An Imprint of Elsevier Science The Curtis Center Independence Square West Philadelphia, Pennsylvania 19106 CLASSICAL HOMEOPATHY ISBN 0-443-06565-9 Copyright © 2003, Elsevier Science (USA). All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, elec- tronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher. Churchill Livingstone and the sailboat design are registered trademarks. NOTICE Complementary and alternative medicine is an ever-changing field. Standard safety precau- tions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the licensed prescriber, rely- ing on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the publisher nor the editors assume any liability for any injury and/or damage to persons or property arising from this publication. Library of Congress Cataloging in Publication Data Classical homeopathy / [edited by] Michael Carlston p.; cm. – (Medical guides to complementary & alternative medicine) Includes bibliographical references and index. ISBN 0-443-06565-9 1. Homeopathy. I. Carlston, Michael. II. Medical guides to complementary and alternative medicine. [DNLM: 1. Homeopathy. WB 930 C614 2003] RX71 .C534 2003 615.5′32—dc21 2002073670 Publishing Director:Linda Duncan Publishing Manager:Inta Ozols Associate Developmental Editor:Melissa Kuster Deutsch Project Manager:Linda McKinley Designer:Julia Dummitt KI-MVY Printed in the United States Last digit is the print number: 9 8 7 6 5 4 3 2 1 Contributors DEBORAH GORDON, MD MICHAEL QUINN, RPh Associate Faculty Founder and Chief Pharmacist Hahnemann College of Homeopathy Hahnemann Pharmacy Point Richmond, California President Hahnemann Laboratories, Inc. STEVEN KAYNE, PhD, MBA, LLM, FRPharmS, FCPP, FFHom (Hon) JULIAN WINSTON, B.ID Hon Consultant Pharmacist Director Emeritus Glasgow Homeopathic Hospital National Center for Homeopathy Visiting Lecturer in Complementary Medicine Alexandria, Virginia University of Strathclyde Glasgow, Scotland RICHARD PITT, RSHom (NA), CCH Director Pacific Academy of Homeopathy San Francisco, California v This book is dedicated to those who are unafraid to ask questions in their desire to learn Foreword A s complementary and alternative medicine The book begins with a rationale for why health (CAM) becomes an increasingly prominent care practitioners should study and learn this system part of our health care system, more knowl- of medicine. It gives a succinct overview of the prin- edge about these practices is needed. Homeopathy is ciples and history of homeopathy and its develop- a CAM system that few professionals know about and ment. It addresses why patients seek it, how it is fewer still understand. Often it is confused with practiced, what it does and does not work for, and herbalism, thought to be simply the use of small summarizes the current state of the science in a bal- amounts of drugs, and approached as if it were sim- anced and evidence-based manner. It gives the reader ply an alternative to disease treatment by conven- information about training, licensure and liability, tional medicine. It is none of these. Controversy and drug production and regulation, self-case use, and bias around homeopathy is often heated and rarely costs. In short, this book has everything the practi- based on factual data. Thus there are gaps between tioner needs to know to understand issues of homeo- public and professional interest, skeptic and advocate pathic practice and where to get more information or opinion, and conventional and complementary prac- training. titioner knowledge. This book can fill those gaps. Homeopathy will, like other areas of CAM, even- Homeopathy was extensively practiced in the tually find its proper place in medicine. This book United States and Europe at the turn of the last cen- will go a long way in helping that process along. Dr. tury and is still widely used in many places of the Carlston is to be commended for taking a clinical world today. Many American medical schools were approach, balanced with evidence, to homeopathy. begun as homeopathic but closed after the Flexner Although research is important, and more is needed, report in 1916 and the advent of laboratory-based medicine ultimately begins and ends in the clinic. medicine. Homeopathy was vigorously suppressed in The strength of homeopathy comes from its gentle the United States and almost died out. Ironically, as nature and holistic view, its foundation in the its popularity waned in the United States, homeopa- dynamics of clinical practice, and its vision of the thy spread widely in South America and India, where healing capacity of the person. It has a lot to teach us it is extensively used today for serious conditions. about the process of healing, and this book is one of Interest in and use of homeopathy in the United our best guides. States and Europe is now on the rise again as the public seeks nontoxic and holistic approaches to WAYNE B. JONAS, MD health care. This book is the first comprehensive Director introduction for nonhomeopathic professionals Samueli Institute for Information Biology about homeopathy—and its history, regulation, prac- Director (1995–1999) tice, and research—to originate from America since Office of Alternative Medicine, National Institutes the rise in interest in CAM. of Health ix Series Introduction T he aim of this series is to provide clear and practiced in North America and Europe. Each topic is rational guides for health care professionals presented in ways that are understandable and that and students so they have current knowledge provide an important understandingof the intellectual about the following: foundations of each system—with translation ● Therapeutic medical systems currently labeled as between the complementary and conventional med- complementary medicine ical systems where possible. These explanations draw ● Complementary approaches to specific medical appropriately on the social and scientific founda- conditions tions of each system of care. ● Integration of complementary therapy into main- Rapidly growing contemporary research results stream medical practice are also included where possible. In addition to pro- Each text is written specifically with the needs viding evidence regarding the conditions for which and questions of a health care audience in mind. complementary medicines may be of therapeutic Where possible, basic applications in clinical practice benefit, guidance is also provided about when com- are explored. plementary therapies should not be used. Complementary medicine is being rapidly inte- This field of health is rapidly moving from being grated into mainstream health care, largely in considered alternative (implying exclusive use of one response to consumer demand and in recognition of medical system or another) to complementary(used as new scientific findings that are expanding our view of an adjunct to mainstream medical care) to integrative health and healing—pushing against the limits of the medicine (implying an active, conscious effort by current biomedical paradigm. mainstream medicine to incorporate alternatives on Health care professionals need to know what their the basis of rational clinical and scientific informa- patients are doing and what they believe about comple- tion and judgment). mentary and alternative medicine. In addition, a basic Likewise, health care professionals and students working knowledge of complementary medical thera- must move rapidly to learn the fundamentals of com- pies is increasingly important for practitioners in pri- plementary medical systems in order to better serve mary care, some biomedical specialties, and the allied their patients’ needs, protect the public health, and health professions. Complementary therapies expand expand their scientific horizons and understandings our view of the art and science of medicine and make of health and healing. important contributions to the intellectual formation of students in health professions. MARC S. MICOZZI, MD, PhD This series provides a survey of the fundamentals Philadelphia, Pennsylvania and foundations of complementary medical systems 1997 xi Series Editor’s Preface E xtraordinary claims require extraordinary results. In perhaps no area of alternative medicine are The history of homeopathy, its purported mech- these issues as delineated as in homeopathy. If all anism of action, and recent research results all explanations of health are to be materialist explana- appear extraordinary when seen through the lens of the tions, as in the biomedical paradigm, homeopathy contemporary biomedical paradigm. As biomedicine falls far short. If we are to recognize that there is a increasingly turns its attention to investigation of nonmaterial, “energetic” aspect to healing (as pro- “alternative” and complementary therapies, encour- posed by Ayurveda, Chinese medicine, many manual aged by popular interest and use, research studies are therapies, and of course, “energy healing,” among increasingly yielding positive results with alternative other modalities), then homeopathy may manifest modalities that were only recently thought not to work itself in an entirely nonmaterial mechanism. because they could not work, as was once famously stated In the United States, homeopathy and so-called for homeopathy itself. The goal of this book series, allopathicmedicine (a name conferred on regular medi- Medical Guides to Complementary and Alternative Medicine, cine by homeopaths in mid-nineteenth century) have is to present information on the historical and scientific defined their practices at least partially in distinction basis of healing traditions outside biomedicine with the and opposition to each other through the years. As hope of expanding the biomedical paradigm to be more stated by the great nineteenth-century physician Oliver inclusive of all observed healing phenomena. Wendell Holmes, “I care little for homeopathy, and even Many contemporary medical researchers and less for so-called alleopathy.” In this, he was setting practitioners assume that once empiric observations aside debates about mechanism in favor of empiricism. prove that alternative modalities work, then a priori The only rational basis for medical practice is whether their mechanisms of action must lie easily within the treatment alleviates human suffering and prolongs or realm of explanations offered by the contemporary improves human life. medical paradigm. Problematically, when research When the prevailing system of healing is unable designs are created to test alternative therapies, con- to cope with the disease burden of a suffering popu- trols are created for presumed mechanisms of action lation, which is increasingly afflicted with stress- within the biomedical paradigm without regard to related conditions of all types, it is useful to consider the actual mechanisms proposed by alternative prac- alternatives that have “survived” over time (as Dr. tice traditions themselves. Carlston aptly puts in his volume) the standardiza- Empiricism has been well established as the basis of tion of medical practice into one relatively narrow scientific observation and of rational medical practice realm. The survival of alternative practice such as since the time of Sir Francis Bacon. On the other hand, homeopathy may ultimately contribute to our own positing mechanisms to explain empiric observations is survival as a healthy civilization. always bounded by the prevailing paradigm of the time. The medical paradigm has evolved through time and MARC S. MICOZZI, MD, PhD will not likely remain frozen much longer in its twenti- Bethesda, MD eth-century reductionist, materialist version. November 2001 xiii Preface “The physician’s highest calling, his only calling, is to aren’t you? The doctors say that my husband’s kid- make sick people healthy—to heal, as it is termed.” neys are failing and there isn’t much they can do. A friend of mine had a problem that an acupuncturist SAMUEL HAHNEMANN, Organon of Medicine1 cured, so it makes me wonder. Is there anything in In the opening sentence of homeopathy’s founding Chinese medicine that can help the kidneys?” The document, Samuel Hahnemann declares his convic- Chinese-American woman responded by saying that tion that the patient’s well-being is the only vital con- she had heard of some treatments that might help. sideration in medicine. Debates about medical Their initial optimism quickly faded after one of the theories and the economics of health care have mean- women raised the concern that the doctors were ing only when considered in light of the patient’s likely to refuse to allow such treatments or would, at health; if it doesn’t help the patient in some way, it the least, be upset by their wish to try. The women doesn’t matter. Conversely, if it does help the patient, decided it was best not to upset the physicians trying it must not be withheld. Like many of the best ideas, so hard to save their husbands’ lives. this one is obvious. Unfortunately, sometimes we for- I wonder how often a tragic scene like this passes get even obvious truths. without an interested eavesdropper to later recount In February of 1994, my father-in-law was seri- the tale. There is simply no ethical rationale for deny- ously ill. He spent 1 week in an intensive care unit ing any safe and potentially effective treatment to any (ICU) at Stanford Hospital. The families of each of patient. As a physician, I am embarrassed and disap- the ICU patients sat together in a room waiting for pointed by our patients’ opinions of us. I am upset the brief periods when two families members could that patients are afraid to discuss complementary go in to hold the hand, stroke the hair or talk to our therapies with their physicians. As it did in this inci- usually unconscious loved one. Each family sup- dent, this fear seems to arise from patients’ convic- ported the other ones with amazing compassion and tions that their physicians are hostile to these sensitivity. In many ways we formed an extended fam- therapies. ily in the ICU waiting room. The emotions of this There has been a barrier between medical ortho- newer, larger family rose and fell with the condition doxy and other forms of health care. Somehow, the of each of the patients, our missing family sheltered health care used by 80% of the world’s population has in the ICU. come to be labeled alternative medicine.2As we form an While waiting for my turn to visit, I read a brief increasingly global society, conventional physicians news item about Columbia University opening an and other Western health professionals are beginning alternative medicine center. At the same time, I over- to accept that human beings have been using these heard a conversation between two women whose hus- methods because they are effective, although to an bands had been in the ICU for many weeks. With unknown degree. With this newfound respect, there their waning hope they lagged behind the other fam- is much that can be learned from the “other” forms ilies who had just rushed in for their 10-minute visit. of medicine in use today. Although few people with One woman said to the other, “You are Chinese, whom I discussed this issue several years ago believed xv xvi CLASSICAL HOMEOPATHY a medical détente could occur in our lifetimes, the Recently some clinicians have begun using homeo- injustice of the schism made me optimistic it would pathic remedies in many new and controversial ways. eventually be bridged. However, I must confess sur- Because these approaches and controversies are in prise at the speed with which this philosophic heal- their infancy and will require many more years to be ing is taking place. The ill-founded barrier is fairly evaluated, they are not the subjects of this text crumbling rapidly. Writing this book is an attempt to on the classical application of homeopathy in medi- further the process. cine. This book is the outgrowth of a homeopathic elective that I have taught since 1993 in the School of OVERVIEW Medicine of the University of California, San Francisco (UCSF). The course has been popular, aver- The goal of this book is to familiarize the reader with aging well over 100 health-sciences students per class. homeopathic medicine in its classic form. We will My side of that learning experience was critical to the attempt to convey an understanding of homeopathy’s evolution of this text. unique view of health and disease, its place (current I am sympathetic to the point of view that criti- and ideal) within the health care system, and a taste of cizes the common use of what would appear to be homeopathic clinical practice. My perspective, and the placebo dilutions in homeopathy. Despite many years perspective of this book, is that patient well-being is of witnessing the beneficial effects of all levels of paramount and homeopathic medicine is an effective homeopathic dilutions in clinical practice, I am still means of achieving that aim. In fact, as a doctor prac- puzzled. How could homeopathy be more than ticing both conventional and homeopathic medicine, placebo? Placebo should not consistently produce the my experience has been that homeopathy often works effects I have seen in patients with all varieties and better than conventional medicine for many common severity of complaints. Very good clinical, animal, chronic health problems. and basic science research has often documented sig- This book should be especially interesting to stu- nificant differences between placebo and homeo- dents of the health professions, practicing health care pathic dilutions. I know that, using homeopathy, I providers with a limited understanding of homeo- can routinely help patients with problems for which pathic medicine, and academicians desiring a funda- my regular medical training offered next to nothing. mental understanding of homeopathic medicine. We However, how can dilutions past Avogadro’s number begin with a discussion of the philosophic principles retain biological activity? In all honesty, I am still of homeopathic medicine. This is followed by consid- amazed that homeopathy works as often as it does. eration of where homeopathy has been and where it In the final analysis, this mystery is fascinating. is currently, in a cultural, historical, and scientific Scientists need mysteries. Without the unknown to context. Later sections of the book delve into the clin- explore, there is no need of science. As a scientist, I see ical practice of homeopathy, including discussions of homeopathy as the most intriguing form of healing the types of health problems particularly suited to in the world. This book is an exploration of the fasci- homeopathic treatment. Hahnemann’s motto for nating science of homeopathy. I hope that reading it homeopathy, which is translated as “to taste and will challenge your thinking about homeopathy and understand,” seems a good idea. Thus I have incor- about the practice of medicine, regardless of your porated an appendix with specific treatment sugges- preconceptions. My greatest hope is that it will, in tions for some common medical problems, so that some way, positively affect your treatment of your the reader can test homeopathy in a small way. patients. Homeopathic medicine can be a powerful medical tool that demands careful application to achieve suc- References cess. Therefore, this book is not a substitute for proper homeopathic or conventional medical train- 1. Hahnemann S: Organon of Medicine, ed 6 (original 1842) ing. Both require a great deal more information and (trans Kunzli J, Naude A, Pendelton P), Los Angeles, experience than can be contained in one book. 1982, JP Tarcher. Another limitation of this book is in the restric- 2. Farnsworth N et al: Medicinal plants in therapy, Bull tion of the homeopathic philosophy discussed. World Health Organ63:965–981, 1985. Acknowledgments I would like to acknowledge the assistance of Mike McConnell at Graphic World Publishing several people. First, the medical students at Services for ironing out the wirnkles. For immense UCSF and the family practice residents at research assistance over many years, the newly retired Sutter Hospital Santa Rosa for their questions that medical librarian Joan Chilton. For their hard work illuminated the essential components of this text. For and perseverance, Stephen Kayne, Julian Winston, the wisdom of their medical perspectives, Wayne Deborah Gordon, Richard Pitt, and Michael Quinn. Jonas, Marc Micozzi, Paul Erickson, Kristin Dillon, For their patience, Morgan, Rachel, and Marissa and Marisha Chilcott. For early editorial assistance, Carlston. Most importantly, for her support, my “in Meg Stemper. For all of the work from the publishing house” editor and spouse, Melanie Carlston. I hope staff at Elsevier Science, particularly Inta Ozols, the result is worthyof the considerable efforts of this Jennifer Watrous, Kellie White, and Melissa Kuster. remarkable group. xvii