It is my intention in this series of articles to introduce a wide range of homoeopathy, drawn from many schools, outlining therapies and practises on the margins of mainstream homoeopathy. It is not my aim to teach the techniques outlined here, nor is it my intention to advocate them in any way, nor to encourage their use. My sole intent is to draw readers' attention to a wide range of therapies on the margins of classical homoeopathy so that they can decide for themselves upon the usefulness of such therapies.

An obvious answer is that classical homoeopathy is that form of homoeopathy expounded by Hahnemann. Unfortunately we do not have any clear idea of exactly what form of homoeopathy he expounded. There are six different editions of the Organon (each differing fundamentally in the way homoeopathy is approached) and analysis of Hahnemann's actual practise notes suggests a much less dogmatic idea of homoeopathy. Hahnemann, at times, seems to have treated the disease rather than the whole person. For instance, in Paris in his later years, he seems to have prescribed Sulphur at the start of most new cases. His justification seems to have been that psora was the basic problem of mankind, so he used his best anti-psoric remedy. This could be seen as prescribing on a disease (called psora). Another example of Hahnemann's disease-based prescribing is recorded when, in 1825, he recommended Thuja 60C for gonorrhoea.

In the United Kingdom and the United States, the most common form of homoeopathy is that professed by J.T. Kent, and for the purposes of these articles I will designate this as "classical." Kentian homoeopathy is constitutional homoeopathy, prescribing single doses, usually in high potency, on the holistic view of the patient; the basis being that a person is seen as diseased on a spiritual or mental and emotional level first. This imbalance pervades the immaterial vital body initially and finally produces changes at the physical level. Therefore, in order to cure the disease, treatment has to proceed in the same direction, the remedy being aimed towards the innermost mental and emotional state rather that the outward physical expression. Within this model the remedy which acts only on the local symptoms of the disease will result in suppression and will be detrimental to the patient as a whole.

The model outlined above represents one idea of "classical homoeopathy." I do not suggest it is the only way to practise, nor do I claim any supremacy for it. It is, more or less, the way I practise. I practise this way because I was taught this way and because I see that it works. Nevertheless, I do on occasion use non-classical methods, such as combination remedies. I use these methods for the benefit of my patients.

There are two different aspects of the use of combination remedies: the use of combinations by untrained people as first aid measures and the use of combinations by trained homoeopaths in cases other than acute diseases.

Combination remedies are widely available to the general public in many parts of the world and thus constitute the first introduction to homoeopathy for many people. Almost by definition, this use is outside the tenets of classical homoeopathy. Prescriptions of these remedies are disease-based rather than being based on the individual analysis of a particular patient. This forms a convenient method for the lay use of homoeopathy and as such has much to commend it as a simple introduction. Unfortunately, it introduces a form of homoeopathy which classical homoeopaths would label as "unreliable" and which does not include the depth of understanding of the individual's needs required to provide the optimum cure.

Basically these combinations are simply groups of remedies known to be sometimes useful in the cure of a particular complaint. The homoeopathic basis of this is tenuous, although it could be claimed that such methods have been well used historically by healers calling themselves "homoeopaths." Particular constitutional types do tend to suffer from a specific range of ailments, so if we prescribe a group of remedies known to help the ailment presented, say sinus problems, we can hope that one of the remedies will help the patient at a deeper level, while the others at least do no harm. This is not good classical homoeopathy, but it is useful for the lay person and at this level it does give acceptable results.

The method is not entirely without risks, as the assumption that those incorrect remedies included in the combination do no harm is not entirely true. Classical homoeopathy has always claimed that taking the wrong remedy can cause problems, especially if the patient happens to be sensitive to it (although in my practise I have seen little evidence of this). Nevertheless, these combination remedies are usually sold only in low potencies and are carefully selected. They seem to do little harm. In many cases the remedies in the combination are small remedies (such as Spongia, Drosera, and Rumex for coughs) and I see no problem in this. On the other hand, when I see combinations of powerful polycrests on sale (such as Sulphur, Lachesis, Lycopodium and Nux vomica) I am less sure that this is a suitable procedure for the general public. However, there has been little research conducted on these matters and all reports seem to be anecdotal.

I have listed the components of a few combination remedies that are widely available. Readers may find it a useful exercise to research the provings of the individual components to try to understand the rationale behind their inclusion in the particular combination. By this exercise you may gain some understanding in an area that seems to be very little researched.

I will start you off with a common migraine remedy, which I know works well. The combination is Cimicifuga, Iris-versicolor, Sanguinaria, and Gelsemium. Taking these individual components as individual remedies we can look at the provings:

Cimicifuga:

Headache, throbbing;
Migraine;
Pain, from eyes to top of head;
Pain, in eyes, with photophobia.

Iris versicolor:

Headache, over the eyebrows, after blurred vision;
Headache, frontal, with nausea;
Headache, sick.

Sanguinaria:

Headache, sick, periodical < sleep;
Headache, American < quiet < dark room;
Headache, sick < rest.

Gelsemium:

Headache, preceded by blindness;
Headache, pains extending over the head.

Clearly all four of the above remedies are well indicated for migraine, and, consequently, the combination could be considered for use against this problem. But is this truly so? A glance at any comprehensive repertory shows some 250 remedies listed under "Headaches, general" and those above are not even all listed as top remedies. Why, then, select these four as part of a migraine combination? I do not know. The fact that it works is some justification (and some would claim that we should not need excuses to prescribe a particular remedy if it helps the patients) but maybe another combination of different remedies would be better. There are some four thousand million possible combinations of four remedies taken from the 250 indicated remedies and I doubt if all these combinations have been tried yet. It would take over a hundred thousand years to test these if we could test at a rate of 150 per day! We seem to be looking at a clinical evaluation here; someone tried a combination of available remedies in a clinical situation and found this to be useful. Then other homoeopaths tried the combination; they, too, found that it worked; and so its use spread. This is not classical homoeopathy, but if it helps our patients it gets my vote.

Many combination remedies are given in the literature, but the reason for selecting a particular one is seldom explained. For instance, Dr. O. A. Julian in Materia Medica of New Remedies states emphatically, "Astragalus 10X + Chamomilla 10X + Nicotiana Tabacum 10X is sure to be effective . . . in cases of acute asthma". The only proof he offers is a reference to his own earlier work which, when consulted, does not offer a scientifically rigorous justification. Having said that, the combination does seem to work in many cases. In these circumstances a homoeopath can only rely on his clinical experience and that of those he trusts.

It has always been a major tenet of classical homoeopathy that a single remedy be prescribed, and that the remedy should be based upon the therapist's understanding of the constitutional type of the client, rather than on a specific disease. Nevertheless, some homoeopaths continue to ignore these principles, either completely or upon occasion, in their practise.

Hahnemann himself was known to use multiple remedies. I have already mentioned his practise of starting all patients with Sulphur. After that he often used a number of remedies in quick succession. In the Fifth Edition of the Organon, we find Hahnemann writing that for acute conditions two or three remedies are to be used in alternation and recommending that for chronic illnesses two remedies, if both are well indicated, should be used together. It is true that in the same edition he also condemned the use of multiple remedies, but the distinction seems to be whether they are well indicated or not. If we look at his case books, we find that in practise he did use combinations. We see him prescribing Mercurius solubilis to a Mme. Erskine (for a sore throat) while continuing to prescribe Sulphur. Later we see him advising the use of firstly Sulphur and Aconitum in alternation and later Ipecacuahna and Nux vomica, also in alternation, to a Mme. Clouzet. It seems that Hahnemann used combinations only in certain circumstances and that he usually used them in alternation rather than together, but this should not lead us to completely ignore the combination method of prescribing.

First we will consider the prescribing of a small number of remedies, say two or three. Most homoeopathic remedies are combinations, in that very few are pure substances in the chemical sense. Some biologically-based remedies are indeed based on very complex substances (such as snake or spider venom) and even simple remedies (such as Causticum) are combinations chemically speaking. This is acceptable to classical homoeopathy simply because they have been potentised in combination and have been proved as a combination. On the other hand, combination remedies are usually combined after potentisation (often different potencies are combined) and most have never been proved in combination.

How then do homoeopaths use combination remedies, or polypharmacy as it is known? The use of combination remedies to avoid the effort of individualising patients is to be deplored, but the use of combinations to aid a patient is valid. However, it must not be thought that of as an easy option. The use of individually prepared polypharmacy at least needs consideration. J. Ellis Baker used polypharmacy in the 1930s and '40s, working on the assumption that if he saw an indication for a particular remedy it should be applied. Thus a client with constipation, flatulence, an adverse reaction to vaccination, and a family history of tuberculosis would be given Carbo vegetablis, Nux vomica, Thuja and Bacillinum. This is certainly a simple method of prescribing and Baker seems to have produced good results using it. I prefer constitutional prescribing, but on occasion, when I have found constitutional prescribing difficult or ineffectual, I have resorted to this method and had good results. Often, I have found that following such a regime, the patient's constitutional type became clearer and that a constitutional prescription was then required to complete the cure.

On the continent of Europe, the French homoeopath Jacques Jouanny further developed a similar system. He advocated prescribing the patient's constitutional plus a miasmic nosode and one or more low potency remedies for any specific disorders observed. In France this particular method of prescribing has been taken to extreme lengths and often the constitutional remedy is not included. This is known as "French Homoeopathy." I have an example of this, from my case notes: a prescription for a young healthy woman facing dental treatment, which involved fourteen different remedies in various potencies given in seven groups at various times relative to the dentistry. I would have advised Arnica 30C in two doses, the day before treatment and the morning of treatment, and later China 30C to control any bleeding. However, many of my colleague classical homoeopaths would have also objected to my treatment of the acute symptoms as non-classical.

There are times when polypharmacy is the only way (e.g. sudden trauma in an unknown client) or when it can be used effectively for minor ailments, but in general I find that a more holistic approach with a single remedy is preferable.

I normally treat clients constitutionally as a classical homoeopath. However, on occasion I do use combination remedies. What follows is one such case from my notes, Case #Z1027 (Mrs. J.L.). The client was a 70-year-old woman in fair health for her age. The presenting problem was a skin disorder on the face to the hairline and on the wrists and arms. She had been under allopathic treatment for the problem for some years, but it had not yielded to conventional medicine and was gradually becoming worse. When she consulted me, it was quite disfiguring and this was clearly causing her some distress. She had stopped taking conventional medicine for the problem presented, but was taking Ranitidine for a hiatus hernia and Amlodipine for high blood pressure. She was also taking a cocktail of proprietary medicines including Vitamin C, multi-vitamin and mineral capsules, bichromium capsules and lecithin granules.

Ranitidine has skin rash as a minor side-effect, but other than that her allopathic treatment did not seem likely to be causing her presenting problem. Both Ranitidine and Amlodipine, however, could have been causing some of her other symptoms (e.g., headache, flushing, nausea, and dizziness). Her intake of nutritional and vitamin complements - she was taking 1000 mg per day of Vitamin C and the lecithin - was not producing any noticeable effect on her skin problem. Consequently, I advised her to discontinue all her proprietary medication, but to continue with the allopathic prescriptions. Her allopathic practitioner was aware that I was treating her and had no objection provided she remained on Amlodipine. She was allergic to milk and milk products.

The first consultation was difficult as most of the symptoms she disclosed were possibly the side effects of her medication and it was hard to identify a good holistic picture. She appeared to be an Arsenicum constitutional type, meticulous in attention to detail, a great, detailed forward planner, a hoarder against a rainy day, a perfectionist. Many of her physical symptoms also pointed in that direction - digestive disorders, diarrhoea, tiredness, headaches, dizziness - but these could have been in part due to her medication. I decided to delay the selection of the first remedy until the next consultation (in two weeks), but she was very keen to start her "homoeopathic cure" immediately so I gave her Calendula Ø cream and some unmedicated Sac. lac. pills. (The prescription of a placebo is legal in the U.K.)

The next session took place as scheduled and confirmed my earlier diagnosis of an Arsenicum constitution. The cream had had no noticeable effect so was discontinued, and I prescribed Arsenicum 30C once daily for seven days and arranged a further session in two weeks.

Two weeks later she returned a much fitter woman, most of her symptoms had disappeared and she was feeling generally very well within herself. But she still had her skin problem as before. She was strangely upset by this. She acknowledged she was much better, but she had come to me to solve her skin problem and I had failed. I tried to explain the fundamentals of a homoeopathic cure, and prescribed Arsenicum 200C. (I do not usually repeat potencies.)

Again she returned with much the same result. She was much, much better in every way, but she still had the skin problem. Her allopathic doctor had taken her off the Ranitidine and she had had no difficulties. The skin problem appeared to be of a Sulphur type, itchy, burning, red, Sulphur 6C in alternation with her constitutional at 30C. She was back within the week with her skin very much worse, but looking Natrum muriaticum rather than Sulphur. It was now bleeding from cracks, no longer itchy. I saw this as a good sign, a possible aggravation even, so took her off both remedies and prescribed Nat-mur. 6C as she was still demanding treatment for her skin. (I resisted the temptation to revert to the placebo)

She returned with her skin problem still troubling her and this time it had reverted to Sulphur: the itch had returned and the bleeding stopped. I was clearly going nowhere with her treatment. Although she was a much healthier person than when we had first met I had not cured her skin problem and that was what she had consulted me about. I then decided to move to a combination remedy and selected:

Anacardium 200C
Sulphur 6C
Bovista 4X
Aconitum 30C

This combination is published in A Materia Medica of Homoeopathic Formulas by B. Copen, under ref C/14, and is one I had used successfully previously. She took it as a single drop twice per day for two weeks, and when she returned her skin was still damaged but was clearly much better with no new eruptions. I discontinued the remedy.

A week later she rang to say there was no change so I posted a further dropper bottle of the same combination remedy with instructions to again take two drops per day. I did not hear from her for over a month, but then she called at my practise, without appointment, and waited to see me between patients. She just wanted to show me her clear complexion of which she was justly proud. The cure was complete. At last it was a complete cure, as far as the patient was concerned. She was clear of a disfiguring skin problem and that was why she had come to me.

There has been no relapse and the last time I saw this client, some four months later, for a recurrence of her gastric problems, I gave her a single does of her constitutional, Arsenicum 200C which cleared the problem without a need for further consultations. She is still taking Amlodipine.

In this article I have presented a view of a very controversial aspect of homoeopathy, and I hope to have provoked some deep thought. I also hope to have caused some consternation amongst my colleagues, especially those who are strictly classical. If that includes you, please do write in and state your view. I would like to see much discussion on these marginal aspects of homoeopathy and I am sure the editor will be able to find room in future issues for letters and articles discussing these matters.