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For the same reason, what constitutes a medicine can be broadened to include any substance with the power to alter human health in either direction, to elicit symptoms or to relieve them, the distinction between a medicine and a poison becoming largely a matter of dosage and the individual sensitivity of the patient.

The homeopathic pharmacopoeia currently recognizes more than two thousand remedies, with more being added all the time. Most are of plant origin and include flowers, leaves, roots, barks, fruits, and resins. While many are highly poisonous in their crude state (e.g., aconite, belladonna, digitalis, ergot, hellebore, nux vomica), others are common medicinal herbs (comfrey, eyebright, mullein, yellow dock, etc.), foods and spices (like cayenne, garlic, mustard, and onion), fragrances, resins and residues (amber, petroleum, charcoal, kreosote, et al.), mushrooms, lichens, and mosses.

The mineral remedies include metals (like copper, gold, lead, and zinc), metalloids (e.g., antimony, arsenic, selenium), salts (calcium sulfate, potassium carbonate, sodium chloride, silver nitrate, etc.), alkalis, acids (hydrochloric, nitric, phosphoric, sulfuric, et al.), elemental substances such as carbon, hydrogen, iodine, phosphorus, and sulfur, and constituents of the earth's crust (silica, aluminum oxide, ores, rocks, lavas, mineral waters, and the like).

Remedies from the animal kingdom include venoms of jellyfish, insects, spiders, molluscs, crustaceans, fish, amphibians, and snakes, secretions (ambergris, cuttlefish ink, musk, etc.), milks, hormones, glandular and tissue extracts or 'sarcodes,' and disease products or 'nosodes' such as TB, gonorrhea, syphilis, abscesses, vaccines, and so forth.

The investigative method is equally applicable to the study of folk remedies as yet unproven, conventional drugs, toxic or laboratory chemicals, pollutants, and commercial or industrial products (dyes, insecticides, paints, solvents, etc.) In effect, the homeopathic materia medica is as boundless and inexhaustible as the creation of the earth and its transformation and breakdown by human and environmental forces.

Finally, though the database of the materia medica is enormous and considerable study and experience are required to use it with skill, its richness and diversity make it likely that some degree of medicinal help can be found for most people, and its basic principles are simple enough that even a novice can obtain creditable results with a small number of remedies. As long as a few commonsense rules are observed, the method is perfectly safe for untrained lay people of average intelligence to learn at their own pace and to use in first aid and the treatment of common domestic ailments.

The "Vital Force"

Like acupuncture, herbalism, and other natural methods, homeopathy belongs to the "vitalist" tradition in medicine, based on the old vis medicatrix naturae, the natural healing capacity, and aptly summarized in these aphorisms of Paracelsus:

The art of healing comes from Nature, not the physician . . .

Every illness has its own remedy within itself . . .

A man could not be born alive and healthy were there not already a Physician hidden in him . . . [note 6]

Underlying these sayings is a coherent philosophy of ancient lineage, whose precepts still ring true in spite of the contemporary fashion to ignore or discount them:

1) that healing is a concerted effort of the entire organism and cannot be achieved by any part in isolation from the whole;

2) that all healing is essentially self-healing, a basic property of all living beings; and

3) that it applies only to individuals and is therefore inherently problematic, even risky, and not reducible to any technique or formula, however scientific its foundation. [note 7]

In homeopathy, the fact that curative remedies have the power to evoke and resonate with the manifest signs and symptoms makes sense insofar as illness is already a self-healing attempt of the organism, which Hahnemann identified with the life energy itself, called the "vital force," and regarded as the ultimate source of health and illness alike, ending only with the death of the organism. Whatever we call it, some version of a "vital force" or unitary life principle is needed to designate the obvious bioenergetic integrity of living beings and to derive the independent perspectives of "mind" and "body" without dualism or paradox.

The Totality of Symptoms

Just as provings include the full range of symptomatology elicited by each remedy, homeopathy teaches that illness is primarily a disturbance of the vital force, manifesting itself as a totality of physical, mental, and emotional responses that is unique for each patient and cannot be adequately understood as a mere specimen of any disease process. Without having to include every last symptom or assume that mental symptoms "cause" physical symptoms or vice versa, the Hahnemannian totality of symptoms is simply a working description of the principal signs and symptoms "mixed up" together, as they appear in the patient, and is complete as soon as a reasonable facsimile and a "flavor" or sense of the illness as a whole are discernible.

To the practicing homeopath, this composite totality or psycho-physical "style," more than any abstract disease category or printout of laboratory abnormalities, furnishes the truest picture of the health and illness of the patient as a whole, as well as of the particular condition for which treatment is being sought.

In addition, the totality of symptoms explains why mental and emotional symptoms often weigh heavily in choosing the remedy. Whereas physical symptoms often refer to a certain part of the body, like the arm, nose, back, or stomach, psychological states describe how patients feel as a whole, so that we say "I am afraid," or happy, depressed, confused, etc., in referring to them. The totality of symptoms gives special importance to those which describe the condition of the patient as a whole.

The Single Remedy

Based on the extensive proving literature, the classical or Hahnemannian method employs one remedy at a time for the whole patient, comparing the totality of symptoms of the individual with those of various remedies until the closest possible match is found. The reason is that only single remedies have the capacity to form meaningful totalities with the individuality and richness of living patients, just as their power and effectiveness are proportional to the ability of patients to respond to them as a whole by virtue of that resemblance.

On the other hand, its encyclopedic scale insures that the homeopathic materia medica can never be grasped in its entirety. Apart from those who have tried to abbreviate and simplify it, there are competent and reputable physicians using two, three, or more remedies simultaneously. Over-the-counter combination remedies are also available in many pharmacies and health food stores and are reasonably safe and effective if properly used.

But only the totality of symptoms enables the serious student to accumulate detailed personal experience of the remedies and generates much of the excitement of learning how to use them. Giving parts of remedies to parts of the patient makes it difficult to know which remedy has acted, so that they have to be selected according to the rough indications of folk medicine or the technical language of abnormalities, which is not very different from conventional drug treatment.

Under these conditions, not much of value will be learned, and what is learned will not yield an experience that can build on itself or a method that can be taught. The improbable revival of American homeopathy in recent years has been achieved in large part on the strength of the single remedy, because only the totality of symptoms can display remedies and patients as unique individualities supremely worthy of study for their own sake.

The Minimum Dose

Since homeopathic remedies are given less to correct a specific abnormality than to stimulate an ailing self-healing mechanism, large or prolonged doses are seldom required and can even spoil the effect. Homeopaths use the smallest possible doses and repeat them only as needed, allowing the remedies to complete their action as much as possible without further interference. Indeed, remedies will not work unless they are correctly chosen, unless they fit the illness so closely as to render the patient uniquely susceptible to their action. Otherwise, the minuteness of the dose makes it exceedingly unlikely that anything untoward or dangerous will occur, an important safety feature.

In a series of painstaking experiments, Hahnemann discovered that remedies are still effective at concentrations too small to be detected chemically, and that mechanical shaking or "succussion" of such dilute solutions actually enhances their healing effect in some way that has never been fully understood. [note 8] Assuming that microdilutions act by stimulating the organism qualitatively on a purely energetic or "vibrational" level, he theorized that succussion liberates medicinal energy from its chemical 'bondage' and releases it into the solution, foreshadowing the discovery of subatomic forces in the twentieth century.

Hahnemann's advocacy of "infinitesimal" doses remains one of the most controversial aspects of his work, and even some committed homeopaths have never dared follow him into this realm. Nor has anyone ever satisfactorily explained how medicines diluted beyond the molecular threshold of Avogadro's number could possibly have any effect, let alone a curative one.

But the standard argument that the remedies are simply placebos cuts both ways. For quite apart from how they do it, the extent to which people can heal themselves of serious illnesses without drugs or surgery proportionally reduces the need for more drastic methods and downsizes the promotional claims made for them. With its dilutions now detectable by laser spectroscopy and bioassay, [notes 9, 10] homeopathy envisions a new bioenergetic science which is still in its infancy.

The "Laws" of Cure

The totality of symptoms also explains why drugs that successfully lower the blood pressure, kill bacteria, or correct whatever abnormality they are directed against may still leave the patient as a whole feeling as bad or worse than before. Not only the definition of health and illness but also judgments about improvement, worsening, and the effectiveness of treatment are all fundamentally ambiguous apart from the totality of symptoms, without knowing how patients feel and function according to their own individual standards. One of the greatest shortcoming of medical science is its insistent refusal to approach its patients as integrated energy systems and to follow them over their lifetime.

1) from above downwards, from the head end of the body toward the feet or bottom end;

2) from inside outwards, from more central or interior to moreexternal, peripheral, or superficial parts;

3) from more vital to less vital organs, from deeper or more important or visceral to less important or essential structures; and

4) in the reverse order of their appearance in the life history of the patient, from the most recent to the oldest. [note 11]

Although the fourth "law" has proved the most reliable for case management, and the relative importance of organs and tissues is often difficult to assess unambiguously, some approximation of the totality of symptoms over time remains indispensable to the general assessment of the patient as a whole for clinician and researcher alike.

Methodology: Materia Medica Study

Homeopathy begins and ends with the study of medicinal substances. With the "vital force," the totality of symptoms, and the "laws" of cure in general use by healers of every stripe, homeopathic philosophy exerts a considerable influence outside the small circle of its adherents. But its method of investigating, preparing, and using remedies is uniquely its own, speaking a language both rich and beautiful but accessible only to those taking the trouble to learn it.

The materia medica literature is drawn from three sources: raw proving data, [note 12] cured clinical cases, and toxicological data from poisoning or overdose with crude substances. [note 13] While its practical goal is to recognize them in illness, the study of remedy pictures teaches how to differentiate each one from all others, especially from those most closely resembling it.

Proceeding "horizontally" as well as "vertically," it both collects detailed knowledge of more and more symptoms and organizes them into themes of ever broader and deeper significance. The first task would seem quite hopeless were it not being continually rescued by the second, and the latter becomes much easier and more fruitful if certain peculiarities of homeopathic thinking are kept in mind.

First, the Law of Similars is fundamentally dualistic in the sense that every remedy can elicit symptoms as well as "cure" them, can function as medicine or poison, such that remedies that influence food cravings, for example, may also help patients who dislike or are intolerant of the same diet. Since remedies encompass themes or issues more than any particular resolution of them, definitions that exclude a certain characteristic or rest smugly on what is already known are likely to mislead or fall short.

Second, knowledge of remedies is built on successive analogies between older, more limited formulations of a symptom and its application to other areas of functioning that lead to broadening and eventual redefinition of the symptom itself.

Typically associated with the pain of headache, pleurisy, or other physical symptoms, for example, the classic Bryonia modality "worse from movement" is equally descriptive of the typical mental state, which shuns intellectual activity or sensory stimulation, and ultimately of the Bryonia energy pattern as a whole, no matter what the illness, on both sides of the mind-body frontier, and indeed prior to the mind-body distinction itself. Just as the materia medica grows in ways that defy pat or rigid formulation, much of the art and fascination of using remedies lies in recognizing the old themes in ever new variations.

Finally, even "acute" remedies commonly used for first aid may also be thought of for chronic states arising from a typical acute episode in the past that failed to resolve. Examples of this "never well since" phenomenon include

Arnica, the classic remedy for blunt trauma to the soft tissues, also used for miscellaneous ailments complicating such injury;

Ignatia, unequalled in the relief of acute grief and bereavement, also indispensable in the treatment of many illnesses following in their wake; and

Staphysagria, a superb remedy for the healing of knife wounds, no less beneficial for patients with obscure or undiagnosed complaints who have never recovered from a surgical procedure in the past.

With any remedy potentially useful in this way, the simple prolongation of acute symptoms over long periods of time illustrates the importance of 'stuckness' as an element in many chronic diseases, just as the validity of the syndrome is itself confirmed by the action of the remedy so indicated. By showing what there is to be healed, the study of remedies can also reveal how our sicknesses are made.

Pharmacy

The Homeopathic Pharmacopoeia of the United States, 8th Edition, with its supplementary monographs, is the official standard for the preparation of homeopathic medicines, and any marketed as such but not conforming to HPUS standards should be regarded with suspicion.

Crude medicinal substances are fashioned into homeopathic remedies by serial dilution and succussion in a liquid or solid medium. First crushed and dissolved in a specified volume of 95% grain alcohol, crude plant materials are shaken and stored, and the supernatant liquid is kept as the "mother tincture" (abbreviated Ø).

The same procedure is used for animal products, nosodes, and any other substances that are soluble in alcohol, while metals, ores, and other insoluble remedies are pulverized or "triturated" with mortar and pestle and diluted with lactose, succussing each time until they too become soluble.

In clinical practice, any dilution may be used, but the most popular for self-care are the 6th, 12th, and 30th (X or C), while higher dilutions for professional work are in the centesimal scale (with the C omitted), namely, the 200th, 1000th, 10,000th, and 50,000th, written 200, 1M, 10M, 50M, and CM, and representing dilutions of 10-400, 10-2000, 10-20,000, 10-100,000, and 10-200,000, respectively.

From Oliver Wendell Holmes to physicians today, a healthy skepticism about ultradilute remedies is amply warranted, since even the 12C and 30C are well beyond Avogadro's number and therefore out of the realm of chemistry entirely. [note 14] Pending further clarification, homeopathy has always lived on both sides of the frontier between ordinary sense experience and the "etheric" realms of clairvoyance, telepathy, radionics, faith healing, and the like. It is supremely ironic that this most immaterial and even alchemical of therapies was devised by an apothecary, and bears throughout the meticulous stamp of that preeminently practical profession.

Case-Taking

As in medicine generally, time spent with patients is much more than taking down information or selecting remedies, which may not work or even be thought of unless an appropriate relationship and setting are created for them. Simply allowing patients to tell their story in its entirety lessens their burden of pain and suffering, often suggests a path of recovery, and makes the homeopathic interview a powerful healing experience in its own right, allowing remedies to continue the process.

Patients are invited to speak and allowed to continue as much as possible without interruption until they have nothing further to say, open-ended questions like "What else?" being asked as often as necessary to elicit more symptoms and to remind the patient that no one "disease" but rather the totality of symptoms is being sought.

Symptoms are written down verbatim whenever possible, leaving space in the right-hand margin for the homeopath's own observations. Ordinarily the interview follows the plan of the standard medical history, including a physical exam and laboratory work as needed to establish a pathological diagnosis.

When the story comes to an end and the principal symptoms have been written down, direct questioning is needed to characterize them in detail and may be confusing at first, because conventional diagnosis is based on common symptoms like fever, pain, cough, and bleeding, while homeopaths look for unusual or idiosyncratic features that tend to be ignored or discarded for precisely that reason. Fully-characterized symptoms may include

1) subjective sensations like pain, vertigo, fatigue, anger, and so on, which often require some imagination to describe them;

2) data about localization (e.g., one-sided, wandering, radiating, circumscribed, diffuse), which is well understood by most patients and can be clarified by studying the body language;

3)"modalities" or factors by which symptoms are intensified or relieved -- such as times of day, foods, changes in weather, and emotional states; and

4) concomitants, symptoms which appear together or in some sequence (nausea with headache, fever after chill, etc.).

Selecting the Remedy

As the case is taken, symptoms are graded in importance by the extent to which they are freely volunteered, clearly delineated, and severely limiting to the overall health and well-being of the patient. Symptoms with the attributes of spontaneity, clarity, and intensity are apt to be significant in the illness and in the selection of the remedy as well.

Homeopathic prescribing illustrates and relies upon the awesome correspondence between the database of the materia medica and the details of the case record. The genius of the method is that each of these great texts continually illuminates the other, but there are too many remedies with far too many symptoms to be studied or used properly without an encyclopedic memory or a book or computer with the same capacity.

Professional homeopaths wanting access to as many remedies as possible therefore need help in proceeding from the clinical totality to the vast literature of possible remedies to study and choose from. This is the purpose of the "repertory," an index of symptoms and the remedies that have elicited them in provings or cured them clinically. By finding remedies that match the leading symptoms in a case, the search can be narrowed to a much smaller group.

Whether in book form or as computer software, the largest, most comprehensive repertories [note 15] include all types of symptoms from every anatomical region and physiological system, as well as mental and emotional symptoms, "generalities" (physical symptoms or modalities attributable to the patient as a whole), and "strange, rare, and peculiar" symptoms whose very oddity can sometimes point to the remedy directly. But the repertory is only a tool for locating remedies that might not have been thought of without it and must then be studied in the materia medica, the final selection depending on their total or qualitative "fit" more than any narrowly technical calculation.

Regimen and Precautions

While stable in the cold and across a wide temperature range, dilute remedies are inactivated by direct sunlight and should be stored in a dark place, kept dry, and shielded from X-rays. Patients are instructed to put nothing in the mouth for at least 30 minutes before and after each dose. Coffee and camphorated products may antidote and should be avoided throughout the treatment period, even when no remedies are actually being taken. The use of strong medicinal herbs, mothballs, and other aromatic substances should also be curtailed.

Although conventional drugs often interfere to some extent and should be avoided when possible, severely ill patients should not stop taking their medications until it is clear they are no longer needed. Because of their potentially synergistic effect, acupuncture, chiropractic, and other deep energy therapies should not be started at the same time but may be continued for maintenance. Relapse may also follow dental work with drilling and local anesthesia.

Administration and Dosage

Remedies are dispensed on tablets or pellets of sucrose and taken dry on the tongue or dissolved in water. In acute situations the lower dilutions are preferred, since they can be repeated as often as necessary and will work to some extent even if only broadly similar to the totality of the case. With the higher dilutions used mostly by professionals for chronic work, more care must be taken in selecting them, and they should not be repeated while their action is still in progress.

In homeopathy, "dosage" refers primarily to the number and frequency of repetitions, which must be tailored to fit the patient almost as much as the choice of the remedy itself. Both in acute and chronic work, the rule is to stop the remedy once the reaction starts, allowing it to continue without interruption for as long as it lasts and repeating only when it is finished.

Pros and Cons

There are few if any absolute contraindications to homeopathic treatment. While patients with severe disabling illness or drug dependence are difficult to help by any method, homeopathy may at least be considered before resorting to more drastic measures or after conventional methods have failed. Homeopathic remedies are wonderfully safe, economical, simple to use, and gentle in their action, with few serious or prolonged ill effects. If subtle at first, the effects of treatment are prompt, thorough, and long-lasting, posing minimal risk of chronic dependence. Patients, friends, and loved ones alike often sense a new vitality or well-being emanating from within, making relapse seem less frightening and in fact less likely.

On the other hand, homeopathy is far from a panacea for all ills. It is a difficult and exacting art, and even after years of study and practice a skilled prescriber may need to try several different remedies before any benefit is obtained. In other cases, despite the most conscientious efforts, there is little or no improvement. As already indicated, the remedies are delicate and easily inactivated, so that certain precautions must be observed. Finally, we do not understand how dilute remedies act and cannot predict how an individual patient will respond, which symptoms will change, or in what order. Like all other forms of medicine, homeopathy is an art, having to do with the life energy of individual human beings.

What Patients Can and Cannot Expect

By cultivating the direct personal awareness of the patient, homeopathy empowers and trains the basic instinct of self-care and self-healing in ways that more drastic methods seldom permit. The often uncanny action of micro-dilutions also reminds patients that healing is always possible and determined by unknown variables embedded deeply in the individual, whatever the name or stage of the illness.

Conversely, people suffering with illness, fear, or pain can get "stuck" at any point. With the best of intentions on every side, illness may continue or worsen, and a favorable outcome can never be guaranteed by even the most skillful homeopath or indeed by any other human agency. In the face of suffering and death or after grievous loss or misfortune, healing may not in fact be possible until we learn to accept what cannot be changed yet remain open to our experience without the judgment of fault or virtue added to it.

Finally, the fact that human beings can respond to such dilute remedies means that they can also receive and transmit energy in other ways that are equally unpredictable and likely to remain so. Self-healing and self-care make sense to the extent that health and illness can be lived and experienced as processes of self-discovery, that although we cannot know what will happen to us in the future, we can trust ourselves to learn whatever we need to know at the proper time.

Historical Development

Although his successful treatment and prophylaxis of a scarlet fever epidemic made him famous all over Europe, Hahnemann continued to be ridiculed and persecuted for his heresies until 1822, when a wealthy patron sheltered him and gave him a stipend to publish his writings. [note 16] In addition to his Organon of Medicine and Materia Medica Pura, he wrote many technical and expository works, maintained a busy correspondence, and continued to practice and conduct experimental research.

In his last years he remarried and moved to Paris, where he enjoyed wealth and celebrity and died secure in the knowledge that his students were practicing homeopathy all over Europe and in America. Driven by ambition and gifted with intellect, Hahnemann left a body of work and a methodology that have stood the test of time.

Homeopathy in America

Several factors contributed to the rapid growth and development of American homeopathy in the mid- to late nineteenth century, when the United States became the center of the movement and produced some of its greatest masters, whose works are still in use throughout the world.

The first was simply the youth of the country, the absence of laws or bureaucracy licensing the practice of medicine, and a tolerant attitude born of the hope to break free from the oppressive social and economic constraints of the Old World. In the 1830's, when the first school of homeopathy opened in Pennsylvania, physicians in America were organized on a voluntary basis, and state legislatures were reluctant to favor or discriminate against any faction or ideology, or to prevent uneducated or lay healers from helping anyone who wanted them. [note 17]

The second was the great westward migration of those seeking land and fortune in territories largely unsettled, where doctors were few and ordinary people were forced to doctor themselves and their animals, families, and friends in time of need. Under these frontier conditions, homeopathy's preference for the lived experience of the patient was well suited to educate the public in basic self-care, and popular manuals of homeopathy for first aid and the treatment of common domestic ailments began to appear during this period. [note 18]

The third was the concept of the materia medica itself, which gave the settlers a method of learning about their own folk traditions as well as the indigenous remedies they found ready to hand. Introducing dozens of native American herbs into the pharmacopoeia, homeopathy in the United States enriched and was in turn enriched by the botanical lore of midwives, medicine men, eclectics, Thomsonians, and other herbalists, often self-taught, and many of whose recipes are still in use today. [note 19]

Under these conditions, homeopathy grew and flourished in the United States as never before, creating hospitals, medical schools, and insane asylums, and scoring notable triumphs that attracted public attention. [note 20] In epidemics of cholera, typhus, scarlet fever, and the like, homeopathy consistently proved its superiority over the drastic treatments then in vogue, [note 21] and physicians practicing it rose to social prominence, treating many of the rich and famous of the time, such as leading members of President Lincoln's Cabinet. [note 22] By the turn of the century, some 10% of all physicians are believed to have used homeopathic remedies to some extent in their practices. [note 23]

During and after the Civil War, the tremendous expansion of American industry generated new pressures and influences that utterly and permanently transformed the nature of medical practice within a few decades. Using such minimal doses at rare intervals, American homeopathy never created a large or profitable industrial base capable of financing large educational or research institutions. As successive waves of immigration engulfed city and country alike, the old-fashioned practice of detailed interviews and immaterial doses could not compete or keep up with the new medicine, based on mass production and the assemblyline efficiency of the machine age. [note 24]

Meanwhile, as prophesied by Claude Bernard, [note 25] experimental medicine based on rigorous physicochemical causality generated magnificent technical achievements without precedent in human history, from anesthesia, antisepsis, and the development of surgery to microbiology, vaccines, antibiotics, and the systematization of knowledge in our own day, culminating in biotechnology and the attempt to decipher the genetic code. With only its fundamentalist principles and a laborious methodology to sustain them, even sincere homeopaths found it difficult to resist the lure of success or the excitement of power when the AMA opened its doors to them after 1900. [note 26]

While the AMA and its state societies had previously excluded homeopaths and forbidden its members to consult or fraternize with them, [note 27] their hostility had little effect until the state legislatures began to license physicians and accredit medical schools and the "regulars," backed by the pharmaceutical industry, won control of the process. [note 28] By inviting homeopaths and eclectic and botanical physicians to become members in exchange for being licensed, the AMA created a unified profession as a guild monopoly against competition from lay healers, midwives, and herbalists. By 1914, with the publication of the Flexner Report, it proposed a uniform standard of education and training for all physicians, based on a permanent teaching faculty and adequate research and laboratory facilities, and used its power of accreditation to phase out homeopathic colleges who fell below these standards. [note 29]

On both fronts the AMA strategy was completely successful. By the 1920's, all the homeopathic schools had either closed down or conformed to the new model, and homeopathy was reduced to a postgraduate specialty for the few physicians who were prepared to swim against the tide after four years of allopathic indoctrination. Although some fine homeopathic physicians continued to practice, the movement declined rapidly over the next forty years, until by 1970 it seemed quite moribund, its teachers aged or dead, and a whole generation of students missing. [note 30]

With world-class homeopaths like Vithoulkas, Eizayaga, and Sankaran now teaching or having taught in the United States, their students have reintroduced homeopathy into American medicine as a workable patient-centered model for primary care. Safe, effective, and inexpensive enough to sustain a busy family practice even without third-party reimbursement, homeopathy has become increasingly popular with young physicians, whose instant waiting lists reflect the almost limitless demand for their services. Yet always clouding these optimistic signs loom crisis and scandal in the health-insurance industry, whose uneven record of reimbursement for homeopathic care spells possible conflict in the near future.

As in frontier days, the renaissance of American homeopathy today could never have happened without the selfless devotion of lay people using remedies for their own self-care, organizing study groups in their communities, and eventually teaching the method to their friends and neighbors. While the infrastructure they built now supports physicians and other licensed health professionals in many places, some dedicated students of the method have seen the need and developed the ability to become semi-professional educators and counselors in their own right, at every level of proficiency, but with no laws either to protect or to regulate them.

At the retail level, the fast-expanding self-care market and the publication of new texts for the lay public [note 37] have helped make single remedies profitable for the first time and widely available in health-food stores and pharmacies all over the country. On the other hand, the same economics have enabled disreputable companies to market products with outlandish or exaggerated claims under the ill-defined homeopathic umbrella, many containing substances not yet included in the Pharmacopoeia, or not in conformity with its standards. [note 38] In short, the amazingly rapid growth of American homeopathy in recent years has exposed the need and created the opportunity to resolve many of the same problems that have weakened it in the past.

Homeopathy Abroad

Homeopathy today is practiced all over the world, mainly in Europe, North and South America, the British Commonwealth, and the Indian subcontinent. In the United Kingdom, it is sponsored by the Royal Family and practiced by physicians in the National Health Service and by registered homeopaths who complete a rigorous four-year course, in keeping with the British custom of lay healing without government or medical interference. Similar medical and nonmedical options are available in Canada, Australia, South Africa, and other countries of the British Commonwealth with strong self-care traditions.

Elsewhere in Europe, homeopathy is practiced by licensed physicians and some naturopaths, as in parts of the U.S. In France, Belgium, Germany, Austria, Switzerland, and the Netherlands, homeopathic remedies are available in most pharmacies, and homeopathy is taught as an elective in medical school, enjoys a certain scientific standing, and has prompted advanced research in biology, chemistry, and physics. [note 39]

With universal health insurance and a medical care system that is popular and efficient, most Europeans enjoy unrestricted access to homeopathic medicine, albeit often nonclassical, of uneven quality, and using low dilutions, polypharmacy, and mixing with allopathic drugs, as in Britain. In Greece, homeopathy was not established until the 1970's, when George Vithoulkas opened a school for physicians that today ranks among the world's finest. With official support from the government, homeopathy is now practiced everywhere in the country, including hospitals and medical schools.

In Latin America, homeopathy has been taught and practiced by physicians since the late 1800's, particularly in Mexico, Argentina, and Brazil. In Mexico, as in the United States a century ago, it has both grown up with and contributed to the study of indigenous plant remedies. Popular with people of all classes, it is practiced mainly by physicians and enjoys a fairly high social standing. The same is true in Argentina and Brazil, where distinctive national styles have been developing for years, each with practitioners throughout the country and mostly cordial relations with their allopathic colleagues. Despite unrest and hardship all over the continent, the future of homeopathy in Latin America looks bright and secure.

In the last fifty years, India has become the world capital of homeopathy, both in the number of physicians practicing it and in its collective impact on the culture. Widely practiced in hospitals and taught in medical schools, the method has also generated a great network of dispensaries and infirmaries all over the country, staffed by trained homeopaths under medical supervision and bringing affordable health care to millions of people in dire need.

Officially recognized and supported by the Indian government, homeopathy also complements the ancient Ayurvedic system, with a pharmacopoeia of more than a thousand remedies, many still awaiting provings to determine their therapeutic range. Thus authorized and experienced in treating the gravely ill, Indian homeopaths have weaned patients from renal dialysis and drugs for intractable congestive heart failure, and palliated or cured patients with advanced metastatic cancer, severe blood dyscrasias, multiple sclerosis, and the like. [note 40] Finally, homeopathy has facilitated communication between modern Western medicine, also much esteemed in India, and the honored traditions of Hindu and folk healers. In Muslim Pakistan, it is equally popular and serves analogous functions.

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20. Coulter, H., Divided Legacy: History of the Schism in Medical Thought, Vol. III, McGrath, Washington, 1973, pp. 285-316. [back]

21. Bradford, The Logic of Figures: Comparative Results of Homeopathic and Other Treatments, B&T, Phila., 1900, pp. 141-145. [back]

22. Coulter,op. cit., III, pp. 140-238. [back]

23. Ullman, D., Discovering Homeopathy: Medicine for the 21st Century, North Atlantic, Berkeley, 1991. [back]

24. Winston, J., The Faces of Homeopathy, NCH Video,1995. [back]

25. Bernard, C., Introduction to the Study of Experimental Medicine, trans. Greene, Dover, New York, 1957, pp. 65-67. [back]

26. Starr, op. cit., pp. 99-123. [back]

27. Coulter, op. cit., III, pp. 140-238. [back]

28. Starr, op. cit., pp. 99-123. [back]

29. Ibid. [back]

30. Winston, op cit. [back]

32. Moskowitz, "Some Thoughts on the Malpractice Crisis," British Homeopathic Journal 77: 17, January 1988. [back]

33. Steel, K., "Iatrogenic Illness on a Medical Service at a University Hospital," NEJM 304:638, 12 March 1981. [back]

34. Starr,Logic of Health Care Reform, Grand Rounds,1992, pp. 16-19. [back]

35. Moskowitz, "Whose Life Is It, Anyway? -- Thoughts about the Doctor-Patient Relationship," Chrysalis 6: 103, summer 1991. [back]

36. Eisenberg, D., "Unconventional Medicine in the United States," NEJM 328:246, 28 January1993. [back]

37. Ullman, D., and Cummings, S., Everybody's Guide to Homeopathic Medicines, Tarcher, Los Angeles, 1991. [back]

38. Moskowitz, "Ethics in Homeopathic Practice," Journal of American Institute of Homeopathy 86:238, December 1993. [back]

39. Resch, G., "Physical Chemistry of Attenuated Remedies," Proc., 42nd Congress, Int. Hom. League, Washington, 1987, pp. 300-304. [back]

40. Chand, D., "Clinical Cases," Ramakrishnan, A. U., "Hemorrhagic Disorders in Homeopathy," ibid., pp.191-199 and 204-206. [back]