by Michael Tomlinson

The principle of "like cures like" itself had been known since the time of the ancient Greeks.

For hundreds of years, physicians have characterized medicines in terms of the desirable actions they have upon the body...

However, any substance which produces one medicinal effect, however apparently desirable, is likely to produce others which are not so desirable.

...belief in the favorable nature of the trade-off is often little more than an act of faith.

The primary action is the toxic action...

...most of us are familiar with the "side-effects" of taking too much coffee.

In analyzing a case we learn to make a selection of symptoms in the patient which are marked and which are truly distinctive.

Not all of these symptoms are found in every patient, or in a patient at every stage of the illness.

We can often benefit by matching our patient symptoms against such a sub-group of candidate medicines which match the overall condition of the patient.

There is another principle of homeopathy which we have not yet looked at, the most important of all — the principle of similarity itself. As we know, Hahnemann hit on this idea empirically, by taking doses of cinchona bark, the standard treatment for malaria of his day and precursor of quinine, and finding that cinchona bark produced the symptoms of malaria which he previously had not experienced. In consequence, he surmised that cinchona bark was the best treatment of malaria available at that time because of its capacity to produce a similar condition to the disease it was being used to treat.
 
Similar observations had been made before by various medical practitioners and writers throughout the centuries. Hahnemann cites a number of these references in the introduction to his summa, the Organon of Medicine [1]. The principle of "like cures like" itself had been known since the time of the ancient Greeks.
 
However previous writers had failed to generalize sufficiently from isolated observations and had failed to investigate the principle of similarity in a systematic fashion to see how wide its application could be. It had not been developed into a comprehensive system of medical practice.
 
Hahnemann's great contribution to medicine was to do precisely this. He was one of the great systematizers of intellectual history, with a capacity to integrate a vast amount of data and observations culled from his extensive experience and reading and distill fundamental principles. Truly, he conformed closely to the psychological picture we have come to identify with the homeopathic medicine Sulphur.
 
Like other Sulphur types, Hahnemann was never lacking in self-confidence. This is how he introduces his seminal idea in the sixth edition of the Organon (par. 25):  

Now, however, in all careful trials, pure experience, the sole and infallible oracle of the healing art, teaches us that actually that medicine which, in its action on the healthy body, has demonstrated its power of producing the greatest number of symptoms similar to those observable in the case of disease under treatment, does also, in doses of suitable potency and attenuation, rapidly, radically and permanently remove the totality of the symptoms of this morbid state, that is to say, the whole disease present, and change it into health; and that all medicines cure, without exception, those diseases whose symptoms most nearly resemble their own, and leave none of them uncured.[2]

What Is A Medicine?
 
In order to understand fully what Hahnemann is saying here, we have to transform our concept of what a medicine is from the conventional to the homeopathic view. For hundreds of years, physicians have characterized medicines in terms of the desirable actions they have upon the body, of their capacity to oppose the undesirable malfunctions of the body found in a particular illness, and to directly counteract or reduce illness symptoms. The great weakness of this approach is that the actions of medicines on the total mind-body system are many and various, and go far beyond the malfunctioning mechanisms which are being targeted. Any medicine which is ingested is drawn into the bloodstream and carried to all parts of the body, including the brain, where it may produce unintended effects — the so-called "side-effects' of modern pharmacology. The physician is then drawn into a labyrinth trying vainly to understand to what extent the intended effects of the drug outweigh the unintended effects in a particular case. Since it is impracticable to measure all the effects of a given drug on a particular patient, he or she must work in partial or complete darkness in this regard. In any event, it is not easy to justify the conceptual basis of the distinction between effects and side-effects. It rests merely on a value-judgment — effects are desired and side-effects are not. It cannot be founded on the basis that effects are curative and side-effects not curative, as allopathic medicines are generally not curative by their nature.
 
One of Hahnemann's central insights was to cut through this conceptual confusion and say that any medicine, instead of producing effects and side-effects, is characterized by the symptoms it produces, rather than the symptoms it counteracts. In the case of a diuretic, for example, the main desired effect of a conventional medicine is to encourage the kidneys to drain excess fluid from the body. This, however, is not a curative effect, since it takes place only so long as the medicine is present in the body. It is, in fact, a medically-induced symptom which is opposite in character to the symptom being treated. Such a medicine, if given to a healthy person, would drain the body of fluid excessively, and the intention is that it will bring the patient with edema towards normal functioning.
 
However, any substance which produces one medicinal effect, however apparently desirable, is likely to produce others which are not so desirable. Take, for example, the diuretic chlorothiazide, which comes under various brand names. In the guide to allopathic medicines produced by the Australian Consumers Association [3], the uses of chlorothiazide are given as "to remove water from the body, for example in hypertension and in many cases of edema." The drug works by inhibiting the re-absorption of sodium from the urine by the kidneys so that more urine is produced. This sounds reasonable, and we go on to read that side effects are normally "not marked." However, the authors point out that the drug can cause levels of potassium in the body to fall below normal, "and this can cause heart problems, especially in the elderly, those taking digitalis-like drugs and those with coronary heart disease." Since the very patients likely to need a drug for edema and high blood pressure are also likely to have heart conditions and to be elderly, this starts to sound a little worrying.
 
Further on we find that:

Gastrointestinal symptoms may include loss of appetite, nausea, diarrhea or constipation. Occasionally, an unexpected hypersensitivity to the drug may occur, and this is characterized by skin rashes, fever, photosensitivity, and deleterious effects on the blood. Other side effects include fatigue, tingling in various parts of the body, and, occasionally, jaundice.

This is quite an impressive list of possible side effects. Rather than making arbitrary distinctions between those effects we like and those we dislike, it would be more rational to characterize chlorothiazide as a drug which produces greater than normal elimination of salt and water from the body, heart problems, salt and potassium imbalances, gastrointestinal symptoms, fatigue and other symptoms. A practitioner who uses such a drug is counting on being able to make a favorable trade-off between the effects which are wanted and those which are not wanted. It is hoped that the former will be significantly more "marked" than the latter. But since little attempt is usually made to measure all the effects of a drug on a particular patient, particularly the long-term effects in the case of chronic treatment, belief in the favorable nature of the trade-off is often little more than an act of faith.

While some data may be available from clinical trials on the incidence of "side-effects" in a conventional drug, there is rarely any attempt made to draw up an overall balance sheet, so to speak, to try and evaluate whether the overall net effect on the patient is favorable, unfavorable, or whether the positive effects and negative effects cancel each other out. The evidence available to the practitioner about the long-term net effects is usually particularly scanty. And we must always remember that evidence from clinical trials refers to a mythical patient or patients who are representative of the wider population — and such patients do not exist. Only individual patients come through the door of the consulting room whose sensitivity to a particular medicine is unknown.

All of the effects of drugs such as those listed above for chlorothiazide are really toxic effects, including the diuretic action. They are all designed to change the mechanisms of the body away from the state of equilibrium it is currently in. Where that equilibrium is disturbed from its natural state, they act to produce a different state of disturbance which has some desired features. But this approach cannot restore the natural state.
 
Actions of Medicines
 
The homeopathic approach is much more rational. One of the most important core principles introduced by Hahnemann is the distinction between the primary action and the secondary action of all medicines. The primary action is the toxic action, in which the medicine changes the body's state of equilibrium away from its natural state of balance. The secondary action is in effect the body's reaction. Hahnemann postulates, extending Newton's laws of motion into a new field, that for every action on the body there is a reaction. This reaction is the body's attempt to resist the action, and to return to its natural state of balance. This is how he explains it in par. 63:

Every agent that acts upon the vitality, every medicine, deranges more or less the vital force, and causes a certain alteration in the health of the individual for a longer or shorter period. this is termed primary action....To its action our vital force endeavors to oppose its own energy. This resistant action is a property, is indeed an automatic action of our life-preserving power, which goes by the name of secondary action or counteraction.[4]

One of Hahnemann's greatest insights was the realization that this reaction of the mind/body system could be mobilized through the law of similars. Returning to our example of cinchona bark, he realized that the primary action of cinchona bark was to produce malaria-like symptoms such as periodic fevers with chills. These are the toxic effects produced in certain cases by exposure to Cinchona. In the case of a patient who already had these "morbid" symptoms as a result of malaria itself, exposure to Cinchona would produce first an intensification of the patient's existing symptoms (the homeopathic aggravation), and then a reaction of the system which would draw the patient towards health.
 
To take another example which will be familiar to readers who are not themselves expert homeopaths: most of us are familiar with the "side-effects" of taking too much coffee. Excessive intake of coffee will bring about symptoms such as trembling, rapid pulse, agitation of the mind, disturbed sleep and restlessness. We are all familiar with these symptoms, which are brought about by the stimulating effects of caffeine, but many other symptoms are produced by coffee which are less familiar, such as increased production of urine. The caffeine in the coffee is a drug, whose primary action on the body is to produce all these effects, and many others besides. It is only too common to use coffee as an allopathic non-prescription drug - students artificially counteract the mind/body system's natural desire for sleep, for example, when they are studying through the night for exams. It is impossible, however, to escape the secondary effect. Excessive fatigue eventually catches up with us — perhaps during the exam itself!
 
The homeopathic use of coffee is much more creative. Coffea cruda and Coffea tosta (derived from unroasted and roasted coffee, respectively) have very similar, but subtly different profiles of symptoms, including the ones outlined above. Let us consider the case of a young baby with sleeping problems. The baby has great difficulty going to sleep in the evening. He cannot get off to sleep easily by himself, and will lie in bed tossing and turning, and making moaning and crying noises if put straight to bed while he is awake. Eventually he becomes extremely frustrated and the crying builds up in intensity until he is quite distressed. The same problem recurs during the night, causing his unfortunate parents to suffer from their own set of symptoms related to lack of sleep. He wakes up at 12 p.m. or 2 a.m. and becomes extremely alert, looking around him on all sides, eyes opened wide, starting at sudden noises. During the day he sleeps for perhaps 40 minutes at a time, and only a few times. His cheeks are flushed and red-looking.
 
The Portrait of a Patient
 
Most of these symptoms are similar to those listed in T. F. Allen's Primer of Materia Medica and other materia medicas as being produced by coffee. The important thing to home in on is that they are not a motley collection of unrelated symptoms. They are in fact all aspects of a state or condition — the state of over-stimulation of the nervous system brought about by coffee. In the case described we can identify that state fairly easily, but in other cases it is not so easy to characterize the state of the patient overall. But it is crucial. In analyzing a case we learn to make a selection of symptoms in the patient which are marked and which are truly distinctive. We then try and match these selected symptoms as best we can to entries in our materia medica, using various tools (which nowadays include computer searches). This can be moderately easy, in some cases, or fiendishly difficult in others. It can be difficult because of the difficulty of the number of symptoms involved in the comparison.
 
The most well-known medicines are known to produce some hundreds of symptoms. These represent a particular selection from the total number of symptoms which can be produced by the mind/body system, which is vast. Each individual medicine, however, does not produce a completely different set of symptoms, but a distinctive selection from the common pool — and there is much overlap between the sets. To make an analogy, we could imagine that each symptom was represented by a different playing card, so that there were the usual "picture cards" as well as cards numbered one to many hundred, instead of one to ten. The significant symptoms of the Coffea patient could be represented by a Queen, an Ace (representing the most marked and unusual symptoms), a 7, a 13, a 146, a 257 and a 353.
 
We have to match these with the most similar hand from a materia medica, which might contain a number of picture cards and several hundred number cards over and above the ones we are interested in. We would want to find the Queen and the Ace in the materia medica hand — it would be suspicious if they were not present. However a particular candidate would not be ruled out if the materia medica hand contained symptoms which were not in the patient hand, even if they were quite significant.
 
This is because the pool of symptoms in the materia medica hand contains all possible symptoms known to be produced in a range of individuals by the medicine concerned. Not all of these symptoms are found in every patient, or in a patient at every stage of the illness. At the time when a patient first develops symptoms they may be few in number, and confined to one sub-system of the body. As the illness develops, the number of symptoms will grow, and spread to other sub-systems.
 
Match-making
 
So our analysis and consideration of the case is essentially a matter of making and matching — making a selection of the most significant symptoms present in the patient, and matching these with a selection of symptoms in a materia medica entry for a medicine. In order to ensure that there is some focus in the process we look at the incidence or non-incidence of particular symptoms, but the process is imperfect for two reasons. First, certain medicines (the so-called "polychrests") have been studied far more than others. This is partly because they produced a wider spectrum of symptoms than other medicines, but also may be a result of accidents of history. Therefore these medicines will always be statistically over-represented in analysis by individual symptoms. Second, the symptoms themselves are not the primary layer of the illness. They are the manifestations of illness. Because the primary equilibrium is disturbed, at a level we cannot measure or see, the body eventually, in its imbalance, brings forth symptoms. But these are not the primary phenomenon.
 
We can get around this problem by thinking in terms of the state or condition of the patient as well as looking at individual symptoms. Many of the symptoms of Coffea are found in other medicines. But as soon as we start thinking in terms of medicines which produce over-stimulation, then we are drawn towards medicines such as Belladonna, Chamomilla, Coffea, and a few others. We can often benefit by matching our patient symptoms against such a sub-group of candidate medicines which match the overall condition of the patient. Thus the gifted clinicians, such as Kent [5], who have been writing materia medicas since the time of Hahnemann, have been able to draw out the themes in a medicine. These themes derive from the condition or state of the patient, which is at the origin of all the individual symptoms. We are really trying to find a medicine which is a perfect match for the condition of the patient, rather than a perfect match for the patient's individual symptoms, although the individual symptoms are an invaluable guide to that match.
 
Whenever one first encounters a homeopathic materia medica, it can be difficult to read. This is because the indications are the mirror image of the indications in the materia medicas of other schools of medicine. All the indications in the homeopathic materia medica represent the primary symptoms of the medicines — the "negative" symptoms they can produce. However we can work from these collections of primary symptoms to find a medicine which can produce similar symptoms , and thereby initiate a secondary reaction in the patient which will restore the sick to health which, as Hahnemann reminds us, is the physician's "high and only mission."

List of References

[1] Samuel Hahnemann, Organon of Medicine, 6th ed. (New Delhi: Jain, 1842, reprint ed. 1988), pp. 85-91.

 

[2] Ibid., p. 110.

 

[3] David M. Jackson, Ph.D. and Rayner Soothill, M.Sc., Is the Medicine Making You Ill? (Australian Consumers' Association and Angus & Robertson, 1989), pp. 124-5.

 

[4] Hahnemann, Organon, p. 149.

 

[5] J. T. Kent, Lectures on Homoeopathic Philosophy (New Delhi: Jain, 1900, reprint ed. 1987)