Introduction
This year, 2010, The Organon of the Art of Healing, the book that Hahnemann wrote which introduced Homeopathic principles, is 200 years old. The first edition of the Organon appeared in 1810.[1] Since the first edition of the Organon, Homeopathy spread throughout the world and now is practiced differently in different places in the world. The present day world teachers have interpreted the original writings of Samuel Hahnemann in different ways and this has resulted in many different styles of Homeopathy, some of which are radically different from the original principles outlined by Samuel Hahnemann. A few of the differences will be discussed below.
Mainstream Homeopathic Practice and Current Trends in Homeopathic Practice
It is not easy to define what is mainstream in homeopathy since it is practiced in different ways and with different approaches by homeopaths in different countries and even by homeopaths in the same country who trained under different teachers.
However as long as the approach is by using a single remedy at a time and the remedy is chosen based on the law of similars then the practitioner is practicing the homeopathic method. Some might want to add that the remedy given has to be prepared in the method of succussion and dilution but since Homeopaths also use mother tinctures in their prescription, this is not essential for the treatment to be defined as a homeopathic treatment.[2]
Single remedy method
The term Hahnemanian homeopathy is now used to indicate the practice of Homeopathy that closely follows the same methods that Hahnemann taught. It is hard to discover who started to use this term to distinguish the original homeopathy from the homeopathy that had branched off into many different styles but one of the advocates of Hahnemanian Homeopathy is a Homeopath called David Little.[3] He is a much respected teacher with a large database of Hahnemanian methodology in homeopathy. Another famous teacher who advocates what he calls Classical Hahnemanian homeopathy is George Vithoulkas who is a teacher for many present day American homeopaths and still runs his classes for doctors who wish to study homeopathy in Greece. This approach is defined as the unicist approach.[4] In this approach, the symptoms of the patient were matched to a remedy that fitted the totality of the patient’s complaints [5] The case taking for this approach is lengthy and the time needed to arrive at a prescription also takes time. The first consultation takes between 45 minutes to two hours however it can last more than 6 hours for some patients and with some practitioners.[6]
Various approaches using a single remedy
In a typical Hahnemanian approach to a case, the symptoms taken into account include, mental emotional as well and physical symptoms.
1. Many homeopathic teachers however have come up with different strategies to arrive at the remedy to be
- Rajan Sankaran who advocates searching for the core of the problem affecting the patient which he states as the central delusion.[7]
- The late Sehgal has a different way of interpreting rubrics and expands the meaning of rubrics to include a psychological state. For example, the rubric in Kent that says “Desire to be carried”,[8] Sehgal interprets it as meaning, wanting to be helped, not just young children wanting to be carried.[9]
These two examples are just two out of many other approaches that various Homeopathic teachers have taught. They are advanced methods which the beginner homeopath will not be able to grasp unless they become familiar with the basic methods as taught by Hahnemann in the sixth Organon.
2. Another method of prescribing is Isopathic [10] prescribing. Thisis by giving the same agent that caused the symptoms as a remedy. As an example, if a person is allergic to cat dander, then the cat dander is made into a remedy for the patient. If there is a fungus that caused an eruption then the actual fungus is made into a remedy and given to the patient.
Some of the Hahnemannian school of thought says this is un-homeopathic because they say that to make a homeopathic prescription; the remedy has to be a similar in that it causes symptoms the same as what the patient has but not the exact causative agent. Hahnemann himself in the 6th edition of the Organon in a footnote to paragraph 56 says that the idea behind isopathy contradicts human understanding and experience. Nevertheless, Ian Watson, a homeopathic teacher and author of the book ‘A Guide to the Methodologies in Homeopathy’ has reported several instances of allergies and sensitivities which he has successfully treated using the isopathic remedies.[10] Another interpretation of Isopathy is using the patient’s own tissue to treat the patient.
3. Prescribing using a nosode: A remedy that is made from diseased material is called a nosode and, nosodes have been successfully applied using homeopathic principles.[11] Nosodes are prescribed under some circumstance which include:
- Too few symptoms to prescribe according to the similimum, a condition known as a paucity of symptoms
- Poor response of the case to the homeopathically prescribed remedy
- The patient does not recover and the illness lingers and there is a weakness of the system after the disease. The nosode used will be the one made from the same disease the patient suffered from. For example the nosode of Tuberculosis for somebody who had tuberculosis and has not had been well since.
- The nosode can be prescribed in the same way as other homeopathic remedies by applying the homeopathic principles of similar when there is an adequate materia medica of the nosode.[12]
Pathological Basis Prescribing
This method was first introduced and made popular in Germany. The use of remedies in this manner is known as ‘specifics’.[13] Most homeopathic practitioners in Germany after Hahnemann practiced on a ‘pathological basis’. This is a homeopathic approach that identifies the cause of illness and then develops a remedy that shares the “essential nature” of that cause.[14][15] The remedy may be of only one substance or, can be a combination of substances.
Complex Homeopathy
The term complex homeopathy means a homeopathic preparation which has a number of remedies in it. The remedies chosen are the ones that is usually effective for a known symptom complex.[16][17]
Common symptoms complexes for such remedies include migraine, vertigo, nausea of pregnancy and children’s fever. The prescription of such complex remedies is sometimes meant for quick symptom relief and is sometimes used by homeopaths that do not have the time nor does the expertise to find the single remedy that fit the case in total. This may not be the case. Some homeopaths are trained to practice solely using complex remedies for chronic conditions although it is frowned upon by those who mainly practice using single remedies. Many homeopathic pharmacies stock complex remedies which are popular in Germany, France and India. Among the well known complex remedies is a preparation called Vertigoheel for which a clinical trial was done and it was found to be significantly effective in vertigo and not inferior to Gingko Biloba in the treatment of the elderly with vertigo.[18][19][20] There are practitioners who use different terms for complex remedies to differentiate it from single remedy prescribing. Example is the Homeopathic Pharmaceutical Company Guna Biotherapeutics.[21] Incorporated and another term that is also used is Homotoxicology.[22][23] Besides homeopathic remedies, complex homeopathy preparations may contain organ parts that have been prepared in the same way as homeopathic remedies. These remedies are thought to stimulate the corresponding diseased or sluggish organs. The organ parts used are usually of animal origin. Remedies that are from healthy tissues are called sarcodes.[24]
Diagram 1 : This is from a training manual of a “biotherapeutics” product that explains the actions of a complex homeopathy product
Fringe Practices Frequently Associated with Homeopathy
Introduction
Diagram 2: Julian Winston’s Diagrammatic Representation of the Homeopathic World.[25]
According to a renowned homeopathic historian, the late Julian Winston,[26] the core of Homeopathic practice is a prescription based on similar suffering which in turn is derived from principles laid down in the Organon of Samuel Hahnemann. The ingredients of this core of homeopathy are:
- The philosophy behind the method
- Homeopathic case taking
- Matching the symptom to the remedy
- Using a single remedy
- Preparing remedies according to the Homeopathic method ie, Homeopathic Pharmacy which does not mean it has to be diluted and potentised because some Homeopaths use the mother tincture as a homeopathic remedy
Remedies used are those that have undergone a homeopathic proving or what is now known as a drug pathogenetic trial. Within this core are the various methods of symptoms matching that have been derived from the original case taking methods taught by Hahnemann. These methods were developed by various Homeopathic teachers to simplify case taking and involve a lot of theoretical constructs as has been discussed earlier with the examples of Sankaran and Sehgal.
Kent is an American Homeopath who was very much influenced by a spiritual teacher called Swedenborg and his writings reflect this influence. Kent’s influence on Homeopathic practice in the US was to introduce metaphysical ideas into prescribing that focused on mind and emotional symptoms. In the figure above, this is at the outer core of theoretical constructs.
There are other ideas introduced by Homeopathic teachers that push the edge of Homeopathic understanding into spiritual and energy concepts and this include dream provings,[27] where the remedy is not taken orally but it is assumed that the effect of the remedy can be felt just by thinking of the remedy or by putting the remedy under the pillow. Such unorthodox methods test the limits of credibility and are considered fringe practices in homeopathy.
Hence for the discerning person to understand what is meant by homeopathy, it is reiterated that anything that falls outside of this core as mentioned above is to be considered derivatives of the core but at the same time they are outside of the core practices.
As pointed out earlier, the practices that have been accepted as homeopathy besides unicist prescribing include pathology based prescribing and complex homeopathy.
Besides the above, there are practices that have been associated with homeopathy by the practitioners but which are not accepted by Homeopathic Practitioner bodies including the Malaysian Homeopathic Medical Council. Among these practices is Radionics.
Radionics
Radionics [28] is a practice that uses dowsing and radionics pendulum.[29] According to a Divining Mind Radiesthetic Supplies [30] which sells instruments and tools for dowsing, Pendulum dowsing is an ancient art of accessing information not available to a person through the use of their senses. A dowsing pendulum consists of a weight suspended on a flexible string. This pendulum gives a reaction in the hand of a sensitive person and the dowser can get movements of the pendulum which are different for positive and negative responses. Radionics practitioners use a specimen from the patient and this is called a witness. The root of the problem will be identified by dowsing this specimen followed by choosing an appropriate remedy similimum for client’s problem.[31]
The practice was popularised in the 1930’s in the UK by practitioners such as Wethered, Drown and Rae. These practitioners who decided to work directly with the energy bodies were attracted to homoeopathically potentised substances because they were already at a vibrational level, and could be “broadcast” to the patient using specialised equipment.[32]
In Malaysia, there are many practitioners and members of the public have associated this practice with homeopathy whereas it is actually a fringe practice that does not have all the core components that make the practice a homeopathic one even though they say they are using homeopathically potentised remedies. Even the remedies are not prepared the way homeopathic pharmacies prepare remedies. Instead the blank sugar pills are placed in a radionics remedy maker [33] and from this, some dials are turned, the number on the dial representing a remedy with different numbers for different remedies and, it is assumed that the sugar pills absorb the frequency of the remedy in this manner.
Patient Education
How to Choose A Homeopath
This is a broad guide for those seeking a Homeopathic practitioner. One has to bear in mind what one is looking for in a Homeopathic practitioner as the knowledge and method of practice varies in different places in the world. The level of training as well as the approach also varies.
1. For a Hahnemannian Classical Homeopath, the practitioner would practice in the following way.
- Adequate case taking, in which a detailed history of the patient as well as the medical, family, mental and emotional history is taken.
- Analysis using a repertory and adequate skills in repertorizing. Most skilled homeopaths now use a repertorial software program since manual repertorizing is time consuming.
- Prescription of only one remedy at a time or, at the most two in alternation and the remedy prescribed is an unproven complex remedy.
2. For homeopaths that use remedy complexes, the ones who are skilled at this would have adequate training in this and their qualifications should reflect this training. Examples of qualifications that reflect this training is the ‘Academy for Bioregulatory Medicine’ which has its address in Manchester United Kingdom.[34]
The use of homeopathic complexes is just a part of this school’s teachings and herbal remedies as well as other complementary therapies are also taught.
3. Homeopaths chosen should be registered with a valid practitioner body and this varies in different countries. The database of practitioner bodies (link to practitioner bodies) on this portal can be a guide. It is wise to check with the practitioner bodies to find out if the homeopath you want to consult is listed.
4. Many people find out about the skills of a homeopath through word of mouth from other patients who have had a good experience with the homeopath that they want to consult.
5. Many naturopaths have a basic training in homeopathy and sometimes add a homeopathic remedy to their prescription of herbs and nutritional supplements. On the other hand, many homeopaths also add herbs and nutritional supplements to their homeopathic prescription.
As a general rule, a naturopath who has some training in homeopathy does not have in depth knowledge of remedies and treatment of chronic diseases with homeopathic remedies and homeopaths who include nutritional supplements and herbs to their prescription are usually not formally trained to do so. This is very relative since some homeopaths have been formally trained in nutritional and herbal medicine and some naturopaths also have a homeopathic qualification. Since in many countries there is no law against any health practitioner or even layman from prescribing homeopathic remedies and many of the homeopathic remedies are available without a prescription, there is no control over these prescriptions and it is up to the patient to find out the level of knowledge and experience the homeopathic practitioner they are going to.
6. Since there are many online homeopathy courses, there are some practitioners who have no formal mentoring or supervised clinical training before they start to see patients. This issue is reduced in countries where the practitioner body takes the role of regulator by making sure the person they register has passed a certain level of competency. This is done by making it a condition of registration that the practitioner has to pass certain exams and attend an interview or conduct a case-taking session in front of a panel of examiners from the governing body. Some practitioner bodies also see to it that their members attend a certain amount of courses and are involved in professional development activities before their registration is renewed and this is done on a yearly basis. Since this role of the practitioner body differs in different countries, it is best for the prospective patient to check
The Health Ministry of the relevant countries may have information on the valid practitioner bodies for homeopathy, although because homeopathy is not always part of the orthodox medical system it may be necessary to research via telephone directories or the internet to find local practitioner associations.
Self Medicating With Remedy Complexes
The sale of remedy complexes for symptom complexes is common in many countries including the UK, Europe, USA and India. These remedies are sold for conditions like migraine, children’s fevers, teething problems, arthritis, to improve memory, and a host of other named conditions. Self prescribing with these ‘homeopathic’ remedies is common among many populations. Examples of Homeopathic Pharmacies that sell complex remedies are Guna Biotherapeutics [35] which is based in Italy but have agents in many countries including the US. This company also trains health practitioners on the method of using their remedies although many of their remedies can be bought without a prescription and even online.[36]
Many people seem to benefit from such over the counter homeopathic preparations but most trained homeopaths feel that this method of self treatment is in the long run not a good way to treat chronic conditions and results in palliation rather than cure. Nevertheless some homeopaths say that it is useful to palliate conditions when there are no suitably qualified homeopaths nearby and as a temporary measure.
What can be ascertained is that these remedies are much safer than patent over the counter drugs and even herbals. Overdosing on these over the counter remedy complexes however may result in the user developing ‘proving symptoms’ which are the unwanted and un-therapeutic effects of the remedies taken repeatedly over long periods of time.
Figure 1: A box containing Arnica in various strengths (potencies) with specific instructions on how to take the remedy.
Figure 2: This is the back of the blister pack of capsules containing Arnica impregnated granules. The strengths of Arnica are different according to the time after trauma that the dose is to be taken starting with 500mg at 1 M potency immediately after trauma followed by 12 c potency the day after. The 12 c is repeated morning and evening for three more days.
Homeopathic Practices and Fees Charged by Homeopaths
Homeopathic clinics differ in the types of services offered and the approach to diagnosis.
The way homeopathy is offered depends on the qualification of the homeopath, the laws regarding practice and the types of patients that the practice attracts.
In India where homeopathy is recognized by the government, the large number of patients seen by the homeopaths makes consultation and case taking necessarily short. Hence keynote prescribing is popular. This means that the case taking may take about five to ten minutes and the key symptoms and signs are noted and a remedy is chosen that has the same keynotes. The whole process would take about 10 to 15 minutes and a large volume of patients can be seen by one homeopath. This also means that the cases are not examined or analyzed thoroughly and the records are brief. The consultations are also cheap because the homeopath earns money from the volume of patients. Consultation and remedy may cost only USD 5 [37] per consultation. This is not necessarily the amount all homeopaths in India charge. Some charge amounts as high as a few thousand dollars. On a discussion in the Homeopathic World Community message board,[38] this range of charges was discussed and a debate ensured about the morality of high fees charged by some homeopaths.
In general, the homeopaths who take a complete case and do a thorough analysis with good case records and analysis need to charge more because they see less patients in the same number of hours of consultation. This is true in India as well as in other countries where Homeopathy is popular as a treatment modality.[39]
Homeopaths in India are more likely to treat more serious cases with homeopathy because they are generally more experienced with such cases. As an example, a case of hydrocephalus would generally be referred for surgery in countries where homeopathic practice is not available in hospitals but in India where some hospitals have homeopathic doctors and even homeopathic surgeons, a trial of homeopathy may be given before the patient is referred for surgery.
In the United Kingdom, consultation fees range between range between GBP 30 and GBP 100 and treatment of a condition by a Homeopath registered under the National Health Service of the United Kingdom may cost around GBP 250 per patient.[40] The type of homeopathic treatment varies depending upon the qualification and training of the homeopath. Professional homeopaths registered with the Society of Homeopaths or any of the main Homeopathic Associations tend to practice in a classical method with long consultations and case taking. Medically trained homeopaths that have a much shorter training in Homeopathy may practice in an integrated manner where homeopathic treatment is given for chronic conditions and conventional drugs are given in acute conditions. As an example, an acute bronchitis may be treated with antibiotics but if the condition is recurrent then the medically trained homeopath may take the case from the homeopathic perspective and then prescribe a homeopathic remedy.
In the US, a survey on patients taking homeopathic treatment, the average cost saving of a condition that on the average lasted from 3 to 4 months cost USD 580 per year.[41] This was paid out of pocket by about 80 percent of the respondents since homeopathic treatment is usually not covered by insurance except in cases where the medical doctor who is a health provider under the person’s insurance scheme is a homeopath as well. This survey was conducted by the American Medical College of Homeopathy based in Phoenix, Arizona.[41]
In Australia, first consultations typically vary from between $70-$180AUD, depending on the practitioners. Many private Health Insurance Funds now cover some homeopathic consultations, although the Government based Medicare system does not recognise homeopathy, and therefore no payments are made to patients.[42]
In Malaysia, there has been no studies done to analyze the type of homeopathic practice done but during a Homeopathy seminar conducted by the Malaysian Homeopathic Medical Association, an invited lecturer from India noted that the students who attended were very good keynote prescribers but poor at repertorizing cases.[43] This was only an observation of the homeopaths that attended the seminar but may not be true of other homeopaths in Malaysia, some of whom were trained in India and Pakistan and hence were exposed to the classical method of prescribing.[44][45] Fees in Malaysia are also very varied, ranging from MYR 30 (USD 10) to MYR 1000 (USD 300+) per consultation.[46]
In conclusion, Homeopathic practice varies from country to country and even in the same country the type of practice varies from the keynote prescribing done in areas where the Homeopath sees a lot of cases during their consultations to the classical methods that take up a lot of time and analysis. Some homeopaths prescribe single remedies, other prescribe complex remedies and use the homeopathic dilutions a different manner to what was originally taught by Hahnemann, giving their methods different names like Homotoxicology and Biotherapeutics.
Fees vary according to the region, the type of practice and the type of patient[47], being higher in places where the patients earn more and are better educated and lower where the patients earn less. More studies have to be done to fully understand the scope and range of Homeopathic practice the world over.
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