Homeopathic Remedies

''Remedy'' is a technical term in homeopathy that refers to a substance prepared with a particular procedure and intended for treating patients; it is not to be confused with the generally-accepted use of the word, which means "a medicine or therapy that cures disease or relieves pain".

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.

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, tissue and sunlight.

Recent ventures by homeopaths into even more esoteric substances include thunderstorms (prepared from collected rainwater).

Today there are about 3,000 different remedies 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 a piece of paper and either pinned to the patient's clothing, put in their pocket, or placed under a glass of water that is then given to the patient, 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.

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 ten hard strikes against an elastic body in a process called ''succussion''.

While Hahnemann advocated using substances which produce symptoms similar to those of the disease being treated, he found that material doses would intensify the symptoms and exacerbate the condition, sometimes causing what amounted to dangerous toxic reactions. He therefore specified that the substances be diluted.

Hahnemann believed that the process of succussion activated the vital energy of the diluted substance. For this purpose, Hahnemann had a saddle maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.

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 one hundred, and then some of that diluted solution diluted by a further factor of one hundred.

This works out to one part of the original substance in 10,000 parts of the solution.

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)(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.

The end product is often so diluted that it is indistinguishable from the dilutant (pure water, sugar or alcohol).

Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 10⁶⁰).

In Hahnemann's time it was reasonable to assume that 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 that is reasonably likely to contain 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 the American homeopath, Constantine Hering.

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.

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.

Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies. 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.

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",

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.

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.

The high dilutions characteristically used are often considered to be the most controversial and implausible aspect of homeopathy.

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.

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 the placebo effect.

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.

At first Hahnemann used material doses for provings, but he later advocated proving with remedies at a 30C dilution, 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.

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.

The first recorded provings were published by Hahnemann in his 1796 ''Essay on a New Principle''.

His ''Fragmenta de Viribus'' (1805) contained the results of 27 provings, and his 1810 ''Materia Medica Pura'' contained 65.

For James Tyler Kent's 1905 ''Lectures on Homoeopathic Materia Medica'', 217 remedies underwent provings and newer substances are continually added to contemporary versions.

Repertory

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.

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.

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.

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.

Flower remedies

Flower remedies can be produced by placing flowers in water and exposing them to sunlight.

The most famous of these are the Bach flower remedies, which were developed by the physician and homeopath Edward Bach.

Although the proponents of these remedies share homeopathy's vitalist world-view and the remedies are claimed to act through the same hypothetical "vital force" as homeopathy, the method of preparation is different.

Bach flower remedies are prepared in "gentler" ways such as placing flowers in bowls of sunlit water, and the remedies are not succussed.

There is no convincing scientific or clinical evidence for flower remedies being effective.

Veterinary use

The idea of using homeopathy as a treatment for other animals, termed ''veterinary homeopathy'', dates back to the inception of homeopathy; Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans.

The FDA has not approved homeopathic products as veterinary medicine in the U.S. In the UK, veterinary surgeons who use homeopathy belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons. Animals may only be treated by qualified veterinary surgeons in the UK and some other countries.

Internationally, the body that supports and represents homeopathic veterinarians is the International Association for Veterinary Homeopathy.

The use of homeopathy in veterinary medicine is controversial, as there has been little scientific investigation and current research in the field is not of a high enough standard to provide reliable data.

Other studies have also found that giving animals placebos can play active roles in influencing pet owners to believe in the effectiveness of the treatment when none exists. leaving only non-specific placebo effects or various novel explanations.

The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics, such as the law of mass action. or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst."

Use of homeopathy may delay or replace effective medical treatment, worsening outcomes or exposing the patients to increased risk.

Referring specifically to homeopathy, the British House of Commons Science and Technology Committee has stated:

The National Center for Complementary and Alternative Medicine of the United States' National Institutes of Health states:

High dilutions

The extremely high dilutions in homeopathy have been a main point of criticism.

Homeopathic remedies are usually diluted to the point where there are no molecules from the original solution left in a dose of the final remedy.

Homeopaths believe that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active "remedy", in contrast to therapeutically inert water.

Since even the longest-lived noncovalent structures in liquid water at room temperature are only stable for a few picoseconds, critics have concluded that any effect that might have been present from the original substance can no longer exist.

No evidence of stable clusters of water molecules was found when homeopathic remedies were studied using NMR.

Furthermore, since water will have been in contact with millions of different substances throughout its history, critics point out that water is therefore an extreme dilution of almost any conceivable substance.

By drinking water one would, according to this interpretation, receive treatment for every imaginable condition.

Practitioners of homeopathy contend that higher dilutions produce stronger medicinal effects. This idea is inconsistent with the observed dose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body. rats, and humans.

Physicist Robert L. Park, former executive director of the American Physical Society, has noted that

Park has also noted that "to expect to get even one molecule of the 'medicinal' substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained".

The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether.

This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 10²⁴).

Scientific tests run by both the BBC's ''Horizon'' and ABC's ''20/20'' programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves.

Research on medical effectiveness

The effectiveness of homeopathy has been in dispute since its inception. One of the earliest double blind studies concerning homeopathy was sponsored by the British government during World War II in which volunteers tested the effectiveness of homeopathic remedies against diluted mustard gas burns.

The methodological quality of the research base is generally low, with such problems as weaknesses in design or reporting, small sample size, and selection bias.

No individual preparation has been unambiguously demonstrated to be different from a placebo. Further, as the quality of the trials become better, the evidence for homeopathy preparations being effective diminishes, and the highest-quality trials show that the remedies themselves have no effect.

Meta-analyses

Meta-analyses, in which large groups of studies are analysed and conclusions drawn based on the results as a whole, have been used to evaluate the effectiveness of homeopathy.

Early meta-analyses investigating homeopathic remedies showed slightly positive results among the studies examined, but such studies have warned that it was impossible to draw firm conclusions due to low methodological quality and difficulty in controlling for publication bias in the studies reviewed.

In 2001, a meta-analysis of clinical trials on the effectiveness of homeopathy concluded that earlier clinical trials showed signs of major weakness in methodology and reporting, and that homeopathy trials were less randomized and reported less on dropouts than other types of trials.

In 2002, a review of systematic reviews found that higher-quality trials tended to have less positive results, to the point that those results were clinically irrelevant. Also, when taking collectively all the systematic reviews, there was no convincing evidence that any homeopathic remedy had better effects than placebo, and current evidence did not allow to recommend its usage in clinical treatment.

In 2005, ''The Lancet'' medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects.

A 2007 systematic review of homeopathy for children and adolescents found that the evidence for attention-deficit hyperactivity disorder and childhood diarrhea was mixed.

No difference from placebo was found for adenoid vegetation, asthma, or upper respiratory tract infection. Evidence was not sufficient to recommend any therapeutic or preventative intervention. dementia, or for the use of homeopathy in induction of labor.

Other researchers found no evidence that homeopathy is beneficial for osteoarthritis, migraines or delayed-onset muscle soreness. the American Medical Association, and the FASEB There have, however, been a number of clinical trials that have tested individualized homeopathy.

A 1998 review found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials.

The authors concluded "that the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo.

The evidence, however, is not convincing because of methodological shortcomings and inconsistencies." Jay Shelton, author of a book on homeopathy, has stated that the claim assumes without evidence that classical, individualized homeopathy works better than nonclassical variations.

Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy "goes beyond current understanding of chemistry and physics." He adds: "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment."

Mainstream explanations for any effects

Mainstream science offers a variety of explanations for how homeopathy, if the preparations themselves are ineffective, may appear to cure diseases or alleviate symptoms:

• Unassisted natural healing - time and the body's ability to heal without assistance can eliminate many diseases of their own accord
• Unrecognized treatments - an unrelated food, exercise, environmental agent or treatment for a different ailment, may have occurred
• Regression toward the mean - since many diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care when discomfort is greatest, they may feel better anyway but because the timing of the visit to the homeopath they attribute improvement to the remedy taken
• Non-homeopathic treatment - patients may also receive non-homeopathic care simultaneous with homeopathic treatment, and this is responsible for improvement though a portion or all of the improvement may be attributed to the remedy
• Cessation of unpleasant treatment - often homeopaths recommend patients stop getting conventional treatment such as surgery or drugs, which can cause unpleasant side effects; improvements are attributed to homeopathy when the actual cause is the cessation of the treatment causing side effects in the first place
• Lifestyle changes - homeopaths often recommend diet and exercise, as well as limitations in alcohol or coffee consumption and stress reduction, all of which can increase health and decrease symptoms
• The placebo effect - the intensive consultation process and expectations for the homeopathic preparations can result in the release of endorphins or other body-effecting chemicals which alleviate pain or other symptoms, or otherwise affect an individual's biology
• Psychological healing - the care, concern and reassurance provided by a homeopath as part of the consultation can assure the patient the symptoms are minor and easily treated, or alleviate tension that could exacerbate a preexisting condition. This caring engagement can prove particularly effective when conventional physicians have limited time with the patient or cannot provide a diagnosis or treatment.

Research on effects in other biological systems

While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain, histamine release by leukocytes, and enzyme reactions, such evidence is disputed since attempts to replicate them have failed.

In 1987, French immunologist Jacques Benveniste submitted a paper to the journal ''Nature'' while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody.

The journal editors, sceptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published.

Still sceptical of the findings, ''Nature'' assembled an independent investigative team to determine the accuracy of the research, consisting of ''Nature'' editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic and magician James Randi.

After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported."

James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data.

Further Reading

• Homeopathy - What is Homeopathy?
• Homeopathy Philosophy
• Homeopathy Regulation
• Homeopathy History
• Homeopathy Ethics and Safety

This article is licensed under the Creative Commons Attribution-ShareAlike License. It uses material from the Wikipedia article on "Homeopathy" All material adapted used from Wikipedia is available under the terms of the Creative Commons Attribution-ShareAlike License. Wikipedia® itself is a registered trademark of the Wikimedia Foundation, Inc.