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Home arrow Naturopathic News arrow Issue #134 Nov. 2013
Issue #134 Nov. 2013
  2. 2014 CLASS SERIS
  4. DYNAMIC DISEASE   June 2008
  5. THE MINIMUM DOSE  January 2009
  7. ACUTE AND CHRONIC DISEASE     February 2010
  8. ACCURACY IN REPORTING         December 2007
  9. FIRST ORDER SYMPTOMS    April 2008
  12. WHEN IS IT TIME TO DOSE?  August 2012
  15. ANKLE SPRAIN      April-May 2011
Welcome to this issue of Naturopathic News, issue #134. It's my mission to help you find optimal solutions to health problems. This newsletter is one way to do that. The more educated you are about your health options the better able you will be to take control of your health. If you would like to stop receiving my newsletter please send me an email and let me know. If you have a friend or family member who you think would appreciate the information provided, send me their email address. 

Whew! It’s done. Definitely a jam packed day. In fact, that’s the only criticism in any of the course evaluations--“Was a very long day w/much material. It might have been better as a 2 day class”. All of the course evaluations have been very supportive. You were a great group of students—attentive, responsive, and asked very appropriate questions. A big thanks to all who attended.

2014 Class Series
So far, everyone has indicated that they are interested in taking more classes. I’m working on next year’s class schedule and am inviting your input for what you would like me to teach. Here are the requested class topics with their votes so far. Please make your voice heard send me an email tell me which are at the top of your list.

Irritable Bowel Syndrome—2 votes
Autoimmune disease—2 votes
Pre Diabetes Prevention and Treatment—1 vote
Brain Nutrition--dementia, Alzheimer's prevention—1 vote 
Breast Cancer prevention—1 vote 
Cancer Prevention—1 vote

Over the last several years I’ve written several articles describing different aspects of homeopathic practice. I thought it might be useful to put them all together in one issue of Naturopathic News to serve as a convenient reference. Here they are.

Recently there have been some interesting questions about the nature of disease and how and what it is that we treat with homeopathic medicines.

The essential idea is that disease consists of deviations from the former healthy state of the individual. These deviations are ones that the patient feels, others around her perceive, and are observed by the homeopath. All these perceptible signs and symptoms represent the disease in its entire extent.

The most intelligent approach is to first clear away any maintaining causes of disease. Some examples from practice are, 1), if someone is drinking 5 cups of coffee a day and has high blood pressure, first you must remove the coffee, 2), when a child has repeated ear infections and consumes dairy products, you remove the dairy products as dairy has been proven to be the most common nutritional cause of otitis media, 3), when complaining of chronic fatigue and stress, the person must change sleep patterns to increase the number of hours of sleep, 4), if a nutritional cause of disease is present, for instance, consumption of artificial colorings, flavorings, and preservatives by an individual diagnosed with Attention Deficit Hyperactivity Disorder, those substances must be removed.

Where there is no obvious maintaining cause to be removed what we then see are the signs and symptoms of the disease itself. Hence it is these symptoms alone by which the disease demands and can point to the appropriate medicine for its relief. More specifically, the totality of the characteristic signs and symptoms of the disease are the outward manifestation of the disease. Characteristic meaning strange, rare, peculiar, unusual. Which is why "I am depressed", or "I am stressed out" are fairly useless statements. There is nothing in these words to convey anything specific to the individual. Hence it is the totality of characteristic symptoms that are the only thing, in every case of disease, to be discerned. So that by means of homeopathic medicines the disease can be cured and health restored. This is Dynamic Disease. 

As my colleague Dr. Kellerstein describes it, it's as if there is a shift in the Operating System of the body that is self-perpetuating. In contrast to the disease that is due to bad lifestyle, errors of nutrition, unhealthy environment, etc. For example, if I complain of heartburn, and eat fried fast food all the time and consume lots of spicy food, is this dynamic or hygienic? It's hygienic. In other words you've stacked the deck in favor of getting heartburn to the degree that the body's response is expected. If you have severe, chronic heartburn, that is getting worse all the time, in spite of having the healthiest, most balanced diet, then this would be more dynamic. This is a shift in the operation of the body without any external provocation. 

Clinically, most patients present with a combination of hygienic and dynamic disease. By clearing away the hygienic maintaining causes, optimizing lifestyle, nutrition, etc. (with safe naturopathic modalities), the disease created by those causes will disappear. If disease persists after this optimization process then it is true Dynamic Disease. This is what we treat with homeopathic medicines.

Problems occur because most people do not want to experience the discomfort of changing their lifestyle, altering habits, or correcting nutritional mistakes. Or they come to me with a single focus of what they want cured. But a single symptom of disease is no more the disease than the foot is the person. Even worse, these single symptoms are treated with suppressive therapies (symptomatic treatment) that do no more than cover up the symptom, not addressing the cause. After perhaps a brief period of relief, the altered symptom(s) return in full force.

Remember, once the hygienic symptoms are cleared away, what remains are the signs and symptoms of the true dynamic disease. These must be felt and experienced so that they can be communicated. For within the characteristic signs and symptoms of the dynamic disease lies the indications for the homeopathic medicine that will cure those very same signs and symptoms. In other words, "suffering is the Language of Nature pointing to its own remedy." Suffering is the language requesting aid, spelling out and specifically defining the remedy that is required. But we have to understand these signs and symptoms at the deepest level possible. "Hay fever" doesn't cut it. "Pain in my legs" is insufficient. 

Now you can see why saying "Nothing is changed", "Everything is the same," communicates no useful information.

A fundamental principle of homeopathic practice is the concept of minimum dose. How this idea gets applied in practice directly determines how I manage your case. All within the backdrop of establishing the most rapid, gentle, and permanent route to cure. Let's look at these three pieces.

What does rapid mean? Isn't it just, "get rid of your symptoms as fast as possible"? When the symptoms you're getting rid of are acute-trauma, cold/flu, pneumonia, etc., the answer is yes. When the symptoms are a repeat of a chronic state the answer is more complex. Let's look at a case of migraine. For purposes of this example we will assume that issues of hygiene related to the migraine occurrence-caffeine, diet, chemical exposure-have been addressed.

If you've had migraines for a number of years, and have used prescription medicines to treat them, there are several questions that need to be answered if you get a migraine after starting homeopathic treatment. If the migraine is worse in intensity and duration, it may mean that the potency or method of dosing needs to be adjusted. If the migraine is significantly different in nature, a reexamination of the chosen homeopathic medicine may be in order. Managing these factors takes time and detailed re-evaluation of prescribed upon symptoms. In addition to how fast symptoms disappear we must also look at whether any other system suffers anew. If your migraines go away but you develop a tic or tremor that is not a desired outcome.

Any medicine that has the power to heal has the power to harm. Some patients are surprised to hear this. At the same time, homeopathic medicine, when used appropriately, is the safest medicine I know. 

There is a lot of leeway in achievement of gentleness when water dosing is used. We can change many factors that impact this-number of succussions, amount of remedy taken, splitting of 1 dose over 1 day, use of 1st and succeeding glasses. These modified dosing methods are very useful, especially when working with sensitive individuals. Typically, there is no reduction in effect of the homeopathic medicine, even when the dose is changed in these ways.

Yes, homeopaths talk about permanent cure of chronic disease, not just control. Setting this high standard necessitates that we deal with the whole person. It's rare that one isolated symptom is the sum total of a person's imbalance. There is an interrelationship between the spiritual, mental, emotional, and physical aspects of health. To seek out cure, the whole person, on all these levels, must be addressed. Otherwise, focusing on each chronic symptom by itself leads to a compartmentalized approach doomed to failure.

All together, working with these goals of rapid, gentle, and permanent cure, hinge upon the application of the minimum dose. Each person, even with the same diagnostic label, requires an individualized dosing regime. Some general principles apply:

Fewest doses possible to further clinical effects.

Best to redose right before symptoms worsen.

Better to wait on dosing when there's question of effect.

More is not better. Often less is best.

When in doubt, wait. Then wait some more.

Hopefully this brief description of homeopathic practice will help you understand the why and how of your case management. It might help you ask the right questions and understand the answers.

There are always a few questions related to homeopathic pharmacy so I thought it would be good to review the basics. I include under pharmacy all the aspects involved in the preparation of homeopathic medicines. 

To start, it’s important to understand where homeopathic medicines come from. Most remedies are made from the major Kingdoms of the natural world—Animal, Vegetable, and Mineral. Everything from relatively inert substances like club moss to innately reactive substances like Phosphorous. When Dr. Samuel Hahnemann created the science of homeopathy in the first half of the 19th century many of the medicines in use were toxic substances like Mercury. Hahnemann recognized the medicinal potential integral to such poisonous materials and sought a way to enhance the healing effects while canceling and negating any deadly effects. Similarly, a method was needed that would evoke the dormant healing properties inherent to inert substances such as oyster shell or cuttlefish ink. Hahnemann’s genius created the homeopathic pharmaceutical process, which solved these seemingly insurmountable problems simultaneously.

To address the issue of toxicity Hahnemann diluted his remedy preparations. To awaken the latent healing properties of a substance he created the succussion process. The combination of serial dilution and succussion is the hallmark of homeopathic pharmacy. For the first time extremely poisonous substances such as snake venoms, spider venoms, Mercury, Arsenic, etc., could be safely utilized as medicine. Understanding the 3 potency scales of homeopathic pharmacy shows us how this can be done.

Homeopathic medicines start from a solution of standardized chemical strength. The first potency scale developed by Hahnemann and the one still most commonly found is the centesimal scale (C potency). To make a centesimal potency one part of this solution is added to 99 parts of the diluent (water and alcohol) and the dilution is thoroughly succussed (vigorously agitated by striking the container against a firm surface). This is called the 1C potency because it is a 1:100 dilution of the original solution (C for centesimal). Then 1 part of the 1C potency is added to 99 parts of diluent. Again the solution is succussed. This new dilution is the 2C potency because it has been prepared by a 1:100 dilution performed 2 times. The strength of the 2C potency is 1/10,000 of the original solution (1/100 of 1/100). Further potencies go up from there—3C from 2C, 4C from 3C, etc. A 200C potency means this process has occurred 200 times, a 1M potency means that this process has occurred one thousand times.

The X or decimal potency is prepared in a similar manner except a dilution factor of 1:10 applies. In other words, one part of the original material is diluted in 10 parts diluent and then succussed to make the 1X potency. Then 1 part of the 1X potency is added to 10 parts diluent and succussed to make the 2X potency, and so on. 

There is a third homeopathic potency referred to as the LM potency (also Q potency) or 50 millesimal potency. The LM potency starts from a 3C potency of a particular remedy. One part of a 3C potency is dissolved in 99 parts of diluent and then 500 milk sugar pellets about the size of a poppy seed are moistened by this solution. Each one of these pellets is now an LM1 potency of that particular remedy.

Why is any of this important? What difference does it make which potency is used? In my experience, and that of many other homeopaths, potency and dose are critical in determining the response to a homeopathic remedy. If the potency is too strong or the dose is too large the vitality of the individual is ‘pushed’ too hard and pushes back with more symptoms—the headache gets worse or the sleep is disrupted. If the correct potency is used based on the assessment of the individual’s Vital Force this effect is minimized. The LM potency was specifically developed by Samuel Hahnemann to be his most ‘perfect method’. His goal was to bring about a rapid, gentle, and permanent restoration of health. I use mostly C and LM potencies in my practice. For those of you that have wondered where those really tiny pellets came from, now you know!

The C and X potencies can be made utilizing a variety of different sized pellets. From those smaller than poppy seed-sized granules that the LMs are always made from to pellets the size of large BBs. If prepared properly, each pellet dosed with the solution of a particular potency is equal to 1 dry dose. 500 poppy seed-sized granules of a LM potency therefore represent 500 dry doses. That’s why you can ignore the instructions on the tube of Oscillococcinum that say take the whole tube as 1 dose. Each one of those tubes contains at least 100 doses. Imagine that, 100 flu doses for less than $10. That’s cost effectiveness in medicine!

As defined in Homeopathic philosophy, the terms acute and chronic are not time dependent. In conventional terms, a disease is acute for the first few days then becomes chronic as either it is not treated or does not respond to treatment. This is not the case in Homeopathy.

In Homeopathic philosophy, a chronic disease is chronic from onset, just as an acute disease is acute from its onset.

Acute disease has a period of onset, a period of activity, and a period of decline to resolution. Unless the disease is severe enough to result in the death of the body, resolution will occur without outside treatment. With treatment, the course of the acute disease can be shortened and the severity of the symptoms lessened.

Some examples of acute disease are trauma, toxins, and fixed infectious disease scenarios such as measles, chicken pox, etc.

Chronic disease also has a period of onset, a period of activity, but no period of resolution. The Vital Force cannot eliminate a chronic disease without outside help. Chronic disease may have periods of latency during which no overt symptoms are seen.
Some common symptoms of chronic disease are restrictive fears, compulsive or repetitive behaviors, chronic discharges, constipation, symptoms before menses, etc.

Many apparently acute diseases clearly represent the acute flare-up of pre-existing chronic disease, sometimes under the influence of an external pernicious influence, such as the recurrent cough as described mentioned above. Sometimes the pernicious influence overwhelms the system. I think that, in order to ensure and maintain health, we need to focus equally on both the chronic and the acute. Otherwise you end up chasing your tail, never getting beyond the temporary relief of acute symptoms.

So why not give a homeopathic remedy for that so-called acute? It’s my experience that it’s very easy to lose the thread of the chronic case when you focus on an acute. Let me give a personal example. I’ve been working with one of the best American homeopaths I know for my chronic disease state-David Kramer. Much has transformed in the time that he has been my homeopath. 

A couple of months ago I was in the middle of having a severe reaction to a composite filling that was placed along my gum line—pain, sensitivity, inability to chew, etc. These symptoms had been building for weeks and reached a crescendo. I wanted to address them as the threat of a root canal or worse was looming. David prescribed a homeopathic remedy for me that worked very well to the point that about 99% of my dental symptoms resolved, and I also felt better in general. However, since then, there has been some slippage of my chronic case. Aspects that had been responding to previous care (with a different remedy) are surfacing again. What happened?

I’d like to use the analogy that Will Taylor, MD uses. We saw the tip of the whale’s fin and prescribed upon it with very good results. But the rest of the whale was submerged under the water at the time. Now the whale has surfaced and that fin is just one part of the larger whole. If we want to be well on all levels we have to grok the whole whale and prescribe on that.

At least with homeopathy there’s much less chance of causing further problems. With prescription or over the counter drugs you suppress symptoms, forcing them deeper into the organism causing new severe problems to show up. Which then need to be treated with other drugs, which cause further symptoms, which need other drugs, ad nauseum. A nice racket if you can get away with it as the status quo. 

So the next time you reach for something to get temporary relief stop and think. What part of the whale are you treating? What part is invisible to you? Are you going to take the steps necessary to address the totality or are you going to see the part and miss the whole?

If you've worked with me for any length of time we've probably had a discussion about how important reporting your symptoms is. More than likely I've grilled you about your altered feeling and function. Asked you "What does the pain feel like?", "How do you feel when you're in that situation?", "What is your experience of depression?". You may not always have an immediate sense of the value of this information. I want to share a recent patient experience with you that dramatically highlights its significance.

About 2 weeks ago a mom brought in one of her sons to see me. I hadn't seen B in several months as he had done very well and no longer needed ongoing care. However, he'd recently been exposed to poison ivy (in November!) and was in dire straights. 

It had been a long time since I had seen anyone with symptoms as bad as B's. Years ago at the California School of Herbal Studies, Michael from Canada had gotten poison oak (West Coast strain) all over his body. His face was greatly distorted by the swelling. B was at least as bad or worse. He also had it in his chest, arms, back, and privates. But when asked by his mom what he wanted to do he said, "I don't want steroids". So here he was in my office for homeopathic care.

In the course of 45 minutes we went into as much depth as possible concerning every aspect of his symptoms. B was used to this as he had responded very well to homeopathic remedies. After all this time there wasn't a lot to go on. Unlike conventional medicine the label doesn't determine the treatment. There are over 50 homeopathic remedies that are noted for Rhus poisoning. Which is why it's so important to get information specific to the patient. Hence the length of time and the detail required individualizing the case.

Usually it's best to know what's strange, unusual, or peculiar in the case as that will tell you where to look for a remedy. It's also important to know how the person has changed since the illness began. What stood out at this visit, and what I latched onto, was the fact that B felt better with really hot water. In my experience it's unusual for people with itchy, burning, stinging skin (B's symptoms) to feel better with hot water-they are usually worse. So with this linchpin and a couple of other specific symptoms I confidently gave B the homeopathic remedy Rhus-tox in a 1M potency. Rhus-tox because it best fit the symptoms-especially better with hot water, and a 1M potency because of the nature and quality of the illness. 

The report the next day was, "No improvement." I had a break in my schedule so I asked the mom to bring B back in. If anything his face was more swollen and his right eye was partially closed. After another 45 minutes we hadn't been any more successful in getting information. I went back to asking about the hot water issue only to learn that B is always better with hot water. In other words this was not a change in his state. Hence I wasn't looking at the right information. 

I went back to asking the mom what was different and she said not really anything-as she had said several times already. However, this time she made an aside about how B wanted to be by himself-because of how he looked. Turns out this is very unusual for B. He really likes being around people and is quite social. When I asked him directly he said this was a big change. This led me down a completely different direction of questioning until I got one more big change-he didn't want to be consoled. Usually, when he's sick he's all over his mom-but not this time. Another big change. These were really the only symptoms I had. Everything else-itching, scratching, and the eruptions-were common manifestations of poison ivy. 

Because of these 2 big changes from his Normal state, and a couple of other confirmatory symptoms, I gave him the homeopathic remedy Natrum muriaticum 200c. The difference in response from the first remedy was striking. Within an hour of taking the first dose of Natrum muriaticum he began to feel better, and the itching was gone. When asked about having a friend over he had an enthusiastic response. Over the next 24 hours the swelling decreased and he was outside playing and laughing. Within 48 hours the swelling was 80% gone and he was back to normal.

What's important to understand in this case? There was such a dramatic and rapid improvement in B's state of health when I chose a remedy that truly matched his altered state. And absolutely no change when his normal symptoms were used. A seemingly circumstantial change-"he doesn't want to be around anybody because of how he looks"-was a significant marker of the shift in his vitality. To quote my homeopathic mentor David Kramer we need to be "Sherlock Holmesopaths", questioning every statement and looking at the details others pass by. B's Vital Force was distuned by his exposure to poison ivy. To restore health we need to ascertain the details of this distunement and apply the homeopathic remedy that best matches the altered state. When that is done cure is rapid, gentle, and permanent.

Recently I heard a lecture by one of my favorite teachers, Joe Kellerstein, ND. Dr. Kellerstein is a naturopathic physician who practices homeopathy in the province of Ontario. He was discussing the nature of how patients report symptoms and described what he termed 'First Order Symptoms' (FOS). I thought this might be helpful as many of you are unsure what to report when you check in or have expressed difficulty in relaying what's happened to you.

First Order Symptoms are the direct experience. They are what you have before you process the overall experience. Everything else is after the fact, having been run through various mental or behavioral filters. Let me offer a really common example.

I often ask you what foods you really like or crave. A food craving is an intense, spontaneous, clear desire for a food. "I love chocolate", or "I could eat bread all day long." The craving itself is a First Order Symptom. It's what you experience. Many people, when they answer this question, run this FOS through a health filter. They think to themselves "I shouldn't eat bread," and they will never say that they crave bread. Even if this person never eats 1 piece of bread, the First Order Symptom is "I really like bread." I'm not judging you if you eat bread or not. I just need to know if the craving for bread exists.

The following situation is another common example. A person finds out at work that someone is talking about them. Immediately in the moment they feel shock, then anger. In their mind they think, "people talking about each other is so common, I shouldn't let this get to me." And the experience gets lumped under the filter, 'work stress'. Which becomes "I'm stressed out." This is not the FOS. The First Order Symptom was what? Shock, with anger. That's what I need to hear to understand what your experience was. When you only relay the category or box you've assigned to your experience-'stress'-I miss out on the richness and diversity of who you are. Which means you miss out on the most individualized care that you can receive.

In working with Homeopathy I need to hear what your 'altered feeling and function' is. What your First Order Symptoms are-anger, shock, surprise, excitement, embarrassment, sadness, etc. How you have these experiences, and what they mean to you, is what counts. It's not how you are like everybody else that helps me understand what you are dealing with. It's how your experience is unusual, peculiar, unique, rare, that can be most telling. 

I want to give one more example of how important this is. When I first give a homeopathic remedy, or at any point while someone is taking a homeopathic remedy, I am looking for what's changed. There are times when someone says nothing has changed. But I think that is rarely the case. Let me give an example.

Someone comes to me for a sharp, shooting pain in their legs. They take the homeopathic remedy I prescribe and the following happens. First the pain is worse for a bit. Then it's better for a bit. Then it's worse again back to where it was or slightly less. This becomes, through the patient's filter, 'nothing's changed'. In their mind it's nothing because sometimes their pain is worse, sometimes it's better. Actually, they experienced a highlighting of their symptoms, then a reduction, with a return to a slightly different state. Rather then 'nothing' this response pattern can be an indicator that a higher potency is needed, or a repetition of the dose.

Think of it as a work of art. First Order Symptoms are the primary colors. With them you must paint a picture of your experience that I can successfully match with the homeopathic medicine that is most similar. The more accurate your description of your FOS-mental, emotional, and physical-the more likely you will heal in a gentle, rapid, and permanent manner.  

So, it's the first visit (or a return visit), you're looking across my desk, and it's time to tell me what is occurring. What do you say? Where do you start? Maybe you've read Dr. Timothy Dooley's wonderful introduction to homeopathy, "Beyond Flat Earth Medicine" and you remember that characteristic symptoms are what I need to hear about. But you don't really know what that means.

Characteristic symptoms are symptoms that illustrate the individuality of the patient. These may be found in the mind, emotions, dreams, general tendencies, food cravings, sleep, sex, energy, and so on. What we're looking for is the individual expression of the person who is sick. The real pathology of the patient if you will.

Characteristic symptoms describe the patient's illness as a unique complete entity. The basic concept is that a person is ill as a total entity, not only a part is sick, but that all of the person is ill. The illness is seen in the symptoms. Some symptoms are common and some are unique but all show the total illness. As a homeopath I pay attention to the most identifying features of the whole. These features run through the whole case.

What do we need to know about a symptom to understand it? What gives us the most comprehensive information? One of the most accomplished homeopaths of the 19th century, Clemens von Boenninghausen, wrote extensively on this subject. He developed the following set of interdependent questions that help us derive the most value from each symptom.

1. Who? 
The personality, the individuality of the patient, must stand at the head of the image of the disease, for the natural disposition rests on it. In this area we find the sex, age, bodily constitution, etc. The more striking or rare the differences from the norm, the greater the attention. 
2. What?
This question refers to the disease, i.e., to its nature and peculiarity. Each person diagnosed with the same disease label still expresses unique symptoms. Various aspects of how they express the disease differentiate them from anyone else with that same label. The ultimate importance lies in the symptoms themselves. It does not rest solely on the attachment of a disease label. 

3. Where?
The seat of the disease, though part of the previous question, deserves further emphasis. Often, a characteristic symptom can be derived from the location of the illness. This is true not only for a local disease like a rash, but also for more systemic diseases like rheumatoid arthritis. In such situations it is rarely the case that the whole body is affected equally. It may be that one side is affected more than another, or the upper (not the lower) part of the body is involved.

4. Concomitant Symptoms (symptoms occurring at the same time).
Every individual presents with a more or less numerous group of symptoms. Taken together they represent the totality of that person's disease (when the image is complete). Think of a mosaic where every tile exquisitely laid in place represents an aspect of the overall picture. One absent or misplaced tile can distort the image (the picture of the disease) making it unrecognizable. Hence the importance of concomitant symptoms. This is especially true when the symptom is seemingly not related to the disease. An individual has acute kidney stone colic and the concomitant symptom is an unusual outburst of anger. Someone has experienced a strong grief and they have a craving for salty foods that they don't usually like. 

5. Why?
The cause of the disease or etiology has a prominent part in pathology books. A large part of this is only untested theories or attempts at explanation. Homeopaths take a much more versatile, wholistic view of etiology that goes beyond simple association with a pathogen. 

At one level there exist internal and external causes. Internal causes properly refer only to the general natural disposition, which in some cases amounts to a peculiar supersensitivity or individual susceptibility. For some, illness always begins with their throat. For others, their skin is affected. Some are indisposed at the level of intellect or emotion. 

The external causes embrace everything that, where there is such an internal disposition to disease, may produce disease. Weather, poor food choices, sick building syndrome, mental or physical abuse, abandonment, grief, etc. Maybe the specific cause of the kidney stone colic was the burst of anger that preceded its onset. If so, this etiology becomes a significant factor in the understanding of the case.

6. Better or Worse?
The modalities of a symptom, or things that make that symptom better or worse, are quite often a key to unlocking the case. Is the cough better from eating food? Does the throat pain increase when cold water is swallowed? Is the pain better with heat? Or with cold? Does the night sweat always occur at the same time of the morning? A clear modality is worth its weight in gold. One strong modality can shift the perception of the case and point the homeopath in the right direction.

7. When?
This concerns the time of the appearance, the aggravation or the amelioration of the ailments. The periodic return of symptoms after a longer or shorter cessation may relate to specific causes such as menstrual ailments, weather changes, seasons, etc. 

Of even greater importance are the aggravations and ameliorations at particular times of the day. Whether this applies to local symptoms that the person has or their general overall state. There is hardly any disease that does not manifest in some form a distinct aggravation or amelioration. 

The next time you need to check in or keep a record of your symptoms, ask yourself these 7 questions. The answers might surprise you and delight your homeopath. 

Everyone who takes a homeopathic medicine while working with me gets a set of instructions (paper or by email) on how to take their dose. Step #2 says to "strike the bottom of the bottle firmly against the palm of your hand __ times (succussing the remedy). Last week a relatively new patient asked me why it was necessary to do this and what it was for. 

When Samuel Hahnemann started working to develop homeopathic medicines he searched for a way to bring out the medicinal power of inert substances. For reactive plants like Belladonna or toxic minerals like Mercury it was fairly obvious that they could be medicinal. Belladonna was well known as the plant used by Italian women to dilate their pupils (hence the name bella donna-or pretty woman) and Mercury was used by conventional practitioners to basically poison patients as a way to cure them of syphilis.

But what about substances like the spores of Lycopodium-club moss, or oyster shell-Calcarea carbonica, or cuttle fish ink-Sepia? We know these today as three of the most comprehensive homeopathic medicines in clinical practice. They each cover a wide variety of mental, emotional, and physical symptomatology based on provings and clinical practice. Yet, chemically speaking, these are not very active substances. Nothing spectacular happens when you heat them up or dissolve them with solvents. How was Hahnemann, and other homeopaths, able to reveal, in a sense, their innate medicinal power?

That's where succussion comes in. Hahnemann had the inspiration to bring out the dynamic aspect of substances by putting energy into the process of making the homeopathic medicine. With powdered substances this is done by grinding in a mortar and pestle. With liquid substances this is done by striking the container firmly against a hard surface. Each level of potency in making a homeopathic medicine is associated with a specific number of succussions. For example, a 30c potency of a remedy has had 3,000 succussions--100 succussions at each level, or 30 x 100.

The number of succussions, along with the dilution factor, is the fundamental difference from one potency to another. A 30c is different from a 12c because of the number of succussions (and the amount of dilution).

Why is it important to succuss your remedy each time before you take it? This is to insure that you are not taking the exact same dose each time. Because you succuss your bottle 1, 3, 5, 10 or however many times, you slightly change the potency each time. This gives your body the best chance to respond fully to each dose. 

Think of what happens when you walk into a room with a bad odor. Initially it's quite strong, then, after a few minutes you notice it much less or not at all. This is the body's natural response to a repeated stimulus--in our example the repeated stimulus is being stuck in the room and having to smell the bad odor, your body adapts to the stimulus and you notice it less. If you repeat your dose without succussing your remedy each time before hand, you give your body a chance to adapt to, and therefore no loner respond to, the dose. 

The number of succussions before each dose is determined by a number of different factors; my assessment of your level of sensitivity, the nature of the disease, and to some extent the remedy itself. I might use a higher number of succussions to bring about a response or a lower number of succussions for someone who is reacting too strongly to their medicine.

This may not seem that pertinent to you in terms of your healing response but it is very useful. Changing the number of succussions is one of several ways to modify the dose and individualize it for you and give your body what it needs to heal. Just in the last few weeks I've had 2-3 patients who did not respond well when taking their remedy. In each case I changed (decreased or increased) the number of succussions and the person began to improve in a more consistent manner.

So the next time someone asks you why you have to smack your remedy bottle against the palm of your hand you can say it's to slightly change the potency each time you dose in order to help you heal faster. It really does make a difference.

It's fair to say that with conventional medicine, more is almost always considered better. Or at least stronger, or faster. If your anxiety med or your acid blocker isn't suppressing your symptoms strongly enough, you'll probably get more of that drug. If you're hypersensitive to prescription drugs--they cause a bad reaction, you get all of the listed side effects, or you're unlucky enough to have some weird side effect that's making you miserable, you're just out of luck. That's your only choice--be miserable or not take the drug. Sometimes you're made to feel that your sensitivity is your fault or that you're making it all up somehow.
When dosing with homeopathic medicine it's a completely different story. More is definitely not always better. Sometimes you need to dose less to feel better. Or at least change how you dose to see if that will bring about the desired improvements in your health. How do we figure this out in a practical way to bring about the most rapid, gentle, and permanent cure? 

Assuming you are taking the medicine most homeopathic to your case (see June and July 2012 Homeopathy 101 for articles on How Homeopathy Works), the focus is then on your response to the homeopathic dose. What we're looking for is progressive improvement in your symptoms. But which symptoms are most important? If your itchy skin is better but your irritability is out of hand that isn't necessarily success. Unless the itchy skin was overwhelming your function--preventing sleep or driving you mad with its constant intensity--it's likely that the irritability is more central to the case. With homeopathy, best results are obtained when looking at the whole person, with extra attention paid to the strange, rare, peculiar, most characteristic symptoms of the case.

Progressive amelioration of symptoms will occur under three conditions; first, if the medicine selected with the utmost care was perfectly homoeopathic; second, if it was given in the minutest dose, so as to produce the least possible excitation of the vital force, and yet sufficient to effect the necessary change in it; and third, if this minutest yet powerful dose of the best selected medicine be repeated at suitable intervals.

We want to administer the selected medicine in such a manner that it will exercise its entire efficacy without injury to the patient, that it may elicit all the good it is capable of performing in a given case of disease. To achieve this result we must be guided by the nature of the patient and the magnitude of their disease.

This is where the sensitivity of the patient can be worked with unlike in the conventional example I gave earlier. If someone tells me that they are chemically sensitive to odors, perfumes, prescription medicines, etc. I know to adjust the potency and the dose accordingly. I can do this in about six or eight different ways so it's rear that someone is 'out of luck' and just can't take a homeopathic medicine. By individualizing the potency selection and the method of dosing we can fine tune the response to get improvement without too much sensitivity reaction.

Dosing is also affected by the nature of the disease. If it's a sudden intense acute the potency and repetition of the dose will be different then if I'm dealing with a slowly progressive chronic disease. The guiding principle is the same however. We're choosing the smallest dose at the best interval, to obtain the most improvement with the least disturbance.

Why don't we just have you dose every day, or 2x/day, as a routine, without any change,  and then see you next visit? Won't this speed up results and work great (more is better idea)? Back in my May newsletter I wrote about succussion (striking the bottle firmly against the palm of your hand) and why we do it. It is ineffective to repeat the same unchanged dose of a remedy once, not to mention frequent repetition at short intervals. The vital principle does not accept such unchanged doses without resistance, that is, without other symptoms of the medicine manifesting themselves than those similar to the disease to be cured. Because the first dose has already accomplished the expected change in the vital principle and a second wholly similar, unchanged dose of the same medicine no longer finds, therefore, the same conditions of the vital force. 

The patient may indeed be made sick in another way by receiving other such unchanged doses, even sicker than he was, for now only those symptoms of the given remedy remain active which were not homoeopathic to the original disease. No step towards cure can follow, only a true aggravation of the condition of the patient. If the succeeding dose is changed slightly every time, namely potentized somewhat higher (succussed) then the vital principle may be altered without difficulty by the same medicine and thus the cure brought closer. Think of it as an adaptation process. When you first walk into a room with a strong odor after a few minutes you no longer smell it--you adapt. By succussing before each dose we slightly change the potency and you continue to respond to the remedy. Adaptation does not happen.

It seems as if the best selected homoeopathic remedy has its best effect, especially on long standing chronic disease, when it's applied in slightly altered form each time. In this way, the dose of the same medicine may be repeated several times according to circumstances, but only so long as until either recovery ensues, or the same remedy ceases to do good and the rest of the disease, presenting a different group of symptoms, demands a different homoeopathic remedy.

To understand how homeopathic medicines work, some associated principles need to be understood. 

The only thing to focus on in disease is the signs and symptoms of the disease.

Medicines are curative when they can engender disease symptoms in the healthy and take them away from the sick.

Medicines only cure disease by creating an artificial disease state, thereby lifting and eradicating the symptoms already present. These symptoms are the natural disease state we wish to cure. 

If you want to cure disease, find the medicine which has been proven to have the greatest tendency to cause symptoms similar to the medicinal symptoms (those similar to the disease). This is the best way to lift disease symptoms and transform them into health, easily, certainly and permanently. 

In homeopathy, we look for a medicine that covers the totality of symptoms of the disease, with regard for the originating cause (when it is known) and for the circumstances of the disease. A medicine is sought which has the power and the tendency to engender the artificial disease state most similar to that of the case of disease in question.

The curative capacity of medicines therefore rests upon their symptoms being similar to the disease but with power that outweighs it. Each case of disease is permanently cured only by a medicine that can cause a totality of symptoms that is the most complete and the most similar to the case of disease but that, at the same time, exceeds the disease in strength.

Based on Hahnemann's experience his most probable explanation for how this all came together was the following:

1. Any disease (which is not strictly a surgical case) consists solely of a specific dynamic disease mistunement of our life force (life principle) in our feelings and functions.   

2. The life principle, which has been dynamically mistuned by the natural disease, is affected, during homeopathic cure, by the similar yet somewhat stronger artificial disease (homeopathic medicine in potency) selected exactly according to symptom similarity. 

3. The action of the natural (weaker) dynamic disease is extinguished and disappears from the life principle which is then occupied solely by the stronger artificial disease (homeopathic medicine in potency). 

4. The artificial disease (homeopathic medicine in potency) soon plays itself out, leaving the patient free and recuperated. 

Understanding this process is helpful in understanding our work together. Let me know if you have any questions.

Last month in Naturopathic News #117 I presented the first part of how homeopathic medicines work. We look at the specific symptoms and signs of the sick person (natural disease). Then we select the most similar homeopathic medicine in potency (artificial disease). When this is given to the sick person the action of the weaker natural disease is extinguished by the stronger artificial disease. The artificial disease (homeopathic medicine in potency) soon plays itself out, leaving the patient recuperated.

In this way, the human organism is more susceptible to homeopathic medicines and therefore natural diseases are overcome. On the other hand, not everyone is susceptible to the same disease stimulus. Even in the same household someone won't get the cold or the flu that is being spread. We become diseased by them only when we are exactly and sufficiently disposed and laid open to be assailed by the cause of disease that is present. This then alters our condition, creating the resulting signs and symptoms. So the disease agents do not make everyone sick every time.

It is very different with the artificial disease substances which we call homeopathic medicines. Every homeopathic medicine works at all times, under all circumstances, on every living human being, and arouses in him its peculiar symptoms. These symptoms will be undeniable if the dose is large enough. Therefore, every living human organism must be affected throughout by the artificial disease which is, as mentioned above, not at all the case with natural diseases.  

The greater strength of the artificial disease that a medicine can produce is, however, not the only requirement for its being able to cure a natural disease. Above all, a medicine must be capable of producing an artificial disease as similar as possible to the disease to be cured. With its somewhat stronger energy, it will thus be able to displace the organism into a disease state very similar to the natural one. In this way it entirely extinguishes the natural disease. 

ANKLE SPRAIN April-May 2011
My pain is your gain. I thought it might be useful to go through my recent ankle injury and treatment to illustrate the process of healing with traditional medicine.

On Thursday, April 28 I fell and severely sprained my left ankle. A little bit of history here. In 1988 I fell off a ladder and sprained this very same ankle. The pain and swelling were so bad that I was on crutches for a week or two. I still remember riding the bus in Berkeley and people stepping on my injured foot as it was sticking out into the aisle. The silver lining was that the injury motivated me to get acupuncture done for the first time. I went to my first acupuncturist, Dr. King, in north Oakland. He was probably in his 70s at that point. He spoke very little English. I had no idea what to expect. His treatments introduced me to the power of traditional Chinese medicine as they were the single best thing I did to heal.

With an ankle sprain the joint has twisted when the foot is planted awkwardly, when the ground is uneven, or when too much force is applied to the joint. Ankle sprains are common sports injuries but can also happen during everyday activities such as walking or even getting out of bed.

Sprained ankles are one of the most common joint injuries. About 25,000 people suffer an ankle sprain every day. Ankle sprains happen while playing sports, just walking, or carrying out daily activities.

A sprain is an injury to the ligaments of the ankle joint. Ligaments are elastic, band-like structures that hold the bones of the ankle joint together and prevent excess turning and twisting of the joint. Normally, the ligaments stretch slightly and then retract back to their normal shape and size as you use the foot. A sprain results when the ligaments of the ankle have been stretched beyond their limits. In Grade 2 and Grade 3 sprains, the ligaments may be partially or completely torn.

Pain and swelling that result from a more severely sprained ankle last for several days to weeks. Grade 2 and higher sprains heal in four to seven weeks. The acronym RICE can be used to remember the standard treatment for a mild sprain:

* Rest: Do not walk on the affected foot.

* Ice: Apply ice packs immediately after a sprain to reduce swelling. Leave ice packs on for 20-30 minutes at a time, up to four times per day.

* Compression: Use of wrap-around elastic bandages helps stabilize the joint and reduce pain and swelling.

* Elevation: Elevate the ankle above the level of the heart for 48 hours after a sprain.

With more severe sprains, you can use an air cast to keep the joint better immobilized for a longer period of time. The recommendation is to begin limited use and rehabilitation exercises as long as you are not increasing pain. NSAIDS like Ibuprofen are suggested to reduce discomfort.

This time around, though I thought about getting acupuncture done once again, homeopathy, herbs, and chiropractic have done the job. 

With the severity of the injury, I immediately started taking Arnica 1M every hour or so. Most of you, even if you are new to homeopathy, are familiar with Arnica. Though there are no specifics in homeopathy there are circumstances where a homeopathic medicine’s symptom picture so well matches a particular acute disease or injury that it is commonly indicated. This is true for Arnica and trauma. Whenever there is bruising, swelling, ecchymosis (black and blue), along with fear of being touched or approached (says they’re fine), and better cold applications, you have strong indications that Arnica is the correct remedy. I went with a higher potency, a 1M, due to the intensity of the injury, and the resulting severity of trauma to the joint. 

In using Arnica in this manner I reduced the resultant swelling, bruising, and pain by 60-75%. After several doses there no longer was improvement of pain or swelling so I stopped the Arnica. I worked with a colleague of mine to determine the next step. Based on my history and what my symptoms were I applied Comfrey oil (comfrey leaves extracted in organic olive oil) topically to the ankle and foot. This is an herbal application designed to facilitate healing and increase the growth rate of cells repairing the traumatized tissue. More importantly, I used Comfrey because I have 31 years experience using it in these types of situations with excellent results.

I gave up using crutches after a day or two because they were causing more trouble then they were worth. I was able to almost immediately put more weight on my foot as the swelling and bruising were reduced by the Arnica and healing was enhanced by the Comfrey. At the one week mark Dr. Solley worked on my ankle and I got ultrasound and high voltage electrotherapy on it. The rest of that day I had no pain and was able to walk the almost normally.

There’s one additional therapy that I started using at some point in the first week, and continue to use now. That’s Traumeel ointment. This product is a combination of 15 homeopathically prepared medicines, though its use is actually not homeopathic. Homeopathy means ‘similar suffering’. You take the specific symptoms of the individual and match them to the similar, specific symptoms of a homeopathic medicine. When I use Traumeel for pain from my ankle trauma this is not an application based on the Law of Similars. It’s a generic, potshot approach that works sometimes without incurring the liver-damaging side effects of NSAID use. 

Due to using my injured ankle to walk and go downstairs I’m feeling more pain, though no swelling or bruising. I use a cold wrap when I’ve been on my feet too long. I still apply the topical comfrey oil. And when the pain in the tissue around my ankle bone and heel is really sore, I apply Traumeel to tone it down. 

My goal at 2 weeks was to be walking with a normal heel to toe gait. I’d say I’m about 90% there. I’d like to be running again in 2 more weeks. Though I’m not going to push that timeline—that would make reinjury more likely. This is a great rehabilitation progress report at 17 days post injury. Considering the previous damaging injury to the same ankle the marked improvement so far is even more noteworthy. 

Think of using natural medicine the next time you sprain a joint or suffer an acute injury.

Here are some pages that are of particular interest:

Store: There are 408 products from Emerson listed on this page. If yours isn’t one of them please let me know and I will add it so you can order online. This is particularly convenient after hours or on the weekend. Of course, you can always order by phone from Emerson at 800-654-4432.

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For those of you who don’t know, Facebook is a social networking website. Users can add friends and send them messages, and update their personal profiles to notify friends about themselves. Additionally, users can join networks organized by city, workplace, and school or college. 

Facebook pages help you discover new artists, businesses, and communities as well as those you already love. On my fan page I post discussions that you can join in with and relay breaking health news related to disease prevention, clinical nutrition, and ways to make you healthier. 

I’m looking forward to exploring this community with you. See you there!

As is often the case, a recent new patient asked if I would review their choice and use of supplements and herbs. Why does this happen so often? For many, taking a vitamin or herb is their introduction to natural medicine. Their desire to be healthier drives them to take supplements and herbs. The death, pain, discomfort, and side effects experienced with over the counter and prescription drugs compel people to look elsewhere. It’s very different with supplements and herbs which, when used correctly, have an incredibly low risk of harm.

Some people take this to an extreme and take every supplement or herb that someone tells them is ‘good for them’. It might be a clerk, an internet ‘expert’ source, or a friend who is marketing the latest or greatest fad. Most of these individuals or companies have no professional training or experience in the medical use of the supplements or herbs that they’re selling. The people they’re selling to come into my office with 5, 10, 15, or more supplements that they’re taking. Sometimes it’s been so long since they started taking them that they don’t remember why they’re doing it. When I ask, they can’t tell me what, if anything, a particular product is doing for them. Yet, they can be quite fearful of stopping any of these items, as if their health would careen off a precipice without them.

Why do I think my approach is any different? Partly, it’s because of my background. I’ve literally been working with nutritional supplements since 1974. That’s 36 years assessing the quality and effectiveness of supplements. Beginning in 1980 I started working with Western and Chinese herbs. The quality of herbs used and how they’re combined together has the greatest effect on the efficacy of the final product. Because I’ve grown, identified, harvested, and produced medicinal herbal products I recognize a good formula when I see one.

Licensed naturopaths like me receive the most extensive academic and clinical training in the use of nutritional supplements and herbal medicines of any professional in the United States. Nothing can substitute for such hands on experience, especially when you see, and are responsible for, the results of your treatments. Very different from the clerk in the store, or coworker who’s part of a MLM scheme. 

What I’m offering to is easy access to this experience and training. Both for you and your family. If you have questions about the supplements or herbs you are taking, or are thinking about taking, now is the time to ask. Send me an email with the brand and name of the product you’re taking. Let me know that you want to bring the bottles in at your next visit, so I can see what you’re taking. Start a discussion on my Facebook fan page. Either way I’ll give you honest feedback about what I think is good, or what isn’t. We’ll fine tune what you’re taking to maximize effect and eliminate waste. 

Let me hear from you and we’ll get started.

It just happened again the other day. A patient sent me a copy of the Vitamin D test she just had done. With frustrating results. The wrong test was done. After all these years, and all the information available, MDs and laboratories still order the wrong test. What a waste of money and time. 

For a long time I looked for a home Vitamin D test. One that would be simple, easy, and accurate to do on your own. I finally found one. ZRT Laboratory in Beaverton OR. ZRT emphasizes research and technological innovation. 

Until now, venipuncture blood serum has been the standard medium for testing Vitamin D. ZRT has developed and refined Vitamin D testing in blood spots. A few drops of blood from a quick and nearly painless nick of the finger, placed on a filter paper to dry are all that is needed. The total 25 (OH) Vitamin D is then determined by liquid chromatography/tandem mass spectrometry (LC-MS/MS). This method has been shown to be as accurate as the assay standard.

Ordering A Vitamin D Test 
ZRT allows anyone to order a Vitamin D test kit for $95 plus shipping and have it sent to their home. ZRT will let me prepay for kits and send them to my office for $55 each, plus $8 shipping. I am charging $65 per kit for patients to cover the total. 

If you are interested in getting a Vitamin D test done through my office please prepay so I can order you a kit. Then you can either pick it up at my office or have it shipped to your home. Once you’ve taken the sample and sent it back to ZRT it’s only a matter of time before your results are sent back to me. I can even look at them online before the mail arrives.

If your doctor has refused to order a Vitamin D test or worse, ordered the wrong one, this is the fastest, least expensive, most accurate way to do it ourselves. Once we know what your Vitamin D levels are, the next step is making sure that you achieve optimum levels for prevention of disease and maintenance of health.

I am often asked what supplements I recommend. Many of you have been surprised to discover that I favor food over pills; lifestyle changes over fads. I have been working with nutrition for over 30 years, herbs for over 20 years. Where and when appropriate I recommend them to my patients. I strive to act from knowledge, experience, and research.

Emerson Ecologics (800-654-4432) carries almost all of the nutritional supplements and botanical extracts that I think are useful. Their customer service is excellent and their delivery is reliable (often only 2-3 days to this region). It’s a great way to get physician quality products at reasonable prices. 

To offset the cost of shipping, reference my name when you establish your account and receive a 10% discount on every order. At the same time, I receive a percentage of each supplement sale. If you have any questions about these items feel free to email me.

That’s it for this issue of Naturopathic News. If you’ve thought a bit extra or learned something new, then I achieved my goal. As usual, if you have questions or concerns brought up by these subjects, let me know. 

Gregory Pais, ND, DHANP
580 E. 3rd. St.
Williamsport PA 17701
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