Homeopathy and Integrative Medicine
The unique methodology of homeopathy prescribing
The uniqueness of prescribing homeopathy which gives it versatility and efficacy
1. The unique characteristics of homeopathic medicinal products (HMPs)
The unique characteristics of homeopathically prepared medicines are central to the uniqueness of homeopathic medicine itself.
Homeopathic medicinal products (HMPs) are substances of various origins that have been serially diluted and then vigorously shaken between each dilution step. This method of preparation is standardised in the European Pharmacopeia[1] and other established pharmacopoeias. The repeated shaking between each dilution gives HMPs their unique characteristics, referred to as dynamisation or potentisation. This serial dilution reduces the potentially toxic nature of the dynamised substances; however, a specific method of use is also required in order for the HMPs to be effective.
The final dilution factor may be so high that no traces of the potentised substance can be measured by analytical methods.It is therefore sometimes argued that homeopathic therapy is a placebo treatment. Basic research in homeopathy mainly investigates whether or not potentisation generates pharmaceutical preparations with specific effects. In short, the outcome of most bioassays is not compatible with the placebo hypothesis: in a large number of investigations, homeopathic preparations demonstrated specific effects different from placebo, when applied under adequate experimental settings. Also in physicochemical research, empirical evidence for specific physicochemical properties was observed.[2]
Substances can be diluted in steps of 1/10, 1/100 or 1/50000, depending on the type being prepared, and are energetically shaken, or succussed, between each step[1]. Without this intermediate succussion, the highly diluted preparation will not have a homeopathic potential in the unique living being which precisely matches the uniqueness of the prescribed substance.[3] Research is being undertaken to examine the biological significance of the succussion/dynamisation phenomenon.[2,3] HMPs are often referred to as diluted/dynamised preparations.
2. Homeopathy’s unique prescribing technique
In order to understand the uniqueness of the prescribing technique of homeopathic medicine, it is useful to compare its origins with the historical development of conventional or modern medicine. Up until the 18th century, medicine had no defined methodology and its reliability was questionable. Both homeopathy and conventional medicine have evolved from developments in central Europe which aimed to bring scientific method and reliability to medicine.
New developments in medicine in the 18th century
One of the main contributions to the birth of modern medicine was the singularly decisive work of Giovanni B Morgagni (1682-1771).[4] He proposed a new rational type of medicine based on research. Morgagni advocated anatomical examination of the corpse, searching for the location of the disease and studying the consequent changes in the body. His idea was that, once the seat of the illness had been found and understood, efficient and reliable treatments could be devised. In previous centuries, Bacon, Newton and many others had developed a new method of scientific-analytic thinking. Morgagni’s concept resonated strongly with contemporary thought and became popular in intellectual circles.[4]
At the same time, and somewhat separate from this new movement, other important advances in medicine included the improvement and awareness of the importance of sanitisation: both sanitation in general and medical hygiene in particular. This was responsible for a dramatic increase in the life expectancy and general health of the population from the end of the 18th to the mid 20th centuries.[5] These improvements inspired medicine to look for causes of disease extrinsic to the patient: their illness must have been caused by external factors. This resulted in an increase in the popularity of The Germ Theory.[6]
Both these historical developments, along with the enormous technical progress achieved during the same period, gave rise to the current conventional medical approach, specialisms and methodologies.
The origin of homeopathic medicine
a) Determining the indication for (homeopathic) medical products
The establishment of the principles of homeopathic medicine is the result of work, following a lifetime of reading, research and rigorous experiment, by the German doctor, Samuel Hahnemann. He successfully condensed different strands of knowledge and ideas, both historical and contemporary, into a new set of clear medical principles that were modern in his own time and still hold true today. He published his findings in his Organon of the Art of Healing, which ran to six editions.
The development of the principles of homeopathic medicine began when Hahnemann realised that testing medicines on healthy people revealed the symptoms for which they are indicated. He then proposed this as a reliable and universal way of verifying the action of known medicines and discovering the indications or medical properties of new substances. This differed from the rationale based on looking within the patient for the seat of the illness. The evolution and development of Hahnemann’s concept of testing medicines is comprehensively described in an article by Peter Morell.[7]
b) Testing the medicines
Once he had realised the importance of this, Hahnemann undertook the testing of many medicines that were popular at the time to verify their indications and improve prescription decision-making. Because some of the substances that he wanted to test were highly toxic, he diluted them. He devised a step-by-step dilution principle in order to ascertain the degree of dilution of the medicines he was testing and to establish a reproducible technique of dilution.
Hahnemann then discovered that testing highly diluted and dynamised substances also produced symptoms (or experiences) in those testing them. When the more toxic activity of medicines and new substances had been eliminated through dilution, more nuanced symptoms were revealed during testing.
Many medicines were tested and large databases built. All the information obtained was recorded in minute detail and in the tester’s own words. The maintenance of records of the tester’s experience has been an important contribution to the success of homoeopathic medicine.[8]
This process of discovering the responses or experiences by testing diluted and dynamised medicines or substances on healthy people is termed proving and those testing it are referred to as provers. There are well-established international protocols to perform such provings, which experiments have shown to be reproducible.[9,10,11]
c) Like cures like
Once the symptoms for which medicines are indicated could be discovered through testing on healthy people, it was a logical next step to adapt the principle of like cures like as a means of selecting the most appropriate medicine for each patient. This similitude principle is present in many historic medical texts, including in work attributed to Hippocrates.[12,13] We note that this concept is not specific to homeopathy: other medical techniques and approaches make use of the same principle.[12,13]
HMPs and the information available for each of them
The collected information from these provings is published in the Homeopathic Materia Medica (HMM). Other information, such as traditional uses for substances tested, their toxic effects, and symptoms cured by the substance, or HMP, are also added to the HMM.[8] The collection of such information provides the material that guides the prescriber to determine the best possible HMP in each case. This information consists of lists of symptoms classified according to the part of the body where these were experienced by the provers. Symptoms are recorded as full phrases, using the prover’s exact words. The individual experience of the prover and the complete description of the symptom or experience is considered highly relevant and is conserved in minute detail.
The accumulated information for the many tested substances and HMPs has become vast. In order to make this easier to use, HMP pictures were and are being built, based on experience and a variety of approaches. Such a picture is a reflection or summary of the situation or presentation by the patient that calls for its prescription. The picture illustrates the dynamic of the HMP: the specific, original dynamic influence or collection of symptoms the HMP can have on the prover and the positive dynamic influence it can therefore have on the patient. In order to achieve this specificity, it is necessary to test substances in their diluted and dynamised form; this helps to discover their subtle effects, which need to be known in order for a prescription to be effective.
To build such a specific dynamic picture, one needs to look for what makes the HMP unique in relation to the effects it can have on the whole individual. In other words, What is the individual effect of the HMP (and which is different from another HMP) in relation to the action it can have in its diluted and dynamised form on the healthy prover in order to improve the health of the patient?
Experiments showed that, in order for an HMP to be effective, its selection has to be based on the combination of the individual expression of the illness and the individual experience of the patient as a whole. Therefore, together with the similitude principle, the principle of individuality is important for the successful use of HMPs.
Prescribing homeopathic medicinal products
a) The individuality principle
The dilution and dynamisation process not only reduces the toxicity of HMPs, making it possible for new symptoms to be revealed during provings, it also adds an individuality to the response which they can elicit: some provers would experience many, often original, symptoms whereas others might experience very few, often less original, symptoms. This introduces the idea of idiosyncrasy into the effect an HMP can have on the prover or patient, who needs to be particularly sensitive to the HMP for it to elicit a noticeable influence. Responses will vary between none, small, more noticeable or very profound.
Taking account of the individuality principle, the most appropriate tested substance in its homoeopathically diluted and dynamised form needs to be selected for each individual patient in order for the homeopathic prescription to be effective. In practice this means that, with a similar diagnosis, some patients may benefit from one HMP but many others will require a different prescription.
This is where the homeopathic prescription differs substantially from that of conventional medicine. The specificity of the conventional prescription tends to rely on in-depth knowledge of the pathological process (i.e. knowledge of the seat of the illness) and the response to a standardised intervention following testing on groups of patients with the same diagnosis. A treatment is accepted as effective if it can perform better than average for a given condition in a group of patients. All patients with a similar diagnosis will receive the same treatment. Individuality tends to be eliminated through statistical analysis.
In homeopathy their symptoms are the reason why and how the patient consults and guides the prescriber but it is the individual experience and expression of the illness, and the consideration of the patient’s particular situation holistically, that determines the best possible prescription. The symptoms are the information which the practitioner uses to determine how to help the patient to regain health. The value of this individuality principle is now recognised in other current approaches, such as Integrative Medicine and Personalised Medicine.
b) Determining the homeopathic individuality of the patient
Determining this individuality must be mastered in order to become a successful homeopath. The practitioner looks for what is peculiar or unusual in the patient and what are their individual sensitivities in order to establish the homeopathic picture, or the homeopathic individuality of the patient as a whole. The patient is listened to as carefully as the original provers of a homeopathic medicine. Once the homeopathic individuality of the patient has been ascertained, the practitioner searches for the HMP that, through its proving and other relevant information, expresses a similar individuality.
Like cures like is therefore the founding principle for the positive effect of the correct HMP prescription – to improve the patient’s homeostasis response. This improvement accords with one of the new definitions of health proposed by Huber: The ability to adapt and self-manage in the face of social, physical and emotional challenges.[14] An effective homeopathic prescription improves the patient’s adaptive and self-management capabilities.
It is not within the scope of this article to teach the reader how to prescribe homeopathic medicines. Those wishing to study this complex subject are advised to enrol in a school or university which offers a nationally or internationally accredited homeopathic programme.[15]
c) From local indication to individuality: the homeopathic picture
A number of HMPs tend to be used for certain conditions and are known to be effective without the need to individualise the patient. Some of the information in the Materia Medica originates from herbal or other medical traditions which have a more condition-oriented prescription principle. Such use of HMPs based on popularity can be considered as local prescribing and has resulted in an array of self-help literature. This approach may be helpful in an appropriate situation.
In other cases, combinations of HMPs are proposed as simple-to-use homeopathic preparations for certain conditions or situations. These combination medicines tend to become new HMPs and can be helpful when prescribed by practitioners who understand their individual dynamics and limitations.
For more effective and lasting benefits from a homeopathic prescription, the specific individuality i.e. the patient’s homeopathic picture, should be respected. Determining – or, more accurately, discovering – the homeopathic picture of the patient in order to select the most appropriate and similar HMP needs much training and practice. It is the case that the more specific, and the more individual, a picture of the patient is established, the more likely it is that the practitioner will select an effective, specific HMP for the patient. For this to be successful, the practitioner needs to select from the very large number of HMPs for which the individual picture is known.
Theoretically, if one considers the individuality principle in full, this would mean that for each individual case only one HMP would be the best-indicated, requiring an endless number of HMPs to have been proved and made available to the prescriber to be able to find an effective solution for each case. However, this is not necessary because the principle applied is of similarity not the same. The prescribed medicine needs to have a similar picture to that of the patient, not the same picture. Of course, the more similar it is, the more profound the beneficial effect of the prescription will be. Furthermore, the type of condition and the state of the patient – whether animal, plant or ecosystem – and the desired outcome of the homeopathic prescription, determine the level of similarity needed to achieve the desired improvement effect. Medicine is an Art where the best possible approach needs to be determined for each case.
This aspect of homeopathic prescribing also illustrates the sliding scale of the positive effect an HMP may have on the patient: the better and the more appropriate the similarity between the prescribed medicine and the patient at the time of the prescription, the better and the more lasting any positive outcome will be
An individual patient may be a person, an animal, a group of animals that live together as one unit and become ill together, or a population in an epidemic situation that results in very similar illness pictures in many patients. Research publications show that HMPs can also be used in anticipation of known stress episodes in laboratory and farming systems. The use of a well-selected HMP results in better outcomes and a reduction in the requirement for conventional medication [2,16,17].
d) Homeopathic prescription techniques in the context of conventional medicine
The more analytical approach of modern medicine, which provides the background or narrative of how society understands the treatment of illness, bases its indications for medicines and intervention principally on anatomical or physiopathological diagnoses. With increased knowledge, these diagnoses have become more detailed and refined over time. The patient’s individual experience tends to receive limited attention in this process since statistical analysis is one of the means used to determine the best approach for each group of patients who all receive the same diagnosis. In addition, modern medicine tends to take a mechanistic view of the working of the body, making a clear distinction between the physical, that can be observed and measured, and the mental experience of the patient, which is viewed as being subjective. Patients are approached as if they are made out of parts and treatment aims to repair the diseased part. In The Master and His Emissary[18] McGilchrist goes so far as to write: It is significant that the ‘normal’ scientific materialist view of the body is similar to that found in schizophrenia (p439). Modern medicine’s mechanistic approach is also discussed in depth by Rosslenbroich.[19]
It is difficult for those trained in this approach to understand and master the specific prescription requirements to be able to use HMPs effectively. The successful prescription of these relies to a great extent on the individuality of the patient’s experience. Although conventional diagnosis plays an important role in the homeopathic approach, the more the individual experience of the patient can be discovered and added to the diagnosis, the more likely it is that a beneficial HMP can be prescribed. The importance of ‘experience’ in considering someone’s life is well-researched and explained in McGilchrist’s The Matter With Things.[20]
This dichotomy and the challenge in prescribing HMPs also influence how homeopathy is approached and portrayed:
- There are a number of different schools of thought about how to prescribe HMPs. This varies from prescriptions based: on knowledge of physiopathology (analytical approach); on modern medical diagnoses; on more detailed but still easy-to-recognise disease pictures; on in-depth analysis of the deep-seated individuality of the patient.
- There are many publications and the internet is awash with simplified messages to ‘help’ patients to self-select remedies for their ailments; this is similar to popular traditional medicine.
- There are a number of peer-reviewed articles investigating homeopathy for the treatment of certain conditions, disregarding the specificity of the homeopathic prescription.[21,22,23,24] Their conclusions tend to be of limited value. However, this could be avoided if peer review of articles relating to homeopathy included experts in homeopathic medicine.[2, 25, 26]
e) Highly diluted and dynamised HMPs
As mentioned above, another dichotomy is the preparation of the medicines used in homeopathy compared to those of mainstream medicine.
Mainstream medicine developed from new concepts of anatomy, physics and chemistry. Hence treatments are based on this knowledge of physical measurements and principles of classical chemistry which have informed the modern world view of illness. Medicines and interventions should therefore be measurable and make sense in relation to traditional chemistry.
Homeopathy had its origin in experimentation and an approach to the patient as a whole. The explanation for how HMPs elicit healing responses in patients is not central to homeopathy. Thus, the use of ultra-high dilutions and dynamised medicines is not an issue as long as patients are helped to regain health.
It should be recognised that it is not sufficient to regard the functioning of the body as being based on classical chemistry and physics alone; many processes and phenomena cannot be explained by chemistry or physics.[2, 19, 26 ]
The effect of low doses may seem counter intuitive, but it is well- known that substances of low dilution can cause effects that are the opposite of their non-diluted properties. It is possible that this hormesis effect[27] may be one aspect of the working mechanism of homeopathy. However, experimental and clinical observations imply that the hormesis effect is not the only dynamic in action, and a complete understanding of the mechanism of action of the HMP is still under investigation. A large body of evidence from laboratory research clearly demonstrates that dynamised substances have an effect on the living cell.[2]
The results of this opposite effect of HMPs must be considered in the context of the treatment of the totality of the patient and the examination of the individual relationship (idiosyncrasy) between the HMP and the patient at the time of prescription. Such an individual relationship extends beyond a chemical and physiological understanding of biological processes; it is therefore possible to successfully use an HMP whose chemical effects on a particular condition in the body are unknown. Homeopathy is phenomenological and respects the individuality of each living being and its relationships to the environment. It is also a medical system that understands health as being a process of maintaining a balance in a living system (patient) that is self-generating and is therefore in line with modern system thinking, as collated in the work of Fritjof Capra and Pierre Luisi.[28] An HMP should be seen as a trigger for the patient to regain health using their own internal homeostasis and repair mechanisms (systems view) rather than a medicine that has a biological or physical effect on the internal functioning of the patient (mechanical view).
The absence of an explanation for the medical effect of a treatment is not an argument against such a treatment. It is accepted in modern medicine that the relationship between the mechanistic explanation of an intervention and its benefit is complex and the development of a medical intervention and its explanation often occur in parallel.[29]
Current considerations about biology and the accumulated evidence for homeopathic medicine should allow the removal of all barriers to engagement in high-quality homeopathy research and mainstream publication of the outcomes.[2,31] There is a rich field of research demonstrating that HMPS have physicochemical properties, such as the presence of nanoparticles. However, there is not yet a clear explanation of how these properties contribute to the mode of action. Several other possible modes of action of HMPs have been investigated and seem plausible.[2] Such findings should be regarded as progress in research which increases our knowledge of the pharmaceutical properties and the possibilities of various substances and medicines.
3. One Medicine
Both conventional medicine and homeopathy aim to provide the best possible care for each patient. They each simply approach the patient in a different way.
Each of these approaches have their particular strengths and weaknesses. According to McGilchrist,[20,32] reality for each of us is a construct largely determined by the references, methods and experiences which we value and prefer to adhere to. He states that we have come to prefer what we can measure or explain in a predetermined, often mechanistic, way to build our view of reality. McGilchrist argues that, for a more complete picture of reality, we should also fully accept and value the unexpected, the unexplained and variable: the narrative. To build a more complete picture of reality, we must allow ourselves to accept that things can change and vary. In simple terms, he argues that a more complete picture of reality is the coming together of the measurable/analytic on the one side and the unexpected/unexplained/the never-before seen or heard /the curious/the narrative on the other.[20]
This argument is a good way to illustrate how modern medicine and homeopathy differ but at the same time are both valuable when we search to approach the reality of the patient. Each system has a role to play in the efforts to improve and develop medicine. In homeopathy the unexpected and the unusual play an important role in the discovery of an HMP, proving and building the remedy picture, and their prescription for each individual patient. For those who practise homeopathy in a high-quality modern medicine setting, it is usual to observe how both systems can contribute to the betterment of the patient, each in their own way, and quite often very effectively when respectful cooperation occurs.
If we accept McGilchrist’s argument, this coming together of approaches to health and disease can only increase our ability to understand the reality of each individual patient. This is already happening in healthcare settings, always with very promising results and is described in the document that describes the Tuscan (Italy) model of integrative medicine which is part of this bundle of articles.
The value of cooperation between traditional and complementary medicines and conventional medicine has recently between recognised in the Gujarat Declaration, endorsed by the representatives of the G20 (August 2024)[33] and in modern definitions of One Health.[34] Respectful and truly multidisciplinary cooperation within the medical context has the potential to transform
medicine.[35] Such a transformation could lead the way to the concept of One Medicine.
References:
1) Liga Medicorum Homeopathica Internationalis. Homeopathic Medicine Preparation https://www.lmhi.org/Home/Documents
2) IKIM, Bern University https://www.ikim.unibe.ch/forschung/uebersichten_zum_stand_der_forschung/homoeopathie/index_ger.html
3) Homeopathic Research Institute. Physico-chemical properties of succussed high dilutions https://www.hri-research.org/hri-research/how-do-homeopathic-medicines-work/physico-chemical-properties-of-high-dilutions/
4) Ventura, H. Giovanni Battista Morgagni and the Foundation of Modem Medicine https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6654806/pdf/CLC-23-792.pdf
5) Crawford, J. (Jan 2020). Draining the swamp. Roots of Progress Institute https://rootsofprogress.org/draining-the-swamp
6) Stewart G.T. Limitations of The Germ Theory. The Lancet vol 291, issue 7551, May 1968, pages 1077-1081 https://www.sciencedirect.com/science/article/abs/pii/S0140673668914256
7) Morell, P. Hahemann’s First Provings http://www.homeoint.org/morrell/articles/firstprovings.htm
8) A free collection of homeopathic Materia Medicas https://www.materiamedica.info/en/free-materia-medica-books.php
9) Liga Medicorum Homoeopathica Internationalis. Homeopathic provings – a fundamental pillar of homeopathic science https://www.lmhi.org/Home/ProvingGuideline
10) Liga Medicorum Homoeopathica Internationalis. The Scientific Framework of Homeopathy https://www.lmhi.org/Home/ScientificFramework
11) Pichler, E. Homöopathische Arzneimittelprüfung mit Atropa Belladonna. Homöopath. Österr. 2019; 3: 30–32
12) Schmidt, Josef M. Samuel Hahnemann und das Ähnlichkeitsprinzip, in Robert Jütte (ed): Medizin Gesellschaft und Geschichte. MedGG, Bd. 29: S.151-184
13) (ref to make to the terms and concepts WG contribution on the similarity principle…)
14) Huber, M. How should we define health. BMJ 2011;343:d4163 https://www.bmj.com/content/343/bmj.d4163
15) Liga Medicorum Homeopathica Internationalis and European Committee for Homeopathy. Medical Homeopathic Education Standards https://homeopathyeurope.org/downloads/medical-homeopathic- education-standards-2015.pdf
16) Whole Health Agriculture. A survey of farmers. https://wholehealthag.org/survey/
17) Whole Health Agriculture Document Library https://wholehealthag.org/farm-health-hub/document-library/
18) McGilchrist, I. The Master and his Emissary: The Divided Brain and the Making of the Western World. Yale University Press. 2009. ISBN 9780300188370.
19) Rosslenbroich, B. (2023). Properties of Life – Towards a Theory of Organismic Biology. The MIT Press. ISBN 9780262546201
20) McGilchrist, I. The Matter with Things. Perspectiva, London. 2023. ISBN 9781914568060
21) Lees, P. et al. Comparison of veterinary drugs and veterinary homeopathy. Veterinary Record. Aug 2017. doi: 10.1136/vr.104278.
22) Doehring and Sundrum. (2022). Efficacy of Antibiotic and Homeopathic Treatments of Bovine Mastitis and Implications for Their Effectiveness on Farms https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4180294
23) Ferreira et al. Persistence of Staphylococcus spp. in milk from cows undergoing homeopathy to control subclinical mastitis. https://pubmed.ncbi.nlm.nih.gov/35831890/
24) Goodyear et al. Randomized double-blind placebo-controlled trial of homoeopathic ‘proving’ for Belladonna C30. https://journals.sagepub.com/doi/10.1177/014107689809101108
25) Gaertner et al. Recommendations in the design and conduction of randomised controlled trials in human and veterinary homeopathic medicine. Complementary Therapies in Medicine Vol 76, September 2023, 102961. https://www.sciencedirect.com/science/article/pii/S0965229923000481
26) Engels, G.L. The Need for a New Medical Model: A Challenge for Biomedicine. https://www.urmc.rochester.edu/MediaLibraries/URMCMedia/medical-humanities/documents/Engle-Challenge-to-Biomedicine-Biopsychosicial-Model.pdf
27) Mattson, M. (2008). Hormesis defined https://www.sciencedirect.com/science/article/pii/S1568163707000712?via%3Dihub
28) Capra, F. and Luisi, P. The Systems View of Life: A Unifying Vision. CUP. 2014. ISBN 978-1-316-61643-7
29) Parkkinen et al. Evaluating Evidence of Mechanisms in Medicine: Principles and Procedures. Springer. 2018
30) Dei, A. Experimental Evidence Supports New Perspectives in Homeopathy. Homeopathy 2020; 109(04): 256-260 DOI: 10.1055/s-0040-1701445
31) Bower, H. Double standards exist in judging traditional and alternative medicine. BM.J 1998; 316 https://doi.org/10.1136/bmj.316.7146.1694b
32) McGilchrist, I. (Sept 2013). Can This Couple Work It Out? (Sept 2013) https://lareviewofbooks.org/article/can-this-couple-work-it-out
33) G20 New Delhi Leaders’ Declaration. (2023) https://www.g20.in/content/dam/gtwenty/gtwenty_new/document/G20-New-Delhi-Leaders-Declaration.pdf
34) One Health High-Level Expert Panel (OHHLEP). (2022). One Health: A new definition for a sustainable and healthy future https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1010537
35) Smith, R. Limits to Medicine. Medical Nemesis: The Expropriation of Health. BMJ 2002;324:923 https://www.bmj.com/content/324/7342/923.1?ijkey=bef8573e16c394176787fd5d4cb8dd5ed7e4a7d1&keytype2=tf_ipsecsha changes made after a comment by Tiziana saying we need to make room for the use of low dosed homeopathic medicines aiming at immune modulation
