Digest 2499 Polypharmacy

[VCCH hom]

Dear David,

In reference to your reply to Ellen - Sun 23/4/06, I think you have made a number of interesting and important comments. While I have been involved in the full time teaching and practice of homoeopathy for many years, I am a newcomer to this chat line.
I agree with what you stated regarding polypharmacy i.e. that we never know what remedy is doing what. By blending Aconite, Spongia and Hepar together, we lose knowledge, but we also cannot foretell its action. Remedies being energetic are like colours, for instance red yellow and blue. We mix them together because we want a bit of red yellow and blue for our patient, but we may just get a medicine that is brown instead. Hahnemann was not against mixing substances together per se, but the medicinal application of combinations and mixtures without a prior proving he believed was obscene negligence. Without a proving, we can never know whether a remedy is red, yellow, blue or brown. Is one compound nullifying one of the others? Who knows - the possibilities are endless and that is the problem.
Regarding your comments on 'the constitutional remedy', it is true that Hahnemann should always be the guide, however it is also fair to say that Hahnemann found homoeopathy wanting when it came to constitutional prescribing, hence the development of the miasm doctrine. This means acute prescribing techniques are missing something valuable when it comes to chronic disease. Of course, the pillars of similimum, totality and infinitesimal dose always apply, but there is something extra needed when it comes to chronic.
There is no doubt Hahnemann was a fantastic acute prescriber, whether scarlet fever, typhus or anything else for that matter, but continually reoccurring chronic disease gave him as many headaches as it does everyone else. His development of the three miasms to explain chronic disease is nothing short of sheer and utter genius, but there is a paradox, even though he was brilliant enough to discover the miasms, I am skeptical about his ability to effectively utilize his own creation.
The reason for this is because Hahnemann was a scientific pragmatist. Obviously, he was open-minded, but at the same time, Hahnemann was a medic, an epidemiologist, a chemist and a researcher all rolled into one. So, what does this have to do with anything? Homoeopathy deals with both acute and chronic complaints, but the modus operandi for each is slightly different and therefore requires a different way of thinking, and I sometimes wonder whether Hahnemann's mind was not as well suited for chronic as it was for acute disease. Before deciding to burn me at the stake, let me explain, acute diseases are due to an environmental impact, a virus, bacteria or parasite. It is something that infects and poisons our system and forces us into an internal struggle for survival. It is life and death stuff. Therefore, a thorough knowledge of anatomy and physiology, pathology as well as diet, nursing and hygiene - both personal and environmental are vital.
Chronic disease however, does not have this base. Chronic disease is the result of internal impact - not external. Our biological inheritance as well as life events, self-belief, emotional trauma and general character are the fundamental causes, not microbes. Hahnemann knew something was missing that is why he spent twelve years researching the topic. The trouble for homoeopathy is that two different thought processes are required. Acute requires deductive and linear thinking, while chronic disease often requires a more lateral approach, and there is no doubt that Hahnemann was more deductive and linear. This does not mean we cannot switch from one approach to the other, our minds are extremely adaptable, but most of us are better and more naturally suited to one of these ways of thinking. This difference has caused much of the hit and miss turmoil found in constitutional prescribing. Acute is understanding illness, while chronic is understanding the person that has the illness. Hence, chronic disease is often more than just the sum total of the illnesses we have. Tyler, as you would know, stated if the patient is Sepia then Sepia will fix any ailment regardless of whether the ailment is found in the schema of Sepia or not.
The trouble at present is three fold

1.. Acute and chronic disease are being viewed with the same logic which is not interchangeable. As a profession we think practitioners should be able to do both equally well but for some this will never be the case
2.. lateral thinking has been replaced by obtuse thinking
3.. basic fundamentals are not being applied

You will note that regarding chronic disease I stated that something extra is needed, not that the whole system needs revamping! What is needed is a better understanding of Hahnemann's miasms together with all the other fundamentals, then, chronic prescribing will become more solid.
You also stated that Hahnemann's 'classical homoeopathy' offers the most broad outlook and I agree. Not just in its embrace of external knowledge as you have rightly pointed out, but also in its usage of remedies. I, like you, use only a small number of medicines particularly when compared to the dispensaries of my contemporaries, and I get nothing but incredulity and sometimes even mockery when I state that my clinic generally runs on 50 to 60 remedies - with the occasional 'odd one' every now and then. I can use remedies repeatedly because I do not look on remedies as people. Medicines are things you need - not things you are. Therefore if someone does well on Calc but later needs China - so what! The whole reason Hahnemann coined the term polychrest was because he saw a variety of different people all with differing complaints and characters respond to the one medicine. In addition, while we are at it, Hahnemann did not just pluck all these remedies out of thin air, most of them were well known, and some date back to antiquity. This means they are suited to human life because they interact well with us - not everything does. We would do well to remember that the Earth is not just designed for us, so when we find medicines that are suitable we should treasure and safe guard them, not throw them away like spoiled brats wanting something new. We need better understanding not better remedies. One thing I get all the time is 'he JUST uses polychrests' this is looked down upon perhaps because it is not exotic enough. Practitioners think they know the polychrest remedies but they don't. I use polychrests everyday in my clinic and still cannot memorize one thousandth of what they are capable of doing. Fair fat and flabby is NOT Calc carb. The polychrests are a gift and let us hope homoeopathy rediscovers them soon, because when someone the caliber of Hahnemann states they are a cut above, we would do well to listen.
regards Grant

Grant Bentley
Victorian College of Classical Homoeopathy
3A/574 Whitehorse Rd
Mitcham
Victoria
Australia 3132
Phone - 613 9873 0567
Fax - 613 9787 5145
www.vcch.org
hom@vcch.org

Dear Ellen,

First of all, the intention of my post was just to point out some of
the difficulties that arise in case management when using polypharmacy and
some of the reasons why Hahnemann decided on using one single remedy at a
time. I wanted to show that we have our logical reasons for the single
remedy and it is not just dogma, etc. As to how to handle "your husband"
you know much better than me! So as I said in the first place, I am glad
everything worked! If this was the only way forward then please! I was only
trying to show the bigger picture over the longer run and share ideas that
may of be of use in the future.

If one selects the first remedy well one often won't need another
remedy. I would say by the fact that it was a crush injury to the big toe
with toe nail damage that Hypericum was probably the leading remedy. I most
likely would have just given Hypericum, AND if it didn't work, I may have
tried my 2nd or 3rd options. If shock seemed to be blocking the cure I
might change to 2. Arnica and then go back to 1. Hypericum, if necessary.
If there was a lot of ragged tissue and wasn't healing up right I might
have followed with 3.Calendula internal and external later to insure smooth
healing.

I have seen Hypericum cure such states so quickly so many times I would
have tried the single remedy first. Hypericum would have been my number 1.
I would have held back my 2 and 3rd options. This is because Hypericum
suits the differential analysis of the cause and symptoms. The tincture can
also be applied to the wound. If this worked well enough I would not have
used anything else. Hahnemann once said, "why use complex methods when
simple methods suffice". Nothing is simpler than 1 remedy! That is why
three of the most important words in our work is "only if necessary".

I don't think that using a simple 1 and 2 (alternation) or the 1, 2, 3
( a triune sequence) is physically difficult under most conditions. People
sit down and eat and drink several things from different cups, bowls and
plates don't they? So why can't they take a few numbered packets or a
teaspoonful from a few glasses if it means healing themselves? In chronic
Boenninghausen often gave remedies at intervals of every 4 to 7 or more
days. Therefore, it is easy to use numbered bottles. There are Indian
homoeopaths who use such methods and they don't have much trouble with
patient compliance. Some use the dry doses others use liquids. Hahnemann
and Boenninghausen would send the persons off with number remedies when
needed. Much of the time number 1 was the remedy and number 2 was placebo.
Hahnemann once gave placebo over 15,000 times in 9 months!

Best, David Little
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