Essentials of Complementary and Alternative Medicine (June 1999)

PROVIDER-PATIENT INTERACTIONS
At first, the patient-physician interaction appears substantially the same in homeopathy as in conventional medicine. The physician sits with the patient, obtains a 
history, examines the patient, and then prescribes a medicine. However, as seen from the previous discussion, the clinical and pharmacological databases, the 
underlying assumptions about illness, and thought processes used for decision-making differ substantially. For the homeopathic practitioner, mastery of both the data 

and approach to the patient can be both refreshing and challenging, and this process is one in which the patient feels at home. The enhanced attention to the 
individual is welcomed by patients and may have an important role in homeopathy's popularity.
Homeopathic Approaches: Complex and Classical Homeopathy
Two important styles of practice have evolved in the application of homeopathic medicines to clinical medicine—classical and complex homeopathy. Classical 
homeopaths use a single medicine prescribed for the totality of symptoms. The second approach, complex homeopathy, uses medicines with a combination of 
ingredients designed to treat a specific condition. To the classical homeopath, the complex approach is not homeopathy, but instead the allopathic use of 
homeopathically prepared medicines (i.e., prescribing medicine based on pathological or diagnosis-based criteria).
C
OMPLEX
 H
OMEOPATHY
Complex homeopathy refers to the use of several medicines simultaneously to achieve relief of a disease state. A number of medicines known to be commonly used 
in a specific condition are combined into a single formulation. This pragmatic approach was developed by the homeopathic pharmaceutical industry, bypassing the 
need for the extensive evaluation required in the classical approach. The underlying assumptions about the medicines are similar to what has already been 
presented, but the need for individualization is limited to that of a conventional, diagnosis-driven, approach. The assumption of the complex approach is that one of 
the elements of the formulation will be the similar remedy. Preparations are designed and labeled for specific clinical entities (e.g., teething, restless children, 
sinusitis, fever, earache). Few of these products have undergone rigorous testing under blinded, controlled clinical trials.
Combination medicines represent 85% of the over-the-counter homeopathic drug market in the United States. They are popular among physicians and the lay public 
because the prescription process is based on a familiar model of disease. For example, a medicine labeled for a sore throat is intended to be used on any sore throat. 
The combination versus single prescription has its parallel in conventional pharmacy. Physicians tend to prescribe a single medicine or several individual medicines. 
The over-the-counter market more often uses combinations of ingredients. Compounds are developed with a rationale based on the known benefit of the individual 
ingredients in a specific diagnosis. The complex approach in homeopathy has been most developed in France and Germany. Only a few of these preparations have 
been subjected to controlled clinical trials and are usually published in proprietary journals. Some complex homeopathic preparations have demonstrated benefit in a 
number of diagnoses, under controlled trial conditions.
The complex homeopathic approach has also been adopted by a group of practitioners who diagnose physiologic disturbance using instruments derived from 
electroacupuncture. These instruments, when placed on acupuncture points, measure disturbances of energy systems, which can then be corrected by placing 
homeopathic preparations in the circuit. Practitioners using this method often prescribe combinations of medicines based on this individualized testing.
C
LASSICAL
 H
OMEOPATHY
In classical homeopathy, patient evaluation has five major components:
1. An interview in which the “totality” of the person's mental, emotional, and physical symptoms is understood.
2. Appropriate physical examinations and diagnostic studies.
3. Analysis of the patient's data using homeopathic methods, often with the assistance of computers.
4. Selection and prescription of the most similar, single remedy, given in minute and infrequent doses.
5. Regular follow-up visits to assess the effect of the prescription and determine if the medication should be repeated, changed, or allowed to complete its action 
without further assistance.
To know what is to be cured has a context in homeopathy that differs considerably from the diagnosis-driven approach of allopathic therapeutics. Homeopathy 
considers the whole person—mental, emotional, and physical. In addition to understanding the patient's medical condition in all aspects, the homeopath must come to 
know them as people: their loves, hates, passions, interests, fears, anxieties, dreams, biorhythms, and reactions to temperature, climate, and food. These 
characteristics are synthesized into a picture, a “totality,” that describes the person's unique response to life and how that defines the person's freedom to express 
and interact, or as Hahnemann expressed, “to achieve the higher purposes of human existence.”
The typical interview between a classic homeopath and a new patient may take 1½ hours. The homeopath listens to the spontaneous story of the patient with as few 
interruptions as possible, paying attention to what the patient says, how he or she says it, and the recurrent themes presented. The expression of the patient's story 
provides a picture of the way in which innate nature or past experiences has led him or her to filter and interpret experiences. Fears, anxieties, and dreams often 
provide important information into the unconscious processes that motivate the person's reactions to life events; this is what homeopaths refer to as the 
mental-emotional picture of the patients. Next in importance are the patient's “generalities.” For example:
Temperature reaction
Biorhythms
Responses to environment, storms, climate, other people, sound, and light
Food cravings and aversions
Final emphasis is placed on the details of the physical symptoms that characterize the patient's disorder (e.g., the side of the body involved, the pattern of radiation of 
a pain, the modalities that aggravate or ameliorate each symptom, and the relation of one symptom to another).
The homeopath will give priority to those symptoms that have the most profound effect on the patient's physical, social, and occupational functioning. Two factors are 
considered in this assessment: the importance of the organ system involved and the intensity of symptoms. A mental symptom of severe depression would take 
priority over a mild skin rash, whereas a severe exfoliative dermatitis would be more important to the patient than a simple, mild phobia.
Homeopathy assumes that disease has a chronic nature and progresses inward within the organism over time. For example, atopy, which presents as eczema in 
infancy, may progress to asthma by early childhood. Syphilis or Lyme disease progress from the skin to the central nervous system. As a disease progresses inward, 
it affects more and more vital organ systems with increasing influence over the person's functioning. A cure reverses this process. Known as Hering's law, under 
homeopathic influence, a cure proceeds from within to without, from top down, from more recent to older expressions of the disease process. For example, under 
homeopathic treatment, asthma may resolve with the temporary return of a eczema that may have been suppressed with topical steroids earlier in life.
The past history, or biopathography, is the unfolding of the patient's internal disturbance over his or her lifetime. The various disorders of the patient, although 
representing a number of seemingly unrelated diagnoses in an allopathic context, are all covered by the symptomatology of a single homeopathic medicine. Referred 
to as a constitutional remedy, this medicine covers the totality of the patient's symptoms. A constitutional remedy is contrasted with a medicine prescribed for an 
acute, circumscribed focus that often has a clear external etiology.
In homeopathy, family history is significant, and not only in the standard medical assessment of risk for inherited illnesses. Homeopaths refer to inherited patterns of 
disease as miasms. The family history often gives a picture of the formative external influence that may have shaped the patient's response to life. In pediatric cases, 
the child may often share the same remedy as the mother or father. The correct prescription in these cases may include symptoms that the mother experienced in 
pregnancy. In the interview, the homeopath notes who comes to the interview with the designated patient and the quality of the interactions with family members 
present.
When a patient is seen for the first time for a chronic complaint, the homeopath uses the data gained from the interview, extracting a set of symptoms that 
characterize the case. Each of the symptoms is then considered in context of what homeopathic medicines have produced these symptoms in provings or reliably 
cured them in clinical cases.  Repertorization is the process by which homeopaths hone in on the most similar remedy. Repertories are printed or computerized 
indexes of symptoms organized by organ system. Each entry, or rubric, is a symptom followed by a list of those remedies that have either produced in their provings or 
healed in accumulated clinical experience that specific symptom.
For example, the rubric “HEAD, PAIN; LOCALIZATION; Forehead; middle; frontal sinuses from chronic coryza” contains five medicines:  Silica, Arsenium album, 
Kali-bichromicum, Sanguinaria, and Thuja occidentalis. The remedies in rubrics are listed in four grades—grade one (plain type) has the weakest association and 

grade four (bold capitals) the strongest.
The process of repertorization leads to the selection of several remedies that may cover the symptoms of the case. Comparative study of the  materia medica of these 
remedies helps to select the one most appropriate remedy. Materia medicas vary in style. Some contain only the original symptoms from the provings, some include 
cured clinical symptoms, and some contain discussions of the remedy synthesized from clinical experience of various authors. From this study of options, a single 
remedy is selected for administration to the patient. Brief examples of this process of remedy selection are given to illustrate these concepts.
THERAPY AND OUTCOMES
Treatment Options
In addition to the professional practice of homeopathy, the over-the-counter status of all but a few homeopathic medicines means that homeopathy is widely available 
for self-prescribing. Eisenberg estimated that only 30% of the people in his sample who used homeopathy sought professional advice. Sales of homeopathic 
medicines have grown by 15 to 20% yearly over the last decade. Homeopathic pharmacies do only a small percentage of their business in single remedies, most of 
which are sold to professionals. The bulk of their sales are in combination products, self-prescribed according to the labeling of these products. Unfortunately, the 
labeling of both single-remedy and combination products, required by FDA regulations, has limitations (
26
).
If a patient is seeking to use homeopathy for chronic complaints or serious acute problems, it is generally advised that a homeopathic professional be consulted. 
Evaluating the abilities of a homeopath may be difficult, but, like choosing any physician, board certification is an important consideration. Medical physicians with 
homeopathic board certification are designated by the initials DHt, naturopaths as DHANP, and other professions (e.g., nurses, physician's assistants, acupuncturists) 
as CCH. Lists of practitioners are maintained and made available to the public by the National Center for Homeopathy and the boards themselves.
Description of Treatments
A C
HRONIC
 C
ASE
A woman in her mid-40s presents with a diagnosis of fibrositis. She has tried many different therapies and is resisting the prescription of an antidepressant to relieve 
her pain. She has sore muscles, especially near the joints at their tendinous insertions. The muscles feel stiff and contracted, almost like spasms. The pains are worse 
on first motion or rest. The pain causes her to be in constant motion, during which time she feels well, until she becomes exhausted and eventually in more pain by 
this prolonged exertion. Her sleep is disturbed by the pains, and she always wakes at 3 am feeling restless. Her pains are relieved by a hot shower and aspirin. These 
symptoms are a constant presence in her day-to-day life. She feels tired and sore most of the time, but she tries not to let this limit her work, family life, or general 
lifestyle.
Her life is dedicated to the care of children. Her husband, a psychologist, states that she has visible physiologic stress response to any circumstance in which issues 
of injustice are involved. She is self-employed as a day-care director, which her husband again remarks is a statement of her issues around authority, arising from a 
dictatorial stepmother. Her own mother died when she was 2 years old. Her father did not process the grief, nor allow her to, but insisted that she go on with her life. 
Her father remarried. She became very concerned with the well-being of her younger siblings and never felt bonded to her stepmother. Her first conscious experience 
with death was when her paternal grandfather died. For years he would come and talk with her in dreams. She has tremendous fears that whenever someone in her 
family is late something bad has happened.
Symptom Chosen
The symptoms chosen for analysis by the homeopath try to capture the unique characteristics of this person. Symptoms are listed in homeopathic references called 
repertories, indexed by body part. The symptoms are indexed in repertories in association with a list of remedies known to have produced that symptom (in provings) 
or cured it (in clinical practice). Each symptom with its associated remedies is called a rubric. Each rubric first lists the symptom in the language of the patient, 
followed by the page number in standard printed references (K =Kent's Repertory, S=Synthetic). The remedies are abbreviated in alphabetical order. In this woman's 
case the following rubrics were chosen from MacRepertory (
26
), a computerized repertory program (
Fig. 28.1
).
F
IGURE
 28.1. Rubrics of chronic case.
Repertorization
A repertorization program graphs the patient's symptoms against the associated homeopathic medicines (
Fig. 28.2
). This repertorization graphically displays the 
strength of the association in four grades. The rubric is listed on the left. The abbreviated names of the remedies are listed across the top. Below them are the 
weighted scores for each matched rubric and the total number of matched rubrics. In this case, a single remedy contained all seven symptoms selected and had a 
clearly higher intensity score. Selection of the proper rubrics for repertorization requires extensive knowledge of homeopathic principles in chronic cases.
F
IGURE
 28.2. Repertorization of chronic case. The patient's symptoms are listed to the left; abbreviations of remedies across the top. The intensity of the correlation 
between the remedy and symptom is graded from one (lowest) to four (highest): white, (0); pale shade, (1); dark shade, (2); and solid, (3). The row named  Rubrics 
indicates the number of rubrics matched for each remedy. The row named  Total indicates the total score for each remedy. The top remedy is  Causticum.
Selected Materia Medica of Causticum
Causticum was chosen as the remedy that best characterized this patient's mental, emotional, and physical symptoms. The homeopathic  materia medicas are 
composed of the verbatim proving symptoms of patients, clinician observations of specific symptoms repeatedly cured by the medicine, or clinicians' descriptions of 
the characteristics of patients who have responded to a remedy. The following statements were taken from materia medica texts of Causticum:
Emotional: ailments from grief [many or long]. Fear something will happen. Internal suffering, kept in. Suffers from injustice in society. Actually helps the 
oppressed and the poor, not only talks about it. Being strongest member of that group, the one who is the most capable of putting up a fight, he regards a 
threat to any one member of that group as a threat to himself. If he doesn't forestall the threat, it would affect the whole group and he will be weakened 
(
27
).
Mental: Immovable points of view, indifference to dictates of conscience. Weakness of memory with the characteristic feeling as if he had forgotten 
something [has to go back and check].

Extremities: Sensation as if muscles and tendons were too short. Restless legs in the evening and at night, in bed.
Follow-Up
The patient was scheduled to return to the homeopath in 6 weeks and told to call in the interim if she had questions or reactions to the treatment. She was given a 
single dose of Causticum 1M (10
-2000
), to be taken after stopping coffee intake for 3 to 4 days. She was in a 2-week break from school, and she was glad because she 
felt tired for 3 days after taking the dose. Her pains were somewhat increased during that time, initially in her legs. As the leg pain gradually improved, there was a 
temporary intensification of her shoulder and neck pain, which had been the original area of symptoms. Despite this, she was able to sleep longer without being 
awakened. She remarked with some wonder that after taking the remedy she was unusually weepy. Gradually her energy improved and after 6 weeks she reported 
feeling better than she had in years. Emotionally she feels “lighter” and was able to not go to work on her days off, demonstrating the improvement in the general 
mental and emotional state of the patient. Over the next 6 months she saw the homeopath twice, and her condition continued to progress. The remedy was repeated 
once 4 months later when, after her dentist replaced an old amalgam filling, her muscle pain began to worsen. After 6 months she was well, with only occasional pain 
when she overexerted herself.
A
N
 A
CUTE
 C
ASE
A 10-year-old boy with a sore throat of two-days duration is brought to a homeopath by his parents. He walks into the office holding a cup half full of saliva. His 
cervical glands are visibly swollen, his breath is fetid, his tongue is coated white and indented, and his pharynx is red with purulent discharge in the tonsils. He is 
feverish, with chills and profuse perspiration at night. Streptococcal antigen test is positive. The rubrics and repertorization are detailed in 
Figure 28.3
 and 
Figure 
28.4
, respectively.
F
IGURE
 28.3. Rubrics of acute case.
F
IGURE
 28.4. Repertorization of acute case. The patient's symptoms are listed to the left; abbreviations of remedies are across the top. The intensity of the correlation 
between the remedy and symptom is graded from one (lowest) to four (highest): white, (0); pale shade, (1); dark shade, (2); and solid, (3). The row named  Rubrics 
indicates the number of rubrics matched for each remedy. The row named  Total indicates the total score for each remedy. The top remedy is  Mercurius.
Selected Materia Medica of Mercury
The following are symptoms from the published  materia medica of mercury:
Salivation (not a strong symptom in deep mental states), especially at night in sleep
Sensitivity to heat or cold
Metallic taste in mouth
Strong halitosis
Offensive perspiration all over the body that aggravates
Swollen glands anywhere on the body
Recurrent or acute otitis media
Green, thick nasal discharge or sputum from throat
Aphthae and ulcerations on tongue, mouth, and throat
Imprinted teeth on tongue
Pharyngitis
The prescription for the child is  Mercurius vivus, 1M (10
-2000
). Within 20 minutes, he is swallowing more easily, and by the next day he is asymptomatic. His symptoms 
and clinical examination normalized and rapid strep test became nonreactive in 48 hours. No repetition of the dose was required.
TREATMENT EVALUATION
In homeopathy, outcomes are seen in a broader context than in allopathic medicine. The similar remedy appears to act by focusing and strengthening the innate 
healing powers of the whole person, rather than by attacking or suppressing a specific disease process or symptom. Consequently, patients describe homeopathic 
treatment as having positive effects not only in terms of the symptoms of the presenting complaint or disease, but in improved vitality and mental and emotional 
well-being.
The evaluation of a homeopathic prescription is scheduled at an interval appropriate to the urgency of the case and the patient's needs. In acute cases, the duration 
may be minutes to hours. In chronic cases, the interval is usually 4 to 6 weeks. In the latter case, the interview usually takes 20 to 30 minutes, during which time the 
key complaints of the patients are reviewed. Each symptom is assessed: Has the intensity diminished or increased? Was there an aggravation of symptoms after 
taking the initial dose? Were there changes in secondary complaints, general energy, sense of well-being, or mental and emotional symptoms? The ideal response 
often begins with a brief period of aggravation, followed by a decrease in the primary symptoms with simultaneous improvements in mental and emotional functioning. 
Curative responses may include a temporary return of old symptoms, which gradually clear in a specified order—i.e., from recent to the older, and from vital to more 
superficial organ systems.
The task of the homeopathic prescriber at follow-up interviews is to determine whether the remedy has acted, if the action is continuing, and if the remedy needs to be 
repeated, changed, or left to continue its action without further intervention. The remedy is seen as a catalyst to a healing process that, once initiated, has its own 
pace and direction as dictated by the innate wisdom of the organism. If this process is continuing satisfactorily, no other intervention is needed (regardless of whether 

the period of response is minutes or months). The remedy is repeated only when the response has ceased or shown signs of relapsing.