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Homœopathy and traditional Chinese medicine
Homoeopathy and traditional Chinese medicine D. T. H. WILLIAMS, MBBS, BDS, DOBSTRCOG In the autumn of 1982 Dr Williams spent three months studying traditional Chinese acupuncture at the Nanjing College of Traditional Chinese Medicine. In the lecture given at the Annual General Meeting of the Faculty of Hom~eopathy in 1983, Dr Williams draws some comparisons and some contrasts between the practice of hom0eopathy and traditional Chinese medicine.
Mr President, Ladies and Gentlemen, I am honoured to be asked to give this Richard Hughes Memorial Lecture. My introduction to acupuncture was an excellent short course by Dr Anthony Campbell in this very Board Room at the Royal London Homoeopathic Hospital. I was subsequently able to take prolonged study leave from general practice and spent three months at the College of Traditional Chinese Medicine at Nanjing, in the People's Republic of China. I intend in this lecture to point out similarities and differences in outlook and practice between homoeopathy and traditional Chinese medicine (TCM). To put TCM in context. The current ratio of TCM to orthodox doctors in China is approximately 1:3. Many modern Chinese do not believe in their own traditional medicine. However, TCM is expanding and the Chinese Government is opening more Colleges of TCM, and nationwide research projects are proving the efficacy of TCM, and of acupuncture in particular. This movement was started by Comrade Mao Zedong whose dicta that "Chinese medicine and pharmacology are a great treasure house of knowledge and experience" and that "the past should serve the present" served as the impetus to this development. Most people's acquaintance with TCM starts with acupuncture, and most Westerners, including doctors, think of acupuncture as somewhat in the nature of the martyrdom of St Sebastian, with all the attendant risks of pneumothorax and other complications. Historically, acupuncture is thought to have been introduced into Europe by Willem ten Rhyjne in 1683. It was he who coined the word acupuncture from the Latin Acus = "needle" and punctura meaning "puncture"! 1 Acupuncture probably went to America with Chinese labour in the 18th and 19th centuries, for in 1826 The North American Medical and Surgical Journal published an article on acupuncture by Dr S. Bache. Later in the same century Dr William Osier recommended acupuncture in his Principles and Practice of Medicine. The eighth edition (1912) 2 was the last to carry this recommendation. On the other hand, Osier poked fun at homceopathy, and in his advice to students The 1983 Richard Hughes Memorial Lecture
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on the difficulty of dealing with the human race as patients he says: "Deal gently with this credulous old human nature with which we work; and restrain your indignation when you find that your pet parson has triturates of the thousandth potentiality in his waistcoat pocket"? Before I can compare, it is necessary to acquaint you with some of the historical background of TCM. The foundation stone of TCM is the book Huang Di Neijing (The Yellow Emperor's Canon of Medicine), which comprises two parts SU WEN (Plain Persons) and LIN SHU (Canon of acupuncture). This book is regarded as the summation of the 2,000 years of experience prior to its publication, somewhere between the 5th to 3rd century BC. It is therefore roughly contemporary with the Hippocratic collection. Today Neifing is still the paramount writing of TCM. It has presided over the health of one-quarter of the people of the globe for roughly 2,500 years. It is therefore a book not to be dismissed lightly, even if current translations are imperfect. It is written as a question/answer dialogue between the Emperor and his chief physician Chi Po, and is full of information. It is however more philosophical than practical, but a few relevant quotations may help to catch its flavour. "Neijing" on the role of the doctor Preventive medicine The superior physician helps before the early budding of disease . . . . The inferior physician begins to help when the disease has already developed: he helps when the destruction has already set in. Since his help comes when the disease has already developed it is said of him that he is ignorant/ To administer medicines to diseases which have already developed and to suppress results which have already developed is comparable to the behaviour of those persons who begin to dig a well after they have become thirsty. ~ The "Neifing" on the relationship of body, soul and disease "When the spirit is hurt severe pains ensue; when the body is hurt there will be swellings. Thus in those cases where Severe pains are felt first and the swellings appear later, one can say that the spirit has injured the body. In those cases where swelling appears first and severe pains are felt later, one can say that the body has injured the spirit. 6
Here follows an interesting statement about Acupuncture--that the cure depends on the patient's own will. The Emperor asked: "When the body is worn out and the blood is exhausted is it still possible to achieve good results"? Chi Po replied: "No because there is no energy left". The Emperor then enquired: "What does it mean--no more energy left"? Chi Po replied: "This is the way of acupuncture; If a man's vitality and energy does not propel his own will, his disease cannot be cured". 7
The Neijing on therapy Neijing lists five methods of treatment in this order. PSYCHOLOGY ("Cures the Spirit") DIET ("Gives proper nourishment to the Body") DRUGS ("Teaches the effects of poisons and medicines") ACUPUNCTURE
CLINICAL MEDICINE ("Examine and treat the bowels, the viscera, the blood and the breath"). Volume 74, Number 2, April 1985
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The concepts in traditional Chinese medicine
TCM has its own complete system of anatomy, physiology and diagnosis. Acupuncture is but one of the available therapies which include herbal medicine, massage, nutrition, manipulation and the therapeutic exercises known as T'ai Chi Ch'uan. TCM considers the living being as a unity whose vitality depends on the uninterrupted flow of life force or energy called "Qi" (pronounced "Chee"). Qi flows around the body and is distributed by means of channels which connect together t h e internal organs and which connect with the surface of the body. Acupuncture points, amenable to needling and to pressure, are found where the channels come to the body surface. The organs of the body are considered to have not only the mechanical functions which orthodox medicine ascribes to them, but are also believed to have organizing functions on emotion, mentality, and other systems, e.g. The heart houses the mind. The liver controls emotional balance. The lung controls skin, hair, and the body's general defences. Diseases are seen as being due to insufficiency or imbalance of energy. The concept of yin and yang, which is applicable to all dynamic systems in nature, deals with the balance and polarity within the body. Yin and yang a r e antagonistic and yet interdependent and complementary. Simplistically, yang is hot, upward going, bright, active and the male principle. Yin is cold, dark, descending, quiescent and female. There are no absolutes in this concept and the Chinese symbol called "Tai Ji" depicts life as a unity with yin and yang intertwined, and merging into each other with yin containing a small amount of yang and vice versa. Circadian rhythms were
Fig. 1. The symbolTAIJIrepresentsthe polaritiesthat existin unity; whichexistin all animateand inanimate systems;they are equal and opposite,withinand yet merginginto eachother.
recognized by the ancient physicians as being due to regular fluctuations of yin and yang. 8 However, if balance is upset, and either yin or yang becomes seriously deficient or greatly excessive, then disease results from the imbalance. If a particular organ is diseased, then the flow of Qi through the channel connected with that 78
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organ, will be out of balance. Stimulation of points on the channel connected to the organ will correct the flow of energy and restore health by restoring balance.
Causes of Disease In homceopathy and acupuncture the modalities are important. In TCM however there are six modalities which are considered to cause disease and these are called the Six External Pathogens (climatic aberrations) Heat Sulphur Summer Heat Glonoine Cold Aconite Damp Pulsatilla Wind Pulsatilla Dryness Bryonia Exposure to excess of any of these modalities would cause disease and, as in homceopathy, would be treated according to aetiology. For example, excess heat disturbs the flow of vital force locally, and causes "stagnation of blood". This leads to pain and is also manifested by boils, carbuncles, abscesses of the teeth etc. It should be noted that heat is the cause, and not simply a by-product, of the disease. Homceopaths would naturally consider the hot remedies Sulphur, Hepar sulph., for these conditions. Whilst the acupuncturist would needle points known to dissipate heat, e.g., Quchi and Hegu (L.I. 11 & 4). Pathogenic dryness characteristically occurs in China's late dry autumn. The voice of Dr R. A. F. Jack reached me in the Nanjing classroom with the words "Bryonia = dryonia". You will, therefore, not be surprised to hear that pathogenic dryness causes painful cracking joints, dry cough, scanty sputum, and chest pain (pleuritis) and a dry rough skin. Pathogenic wind (I~ENG) is a concept which does include meteorological wind, but also applies to manifestations described as being wind-like in the body. Wind is upward-going, expansive, blowing here and there, and with constant movement and rapid change; urticaria, migrating rashes, flitting arthritis. Flitting pains are regarded and treated as being due to wind at points named Fenchi and Fengfu (pool of wind and market of wind). It is an interesting coincidence(?) that one of the main homoeopathic treatments for such conditions is Pulsatilla--the wind flower. During the winter, in China, one sees many people wearing masks of the type we use in operating theatres; even young babies of a few months old are seen wearing su~ch masks. I thought this was a public spirited measure promoted to prevent the spread of upper respiratory disease. I was soon disabused and told that the wearing of such masks prevented the invasion of the interior of the body by pathogenic cold and wind.
Internal Pathogens (Pathological Emotion) The human being is under the influence of emotion, according to circumstances; there are considered to be seven emotions, and an excess of any one of them may cause disease. Five of these feelings are specific and arise from a particular organ Volume 74, Number 2, April 1985
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which may become diseased from the strain of supporting the emotion associated with it damages Liver Excess Anger damages Lung Excess Melancholy damages Heart Excess Joy damages Kidney Excess Fear damages Spleen. Excess Meditation (Brooding) Grief and Fright may damage the Lung and Heart respectively. 9 Such associations, of course, may be used diagnostically since it could be inferred that an easily angered choleric person is suffering from a disease of the liver which is failing in the command function in respect of emotion. The message here is plain: prolonged or excessive emotional stimulation eventually affects the vital force (Qi) and leads to damage of internal organs.
Miscellaneous pathogens This group again includes a number of causes of disease well recognized by homoeopaths and by orthodox doctors. It includes a category known as "Irregular food intake" which comprises excess or deficiency of food, excess alcohol and insanitary food or poisons. These injure the transportation and transformation functions of the stomach and spleen. This category is covered in the homeeopathic materia medica by such remedies as Arsenicum, Lycopodium, Carbo vegetabilis, Sulphur and Nux vomica. Also included under miscellaneous pathogens are excesses of mental activity (Nux vomica), excess of physical activity (Arnica) excessive sexual activity (Silica). Trauma is of course included as a miscellaneous pathogen. The concept of Qi (vital Force) The concept of vital force is familiar to homoeopaths and has been part of many philosophies of medicine throughout the ages. I came to understand Qi as a generalization of genetic influences and of acquired substances from food and oxygen. Qi has many sub-categories, the most important of which is Yuan Qi or genetic influence. Next in order of priority is antipathogenic Qi, which equates to a summation of all defence forces of the body and which is controlled by the lung. The TCM concept that the occurrence of disease is the visible evidence of the struggle between pathogens and antipathogenic Qi, was written down in the "Neijing Su Wen" before the birth of Christ. This concept of struggle corresponds exactly with the homceopathic view; that the symptoms appearing at any moment on the emotional, mental or physical planes, constitute the best possible reaction of the defence mechanism which is attempting to maintain homeeostasis. The reaction may be inadequate or hyperreactive, but it is the best the organism can do. The symptom is an attempt to maintain order whilst the organism regains health. If treatment can stimulate reaction a little more, perhaps cure can be obtained. Hom0eopathy and TCM both attempt to do this; in other words, both stimulate the vital force. The acupuncturist actually speaks of regulating or stimulating the flow of Qi. The TCM doctor, like the homeeopath, is a generalist, and in the TCM clinic the first and most noticeable similarity between the two disciplines is in the diagnostic 80
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process. For a chronic case this could take two or three hours. In the hurly-burly of our Nanjing outpatient clinic it never did. Kent's lengthy article entitled "What the doctor needs to know in order to make a successful prescription ''1~would not put a TCM doctor to shame, even though the diagnostic/therapeutic inferences would be different. The hom0eopath could very easily use a history taken by a good TCM doctor and vice-versa. The Generals, Mentals, Locals, Modalities and the Social History are all there. Failure to ask these questions is being guilty of one of the "Four errors and Five mistakes" mentioned in "Nei jing". A general physical examination follows the history. This examination was quite superficial in the very public examination rooms of our clinic in Nanjing. The traditional reluctance of Oriental patients and doctors to expose the body to extended and deep physical examination may also explain why tongue and pulse diagnosis have reached the state of a high art in Chinese medicine. The state of the tongue has achieved the status of a "General" symptom as compared with its "Local" hom~eopathic interpretation. The interpretation of the qualities of the twelve wrist pulses is not as important as in old China, modern trainees being taught a generalization of the art of pulse diagnosis. A detailed observation is made of face, habitus, body odour, and skin. The whole aim of the diagnostic interview is to achieve a diagnosis which will be based on the constitution of the patient. It must, however, be said that, just as in hom0eopathy, acute local problems are dealt with on the basis of local symptoms. The importance of a good history and examination is shown by the following ancient classification of the skill of doctors in accordance with their ability to achieve correct diagnosis and prescription: thus a "very excellent" doctor needed only to observe his patient to achieve a diagnosis and prescription; whereas a "god-like" doctor, who is not as good as an "excellent doctor", needed in addition, to listen to the sounds of the body and to smell the odour and parts of the body; a "perfect doctor" needed, in addition, to make salient enquiries of the patient and the relatives; and a "technically skilful" doctor in addition to all the above, needed to take the pulses. 11 In taking the history and achieving the correct prescription, a knowledge of the syndromes of disease in TCM is as important as the homoeopath's knowledge of his materia medica. On the other hand, an inexperienced practitioner of either art may yet be confused after asking dozens of questions. The experienced doctor may, by selective questioning, achieve a correct prescription quite quickly.
Professional Negligence in TCM It was written down centuries ago that there were five categories of professional negligence in respect of diagnosis which leads to mishaps, and for which the practitioner is not condoned. Four of these are of special interest to the homceopath. --Issuance of a prescription abruptly, guided only by symptoms, without probing into the underlying cause of an ailment (which may happen to be mental or emotional). --Failure to study and examine correctly the causes behind certain casual symptoms which may be misleading. Volume 74, Number2, April 1985
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- - N o t endeavouring to direct the patient towards an improvement in his life style, which may be the indiscernible basis of the complaint. --Incorrect use of tonics or purgatives resulting in the further depletion of the Qi of the patient. --Failure to apply the principles of Yin Yang doctrine to arrive at a correct diagnosis. ~2 Our tutors in Nanjing emphasized many times that to prescribe on local symptoms was bad practice. That in general, treatment might just succeed if so based, but the failure or worsening of a patient's condition could be expected if treatment was given without consideration of the correct constitutional history. I would remind you that the ancient doctors of TCM who formulated these rules had no blood tests or X-rays available to them. They relied on clinical observation for diagnosis and prognosis. They had astute eyes firmly fixed on their patients. Quite literally their own lives, as well as those of their patients, frequently depended on their powers of observation and deduction. A r n d t - S c h u l t z Law
I was surprised to find that acupuncture (as part of TCM) seemed to conform at least superficially to the Arndt-Schultz Law, and to have a biphasic effect which depended partly on the nature of the stimulation. One of the diagnostic categories into which any disease may be fitted is that of either "excess" (shi), e.g. acute infections fever, or "deficiency" (xu), e.g. the low grade fever and night sweats of pulmonary tuberculosis. Having determined which organs and channels are affected, the acupuncturist will treat by reducing or reinforcing the energy in those channels. Reduction of local energy, e.g. in fevers or in severe pain, is achieved by large amplitude, rotation and deep thrusting for short periods of time, and is usually quite painful. In other words, where the response of the organism seems excessive, a large dose of acupuncture depresses the vital force. Reinforcement is achieved by weak stimulation for longer periods, i.e. if the reaction of the organism and the pathogenic forces are at deadlock, and a chronic "deficiency" situation occurs, a weak dose of acupuncture will stimulate the vital force. The biphasic response to acupuncture has been demonstrated in the blood. Papers published in the 1979 Beijing Symposium 13indicate that in animals, and in man, acupuncture applied to specific points has a biphasic effect, e.g. in patients with initially high white blood cell counts the levels are decreased by acupuncture, whilst the application of needles to the same point in patients discovered to have low initial counts, causes the levels to increase. In both groups there is a tendency after a few hours to return to the status quo. These effects are used therapeutically in appendicitis to reduce high white cell counts, and in neutropenia caused by cancer chemotherapy, to raise the count. Similar regulatory effects have been found to occur in hyper- and hypotension and in excess and deficient gastric motility. If you believe in the phenomenon of aggravation you might add this also to the proof of biphasic action, since it is recognized that many acupuncture patients 82
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experience a worsening of symptoms which precedes improvement. Generally treatment is used which is appropriate to the constitution of the patient. For elderly people and children and intellectuals, shorter periods and relatively weaker stimulation is given with finer needles. For labourers and peasants, much stronger stimulation, for longer periods, with thicker needles, is given. I think you may see a definite similarity between the need for correct potency selection for the constitution of the homceopathic patient, and the acupuncturist's assessment of his patient for choice of needle size and type and duration of needling. TCM also takes a common view with homceopathy that long established disease takes a long time to heal. The treatment continues and is modified as the cure progresses. Unlike hom~eopaths, however, the TCM doctor does not stop once he has stimulated the vital force into a healing momentum. He continues to push by giving "consolidation" treatment at less frequent intervals until the patient is well recovered. Needling treatments on average may take up to 30 minutes daily or on alternate days until healing is well established. Since the actual time spent by a doctor in consultation and needle insertion may only be 5 to 10 minutes, it can be seen that treatment with acupuncture can be wasteful of professional time unless properly organized. This consideration is reflected in the organization of clinics in China in which one doctor with a receptionist and nurse may treat up to 10 or 12 patients per hour on couches in a large room, without screens, so that all patients can be observed by the supervising nurse. This, coupled with the long life of a needle, makes acupuncture a very inexpensive therapy.
Suppression Suppression--a subject dear to the heart of hom~opaths---is clearly recognized in TCM and is called "Bian Zheng" ("transmutation~of proof"). "Bian Zheng" may occur due to mistaken therapy or prescription. An example of "Bian Zheng" in Chinese medicine would be the treatment of measles or eczema causing the rash to disappear and to reappear later as asthma. In this example treatment has caused suppression of the superficial disease and its reappearance as a proof of illness on a deeper level.
The theory of miasms The miasmatic theories of Hahnemann were foreshadowed by the authors of the "Neijing" and can be discussed in two ways. Firstly there is the concept of Qi. I mentioned earlier that Qi has many sub-divisions; the most important of these being " Y U A N QI" or "PRIMARY Q I " - - t h e essential force of life (known also as "JING QI"). This is inherent and inherited, but is not synonymous with the reproductive cells. This "Yuan Qi" is stored in the kidneys, and all other organs depend upon it for vitality. Poor quality "Yuan Qi" leads quite literally to poor stock and the susceptibility to many diseases and disorders. This idea accords well with the theory of miasms. Within one lifetime on the other hand, the idea of miasm is beautifully encapsulated in the concept of "Biao Ben". Translated literally "Biao Ben" means branch and root. "Biao" is spoken of in medicine to mean the symptoms of the manifestaVolume 74, Number 2, April 1985
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tions of a new disease arising out of Ben which is the defect in the constitution. This concept is usually applied where a primary illness has subsided or been suppressed, only to recur later in a new or varied form. Ben (the root) is the primary illness and corresponds to our miasm, and the secondary on this is "Biao" which is the branch or manifestation of the disease. In considering treatment, the symptoms of "Biao", the new disease, are treated first. When they have subsided then the treatment of "Ben" can be attempted.
Chronobiology All hom0eopaths know the importance of the periodicity of symptoms and the significance of times of aggravation. The same observations were made in Ancient China and "Neijing" states quite clearly that the physician should "do what is suitable for the time". "Neijing" records the effects on humans of circadian, lunar and annual rhythms and discusses it in terms of Yin Yang theory and the waxing and waning of vitality in correspondence with these rhythms. It also notes that host resistance is lower at night. 14 Vital force (Qi) and blood circulate in the body channels--the amount varying in the channels and organs according to the time of day. This forms the basis of a theory of point selection in acupuncture. To make a simple comparison: Consider diarrhoea at 5 a.m. driving the patient out of bed, coupled with aversion to cold. To most hom0eopaths this would indicate a probable first choice of Sulphur as the remedy. Diarrhoea at 5 a.m. is well known to the practitioner of TCM, and it indicates that the kidney (responsible for control of body water) is weak and not fulfilling its command functions. The colon therefore fails to reabsorb fluid and a diarrhoeic stool results. In both therapies the diagnosis and treatment depends upon the timing of diarrhoea at 5 a.m. coupled with the modality; the underlying pathology seems irrelevant: "Neijing" emphasizes several times that "Therapy must suit the time local conditions and the individual"--in other words, the use of acupuncture and drugs must be varied according to biological rhythms. In effect, this means that the acupuncturing physician altered his needling sites according to the time of day or got up at night, if necessary, to give the optimum treatment to a particular acupuncture point. "Neijing" demanded that doctors thoroughly understood the rhythms of nature and the diagnostic-therapeutic importance of noting the times of aggravation of symptoms and of any periodicity: 15 Periodicity is ~mportant also to homceopaths in considering such remedies as Kali bich. (daily) Lachesis (14 days), Sepia (28 days) and Nux vom. (28 days). Sepia and weakness of the Qi of the spleen The following passage is taken from the book "Essentials of Chinese Acupuncture" which is the official text book used by schools of Traditional Chinese Medicine in China. The passage concerns the weakness of the vital energy (Qi) of the spleen. Clinical manifestations "Sallow complexion, anorexia, oedema and lassitude. Distension and bearing84
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down sensation of the abdomen and prolapse Of the rectum and uterus or chronic haemorrhage, such as purpura, bloody stools and uterine bleeding; pale tongue, thready pulse of Xu type. If there is evidence of Xu (deficiency) of the Yang of the spleen there may appear cold manifestations such as chilliness and cold limbs, in addition to the symptoms and signs mentioned above. The aetioiogy of this condition includes excessive mental strain or protracted disease and multiparity. When the Qi of the spleen is weak it loses its ability to uplift the tissue so that there is distension and bearing down sensation. "Weakness of Qi of the spleen which controls blood, is also the cause of various kinds of chronic haemorrhage. Deficiency of the Yang of the spleen is the cause of chilliness and cold limbs since Yang is warmth-producing.'16 Deficiency of Qi of the spleen is beautifully covered in a quote from Margaret Tyler: "Ptosis, ptosis everywhere".17 Tyler was describing Sepia; Sepia (Wu Tse Ku) is used in China, in decoction, for metrrohagia, leucorrhoea and spotting. It is also used for nocturnal seminal emission for which both Kent ~sand BoerickO 9 have it in the highest type. In TCM such "wet dreams" are one sign of deficiency of the Yin of the kidney--a diagnosis which in both sexes includes mentals such as the fatigue of spirit and aversion to sex, and physicals such as infertility, low back soreness, and weakness of the knees. Whilst this diagnosis depends heavily on mentals, the use of Sepia in China depends more on the diagnosis of deficient kidney Yin than on the specific mentals of Sepia, which do not seem to have been recorded. Sepia or squid is a common food in China and found everywhere quite cheaply. Eating squid soup in a famous restaurant in Peking, the interpreter told me with a smile, that I was eating the very same important recipe prepared for the Emperors of China who had many wives and concubines to keep happy. Hughes himself records that he used the 12th potency of Sepia and knew of no records indicating activity below the third. 2~However, the Sepia decoctions and soups used by TCM doctors are undoubtedly, but unconsciously, hom~eopathic. They serve as a reminder that hom~eopathy is concerned primarily with similarity and only secondarily with potency. It is worthwhile also noting, at this point, that the ordinary people of the Orient, and here I include countries beyond China, are much more aware of the therapeutic qualities of the food they eat than are we in the West.
Some TCM prescriptions The TCM doctor, having taken his constitutional history, may decide to use prescribed remedies. If so, he usually uses them in an allopathic way; that is in opposition to the progress of the disease. The traditional pharmacy is a herbalist's and hom0eopath's delight: large cabinets of mahogany comprising deep square drawers full of shells, barks, buds, seeds, insects and other animal products. The aroma is wonderful and I used to put my nose through the pharmacy door daily for a quick sniff on my way to the acupuncture clinic. Although proprietary combinations of traditional medicines are available, a doctor will usually prescribe an individualized preparation; each constituent chosen especially for that patient; the prescription will conform to the rules of compatibility of herbs, but even more Volume 74, Number2, April 1985
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importantly to the rules of Yin Yang. It is also possible to purchase tonics which adhere to the doctrine of "Eat like to improve like", thus if the kidney is diseased, then the patient is advised to eat ox or lamb kidney. When the brain is disordered, he eats brain. Impotence is treated by eating the male organs of ox, deer or dog (a form of hormonal replacement therapy); this form of therapy is well known on the European Continent and to anthroposophical prescribers. Other medicines may be prescribed on the basis of the Doctrine of Signatures in an effort to improve body or organs which have similar shape or pathological consistency; thus toad sk!ns may be prescribed for warty or unhealthy skin, or deer horn for the impotent man. Extract of cicadas, well known for their loud screeching, are believed to help those with vocal disorders. 21 However, the homoeopathic principle was not totally unknown in Ancient China, but any homceopathic prescribing done today is not done consciously on the Doctrine of Similars, but rather on the basis of traditional experience.
Homaeopathic references in Ancient Chinese writing By courtesy of the Librarian of the Nanjing College of TCM, I obtained three definite references to the use of medicines on the basis of the Doctrine of Similars in Ancient China. 22 The root and stem of Rheum palmatum (Rhubarb) known as "Da Huang" is referred to in Shen Nong's Herbal (200 BC) as a purgative. However, by the l l t h century AD in the book Su Wen, it is recognized that "Da Huang" prepared with wine could be used for the treatment of diarrhoea or dysentery with pus, bloody stool and tenesmus. The name of this book, Su Wen, by the physician Liu Wan Su, is of interest itself, being fully translated as "a collection of prescriptions for protecting the life according to the aetiology of disease and circulation of Qi". It will be noted that the aetiology and the condition of the vital force form the basis of a prescription--principles that are well known to the homceopathic doctor. The second reference concerns the Chinese herb "Ban Xia" (Synonyms pinellia turnata or Thunbergia breit) which in the raw state causes vomiting in the healthy p e r s o n - this condition is known as the "abnormal ascent of stomach Qi". However, as early as 200 BC in Shen Nong's Herbal, it is recognized that "Ban Xia" properly prepared is used to suppress the Qi which is abnormally ascending from the stomach, i.e. vomiting, and could also be used to suppress the abnormal ascent of Qi from the lung, i.e. coughing. The third example concerns "Lang Dang Zi" (Hyoscyamus niger) which is well known to us as being a very violent remedy from poisoning and proving. The Chinese knew this herb well. Shen Nong records that, "overeating of Lang Dang Zi makes a man run violently with mania and mental disorder". Five hundred years later, another physician, Tao Hong Jing, recorded in the Transactions of Famous Physicians that "Lang dang Zi could be used to treat epilepsy, mania and wind epilepsy" (grand mal). Many other homceopathic indications can be found in the translation of the Barefoot Doctors Manual. These include-Whole scorpion for the treatment of "wind arising from fire in the liver" A condition of convulsions, neck rigidity, opisthotonos and coma. 23 Clarke has 86
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Scorpio for tetanus, presumably based on toxicology 24 The aconites, Chuan Wu and Ts'ao Wu, are used for wind-chill numbness. Spasms of the extremities. Wind blown headaches. Abdominal pain due to cold. Sciatica and arthritis, and interestingly for uterine cancer. 25 Cimicifuga is used for menorrhagia. 26 Thlaspi (Capsella pastoris bursa) is used for haemorrhages which it can cause. 27 Valeriana is used for hysteria, neuraesthenia and insomnia. 28 Arctium lappa for boils, abscesses and hordeolum. 29 Cantharis is used for scabies, fungal infections and rabid dog bites for which Boericke has it 3~ (hydrophobia). It would not really be surprising that in such long continuous herbal tradition, the homceopathic principle might exist. What is surprising is that greater use is not made of it. Similarities of points and remedies In general, homceopathic remedies and points of acupuncture have much in common, i.e they can be used for local or constitutional effects and their actions vary with potency or strength of stimulus. One remedy or one point may be used to treat a whole variety of differing diseases with the expectation of success if properly diagnosed and prescribed. The phenomenon of gratuitously cured symptoms occurs in both homceopathy and in acupuncture, and is the basis of repertory additions in both systems. The question arises: are homceopathic remedies and points of acupuncture compatible in use? A Frenchman, Dr Roger de la Fuye in Traitee de l'Acupuncture 1956, lists ninety-six commonly used remedies which he, on the basis of clinical experience, equates with acupuncture points. I cannot comment critically since I have not seen the original book. However, I will give two examples from his list. (1) Acupuncture point Taiyuan (Lung 9) is said to be equivalent to three remedies. When stimulated by rapid deep thrusting and high frequency rotation with large amplitude (known as "reduction" or "sedation" of the point). It may be said to be equivalent to Sanguinaria for the treatment of: sudden feeling of hot and cold, hot flushes arising from below; neuralgias , claustrophobia, migraine, nausea with vomiting, conjunctivitis and insomnia. Alternatively when stimulated weakly by low amplitude manipulation ("reinforcement") symptoms resembling Carbo vegetabilis and Ammon. carb. may be treated re. asthma (deficiency type), dyspnoea, respiratory wailing noises, pulmonary pain, emphysema. (2) Acupuncture point Shen men (Heart 6) is used for psychological and physical cardiac diseases and may also be treated by reinforcing or reducing. By reinforcing (gentle stimulation) it is equivalent to Crataegus in its effect on physical cardiac diseases: e.g. precordial pain; congestive cardiac failure; irregular heart rhythm; cardiac oedema and retention of fluid. The reducing method applied to this point is used for fear; hallucination; hysteria; dream disturbed sleep; functional disorders such as palpitations; red face; tonsillitis; cold feet; shivering and fear of cold. This is the homceopathic equivalent of Aconite. 32It is therefore interesting to note that in Chinese medicine "the heart houses the mind" and that the translation of the name of this point, "Shen men", is "gate of the spirit". Volume 74, Number 2, April 1985
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A Modern military use for acupuncture Military doctors down the ages have always had difficulty in providing adequate pain relief for the terrible wounds of war. In ancient China, military doctors have used acupuncture for men and animals in the service of the emperors and war lords. The modern Chinese People's Army have made many contributions to acupuncture research. A symposium was held at the Royal College of Surgeons in London in 1983 to discuss the medical aspects of the Falkland Islands conflict. Analgesia was a problem on the hospital ships and Surgeon Lieutenant Henley of the Hospital Ship Belfast reported that he used hypnosis or electro-acupuncture on several occasions with excellent results. 33 Acupuncture needles are very light, strong and re-usable, ideal for a medical battle pack. The electrical stimulator is an optional extra. Should nuclear war happen, or economic disaster overcome the world, it is probable that drugs as we know them would cease to be available. Homceopaths and herbalists would be invaluable for their knowledge of sources of medication in the countryside. However, in fall-out areas where plants would be suspect because of contamination, acupuncturists would have at their disposal one of the few cheap and effective sources of healing.
The Defence of the traditional system Although I found that TCM and hommopathy had much in common, I must emphasize that the TCM diagnosis bears no relation in most cases to Western medical diagnostic or pathological labels, or to homoeopathy for that matter. It is a completely different system with its own classifications, capable, without the aid of a pathology laboratory or X-rays, of making a diagnosis and prescribing a successful treatment. I found this both fascinating and uncanny. The fact is, of course, that the TCM doctor now has a path lab. and an X-ray department on which he can call if he wishes, but the results available from these sources do not in most cases affect the diagnosis or the treatment. The same is true in homoeopathy. We insist that we are "proper doctors". We have our diagnosis couched in medico-pathological language. We pay scant attention to it in homoeopathic prescribing! Nearly all classical homoeopathic texts and modern teachers insist that the pathological diagnosis is not relevant to the prescription. We do not make a hommopathic diagnosis at all. We say: "Oh, he is a classical Nux Vom.", or "She is a typical Sepia". The point that I am making is that in neither system does the pathological diagnosis affect the choice of treatment. The Falklands experience shows that an increasing number of Western doctors are prepared to use acupuncture. The practice is, however, largely confined to so-called "scientific acupuncture". In the past, in Europe and America, acupuncture, along with hom0eopathy, has been ignored, derided and outlawed, because no one could understand how sticking pins in people would help their disease. Now that acupuncture has been shown to produce measurable changes in endorphin and encephalin in the cerebro-spinal fluid and because this accords with modern theories of pain control, acupuncture has become respectable. Nearly every edition of the BMJ carries an advertisement for a short acupuncture course, and it is one of the few alternatives or complementary therapies which orthodox 88
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doctors are prepared to countenance. I look forward to the time when hom~eopathy also breaks the scientific barriers of physiology and physics--perhaps as a result of the work of the British Homeeopathic Research Group. "New acupuncture" or "scientific acupuncture" runs the risk of the bedevilment with routine specific prescriptions for named diseases. A danger of which all good homoeopaths are aware. Four thousand years of usus in morbis, 34 as Hughes called it, should not be discarded because the language in which it is written is couched in terms which are antique, and were moreover, like the Book of Genesis, an attempt to explain observed phenomena. Traditional Chinese acupuncture has a good empirical working theory which enables successful treatment. The Chinese, proud of their healing heritage, are applying their scientific methods and are trying to refine the accumulated wisdom of the centuries rather than discard it. They are even conducting experiments which are in the nature of provings. My trip to China was a really fascinating experience. In many ways a trip into the past and a glimpse of the future. China wants Western diagnostic equipment and methods--they are learning them eagerly. In return their ancient medicine is being revitalized and is gaining ground in the West. The Chinese do believe that their ancient therapies are superior to the allopathic and surgical methods of the West. Chinese therapeutic concepts based on philosophy, have, I think, much in common with homoeopathic and anthroposophical thought. Earlier in the lecture I quoted Osier poking fun at homeeopathy, but he was a wise man and recognized what TCM doctors and homeeopaths have always recognized, namely, the individuality of the patient. Just listen to this from a lecture to students. "Our study is man as the subject of accidents and diseases. Were we always, inside and out, cast in the same mould, instead of differing from his fellow man, as much in his constitution and in his reaction to stimulus, as in his features, we should ere this have reached some settled principles in our Art.'35 It is strange that he was not a homoeopath. Homeeopaths and doctors of Traditional Chinese Medicine do have settled principles in their respective arts. Though life is short, the Chinese art has been very long. I would, therefore, leave the last words to the Emperor and to his chief physician, Ch'i Po, discussing healing somewhere about 400 Bc. Ch'i Po said: "The utmost in the art of healing can be achieved when there is unity." The Emperor enquired: "What is meant by unity?" Ch'i Po replied: "When the minds of the people are closed and wisdom is locked out, they remain tied to disease. Yet their feelings and desires should be investigated, their wishes and ideas followed; it then becomes a fact that those who have attained spirit and energy are flourishing and prosperous; while those perish, who lose their spirit and energy." The Emperor exclaimed: "Excellent indeed") 6
REFERENCES 1 Lu G and Needham J. Celestial Lancets, p. 271. Cambridge Univ. Press 1980. 2 Osier, Sir William. Principles & Practice of Medicine 8th Ed. London 1912. P. 1131. 3 Verney RE. The Student Life (Philosophy of Osier). P. 39. Edinburgh: Livingstone, 1957. 4 Veith I. Yellow Emperors Classic of Internal Medicine (translation). P. 220. London: University of California Press.
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5 6 7 8 9
lbid (1) P. 105. lbid (2) P. 117. Ibid (3) P. 152. Wu J. Neijing Chronobioiogical Medical Theories. Chin. Med. J. (translation). 1982;95(8):569-578. Veith I. Yellow Emperors. ClassicoflnternalMedicine(translation). P. 120. London: University of California Press. 10 Op. cit. Reprint. New Delhi: Jain, 1981. 11 Personal lecture notes. Nanjing 1982. 12 Liu F and Liu YM. Chinese Medical Terminology. P. 107. Hong Kong: Commercial Press 1980. 13 National Symposia of Acupuncture & Moxibustion, P. 63,513-516. Beijing: Foreign Language Press, 1979. 14 Wu J. Neijing Chronobiological Medical Theories. Cin. Med. J. 1982;95(8):569-578. 15 Veith I. Yellow Emperors Classic of Internal Medicine. P. 219. London: University of California Press, 1949. 16 Op. cit. P. 69. Beijing: Foreign Language Press, 1980. 17 Tyler M. Horrmeopathic Drug Pictures. P. 739. Bradford Devon: Health Science Press, 1952. 18 Kent J. Repertory ofMateria Medica. P. 710. 19 Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory. P. 825. Philadelphia: Boericke and Runyon, 1925. 20 Hughes RH. Manual of Pharmacodynamics. P. 814. New Delhi: Jain, 1980 (reprint). 21 Barefoot Doctors Manual. P. 328. London: Routledge, 1978. 22 Private communication, Nanjing 1982. 23 Barefoot Doctors Manual. P. 248. London: Routledge, 1978. 24 Clarke JH. Dictionary ofMateria Medica. P. 1126. Bradford Devon: Health Science Press, 1977. 25 Barefoot Doctors Manual. Pp. 208 and 278. London: Routledge, 1978. 26 Ibid. P. 225. 27 Ibid. P. 285. 28 Ibid. P. 329. 29 Ibid. P. 215. 30 Ibid. P. 312. 31 Boericke W. Pocket Manual of Homaeopathic Materia Medica and Repertory. P. 691. Philadelphia: Boericke & Runyon, 1927. 32 Lawson D & J. Acupuncture Handbook. Pp. 22, 38. Wellingborough: Health Science Press, 1964. 33 Meredith S. The other victory of the Falklands. Med. News., 10 March 1983. 34 Hughes RH. Manual ofPharmacodynamics. P. 8. New Delhi: Jain 1980 (reprint)i 35 Verney RE. The student Life (Philosophy of Osier). P. 8. Edinburgh: Livingstone, 1957. 36 Veith I. Yellow Emperors Classic oflnternal Medicine. P. 151. London: University of California Press, 1949.
Twenty years ago The British Hom~eopathicJournal, April 1965 NOEL J. PRATT, MRCS, LRCP, FFHOM
The Richard Hughes Memorial Lecture for 1964 was delivered by Dr Kathleen Priestman with the title "Potency in Practice". She said she had been taught to use high potencies, but in time came to see the value of the low potencies. In contrast, 90
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Mr President, Ladies and Gentlemen, I am honoured to be asked to give this Richard Hughes Memorial Lecture. My introduction to acupuncture was an excellent short course by Dr Anthony Campbell in this very Board Room at the Royal London Homoeopathic Hospital. I was subsequently able to take prolonged study leave from general practice and spent three months at the College of Traditional Chinese Medicine at Nanjing, in the People's Republic of China. I intend in this lecture to point out similarities and differences in outlook and practice between homoeopathy and traditional Chinese medicine (TCM). To put TCM in context. The current ratio of TCM to orthodox doctors in China is approximately 1:3. Many modern Chinese do not believe in their own traditional medicine. However, TCM is expanding and the Chinese Government is opening more Colleges of TCM, and nationwide research projects are proving the efficacy of TCM, and of acupuncture in particular. This movement was started by Comrade Mao Zedong whose dicta that "Chinese medicine and pharmacology are a great treasure house of knowledge and experience" and that "the past should serve the present" served as the impetus to this development. Most people's acquaintance with TCM starts with acupuncture, and most Westerners, including doctors, think of acupuncture as somewhat in the nature of the martyrdom of St Sebastian, with all the attendant risks of pneumothorax and other complications. Historically, acupuncture is thought to have been introduced into Europe by Willem ten Rhyjne in 1683. It was he who coined the word acupuncture from the Latin Acus = "needle" and punctura meaning "puncture"! 1 Acupuncture probably went to America with Chinese labour in the 18th and 19th centuries, for in 1826 The North American Medical and Surgical Journal published an article on acupuncture by Dr S. Bache. Later in the same century Dr William Osier recommended acupuncture in his Principles and Practice of Medicine. The eighth edition (1912) 2 was the last to carry this recommendation. On the other hand, Osier poked fun at homceopathy, and in his advice to students The 1983 Richard Hughes Memorial Lecture
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on the difficulty of dealing with the human race as patients he says: "Deal gently with this credulous old human nature with which we work; and restrain your indignation when you find that your pet parson has triturates of the thousandth potentiality in his waistcoat pocket"? Before I can compare, it is necessary to acquaint you with some of the historical background of TCM. The foundation stone of TCM is the book Huang Di Neijing (The Yellow Emperor's Canon of Medicine), which comprises two parts SU WEN (Plain Persons) and LIN SHU (Canon of acupuncture). This book is regarded as the summation of the 2,000 years of experience prior to its publication, somewhere between the 5th to 3rd century BC. It is therefore roughly contemporary with the Hippocratic collection. Today Neifing is still the paramount writing of TCM. It has presided over the health of one-quarter of the people of the globe for roughly 2,500 years. It is therefore a book not to be dismissed lightly, even if current translations are imperfect. It is written as a question/answer dialogue between the Emperor and his chief physician Chi Po, and is full of information. It is however more philosophical than practical, but a few relevant quotations may help to catch its flavour. "Neijing" on the role of the doctor Preventive medicine The superior physician helps before the early budding of disease . . . . The inferior physician begins to help when the disease has already developed: he helps when the destruction has already set in. Since his help comes when the disease has already developed it is said of him that he is ignorant/ To administer medicines to diseases which have already developed and to suppress results which have already developed is comparable to the behaviour of those persons who begin to dig a well after they have become thirsty. ~ The "Neifing" on the relationship of body, soul and disease "When the spirit is hurt severe pains ensue; when the body is hurt there will be swellings. Thus in those cases where Severe pains are felt first and the swellings appear later, one can say that the spirit has injured the body. In those cases where swelling appears first and severe pains are felt later, one can say that the body has injured the spirit. 6
Here follows an interesting statement about Acupuncture--that the cure depends on the patient's own will. The Emperor asked: "When the body is worn out and the blood is exhausted is it still possible to achieve good results"? Chi Po replied: "No because there is no energy left". The Emperor then enquired: "What does it mean--no more energy left"? Chi Po replied: "This is the way of acupuncture; If a man's vitality and energy does not propel his own will, his disease cannot be cured". 7
The Neijing on therapy Neijing lists five methods of treatment in this order. PSYCHOLOGY ("Cures the Spirit") DIET ("Gives proper nourishment to the Body") DRUGS ("Teaches the effects of poisons and medicines") ACUPUNCTURE
CLINICAL MEDICINE ("Examine and treat the bowels, the viscera, the blood and the breath"). Volume 74, Number 2, April 1985
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The concepts in traditional Chinese medicine
TCM has its own complete system of anatomy, physiology and diagnosis. Acupuncture is but one of the available therapies which include herbal medicine, massage, nutrition, manipulation and the therapeutic exercises known as T'ai Chi Ch'uan. TCM considers the living being as a unity whose vitality depends on the uninterrupted flow of life force or energy called "Qi" (pronounced "Chee"). Qi flows around the body and is distributed by means of channels which connect together t h e internal organs and which connect with the surface of the body. Acupuncture points, amenable to needling and to pressure, are found where the channels come to the body surface. The organs of the body are considered to have not only the mechanical functions which orthodox medicine ascribes to them, but are also believed to have organizing functions on emotion, mentality, and other systems, e.g. The heart houses the mind. The liver controls emotional balance. The lung controls skin, hair, and the body's general defences. Diseases are seen as being due to insufficiency or imbalance of energy. The concept of yin and yang, which is applicable to all dynamic systems in nature, deals with the balance and polarity within the body. Yin and yang a r e antagonistic and yet interdependent and complementary. Simplistically, yang is hot, upward going, bright, active and the male principle. Yin is cold, dark, descending, quiescent and female. There are no absolutes in this concept and the Chinese symbol called "Tai Ji" depicts life as a unity with yin and yang intertwined, and merging into each other with yin containing a small amount of yang and vice versa. Circadian rhythms were
Fig. 1. The symbolTAIJIrepresentsthe polaritiesthat existin unity; whichexistin all animateand inanimate systems;they are equal and opposite,withinand yet merginginto eachother.
recognized by the ancient physicians as being due to regular fluctuations of yin and yang. 8 However, if balance is upset, and either yin or yang becomes seriously deficient or greatly excessive, then disease results from the imbalance. If a particular organ is diseased, then the flow of Qi through the channel connected with that 78
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organ, will be out of balance. Stimulation of points on the channel connected to the organ will correct the flow of energy and restore health by restoring balance.
Causes of Disease In homceopathy and acupuncture the modalities are important. In TCM however there are six modalities which are considered to cause disease and these are called the Six External Pathogens (climatic aberrations) Heat Sulphur Summer Heat Glonoine Cold Aconite Damp Pulsatilla Wind Pulsatilla Dryness Bryonia Exposure to excess of any of these modalities would cause disease and, as in homceopathy, would be treated according to aetiology. For example, excess heat disturbs the flow of vital force locally, and causes "stagnation of blood". This leads to pain and is also manifested by boils, carbuncles, abscesses of the teeth etc. It should be noted that heat is the cause, and not simply a by-product, of the disease. Homceopaths would naturally consider the hot remedies Sulphur, Hepar sulph., for these conditions. Whilst the acupuncturist would needle points known to dissipate heat, e.g., Quchi and Hegu (L.I. 11 & 4). Pathogenic dryness characteristically occurs in China's late dry autumn. The voice of Dr R. A. F. Jack reached me in the Nanjing classroom with the words "Bryonia = dryonia". You will, therefore, not be surprised to hear that pathogenic dryness causes painful cracking joints, dry cough, scanty sputum, and chest pain (pleuritis) and a dry rough skin. Pathogenic wind (I~ENG) is a concept which does include meteorological wind, but also applies to manifestations described as being wind-like in the body. Wind is upward-going, expansive, blowing here and there, and with constant movement and rapid change; urticaria, migrating rashes, flitting arthritis. Flitting pains are regarded and treated as being due to wind at points named Fenchi and Fengfu (pool of wind and market of wind). It is an interesting coincidence(?) that one of the main homoeopathic treatments for such conditions is Pulsatilla--the wind flower. During the winter, in China, one sees many people wearing masks of the type we use in operating theatres; even young babies of a few months old are seen wearing su~ch masks. I thought this was a public spirited measure promoted to prevent the spread of upper respiratory disease. I was soon disabused and told that the wearing of such masks prevented the invasion of the interior of the body by pathogenic cold and wind.
Internal Pathogens (Pathological Emotion) The human being is under the influence of emotion, according to circumstances; there are considered to be seven emotions, and an excess of any one of them may cause disease. Five of these feelings are specific and arise from a particular organ Volume 74, Number 2, April 1985
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which may become diseased from the strain of supporting the emotion associated with it damages Liver Excess Anger damages Lung Excess Melancholy damages Heart Excess Joy damages Kidney Excess Fear damages Spleen. Excess Meditation (Brooding) Grief and Fright may damage the Lung and Heart respectively. 9 Such associations, of course, may be used diagnostically since it could be inferred that an easily angered choleric person is suffering from a disease of the liver which is failing in the command function in respect of emotion. The message here is plain: prolonged or excessive emotional stimulation eventually affects the vital force (Qi) and leads to damage of internal organs.
Miscellaneous pathogens This group again includes a number of causes of disease well recognized by homoeopaths and by orthodox doctors. It includes a category known as "Irregular food intake" which comprises excess or deficiency of food, excess alcohol and insanitary food or poisons. These injure the transportation and transformation functions of the stomach and spleen. This category is covered in the homeeopathic materia medica by such remedies as Arsenicum, Lycopodium, Carbo vegetabilis, Sulphur and Nux vomica. Also included under miscellaneous pathogens are excesses of mental activity (Nux vomica), excess of physical activity (Arnica) excessive sexual activity (Silica). Trauma is of course included as a miscellaneous pathogen. The concept of Qi (vital Force) The concept of vital force is familiar to homoeopaths and has been part of many philosophies of medicine throughout the ages. I came to understand Qi as a generalization of genetic influences and of acquired substances from food and oxygen. Qi has many sub-categories, the most important of which is Yuan Qi or genetic influence. Next in order of priority is antipathogenic Qi, which equates to a summation of all defence forces of the body and which is controlled by the lung. The TCM concept that the occurrence of disease is the visible evidence of the struggle between pathogens and antipathogenic Qi, was written down in the "Neijing Su Wen" before the birth of Christ. This concept of struggle corresponds exactly with the homceopathic view; that the symptoms appearing at any moment on the emotional, mental or physical planes, constitute the best possible reaction of the defence mechanism which is attempting to maintain homeeostasis. The reaction may be inadequate or hyperreactive, but it is the best the organism can do. The symptom is an attempt to maintain order whilst the organism regains health. If treatment can stimulate reaction a little more, perhaps cure can be obtained. Hom0eopathy and TCM both attempt to do this; in other words, both stimulate the vital force. The acupuncturist actually speaks of regulating or stimulating the flow of Qi. The TCM doctor, like the homeeopath, is a generalist, and in the TCM clinic the first and most noticeable similarity between the two disciplines is in the diagnostic 80
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process. For a chronic case this could take two or three hours. In the hurly-burly of our Nanjing outpatient clinic it never did. Kent's lengthy article entitled "What the doctor needs to know in order to make a successful prescription ''1~would not put a TCM doctor to shame, even though the diagnostic/therapeutic inferences would be different. The hom0eopath could very easily use a history taken by a good TCM doctor and vice-versa. The Generals, Mentals, Locals, Modalities and the Social History are all there. Failure to ask these questions is being guilty of one of the "Four errors and Five mistakes" mentioned in "Nei jing". A general physical examination follows the history. This examination was quite superficial in the very public examination rooms of our clinic in Nanjing. The traditional reluctance of Oriental patients and doctors to expose the body to extended and deep physical examination may also explain why tongue and pulse diagnosis have reached the state of a high art in Chinese medicine. The state of the tongue has achieved the status of a "General" symptom as compared with its "Local" hom~eopathic interpretation. The interpretation of the qualities of the twelve wrist pulses is not as important as in old China, modern trainees being taught a generalization of the art of pulse diagnosis. A detailed observation is made of face, habitus, body odour, and skin. The whole aim of the diagnostic interview is to achieve a diagnosis which will be based on the constitution of the patient. It must, however, be said that, just as in hom0eopathy, acute local problems are dealt with on the basis of local symptoms. The importance of a good history and examination is shown by the following ancient classification of the skill of doctors in accordance with their ability to achieve correct diagnosis and prescription: thus a "very excellent" doctor needed only to observe his patient to achieve a diagnosis and prescription; whereas a "god-like" doctor, who is not as good as an "excellent doctor", needed in addition, to listen to the sounds of the body and to smell the odour and parts of the body; a "perfect doctor" needed, in addition, to make salient enquiries of the patient and the relatives; and a "technically skilful" doctor in addition to all the above, needed to take the pulses. 11 In taking the history and achieving the correct prescription, a knowledge of the syndromes of disease in TCM is as important as the homoeopath's knowledge of his materia medica. On the other hand, an inexperienced practitioner of either art may yet be confused after asking dozens of questions. The experienced doctor may, by selective questioning, achieve a correct prescription quite quickly.
Professional Negligence in TCM It was written down centuries ago that there were five categories of professional negligence in respect of diagnosis which leads to mishaps, and for which the practitioner is not condoned. Four of these are of special interest to the homceopath. --Issuance of a prescription abruptly, guided only by symptoms, without probing into the underlying cause of an ailment (which may happen to be mental or emotional). --Failure to study and examine correctly the causes behind certain casual symptoms which may be misleading. Volume 74, Number2, April 1985
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- - N o t endeavouring to direct the patient towards an improvement in his life style, which may be the indiscernible basis of the complaint. --Incorrect use of tonics or purgatives resulting in the further depletion of the Qi of the patient. --Failure to apply the principles of Yin Yang doctrine to arrive at a correct diagnosis. ~2 Our tutors in Nanjing emphasized many times that to prescribe on local symptoms was bad practice. That in general, treatment might just succeed if so based, but the failure or worsening of a patient's condition could be expected if treatment was given without consideration of the correct constitutional history. I would remind you that the ancient doctors of TCM who formulated these rules had no blood tests or X-rays available to them. They relied on clinical observation for diagnosis and prognosis. They had astute eyes firmly fixed on their patients. Quite literally their own lives, as well as those of their patients, frequently depended on their powers of observation and deduction. A r n d t - S c h u l t z Law
I was surprised to find that acupuncture (as part of TCM) seemed to conform at least superficially to the Arndt-Schultz Law, and to have a biphasic effect which depended partly on the nature of the stimulation. One of the diagnostic categories into which any disease may be fitted is that of either "excess" (shi), e.g. acute infections fever, or "deficiency" (xu), e.g. the low grade fever and night sweats of pulmonary tuberculosis. Having determined which organs and channels are affected, the acupuncturist will treat by reducing or reinforcing the energy in those channels. Reduction of local energy, e.g. in fevers or in severe pain, is achieved by large amplitude, rotation and deep thrusting for short periods of time, and is usually quite painful. In other words, where the response of the organism seems excessive, a large dose of acupuncture depresses the vital force. Reinforcement is achieved by weak stimulation for longer periods, i.e. if the reaction of the organism and the pathogenic forces are at deadlock, and a chronic "deficiency" situation occurs, a weak dose of acupuncture will stimulate the vital force. The biphasic response to acupuncture has been demonstrated in the blood. Papers published in the 1979 Beijing Symposium 13indicate that in animals, and in man, acupuncture applied to specific points has a biphasic effect, e.g. in patients with initially high white blood cell counts the levels are decreased by acupuncture, whilst the application of needles to the same point in patients discovered to have low initial counts, causes the levels to increase. In both groups there is a tendency after a few hours to return to the status quo. These effects are used therapeutically in appendicitis to reduce high white cell counts, and in neutropenia caused by cancer chemotherapy, to raise the count. Similar regulatory effects have been found to occur in hyper- and hypotension and in excess and deficient gastric motility. If you believe in the phenomenon of aggravation you might add this also to the proof of biphasic action, since it is recognized that many acupuncture patients 82
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experience a worsening of symptoms which precedes improvement. Generally treatment is used which is appropriate to the constitution of the patient. For elderly people and children and intellectuals, shorter periods and relatively weaker stimulation is given with finer needles. For labourers and peasants, much stronger stimulation, for longer periods, with thicker needles, is given. I think you may see a definite similarity between the need for correct potency selection for the constitution of the homceopathic patient, and the acupuncturist's assessment of his patient for choice of needle size and type and duration of needling. TCM also takes a common view with homceopathy that long established disease takes a long time to heal. The treatment continues and is modified as the cure progresses. Unlike hom~eopaths, however, the TCM doctor does not stop once he has stimulated the vital force into a healing momentum. He continues to push by giving "consolidation" treatment at less frequent intervals until the patient is well recovered. Needling treatments on average may take up to 30 minutes daily or on alternate days until healing is well established. Since the actual time spent by a doctor in consultation and needle insertion may only be 5 to 10 minutes, it can be seen that treatment with acupuncture can be wasteful of professional time unless properly organized. This consideration is reflected in the organization of clinics in China in which one doctor with a receptionist and nurse may treat up to 10 or 12 patients per hour on couches in a large room, without screens, so that all patients can be observed by the supervising nurse. This, coupled with the long life of a needle, makes acupuncture a very inexpensive therapy.
Suppression Suppression--a subject dear to the heart of hom~opaths---is clearly recognized in TCM and is called "Bian Zheng" ("transmutation~of proof"). "Bian Zheng" may occur due to mistaken therapy or prescription. An example of "Bian Zheng" in Chinese medicine would be the treatment of measles or eczema causing the rash to disappear and to reappear later as asthma. In this example treatment has caused suppression of the superficial disease and its reappearance as a proof of illness on a deeper level.
The theory of miasms The miasmatic theories of Hahnemann were foreshadowed by the authors of the "Neijing" and can be discussed in two ways. Firstly there is the concept of Qi. I mentioned earlier that Qi has many sub-divisions; the most important of these being " Y U A N QI" or "PRIMARY Q I " - - t h e essential force of life (known also as "JING QI"). This is inherent and inherited, but is not synonymous with the reproductive cells. This "Yuan Qi" is stored in the kidneys, and all other organs depend upon it for vitality. Poor quality "Yuan Qi" leads quite literally to poor stock and the susceptibility to many diseases and disorders. This idea accords well with the theory of miasms. Within one lifetime on the other hand, the idea of miasm is beautifully encapsulated in the concept of "Biao Ben". Translated literally "Biao Ben" means branch and root. "Biao" is spoken of in medicine to mean the symptoms of the manifestaVolume 74, Number 2, April 1985
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tions of a new disease arising out of Ben which is the defect in the constitution. This concept is usually applied where a primary illness has subsided or been suppressed, only to recur later in a new or varied form. Ben (the root) is the primary illness and corresponds to our miasm, and the secondary on this is "Biao" which is the branch or manifestation of the disease. In considering treatment, the symptoms of "Biao", the new disease, are treated first. When they have subsided then the treatment of "Ben" can be attempted.
Chronobiology All hom0eopaths know the importance of the periodicity of symptoms and the significance of times of aggravation. The same observations were made in Ancient China and "Neijing" states quite clearly that the physician should "do what is suitable for the time". "Neijing" records the effects on humans of circadian, lunar and annual rhythms and discusses it in terms of Yin Yang theory and the waxing and waning of vitality in correspondence with these rhythms. It also notes that host resistance is lower at night. 14 Vital force (Qi) and blood circulate in the body channels--the amount varying in the channels and organs according to the time of day. This forms the basis of a theory of point selection in acupuncture. To make a simple comparison: Consider diarrhoea at 5 a.m. driving the patient out of bed, coupled with aversion to cold. To most hom0eopaths this would indicate a probable first choice of Sulphur as the remedy. Diarrhoea at 5 a.m. is well known to the practitioner of TCM, and it indicates that the kidney (responsible for control of body water) is weak and not fulfilling its command functions. The colon therefore fails to reabsorb fluid and a diarrhoeic stool results. In both therapies the diagnosis and treatment depends upon the timing of diarrhoea at 5 a.m. coupled with the modality; the underlying pathology seems irrelevant: "Neijing" emphasizes several times that "Therapy must suit the time local conditions and the individual"--in other words, the use of acupuncture and drugs must be varied according to biological rhythms. In effect, this means that the acupuncturing physician altered his needling sites according to the time of day or got up at night, if necessary, to give the optimum treatment to a particular acupuncture point. "Neijing" demanded that doctors thoroughly understood the rhythms of nature and the diagnostic-therapeutic importance of noting the times of aggravation of symptoms and of any periodicity: 15 Periodicity is ~mportant also to homceopaths in considering such remedies as Kali bich. (daily) Lachesis (14 days), Sepia (28 days) and Nux vom. (28 days). Sepia and weakness of the Qi of the spleen The following passage is taken from the book "Essentials of Chinese Acupuncture" which is the official text book used by schools of Traditional Chinese Medicine in China. The passage concerns the weakness of the vital energy (Qi) of the spleen. Clinical manifestations "Sallow complexion, anorexia, oedema and lassitude. Distension and bearing84
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down sensation of the abdomen and prolapse Of the rectum and uterus or chronic haemorrhage, such as purpura, bloody stools and uterine bleeding; pale tongue, thready pulse of Xu type. If there is evidence of Xu (deficiency) of the Yang of the spleen there may appear cold manifestations such as chilliness and cold limbs, in addition to the symptoms and signs mentioned above. The aetioiogy of this condition includes excessive mental strain or protracted disease and multiparity. When the Qi of the spleen is weak it loses its ability to uplift the tissue so that there is distension and bearing down sensation. "Weakness of Qi of the spleen which controls blood, is also the cause of various kinds of chronic haemorrhage. Deficiency of the Yang of the spleen is the cause of chilliness and cold limbs since Yang is warmth-producing.'16 Deficiency of Qi of the spleen is beautifully covered in a quote from Margaret Tyler: "Ptosis, ptosis everywhere".17 Tyler was describing Sepia; Sepia (Wu Tse Ku) is used in China, in decoction, for metrrohagia, leucorrhoea and spotting. It is also used for nocturnal seminal emission for which both Kent ~sand BoerickO 9 have it in the highest type. In TCM such "wet dreams" are one sign of deficiency of the Yin of the kidney--a diagnosis which in both sexes includes mentals such as the fatigue of spirit and aversion to sex, and physicals such as infertility, low back soreness, and weakness of the knees. Whilst this diagnosis depends heavily on mentals, the use of Sepia in China depends more on the diagnosis of deficient kidney Yin than on the specific mentals of Sepia, which do not seem to have been recorded. Sepia or squid is a common food in China and found everywhere quite cheaply. Eating squid soup in a famous restaurant in Peking, the interpreter told me with a smile, that I was eating the very same important recipe prepared for the Emperors of China who had many wives and concubines to keep happy. Hughes himself records that he used the 12th potency of Sepia and knew of no records indicating activity below the third. 2~However, the Sepia decoctions and soups used by TCM doctors are undoubtedly, but unconsciously, hom~eopathic. They serve as a reminder that hom~eopathy is concerned primarily with similarity and only secondarily with potency. It is worthwhile also noting, at this point, that the ordinary people of the Orient, and here I include countries beyond China, are much more aware of the therapeutic qualities of the food they eat than are we in the West.
Some TCM prescriptions The TCM doctor, having taken his constitutional history, may decide to use prescribed remedies. If so, he usually uses them in an allopathic way; that is in opposition to the progress of the disease. The traditional pharmacy is a herbalist's and hom0eopath's delight: large cabinets of mahogany comprising deep square drawers full of shells, barks, buds, seeds, insects and other animal products. The aroma is wonderful and I used to put my nose through the pharmacy door daily for a quick sniff on my way to the acupuncture clinic. Although proprietary combinations of traditional medicines are available, a doctor will usually prescribe an individualized preparation; each constituent chosen especially for that patient; the prescription will conform to the rules of compatibility of herbs, but even more Volume 74, Number2, April 1985
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importantly to the rules of Yin Yang. It is also possible to purchase tonics which adhere to the doctrine of "Eat like to improve like", thus if the kidney is diseased, then the patient is advised to eat ox or lamb kidney. When the brain is disordered, he eats brain. Impotence is treated by eating the male organs of ox, deer or dog (a form of hormonal replacement therapy); this form of therapy is well known on the European Continent and to anthroposophical prescribers. Other medicines may be prescribed on the basis of the Doctrine of Signatures in an effort to improve body or organs which have similar shape or pathological consistency; thus toad sk!ns may be prescribed for warty or unhealthy skin, or deer horn for the impotent man. Extract of cicadas, well known for their loud screeching, are believed to help those with vocal disorders. 21 However, the homoeopathic principle was not totally unknown in Ancient China, but any homceopathic prescribing done today is not done consciously on the Doctrine of Similars, but rather on the basis of traditional experience.
Homaeopathic references in Ancient Chinese writing By courtesy of the Librarian of the Nanjing College of TCM, I obtained three definite references to the use of medicines on the basis of the Doctrine of Similars in Ancient China. 22 The root and stem of Rheum palmatum (Rhubarb) known as "Da Huang" is referred to in Shen Nong's Herbal (200 BC) as a purgative. However, by the l l t h century AD in the book Su Wen, it is recognized that "Da Huang" prepared with wine could be used for the treatment of diarrhoea or dysentery with pus, bloody stool and tenesmus. The name of this book, Su Wen, by the physician Liu Wan Su, is of interest itself, being fully translated as "a collection of prescriptions for protecting the life according to the aetiology of disease and circulation of Qi". It will be noted that the aetiology and the condition of the vital force form the basis of a prescription--principles that are well known to the homceopathic doctor. The second reference concerns the Chinese herb "Ban Xia" (Synonyms pinellia turnata or Thunbergia breit) which in the raw state causes vomiting in the healthy p e r s o n - this condition is known as the "abnormal ascent of stomach Qi". However, as early as 200 BC in Shen Nong's Herbal, it is recognized that "Ban Xia" properly prepared is used to suppress the Qi which is abnormally ascending from the stomach, i.e. vomiting, and could also be used to suppress the abnormal ascent of Qi from the lung, i.e. coughing. The third example concerns "Lang Dang Zi" (Hyoscyamus niger) which is well known to us as being a very violent remedy from poisoning and proving. The Chinese knew this herb well. Shen Nong records that, "overeating of Lang Dang Zi makes a man run violently with mania and mental disorder". Five hundred years later, another physician, Tao Hong Jing, recorded in the Transactions of Famous Physicians that "Lang dang Zi could be used to treat epilepsy, mania and wind epilepsy" (grand mal). Many other homceopathic indications can be found in the translation of the Barefoot Doctors Manual. These include-Whole scorpion for the treatment of "wind arising from fire in the liver" A condition of convulsions, neck rigidity, opisthotonos and coma. 23 Clarke has 86
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Scorpio for tetanus, presumably based on toxicology 24 The aconites, Chuan Wu and Ts'ao Wu, are used for wind-chill numbness. Spasms of the extremities. Wind blown headaches. Abdominal pain due to cold. Sciatica and arthritis, and interestingly for uterine cancer. 25 Cimicifuga is used for menorrhagia. 26 Thlaspi (Capsella pastoris bursa) is used for haemorrhages which it can cause. 27 Valeriana is used for hysteria, neuraesthenia and insomnia. 28 Arctium lappa for boils, abscesses and hordeolum. 29 Cantharis is used for scabies, fungal infections and rabid dog bites for which Boericke has it 3~ (hydrophobia). It would not really be surprising that in such long continuous herbal tradition, the homceopathic principle might exist. What is surprising is that greater use is not made of it. Similarities of points and remedies In general, homceopathic remedies and points of acupuncture have much in common, i.e they can be used for local or constitutional effects and their actions vary with potency or strength of stimulus. One remedy or one point may be used to treat a whole variety of differing diseases with the expectation of success if properly diagnosed and prescribed. The phenomenon of gratuitously cured symptoms occurs in both homceopathy and in acupuncture, and is the basis of repertory additions in both systems. The question arises: are homceopathic remedies and points of acupuncture compatible in use? A Frenchman, Dr Roger de la Fuye in Traitee de l'Acupuncture 1956, lists ninety-six commonly used remedies which he, on the basis of clinical experience, equates with acupuncture points. I cannot comment critically since I have not seen the original book. However, I will give two examples from his list. (1) Acupuncture point Taiyuan (Lung 9) is said to be equivalent to three remedies. When stimulated by rapid deep thrusting and high frequency rotation with large amplitude (known as "reduction" or "sedation" of the point). It may be said to be equivalent to Sanguinaria for the treatment of: sudden feeling of hot and cold, hot flushes arising from below; neuralgias , claustrophobia, migraine, nausea with vomiting, conjunctivitis and insomnia. Alternatively when stimulated weakly by low amplitude manipulation ("reinforcement") symptoms resembling Carbo vegetabilis and Ammon. carb. may be treated re. asthma (deficiency type), dyspnoea, respiratory wailing noises, pulmonary pain, emphysema. (2) Acupuncture point Shen men (Heart 6) is used for psychological and physical cardiac diseases and may also be treated by reinforcing or reducing. By reinforcing (gentle stimulation) it is equivalent to Crataegus in its effect on physical cardiac diseases: e.g. precordial pain; congestive cardiac failure; irregular heart rhythm; cardiac oedema and retention of fluid. The reducing method applied to this point is used for fear; hallucination; hysteria; dream disturbed sleep; functional disorders such as palpitations; red face; tonsillitis; cold feet; shivering and fear of cold. This is the homceopathic equivalent of Aconite. 32It is therefore interesting to note that in Chinese medicine "the heart houses the mind" and that the translation of the name of this point, "Shen men", is "gate of the spirit". Volume 74, Number 2, April 1985
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A Modern military use for acupuncture Military doctors down the ages have always had difficulty in providing adequate pain relief for the terrible wounds of war. In ancient China, military doctors have used acupuncture for men and animals in the service of the emperors and war lords. The modern Chinese People's Army have made many contributions to acupuncture research. A symposium was held at the Royal College of Surgeons in London in 1983 to discuss the medical aspects of the Falkland Islands conflict. Analgesia was a problem on the hospital ships and Surgeon Lieutenant Henley of the Hospital Ship Belfast reported that he used hypnosis or electro-acupuncture on several occasions with excellent results. 33 Acupuncture needles are very light, strong and re-usable, ideal for a medical battle pack. The electrical stimulator is an optional extra. Should nuclear war happen, or economic disaster overcome the world, it is probable that drugs as we know them would cease to be available. Homceopaths and herbalists would be invaluable for their knowledge of sources of medication in the countryside. However, in fall-out areas where plants would be suspect because of contamination, acupuncturists would have at their disposal one of the few cheap and effective sources of healing.
The Defence of the traditional system Although I found that TCM and hommopathy had much in common, I must emphasize that the TCM diagnosis bears no relation in most cases to Western medical diagnostic or pathological labels, or to homoeopathy for that matter. It is a completely different system with its own classifications, capable, without the aid of a pathology laboratory or X-rays, of making a diagnosis and prescribing a successful treatment. I found this both fascinating and uncanny. The fact is, of course, that the TCM doctor now has a path lab. and an X-ray department on which he can call if he wishes, but the results available from these sources do not in most cases affect the diagnosis or the treatment. The same is true in homoeopathy. We insist that we are "proper doctors". We have our diagnosis couched in medico-pathological language. We pay scant attention to it in homoeopathic prescribing! Nearly all classical homoeopathic texts and modern teachers insist that the pathological diagnosis is not relevant to the prescription. We do not make a hommopathic diagnosis at all. We say: "Oh, he is a classical Nux Vom.", or "She is a typical Sepia". The point that I am making is that in neither system does the pathological diagnosis affect the choice of treatment. The Falklands experience shows that an increasing number of Western doctors are prepared to use acupuncture. The practice is, however, largely confined to so-called "scientific acupuncture". In the past, in Europe and America, acupuncture, along with hom0eopathy, has been ignored, derided and outlawed, because no one could understand how sticking pins in people would help their disease. Now that acupuncture has been shown to produce measurable changes in endorphin and encephalin in the cerebro-spinal fluid and because this accords with modern theories of pain control, acupuncture has become respectable. Nearly every edition of the BMJ carries an advertisement for a short acupuncture course, and it is one of the few alternatives or complementary therapies which orthodox 88
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doctors are prepared to countenance. I look forward to the time when hom~eopathy also breaks the scientific barriers of physiology and physics--perhaps as a result of the work of the British Homeeopathic Research Group. "New acupuncture" or "scientific acupuncture" runs the risk of the bedevilment with routine specific prescriptions for named diseases. A danger of which all good homoeopaths are aware. Four thousand years of usus in morbis, 34 as Hughes called it, should not be discarded because the language in which it is written is couched in terms which are antique, and were moreover, like the Book of Genesis, an attempt to explain observed phenomena. Traditional Chinese acupuncture has a good empirical working theory which enables successful treatment. The Chinese, proud of their healing heritage, are applying their scientific methods and are trying to refine the accumulated wisdom of the centuries rather than discard it. They are even conducting experiments which are in the nature of provings. My trip to China was a really fascinating experience. In many ways a trip into the past and a glimpse of the future. China wants Western diagnostic equipment and methods--they are learning them eagerly. In return their ancient medicine is being revitalized and is gaining ground in the West. The Chinese do believe that their ancient therapies are superior to the allopathic and surgical methods of the West. Chinese therapeutic concepts based on philosophy, have, I think, much in common with homoeopathic and anthroposophical thought. Earlier in the lecture I quoted Osier poking fun at homeeopathy, but he was a wise man and recognized what TCM doctors and homeeopaths have always recognized, namely, the individuality of the patient. Just listen to this from a lecture to students. "Our study is man as the subject of accidents and diseases. Were we always, inside and out, cast in the same mould, instead of differing from his fellow man, as much in his constitution and in his reaction to stimulus, as in his features, we should ere this have reached some settled principles in our Art.'35 It is strange that he was not a homoeopath. Homeeopaths and doctors of Traditional Chinese Medicine do have settled principles in their respective arts. Though life is short, the Chinese art has been very long. I would, therefore, leave the last words to the Emperor and to his chief physician, Ch'i Po, discussing healing somewhere about 400 Bc. Ch'i Po said: "The utmost in the art of healing can be achieved when there is unity." The Emperor enquired: "What is meant by unity?" Ch'i Po replied: "When the minds of the people are closed and wisdom is locked out, they remain tied to disease. Yet their feelings and desires should be investigated, their wishes and ideas followed; it then becomes a fact that those who have attained spirit and energy are flourishing and prosperous; while those perish, who lose their spirit and energy." The Emperor exclaimed: "Excellent indeed") 6
REFERENCES 1 Lu G and Needham J. Celestial Lancets, p. 271. Cambridge Univ. Press 1980. 2 Osier, Sir William. Principles & Practice of Medicine 8th Ed. London 1912. P. 1131. 3 Verney RE. The Student Life (Philosophy of Osier). P. 39. Edinburgh: Livingstone, 1957. 4 Veith I. Yellow Emperors Classic of Internal Medicine (translation). P. 220. London: University of California Press.
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5 6 7 8 9
lbid (1) P. 105. lbid (2) P. 117. Ibid (3) P. 152. Wu J. Neijing Chronobioiogical Medical Theories. Chin. Med. J. (translation). 1982;95(8):569-578. Veith I. Yellow Emperors. ClassicoflnternalMedicine(translation). P. 120. London: University of California Press. 10 Op. cit. Reprint. New Delhi: Jain, 1981. 11 Personal lecture notes. Nanjing 1982. 12 Liu F and Liu YM. Chinese Medical Terminology. P. 107. Hong Kong: Commercial Press 1980. 13 National Symposia of Acupuncture & Moxibustion, P. 63,513-516. Beijing: Foreign Language Press, 1979. 14 Wu J. Neijing Chronobiological Medical Theories. Cin. Med. J. 1982;95(8):569-578. 15 Veith I. Yellow Emperors Classic of Internal Medicine. P. 219. London: University of California Press, 1949. 16 Op. cit. P. 69. Beijing: Foreign Language Press, 1980. 17 Tyler M. Horrmeopathic Drug Pictures. P. 739. Bradford Devon: Health Science Press, 1952. 18 Kent J. Repertory ofMateria Medica. P. 710. 19 Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory. P. 825. Philadelphia: Boericke and Runyon, 1925. 20 Hughes RH. Manual of Pharmacodynamics. P. 814. New Delhi: Jain, 1980 (reprint). 21 Barefoot Doctors Manual. P. 328. London: Routledge, 1978. 22 Private communication, Nanjing 1982. 23 Barefoot Doctors Manual. P. 248. London: Routledge, 1978. 24 Clarke JH. Dictionary ofMateria Medica. P. 1126. Bradford Devon: Health Science Press, 1977. 25 Barefoot Doctors Manual. Pp. 208 and 278. London: Routledge, 1978. 26 Ibid. P. 225. 27 Ibid. P. 285. 28 Ibid. P. 329. 29 Ibid. P. 215. 30 Ibid. P. 312. 31 Boericke W. Pocket Manual of Homaeopathic Materia Medica and Repertory. P. 691. Philadelphia: Boericke & Runyon, 1927. 32 Lawson D & J. Acupuncture Handbook. Pp. 22, 38. Wellingborough: Health Science Press, 1964. 33 Meredith S. The other victory of the Falklands. Med. News., 10 March 1983. 34 Hughes RH. Manual ofPharmacodynamics. P. 8. New Delhi: Jain 1980 (reprint)i 35 Verney RE. The student Life (Philosophy of Osier). P. 8. Edinburgh: Livingstone, 1957. 36 Veith I. Yellow Emperors Classic oflnternal Medicine. P. 151. London: University of California Press, 1949.
Twenty years ago The British Hom~eopathicJournal, April 1965 NOEL J. PRATT, MRCS, LRCP, FFHOM
The Richard Hughes Memorial Lecture for 1964 was delivered by Dr Kathleen Priestman with the title "Potency in Practice". She said she had been taught to use high potencies, but in time came to see the value of the low potencies. In contrast, 90
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