Homeopathic Remedies by Symptoms

About Homeopathy » Remedies

Homeopathic practitioners rely on two types of reference when prescribing remedies: materia medica and repertories. A homeopathic materia medica is a collection of "drug pictures", organised alphabetically by "remedy," that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms.^[39]

Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include arsenicum album (arsenic oxide), natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), opium, and thyroidinum (thyroid hormone). Homeopaths also use treatments called "nosodes" (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue.^[40] Homeopathic remedies prepared from healthy specimens are called "sarcodes".

Some modern homeopaths have considered more esoteric bases for remedies, known as "imponderables" because they do not originate from a material, but from electromagnetic energy presumed to have been "captured" by alcohol or lactose. Examples include X-rays^[41] and sunlight.^[42] Today, about 3,000 different remedies are commonly used in homeopathy. Some homeopaths also use techniques that are regarded by other practitioners as controversial. These include "paper remedies", where the substance and dilution are written on pieces of paper and either pinned to the patients' clothing, put in their pockets, or placed under glasses of water that are then given to the patients, as well as the use of radionics to prepare remedies. Such practices have been strongly criticised by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.^[43][44]


Preparation
In producing remedies for diseases, homeopaths use a process called "dynamisation" or "potentisation", whereby a substance is diluted with alcohol or distilled water and then vigorously shaken by 10 hard strikes against an elastic body in a process called "succussion".^[45] Hahnemann advocated using substances that produce symptoms like those of the disease being treated, but found that material doses intensified the symptoms and exacerbated the condition, sometimes causing dangerous toxic reactions. He therefore specified that the substances be diluted. Hahnemann believed the succussion activated the "vital energy" of the diluted substance^[46] and made it stronger. To facilitate succussion, Hahnemann had a saddle-maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.^[47][48] Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose ("trituration").


Dilutions
Three logarithmic potency scales are in regular use in homeopathy. Hahnemann created the "centesimal" or "C scale", diluting a substance by a factor of 100 at each stage. The centesimal scale was favored by Hahnemann for most of his life. A 2C dilution requires a substance to be diluted to one part in 100, and then some of that diluted solution diluted by a further factor of 100. This works out to one part of the original substance in 10,000 parts of the solution.^[49] A 6C dilution repeats this process six times, ending up with the original material diluted by a factor of 100⁻⁶ = 10⁻¹² (one part in one trillion or 1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies.^[50] The end product is often so dilutedas to be indistinguishable from the dilutant (pure water, sugar or alcohol).^[8][51][52]

Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 10⁶⁰).^[53] In Hahnemann's time, it was reasonable to assume the remedies could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized. The greatest dilution reasonably likely to contain even one molecule of the original substance is 12C.

Some homeopaths developed a decimal scale (D or X), diluting the substance to ten times its original volume each stage. The D or X scale dilution is therefore half that of the same value of the C scale; for example, "12X" is the same level of dilution as "6C". Hahnemann never used this scale, but it was very popular throughout the 19th century and still is in Europe. This potency scale appears to have been introduced in the 1830s by an American homeopath, Constantine Hering.^[54] In the last ten years of his life, Hahnemann also developed a quintamillesimal (Q) or LM scale, diluting the drug 1 part in 50,000 parts of diluent.

If a dilution is designated as q on the Q scale, and c on the C scale, c/q = log₁₀(50,000)/2=2.349485.

A given dilution on the Q scale is roughly 2.35 times its designation on the C scale. For example, a remedy described as "20Q" has about the same concentration as a "47C" remedy.^[56]

X Scale, D Scale	C Scale	Ratio	Note
Ø	Ø	1:1	mother tincture[57] (undiluted)
1X, D1	—	1:10	described as low potency
2X, D2	1C	1:100	called higher potency than 1X by homeopaths
6X, D6	3C	10−6
8X, D8	4C	10−8	allowable concentration of arsenic in U.S. drinking water[58]
12X, D12	6C	10−12
24X, D24	12C	10−24	Has a 60% probability of containing one molecule of original material if one mole of the original substance was used.
60X, D60	30C	10−60	Dilution advocated by Hahnemann for most purposes;[53] the patient would need to consume 1041 pills (a billion times the mass of the Earth), or 1034 gallons of liquid remedy (10 billion times the volume of the Earth) to consume a single molecule of the original substance.[38]:272 Moreover, since even in a 15C solution, very likely be no molecules of the original substance would be left, the 30C solution would probably contain no molecules of water that had come into contact with the original substance.
400X, D400	200C	10−400	Dilution of popular homeopathic flu remedy Oscillococcinum
Note: the "X scale" is also called "D scale". 1X = D1, 2X = D2, etc.

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies.^[59] Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times.^[60][61] Another example given by a critic of homeopathy states that a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans",^[60][61] which is approximately correct.^[62] One-third of a drop of some original substance diluted into all the water on earth would produce a remedy with a concentration of about 13C.^[63][59][64] A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10³²⁰ more universes to simply have one molecule in the final substance.^[65] The high dilutions characteristically used are often considered to be the most controversial and implausible aspect of homeopathy.^[66]

Dilution debate
Not all homeopaths advocate extremely high dilutions. Many of the early homeopaths were originally doctors and generally used lower dilutions such as "3X" or "6X", rarely going beyond "12X". The split between lower and higher dilutions followed ideological lines. Those favoring low dilutions stressed pathology and a strong link to conventional medicine, while those favoring high dilutions emphasised vital force, miasms and a spiritual interpretation of disease.^[67][68] Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond that of a placebo.^[69][70]


Provings
Hahnemann experimented on himself and others for several years before using remedies on patients. His experiments did not initially consist of giving remedies to the sick, because he thought that the most similar remedy, by virtue of its ability to induce symptoms similar to the disease itself, would make it impossible to determine which symptoms came from the remedy and which from the disease itself. Therefore, sick people were excluded from these experiments. The method used for determining which remedies were suitable for specific diseases was called "proving", after the original German word Prüfung, meaning "test". A homeopathic proving is the method by which the profile of a homeopathic remedy is determined.^[71]

At first Hahnemann used material doses for provings, but he later advocated proving with remedies at a 30C dilution,^[53] and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain.^[72] During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a "drug picture". The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms.

Provings have been described as important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine.^[73] The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence that nitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time.^[74] The first recorded provings were published by Hahnemann in his 1796 Essay on a New Principle.^[75] His Fragmenta de Viribus (1805)^[76] contained the results of 27 provings, and his 1810 Materia Medica Pura contained 65.^[77] For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 remedies underwent provings and newer substances are continually added to contemporary versions.

Though the proving process has superficial similarities with clinical trials, it is fundamentally different in that the process is subjective, not blinded, and modern provings are unlikely to use pharmacologically active levels of the substance under proving.^[78] As early as 1842, Holmes noted the provings were impossibly vague, and the purported effect was not repeatable among different subjects.^[6]


Physical, mental, and emotional state examination; Repertories
Homeopaths generally begin with detailed examinations of their patients' histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type.^[79]

From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a "homeopathic materia medica". But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the "homeopathic repertory", which is an index of symptoms, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and practitioners over the veracity of a particular inclusion.

The first symptomatic index of the homeopathic materia medica was arranged by Hahnemann. Soon after, one of his students, Clemens von Bönninghausen, created the Therapeutic Pocket Book, another homeopathic repertory.^[80] The first such homeopathic repertory was Georg Jahr's Symptomenkodex, published in German (1835), which was then first translated to English (1838) by Constantine Hering as the Repertory to the more Characteristic Symptoms of Materia Medica. This version was less focused on disease categories and would be the forerunner to Kent's later works.^[40][81] It consisted of three large volumes. Such repertories increased in size and detail as time progressed.

Some diversity in approaches to treatments exists among homeopaths. "Classical homeopathy" generally involves detailed examinations of a patient's history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while "clinical homeopathy" involves combinations of remedies to address the various symptoms of an illness.^[82]


Homeopathic pills
Homeopathic pills are made from an inert substance (often sugars, typically lactose), upon which a drop of liquid homeopathic preparation is placed.^[10][83]


"Active" ingredients
The list of ingredients seen on remedies may confuse consumers into believing the product actually contains those ingredients. According to normal homeopathic practice, remedies are prepared starting with active ingredients that are often serially diluted to the point where the finished product no longer contains any biologically "active ingredients" as that term is normally defined.

James Randi and the 10:23 campaign groups have demonstrated the lack of active ingredients in homeopathic products by taking large overdoses.^[84] None of the hundreds of demonstrators in the UK, Australia, New Zealand, Canada and the US were injured and "no one was cured of anything, either".^[85]

While the lack of active compounds is noted in most homeopathic products, there are some exceptions such as Zicam Cold Remedy, which is marketed as an "unapproved homeopathic" product.^[86] It contains a number of highly diluted ingredients that are listed as "inactive ingredients" on the label. Some of the homeopathic ingredients used in the preparation of Zicam are galphimia glauca,^[87] histamine dihydrochloride (homeopathic name, histaminum hydrochloricum),^[88] luffa operculata,^[89] and sulfur. Although the product is marked "homeopathic", it does contain two ingredients that are only "slightly" diluted: zinc acetate (2X = 1/100 dilution) and zinc gluconate (1X = 1/10 dilution),^[86] which means both are present in a concentration that contains biologically active ingredients. In fact, they are strong enough to have caused some people to lose their sense of smell,^[90] a condition termed anosmia. This illustrates why taking a product marked "homeopathic", especially an overdose,^[84] can still be dangerous because it may contain biologically active ingredients, though as discussed previously, most homeopathic preparations contain no active ingredients. Because the manufacturers of Zicam label it as a homeopathic product (despite the relatively high concentrations of active ingredients), it is exempted from FDA regulation by the Dietary Supplement Health and Education Act of 1994 (DSHEA).