Positive Health Online

Over the past two decades, homeopathic medicine has emerged internationally as a potent, therapeutic intervention. I studied homeopathy at the Royal London Homeopathic Hospital in Queen's Square in 1982 and felt myself to be part of what was regarded by my orthodox colleagues as an eccentric minority. I and my fellow students, all medical doctors, were at best tolerated and at worst ridiculed or completely ignored.

I remember attending a medical conference ten years ago where I struck up a conversation with a urologist. We chatted for about ten minutes about what the future held in store for benign prostatic hypertrophy (BPH) and I listened carefully to talk about how surgery would probably be replaced soon by less invasive approaches. I didn't breathe a word about some interesting results I'd had with homeopathic Sabal serulata (Saw palmetto). Finally he asked me what field I was in. I said "Homeopathy" and he did not utter another word, not even bothering to say good-bye or that it had been a pleasant chat! Thankfully this sort of attitude is as rare as rocking horse manure these days, to use a common medical metaphor for rare diseases. When I tell doctors I use homeopathy they are generally quite interested and at worst bemused.

When I studied homeopathy at Queen's Square nearly 20 years ago, they struggled to get doctors to come to their courses. Now the interest is huge with vibrant training courses in London, Oxford, Bristol, Liverpool, Tunbridge Wells and a brand new hospital in Glasgow. There are also at least 20 courses for non-medical practitioners, some of them full-time degrees. What fascinates me is that the emphasis in all these courses for doctors appears to be on the classical approach. This has not always been the case....

Beginnings

Samuel Christian Hahnemann published the seminal text on homeopathy, The Organon, in 1810 and revised it five times before his death. In it he enunciates the famous maxim of homeopathy, similia similibus curentur. (Let likes be cured by likes). This means that substances capable of producing certain sets of symptoms in healthy patients are capable of curing similar sets of symptoms when they are met in an ill patient. This was straightforward enough but its interpretation over two centuries has been very full of controversy and debate. In fact it led to an acrimonious disagreement between homeopaths on either side of the Atlantic. This led to two very different homeopathic schools of thought about which Anthony Campbell, an ex-consultant at the Royal London Homeopathic Hospital, has described articulately in his excellent book The Two Faces of Homoeopathy.[1]

The London Scene

Scholarly homeopaths in London, such as Professor Richard Hughes and Robert Dudgeon, wanted to stick to the letter of similia similibus curentur and would only use homeopathic medicines that matched the actual symptoms in the homeopathic materia medica which had been recorded in the provings (the testing of the medicines on healthy volunteers). Hughes produced a four-volume materia medica, A Cyclopedia of Drug Pathogenesis, accurately based on a careful re-appraisal of the provings. It was hailed as a classic in its time and homeopaths in Britain thought it would be the most important textbook for many years.

In the USA

'Eclectic' doctors of quite a different educational background in the USA had quite a different attitude however. More influenced by the mystical ideas of Emmanuel Swedenborg than by scientific inquiry, famous homeopaths, notably James Tyler Kent (but also Hering, Boericke, Nash, Farrington and many others), took a more pragmatic approach. They observed what type of patient responded favourably to prescriptions of homeopathic remedies. They then included features of that type of patient into the materia medica. So the American materia medicae of the time, notably Kent's Lectures on Materia Medica, included 'symptoms' such as blonde hair and blue eyes (Pulsatilla), fair, fat and flabby (Calcarea carbonic), and ragged philosopher (Lycopodium). Such features are hardly symptoms and were denounced by Hughes and most of his colleagues in London. Nevertheless, this approach became very popular in America and influenced successive generations of homeopaths in England as well.

Today the scholarly works of Hughes and Dudgeon are hardly read at all, while the works of the American school have become classics of homeopathic literature. My personal view of this is simply that the American homeopaths were getting far superior results in the clinic and inevitably seduced some of their English and European colleagues to their way of thinking. It is interesting, in retrospect, to ask ourselves why they may have been more successful in the clinic.

The Classical Approach

My personal view is that it had less to do with their religious beliefs than with their astute observational skills in the clinic. Kent and his colleagues had no compunction about transferring the clinical symptoms observed in the clinic (but not necessarily in the provings) straight into their materia medica. These books of homeopathic medicines have become classics of the literature. Hardly any homeopathic students read the learned works of Hughes and Dudgeon these days, but almost every homeopath reads the works of Kent, Nash, Allen and others. This has resulted in a type of homeopathy practised today that has become known as classical homeopathy.

Classical homeopathy is generally understood to be an approach where a homeopathic remedy is chosen for the whole patient rather than the symptoms of their disease. The term appears to be in common use and I am not infrequently asked by a prospective patient if I am a classical homeopath. The rise of classical homeopathy to its present dominating position owes a great deal to one man, the Greek homeopath, George Vithoulkas. Over at least three decades he has tirelessly promoted, taught and written about the superiority of the classical approach. He has by no means been the only proponent of classical homeopathy. The late Dr Marjorie Blackie, consultant at the Royal London Homeopathic Hospital and homeopath to the royal family won over many British doctors to the homeopathic cause and she was unequivocally classical in her approach and teaching as was her predecessor in the appointment of royal homeopathic physician, Dr John Weir, about whom I have written a short, illustrated article.[2]

There has always been a strong presence of classical homeopathy in Germany, Holland and Switzerland. The Swiss homeopaths Schmidt and Kunzli also practised and lectured on classical homeopathy but their influence was much on the German-speaking homeopathic community and did not reach the international homeopathic scene in the way that Vithoulkas (a self-avowed disciple of Kent) has influenced an entire generation of homeopaths. A few years ago he established the European College of Classical Homeopathy near his home on the beautiful Greek isle of Alonissos. It is an imposing building, purpose-built for teaching homeopathy with magnificent views of the Mediterranean. Many classical homeopaths, both doctors and non-medically qualified practitioners, have made the pilgrimage to Alonissos and Vithoulkas has influenced many eminent teachers of classical homeopathy.

Mechanism and Holism and Homeopathy in 21st-Century Medicine

The last two decades has seen the influence of these homeopaths shift the practice of homeopathy strongly towards the classical approach. The dominance of the whole person-oriented approach amounts to no less than a revolution in homeopathic medicine, with important consequences for patients seeking homeopathic treatment.

A consultation with a classical homeopath, be he or she a medical doctor or not, will feel very different to the patient compared with a consultation with a medical doctor or medical professional trained exclusively within the paradigm of medical science. This is because the doctor or professional who considers himself or herself a practitioner of medical science must necessarily adopt a mechanistic approach in the clinic. My teacher, Dr Eric Ledermann, author of the ground-breaking Philosophy and Medicine[3] has clearly described both the advantages and disadvantages of the mechanistic approach of medical science. In conditions such as acute appendicitis, retinal detachment and meningitis the most appropriate treatment is surgery, laser treatment and appropriate antibiotics respectively. There is no room for homeopathy or any other 'alternative' or 'complementary' medicine - the mechanistic approach is not only the treatment of choice here, it is the exclusive treatment of choice. In situations where there is a risk of mortality, morbidity or irreversible damage, medical science, with its mechanistic approach, is indispensable.

Fortunately the great majority of presenting complaints in medicine do not carry the risk of mortality or morbidity. In all such cases, it is ethical to try a holistic approach before resorting to mechanistic orthodox medicine as a last resort. The holistic approach in medicine can best be understood by looking at what Eric Ledermann has called a holistic stimulus. A holistic stimulus is anything that stimulates the organism to heal itself. It is always focused on the whole person as it aims to catalyse a healing reaction in the organism. You cannot stimulate a disease to heal itself, but it is reasonable to attempt to stimulate the organism to deal with the dis-ease within itself. A fast, a change of diet and an exercise programme are all examples of holistic stimuli, but the homeopathic remedy prescribed according to classical principles is a perfect example of an holistic medicine. In fact, I have often explained classical homeopathy to my patients as "the use of medicines to stimulate the body to heal itself". When patients hear this, they understand why the homeopath needs to ask them all about all sorts of physical details seemingly unrelated to their main complaint as well as trying to build up a full psychological profile. Telling patients that it's all about treating 'likes with likes' doesn't really give them any idea of why you need to hear about them, as well as their diseases. I will now explore some cases where a homeopathic remedy was chosen to suit the whole individual and was able to act as a holistic stimulus and effect a cure.

Case Studies

Case Study 1

A colleague, practising classical homeopathy, recently told me about a woman who consulted her with a strange ophthalmological problem. The patient had injured one of her eyes in an accident. She had received excellent treatment and the injury had healed. However, she was unable to close the eye properly and experienced a spasm of the eyelid every few hours. She had been seen by several ophthalmologists and neurologists, none of whom had been able to make a diagnosis or offer any treatment. My colleague tried some standard homeopathic remedies for trauma such as Arnica and Hypericum but without any result. In fact the eye started to twitch more and then the twitch spread to one of her arms. When this happened, the homeopathic doctor began to view the case in a new way which was much more holistic. Instead of seeing the problem as an eye problem, in spite of the fact that it all started with an injury to the eye, she now saw that the problem was affecting the whole organism. The patient was understandably anxious, but the homeopath wondered if she was in a slightly hysterical state and whether it was this that was producing the symptoms in the eye and the rest of the body. Acting on this assumption, she prescribed Ignatia, the main homeopathic remedy for hysterical states. The result was dramatic, with elimination of all twitches and eye spasm. This was an excellent example of holistic homeopathy where the whole person was treated even though the pathology initially appeared to be very localized. Once the organism was stimulated to deal with the neurological hysterical state, all symptoms disappeared.

This case demonstrates a particular type of classical homeopathy based on what George Vithoulkas has called 'essence'. The essential nature of the case was one of hysteria, although this was not initially obvious and was not recognized by the ophthalmologists, the specialists in the apparent area of the disease. However, as soon as this was considered a possibility by the homeopath, the prescription became clear.

Case Study 2

A woman in severe pain consulted a colleague who uses a very passive listening approach in the consulting room. He had asked her to describe the pain, which she began to do. Eventually she remained silent. As is his custom, he remained comfortable in that silence and waited for the next unsolicited symptom to be revealed. The silence continued.... Eventually the patient could take no more of it and, thumping her fist on the desk, she yelled at the doctor "Don't just sit there, do something!" That homeopathic doctor's description of what he did will remain forever etched in my memory. "I gave her Chamomilla and it did something!" This was homeopathic information of the highest order. The patient did not tell him that she had the symptom 'angry when in pain' (a black letter symptom for Chamomilla), she demonstrated it right in front of him. And this would not have happened if he had spoken instead of remaining silent - even though he must have been aware that his patient was not exactly as comfortable with the silence as he was.

This case illustrates how useful it can be for a doctor to remain patient and comfortable with silence in the consulting room, quietly hoping for the real disturbance in his patient to reveal itself. In this case this is exactly what happened. The patient demonstrated how she functioned psychoneurologically and fortunately there was a homeopathic remedy that matched that pattern exactly.

Case Study 3

A patient had booked to see me at 3.00pm for a one-hour first consultation. I had fallen a little behind in my daily schedule and only went down to the waiting room to fetch him at 3.12pm. I called his name and received a surly greeting from a middle-aged man dressed in a 'smart/casual' outfit including a tan leather jacket. I apologized for being late but received no reassuring "It's alright". The vibes weren't good at all, but I decided to remain calm and try to get to the bottom of things. The thought flashed that he might be angry because I was late. But surely not, for only twelve minutes?

In my consulting room, I offered to hang up his jacket, but this was refused, so I began taking a history by asking his name, date of birth, address, etc. He had not finished giving me his address when he could restrain himself no longer. "Dr Kaplan, I just have to say that I resent being kept waiting. I've made a long journey to visit you and time is valuable. I just had to say that...."

I thought of any number of things to say in my defence but something told me that this might be the crucial moment in the whole conversation. I apologized again but without grovelling and told him I was glad that he had spoken openly about how he felt. I went on to ask him about his work. He told me that he was a "cinematographer, traveller and businessman". And he thought he should add, "an ex-alcoholic".

At this point I knew that I had enough to make a useful prescription. The remedy Nux vomica is well suited to high powered, type A individuals, especially those who have sought respite in alcohol. It also suits aggressive, pushy, power-hungry people more than it does meek and self-effacing patients. But I still had not determined why he was consulting me! It came as no surprise to hear that his main complaint was to do with his digestion as Nux vomica is one of the major homeopathic remedies for illnesses of the gastrointestinal tract. At this point, less than ten minutes into the consultation, I knew the remedy was Nux vomica and had to resist the mischievous urge to prescribe it there and then on the pretext of not wasting any more of his precious time! I resisted the temptation and the rest of the hour revealed many symptoms that confirmed Nux vomica as the remedy that suited both his problem and his underlying constitution. I prescribed it in high potency.

A month later he returned to tell me, albeit with some reluctance, that he was feeling much better. The point of this case is that a patient may exhibit essential clues to his or her homeopathic remedy at any stage of a consultation. Michael Balint, the psychoanalyst whose classic text, The Doctor, His Patient and the Illness,[4] was a seminal influence on a generation of general practitioners, drew our attention to the importance of the apparently offhand comment made by the patient as he leaves the consulting room. This case shows how the patient may on occasion tell you almost everything you need to know in the first few seconds of your relationship with them. Classical homeopathy rewards the vigilant and the observant.

References

1. Campbell A. The Two Faces of Homoeopathy. Robert Hale. London. ISBN 0709020821. 1984.
2. The article 'Sir John Weir, Homeopath to Kings and Queens' can be read on http://www.drkaplan.co.uk/news.htm
3. Ledermann, EK. Philosophy and Medicine. rev. ed. Gower Publishing. London. ISBN 0-566-05062-5. 1986.
4. Balint M. The Doctor, His Patient and the Illness. Pitman Medical Publishing. London. ISBN 04430361525. 1957.