Back to basics

British Homoeopathic Journal April 1996, Vol. 85, pp. 75-78

From the teaching centres

Back to basics The George Macleod lecture ANNE CLOVER, MB, BS, MRCS, LRCP, DOBSTRCOG, DPM, FFHOM could also at times occur on farms and in the cowshed. Naturally, my direct experience of this is rather limited. However, we all know that it is easier to clarify the principles on which our work is founded before we develop the aptly termed 'practice'. In addition, there is another, more searching implication of the term 'rational' applied in this context. Hahnemann was well versed in the writings of the early Greek philosophers and it is arguable that he applied the term 'rational' to correlate with their use of the word 'ratio'. To them, 'ratio' implied the given order of a self-structured universe. In other words, that the universe has an integral balance and self regulation. Some thinkers would argue that man comes along later in evolution and tries to interfere with the established order. Despite such human disruption the inherent order persists, with planetary orbits, ocean currents and land mass changes still conforming to an essential order. They further deduced that such a balanced order can apply to man who originally shares in the inter-functioning cycles of activity. Disease can be considered a disruption, or disease, of such balanced interfunction. Treatment would therefore be a restoration of the original ordered interfunction. Hahnemann's reference to homoeopathy as a 'rational art' in the title of the Organon therefore ties in with his statement in the second paragraph that the aim of the physician is to 'restore' health. Such a restoration remains the basic aim of homoeopathic prescribing. The pursuit of this goal brings us to the basics of our practical work and the similia principle. Although Hahnemann is the pioneer whose work we respect for the development of the application of this principle in a modern medical setting, a statement of its potential goes back as far as Hippocrates. In a translation of his writings on medicine, we read 'the

T h a n k you for inviting me to join y o u r C o n g r e s s t o d a y and to give the G e o r g e Macleod Lecture. It is a privilege and a welcome opportunity to share ideas with you. I know that many medical homoeopaths feel i n c r e a s i n g l y i n d e b t e d to v e t e r i n a r y colleagues for their input to homoeopathic medicine. Your practical work and research is increasingly important for the development of homoeopathic medicine. On a more personal note, I have many happy memories of attending previous meetings with veterinary c o l l e a g u e s and t h e r e f o r e w e l c o m e d the chance of coming again. Although I have called this talk 'Back to basics' I have no intention at all of making it a political review. The phrase has other applications, perhaps fortunately! Politics may have some importance for life today but they are not, in my view, the 'basics'. This term surely implies factors that are more profound than even the subtleties of the modem political drama. So what are the basics of contemporary homoeopathy? Let us go straight back to Hahnemann and recall the title of his first edition of the Organon. As you k n o w , the six editions of the Organon are a statement of his evolving insight concerning the philosophy on which the practice of homoeopathic treatment was founded. The first edition, published in 1810, was entitled The Organon of the Rational Art of Healing. This is highly significant. To many of us the word 'rational' today implies 'thought through' and could refer to homoeopathic medicine being based on principles deduced before they are applied in the hospital consulting room or the cowshed. I know that h o s p i t a l settings can be s o m e w h a t fraught and I imagine that similar disruption Paper read at the AnnualConferenceof the British Association of HomoeopathicVeterinarySurgeons,June 1995 75

76 majority of maladies may be cured by the same things as caused them'? Although such early statements of the principle exist it was only through Hahnemann's work that its application was developed for modem medical practice. Hahnemann continued his work on the similia principle in a structured manner using a three-stage approach: 1) a knowledge of disease; 2) a knowledge of medicines; and 3) a knowledge of the application of these two in a therapeutic system. I will follow these three headings, considering first the basic principles relevant to each of them and then move on to look at their application in contemporary practice. In all three stages of the assessment of homoeopathic therapeutics, Hahnemann argued for the importance of a polarized approach, saying that whatever obvious provoking factors and gross effects of disease occur, the covert or hidden aspects should also be considered. For Hahnemann every apparent cause and effect required scrutiny to discover its precise rather than superficial determinants. Philosophers of all ages have reminded us that the visible world that we see around us is a fragmentary aspect of total reality. That whatever is seen is like the tip of an iceberg and supported by unseen activity. In pursuing this awareness in relation to disease, Hahnemann considered factors as various as diet and drains on one hand, and subtle energies that he termed 'conceptual essences' on the other. It is a polarized approach that we need similarly to follow today towards a thorough understanding of homoeopathic treatment.

Knowledge of disease The application of this polarized approach is seen in Hahnemann's insistence that disease should always be assessed for its totality and its individuality. He regularly stated that any review of disease must not be fragmentary. In w of the Organon he states this particularly clearly. So it is the totality of symptoms, the outer image expressing the inner essence of the disease, that must be the main, even the only means by which the disease allows us to find the necessary remedy. Hahnemann repeatedly argued that disease assessments should include reference to a patient's environment, home life, internal emotional stresses, physical trauma and how

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all of these could influence a contemporary disease? This holistic review was always accompanied by a corresponding insistence on attention to individual details in a patient's profile, a point taken up by Clarke when he wrote 'Homoeopathy is from first to last an art of individualizing.'3 We all remember that when Hahnemann assessed disease processes, he recurrently referred to the 'vital force'. This term was used in his day to refer to unseen energies that direct the physical function of the human organism. It was his way of considering the individual dynamic processes that could affect overt physical disease. Although the terminology used in his day is now generally considered obsolete, the insight to which it referred remains fundamentally important to a s s e s s m e n t s of d i s e a s e p r o c e s s e s and medicines able to treat them.

Knowledge of medicines Searching for a stimulus able to correct such dynamic forms of disease Hahnemann sought a corresponding dynamic form of medicine. His cardinal aim, evidenced throughout all his w r i t i n g s on h o m o e o p a t h y , was the application of the smallest possible dose to provoke the required therapeutic effect. We need to remember the time in which he was working when heavy metals were widely used in the treatment of disease and could induce horrendous side-effects. Related to this, he initially sought to use small doses to minimize the impact of medicines on the human organism. It is notable that as time went on he realized that small doses not only p r o v o k e d fewer side-effects but actually achieved the desired effect more efficiently. In the light of this observation he revised his original c o n c e p t s and deduced that the rarefied doses p r o g r e s s i v e l y presented a stronger stimulus. This lead to the concept of medicines as 'potencies' and their development as 'potentization' or unlocking 4 of the hidden powers of the medicine. It is one of the many examples of Hahnemann's revision of his initial ideas as he c o n t i n u e d his p r a c t i c e . He d e d u c e d that the e x p o s e d 'dynamic radical', a translation of the phrase he used to imply the hidden power of the medicinal agent, could interact with the dynamic cause of disease to produce the required therapeutic effect. Again, therefore,

Volume 85, April 1996 he was pursuing his understanding that the gross form, whether of the human organism or the medicine used to treat it, implies a dynamic causal force. For treatment he was therefore seeking to apply the dynamic nature of the medicine to modify the dynamic cause of the human disease. This brings us to his third stage.

Knowledge of the application of medicines A fundamental principle here was Hahnemann's insistence on astute observation at all stages of the process. In w of the Organon he reminds us that observation is the cardinal art of a physician. Having seen veterinary homoeopaths at work I am sure that physicians have a lot to learn from you. Your patients do not speak, we might also say at times that they do not lie. This means that vets are shrewd observers and as physicians we need to emulate your example of watching for behavioural features that indicate functional change in a patient. Some of us remember Dr Margery Blackie, a senior medical homoeopath in my own early days in this specialty. Margery reminded doctors regularly that a medical examination begins as soon as we meet a patient. A handshake can be so robust it almost breaks your fingers or like cold, flabby fish. We know the importance of observing such features as part of the assessment required for homoeopathic medicine. Through his own continuing wide-ranging yet detailed observations Hahnemann constantly revised his understanding of the work he was doing and adjusted his practice accordingly. Again, it is a fundamental principle that we need to follow today. All understanding is progressive. In the slow continuing process of evolution, it might be said that we are half-way out of the pond. As our knowledge of disease and the medicines able to treat it increases, our concepts of the therapeutic process will also need to change. Many of you know that most of my own work is involved with complementary cancer therapy. Such work frequently brings home to us the limitations of the present understanding of disease, its development and its treatment, and the corresponding need to be ready to follow new insights for improving methods of therapy. We are therefore already moving on to the contemporary scene. I suggest that here again we refer to Hahnemann's

77 three-stage approach to see how the ideas he applied remain valid, although with revised terminology, perhaps expanding their implications. The understanding of disease has increased remarkably in the last 50 years. Epidemiology and histopathology have brought many new insights concerning the transmission and effects of disease. World-wide patterns of diseases and their effects are noted, often in microscopic detail. At the same time there has been increasing recognition of the importance of psychosomatic medicine. An example of this is the development of departments of p s y c h o - i m m u n o t h e r a p y in the United States, a growing use of counselling, yoga and related techniques to assist in the treatment of certain physical disorders, and wider acceptance generally of the importance of psychological processes in the cause and course of many diseases. Concepts of three-part man referring to the continual interfunction of thought, emotion and physical activity are now widespread and there is a corresponding acknowledgement that e m o t i o n a l or i d e o l o g i c a l c o n f l i c t , bereavement etc have their physiological counterparts. The awareness that ideals and emotions can influence body chemistry is much easier to understand when we recall that the body is fundamentally an energy system. We are not looking at a discrete entity that m i g h t be m a n i p u l a t e d by a b s t r a c t thoughts but at a dynamic system where thought, emotion and physiological energies continually interact. We were reminded of this long ago by the writer of the Book of Proverbs who stated that 'a merry heart doeth good like a medicine' (17:22). Perhaps today we are beginning to catch up with such insights. Of course there is further to go and we will all know colleagues who resist consideration of p s y c h e - s o m a interfunction, preferring to maintain a blinkered organic bias. But overall I believe there are signs of a more holistic approach to the assessment of disease processes. Knowledge of medicines has similarly intensified and expanded. The components of particular medicinal agents and their effects are understood to an increasing degree. At the same time we have a vastly increased range of available medicines today. Concepts of energy medicine are highly

78 important for an understanding of homoeopathic therapy. Suggestions that energy imprints may be conveyed in the alcohol-water solutions of high-potency homoeopathic medicines are very important towards assessing how such stimuli can operate. Perhaps science is beginning to endorse Hahnemann's suggestions that the gross form of medicine contains a 'dynamic radical' able to influence the corresponding dynamic determinants of human health or disease. In short, we are increasingly understanding that the similia principle implies far more than matching the gross effects of a particular stimulus with the overt effects of a disease in order to prescribe a suitable homoeopathic preparation. We can also deduce that the similia implies a correspondence of the energy levels exposed in potentized medicines and the energy determinants of disease processes. The similia principle relates to the quality, or we could say the intensity, of a homoeopathic stimulus as well as to its overt effects. Whilst clinical awareness of the value of homoeopathic medicines in human and veterinary practice is expanding, we all know that we are constantly asked for audit and research studies to validate our impressions. Here medical homoeopathy owes a particular debt of gratitude to our veterinary colleagues. I personally know of medical colleagues who have attempted to dismiss apparent responses to h o m o e o p a t h i c medicines as ' m e r e p l a c e b o ' . Although we might well question their use here of the term 'placebo' their intention to use it in a dismissive manner is usually clear. The same colleagues have pricked up their ears with interest when they heard of cows with mastitis and dogs with k e n n e l c o u g h r e s p o n d i n g well to homoeopathic medicine, especially when these impressions have been supported by controlled clinical trials. Such research is enormously important to the progress of human homoeopathic medicine. These ideas remain highly provocative to our colleagues. But the growing body of evidence

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f r o m h u m a n and v e t e r i n a r y r e s e a r c h is increasingly difficult to dismiss. Finally, let us dare to take a peep at the future. Arguably, homoeopathy is the medicine of the future. With concepts of energy medicine increasingly discussed, good research data backing up the claims for the efficacy of homoeopathic prescribing, and other research c o n f i r m i n g e n e r g y t r a n s m i s s i o n in high potencies, surely this form of practice will continue to progress. There will be opposition. I recall the comment m a d e by a s c i e n t i s t i n t e r v i e w e d w h e n Benveniste's research on basophil degranulation was initially published. His comment was that such findings would 'stand conventional science on its head'. Perhaps this is just what many of our professional colleagues fear. But surely this attitude needs to be revised. Evolving ideas are exciting and enlivening. There is nothing so dead as stasis, physiological or ideological. The challenge of homoeopathy is important not only to the advancement of this form of practice but to medicine as a whole. This brings me back to the principle I consider to be basic to all Hahnemann's work and the continuing practice of homoeopathy today: the need for commitment to increasing insight. Hahnemann described this as the highest aim for a physician. In the Organon, referring to provings conducted by a physician on himself, he writes: such observation on himself leads him to an understanding of his own sensations, the way he thinks and feels, (the essence of all true wisdom--know thyself)? The continuing need for increased insight has been expressed more recently by HRH the Prince of Wales in an address to the British Medical Association. I close with his comment: Today's unorthodoxy can become tomorrow's orthodoxy. Thus it behoves all of us who study this area of activity to approach it with a degree of humility which reflects the current ignorance both in orthodox and alternative treatments. References

Address for correspondence

1 Hippocratic Writings~Medicine. Transl.

Dr Anne Clover Tunbridge Wells Homoeopathic Hospital Church Road Tunbridge Wells Kent TN1 1JU

2 3 4 5

Chadwick and Nunn. Penguin. Hahnemann. Organon w Transl. Kunzli et al. Clarke. Materia Medica. Introduction. Hahnemann. Organon w Ibid. w