By Richard Moskowitz, M. D.

THE FUNDAMENTALIST CONTROVERSY: An Issue That Won’t Go Away

I am honored by your invitation to speak, and delighted to participate in your 25^th Anniversary celebration by talking about what we all know and love yet never quite seem to get to the bottom of. But I warn you that my subject is one of those doctrinal and almost theological matters about which there is right and wrong in every position, yet everyone feels the pressure to declare unequivocally for one or the other. In America, where the dispute became so contentious that old friendships were broken on account of it, individuals on both sides are reaching out to compose their differences, such that fellowship and civility may yet prevail over abstract ideologies, however deeply felt.

I must also point out that the terms "innovation" and "fundamentalism" were both coined by me after the fact to characterize the two main opponents, and not chosen or used by the major players themselves.¹ In fact the whole controversy began with a series of attacks on the teachings of Rajan Sankaran, Jan Scholten, Jeremy Sherr, Nancy Herrick, and others, largely based on the accusation that they are speculative in nature. So I need to begin by examining the arguments of these critics in some detail.

The Fundamentalist Critique. In North America the first broadside came from Julian Winston, editor of Homeopathy Today, which enjoys the largest circulation of any homeopathic journal in the United States and represents the official views of the National Center for Homeopathy. In his lead editorial, Julian lampooned several of the new teachings as speculative and therefore contrary to both the spirit and the letter of the generally-accepted classical style:

The earliest remedy "pictures" were popularized by Kent, whose students used them as short-cuts to find the curative remedy. In 1974 Vithoulkas brought out his "essences," which were misapplied by students to make homeopathy easier to understand, and which Künzli spoke out against. Now we have Sankaran’s "core delusions," Scholten on the Periodic Table, Herrick anthropomorphizing animals and dinosaur bones, and remedy "families" and "kingdoms," all leading to prescriptions based on theory and speculation. Some who consider themselves classical homeopaths and eschew combination remedies, radionics, etc., don’t see that overpsychologizing, dream provings, and all aren’t homeopathy either!²

In the same issue Julian also reviewed Nancy Herrick’s book on animal provings and found it wanting in almost every detail:

Hahnemann cautioned against "weaving empty speculations," and Hering warned, "if our school gives up the strict inductive method, we are lost and deserve to be mentioned only as a caricature in the history of medicine." I’m afraid this book is guilty on both counts. If it had just presented the raw data, the provings could stand by themselves, and a picture of the remedy would emerge, developed through use. But the author has added "themes" that are nothing but empathic think-ing and anthropomorphic speculation.

Thus the mating of elephants is described as "an all-out party atmosphere," in which "everyone gets in on the act," and young male lions trying to dethrone the leader is read as "problems with authority figures." A piece of fossilized dinosaur bone found in a nest led Herrick to potentize it and to infer nurturing behavior under the theme "helping or no one helping." What about letting the symptoms stand on their own? Can’t a cigar just be a cigar?³

The same themes are still being sounded today. This summer, German homeopath Dr. med. Klaus Habich and two colleagues wrote a piece in the American Journal of Homeopathic Medicine which contrasts some of the new teachings with the methodology of Hahnemann:

What is so special about homeopathy? It is not the prescription of potentized substances according to the Law of Similars, which is also used by spagyric, anthroposophic, and Bach flower treatment. It is its scientific mode of working. Hahnemann despaired of the speculative, arbitrary practices of his day and tried to develop rules for a reliable art of healing. It is no accident that the call for "clearly perceptible reasons" comes at the beginning of the Organon, before the word "homeopathy" is ever mentioned.

In homeopathy, each step is subject to verifiability. All provings, dynamizations, and remedy selections can be confirmed by impartial observers. Those who deviate from this practice should expect to be asked what is homeopathic about whatever they do.⁴

Also identifying homeopathy with a scientific world-view, Dr. Jennifer Jacobs wrote Julian a letter supporting his position from the radically different perspecive of experimental medicine, and pro-moting the double-blind model and other modern research standards:

Many of us are concerned about the direction in which we are moving. Provings without a blinded supervisor and symptoms elicited in group discussion are subjective and only preliminary to a formal double-blind process using symptoms of individual provers independently reported. Applying plant or animal characteristics from biology to human subjects is seductive and speculative without solid evidence of provings and clinical verification.

It is disturbing when new students know more about new or small remedies than time-tested polychrests. It is suspicious when three cases of a new remedy show up in the office a week after attending a seminar featuring it. Wouldn’t they have been helped before the remedy was known or the practitioner learned of it? Those offering new ideas must accept criticism without taking it as a personal attack.⁵

But the most learned, detailed, and impassioned opposition has come from André Saine, the Canadian naturopath, whose long, scholarly diatribes have appeared in Homeopathy Today, Simillimum, and the American Journal of Homeopathic Medicine. In the following excerpt, he equates homeopathy with the method of individualization and the hypothetical generalizations of Sankaran and Scholten with the abstract diagnostic entities of allopathic medicine:

Making use of hypothetical generalizations contradicts two fundamental principles of homeopathy. First, the materia medica must be kept free from all hypotheses and conjectures. Second, in homeopathy we must individualize at all times, even though our human nature entices us to generalize. Didn’t Hahnemann teach us to individualize each case and every remedy, and warn us against generalization? Individualization is the essence of homeopathy, generalization a trademark of conventional medicine. Those who individualize succeed in curing, while those who generalize fail.⁶

In a later editorial, Julian softens his criticism a bit, granting that such methods could be accept-able in the hands of experienced teachers well-versed in the classical method, but admonishing them to be more conscientious in teaching their students the fundamentals:

For most of our teachers, materia medica study and repertory work are second nature: they look at homeopathy from new perspectives, as if unaware of how much the basics still guide them. But what about their students? Kent’s Lectures on Materia Medica were for graduates with anatomy, physiology, pathology, and four years of homeopathic education.

The problem with most seminars today is that there are no such prerequisites. The material is post-graduate level, where knowledge of the basic principles is assumed. They should be for experienced practitioners, not beginners. Teachers may say, "It’s not our fault if the students don’t do it right," but I believe it is. There must be accountability in the process.⁷

Most of the remaining criticisms were directed at generalization and speculation in specific areas, such as "essences." The most pertinent argument against essences in particular, and overly mentalized remedy pictures in general, actually dates from the early 1980’s, when the great Swiss homeopath Jost Künzli roasted the non-physician Vithoulkas for using them, despite knowing of his work mainly from hearsay:

In Vithoulkas’ courses, too much attention is paid to the mental and emotional symptoms and the psychological approach. Students analyze these aspects as if they were qualified psychologists and come up with a hypothetical answer. Since it is impossible to duplicate such a train of thought, he can easily prove them wrong by taking them into a labyrinth from which he alone can find the way out.

It is also wrong in my opinion to judge the success of treatment mainly on the emotional level. The whole patient must be improved. I don’t care if my hypertensive feels better or likes me if his blood pressure isn’t down.

I also dislike assigning each remedy an "essence." If the essence of Lycopodium is cowardice, this should be the core of the remedy and explain its entire symptomatology. But Lycopodium has many other facets. With this schema we can miss 90% of the cases.⁸

Another pet peeve of the critics is the alleged emphasis on "signatures," i.e., correspondences between the non-homeopathic features of remedies, such as their natural history or chemical properties, and their actual use in homeopathic treatment. Once again the alarm is sounded by Dr. Saine, who can quote the Hahnemannian catechism on demand for any fundamentalist cause:

For Hahnemann the doctrine of signatures meant looking for therapeutic meaning in all external, perceptible properties or characteristic features of a substance: "All our senses applied with utmost care to studying the external properties of medicinal substances furnish no information as to their power to alter human health." In examining patients, "the physician sees, hears, and observes what is altered and peculiar," writing down all that is noticeable, his "behavior, habits, activities, domestic situation, way of life, diet, etc., these signs representing the whole of the sickness, its true and only form."

He excludes "preconceived notions, conjectures, classifications, or guesswork," and insists that homeopaths refrain from "prejudice and speculation:" "This healing art derives no knowledge from impure sources of materia medica, pursues no dreamy, false path, but the way consonant with nature, giving no medicine before testing it experimentally on healthy men."⁹

Even though the teachers in question rarely emphasize the actual use of such signatures in practice, Habich et al. likewise raise a considerable fuss about their willingness even to talk about them:

The question as to whether signatures should become a component of the materia medica is a decisive one. We believe that only remedy provings and toxicology can be materia medica sources. Signatures may be useful didactic models in teaching, but statements of fact can only result from direct observations, and the model often becomes confused with the fact. As Hahnemann said, "The inner nature of remedies is not recognizable by the intellect alone, but solely by the experience of perceiving their action in individuals."¹⁰

On the issue of remedy families, André is even more contemptuous:

Dr. Morrison generalizes that "common threads run through the nitric remedies – craving fat, fissures, splinter-like pains, and imminent sense of danger," and that "most Kali’s wake between 1 and 3 a.m." How can he be taken seriously about the nitrics when only Nitric. acid. and Arg. nit. have all 4 symptoms, while Kali nit. lacks splinter-like pains, none but Glonoin has a sense of impending misfortune, and Amyl nit., Benzin. nit., Natrum nit., Nitr. spir. dulc., Nitrog. oxyd., Nitromur. acid., Stront. nit., and Uranium nit. have none of the 4? What about waking at 1 to 3 a.m. for the Kali’s, when only Kali carb., Kali bich., and Kali nit. are listed for these hours, while the rest are not?¹¹

 

Habich et al. also take issue with remedy families and kingdoms, but their tone is rather more judicious, thoughtful, and not wholly dismissive of the concept per se:

Snake venoms share discomfort from tight clothing around the neck. But can we extrapolate to snakes in general, since some venoms are hemolytic, while others are neurotoxic? Similar plants can also have similar effects, as we know from the Solanaceae. But we doubt whether such generalizations are applicable to the vegetable or animal kingdom as a whole, such as that all animals are jealous.¹²

Oddly enough, André, Julian, and Habich, et al., have very little to say against Sankaran’s ideas about miasms, which are by far the most hypothetical and admittedly speculative of his numerous contributions, a paradox which I will say more about presently.

 

The Battle Lines Are Drawn.

As the pages of Homeopathy Today were increasingly filled with such criticisms, and little space was given for favorable or even neutral reporting about the new teachings, Roger Morrison wrote a letter to Julian complaining that he had misused his editorial position on behalf of a stridently partisan viewpoint that was unrepresentative of the American homeopathic movement as a whole:

While Mr. Winston clearly has great love for homeopathy, his use of the editorship to advocate his personal beliefs has become divisive. We don’t like his ridiculing serious people. He says Scholten’s work lacks provings, ignoring the dozen reported in his book. When Sankaran uses dreams, he’s not interpreting or theorizing, only asking how the patient feels, about his "state," as Hahnemann puts it. Mangialavori speaks of families, Sankaran of kingdoms, Vithoulkas of essences, Herrick of animal behavior, Scholten of chemical groupings. They don’t propose throwing out the Repertory, but only looking at cases in another light when repertorization gives no clear answer.¹³

This letter was co-signed by Sankaran, Scholten, Herrick, the Editors of Links, two NCH Directors who removed their names when the Board so ordered them, and about a dozen senior American homeopaths, including myself.

In the ensuing months, Julian published a spate of fan mail thanking him for his principled stand and accusing the signers of attempting to censor his words. These letters culminated in the long article by André cited above, "Homeopathy vs. Speculative Medicine: a Call to Action," which congratulated him for defending Hahnemann’s work and placed the blame exclusively on the infamous twenty-one:

Twenty-one prominent homeopaths accuse Julian of being intolerant and divisive by advocating his personal beliefs. Such accusations are not new, because Homeopathy is based on fixed principles, despite practitioners taking license to practice contrary to them. Divisions in homeopathy are always initiated by approaches incompatible with Hahnemann’s: his disciples must keep denouncing such misrepresentations.

The present will be remembered for its extravagant deviations: teachers taking chronic cases in 15 minutes and prescribing on clothing worn at the visit; provings given to some attendees but including symptoms of the others; provings of doses kept under the pillow.¹⁴

What infuriated me at the time was his one-sided definition of heresy as the fact, appearance, or mere possibility of meaningful change in our art. Now what strikes me is his absolutist sense of right and wrong, so eerily reminiscent of fundamentalisms everywhere, which gave me the idea for my title, and is indeed, as he says, so deeply and inextricably rooted in our history.

In any case, the Inquisitorial tone of his words continues to reverberate through the movement, as in the Declaration that followed the article of Habich et al., seems to have been drafted by them as well, and was co-signed by an equally large and impressive roster of homeopaths from around the world, including several former LIGA Presidents:

With great concern we have observed attempts to introduce speculative and metaphysical elements into homeopathy. Homeopathy was founded as rational medicine, with its guiding dictum of treating the sick on clearly comprehensible principles. Fantasy, free association, signatures, and other such analogies cannot be the basis for such an art. Association and speculation are tempting from a didactic viewpoint, but to augment the materia medica, drug provings, toxicology, and clinical verification are the only reliable basis. Knowledge from other sources should be carefully separated from materia medica. Whoever uses different methods should name them differently to avoid misleading patients and public and have no right to call them homeopathy.¹⁵

In spite of its carefully measured tones and its acceptance of clinical verification as a legitimate materia medica source, the flavor and spirit of this Declaration are essentially those of a loyalty oath, a creed or solemn declaration of faith to be signed and sworn to, and thus a basis for excommunication in the event of future backsliding and as binding as any latter-day Torquemada could possibly wish.

So the battle lines are drawn. Just as the new teachings have arisen more or less independently in many different parts of the world, the opposition to them is also global. Much as we might prefer to forget the whole thing as simply an aberration or a bad dream that we wandered into by mistake, the overblown rhetoric on all sides has come to designate a serious issue at the heart of what we all do, so that whichever side we favor, we have no choice but to develop acceptable criteria for deciding whether and to what extent the new teachings are speculative, and if, when, and how they deviate from the letter and spirit of our rule, or might indeed serve a valid and useful purpose.

Moreover, while the charges of speculation and heresy are as old as homeopathy itself, applying them to the teachers under scrutiny is unprecedented and indeed superbly ironic, given that every one of them would have no difficulty qualifying as a good classical homeopath, according to the strict criteria of the International Hahnemannian Association, the same fundamentalist group that André throws up to us for our edification:

Declaration of Principles. Hahnemann’s Organon is the only reliable guide to therapeutics. Homeopathy consists of the Law of Similars, dynamization, the single remedy, and the minimum dose.

Resolutions

Homeopathy should free itself from mixing or alternating two or more medicines; using topical medications or mechanical appliances in non-surgical cases;and giving medicine in quantity to suppress symptoms by primary action.

The utmost possible relief from suffering in incurable cases is obtained by the simillimum, while antipathic or allopathic palliatives are injurious and unnecessary.

Provings on the healthy are the basis of our materia medica, but we may cautiously supplement these by frequently verified clinical experience.¹⁶

 

Remedy "Essences" and Materia Medica Study.

With that as background, I want to return to materia medica study, the issue we began with, to show you that the concept of a remedy "essence," like everything else in homeopathy, is already central to Hahnemann’s thought, e.g., in the opening paragraphs of the Organon, where he develops the axiom-atic concept of the "vital force:"

In the healthy condition of man, the spirit-like vital force that animates the material body rules with unbounded sway, and retains all parts of the organism in harmonious co-operation, so that our reason-gifted mind can freely employ this living, healthy instrument for the higher purposes of existence.

When a person falls ill, it is only this spirit-like, automatic vital force, everywhere present, that is primarily deranged. Only the vital force can furnish the organism with its disagreeable sensations.

As a power invisible in itself and only cognizable by its effects on the organism, its morbid derangement makes itself known by morbid symptoms, and in no other way. In like manner the disappearance of all morbid phenomena under treatment necessarily implies the restoration of the integrity of the vital force and therefore the health of the organism as a whole.¹⁷

 

The same theme is recapitulated when introducing the concept of materia medica:

There is no way to ascertain the peculiar effects of medicines other than to administer them experimentally to healthy persons, and to observe the signs and symptoms that each individually produces on body and mind. As certainly as every species of plant differs in its form and mode of life from every other, and every mineral and salt as well, so they all differ in their pathogenetic and therapeutic effects. Each produces alterations in health in a different, peculiar, and determinate manner so as to preclude the possibility of confounding one with another.¹⁸

All these passages stress the dynamic character of the vital force as a ubiquitous, unbounded, indivisible, and thus seamlessly unified living system, but one that cannot be known apart from the particular signs and symptoms it exhibits. In short, the homeopathic enterprise is thoroughly empirical and scientific in its method, but the totality it implies, the life energy of both patients and the remedies that match them, remains a mystery that cannot be analyzed or comprehended, but only approximated, a task for which science alone is inadequate, and art and imagination are also required.

The implications of this paradox were already evident to the great E. A. Farrington, the first American homeopath who clearly foresaw the need and the possibility of what we now call remedy "essences:"

We include all the symptoms that we observe. Then what have we? A mass of symptoms seeming to have no connection at all. When you have the changes in toto that this substance makes on the system, you have the pathology of the case. This grand effect of the drug must always be kept in mind, qualifying the individual symptoms, or these latter are worthless. You must know what the whole drug does, or you will not be able to appreciate any part of it. You can find twenty drugs with the same symptoms. How will you decide between them? By study of the drug as a whole.¹⁹

The critical importance of this passage is drummed into the soul of every well- trained classical homeopath, fundamentalist or otherwise, who before choosing a possible remedy in the case knows to read it in the materia medica, to ascertain how well it fits, not just symptom by symptom but globally, and including such elusive and indefinable properties as "flavor," style, and the Gestalt or arrangement of the symptoms as a whole.

But this is also the problem with Farrington’s instruction, for there is and can be no rule or formula for carrying it out, no royal road or shortcut for comprehending the esoteric and mysterious unity of our living patients and the remedies that can heal them. So Farrington’s words live on as a vision or prophecy of what is possible, which neither he nor his successors had the tools to fulfill or bring about in any practical or uniformly reproducible way.

Most early materia medicas were duly compiled after the fashion of Hahnemann’s Materia Medica Pura, i.e., as simple lists of symptoms arranged by region or system, beginning with "Mind" and ending with "Generalities," a custom that has been preserved right up to the present. From Lippe, for example, a fine text of this older type, I have extracted an abridged version of the mental and general symptoms he offers for Ignatia:

Mind and disposition. Sensitiveness of feeling; delicate conscientiousness. Fearfulness, timidity. Irresolution: anxious to do this, now that. The slightest contradiction irritates Intolerance of noise. Taciturn, with continuous, sad thoughts. Still, serious melancholy, with moaning. Anger, followed by quiet grief and sorrow. Inclination to grief, without saying anything about it. Great tenderness. Changeable disposition: jesting, laughing, changing to sadness. (Hysteria.)

Generalities. Convulsive twitchings, especially after fright or grief. Convulsions alternating with oppressed breathing. Hysterical spasms. Trembling of the limbs. Pressing pains, as from a hard-pointed object pressing outward. Sensation as of dislocation in joints. Lancinating stitches, as from sharp knife.²

In trying to characterize the remedy as a totality rather than merely an arithmetic sum of items, Hahnemann and Lippe simply added a final list of "general" symptoms that, like those of the "mind" section, referred to the organism as a whole rather than a part only. Notice too that Lippe identifies Ignatia with grief, but not yet with "ailments from grief," a far more complex and long-term connection that lies beyond the scope of most provings, emerges only gradually with repeated clinical verification,, and requires a significant component of logical inference and imaginative synthesis that is a lot of what "ordinary" medical practice tends to be about.

A generation later, in his popular Lectures on Materia Medica, Kent added illustrative vignettes to highlight the most important themes of the remedies, often including a number of variations, and comprising portraits or "remedy-pictures" that are lifelike, readily accessible to students, and highly evocative even today, with strong and at times uncanny resemblance to people we know:

Ignatia is suited to sensitive, delicate women and children, to gentle, fine-fibered, refined, educated women with nervous complaints similar to hysteria. When overwrought, excited, or emotional, a woman will do things that she regrets or cannot account for. She has undergone controversy, is excited, and goes into cramps, trembles and quivers, goes to bed with a headache.

A sensitive, nervous girl finds she has misplaced her affections: the young man has not been true to his word; she has a weeping spell, headache, trembling, is nervous and sleepless. A delicate, sensitive woman loses her husband or child, suffers from grief, has headaches, trembles, weeps, is excited, can’t sleep or control herself, feels ashamed.

Quivering of limbs, nervous excitement, sudden weakness, hysterical fainting, jerking, convulsive twitching. Children convulse in sleep, during dentition, or after punishment. Hysterical paralysis. She does unaccountable things, the opposite of what would be expected.²¹

In these synthetic or composite portraits we see again with particular clarity the importance of clinical verification, for filling in the gaps between the individual proving symptoms and providing the interpretation that glues these disparate elements together and gives them meaning within an integrated whole.

In the 1980’s George Vithoulkas appeared on the scene as another world-class prescriber who inspired a whole generation of homeopaths by his precept and example. As with Kent’s, his materia medica first appeared in the form of lecture notes, and his remedy-portraits or "essences," as they came to be known, had to be "stolen" by his students, i.e., compiled and circulated unofficially and in fact against George’s often-stated wishes. Time and again he repudiated every written formulation of these remedy pictures, which he insisted were continuously evolving and forever elusive and incomplete. Here is one such version of Ignatia, very much in the Kentian tradition, but with a more idiosyncratic and contemporary feel, featuring a wider latitude for interpretation and at times a provocative edge:

Frequently indicated today because of women’s liberation. She tries to assert herself, to be equal to men. Sensitivity with romanticism, which eventually comes into conflict with reality. Overstrained by grief or vexation, she breaks down with spasms or hysteria, unable to talk or think, or faints, unresponsive and unable to cry. Then she locks her door and cries, sobbing spasmodically.

Physical problems after feeling better emotionally: becomes cold, hard, irritable, or insulting, and tries to compose herself. Moods change very frequently. Symptoms begin after a death or the breakup of a love affair, suppressing feeling until it comes out in a hysterical reaction.

Torticollis: emotions go into the physical plane with great force. Chorea and cramping in response to internal or external stimuli. Unexpected reactions: emotionally nasty when you arenice to her; unpredictable mentally and physically.²²

 

It was just such alleged overmentalization and oversimplification that led Künzli to repudiate the whole project, and motivated Vithoulkas himself to disappear or equivocate whenever his students tried to pin him down to any concrete or definitive formulation. Yet almost all classical prescribers accept the special priority of the mental and emotional symptoms in choosing the remedy, as did Hahnemann himself, not only because they refer to the patient as a whole rather than any part of the body, but also because they offer a glimpse of the "vital force," that which transmutes the particulars into a unity and can thus impart meaning to them, can fashion them into a story. This simplest kind of "essence" is well illustrated by a short case from the early years of my practice:

A girl of ten was brought in for a nasty sore throat that had interfered with her sleep for weeks. Complaining of a lump there in the morning, especially before lunch, she said that the pain was actually better from eating and hurt most when not swallowing.

This unusual pattern helped lead me to the further discovery that her best friend’s mother was receiving chemotherapy for breast cancer, which a close family member had also recently died of, and that the girl herself had been troubled with thoughts of illness and death for a long time, and often woke in a panic if her mother was not there to comfort her.

After a round of Ignatia 200, she bounced back from this embryonic illness in a few days. When it recurred in somewhat milder form about a year later, she asked for the remedy herself, and this time it acted at once and didn’t have to be repeated.²³

However elusive in practice, the quest for meaning or essence helps us look past the narrowly physical and mental dimensions of cases and remedies, and to peer into Hahnemann’s dynamic realm, where remedies and patients are comprehensible as unified energy systems, independent of "mind" or "body" and conceptually prior to both.

How materia medica study propels us forward in this way is evident in the historical evolution of a remedy like Bryonia. First associated with particular symptoms like headache or pleurisy, its grand modality, "worse from motion," eventually proved applicable to mental and emotional states as well, such that patients needing the remedy were found to be gruff, withdrawn, incommunicative, and averse to human interaction, sensory stimulation, or mental effort of any kind. When generalized in this global fashion, "worse from motion" has come to preside over the Bryonia state or energy pattern as a whole, no matter what the illness, on both sides of the psychosomatic frontier, and thus in a sense prior to the mind-body distinction itself.²⁴

Another example is Staphysagria, which began its career as a remedy for surgical incisions and other linear knife wounds. After a time it was successfully applied to miscellaneous ailments develop-ing in the wake of a surgical procedure in the past, a "never-well-since" pattern in which the energy of the original insult becomes chronically "stuck" or fixed in place and then branches out unpredictably through the organism in the form of both physical and mental symptoms. Others found the remedy equally beneficial for obscure and idiosyncratic complaints arising from suppressed anger, as after humiliation or physical or sexual abuse.

These seemingly unrelated applications led to the further revelation that surgery offers the ideal energetic prototype for ailments from suppressed anger: the continuity and integrity of the vital force are interrupted by the surgeon’s knife, while the anesthetized patient remains helpless to express or even fully experience the "anger" that such a violation implies. The mere existence of such illnesses, and the usefulness of the remedy in treating them, cannot be adequately explained in either the medical language of cells, tissues, and organs or the psychological language of ideas and emotions, or both. Such dilemmas indicate the need for an energetic language that is mind-body neutral and thus comfortable in either mode and on both sides of the boundary. By defining what is out there to be healed, remedies can teach us how our illnesses are made.²⁵

There is nothing new or even remotely speculative about any of this. All good homeopaths of every persuasion make connections and analogies like this all the time, but they are the fruit of clinical verification, nowhere to be found in provings or the works of Hahnemann, and require considerable art and imagination as well. These are undoubtedly the reasons why our fundamentalist critics have so little to say about them.

But they use them just the same, or they couldn’t be the effective prescribers we know them in fact to be. In his Materia Medica, even the great Lippe, whom André considers the finest prescriber of all time, limits himself to "the most characteristic symptoms of the best-proved and most used of our remedies;" in other words, he makes a selection. But on what basis? What criteria does he use in deciding that some symptoms are more important, more characteristic, more "essential" than others?

When Kent and Vithoulkas try to articulate the essence of a remedy, what they offer is merely their own version of these choices, augmented by clinical verifications for unity and dramatic effect. The only real difference between "illuminists" or essence prescribers like Kent or Vithoulkas and "fundamentalists" like Lippe and Künzli is that the former are brave or rash enough to talk about what they’ve learned from clinical experience, while the latter are careful to keep their innermost thought-processes to themselves, secret and inviolable.

Sankaran’s materia medica is simply a further attempt to locate the dynamic or energetic core of the remedy, on the basis of which the physical, mental, and emotional symptoms can all be understood and located within the same framework. His "essences" include the chemical grouping or biological family, the miasmatic affiliation, and his own selection of the most important rubrics that illustrate his sense of the remedy as a whole, just as Lippe has done:

Ignatia: Loganiaceæ, cancer miasm [the need to keep in control] Grief, undemonstrative. Mildness: bears suffering, even outrage without complaining. Silent grief, cannot cry. Ailments from death of a child, of parents, or of friends. Ailments from shock, grief, or disappointment. Ailments from embarrassment, from shame. Dreams of unsuccessful efforts. Delusion he has done wrong. Conscientious about trifles. Fixed ideas. Back pain, lumbar region, extending down legs. Change of position ameliorates.²⁶

As a rough guideline, then, I offer the simple conclusion that essences are valid and useful if helping us to organize our study of remedies, but misleading and inaccurate when memorized and used as a substitute for that process: to that extent, the fundamentalists are quite correct. Like the Repertory from whence they come, essences are merely another way to suggest possible remedies we might not have thought of without them. They should not and must not be allowed to spare us the final task of reading the remedy as a whole, in search of the best possible fit.

Sankaran’s quest for the essence also reminds us to pay attention to the imagery and indeed the exact words of the patient, which sometimes lead straight to the goal without the Repertory at all:

A 57-year-old engineer came in for muscle cramps in his legs after heavy physical work, and was also bothered by tightness in his muscles that made him feel "all locked up," especially in the cold, from a draft or a fan, or when his throat felt cold. Sciatica also "pulled" and "tugged" at his left hip, making exercise difficult. Arthritic changes were found on X-ray.

Testing materials for an electronics firm, he drove himself to finish any project he started, no matter how late he had to stay. Born and raised in Nazi Europe, he came to America at the age of eleven, with his father dead, his mother traumatized, and the political situation "all locked up" in the tense atmosphere of the Cold War.

Proud of his squeaky-clean habits, and devoted to keeping his house and yard in top shape, he rarely paused to relax and enjoy life. His defiant teen-age daughter, whom he could not influence or even talk to most of the time, presented yet another "locked-up" situation, the oft-repeated phrase thus becoming a central metaphor linking his health problems to the character of his life as a whole.

Six weeks after a dose of Causticum 1M, he was much better. His feet felt warm, the "bounce" was back in his legs, and he felt much less sensitive to cold in general. Infrequent doses of Causticum 30 were helpful when symptoms returned. He has needed no remedies for over two years.²⁷

On the other hand, although this man’s choice of words certainly helped me find a good remedy for him, I think I could have found it using the Repertory just as well. I tell his story mainly to show that the primary validity and usefulness of essences is as a study aid, while in finding the remedy it is only one strategy among many, and not always the best for everyone.

Non-Proving Data: Families, Chemistry, Natural History, "Signatures."

As we have seen, this broad, heterogeneous area has drawn almost a wider variety and greater intensity of criticism than any other. I am still rather mystified by the almost puritanical resistance to this kind of information, in part because I myself am unashamedly addicted to it, and have found it to enrich and enhance my practice in countless ways, all entirely homeopathic as far as I can tell, and wholly innocent of any heretical imputation.

I begin with the concept of remedy "families," because it is the oldest, and, like that of essence, arises directly from our earliest homeopathic training, which requires us to study each remedy by learn-ing to differentiate it from all others, but especially from those which most closely resemble it. The old way of doing this was symptom-by-symptom, by comparing all the remedies listed for a particular key-note, for example; but the enormous number of rubrics and almost infinite diversity of remedies con-spire to make this strategy too cumbersome for ordinary daily or practical use.

Once again, Farrington was the first who clearly understood the value of looking for deeper and more systematic levels of similarity by following the trail of biological and chemical groupings that already exist in nature:

It is my duty to show you the genius of each drug, and the relations which they bear to one another. The first I have called the family relation, derived from their similarity in origin. When drugs belong to the same family, they must have a similar action. The halogens chlorine, iodine, bromine, and fluorine have many similarities because they belong to one family. So too with drugs from the vegetable kingdom. In the family to which Arum triphyllum belongs, you also find drugs which resemble one another from their family origin. Among ophidians, you will be perplexed to tell the differences between Lachesis, Elaps, and Crotalus.²⁹

 

As with essences, his words envisioned a whole new way of studying remedies, but both the small number of remedies that were then available and the limited technical means for studying them kept his splendid prophecy from being fulfilled in his own lifetime and for many generations to come. It was the development of computer hardware and software with enough memory and power to access the vast homeopathic literature and scan it at high speed that has allowed Farrington’s great project to be carried out in a more or less reproducible way for the first time. It is no accident that the new teach-ings under discussion have all arisen within the past few years semi-independently of one another and in widely separated locations, but with remarkable similarities in purpose and direction.

In an early example, the fine Italian homeopath Massimo Mangialavori analyzed the symptoms of the snake remedies using MacRepertory and Reference Works, and found, exactly as Farrington had said, that most familiar keynotes of Lachesis were in fact characteristic of the family as a whole:

Bilateral asymmetry: one-sided symptoms. Intolerance of tight clothing, especially around the neck. Aggravation during and after sleep. Affinity for the ENT and neck region, with choking and constriction. PMS, general aggravation of all symptoms before menses. General relief of all symptoms during menses, and from talking or any discharge. Passionate, sexual, competitive nature. Deadly cunning, deviousness. Psychic, clairvoyant, intuitive predilection and ability. Thrombotic and hemorrhagic phenomena.³⁰

He did not claim that every snake has all of these symptoms, but only that each keynote is found in other remedies in the family, so that those we thought were peculiar to the most thoroughly proved venom must now be attributed to the whole family and thus eventually to other members which have not yet been shown to have them. Far from being an empty generalization of the kind that André is so rightly uptight about, his work actually offers a new and better way to differentiate the various snake remedies from one another, and thus offers more accurate and precise criteria for individualization as well. The family concept merely provides a schema for clarifying which symptoms are peculiar to the remedy, and which are shared by the group.

As with essences, such schemas are not yet available in every instance and would not always be necessary even if they were. As the following case shows, the family dimension often proves useful when the most prominent member of the group appears well indicated but fails to act well or deeply enough to hold:

Her face swollen and disfigured by crops of red pustules, a woman of 41 was tormented by hot, stinging, stiletto-like pains that were worse from heat, better from ice, and made her angry at everyone. Afflicted with impetigo as a child, she’d had a bad case of chicken pox at 13, followed by recurrent boils and a persistent Staph. infection, for which she had taken antibiotics many times.

Her skin flared up all over after the death of her father, a convicted felon who had left at her mother’s insistence when she was 20, and got even worse when she was carrying her second son, who was 3 when I first saw her. Apis 200 worked beautifully but soon wore off, and she didn’t come back for a year, by which time her face stung so intensely that it reminded her of being attacked by a swarm of yellowjackets in her teens.

This led me to study Vespa crabro, the hornet, and in 24 hours after the 200 her whole face was flaming-red and hugely swollen, followed by rapid disappearance of all signs and symptoms of inflammation. By her next visit her skin looked clearer than it had for years, and she has remained well ever since.³¹

Sankaran often uses the pain rubrics to describe the sensations of remedies energetically, confirms them with the fears, dreams, and delusions, i.e., with the mental and emotional state, and then compares individual family members to extract the common features and distinguish each remedy within it. As with essences, there is nothing speculative about this: the rubrics are all there in the literature, well documented and confirmed. One could argue with his selection of rubrics, just as with Lippe’s or anyone else’s, since their relevance and importance will require years of clinical experience to verify. But that caveat does not invalidate either the concept or the procedure, which is simply to use the computer to help us study the rubrics. As with essences, his preference for the energetic language of sensations also provides another possible focal point around which other rubrics may group themselves:

With a history of back injuries, a woman of 45 complained of sciatica and numbness in her buttock and thigh, which made it difficult for her to drive or sit, especially in cold, damp weather. The pain felt "hot, inflamed, and burning," and the sole of her foot felt "cushioned, as if walking on a waterbed."

With her mother unpredictably violent, her father ineffectual, both of them alcoholic, and her older sister absent, she always felt "lost" as a child, with no one to turn to for help, and prayed for her mother to be taken away so she could have a life of her own.

In one dream she was rowing a boat but not moving ahead, and felt the same confusion she had known as a child. In another she was driving a school bus with no brakes, while her spirit guide "floated in and out" trying to fix them. Again the feeling was confusion and bewilderment as to why they were there and where they were going. She also recalled other dreams in which people "floated in and out" or she found herself in a place with no idea how she had got there.

Using her themes "confused" and "bewildered," I studied the family Magnoliæ, which includes Asarum, Aristolochia, Camphora, Cinnamon, Myristica, and Nux moschata, and the following common themes:

Sensations: Confused, bewildered, beclouded [and isolated as a result]

Passive reactions: Faint, sleepy [shutting out the bad reality, living in one’s own world. Floating, divided, withdrawn, unconscious. Fear of sleep or anesthesia, agg. on waking. [Transition from inner to outer world difficult or threatening]

Active reaction: Clarity.

Under Nux moschata, I found rubrics that seemed to fit her very well:

"Beclouded, delusion that everything has changed." "Delusion that the world or surroundings don’t exist." "Delusion that time and space are confused."

One month after Nux moschata 200, she reported feeling "much better," sleeping 18 hours that night, her back and leg pain subsided very quickly, and she resumed yoga and bike riding, even losing five pounds. She came back in 7 months for aching joints and a swollen sensation in her back, but no sciatica. I gave her another dose, and she has continued to do well ever since.³²

Much the same is true of Scholten’s method of group analysis of related mineral remedies, such as the halogens, or metal elements in the same row of the Periodic Table, or the various salts of calcium or barium: in each instance he identifies the common characteristics of the group and then distinguishes the individual members within it:

Until now the most important method of studying homeopathic remedies has been to look at each one separately. In group analysis we look at groups of remedies and extract what is in common. These symptoms will then be used in the various remedies which contain that element.

The method is least successful on the level of local complaints. On the level of general characteristics it can be applied very well. But it is on the level of mind that group analysis offers the greatest benefit. Once the central themes of the components are known, it is possible to deduce the themes of the compound.

A great advantage is getting not only the separate themes of the component elements but also those of the combination. An incidental effect is that certain aspects of remedies we already know can become clearer.³³

While his themes are not always identical to Sankaran’s, they overlap to a great extent, and their methodologies are similar. He also uses group analysis to deduce the symptoms of unproven remedies, not instead of proving them, but as an incentive to do so, as a test of his thinking, precisely in the spirit of modern science, which judges hypotheses by the accuracy of the predictions they generate. As once suggested by Kent, one common application is to consider the salt when the symptoms of the case are relatively nondescript and both elements composing it rank high in the repertorization:

Brought in for treatment of asthma, a boy of five clung tightly to his dad, whispering to him in answer to my questions. For the past year he had wheezed with every cold and from running in cold air, but needed no inhalers in between.

Athletic and talented in all sports, he played to win but was never wild, persevering until he mastered the skill, and finishing what he started. Cheerful and even-tempered, he was less affectionate outside the family, shunned loud noises, and kept his life and surroundings as orderly as possible.

After Carcinosin. 1M, he developed a fever and asthma for a few days, followed by excellent peak flows for months. But by autumn he was wheezing and coughing even at rest and in warm weather, coming down with colds and Strep throats, and burping repeatedly during attacks.

Since the repertorization pointed equally to Natrum mur. and Phosphorus, I studied and gave him Natrum phos. 200. He never came back. In the four years since he has had few colds, almost no asthma, and has needed no medication at all.³⁴

Much the same considerations apply to the use of non-proving data of any kind, such as natural history, chemistry, and the infamous "doctrine of signatures," which has provoked intense antipathy and opposition from critics as diverse as fundamentalists like Saine, Habich, and Winston on the one hand and modern scientists of the double-blind persuasion like Jennifer Jacobs on the other.

Of course, André is entirely correct about Hahnemann’s insistence that the materia medica be kept free of such impurities, so that even those of us who like to use them, like Sankaran, Herrick, and myself, assign them at most a secondary importance. But our understanding of remedies would be very much poorer without them. Thus even Julian always took his students on plant walks to identify the remedies and teach them some folklore, and Clarke liked to introduce his remedies with chemistry or natural history wherever possible. In Whitmont’s Psyche and Substance and Vermeulen’s Prisma, the non-proving data transport us straight to the mythic realm, where essence and meaning are intertwined. How useful is such information to the prescriber? Consider Lachesis, a favorite example of mine. The snake is named for the second of the three Greek Fates, who were said to determine the length of a man’s life: namely, Clotho, who spins the thread, Lachesis, who draws it out to its appointed length, and Atropos, who cuts it. Even hard-core fundamentalists might well reflect on the coincidence that Hering, who proved the venom on July 28, 1818, died on July 23, 1880, 52 years later, almost to the day.³⁵ This is partly a matter of toxicology, I suppose, which we’re told is OK, but it also speaks to the naming of the animal, which is a kind of "signature" after all.

 

My book Resonance teems with other examples. I connected the Arsenicum delusion of being poisoned with the biochemical fact that arsenic is toxic to all living cells, and used "auto-intoxication" as a kind of metaphor to derive and even "explain" the other keynotes as well: coldness, restlessness, anxiety, fastidiousness, etc.³⁶ Is this not precisely the sort of "didactic value" that Habich et al. were talking about? It won’t help you repertorize, and can assuredly be treacherous in inexperienced hands, as we all agree. But it does often remind me to think of the remedy, which is why I wrote it down; others will no doubt prefer the metaphors that work best for them.

What of Pulsatilla, whose common name, the "windflower," aptly corresponds to its mutable nature as a remedy, so easily swayed and influenced by outside forces;³⁷ or Natrum mur., about which the Biblical tale of Lot’s wife and the pillar of salt come readily to mind;³⁸ or Sulphur, the business end of insulin and Coenzyme A, which govern our basic energy production, as does the remedy itself?³⁹

These are all simply metaphors, or teaching aids. Like essences, they are indeed seductive and unnecessary for good practice. But neither Sankaran nor Herrick nor I in our wildest dreams covets more than a didactic rôle for them, or hopes to smuggle them into the Repertory or materia medica without anyone noticing. In this matter at least, the fundamentalists are merely beating a dead horse, conjuring up the spectre of new age psychobabble that only our most credulous groupies are actually guilty of, and these will always be with us, and with André too. Nor should the pot call the kettle black: to anyone who can swallow classical homeopathy, ESP, radionics, kinesiology, dowsing, clairvoyance, spiritualism, and all the rest should pose no insuperable obstacles.

For non-proving data, then, as for essences and families, the bottom line is primarily to suggest remedies we might not otherwise think of:

Brought in by her grandmother for bronchitis that tended to last all winter, a girl of five had been orphaned as a baby when her drug-abusing parents were both brutally murdered. Described as "a happy child who gets along with everyone," she sulked whenever she felt left out, blew her nose constantly, hawking up thick, green mucus from her throat, and wet the bed almost every night. When she smiled, her upper teeth were rudimentary, brown-stained, and broken off in places. Her eyes turned in, alternating from side to side, and she craved salt and milk primarily and was intensely allergic to cats.

Calcarea sulph. 200 did nothing. In a month she was back, sniffling loudly, but sporting a new sweatshirt that featured dogs of all kinds, reminded me of her alternating strabismus, and thus led me to study and eventually give her Lac caninum 1M. By her next visit her cough was gone, she wet the bed much less often, and was breathing freely through her nose. I repeated it in the fall, and the winter was her best ever, with minimal cough and no bronchitis. I’ve not seen her for five years, but another patient and family friend assures me that she has continued to thrive.⁴⁰

In this instance, the dogs on her shirt merely reminded me of the remedy I’d already thought of for other reasons. In the following case, the details of her history and physiognomy added up to a kind of totemic "signature" that was all I had to go on, and may therefore be taken to represent the furthest possible application of this admittedly outlandish type of clue:

With a history of benign fibroadenomas that had already resulted in four breast surgeries, a 45-year-old artist came in hurting from a fifth and hoping to prevent them in the future. A painter of horses especially, she had suffered chronic back pain ever since falling from a horse and crush-ing three vertebrae in her teens, but never gave up riding, having grown up with horses and still feeling mystically drawn to them.

Estranged and enraged by abusive relationships in her family of origin, she was raised by a grandmother, spent her childhood mostly alone in the woods, and thought of herself as an Indian brave riding her pony in the wilderness. Lean and lanky, with a long, graceful neck, two buck teeth jutting out in front, and a craving for lumps of pure cane sugar, even in her physique and constitution she seemed to conjure up the equine archetype as a kind of personal totem.

With little else to prescribe on, I studied Lac equinum and decided to give her the 200C as an ex-periment. In 6 weeks the walnut-sized tumor was no longer palpable. I haven’t seen her for six years, but she phoned recently to say that she was well and the tumors hadn’t come back.⁴¹

I’m far from advocating this hail-mary pass as a strategy. The truth is, I was out on a limb, and tried the remedy because I couldn’t think of anything else to do. I know it’s bad homeopathy, and not really homeopathy at all. But it also shows that uncanny signatures and non-homeopathic similarities do indeed exist in nature, are often highly individualized in just the way we need our patients and their remedies to be, and thus may occasionally even be relevant and useful in our prescribing.

So in the end, whether a Supreme Court or Hahnemannian Inquisition of the highest repute is willing to proclaim such adventures strictly homeopathic or not is not of very great moment to me. But I do most emphatically believe that the discriminating use of non-proving data can enrich and indeed transfigure us all, and that the imaginative faculty is as indispensable to the science as to the art of good medical practice, whether homeopathic or otherwise. It grieves and saddens me beyond measure to hear these truly divine gifts maligned by grown men, let alone old friends and colleagues who should know better.

The Theory of Miasms.

As I’ve said, I’m especially curious about the dearth of critical attention that Sankaran’s ideas about miasms have received, pro or con, since they are by far the boldest, most brilliant, and even the most avowedly speculative of his many innovations, Moreover, unlike his work with essences, remedy families, chemical groupings, and signatures, they are uniquely his own, and have not been uniformly accepted even by his students and colleagues, who eagerly devour almost everything else he says.

If I’m right, the reasons are intriguing and instructive, and again take us all the way back to Hahnemann himself. Listen to the master in his later years, as he grapples with the dark and mighty enigma of the chronic diseases, like Jacob wrestling with the angel:

After being removed time and again with proven remedies, the non-venereal chronic diseases always returned in varied form and with new or increased symptoms. This gave me the clue that the homeopath must combat not only the disease presented before his eyes, that he meets but a separate fragment of a more deep-seated original disease. He must therefore ascertain the whole extent of the symptoms belonging to the unknown primitive malady before he can discover medicines to remove it.

Once it has advanced to a certain degree, it can never be removed by any robust constitution, be overcome by the most wholesome diet or regimen of life, or die out of itself, but rather increases from year to year until the end of life.

Then I found that the obstacle to cure often lay in a past eruption of itch that was not noticed or told of, and that all later sufferings dated from this time. So far as is known, only three chronic miasms are found which manifest themselves through local symptoms, and from which most if not all chronic diseases originate, namely, psora, sycosis, and syphilis.⁴²

From watching the underlying disease worsen even after the remedy had acted beautifully, he realized that the symptom-picture as it appears at a particular moment is only a fragment of the totality that needs to be considered, that our prescription must encompass the whole symptom-picture as it has evolved throughout the patient’s lifetime. In a tour de force requiring decades of careful scholarship, he claimed to trace these underlying maladies to "psora," the itch disease, and two other chronic styles, the venereal "miasms" of gonorrhea and syphilis. In short, he formulated a speculative hypothesis, which he backed up with an enormous mass of documentation, but remained appropriately tentative about it, using such qualifying phrases as "so far as is known" and "from which most if not all chronic diseases originate" to leave room for those of future generations to confirm, refute, or build upon.

The reason I suspect that the fundamentalists have let Sankaran’s miasms alone, then, is that building on Hahnemann is exactly what he has done, so that to go after Sankaran here is to go after the master as well. From Hahnemann’s time right up to the present, the whole concept of miasms has remained so controversial and even embarrassing from the viewpoint of contemporary medicine that many eminent homeopaths have declined to follow him into this realm, which even today lies wholly beyond the pale of what passes for science.

Thus in his splendid text, The Science of Homeopathy, even the great Vithoulkas offers only the briefest formulation, almost as a footnote to the idea of predisposition, accepting Hahnemann’s basic principle but refusing to limit its application to his three main pathological styles, or indeed to any fixed number:

A miasm is a predisposition toward chronic disease which is transmissible from generation to generation, and may respond beneficially to the corresponding nosode prepared from the pathological tissue, drug, or vaccine. From this definition it is clear that there are a large number of miasms, and that the total number is constantly increasing with the advent of suppressive therapies.⁴³

I suspect that Vithoulkas favors as broad an interpretation of the concept as possible, and as many examples of it as possible, simply to avoid having to take a position for or against the venerable triad of Hahnemann. But he is certainly right about the value of the concept in general. Hahnemann’s exigesis of the scabies vesicle, the venereal wart and gonorrheal discharge, and the syphilitic chancre as simply external stigmata of the underlying miasms or pathological styles, which are transmissible across the generations and require a lifetime to develop their mature form and global extent, is a masterpiece of pure thought, and has been repeatedly validated through the successful use of the nosodes corresponding to them.

Sankaran’s work lies entirely within this Hahnemannian tradition. First, through computer-assisted study of the nosodes, he was able to preserve, redefine, and reinterpret the original three, and eventually to identify a new one, the "acute" miasm, which has no nosode but encompasses a group of remedies like Aconite, Belladonna, Camphora, Arnica, Veratrum, and others typical of ailments that appear suddenly and heal completely without residue, making a total of four basic miasms.

Then he found five others that appeared to lie "between" different pairs of these, each similarly named for a well-known disease with its own distinctive lesions and other features that exemplify the more general type. Thus "cancer" and "TB," which had been proposed long before, and whose corresponding nosodes were already familiar and well-studied, were "located" between sycosis and syphilis, showing elements of both. To this same sycosyphilitic position he also assigned the "leprosy" miasm, with its nosode Leprominium, which had long been used in India. Two other major examples are the "typhoid" or subacute miasm, lying between the acute and the psoric, and the "malarial" or intermittent miasm, between the acute and the sycotic.

He freely admits that these names and sitings are tentative, approximate, and will take years to evaluate properly. But in each case, by studying the nosode and the typical remedies that correspond most closely to it, he has identified a nexus of sensations and systemic features that has repeatedly proved its worth in practice, as in the following case:

A 70-year-old artist and writer consulted me for arthritic attacks in her hand that she described as "terrible, so bad, incredible!" Also nursing her husband for a ruptured disc, she was sure that exhaustion played a major rôle in her problems. Primarily in her fingers, the pain made it hard to write, weakened her grip, and was better from warmth. But she insisted that her biggest problem was her sense of family responsibility, such that "if something needs to be done, I do it," while "I never needed anything for myself!"

The intermittent character of the pains, with an intensity unmatched by any objective findings, plus the curious blend of self-pity and moral superiority in her complaining, suggested a remedy of the malarial miasm, which Sankaran describes as follows:

Sensations: Attitude: "Stuck," limited, unfortunate You have to bear it Imprisoned, dependent Fixed limitation, dependent Intermittent attacks

Successful Stage: Failed Stage: Accepting limits, Miserable, brooding, not fighting them sees no good anywhere Intermittent anger Complaining, lamenting Sentimental, phobic Paroxysms of rage

Pathology (partial list): Migraine, neuralgia Rheumatism, arthritis Colitis, labyrinthitis Asthma

Remedies (partial list): Antimonium crud. China Cina Natrum mur. Colchicum Eupatorium perf. Cactus grand. Capsicum Colocynthis Chelidonium Ranunculus bulb. Spigelia

I found what I was looking for under the Compositæ, a family of wound remedies like Arnica, Bellis perennis, Calendula, and Eupatorium

Sensations:

Injured, hurt Fear of being hurt, touched, or approached Shocked, insulted

Passive Reactions: Active Reactions Numbness Touchy Anesthesia Hurting, hurtful Stupor Cruel, violent, strikes

Compensation: Tough guy: "I can take it!" Protective of others

With the help of this summary, especially the part about the "tough guy" who bears his own pain to protect others from theirs, I studied and eventually gave her a 200 of Eupatorium perfoliatum, the malarial remedy of the family. Six months later, she reported, "That remedy really made a difference! No complaints!" None, that is, until recently, when I repeated it. In the last two years, she has only needed it after her "annual kvetch" every spring, each time with excellent results.⁴⁴

This case also illustrates Sankaran’s technique of "mapping" plant remedies as points of inter-section between the miasm and the family. As with his essences, families, and chemical groupings, each miasm is defined using the exact words and imagery of the patient, and is thus capable of more precise individualization than repertorization alone.

Provings.

As we have seen, the provings of Rajan Sankaran, Nancy Herrick, and Jeremy Sherr have also drawn a lot of criticism both deserved and otherwise, which undoubtedly reflects the iconic status of this uniquely Hahnemannian procedure as well as the current obsession to nail down what is or is not "the real thing." I leave aside for the moment the inconvenient fact that we continue to manage very nicely with hundreds of remedies that have been proved inadequately or not at all. Homeopathy did begin with a proving, after all, and the procedure does beautifully epitomize the whole of what we do, from how to study remedies to the uncannily fruitful parallelism between them and our patients. So it is only fitting that we should feel inclined to fight for our sometimes differing visions of how to conduct them. I begin with a digest of what Hahnemann has to say on the subject:

Each medicine is taken in pure, unadulterated form, without any other medicine being taken during the time we wish to observe. The diet must be simple, nutritious, and free of spices and stimulant drinks. The prover must be in good health, avoid all passions, dissipations, and overexertion of mind and body, and have no urgent business. He must devote himself to careful, undisturbed observation and be intelligent enough to describe his sensations accurately. Weak medicines do not exhibit their powers as fully in their crude state as when given in the 30^th potency.

All changes in health during the proving are said to belong to the medicine, even if the prover had experienced them in the past. He must record all the sensations he experiences after taking it, as well as when and for how long they occur. If the physician gives the drug to others, he must examine their report afterward, or daily if the trial lasts for several days, amending it if necessary.

From such a materia medica, all that is conjectural, imaginary, or mere assertion must be strictly excluded. All must be the pure language of nature, carefully and honestly interrogated.⁴⁶

The provings of Sankaran, Herrick, and Sherr do indeed depart slightly from the letter of these instructions in varying degrees, and in overlapping but not identical respects. As we saw, Sankaran has been castigated mainly for importing foreign elements from contemporary psychology, namely, the idea of "group mind," exemplified by his interest in the symptomatology exhibited by the "controls" who attended the seminar but did not actually take the remedy; and the use of "dream provings," a wholly novel procedure in which only the dreams are recorded, making straight for the unconscious material and ignoring the physical symptoms altogether.

I will not say much about dream provings, because they are intended only as a supplement to the usual kind, to bring out and highlight an important dimension of remedies that is likely to be missed amid the welter of physical sensations. As mere addenda to the usual procedure, I can’t see how dream provings raise any serious methodological issues. On the related issue of group mind, those who can’t resist the impulse to ridicule what they know only by hearsay will do well to read Rajan’s own words:

The provers, students or practitioners at a seminar, were all given a dose of 30C. Another dose was given after four days if there were no symptoms or they had ceased. They were asked to record all symptoms, dreams, and non-ordinary experiences; all physical symptoms with exact modalities; all dreams, with exact feelings; all incidents occurring around them; observations by others about changes in their state; and persons, movies, books, etc., that they liked or disliked. Some not taking the dose experienced symptoms, which were also recorded.

I met each prover alone each week, recorded all their symptoms, and videotaped every session. We met as a group after two weeks and again after three or four weeks. At this stage provers’ experiences often elicited memories in others, creating a powerful effect in the room, so the underlying state could be more clearly defined. Only then would I reveal the name of the remedy.

The only symptoms recorded here are a transcription of the video interviews of each prover. I have tried to gather and report the data with a minimum of error, bias, and subjectivity. Provers were instructed not to discuss their experiences among themselves. I elicited their mental and emotional symptoms in the interview without prompting or suggestion, just as in casetaking. No summaries or conclusions are offered, to be faithful to the data and not prejudice the result.⁴⁷

As in all of his work, the spirit of Sankaran’s provings is thoroughly Hahnemannian, from first to last. As the above makes clear, the symptoms of non-provers are only recorded for comparison, i.e., as a built-in control group, and are therefore subtracted and omitted from the final or published result. In short, the motive is essentially one of scientific curiosity, stimulated by his actual experience of the phenomenon, which while unknown to Hahnemann has been well documented by modern psychology.

In our laudable zeal to defend the integrity and scientific rigor of his work, we often forget that Hahnemann, the fundamentalist par excellence, was also our greatest innovator, and that apart from the redevelopment of homeopathy itself throughout his lifetime, including provings, dynamization, miasms, LM potencies, and all the rest, he maintained a lively curiosity about the science of his time, especially in the "etheric" realms of clairvoyance, spiritualism, mesmerism, mediumship, and the like:

The curative power of animal magnetism or mesmerism streams upon a patient by contact with a well-intentioned person powerfully exerting his will. It can act homeopathically, by producing symptoms similar to those of the state to be cured, or otherwise, by redistributing the vital force uniformly throughout the organism.

For the former purpose, a single pass, made with the palms from head to toe, is useful in uterine hemorrhage in the last stage. For the latter, the restoration of the vital force to the whole organism or some weakened part cannot be attained by any other treatment as certainly and with as little interference as by mesmerism.

Many rapid cures in all ages belong to this class. It is done by concentrating a very powerful and well-intentioned will and placing the hands on the weakest parts. The effect is most notably shown in the resuscitation of persons who had lain apparently dead for some time, of which history records many undeniable examples.⁴⁸

The methodology of Nancy Herrick’s work is very close to Rajan’s, with a few exceptions and modifications that I will consider in a moment. Unfortunately her Preface is ambiguous about whether her provings were blinded or not, so I’ve taken the liberty of editing her words slightly to make clear that they were, as she reassured me when I asked her: "Neither provers nor supervisors know what the substance is." ⁴⁹

Her views differ most significantly from Rajan’s in the area of supervision. Here are her own words on the matter:

Up to twenty volunteer, preferably students or colleagues, but not patients or anyone unfamiliar with homeopathy. I trust homeopaths to record symptoms accurately and in detail, especially about mental and emotional states. Provers who are homeopaths decide if they want a super-visor, and if so I will provide one. Non-homeopaths must have a supervisor, who also takes their case beforehand.

Provers get a vial of 30C and a booklet to record symptoms. 3 weeks after the dose they record in detail all symptoms that differ from their usual state. Supervisors call to review physical symptoms, experiences, and state of mind. Dreams, emotional states, and unusual events such as acute illness or crises are important. If they have no symptoms, they repeat the remedy twice more, two days apart. If their symptoms are slight, they repeat it once more after they’ve gone. If they are strong, they wait and watch.

After three weeks a group meeting is held in a quiet room where we will not be interrupted. Provers are asked not to discuss symptoms or their state with anyone before then. The session is videotaped, but anyone may choose not to be filmed. All provers read their booklets, summarize their experiences, and elaborate as seems appropriate. Then I reveal the name of the substance, and we conclude.⁵⁰

As I wrote in my own review of her book, I have doubts about allowing provers to decide for themselves whether they need a supervisor or not.⁵¹ Exactly analogous to that of taking the case of a patient, the supervisory rôle is likewise no more to be left to the provers’ discretion, it seems to me, than we give our patients the option of taking their own case. But these are practical guidelines that cannot and should not be written in stone. Nancy chooses to take advantage of the special trust she clearly enjoys with her own students and colleagues, by giving higher priority to positive feelings of love and communication than to "checking up" or surveillance. To that I say, more power to her. I’m willing to give her the benefit of the doubt, but I have to admit I’m not convinced.

A related issue for me is conducting the supervision by telephone, which I distrust in the same way and measure as patient interviews, although like everyone else I have to do them that way at times. Without in-person contact and the non-verbal communication that helps me to ask or reframe questions in ways I’d never have thought of, the phone interview reduces to merely taking down information, and the quality of the data is likely to suffer from that impoverishment.

The alleged "anthropomorphizing" that so bothered Julian and others is not an issue for me. As I’ve already said on the subject of signatures and other non-proving data, these are simply metaphors or learning tools that we use to describe animal behavior as best we can, and Nancy’s versions are not at all wild, extreme, or out of the mainstream of how animal biologists do natural history today.

Another issue that Julian raises is her choice of remedies, which in the past has always been left to the discretion of the master prover. Thus Swan and several others were inspired more or less simul-taneously to make a dilution of ordinary pus, Pyrogenium, which has turned out to be a marvelous remedy, while Hahnemann’s interest in non-material energies or imponderabilia led him to prove the magnet and its poles, Caspari similarly went for electricity, and Rajan is drawn to rat’s blood, the main reservoir of bubonic plague, which survives in India, and to plastic, that ubiquitous and non-degradable symbol of humans befouling their own nest.

Most of Nancy’s book is taken up with the milks of important mammals, which are obvious and welcome additions. Her two most quixotic choices were the butterfly, the most ephemeral of living things, which perhaps explains why the Hopi still dance an annual ritual in its honor; and the fossilized bone of a dinosaur that has been extinct for millions of years, about the symptoms of which I can only say, good luck and God bless her for trying.

What struck Julian as her most egregious innovation, her attempt to identify "themes" on the basis of group discussion rather than simply letting the data speak for themselves, also strikes me as far less threatening and certainly no cause for alarm or ridicule. As I said in my review, her aim is simply to find the essence, which she wins my admiration just for daring to attempt, because it’s difficult and risky, and nobody else will touch it with a ten-foot pole. My beef with her themes is just the opposite, that they’re too vague and general, maybe because of her laid-back attitude to supervision, and offer no really controversial interpretations, revealing little more than the sort of topical headings that Sankaran uses to organize his data, which is to say, a lot less radical and threatening than Julian feared, but less interesting and useful as well.

Jeremy Sherr has made several fine provings, the main critic of which is Vithoulkas, but chiefly it seems to me on flimsy or ad hominem grounds, such as 1) that "no case in my life needed Hydrogen or Chocolate," i.e., these are remedies we don’t really need; and 2) that George got very different symptoms when he gave Hydrogen to his own seminar, which led him to disparage the integrity of Jeremy’s work, but came up with only lame and perfunctory assumptions about where he went wrong. But I’ll come back to Vithoulkas later. First listen to what Jeremy says, because it seems to me he gets it exactly right on the very same issues that we’ve been discussing:

It has been my experience that "echo" symptoms highly consistent with the proving have often occurred in those in close proximity who did not actually take the remedy, namely, supervisors, placebo controls, class members, or close relatives. I’ve not included them, but the phenomenon is interesting, and raises questions about the validity of giving placebo.

Good supervision is the key to a quality proving. Supervisors should be experienced homeo-paths and should take no more than two supervisees, since they must take their cases every day. Indeed, it’s best if they are well acquainted with them already, if they are already their patients, or at least in geographical proximity. It is essential to take each prover’s case beforehand, to compare symptoms before and after the proving.

Inadequate supervision is the main reason for poor results. The provers become the proving, as if "infected" by the remedy, and cannot perceive that they are changing. Quite a few report that nothing has happened. So I send the provers back to investigate more thoroughly, and they return saying things like "I hadn’t noticed this was happening," or "the prover didn’t realize these were proving symptoms." The surprising thing was that these unnoticed symptoms were all unusual, and so they recorded many symptoms which were omitted.⁵²

For Jeremy the need for supervision has less to do with trust or the lack of it than the built-in tendency for the best and most distinctive symptoms to remain hidden from the patient’s conscious awareness and thus go unreported with even the best of intentions. He also makes highy pertinent comments on themes or essences that resolve this issue along the same lines that Habich et al. have proposed, namely, that such formulations should be withheld from the proving itself, but may be published as opinion in later articles for teaching purposes, leaving ample room for others to do the same in their own fashion, which is exactly the way the materia medica and our understanding of particular remedies develops over the years:

I decided not to venture any of my private ideas concerning the "image" of the remedy. My opinion is that a proving should be a pure document, without prejudice or interpretation. It should be left to each individual homeopath to weave the symptoms into a meaningful and coherent picture. Any early attempt to sum up the elaborate proving symptoms carries the price of sacrificing the totality of symptoms. It is much easier for the student to hang onto a few simple lines of "essence," which would be fine if the totality were also studied. But the mind always grasps the convenient, short-term solution.

The master prover will have perceived many hidden threads running through the proving, and these can be explained in a general way or published in future articles to facilitate the work of the student. But the provings themselves should be in the format of the Materia Medica Pura and not diluted to simple essences, which can cause so much damage to homeopathy.⁵³

This Solomonic judgement offers a sensible compromise that could satisfy innovators and fundamentalists alike, giving each side their due, acknowledging the validity and usefulness of formulating the essence, but leaving that task for each practitioner, while adhering to the traditional format for the proving itself.

Innovation and Fundamentalism in Our History.

As I reconsider all the arguments and counter-arguments, I can feel these same controversies stirring and echoing from the depths of our history, in which contentious and internecine theological disputation has figured prominently from the beginning. Here is Hahnemann railing against the "half-homeopaths" of Leipzig, and torpedoing his own pet project for a homeopathic hospital in the process:

Some who pretend to be homeopaths allow their patients to choose whether to be treated homeopathically or not. Whether they are not yet sufficiently grounded in the new doctrine, or lack due benevolence to their species, or dishonor their profession for sordid gain, they should not expect me to recognize them as disciples! Combined with the use of our remedies, such quackeries as bloodletting, mustard plasters, salves, emetics, purgatives, etc., identify these crypto-homeopaths as surely as a lion is known by his claws.

Practice honorably as an allopath, as yet ignorant of anything better, or as a homeopath for the welfare of mankind. But as long as you wear this double mask, you will be a contemptible hybrid of a physician, of all the most pernicious. Should any false doctrine be taught in the name of homeopathy, or patients be treated with any imitation of allopathic practice, I will raise my voice to warn against such treachery.⁵⁴

To that extent, André is simply doing his duty according to his lights, just like Hahnemann and Lippe before him:

Possibly some of the twenty-one signed mainly to protest against censorship or dogmatism, for liberty of opinion and the freedom to investigate. But while everyone is free to practice medicine as they choose, nobody has the license to call Homeopathy what is not Homeopathy. In 1870 Lippe warned, "There are true and good men among us who erroneously believe that anyone professing to be a homeopath must be allowed full freedom of opinion and action, to do whatever he has a mind to do. But the liberty to accept homeopathy does not include the freedom to reject, alter, or modify its fundamental principles."

Some want us to believe that the method of Hahnemann is a thing of the past, that we must evolve from it. But his inductive method is what brought medicine out of its chaos. If the basic principles of homeopathy were true yesterday, they will continue to be true until the end of time. Others want to combine both methods, homeopathy with the speculative approach. But it is impossible to advocate both: they are as opposite as day and night, as truth and falsehood.⁵⁵

And in one sense he is perfectly right. Since the laws of homeopathy do indeed have the shine of the eternal and immutable about them, it seems as though they can only be added to, not changed in any significant way, so that by definition the method is incompatible with innovation per se, with any possibility of meaningful change. It is truly a philosophy in that sense, a coherent system of principles about health and disease that all follow logically from a few simple axioms, like the vital force and the "Law of Similars," which cannot themselves be proved or disproved in the same way that ordinary scientific hypotheses are expected to be.⁵⁶ Moreover, the method which Hahnemann left us remains practical and serviceable even today, having stood the test of time, such that we who carry on his work are quite content and even proud to acknowledge our greatest achievements as mere footnotes to the books he wrote and the principles he enunciated so long ago.

But homeopathy has also grown and developed over the years in important ways that the master did not and could not have foreseen, less by the addition of new remedies than in the depth of how we understand the ones we already know. As André has said so often and so well, it is the fixed and seem-ingly unalterable character of our principles that effectively assures every innovation of being opposed and rejected, just as is happening now.

Less well known is the coincidence that the innovators of yesterday are apt to become the fundamentalists of tomorrow. Just as Kent in later life took up the cudgels against mongrels and backsliders even more zealously than Lippe had before him, so the incomparable Vithoulkas, the "illuminist" par excellence of his time, now dishes it out to Rajan, Jan Scholten, and Jeremy in much the same casserole of curmudgeonly rant and seasoned wisdom that Künzli once served up to him, and sounding a lot like Julian, André, and Habich in the process, as if no further innovations could be possible or tolerable after his own:

You can separate what is serious from what is not. If I give a remedy and the placebo group has the same dream as the ones who took it, and I say the dream belongs to the remedy anyway, it’s not to be taken seriously. Why not potentize a stanza or a piece of music? Put the powder here, play the music, and make a proving with the powder: do you believe it can make a proving, can make you sick?

If you put remedies in the same chemical group, like lead with antimony, what’s the use? First of all, it’s a fantasy. Second, it doesn’t prove anything. If you prove a substance correctly, OK, I have no problem. But to imagine that Diamond will be a hard person because the diamond is very hard, that’s ridiculous. Sankaran and Scholten have done more harm to homeopathy than all our enemies put together.

People go crazy over hearing that a patient looks like an animal or a flower, yet claim to be classical homeopaths. I gave Hydrogen to some Italian doctors, and the results were totally different from Jeremy’s. No case in my life needed Hydrogen or Chocolate. Scorpion is a remedy, but prove it right, so the information you give out is correct. First, take people who are poisoned. Only those sensitive to a remedy develop clear, reliable symptoms. You can’t just give a dose of 30C to fifty people and expect them to develop symptoms. To record all the euphoria, fantasy, and group nonsense as provings of the remedy is killing homeopathy.⁵⁷

So the wheel has come full circle once again, a fable from which I conclude that both innovators and fundamentalists are permanent features of our landscape, equally important and perhaps inseparable parts of the legacy that Hahnemann left us, each needing the other a lot more than the rest of the world seems to need or want us in either guise. Simply acknowledging the validity of our principles lends to everything that follows the force of absolute truth, so that every disagreement can easily become a holy war. Yet failing to honor them will indeed undermine the elegant system and the incomparable method that we all hold dear. So I think we must simply agree to disagree, and leave it to our patients to decide the question on its merits individually in each case, as indeed they always do.

NOTES.

Moskowitz, R., "Innovation and Fundamentalism in Homeopathy," American Journal of Homeopathic Medicine 95:91, Summer 2002.

Winston, J., "But Is It Homeopathy?" Homeopathy Today, December 2000.

Winston, J., Book Review, loc. cit.

Habich, K., et al., "Controversy in Homeopathy: Magic or Science?" American Journal of Homeopathic Medicine 96:82, Summer 2003.

Jacobs, J., and Crothers, D., "The Emperor Has No Clothes," Homeopathy Today, July-August 2001.

Saine, A., "Drawing a Line in the Sand: Homeopathy or Not Homeopathy?" American Journal of Homeopathic Medicine 95:69, Summer 2002.

Winston, J., "Back to Basics," Homeopathy Today, April 2001.

Künzli, J., "Impressions of Homeopathy in the United States," Journal of the American Institute of Homeopathy 75:42, March 1982.

Saine, op. cit., 2002.

Habich, op. cit.

Saine, op. cit., 2002.

Habich, op. cit.

Morrison, R., et al., "Against Divisiveness," Homeopathy Today, May 2001.

Saine, "Homeopathy vs. Speculative Medicine: a Call to Action," Homeopathy Today, September 2001.

Ibid., pp. 125-126.

Declaration, American Journal of Homeopathic Medicine 96:91, Summer 2003.

Preamble and Resolutions, International Hahnemannian Association, Adopted 1881, IHA Transactions, 1881-83, pp. 10-11 and 14-15, passim.

Hahnemann, S., Organon of Medicine, 5^th Edition, with Additions from the 6^th, W. Boericke, trans., ¶9,10, 12, passim.

Ibid., ¶108, 119, 144, passim.

Farringron, E. A., Clinical Materia Medica, pp. 20-21.

Lippe, A., Textbook of Materia Medica, pp. 294, 299.

Kent, J. T., Lectures on Homeopathic Materia Medica, pp. 574-576, passim.

Vithoulkas, G., Essence of Materia Medica, pp. 88-90, passim.

Moskowitz, Resonance: the Homeopathic Point of View, p. 86.

Ibid., p. 85.

Ibid., pp. 87, 117, 119, passim.

Sankaran, R., An Insight into Plants, vol. 2, pp. 569-570, 576.

Resonance, pp. 196-197.

Ibid., pp. 62-64.

Farrington, op. cit., pp. 23-24.

Mangialavori, M., NCH Summer School Handout, 1995.

Resonance, pp. 162-163.

Scholten, J., Homeopathy and Minerals, p. 23.

Resonance, p. 200.

Knerr, C., Life of Hering, p. 197.

Resonance, pp. 183-187.

Ibid., p. 106.

Ibid., p. 189.

Ibid., pp. 170-171.

Ibid., p. 151.

Ibid., pp. 168-169.

Hahnemann, Chronic Diseases, pp. 4-9, passim.

Vithoulkas, The Science of Homeopathy: a Modern Textbook, p. 130.

Resonance, pp. 327-329.

Ibid., pp. 317-318.

Organon, ¶123-144, passim.

Sankaran, Provings, pp. 2-4.

Organon, ¶293.

Herrick, N., Animal Mind, Human Voices, pp. xii-xiv, passim.

Ibid.

Moskowitz, Book Review, Homeopathy Today, January 1999.

Sherr, J., Dynamics and Methodology of Provings, pp. 33, 46, 47, passim.

Ibid., pp. 79-80.

Hahnemann, "To the Half-Homeopaths of Leipzig," in Bradford, T. L., Life and Letters of Hahnemann, p. 300.

Saine, op. cit., 2001.

Moskowitz, "Hahnemann’s Achievement and Legacy, American Homeopath, 2000.

Vithoulkas, Interview, Homeopathic Links, 1999.

 

© By Richard Moskowitz, M. D., http://doctorrmosk.com