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Installment 9 of a series on case analysis

© Will Taylor, MD 2001 (bio)

On our Knowledge of the Materia Medica:
Part 2: Qualitative knowledge of remedies proving vs. clinical symptoms

Section 1

Sections: 1 | 2 | 3

In last month's article I addressed the quantitative aspect of our knowledge of remedies - the actual volume of knowledge we have amassed in our materia medicas and repertories. There is a great range in the actual volume of information we have for the substances we employ for cure.

Just as important as the quantity of information, though, is the quality of that information. There are many aspects of symptom quality that we might examine. I'd like to focus here on a symptom-quality question that has plagued homeopathy since its inception - the relative value of symptoms obtained from provings, versus those obtained from clinical verifications of cure.

As a concrete example, let's look at the rubric {Mind - Indignation} in the Synthesis Repertory. A conservative view of the repertory - Kent's plus modern additions through Pierre Schmidt - lists 29 remedies for this symptom. Yet a review of the provings literature reveals indignation and reasonable synonyms as a symptom of only 5 of these remedies - Ambra grisea, Arsenicum album, Calcarea phosphorica, Ferrum phosphoricum, and Nitrous oxide.

Notably missing from the list above is two of the remedies most strongly marked in the Indignation rubric - Staphysagria and Colocynthis. A search of the homeopathic literature for the term indignation (using Encyclopedia Homeopathica) reveals far more references to these two remedies than to any other.

The well-known indignations of Staphysagria and Colocynthis are known from clinical experience - and have not been revealed in their provings.

Delphinium staphysagria Citrullus colocynthis

How can we reconcile the use of such clinically-obtained symptoms, with Hahnemann's insistence that provings - symptoms obtained from experiments on the healthy - serve as the gold-standard of our knowledge of the curative power of our remedies?

It is useful to look closely at Hahnemann's specific objections to relying on clinical experience in order to ascertain the medicinal properties of drugs. He cites several difficulties with reliance on clinical empiricism.

"Will the chance of such discoveries suffice to perfect the healing art, to supply its numerous desiderata?" 1

With the tremendous diversity of ways in which the organism can fall ill, clinical empiricism becomes a highly impractical method of identifying curative substances. Compounding this, even as early as the 1798 date of this essay, Hahnemann recognized the individual nature of each case of disease, and our inability to assign a specific medicine for each disease-as-named. Reliance on the "chance discoveries" of clinical empiricism would not only be impossibly burdensome, but would necessitate ignoring the individual nature of each case treated.

"Only for a want of a constant character can we suppose a supply of a constant character." 1

Most of the recorded "cures" of the old-school medicine of Hahnemann's day were effected by polypharmacy, often in conjunction with other non-pharmacologic modalities such as bloodletting and hydrotherapy. It was rarely possible to clearly attribute cure to any one intervention.

"Few, if any, recorded clinical cures were effected by a single medicine." 1

Are there examples of clinical empiricism which side step these concerns raised by Hahnemann? Even after raising the above objections, Hahnemann cuts clinical empiricism some slack - or at least honors some of its discoveries.

"I have no intention of denying the high value of this mode of discovering medicinal powers - it speaks for itself." 1

Perhaps the best example of this is seen in our employment of Arnica montana as a near specific in soft-tissue contusion.

Arnica"All the artificial dogmas enunciated by the ordinary medical art, which is in its way a learned science, all its scholastic definitions, distinctions, and hair-splitting explanations were in all past centuries unable to discover the specific curative power of this plant or to find out the real remedy for the often dangerous general derangement of the health which is caused by a severe fall, by blows, knocks, contusions, sprains, or by over-stretching or laceration of the solid parts of our body.

"Common people had to do this for them, and after the fruitless employment of innumerable things they found at last by accident the true remedy in this vegetable and hence they called it Fallkraut (fall-plant)." 2

Such an empirical discovery was largely made possible by the near-uniformity of the derangement of health brought about by soft-tissue contusion.

"The symptoms of all injuries caused by severe contusions and lacerations of the fibres are tolerably uniform in character." 2

We have in our materia medica a very small number of such remedies, which on the basis of clinical experience have been established as near-specifics for rather invariant conditions - circumventing Hahnemann's second objection, "Only for a want of a constant character can we suppose a supply of a constant character". Examples include Arnica for soft tissue contusion, Symphytum for fractures of bone, and Calendula for non-uniting lacerations.

Even in these cases, though, we do not have any true specifics in our materia medica. The extreme skier wiping out at 60mph and landing in a heap after being hurled 16 feet into the air likely still needs his Agaricus.

Agaricus Injury

Sections: 1 | 2 | 3

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1. Samuel Hahnemann, Essay on a New Principal for Ascertaining the Curative Power of Drugs; Hufeland's Journal, 1798
2. Samuel Hahnemann, Materia Medica Pura (chapter on Arnica Montana)