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An Essay about the theoretical contentions between Homeopathy and TCM

by Todd Luger, L.Ac.

The most basic rule of treatment in Chinese medicine is to use cold substances to eliminate heat and warm substances to remove cold. This has been called heteropathy.1 This stands in contrast to the homeopathic principle of "like cures like". In homeopathy, infinitesimal amounts of "hot" substances, like fever inducing aconite, for instance, would be used to treat a "hot", i.e. feverish, disease. Both approaches to the use of substances claim great success, not only in relieving suffering, but in addressing the true root of a patient's disease. How can this be? TCM herbalists often look curiously at homeopaths, for no other reason than the fact the Chinese herbology is practiced with extremely large dosages of medicinal substances (in modern China, on the order of 150 g or 1/3 pound per day). Similarly, classical homeopathy views this massive use of pharmacologically potent substances as "suppression" of the highest order. As a TCM herbologist, with some education in homeopathy, I will endeavor to examine this dilemma.

Homeopathy is practiced in several different ways worldwide. Classical homeopathy, with its psychospiritual leanings, was influenced mainly by James Kent (and through him, by Emmanuel Swedenborg). It is now promulgated by Vithoulkas and Murphy and Margaret Kent, and is definitely the current vogue in the US. In the past, the Kentian approach was given stiff competition in America from more physiologically oriented practitioners, such as Clarke.2 In India, multiple remedies are often prescribed, indicated at different times of the day or in various combinations. On the European continent, combination remedies are popular, often involving modern concepts, as in the use of viral nosodes. In general, the approach is more physiological than psychospiritual. All these methods are also currently used by American homeopaths, but the classical method appears to prevail, especially in the main learning institutions. All these schools of thought hold allegiance only to the rule of dilution. They vary greatly with regard to the law of similars, the single remedy, etc.

For instance, many modern combination remedies have not been proved, but some have been shown to be clinically efficacious in double blind studies.3 Many remedies in Boericke's Materia Medica have essentially the same indications as listed in Felter's Eclectic Materia Medica (see table I below). Many of these mild herbal substances (i.e. echinacea, Oregon graperoot, calendula) are dosed in tincture form or low potency, rarely in the truly infinitesimal, transmolecular range. They are used heteropathically, in other words. Thus, the law of similars may apply only to the very poisonous (aconite, gelsemium, belladonna, lachesis), the inert (lycopodium), minerals (sulfur, calc carb, phosphorus), microorganisms (nosodes), acids, psychoactives (coffee, cocaine, cannabis, opium),and other very strong botanical extracts (camphor). If this is true, there may be another way to understand the relationship between Chinese herbology and homeopathy.

The law of biphasic action is well known with regard to the physiological effects of poison on the system. That is to say that small amounts of very potent substances often have diametrically opposed actions to larger amounts of the same substance.4 This rule does not apply to many mild herbal constituents, but mainly to medicinal substances which are mainly comprised of potent alkaloids and essential oils (see table II below). It is the milder substances that make up the vast bulk of the Chinese materia medica. And like their American equivalents, they are used heteropathically. Most American homeopaths do not use these mild substances in dilution anymore. Those who use herbs like echinacea are likely to use standard tinctures or pills. This practice amongst early 20th century homeopaths (like Boericke) can be clearly seen as an incorporation of proven eclectic remedies into the practice of homeopathy during the beginning of its decline in America. For example, echinacea is not used to treat excessive salivation, even though the herb induces this symptom. Boericke actually indicates it for dry mouth, as would be heteropathically expected.5

As for poisons, the Chinese tend to use them like the eclectics did, rather than like the homeopaths. The eclectics used small amounts for the direct effect of the poison to stimulate the "vital force". The Chinese do similarly, when using scorpion or centipede to "open the channels". Other herbs, such as pinellia ternata, aconite and arisaema, are generally detoxified before use in various ways and are no longer considered poisonous. The Chinese use of minerals also appears to be physiological in most cases, relying on rather large doses of compounds which are then extracted into solution. It has been suggested by one of my students that some minerals which are known to extract very poorly, such as Gypsum, may exert their action "homeopathically", noting that the indications for magnesium sulphate are somewhat similar to those for Chinese shi gao (see table III). He further suggests that the vigorous boiling of the herbs has a "succussive" effect, as well. I find this an intriguing proposition, which may bear further study. Heiner Fruehauf, L.Ac., Chair of the Department of Classical Chinese Medicine at NCNM, has suggested in lecture that it is the resonance of the herbs that effects the profound changes that occur in some cases of herbal treatment, rather than their pharmacological constituents.

Some Homeopaths would consider the use of minerals and poisons in full strength to be particularly "suppressive" in nature. The Chinese actually consider such substances to be "inferior medicines" and generally only use such substances short term and always in combination with balancing and harmonizing substances. As elaborated below, TCM sees a purpose to the control of symptoms that is certainly anathema to homeopathy. Classical homeopaths would only use special preparations of either such potent, poisonous or apparently inert substances (preparations that in medieval Europe or China or India would probably have been considered alchemical in nature). They believe full strength preparations of these substances generally damage the body in the long run. Classical homeopaths make little or no use of mild herbs, at least not in dilution. On the other hand, the Chinese practice of heteropathic medicine centers on the use of such mild herbs. To reiterate, that the law of similars does not apply to these herbal preparations can be seen in the fact that similar mild herbs included in materia medicas such as Boericke's do not really have "homeopathic" indications (i.e. their indications are not the opposite of their actions in larger doses).

Yet despite having demonstrated that the law of similars has not generally been applied to the use of mild herbal substances, one question still remains. Is Chinese herbal medicine "suppressive" or does it promote " true healing"? Most American classical homeopaths do not bother to use dilute preparations of mild herbal substances, knowing full well that these substances are actually heteropathic in nature. Classical homeopathy proposes that the use of such herbs is inherently suppressive. While some may admit their occasional clinical usefulness, pure classical homeopaths believe the use of full strength botanicals can ultimately only lead to more suffering. I would argue that the prevailing position of homeopathy towards herbalism is based in experiences that bear little relation with the practice of Chinese herbology.

In the early days of homeopathy, Galenic herbalism was dying and allopathy was on the rise. Very few people were gently balancing humors anymore. Drastic purges and bloodlets and sweats and pukes were the rage. Suppressive poisons ruled the day. As time went on, the Homeopaths also did battle with the Thomsonians, the Physiomedicalists and the Eclectics, too, calling all of their herbal therapies "suppressive", too. It was only at the turn of this century that nature curists united various practitioners of herbs, diet and homeopathy, ultimately founding the most truly eclectic and durable of all professional, holistic medical practices, Naturopathy. Pushed to the fringes of society for most of this century, naturopaths have quietly continued to argue about this homeopathic dilemma. Now, with many herbs being used according to their recently discovered pharmacological actions, homeopaths seem more resolute than ever. According to classical homeopathy, whenever herbs are used like drugs to affect "diseases" or adjust particular physiological "mechanisms", they are being used incorrectly. The classical homeopath is instructed to treat patients according to their signs and symptoms taken in their entirety. It is in this point that we find some important common ground with traditional Chinese herbology.

Chinese herbology also does not attempt to treat diseases or adjust biochemical mechanisms. All professional Chinese medicine adheres to at least one common principle, bian zheng lun zhi, which is the rule to administer treatment according to the differentiation of symptom complexes. TCM says one disease may require various different treatments and one treatment may be applicable to many different diseases, all depending on the nature of the patient. Even though Chinese medicine does not use infinitesimal doses of herbs, it attempts to correct the root imbalance of the patient. Chinese medicine gauges its success on the changes in the four evaluations (asking, looking, touching, listening) and does not accept symptom relief alone to be a sign of "healing". It has long been a caution in Chinese medicine that you can make someone feel better in the short term at the expense of their longterm health. The injudicious use of tonics (astragalus, ginseng) is usually the cause of this, as described in historical texts.6

Homeopathy also gauges its success according to particular rules of evaluation. Hering's law is the most important, according to which the disease process reverses itself from top to bottom, inside to outside, most recent symptoms to those long suppressed. According to Vithoulkas, one should also see the focus of the symptoms recede from the mental to the physical sphere, even if Hering's law is not in obvious activity. I would argue that Chinese herbologists have observed the improvement in total symptom/sign complexes concurrent with the use of particular mild herbal substances for millennia and that homeopaths have similarly witnessed Hering"s law in action when using their "alchemically" prepared, infinitesimally dosed remedies. And that neither one of these experiences contradicts the other.

Homeopaths are probably correct that certain substances can only be used in dilute and/or potentized form to exert a long term beneficial therapeutic effect. Otherwise these substances are harmful to overall health. Homeopaths are also probably correct that the use of mild herbal substances can be "suppressive", as well. Chinese herbology has a saying that all medicinal substances can be "poisons", meaning that any single substance will ultimately unbalance the system and create disease. That is why classical Chinese herbologists always use formulae for chronic illness, reserving single herbs for symptom relief, if at all. It is also why one formula is rarely used unchanged for extended periods of time. After all, according to Chinese philosophy, change is the only true constant.

However, just because some medicines can only be used to treat root imbalances if they are prepared alchemically (dilution and succussion, in this case), that does not mean there is no holistic way to use those substances whose only mode of action is heteropathic. I believe the preponderance of historical evidence lends credence to the idea that the Chinese, the Egyptians and the Hindus, among others in the ancient world, discovered how to such mild medicinal substances to restore health, not just suppress symptoms. They did this through careful observation of the changes in their patients who ingested these substances. This same method was also duplicated by the 19th century eclectic physicians. The success of homeopathy is historically evident as well, but no moreso than that of TCM. That they both enjoy such widespread worldwide popularity at this time is certainly a testament to the perceived efficacy of both of these "systems" of medicine by their consumers.

There does remain the apparently irreconcilable difference between homeopaths and TCM herbologists, with regard to short term symptom relief. Two thousand years of holistic Chinese herbology supports the use of herbs that soothe cough, stop spasms, astringe chronic discharges (but not acute ones!), sedate the mind, etc. It is the observation of Chinese herbologists that if certain symptoms are are not controlled, the patient will be unable to improve, even when using Chinese formula to treat their root imbalance. These include coughing, dyspepsia, insomnia, to name a few. When combined with herbs that treat the root imbalance of the patient, these "suppressive" agents are not thought to do long term harm. The four evaluations demonstrate that the judicious use of such herbs does not drive diseases deeper into the body. This may be a rule that applies to the practice of holistic herbology, when applied using mild heteropathic substances. That homeopathy, which uses "potentized" substances, has a different rule for its very different preparations is no contradiction of this principle. This is not to say that Chinese herbs canít be used "suppressively". In fact, in my judgment, they are quite often used that way by practitioners following a modern disease model and those unfamiliar with the insights of homeopathy and naturopathy in this area.

As a final note, we should remember that the ancient Chinese understood their medicinal substances to have a heteropathic nature because of their observed effects, not their assumed mode of action. In other words, because coptis lowers fever, stops acute bacterial dysentery and sedates the mind, it is classified as an herb that "clears heat from the heart, stomach and intestines". Similarly, if a Chinese doctor was told that homeopathic sulfur treated signs of red rash, feeling of heat, etc., he would classify it also as a "clear heat herb". Thus, the fact that full strength sulfur is considered hot and poisonous in TCM would be meaningless. It could easily be accepted that a hot, poisonous herb had been processed into a cool, nontoxic herb (an example from TCM is the transformation of tian nan xing to dan nan xing). The fact that the use of an herb was also reserved for a very specific presentation would not rend the conceptual fabric of TCM, either. In fact, some homeopaths in India differentiate their remedies according to the ayurvedic system7 , which has many similarities to TCM.8 Thus, to this TCM herbologist, it appears that Hahnemann did not discover a general law of medicine and pharmacology, so much as a specific method by which to reveal otherwise hidden properties of certain types of compounds (i.e. external alchemy, which he definitely studied, at least in the writings of Paracelsus).

Hahnemann speculated that the method by which homeopathy works is by introducing a weak, but similar, artificial disease into the body, which induces the vital force to expel the true disease; the artificial disease then can be easily removed itself by the bodies vital force.9 It is still not known if this is true. This was assumed due to the characteristic aggravation of symptoms observed in "true" homeopathic healing. The aggravation was explained as the temporary summation of the true and artificial diseases, which magnified the existing symptoms. This of course would not "explain" the reappearance of old diseases and symptoms, which are often unrelated to the symptom picture of the initial remedy. Thus, it remains possible that the action of those medicines which exhibit biphasic activity is actually heteropathic in nature. In other words, homeopathic sulfur may have actually been changed into a substance that clears heat; its mode of action may simply be to direct the body to "clear heat", rather than to introduce an artificial "heat syndrome", which will then ultimately cause the body to respond by eliminating the symptom/sign complex.

That homeopathic Sulfur treats symptoms that it causes in heteropathic doses may be just a peculiar property of certain types of substances, not reflective of its mode of action. Conversely, as stated above, it may be that the mode of action of even "monophasic" substances, like most Chinese herbs, actually occurs by introducing a "similar" artificial "resonance" into the body. Whichever the case, this quibbling over modes of action has never been prominent in the writings of Chinese herbologists. And it should not occupy the time of homeopaths, nor cause rifts between them and TCM herbologists. Homeopathy and TCM can both be practiced without any need to understand their "mechanisms", however intellectually satisfying that might be. Historically, most Chinese herbologists and Homeopaths are in cross-cultural agreement on the most fundamental tenet of holistic medicine, which is that the only proof of correct treatment is improvement in the patient's total symptom/sign complex (i.e. if your fatigue is better, but your sleep is now disturbed, something is not right). From this common ground, we should work together to resist the powerful forces that would truly turn modern herbal medicine into the "natural" equivalent of the old drug company credo: better living through chemistry.

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