Essentials of Complementary and Alternative Medicine (June 1999)

History and Development
The law of similars was first articulated in Germany by Samuel Hahnemann in 1796. His observations and discussion of this healing system were described in the 
Organon of the Medical Art, first published in 1810 (
1
). Five subsequent editions were printed during his career, the sixth and last in 1842, the year before his death. 
His method engendered both antagonism and enthusiasm among his colleagues in the medical profession. A committed group of students, the most famous of which 
in Europe was Clemens Baron von Boenninghausen, complemented the discoveries of their mentor with their own written works and provings (tests on healthy 
individuals) of new medicines. Other Hahnemann students emigrated to the New World, where homeopathy flourished throughout the rest of the nineteenth century 
(
2
).
Hans Graham was the first homeopathic physician to come from Europe to the United States. His arrival in 1825 was soon followed by Constantine Hering, who in 
1844 helped to found the America Institute of Homeopathy (AIH) to promote the practice of homeopathy. The AIH is the oldest national medical organization and 
continues to represent the interests of homeopathic physicians to government, the public, and the insurance industry. Homeopathy flourished in the late 1800s. 
Developments instituted by a number of American practitioners remain essential to homeopathic practice today. James Tyler Kent authored  Lectures on Homeopathic 
Philosophy (
3
), Lectures on Homeopathic Materia Medica (
4
), and Kent's General Repertory(
5
). The repertory (an index used to help select medications for a patient) 
changed the way homeopathy was practiced and forms the basis of computerized repertorization systems used today. Many of the original provings of Hahnemann 
and his disciples were repeated and new substances were also tested. These provings, together with toxicologic and clinical observations of the medicines, were 
compiled in materia medicas. The most famous of these are The Encyclopedia of Pure Materia Medicas by Timothy F. Allen, MD (
6
), and Guiding Symptoms by 
Constantine Hering (
7
), both of which are used daily by modern homeopaths.
A contentious relationship existed between homeopathic and the allopathic physicians since the nineteenth century. The code of ethics of the American Medical 
Association (AMA), founded in 1846, was designed to prevent medical practitioners from associating with homeopaths (
8
).
No one can be a regular practitioner, or fit associate in consultation, whose practice is based on an exclusive dogma, to the rejection of the accumulated 
experience of the profession, and of the aids actually furnished by anatomy, physiology, pathology, and organic chemistry (
9
).
Around 1900, 8% of American physicians' practices included homeopathy, and there were twenty homeopathic medical schools (
9
), including Boston University, 
Hahnemann Medical School, New York Medical School, and University of Michigan. With the changes in medical education catalyzed by the Flexner report in 1910 
and the discovery of antimicrobials, the popularity of homeopathy took a steep decline. Hahnemann Medical School issued its last homeopathic diploma in 1950. 
However, since the late 1970s, there has been a resurgence of interest prompted by the widespread experience of the limitations of the current conventional medical 
model: costs, side effects, depersonalization, and ineffectiveness in treating many chronic and acute conditions. Currently in the United States, there are an estimated 
500 medical or osteopathic physicians who use homeopathy as a primary modality, and many more who use homeopathy on a limited basis. There are another 1000 
practitioners of homeopathy who have other licences (e.g., NP, PA, RN-C, LicAc, DC). Extrapolation of data in a January, 1993,  New England Journal of Medicine (
10
) 
report suggested that 2.5 million Americans used homeopathic medicines; of these, about one third actually visited homeopaths in 1990.
H
OMEOPATHY AS AN
 I
NTERNATIONAL
 M
EDICINE
According to the World Health Organization (WHO), homeopathy is the second most used health care system in the world. Throughout India, most of Eastern and 
Western Europe, and Central and South America, homeopathy enjoys public popularity, government recognition, and support. In France, 36% of the population uses 
homeopathic medicines (
11
), 68% of French physicians consider homeopathic medicines effective, 32% use it in their practice, and all pharmacies carry the 
medicines. Data from the French social security system (
12
) have shown that the total costs per homeopathic physician yearly, including fees, indemnities, laboratory 
tests, and medications, is 46% lower than that of their allopathic colleagues. Homeopaths spend more time with patients, so fees per consultation are 35% higher; but 
the average number of consultations is lower by 25%. Additional cost reductions are noted in laboratory examinations (20%), per diem indemnities (50%), and 
prescription costs (23%), leading to an overall 9% reduction of costs per procedure.
In Germany, 20% of physicians use homeopathic medicines. In Great Britain, 42% of physicians refer patients to homeopaths, and homeopathy is reimbursed by the 
National Health Service. In Scotland, 20% of general practitioners have taken a postgraduate course in homeopathy. In the Netherlands, 45% of physicians consider 
the medicines effective (
13
).
H
OMEOPATHY IN
 P
RIMARY
 C
ARE
Increasing numbers of families choose homeopathy as their preferred method of primary care, seeking a safe, effective treatment that easily adapts to self-care. Many 
patients come to homeopaths after finding conventional treatments an unsatisfactory solution for their specific complaint. Based on a survey of AIH members in 1992 

(14), 82% of patients seen by homeopaths in the United States seek care for chronic complaints, compared with 48% of the conventional primary care population. The 
top 10 diagnoses treated by homeopaths surveyed were asthma, depression, otitis media, allergic rhinitis, headache, psychological complaints, allergy, dermatitis, 
arthritis, and high blood pressure.
The majority of physicians using homeopathy have training in family practice, primary care pediatrics, or general internal medicine, and have supplemented their 
standard education with the study of homeotherapeutics. Most continue to practice in an outpatient setting in their primary care role. As their homeopathic expertise 
develops, many physicians and allied health providers function as specialists, seeing patients referred for homeopathic treatment of specific problems.
Principal Concepts
An approach to healing based on the law of similars can be clearly differentiated from conventional medicine. Most modern drugs either inhibit the growth of identified 
infectious agents, suppress specific processes in the body, or counteract disturbances of physiology. The processes held responsible for the observed pathology 
and/or changes in function are measured by cellular or biochemical markers. Homeopaths have coined the term  allopathy [allos is Greek for opposite] to describe 
those treatments that oppose the underlying physiological disturbance of the disease process. Allopathy is most effective when the underlying infectious agent or 
physiology of the disease process is understood, and the drug is targeted at a known biochemical pathway.
Replacement therapy is a second approach used in modern medicine and is appropriate to diseases of an endocrine nature in which the glands are hypofunctioning, 
or to nutritional conditions in which the specific vitamins, minerals, or amino acids are lacking or poorly absorbed. Again, this system assumes a knowledge of the 
disturbed physiology.
Isopathy, a third conventional approach, has many parallels to homeopathy. Isopathy uses smaller or attenuated doses of the actual substances responsible for 
disease to induce a resistance in the organism to developing the actual disease. Examples of isopathy are allergy desensitization and immunization. Although the 
production of protective antibodies in immunization is understood, the mechanism by which desensitization works is less well known; it depends on complex feedback 
loops within the immune system.
L
AW OF
 S
IMILARS
The law of similars, as used in homeopathy, is based on empirical observations. A medicinal substance given to healthy people provokes a reproducible set of 
symptoms on mental, emotional, and physical levels. The process by which homeopathic medicines are tested on healthy volunteers is referred to as  proving (from the 
German prüfung, which means “test”). The resemblance of the proving symptoms of a medicine to the symptoms of a patient renders the patient uniquely sensitive to 
that medicine's action. An appropriately selected dose of the similar, homeopathically prepared medicine is capable of stimulating the innate curative responses in the 
body. This curative response occurs with minimal side effects, and often leads to the long-lasting resolution of both acute and chronic symptoms as well as the 
underlying functional disturbance from which they arise.
Although treatment by similars may be conceptually challenging to modern clinicians and scientists, it may account for the paradoxical action of a number of drugs 
used in conventional medicine. For example, psychostimulants (e.g., Ritalin) produce many of the same symptoms in otherwise healthy people that they help to 
control in patients with attention deficit hyperactivity disorder. Digitalis can produce any arrhythmia that it can treat, depending on the dose. The effects of these drugs 
are well documented, but their mechanism of action is not well understood.
T
HE
 M
INUTE
 D
OSE
In addition to the law of similars, other aspects of homeopathic theory are controversial. The most significant controversy surrounds the minute dose of the medicine. 
Some modern pharmacists jokingly refer to the “homeopathic dose,” by which they mean a dose too small to have an effect. In homeopathy, the principle of the 
minimum dose states that one should use the smallest dose and lowest frequency of repetition possible. All good medical practice would agree with this principle. But 
homeopaths have taken the idea of the minimum dose to a degree that defies any verified law of physics or biochemistry. Homeopathic medicines are prepared by 
process of serial dilution and agitation. The concentration of the diluted medicine is often so dilute that no molecules are measurable. Furthermore, homeopathic 
medicines are classically given in single doses at intervals ranging from minutes to months.
T
OTALITY OF
 S
YMPTOMS
In addition to the law of similars and the minimum dose principle, there is a third way that the homeopathic model differs from the conventional medical model. The 
homeopath tries to comprehend the totality of symptoms. The homeopath views the signs and symptoms of illness as a representation of the organism's attempt to 
heal itself. These symptoms, rather than being viewed as an enemy, become the window into the healing efforts of the organism. To apply homeopathy, the physician 
does not need to know the underlying pathophysiology involved. Hahnemann went so far as to state that “diseases are not mechanical or chemical alterations of the 
material substance of the organism .... They are solely spirit-like, dynamic mistunements of life” (
1
). Hahnemann believed it is impossible to know the hidden causes 
of disease, and that fully knowing the “deviations ... felt by the patient himself, perceived by those around him, or observed by the physician himself” were all that is 
needed to cure a disease (
1
).
In other words, disease exists on a dynamic or energetic level before the appearance of measurable and observable changes. This concept is similar to the  chi in 
acupuncture, which describes an organized energy system in the body that causes all physical events to occur. Disease is, first, the disruption of the energy of the 
system. That disruption is experienced through signs and symptoms. Molecular and tissue changes occur from the energetic disruption. In practice, what is curable by 
homeopathy is known through the signs and symptoms displayed by the organism to the observing physician. These dynamic changes can be cured only by dynamic 
medicine. Dynamic medicines affect the energy system, or the vital force, active in the body. When the energy is balanced, the signs and symptoms of the disruption 
resolve spontaneously. Homeopathic medicine communicates information to this system that assists autoregulation.
Conventional medicine attempts to know disease by understanding what is clinically observable and by knowledge of the hidden pathophysiologic disturbances of the 
organism. Categorization of disease proceeds by defining what is common in people with a given condition, and then through objective measures: pathology 
specimens, biochemical markers, radiologic images, and electrophysiology. The unique characteristics of the patient are less important. This perspective has led to a 
therapeutic system that treats conditions rather than patients; it is often described by patients as depersonalized.
Homeopaths emphasize the characteristic, or individualizing, subjective symptoms of the patient (i.e., the totality of symptoms). The medical diagnosis of the patient 
carries less importance to the homeopathic prescription than the patient's temperament or the sensations experienced and reported by the patient or observers. 
Homeopaths describe a state of the patient that needs to be cured; they describe this as synonymous with the state produced in the provings by the most similar 
homeopathic medicine. Therefore, patients with a single diagnosis may receive any medicine in the homeopathic  materia medica; and patients with disparate 
conditions (e.g., migraine headaches, acute pharyngitis) may receive the same medication.
Modern homeopathic physicians, with their conventional training in the pathophysiologic basis of disease, operate simultaneously in two world views, recognizing the 
strengths and limitations of both. Surgery is needed when mechanical disturbances are present or the results of an underlying disease process have led to physical 
changes that are beyond the abilities of the organism to repair. Conventional replacement therapies are essential at times when the body's own sources have become 
inadequate. Allopathic medications are often lifesaving in acute disease; however, in many acute conditions, they are overused, and in chronic disease may lead to 
side effects that occasionally rival the severity of the underlying disease process.
THE HOMEOPATHIC PHARMACY
The preparation of homeopathic medicines follows guidelines defined in the Homeopathic Pharmacopoeia Convention of the United States (HPCUS), with oversight 
by the FDA. The HPCUS was grandfathered into the original Food, Drug and Cosmetic Act of 1938 and was also written into the Medicare Act in 1965. With few 
exceptions, homeopathic preparations are in the over-the-counter classification, although the HPCUS was included in the 1970 Controlled Substances Act. Forty-five 
percent of homeopathic medicines are sold through health food stores.
The modern terminology for the process of producing a homeopathic medicine is  serially agitated dilution (SAD). Classical homeopathic texts refer to it as 
potentization, referring to the observation that the more dilute the substance, the more powerful and specific its effects are on the human organism. Homeopathic 

medicines are manufactured from substances of plant, mineral, animal, or even disease origin. The preparation of each medicine is specified in monographs approved 
by the HPCUS.
Preparation of a Homeopathic Medicine
The original substance is initially dissolved in pharmaceutical alcohol. One part of this solution is mixed with nine (decimal, D, or X) or ninety-nine (centesimal, C, or 
CH) parts of distilled water or pharmaceutical alcohol and vigorously agitated, or succussed. This process of serial dilution and agitation is carried out until the desired 
potency is achieved. The dilution of typical low potency remedies range from 6X (10
-6
) to 12C (10
-24
), intermediate potencies from 30X (10
-30
) to 200C (10
-400
), and 
high potencies from 1000C or 1M (10
-2000
) to 100M or CM (10
-100,000
). Substances that are insoluble in water or alcohol are initially triturated—ground in a mortar and 
pestle—and then serially diluted using lactose in a manner parallel to the liquid method. At the concentration at which the lactose mixture becomes soluble, 
preparation continues using alcohol dilution. The solution in which the medicines are prepared may be used directly, sprayed on sugar pellets of various sizes, or 
mixed with lactose and pressed into a tablet form.
A standard dose of a homeopathic medicine is 1 to 5 pellets, taken sublingually, with nothing else in the mouth for 10 minutes before or after the dose. The dose is 
repeated when the action of the first dose is exhausted; this can range from minutes to years, depending on the response. During the time a patient is using 
homeopathy or the action of the homeopathic dose is continuing, many practitioners recommend that certain exposures, thought to be antidotal to many homeopathic 
drugs, be avoided. These recommendations vary but include avoiding coffee, strong aromatic oils such as camphor and mint, invasive dental work, exposure to 
electromagnetic fields, MRIs, electric blankets, and ultrasound.
A discussion of the extraordinary dilutions used in homeopathic medicine is given context by referring to the concept of Avogadro's number from basic chemistry. 
Avogadro's number is the theoretical number of atoms or molecules in a mole, or the gram molecular weight of a given substance. For example, a mole of sodium, 
with a gram molecular weight of 22.99, and platinum, with a gram molecular weight of 195, both have the same number of molecules (6.02 × 10
23
). Therefore, at a 
dilution of 12C or 24X (10
-24
), the probability of there being a molecule of the original substance in the solution is 1:10. Given the high level of dilution, the activity of 
homeopathic medicines is thought to follow from properties of the solvent water conferred to it by the original substance, not the molecules themselves. For the 
scientist grounded in concepts of chemistry and molecular biology, the observation that medicines that contain no molecules could have biological activity defies all 
logic, and is frankly unbelievable. But this is precisely what homeopathic proponents claim and is increasing demonstrated in controlled trials (
15
).
Although evidence of the biological activity of SADs is accumulating, the mechanism of action of these medicines is speculative. Theoretical explanations have 
revolved around the “memory of water” and a subtle energy system in the living biological systems that can perceive and respond to the information encoded in a 
homeopathic solution. The physicist Callinan (
16
) suggests that the process of succussion (i.e., agitation of the solution) produces energy storage in the bonds of the 
diluent in the infrared spectrum that downloads in contact with the water in living systems. Perhaps the information then spreads like “liquid crystal” through the body 
water, modifying receptor sites or enzyme action. Proponents refer to the observation that nuclear magnetic resonance (NMR) spectroscopy (
17
) of solutions 
containing homeopathic medicines differ from the control solvent that has been similarly diluted and succussed.
The recent discovery of I
E
 structures in water may be the clearest evidence to date of a mechanism of action of homeopathic medicines (
18
, 
19
). I
E
 structures are 
crystalline-like structures of water molecules generated in response to electrical dipoles surrounding ions or proteins in solution. They have a circular symmetry and 
are measurable by ultraviolet transmission; they are also visualized by electronmicroscopy and atomic force microscopy. At ion concentrations below 10
-7
, these 
structures become stable and when exposed to shearing forces, break apart into three nanometer fragments, but then reaggregate into more stable structures that are 
capable of self-replication in more dilute solutions, despite the absence of the original polar molecule. The form that these aggregates take is determined by the 
electrical field of the original polar solute around which they formed. The shape of these aggregates may contain information that is communicated to highly specific 
receptor sites on cell surfaces, antibodies, and so on.
The extraordinary implications of the homeopathic theory challenges the molecular biological model. Publication of the results of homeopathic trials has led to several 
angry exchanges in the scientific press, the most notable being the publication of Benveniste's finding that human basophils degranulated in the presence of 
antiserum directed against immunoglobulin E (IgE) at dilutions of 10
-120
(
20
). More recently, after Pediatrics published research on the homeopathic treatment of 
childhood diarrhea (
21
), the journal later printed a five-page critique (
22
). Subsequent letters pointed out that the opinions of these critics reflected lack of knowledge 
of research design and basic homeopathic principles as well as reflecting a philosophical and political bias (
23
).
The current evidence for the action of homeopathic medicines in a clinical (
15
) and laboratory setting (
24
) are summarized in two meta-analyses. A number of 
high-quality clinical trials have demonstrated the efficacy of homeopathic medicines, but none has ever been independently replicated. Proponents accept this as 
adequate information for practice. Skeptics say such extraordinary claims require objective evidence for a mechanism of action. Both critics and proponents agree that 
more high-quality clinical and laboratory research is needed.
HOMEOPATHIC PROVINGS
Some of the first double-blind, placebo-controlled experiments in human subjects were performed by homeopaths to test their medicine on healthy subjects. Provings 
provide the data on which knowledge of the different homeopathic medicines is based. Standardization in the methodology of provings is a subject of significant effort 
among homeopathic physicians and researchers (
25
).
Provings begin by interviewing healthy volunteers, or  provers, to assess their state of health and record for a period of time their baseline symptoms in a diary. The 
homeopathic medicine is prescribed to each prover in potency for several days or until symptoms begin to develop. The prover records in detail the symptoms that 
develop, including any new thoughts, feelings, changes in sleep, dreams, food cravings and aversions, physical sensations, eruptions, and discharges.
At the end of the proving, each subject is interviewed by the master prover, who is ideally blinded to the substance being proven. The experience of multiple provers is 
synthesized by the master prover with input from the provers. A picture of the remedy arises from these discussions of the proving experience. Key symptoms are 
indexed for possible addition to the repertory. The provings are published in journals or electronic media, making them readily accessible to prescribing physicians. 
The ability to archive and retrieve video images on digital media has made a far richer experience of the provings accessible than the written  materia medicas of the 
past could capture.
The provings lead to a detailed understanding of the effect of homeopathic substances in human beings. Although allopathic drug testing focuses on biochemical and 
physiologic effects, disease-based therapeutic indications, and side effects, homeopathic provings generate a list of the detailed symptoms experienced across all 
organ systems. The provers are used as an instrument through which the symptoms of the medicine are expressed and can be used in healing the sick.
The goal in the development of allopathic medicines is the “magic bullet”—i.e., a drug with very specific therapeutic effects and a narrow range of untoward effects. 
The side effect profile of any medicine is an undesirable but necessary byproduct of this therapeutic system. In homeopathy, these symptoms, side effects, are 
valued; the experiences of provers tell the homeopath the therapeutic indications of the medicine.
Materia Medica
The knowledge of the remedies gained from provings is supplemented by clinical experience. Symptoms that are cured by a specific remedy in multiple patients are 
added to the materia medica of that remedy. The database of symptoms for some of the better known homeopathic remedies often require 80 or 90 pages of written 
text. Access to this information has been dramatically altered by computers. The current database of the homeopathic  materia medica includes information for 
approximately 2500 remedies and consumes approximately 700 megabytes. Programs specifically written to assist homeopathic practice have had a profound effect 
on the quality of homeopathic prescribing over the past two decades, significantly contributing to the renaissance of homeopathy in this same period.