication?" and "Is there a remedy for my condition?" Most homeopathic pharmacies recommend dissolving several pellets in the mouth, making sure that the mouth does not have strong odors or flavors in it. (For example, mint toothpaste or mouthwash may interfere with the remedies, especially if the flavor is currently in the patient's mouth.) Some professional homeopaths recommend avoiding coffee and aromatic substances like mint or camphor during the days or weeks the patient is under homeopathic care. However, these substances are more of a concern in chronic conditions being treated professionally, in which the patient may be given a single dose of a remedy whose action is intended to last for several weeks or months. It is less of a concern in acute, short-lived conditions, in which the patient takes repeated doses throughout the day. Two important points to emphasize to patients are that the mouth should be clean and free of odors; and that if a remedy seems not to be working, the patient can experiment with abstaining from coffee and aromatics. Also, patients should be instructed not to let their remedies go through the metal detector in airports since the remedies may be inactivated by radiation.

Internet Sites for Homeopathic Resources
NAME WEB SITE

Council on Homeopathic Education

http://www.chedu.org
Homeopathic Educational Services http://www.homeopathic.com
National Center for Homeopathy http://www.homeopathic.org
New England School of Homeopathy http://nesh.com

The Homeopathic Academy of Naturopathic Physicians

http://www.healthy.net/HANP
Source: reference 1

Dosage recommendations for acute conditions vary; most homeopaths and homeopathic pharmacies recommend taking several doses per day of a 12C to 30C remedy. A stronger acute condition (like a sudden high fever) is likely to need more frequent repetitions than a mild, subacute condition. As the patient feels better, he or she repeats the remedy less frequently. An essential point of patient education is that the remedy should be stopped as soon as the condition is completely relieved. Homeopathic remedies are unlike some conventional pharmaceuticals, which must be continued for the duration of the prescription despite the cessation of symptoms. If remedies are continued too long, the body's healing energy can no longer use them. A surplus can build up, causing a homeopathic aggravation.

The concept of an aggravation is another important aspect of patient education, since it represents an aspect of remedy action very different from that of conventional pharmaceuticals. If a remedy is too strong or repeated too frequently, it can cause a brief and temporary intensification of the patient's symptoms. This means that the remedy is working in the right direction, but pushing the patient too vigorously towards healing. Usually when the aggravation wears off the patient feels better than before taking the remedy; sometimes the condition is completely resolved. An aggravation is extremely unlikely with typical OTC potencies; however, a pharmacist may encounter a question about an aggravation from a high potency remedy given by a professional homeopath. In such a case--and in the unusual situation that the aggravation is unpleasant and long lasting--the patient can deliberately antidote with caffeinated coffee or aromatic substances.

Remedies do not have side effects such as the drowsiness typical with antihistamines. However, a patient may feel sleepy immediately after taking any remedy. This is a good sign and indicates that the body's energy is being directed towards healing. The patient should be counseled to take the needed time to sleep and to heal. This effect is temporary as well as short-lasting, usually occurring only after the first few doses, if at all.

One of the fundamental principles of homeopathy--and one shared with traditional Chinese medicine--is that healing occurs from the inside out; so, when treating a lung or colon condition the healing process can drive the illness out via the skin, in the form of a rash or eruption. If a patient is being treated homeopathically for a chronic condition and develops a skin condition as a result, s/he should be counseled not to treat the skin condition with suppressive measures such as cortisone ointment. This will only drive the condition back into the deeper organs and bring back the original symptoms. Other, non-suppressive measures can be used to relieve any itching or discomfort, including aloe vera gel (which is especially soothing when chilled), homeopathic calendula cream, or an oatmeal bath (made by powdering a cup of oats in the blender and adding to a hot bath).

Other cleansing reactions, which represent the body's attempt to drive an illness to the exterior, can include a vaginal discharge when a uterine or ovarian condition is being treated; phlegm coming up from the lungs in a chronic pulmonary condition; and mucus draining from the sinuses in a patient with chronically blocked sinuses. These discharges should not be blocked with suppressive treatments but rather cleansed, if necessary, with a simple saline rinse or chest PT. Homeopathic remedies do not interact with prescription medications, since they operate on a different level. They are completely safe to take as an adjunct to conventional therapy. However, pharmacists should be aware of anecdotal reports that as a homeopathic remedy begins to work for a condition, the dose of the pharmaceutical medication may need to be reduced, to prevent the patient from developing symptoms of overdose. The pharmacist should always consider the possibility that a patient with a chronic illness may be employing homeopathy or another complementary modality, which may require dosing adjustments of the prescription medications being taken.

Conditions for which homeopathic self-treatment can be safe and effective include any condition which a consumer would attempt to self-treat with conventional OTC medication. In homeopathy, as in conventional medication, consumers should not attempt to self-medicate for chronic conditions or for potentially dangerous acute situations (such as a high fever with stiff neck in a small child). Nor should patients continue to self-medicate if an acute condition persists and escalates. While combination remedies for chronic conditions are available--such as for headache or arthritis--these are less likely to be effective than the combination product for typical acute situations. Chronic situations are much more likely to require the individualization that a professional homeopath can provide.

The pharmacist who is interested in learning more about homeopathy can refer to the resources given in Part 1 of this article and may want to explore the Internet sites given in TABLE 1. Those who are interested in finding a list of professional homeopaths in the U.S. can use the National Center for Homeopathy web site. Continuing Education modules for pharmacists are available from the American Association of Homeopathic Pharmacists14 and Boiron Institute.15