Polypharmacy and Patent Medicines – A boon or a curse to homoeopathy

Dr Priyanka Shroff 

One of the leading factors for the growth of homoeopathic products globally is the concern regarding the high usage of allopathic medicines. People are becoming more and more aware of the cumulative side effects of the allopathic medicine. This is leading consumers towards alternative treatments including homoeopathy.

Cheap to make, safe to take, do not destroy the environment and neither require any chemicals to make the remedy are some positive sides of homoeopathic medicines.
But when it comes to polypharmacy or so called “Homoeopathic patent medicines” available over the counters in pharmacies, it becomes a controversial topic.

Are they actually homoeopathic? Or Homoeopathy for Name-Sake. Firstly what is polypharmacy or Homoeopathic Patents?

Polypharmacy is giving of more than one medicine at the same time – the concept against Hahnemann and an ideal follower of him. Homoeopathic patents comes under polypharmacy prescribing, are so called mixtures of more than three in many we can find even seven or more of potentised medicines or even crude mother tinctures, packed given a nosological name and sold in market without proper authentication. They are contrary to the ideals set forth by Hahnemann

Let us look into the Hahnemann’s Organon what he has mentioned:
As mentioned in literature ‘Hahnemann was the first to raise his voice against the compounding of prescriptions, holding that the effects of compounds on disease could never be known precisely.’ [Coulter, Vol. 2, p.335]

Hahnemann was the first physician who raised his voice against such practice and advised the application of single medicine in single form in the world of therapeutics.
In Organon of Medicine we need to go through the Aphorism 272-273 in fifth edition of Organon of Medicine. These are the aphorisms wholly re-written in the sixth edition of Organon.

In 5th Edition of Organon of Medicine:
In Aphorism 272- “In no case is it requisite to administer more than one single, simple medicinal substance at once time.”
The footnote to this is interesting where Hahnemann mentions that some homoeopathists have made experiment in cases where they considered one remedy homoeopathically suitable for one portion of symptoms of a case of disease and a second for another portion and administering both the remedies at same or almost at the same time.

But Hahnemann mentioned in the footnote that he seriously disapproved such a hazardous experiment. Such thing should never be thought even though it seems to be of use.

Hahnemann was known as Experimental pharmacologist, great literary expert and profound thinker of his time in the 6th Edition he directly mentioned and concluded that “In no case under treatment it is necessary and therefore not permissible to administer to the patient more than one single simple medicinal substance at a time”

History of this Concept:
How Hahnemann came to the idea of Single drugs in Homoeopathy:
It was probably the information he gathered while translating medical text from other languages, which triggered his new interest in single drugs and similars, and turned him away from mixed drugs and contraries. It must have been this new data that suddenly changed his focus from being a merely passive translator, to wanting to become an experimenter. This change in his attitude in the period 1784-90 was critical, as it paved the way for his proving.

This was mentioned in Are the Obstacles to Certainty and Simplicity in Practical Medicine Insurmountable? 1797, in Lesser Writings, p.320 – ‘Then let us…agree to give but one single, simple remedy at a time, for every single disease…’ Hahnemann further writes that ‘I have no hesitation in asserting that whenever two medicines are mingled together, they almost never produce each its own action on the system, but one almost always different from the action of both separately – an intermediate action, a neutral action, – if I may be allowed to borrow the expression from chemical language.
History says that Dr Boenninghausen was interested in experimenting with polypharmacy in homoeopathy. Considering his interest, Hahnemann with his careful experiments and inductive methodologies came to final conclusion that for homoeopathic principles and practice, MONOPHARMACY alone is suitable.

The concept of dual remedies was introduced by Dr Aegidi, one of the Hahnemann’s disciples who forwarded the founder 233 cases about his new method. Dr Aegidi and Boenninghausen based on the evidence of correspondence between them likely used such methods in difficult cases for at least a year prior to 1833 with Hahnemann’s knowledge and support in such cases where he could not find a single remedy which matched the complete symptoms. Thus in such cases, the combination to two homoeopathic remedies were done to fit the case.

Even Hahnemann himself undertook in using two remedies at short intervals. Even on Pp.182, in Samuel Hahnemann, His life and Work has been quoted by Richard Haelh , it is quoted – “On one hand , it shows that Hahnemann was continually seeking out new paths and further improvement for his process of healing. On other hand it shows that he was never struck to his own opinions and views refusing to be taught, but that he was ready to leave them and alter them if something better idea was taught to him.” Haehl writes further that Hahnemann was easily convinced because he only made a few experiments and considered them of only limited use in the clinic. Hahnemann writes clearly that out of the many attempts only one or two were successful and he was going to write in Organon of Medicine that this seems to be very difficult and doubtful method.

We found our master an experimenter all his life. He never allowed theories to modify facts but he was always prepared to be led by his observation and experiments.

Various authors view on Polypharmacy:

Luc de Schepper in the year 1999 writes an article “The real danger to Homeopathy” in which he writes that Polypharmacy (giving many prescriptions is dangerous in homeopathy as well as in Allopathy. He says that remedies bear a powerful force.If they can consistently cure the so-called “incurable diseases,” they must be highly active agents. Each remedy delivers an energetic “punch” to the Vital Force, and it is the secondary response of the Vital Force which acts against the illness and heals the patient.

Giving too many remedies at once can leave the Vital Force punched down like a boxer staggering to his knees. From his clinical experience, he writes he has seen patients who have been given so many remedies by previous homeopaths that their Vital Force no longer responds to the single well-chosen remedy, which could have cured their case in the first place before they were rendered incurable by polypharmacy.

As per Dr. Clarke, the practice of giving a single dose and allowing time for it to evolve its action is an excellent one when it is possible to carry it out and observe its effects. Remedies may sometime be alternated with advantage, but they should not be adopted as a routine method. If two medicines seems almost equally indicated, it is best to decide upon one of them, and give that. When the homoeopath has seen whether the remedy come to his expectations or not he will be able to decide on the propriety of giving the other. To give both at same time destroys the value of observation, and tends to weaken the homoeopaths power of diagnosing the remedy.

Polypharmacy is not at all….a boon

Explaination :
Hahnemann has said in aphorism 119 that every single substance produces alteration in health of human being in a peculiar, different yet in a determined way so that it is impossible we confuse one with another. At a given time only one remedy is the Similimum. Hahnemann has clearly said only one remedy can be serviceable at a time. There is NO SURROGATE OR EQUIVALENT remedies in homoeopathy.

In spite of clear instructions of our Master as quoted above, now a day a peculiar trend is noticed among many homoeopaths that many of us are interested in administering several medicines at a time or in alteration. Not only that several potentised medicines are mixed and allowed to take for several days and that also many times in a day.

If we go through our Materia Medica’s, Keynotes and therapeutics, there are many famous formula’s of alternation of medicines which has been used by homoeopaths world over since the inception of homoeopathy. But mind me they are alterations not mixtures. To name a few:

  1. Sulphur and Nux alternated in Hemorrhoids and when it has improved the Hemorrhoids, Aesculus hip will clear the remaining symptoms.
  2. Bryonia and Rhux Tox in Fevers
  3. Belladonna and Rhux Tox in infectious diseases like Measles andMumps.
  4. Belladonna, Hyoscyamus and Stramonium in Schizophrenia.
  5. Aconite, Belladonna, Hepar Sulph and Spongia in Croup (Known as Dr. Boenninghausen’s Croup Powders)

For combination of medicines the best example would be: Biochemic Universal Combinations. Many pharmaceutical companies like Schwabe (Germany), B & K (USA), Reckweg (Germany) are selling selective clinically tested formulations for certain disease conditions which are being used since long and widely accepted by homoeopaths world over. If this theory of alternation and combination is incorrect as per the principles of homoeopathy then it is very difficult for these combinations/formulations to survive for such a long time in today’s scenario. As a result of which you will find that after some period that patent drug would no more be available in the market.

Even though we have the standard benchmark of prescribing a single remedy at a time then why do we find the extensive sale of combination remedies or patents?

Is this the prescription based on clinical diagnosis? If so it cannot be homoeopathic because we believe in individualization.

In reference to patient who comes to us after failed visit to “single remedy homoeopath” which everyone would have come across, Hahnemann has discussed them in his work and has commented that such cases are due to failure often in perception of the practitioner.

Probably because they are one of those who have not learned proper case taking or neither material medica and does not even want to do hard

It’s a boon when a remedy does not strike you or when you are a fresher. Yes when you do not find a remedy if you look at the composition of that patent you get an idea about the remedies, that’s a short cut but prescribing requires individualization work in finding the most similimum medicine return to polyphramcy with potentised remedies as a short cut. They even criticized classical homoeopath for his detailed case taking and prescribing single remedy just because they did not learn correctly.

On the other hand, there are some who are working towards master in classical homeopathy who use a double remedy or combination on occasions. We can use word “Mongrel Sect” used by Hahnemann (Aphorism 67 footnote) for such all such practitioners.

Even Hahnemann has mentioned in aphorism 149 that in order to cure long standing diseases, chronic diseases when given long continued large doses of violent acting remedies on basis of empty speculations and false theories claiming useful without any proofs in cases of diseases appearing similar finally takes away all the strength and jucies of the patient and render them weak and disease becomes incurable. Again though Hahnemann was talking about allopathy but same thing can happen while prescribing polypharmacy blindly with any proofs.

We can perceive the same scenario that Hahnemann has mentioned in footnote second to aphorism 119. Highlighting the physicians of former ages he mentions that those physicians used to satisfy themselves by blindly prescribing for diseases, medicines whose value and dynamic action was unknown and has never been tested on health of a man.

He criticized them that they mingled several of these unknown medicines that differed so vastly among each other in one formula and left it by chance, what effect they would produce on the patient. Definitely he was talking about allopathic physician but today by prescribing mixtures, patent medicines we are doing the same thing which our Master strongly condemned.

Hence there is a need for standardization in practice. The further experiments should be aimed to explore if there is any hidden truth behind such unacknowledged polypharmacy practices and its relevance in modern day practice. Its effects should be strictly scrutinized. The label “no side effects”should be strictly removed. It is not advisable to use polypharmacy.

It is far valuable to experiment with alternations, intercurrents, or series of remedies rather than mixing remedies together. In this way they can contribute to the development and growth of Homoeopathy.

References:
1. Organon of Medicine by Samuel Hahnemann 5th and 6th Edition of Organon
2. Articles on homoeopathy by Peter Morrell Articles on homoeopathy by Peter Morrell: Single Drugs, Small Doses, Similars
3. Life and works of Samuel Hahnemann by Richard Haehl 4. Principle and practice of Homoeopathy by M.L.Dhawale
5. The real Danger of Homoeopathy by Luc De Schepper 1990 November [cited.2018.October.28].https://abchomeopathy.com/forum2.php/521911
6. https://www.homeopathycenter.org/homeopathy-today/polypharmacy- and-simillimum.

Dr Priyanka Shroff MD(Organon of Medicine),
Reader,Dept: Organon of Medicine,
Shree H.N.Shukla Homoeopathic Medical College & Hospital,Rajkot

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