Provings in Homeopathy

Provings in Homeopathy

Vergleich: Siehe: Prüfungen + Provings

http://www.homeoint.org/morrell/articles/firstprovings.htm

[Burkhard Hafemann]

Das zentrale Kennzeichen der neueren Homöopathie ist die Untersuchung von Heilmittelklassen. Im Falle pflanzlicher Arzneien beispielsweise handelt es sich um

natürliche „Familien", d.h. Gruppen biologisch verwandter Pflanzen und Heilmittel. Durch fortschreitende „Einschachtelung" wird dabei versucht, das für eine Person

am besten geeignete Heilmittel ausfindig zu machen.

Angenommen, die Person benötigt die Arznei Thuja, so wird dies durch mehrere Schritte ermittelt.

1. Es wird bestätigt, dass der Patient tatsächlich ein pflanzliches Mittel benötigt und nicht statt dessen ein mineralisches oder animalisches. Diese Differenzierung gelingt

dabei durch bestimmte Kriterien (Kennzeichen des pflanzlichen Typus).

2. In diesen Schritt wird zweitens festgestellt, dass die Person einer der pflanzlichen Klassen zugehört, in unserem Fall den Koniferen (Kiefernartigen).

3. Beim dritten Schritt bildet die Ermittlung des Reaktionstyps („Miasma"):

Die Arznei Thuja liegt im sogenannten Sykose-Miasma. Wenn die Kennzeichen dieses Reaktionstyps auf den Patienten zutreffen, ist es sehr wahrscheinlich, dass dieser von Thuja profitieren wird.

4. Den letzten Schritt bildet die Abgleichung des klassischen Arzneimittelbildes der Pflanze mit der betreffenden Person.

Unser Beitrag zur neueren Homöopathie betrifft v.a. die oben genannten Punkte 2 und 3. Die Zuordnung von Arzneimittelklassen zu den „vier Elementen" (FEUER, WASSER, ERDE, LUFT) gestattet es, angesichts des Temperaments einer Person die in Frage kommenden Arzneimittelklassen (seien es mineralische, pflanzliche oder animalische) vorab bereits auf etwa ein Viertel einzugrenzen.

Die Koniferen fallen beispielsweise ins WASSER-Element (phlegmatisches Temperament). Nur eine Person, die von ihrem Temperament her ein WASSER-Typ ist, kommt

in der konstitutionellen Behandlung als Kandidat für eine Arznei aus dieser Arzneimittelfamilie, also etwa Thuja, in Frage. In ähnlicher Weise verhält es sich bei mineralischen oder animalischen Typen:

Die Zuordnung von Mineralienklassen oder tierischen Klassen zu den vier Elementen ermöglicht eine deutliche Einschränkung der in Frage kommenden Arzneien bzw. Arzneimittelklassen.

Der 2e zentrale Frage betrifft den Reaktionstyp (das sogenannte „Miasma"?) in welches eine Person fällt.

Die Lehre von den vier Elementen umfasst eine Konzeption von Reaktionstypen (Aktivitätstypen). Und zwar folgen diese Typen einer Dreiheit von Qualitäten:

Impuls gebend (kardinal), fix und beweglich. Indem wir eine Person einer dieser Qualitäten zuordnen, wird zugleich die Zuordnung zu den drei Grund-Reaktionstypen

der Homöopathie möglich: psorisches, sykotisches und syphilitisches Miasma. Dem sykotischen Miasma beispielsweise entspricht die fixe Qualität.

Ein Thuja-Patient wird also im fixen Aktivitätsmodus liegen.

Vorschlag gemacht, das Element und den Aktivitätstyp vom sogenannten Geburtshoroskop abzulesen: Das Sonnenzeichen („Sternzeichen") einer Person gibt dabei Aufschluss über das primäre Element, in dem diese Person liegt, der „Aszendent" bzw. die Hauptachsen im Horoskop hingegen geben durch ihre Qualitäten (kardinal, fix oder beweglich) Aufschluss über das Miasma.

Zuordnung von Pflanzen klassen zu den vier Elementen

Menschen, die konstitutionell auf pflanzliche Arzneien ansprechen, sind empfänglich für vielfältige Gefühle und sind mehr stimmungsgeleitet als mineralische

Typen, sie verlieren häufiger die mentale Kontrolle und leiden unter vielfältigen Befindlichkeitswechseln. Pflanzliche Typen sind schnell berührt, betroffen, beeindruckt,

verärgert, verletzt durch äußere Eindrücke und das Verhalten anderer und leiden seelisch an diesen Dingen.

Wenn wir pflanzliche Arzneien den vier Elementen zuordnen, ist, wie auch im Falle der Mineralien, sowohl deren psychisches als auch körperliches Wirkprofil

berücksichtigt. In diesem Zusammenhang lässt sich auch auf Erfahrungen der traditionellen Vier-Elemente-Medizin zurückgreifen, die Attribute von Pflanzen

wie Farbe, Geruch, Erscheinungsform untersucht hat. Pflanzen mit Nähe zum Feuerelement gelten z.B. als scharf, bitter, würzig, intensiv; sie haben eher leuchtende

Farben (gelbe oder rote Blüten).

Zunächst ein Beispiel einer Elementzuordnung:

Der Lebensbaum gehört zu den Zypressengewächsen innerhalb der Ordnung der Kiefernartigen (= Coniferae/= Pinales). Die Kiefernartigen wiederum sind

Teil der Nacktsamer (Gymnospermae). Das Persönlichkeitsprofil des typischen Thuja-Patienten lässt sich folgendermaßen umreißen:

Psyche: Empfindsame Menschen, die sich oft in einer diffusen Weise wertlos oder schuldig fühlen. Sie entwickeln eine Abneigung gegen sich selbst, die im Extremfall

bis zum Selbst-Ekel gehen kann. Thuja zieht sich gerne in seine Privatsphäre zurück und kapselt sich ab. Mitunter kann er ungeduldig, bockig oder wütend reagieren.

Diese Leute haben häufig einen Bezug zum Spirituellen bzw. eine stark intuitive bis mediale Wahrnehmung. Im weiteren Verlauf der Störung werden sie zunehmend

unsicher, konfus und depressiv.

Körperliche Beschwerden: verfroren, träge-blockiert oder in Eile, trockene, gespaltene Haare, weißliche Lippen; gelbe, blasse, fleckige, ölige Haut, oft mit Pickeln;

Warzen im Gesicht und an Extremitäten

Die Nähe zum phlegmatischen Temperament/WASSER-Element sticht ins Auge; der Bezug zu den flüssigen Verteilersystemen, die Beschwerden in den

Bereichen WASSER l, WASSER 2 und WASSER 3 werden deutlich; auch die Signaturen des immergrünen Baumes deuten in diese Richtung. Wir ordnen den

Thujabaum, wie auch andere Vertreter der Kiefernartigen, dem Wasserelement zu.

[Léon Scheepers]

Following the guidelines of subcommittee proving of the E.C.H. ( European Committee of Homoeopathy).

• Monocentric: proving organised in one centre.

• Non-randomized: everybody knows from everybody that he/she is taking the verum. No placebo was taken.

• Double blind: nobody participating at the proving (provers, supervisor, director) knows the nature of the verum proved.

• Non-controlled. No control group/no placebo.

• Pre-observation period: observation period of two weeks before the intake of the verum.

• No cross-over: only the verum is taking, in a 30K dilution in 6 takes during two days.

• Proving takes place under the name of “self-experience” and not under the name “proving” or “medical experiment” because other wise an ethical commission has to

give his advice.

[Jan Scholten]

1. Sense Provings

Sense provings is a kind of proving I developed in order to get good pictures of remedies in a short time.

This was needed to get an idea of a vast array of remedy pictures.

Format

A plant in flower is picked and experienced in as many ways as possible. The experience is visual by looking at it;. The smell, taste and touch of the plant are experienced.

The name of plant is experienced. All these influences give an impression on the prover who meditates on all of them.

Advantages

1. Relatively little investment is needed, about one hour.

2. The format gives full focus, gives a strong signal.

3. There is little noise.

4. Sense provings have the best cost benefit ratio.

5. A mother tincture can be made by a pharmacist to produce the potencies for use in practice.

Disadvantages

1. Personal aspects of the prover can distort the picture.

2. The result is very dependent on the prover quality.

Comment

1. This is mostly done with Plant remedies.

2. It is a good way of doing a proving with one prover.

3. Sense provings have helped me a lot in bringing forth the Plant theory as expressed in my book Wonderful Plants.

https://ir.dut.ac.za/xmlui/bitstream/handle/10321/667/Hansjee_2010.pdf?sequence=1&isAllowed=y

[Sharad Hansjee]

2.1.4.1

Dream proving is defined as a systematic procedure which entails getting in touch with the dynamic influence of the remedy and focussing on and observing the remedy’s influence on the vital force, in the form of symptoms, with dreams being the important focus (Dam, 1998). These provings focus upon eliciting the unconscious play of

dreams. The notion is that the dream state is altered by the proving and that it is a reflection of the mental and emotional state of the prover (Herscu, 2002) as well as a

means of access to deeper aspects of the remedy picture.

Although the focus is on dreams, other symptoms are not excluded (Kreisberg, 2000). Brilliant (1998:113) is of the view that dreams are feelings and to interpret them can

be treacherous. There are limitations to dream provings related to whether the dream is part of the picture or all of the picture of the substance that is being experienced

(Pillay, 2002).

2.1.4.2

Meditation proving establishes a meditation group that meet together to meditate a few times before a proving. The idea is that the group meets together to form a single consciousness. The meditative state makes the prover group more attuned to their individual selves and thus able to pick up variances in the mental, emotional and physical states. The substance can be ingested or be in close proximity to the meditation group (Herscu, 2002).

Scholten (2007) was cautious in using the data gained from meditative provings unless they were verified in clinical cases. The lack of a scientific basis in the data was noted as recordings are provers imaginations and manifestations on their meditation and on this basis he discarded them.

2.1.4.3

In seminar provings the remedy is administered to a group of people a few days prior to or during attendance at a seminar. The effects of the dose is then discussed during

the seminar. The proving thus reveals the unconscious level of the remedy and its symptomatology on the mental, emotional and dream levels which are then discussed

(Herscu, 2002).

2.1.4.4 C4

Trituration provings are carried out in groups during a trituration process where the trituration is carried out by hand. Provers grinding the proving substance experience the symptoms of the remedy although the identity of the substance is kept hidden (Hogeland and Schriebman, 2008). A recent C4 trituration proving of the Protea cynaroides

by Botha (2010) was conducted at the Durban University of Technology. Botha (2010) gathered clear and verified data in this trituration proving so as to evaluate the effectiveness of the methodologies employed during the trituration. This proving was conducted as a double blind placebo controlled trial in accordance with the proving methodology as set out by Sherr (1994).

2.1.5 Randomised controlled trials (RCT) and provings Wieland (1997) asserts that Hahnemann’s provings have demonstrated reliable results as tested by the clinical application of these remedies, although his protocols can be regarded as unreliable according to the modern standard measures of clinical trials. He argues further that the purpose of RCT is to demonstrate the efficacy and safety of a drug compared to placebo in terms of statistical significance. The key components of a RCT is the double blinding, placebo control and crossover technique (Dantas, 1996).Dantas (1996: 232) explains the importance of placebo control in the perspective of provings as the

only means to effectively assess the effects of the test substance specifically. He further recommends that the placebo control material undergoes the same manufacturing process only without adding the active ingredient. He suggests that this is the only way that probable pathogenetic effects can be properly associated with the presence

of the original substance in the preparation.

Placebo control is accomplished by administering a dose of the placebo which is identical to the verum, in both gustatory and visual sense, to a percentage of the placebo

group thus to accurately evaluate which symptoms are produced due to the verum or the placebo.Sherr (1994: 37) believes that the placebo has three major benefits:

1. It distinguishes the pharmacodynamic effects of a drug from the psychological effects of the drug itself.

2. It distinguishes the drug effects from the fluctuations in disease that occur with time and other external factors.

3. It avoids „false negative‟ conclusions i.e. the use of placebo tests the efficacy of the trial itself. Vithoulkas (1998) states that the double blinding or masking technique ensures that the codes identifying the verum and placebo groups remain hidden from both the researcher and the provers.

Sherr (1994) makes a comparison of homoeopathic provings to the first phase of clinical drug trials. The first phase is where new drugs are experimented upon healthy volunteers to examine the pharmacodynamics, pharmacokinetics, tolerance, efficacy and safety. Homoeopathic drug provings can thus be conducted as they conform

to the biomedical model by incorporating placebo control, double blinding and crossover.

Hahnemann in the “Organon of Medicine” presents basic guidelines for ascertaining the medical actions of a substance. These are listed below:

The medicinal substance must be known for its purity;

Provers should take no medicinal substances during the proving;

The provers diet must be simple, nutritious and non-stimulating;

Provers must be reliable, conscientious, able to clearly and accurately record their symptoms while being in a relatively good state of health.

Provers must be both male and female.

The proving substance should be in the 30^th centesimal potency;

All symptoms need to be qualified in terms of the character, location and modalities;

To prove a substance multiple provings should be done on the substance including provers of both genders and various constitutions;

Moderate proving doses yield better results and are safer than large doses;

During the proving all ailments and alterations should be attributed to the proving substance;

Provers should keep detailed proving journals; and Provers should be interviewed daily by the supervising physician.

Many authors have considered that since the Hahnemannian era, provings have deteriorated in quality and methodology (Sherr, 1994/Vithoulkas, 1998/Walach, 1994).

Sherr believes that provings carried out in the 20^th century have lacked the refinement of earlier provings. As a result he asserts that there are few refined provings,

the rest of the materia medica containing partial provings or toxicological reports (Sherr, 19949).

There has been great debate about the best protocols to be used for provings today. The growing interest in provings and the need to present a consistent front to a

sceptical scientific world has led to attempts to develop general guidelines and minimum standards for drug proving protocols, such as the efforts by the Drug Provings

Group of the European Committee for Homoeopathy at five symposia since 1992 (Wieland, 1997: 231). The aim is to produce a scientific standard for good homoeopathic drug provings (Wieland, 1997:231).

De Schepper (2001) expounds the importance of conducting reliable provings. He also employs the basic protocols as laid out by Hahnemann, but he further details the essentiality of prover selection, potency, substance and the duration of the provings.

In 1994, Jeremy Sherr published the 1^st edition of his book entitled “The dynamics and methodology of provings”. This book covers every topic that is relevant to a good proving protocol. Herein is found clear and detailed guidelines to conduct a proving.

The International Council of Classical Homoeopathy (ICCH) (1999:35) also recommends Sherr’s proving methodology to perform a thorough and reliable Hahnemannian proving.

The ICCH (1999:16) further expounds that the aim of the homoeopathic drug proving is to elicit, observe and document proving symptoms which are essential for the prescription of a homoeopathic remedy according to the law of similars. The drug proving thus serves to broaden knowledge about insufficiently proved remedies and introduce new remedies to the materia medica.

According to the ICCH the aim of the homoeopathic drug proving is to gain knowledge about the innate character of a drug thus obtaining a remedy picture which is of

good quality. The symptoms are then collated and communicated to the homeopathic community so that they can be clinically verified.

This means that a symptom which has occurred in a drug proving can now, if occurring in a sick patient, be alleviated by the proved remedy, which produced the proving symptom after the administration of it. Vithoulkas (1998: 97) mentions that during a proving, one introduces into the organism a substance that is sufficiently high in concentration that disturbs the organism and mobilises its defence mechanism. The defence mechanism then produces a spectrum of symptoms on all three levels of the organism i.e. mental, emotional and physical. The symptoms thus produced characterise the unique nature of the substance. In order for a drug to be fully proved it should

first be tried on healthy persons in toxic, hypotoxic, and highly diluted and in potentised doses. The symptoms produced from the drug are recorded on all three levels.

The proving methodology for this proving was adapted from the proving methodology of Sherr (1994).

http://www.interhomeopathy.org/archives-by-category?c=provings

Scientific Provings

Materia Medica

Toxicology

Proving Data

Clinical Verification

Toxicology

Ethnobotany

Accidental poisonings

Provings

Methodologies

Blinding and Placebo control

Protocol and Posology

Placebo control is controversial

Wieland (1997) - modern scientific investigation techniques may hinder the pursuit of

Smith (1979) - suggests that Hahnemann and his followers were aware of the effect of suggestion, but saw it as inconsequential and chose to ignore it.

Jansen (2008) - it would be more efficient to give all participants verum. Reliable results can be obtained by comparing the proving results with the baseline symptoms

of each prover, by utilising a placebo run-in phase and by excluding old symptoms of the prover.

Walach et al. (2004: 182) investigated whether the proving symptoms were the result of local, non-local or placebo effects

Conclusion, that what was experienced during the proving was different from mere background noise.

Walach, 1997: Advocates the importance of using both qualitative and quantitative methods when designing the trial and suggests the use of a double blind, placebo controlled study.

Signorini et al. (2005) investigated the difference between placebo controlled trial and traditional trials lower number of mental symptoms in the placebo group compared to the verum group unusual symptoms did not arise in the verum and placebo in a similar way.

They concluded that the placebo group seemed important for the selection of real symptoms.

Rosenbaum et al.(2006: 216) Significant differences between the narratives of the placebo and verum groups

Verum group tend to use expressions such as ‘I‘ve never felt that before, Those weren‘t my symptoms‘ and ‘My headache is completely different‘.

Placebo group seem to have vaguer descriptions and are not able to describe the symptoms and modalities clearly during cross-examination.

Emphasise the importance of personally verifying each of the symptoms elicited during the proving.

Proving Protocol and Posology

PHYSICAL DOSE REQUIRED

Blinded: Single, Double or Triple Unblinded

NOPHYSICAL DOSE REQUIRED

Dream

Meditative

Trituration

Gold standard - ICCH (1999)

Healthy volunteers that use no drugs, have no mental pathology and have been clear of any homoeopathic remedies for at least three months

A comprehensive case must be recorded prior to the trial detailing all past symptoms and states

Participants must be over the age of 18 and pregnant and breast-feeding women are excluded

The group must consist of homoeopaths or homoeopathic students, but may also include provers from a non-homoeopathic background to balance the group.

The number of provers must be between 10 and 20

The substance must be sourced from a natural source free from pollution. The precise origin of the substance should be carefully detailed, including when, where and

how it was obtained, the name, species, gender, family and other pertinent data

They recommend using two to three potencies during the proving, as well as using a placebo control (10 to 30%) as - a means to increase provers‘ attention.

Relative Efficacy:

Tested three methodologies (2008 - 2009)

Single blind C4 trituration – no physical dose, 2 groups of 10 provers

Double-blind Placebo controlled - 6 doses over 2 days, 2 groups of 15 provers (5 placebo and 10 verum)

Single blind Dream proving - 1 dose daily for 3 days, 2 groups of 10 provers

Results

Double blind Placebo controlled group elicited the most verifiable symptoms, covering 36 repertory chapters

An updated version of the methodology developed by Hahnemann and is able to accommodate a 21st century life style.

The duration of the proving varies according to the nature of the proving substance, but normally lasts for four to six weeks.

Limitations of this methodology

Strict exclusion criteria

Longer duration

Complying with most of the ICCH regulation regarding provings and the ethics of provings. It is also placebo controlled, which makes it admissible under phase

one clinical trials.

C4 and Double blind methodologies are equivalent in 25 of those chapters, only differing with regards to symptoms that take a longer time to develop e.g.

Digestive disturbances,

The C4 limited to the four hours during which the trituration takes place and consequently few symptoms are experienced once the trituration have been completed, thus a paucity of more insidious symptoms, limited to those provers who are very sensitive to the substance and would react to the olfactory mode of medicine administration.

Also confirmed Sherr‘s (1994: 16-7) observation that provings offering a -short cut to an inner essence lack the larger totality of physical, general and long term

symptoms.

The advantages short duration of the proving, relative scarcity of long term effects.

The C4 methodology seems to favour the chapters dealing with the senses, evident in the Ear, Eye, Hearing, Mouth, Nose, Skin and Vision chapters

Dream methodology indicated the least amount of chapter affinities, eliciting mainly Mind, Dream and General symptoms, but not as prominently as the other

methodologies

Represents the sentiments of group provings, seminar provings and meditative provings

Minimum dosages are administered

Proving takes place in the subconscious mind, represented by dreams and imagery

Adjustable to suit any time frame and is less rigorous

Disadvantage

standardisation of the method nearly impossible

The verum portion elicited 63% of the total rubrics compared to the placebo portion which only elicited 28%

Reproducibility

Hypothesis: Proving symptoms are reproducible when applying identical proving methodologies in consecutive years.

The results of statistical tests reflected a reasonable level of reproducibility

BUT different provers would result in different symptoms due to their individual susceptibility and sensitivity to the proving substance.

Not one of the groups that exhibited a reproducibility level of less than 50%

The verum portion elicited 63% of the total rubrics compared to the placebo portion which only elicited 28%.

2.1.4.1

Dream provings

The dream proving is defined as a systematic procedure which entails getting in touch with the dynamic influence of the remedy and focusing on and observing the remedy’s influence on the vital force, in the form of symptoms, with dreams being the important focus (Dam, 1998). These provings focus upon eliciting the unconscious play of dreams. The notion is that the dream state is altered by the proving and that it is a reflection of the mental and emotional state of the prover (Herscu, 2002) as well as a means of access to deeper aspects of the remedy picture. Although the focus is on dreams, other symptoms are not excluded (Kreisberg, 2000). Brilliant (1998:113) is of the view that dreams are feelings and to interpret them can be treacherous. There are limitations to dream provings related to whether the dream is part of the picture or all of the picture of the substance that is being experienced (Pillay, 2002).

2.1.4.2

Meditation provings

These provings establish a meditation group that meet together to meditate a few times before a proving. The idea is that the group meets together to form a single consciousness. The meditative state makes the prover group more attuned to their individual selves and thus able to pick up variances in the mental, emotional and physical states. The substance can be ingested or be in close proximity to the meditation group (Herscu, 2002).

2.1.4.3

Seminar provings

In this proving, the remedy is administered to a group of people a few days prior to or during attendance at a seminar. The effects of the dose is then discussed during the seminar. The proving thus reveals the unconscious level of the remedy and its symptomatology on the mental, emotional and dream levels which are then discussed (Herscu, 2002).

2.1.4.4 C4 trituration provings

The C4 trituration provings are carried out in groups during a trituration process where the trituration is carried out by hand. Provers grinding the proving substance experience the symptoms of the remedy although the identity of the substance is kept hidden (Hogeland and Schriebman, 2008). A recent C4 trituration proving of the Protea cynaroides by Botha (2010) was conducted at the Durban University of Technology. Botha (2010) gathered clear and verified data in this trituration proving so as to evaluate the effectiveness of the methodologies employed during the trituration.

This proving was conducted as a double blind placebo controlled trial in accordance with the proving methodology as set out by Sherr (1994).

2.1.5 Randomised controlled trials (RCT) and provings

Wieland (1997) asserts that Hahnemann’s provings have demonstrated reliable results as tested by the clinical application of these remedies, although his protocols can be regarded as unreliable according to the modern standard measures of clinical trials. He argues further that the purpose of RCT is to demonstrate the efficacy and safety of a drug compared to placebo in terms of statistical significance. The key components of a RCT is the double blinding, placebo control and crossover technique (Dantas, 1996).

Dantas (1996: 232) explains the importance of placebo control in the perspective of provings as the only means to effectively assess the effects of the test substance specifically. He further recommends that the placebo control material undergoes the same manufacturing process only without adding the active ingredient. He suggests that this is the only way that probable pathogenetic effects can be properly associated with the presence of the original substance in the preparation. Placebo control is accomplished by administering a dose of the placebo which is identical to the verum, in both gustatory and visual sense, to a percentage of the placebo group thus to accurately evaluate which symptoms are produced due to the verum or the placebo.

Sherr (1994: 37) believes that the placebo has three major benefits:

1. It distinguishes the pharmacodynamic effects of a drug from the psychological effects of the drug itself.

2. It distinguishes the drug effects from the fluctuations in disease that occur with time and other external factors.

3. It avoids „false negative‟ conclusions i.e. the use of placebo tests the efficacy of the trial itself.

Vithoulkas (1998) states that the double blinding or masking technique ensures that the codes identifying the verum and placebo groups remain hidden from both the researcher and the provers.

Sherr (1994) makes a comparison of homoeopathic provings to the first phase of clinical drug trials. The first phase is where new drugs are experimented upon healthy volunteers to examine the

pharmacodynamics, pharmacokinetics, tolerance, efficacy and safety. Homoeopathic drug provings can thus be conducted as they conform to the biomedical model by incorporating placebo control, double blinding and crossover.

The homoeopathic proving of Dendroasp is angusticeps 30CH was carried out as a randomised, double blind, placebo-controlled trial on a proving population of 30 healthy volunteers.

24 of the provers were in the experimental group and they received the potentised snake venom. 6 provers were in the control group and they received the placebo.

OTHER PROVING METHODOLOGIES

There are many different types of provings that help gather information about a remedy. Each type of proving has its own strengths and weaknesses.

2.4.1 Trituration proving

The remedy is prepared by the process of trituration followed by observation of the effect of the remedy. It consists of a group of six provers.

C4 trituration provings are a controversial method of determining the therapeutic value of homoeopathic remedies. This method is advantageous as it can be proved in hours instead of months or weeks compared to the traditional methods of provings. There is insufficient research to indicate if the results of these two methods can be compared (Goote, 2011).

The C4 proving method does not make use of the traditional method of testing a substance which is on a group of healthy individuals, but is conducted individually or on

a group of provers during the trituration process. The prover should establish a resonance with the substance so that the spiritual level of the remedy can be experienced.

In 1993 Ehrler investigated the concept of the C4 triturating proving methodology through self-experimentation (Botha, 2010).

During Ehrler’s first homoeopathic trituration he experienced physical and psychological symptoms and also obtained insight into the triturated substance.

If a natural substance needs to be triturated as part of the potentisation process, it is triturated to the 3CH level and then from then onwards liquid potencies are generated.

Becker and Ehrler discovered that triturating a remedy to an additional level, i.e. the C4 level, raised the healing potential of the remedy thus revealing the essence of the remedy.

The methodology of this type of proving requires a group of provers to participate in a process of trituration by hand and the proving substance identity is unknown

(Hogeland and Schriebman, 2008). While the proving is being conducted the prover will experience symptoms that are physical and psychological. The provers will also

see images and ideas of the proving substance (Botha, 2010).

At the completion of each level of the trituration process the provers had to record their feelings and impressions that were gathered during the trituration. The trituration

to a C4 level of a substance occurs for a duration of 5-6 days. The symptoms encountered by a prover on a single level will disappear when moving on to the next level

of trituration (Brinton and Miller, 2004).

Becker presented Ehrler’s experiences during the 53^rd Congress of the Liga Medicorum Homoeopathica Internationalis in Amsterdam in 1998. Becker and Ehrler claimed that the C4 trituration level gave “a new, spiritual dimension to the picture”, thus giving a deep knowledge and understanding as to the homoeopathic potentisation (Becker and Ehrler, 1998). This was received with mixed responses by the homoeopathic community.

According to Becker and Ehrler (1998) the mechanical friction with lactose during the process of trituration is where the vital and valuable form of the homoeopathic potentisation occurs.

The friction of the succussion with alcohol increases the rhythm of the oscillation level (Becker & Ehrler, 1998).

Botha and Ross (2010) presented evidence of the physico-chemical importance of trituration.

The efficacy and scientific footing of C4 trituration is disputable as Becker cannot clarify as to where spiritual level images are derived from. Timmerman was fascinated by Becker and Ehrler’s statements and she began to investigate further in this avenue. Timmerman used the 4CH trituration level and thereupon converted it into liquid potencies. Timmerman stated that she gathered positive results in the treatment of chronicly ill patients. The 4CH trituration provings are a debateable issue with homoeopaths who deem that homoeopathic medicines should be processed as Hahnemann had advised. Dellmour (1998) is of the opinion that symptoms collected from the C4 trituration proving should not be entered into the materia medica. He believes that they contradict the teachings of Hahnemann and outlines them as vague, illogical and unhomoeopathic.

Botha and Somaru (2010) hypothesised that the remedies of the C4 trituration for each level of trituration revealed distinct effects.

2.4.1.1

C4 Proving At Durban University Of Technology

Ten provers form a stable proving group for a C4 trituration proving.

Botha (2010) conducted a C4 trituration proving of Protea cynaroides at the Durban University of Technology. The trituration process produced viable symptoms.

The group discovered that the intensity of the triturations they experienced increased the more they worked together (Botha, 2010).

An other example of a profound C4 trituration proving conducted at the Durban University of Technology was the proving of Vibhuti (Somaru, 2010).

Goote(2011) conducted a study to compare the symptoms derived from a C4 trituration proving with the symptoms displayed in a traditional proving of the same substance found in the materia medica. The prover population consisted of ten provers who were experienced in the trituration process but had no knowledge regarding the substance being proved. Information was collected by interviewing sessions and records kept by the triturators. The results of the proving were that the comparison did not find a valid correlation between the rubrics of the traditional provings of Borax 30CH and the C4 trituration proving of Borax (Goote, 2011).

According to Goote (2011), although C4 provings were faster compared to traditional proving methods and refined by Sherr it cannot be recommended as an avenue of developing homoeopathic remedies to replace traditional proving methods as the C4 proving will not produce a complete symptom picture.

2.4.2

Dream proving

A dream proving is similar to other provings in that it is a systematic procedure requiring the development of uniformity with the influence of the remedy on the vital force. The central focus is on dream symptomatology although other levels of symptomatology are included (Kreisberg, 2000). The concept that the dream state is altered by the proving reveals the mental and emotional state of the prover. This provides a deeper connection to the remedy picture.

Jurgen Becker began conducting dream provings at the Bad Boll seminars 25 years ago. This seminar took place twice a year for one-week at Bad Boll, in Goppingen in Germany.

The seminar consisted of approximately 100 participants.

The proving was conducted by Jurgen Becker and Gerhardus Lang (Pillay, 2002). At these seminars homoeopaths presented their discovery of a homoeopathic remedy that they felt strongly about and had proved the same remedy thoroughly.

During the seminar a dream proving was conducted daily and the symptoms were analysed on the last day (Pillay, 2002).

Many dream provings were conducted during Sankaran’s seminars at Mumbai with his students (Dam, 1998). Sankaran states that in our dreams our actions and emotions

are wholesome, pure and unblemished in comparison to our state of consciousness where we are able to hide our true emotions. Therefore our experiences in dreams reflect

our emotions towards certain incidents or events and experiences (Sankaran, 1998).

The methodology of dream proving focuses on the extraction of mental, physical and emotional symptoms by exposure of the prover to the remedy in one of the following ways:

Consuming the remedy orally; Inhaling the remedy; Holding the remedy in the hands for a certain amount of time; Sleeping on the remedy; By contact with another prover who has taken the remedy; and present in the same room with other provers (Dam, 1998)

A large part of the homoeopathic community believe that dream provings are non-Hahnemannian provings (Dam, 1998). Dream provings are a debatable aspect of homoeopathy. The interpretation of dreams can be deceitful because dreams are one’s feelings and when a homoeopath prescribes a remedy the practitioner needs to understand the individual as a whole and not only view the mental aspect of the person (Brilliant, 1998).

According to Sherr (2003) dream provings are “partial provings” and beneficial only to the extent that this is a short cut method to obtain the nucleus of a remedy

(Sherr, 2003).

2.4.2.1

The advantages of a dream proving are as follows: It does not require much commitment from the prover or supervision by the researcher so dream provings are not intrusive (Fraser, 2010).

It has an easy and quick set up with an easy collection of data and publication (Fraser, 2010).

Dream provings reveal dramatic useful imagery which allows for better understanding of the remedy (Fraser, 2010).

2.4.2.2

The disadvantages of a dream proving are as follows:

The quality of the information obtained and reliability in this proving is a disadvantage. Emotional symptoms are mainly produced whereas physical symptoms are rare (Fraser, 2010).

There is difficulty in distinguishing between personality and the proving for both the provers and the researcher as the proving of dreams is a combination of the influence of the remedy and the provers own situation and concerns (Fraser, 2010)

2.8

BLINDING

This was first adopted by the homeopaths to test substances. Kent introduced the concept of blinding in homoeopathic drug provings. The writings of Kent revealed that the concept of blinding was considered normal and routine in homoeopathic provings by 1900 (Kaptchuk, 1997: 50).

The first double blind experiment was a proving of Belladonna. Presently, most provings are blinded and the practice of the blinding technique is widely recognised as a method to differentiate between the feedback of the placebo from the reaction of the proving medicine (Ullman, 1991: 56).

Historically most homoeopathic proving substances were known to the prover. The double blind methodology is standard in modern day provings where the proving substance is known only by the researcher.

The provers are unaware of the proving substance. In a double blind proving both the provers and researcher are unaware of who is taking the remedy and who is on placebo (Sherr, 1994: 36).

Thus the possibility of bias is ruled out. Blinding can decrease the different evaluation results but can also improve compliance of the provers.

At Durban University of Technology proving studies follow either a double blind (Pather, 2008 and Somaru, 2008) or triple blind (Ross 2011) method to ensure lack of bias. The process of randomisation is conducted electronically by a homoeopathic clinician and lecturer in the Department of Homoeopathy at Durban University of Technology as recommended by the Departmental Research Committee.

2.9

RANDOMISATION

Randomised controlled trials are experimental studies to determine the effect of an intervention by assessing the information gathered prior to and on completion of the intervention. The objective of randomised controlled trials is the comparison of intervention with a single or many other inventions or without intervention.

These interventions are most likely clinical treatments but can also be educational interventions (Levin, 2007).

The aim of randomisation in a double blinded proving explains that both the provers and researcher are unaware of who belongs to the placebo or verum groups.

Advantages of randomised controlled trials include:

Randomised controlled trials provide strong evidence of the efficacy of a treatment (Levin, 2007).

The randomisation of the provers into the experimental and control groups (Levin, 2007).

Allocation concealment ensures that allocation bias and confounding of the unknown component are reduced (Levin, 2007).

Randomised controlled trials can be modified to answer a precise question (Levin, 2007).

Disadvantages of randomised controlled trials include:

There is a high dropout when the provers experience undesirable side effects of the intervention or when little incentive is provided to remain in the control group (Levin, 2007).

Due to ethical considerations a research question may not be determined using the randomised controlled trial design (Levin, 2007).

An observational design may be easier and cheaper to make use for a descriptive overview (Levin, 2007).

Information is needed regarding the level of clinically significant improvement and the conventional variation of development in the sample so that the sample size can be calculated in the randomised controlled trials (Levin, 2007).

THE EXPERIMENTAL DESIGN

The homoeopathic drug proving of Acacia xanthophloea 30CH was conducted as a randomised double blinded placebo controlled research study. The sample size of the study consisted of 30 provers who were selected after meeting the inclusion criteria (Appendix E).

In the proving provers received the proving substance and the remaining six provers received the placebo. The sample size adheres to the recommendation made by standard international guidelines

as articulated in the “Homoeopathic Proving Guidelines” (Jansen and Ross, 2014).

The powders were randomly allocated and both the verum and placebo powders were identical in physical appearance and presentation. In a double blind study both the researcher and provers are unaware as to whether they were assigned the verum or the placebo powders. The randomisation method was performed by Dr I Couchman an independent clinician and lecturer at the Durban University of Technology in the Department of Homoeopathy, appointed by the Departmental Research Committee.

The population of provers was made up of male and females in the age range 18 - 59 years.

The study was conducted by two researchers A. Gobind and G. Zondi who were responsible for 15 provers each. Within a group of 15 provers 12 provers were allocated into the verum group and the remaining three provers were allocated into the placebo group.

Each prover was allocated an individualised prover code, a journal and pen prior to the commencement of the proving. During the duration of the proving each prover was required to accurately record all signs and symptoms that arose during the homoeopathic drug proving. As an „internal‟ control all provers were instructed to record their „normal state‟ also known as their baseline for one week prior to taking the verum/placebo powders (Vithoulkas, 1986). Each prover received nine powders with instructions to take one powder three times a day for three days. On completion of the proving period the journals were collected. The symptoms experienced by the provers was collected, collated and converted to materia medica and repertory format for future use in clinical practice. A homoeopathic remedy image was formed with distinct themes and characteristics which were subsequently compared to the way in which Acacia xanthophloea is used in the African medicinal

tradition.

3.2

OUTLINE OF THE EXPERIMENTAL METHOD

1. The study was conducted by two M.Tech. Homoeopathy students under the supervision of research supervisor Dr. M. Maharaj and co-supervisor Dr. C. Hall.

2. The proving substance Acacia xanthophloea 30CH was prepared by the researchers according to Method 6 (Triturations by hand) and modified Method 8a (Liquid preparations made from triturations) as specified in the German Homoeopathic Pharmacopoeia (GHP) (Appendix G).

3. Provers were recruited by advertisements placed on notice boards at various sites at the Durban University of Technology and by personally inviting potential provers (Appendix H).

4. The researcher conducted interviews with prospective provers who were screened for suitability and the researcher questioned the provers about their medical history and lifestyle to determine if the provers met the inclusion criteria (Appendix E).Those provers who met the inclusion criteria continued to the next procedure in the proving.

5. After the selection process all provers attended a pre-proving seminar which was conducted by the researchers. During the seminar the procedure of the homoeopathic proving was explained to inform provers of what was expected of them during the proving (Sherr, 2003). All aspects of the research study were explained to all the provers. The seminar provided all provers the opportunity to clear up any queries they had regarding the research proving study.

6. Provers were randomly assigned by an independent clinician into the verum or placebogroups.

7. The researcher and each prover agreed to meet on an allocated date and time.

8. At the consultation each prover received a preliminary letter of information outlining the procedure of the proving. The prover was required to sign the preliminary consent form. Provers between the ages of 18-21 needed consent from their parents or guardians prior to participating in the study (Appendix A).

9. The provers were guided through the letter of information (Appendix D) and signed the informed consent form.

10. A detailed case history of each prover was taken. Thereafter a physical examination was conducted (Appendix C).This served as an additional screening procedure.

11. After the physical examination a pregnancy test (urine test) was conducted on all female provers. Those provers with a negative result was accepted into the proving.

A positive result of the prover was deemed to be an exclusion criteria (Appendix E).

12. Each prover was allocated with a personalised prover code, pens, and a journal with a prover code corresponding to the prover number in which to record their experiences during the proving.

All provers also received a personal copy of the preliminary letter of information and letter of information containing instructions to be adhered to during the proving as well as proving information about the homoeopathic drug proving.

In addition, each prover received a list of contact numbers of the research investigator and supervisors.

13. All provers were informed of the date of commencement of the proving after the case history and physical examination was completed.

14. Each prover received an envelope labelled with their corresponding prover code containing 9 powders (verum or placebo) with instructions to take one powder 3x daily.

15. The provers began capturing their daily symptoms on the date assigned in their journals with a minimum of three entries daily for one week prior to consuming the proving substance. The “normal state” of a prover (baseline) is important as it shows the standard state of health of an individual prover. This constituted the control for the comparison of the symptomatology for the pre-proving and post-proving periods.

16. Upon the completion of the pre-proving week each prover commenced taking their powders with a maximum of 3x daily for three days or until symptoms appeared.

No further doses of the proving substance would be taken if symptoms arose although the prover continued to record their symptoms throughout the proving. A minimum of three recordings a day was required for six weeks. The provers were required to accurately and diligently record their symptoms experienced daily.

17. In the first week of the proving the researcher communicated daily with each prover telephonically to discuss their symptoms. This ensured compliance and accuracy in symptom recording.

18. The prover would not take any further doses of the proving remedy if symptoms were experienced. The prover discussed the symptomatology experienced with the researcher to determine if the symptoms were as a result of the proving remedy. The powders were immediately discontinued if the symptoms were as a result of the proving remedy.

19. During 3 days if all 9 powders were taken and no symptomatology occurred the prover was required to continue making journal entries until proving symptoms began or

till the end of the proving period.

20. Each prover was required to record in the journals until all their proving symptoms had subsided.

21. In the second week, telephonic contact with the provers by the researcher occurred every second day and in the third week contact was maintained every third day.

The researcher contacted each prover once only in the fourth week. The prover would continue to record all their symptoms until the complete duration of all proving symptomatology.

22. Provers continued journaling for a post-proving observation period of one week. This was to ensure no recurrence of proving symptoms.

23. If a prover had an adverse event then they would have been antidoted but remained a part of the study by continuing to record symptoms.

24. The study lasted six weeks which included one week pre-proving period and one week post-proving observation phase.

25. After six weeks the journals from each prover was collected.

26. A follow-up case history was taken and physical examination was conducted on each prover.

27. The data collected during the research was carefully studied and the process of symptom extraction initiated.

The symptoms that arose in the study was screened in accordance with the symptom inclusion and exclusion criteria.

28. The symptoms experienced by the provers was collected and collated then converted to materia medica and repertory format with subsequent comparison to the African medicinal tradition.

29. The researchers were unblinded to the verum / placebo assignment to facilitate distinction between the verum and placebo groups.

3.3

THE PROVING SUBSTANCE

3.3.1

According to Hahnemann the 30CH potency was most valuable for the use of determining the dynamism of medicinal substances in provings. Hahnemann defined this proposal in Aphorism 128 of The Organon of the Medical Art (O’Reilly, 1996). Initially Kent questioned this proclamation but later supported the use of the 30CH potency.

Stomach: Thirst for large quantities (often/unquenchable/before vomiting)

Vomiting - < after breakfast/> drinking/sudden/after eating (eggs)/inclination to vomit

Abdomen: Heaviness

Distension

Rectum: Abscess

Constipation (+ flatulence/+ stomach complaints/difficult stool/in women)

Constriction – night/painful/during urging to stool

Rectum: Diarrhea (+ weakness/< after eating)

“As if empty”

Flatus

Pain after/during hard stool

Stool: Black/copious/dark/frequent (at night)/hard/offensive/watery (at night)

Bladder: Inflammation + burning urine

Pain – burning (evening)/(<) during urination/< beginning +/ o. end of urination

Retention of urine

Urination frequent

Female genitalia / sex:

Bleeding after coition

Sexual Desire diminished

Eruption – itching/nodosities/painful pimple/pustules before menses

Heaviness during menses

Itching in vagina

Sexual Desire increased

Leukorrhea cream like

Menses - bright red (clotted)/partly clotted

Menses – brown/changeable in appearance/copious (daytime)/dark with clots/too early/scanty too late/membranous/during menopause/offensive/painful (+ complaints

of ovaries)/pale/protracted/scanty/”As if copious”/too short/thick/thin (with clots)/watery

Pain – during menses

Chest: Anxiety heart

Itching of nipples

Oppression anxious

Pain (r./constriction/cramping cutting/< exertion/< motion/cutting pain [middle of chest – morning/afternoon/evening (ext r. side)/<: motion/expiration/inspiration;]/> rest/

Palpitation - with anxiety

Back: l. /r.

Pain [morning/afternoon/lumbar region/aching/< bending/< cold/after taking a cold/drawing/l. stitching pain/lumbar region (/in afternoon “As if sprained”/sore/”As if broken”/> rubbing)/< motion – drawing pain

Pain – r. (stitching)/< motion of shoulders/”As if someone is poking”/> rubbing/scapular sore/< sitting down/spine (aching/sore)/< turning (drawing/head)/unbearable/< standing (lumbar region)

Tight feeling

Extremities: Feet icy cold

Cramps in feet

l. foot < walking/l. foot feels hot uncovering

Heat in upper arms

Numb legs morning (r./< motion/< rising/< standing)

Pain in feet - ankles [(l./after walking)/elbows (l./drawing/< motion/ext. head/feet (morning/l. heel/pulsating/< after walking/sore (at night)/< standing/< stepping

Pain in - forearms (morning/daytime/aching/drawing downward/near elbow/< after exertion/ext. elbow/ext. hand/< lying)

[Ruth Heather Hull]

A proving is a controlled, reproducible and hence reliable method used to determine what a particular substance does to a healthy person. A potentized remedy made from

a substance is given to a group of healthy people and all their symptoms, physical, mental and emotional, are recorded and from these symptoms a remedy picture can be developed. This remedy picture is then recorded in the materia medica

[Jan Scholten]

What are provings?

The word proving has several aspects. One is to prove, to establish as a fact, to make it certain. Another is to experiment or to test. This aspect is marked in the Dutch word "proeven", which means to taste. Taste and test come from the same origin.

Provings are procedures where provers are exposed to a substance or influence and invited to express the impressions of that exposure. The procedure can be compared with radio or television broadcasting with a transmitter and receiver. The remedy can be compared with the transmitter, the prover with the receiver. The procedure has several aspects: the remedy, the prover sensitivity and the prover attention.

1. Remedy

The remedy, or any other influence, is the signal. The signal has to be strong enough to be received. In provings the signal can be made stronger in several ways.

One obvious way is to give the remedy in a crude form, as is done in intoxications. This has the danger of overloading and ruining some parts of the receiver, it makes the prover ill.

Another way to strengthen the signal is to give repeated doses. People have also tried to strengthen the signal by using higher or lower potencies. The experience of Sherr and myself is that it’s hard to discern in provings which potencies are stronger than others.

2. Prover sensitivity

The sensitivity of the provers is crucial for the proving. Some provers hardly get any symptoms or they hardly dare to trust their impressions, in which case a good supervisor can be of help to strengthen their trust.

Sherr stresses the importance of sensitive provers in the proving: “One sensitive prover can make a whole proving, bringing to light the most profound aspects of the remedy

in a most beautiful way” and “Often the most important proving symptoms are brought mainly by one or two sensitive provers, the others serving to fill out the bulk of common symptoms.” One 'master prover' in his provings has been crucial; some provings only made sense after she joined in again.

Another way to amplify the result of the proving is to involve many provers. Many provers can receive more information than one and different aspects of the remedy.

Another way is to repeat the provings, in different times and circumstances, with different provers and in different cultures. This aspect will also be discussed below in

the 'Prover attention'.

3. Prover attention

The attention of the prover is crucial. The attention of the prover can be compared with the tuning of the receiver. A radio receiver will only amplify what it’s attuned to;

other senders will not be amplified and heard. When the attention of the prover is not focused on the remedy, all kinds of other influences can present during the proving.

It’s like a receiver that has to be tuned to the right signal. Hahnemann was already very much aware of this fact, as he shows in Aphorism § 126 of the Organon:

“During the whole time of the experiment he (the prover) must avoid all overexertion of mind and body, all sorts of dissipation and disturbing passions. He should have

no urgent business to distract his attention. He must devote himself to careful self-observation and not be disturbed while so engaged.”.

There are several techniques to enhance the attention of the prover. Frequent talks with a supervisor are a good help and according to Sherr indispensable.

Another technique is meditation. Then, almost all the attention is directed to the remedy, although it’s by no means a guarantee that other influences will not come in.

This aspect of attention is crucial. The opposite of good attention is disturbance or noise. The incorrectly attuned receiver will show another sender or just noise and rumble. Attuning a prover is not as easy as attuning a radio receiver. Other influences cannot be excluded so they have to be taken into account. In every proving there will (probably) be incorrect information and disturbances. The topic of incorrect proving information has been for the most part neglected in homeopathy. Hahnemann excluded the possibility in paragraph 138 of the Organon. There are no procedures for removing incorrect information out of our repertories and Materia Medica (except obvious mistakes like confusion of "con" and "com"). The homeopathic community behaves as if mistakes don’t exist. In my experience there are many errors. The problem is how to sift them out.

Using more provers in one proving or repeating provings in different circumstances and cultures is a means to single out disturbances. A symptom that is produced by only one prover has a higher likelihood of being just a symptom of the prover. The fact that only one prover has a particular symptom is no guarantee that the symptom comes from a personal disturbance. Sherr has pointed this out clearly and it’s also my experience. One prover can perceive the essence of the remedy and even know that it is the essence. Using groups is also no guarantee against group disturbances.

A frequently encountered disturbance is “homeopathic thinking” as most provers are homeopaths. This is a form of the more general cultural disturbances. A nice example is a proving by Sankaran of Ferr-met. Many provers were dreaming about marriage, but it was not because Ferrum as such has anything to do with marriage, but that the symptom “being forced to” of Ferrum is connected to marriage in the Indian culture.

Disturbances can be seen as the consequence of being out of tune, or being attuned to something else, other than the remedy we want to “measure”. Several kinds of disturbance can be recognized:

1. Event disturbances

All kinds of events happen at the same time as the proving. It’s almost impossible and never done to isolate the provers from all impressions other than the proving substance. Eating is an immediate influence just as not eating is.

A nice example of an event disturbance is described by Shore in the proving of Pelecanus occidentalis: “Everyone is aware of the terrorist attacks on New York and Washington DC on September 11, 2001. These tragedies happened one week after we started the proving. This event had an impact on all of us and colored the proving in ways we cannot predict or separate out”. This event is obvious for the impact it can and will have. But minor events too can influence the proving, like a dinner with friends, the kind of food eaten, a television program or a story in a journal or a quarrel with a family member.

Events can also be subtler. In meditation provings one clear event is the meditation. This produces meditation symptoms like light feeling, floating sensation, tingling, hyperventilation, awareness of heartbeat, respiration and of the body. One can find symptoms like these in all meditation provings and most of the time they say nothing about the remedy.

One of the problems is to discern if the event belongs to the remedy or not, if it’s accidental or synchronicity. There’s no way beforehand to know for sure which of the two is the case.

2. Personal disturbance

Every prover brings with him his personal make-up, ideas, character and state. One could call them stored events, as they are the consequence of events in the past and adaptations to those events. They are fixed, conserved and can be triggered by new events or come up by themselves. Events like provings can trigger them just as much.

A nice example has been published by Vermeulen in Dynamis. He compared the provings of six remedies and found out that they all had the symptom of misanthropy, aversion to people. It turned out that that symptom was every time coming from the same prover. That prover's character had plenty of timidity and misanthropy.

Group states can also be of influence. An example is the proving by Jürgen Becker of Ferr-p., which produced the symptoms of transvestism. In my experience that symptom doesn't belong to

that remedy. I haven’t seen it in my own and other homeopaths' cases and it doesn't fit in with the Element theory.

Every prover brings with him a lot of themes. They can arise from himself, but can also arise in these cases from his family, the group that he works in, his culture or the history of the world.

It’s hardly possible to discern during the proving whether symptoms belong to the remedy or not. Even when a symptom is typical of the prover it might be that the remedy has that symptom too

and that might be the reason it could be triggered so easily.

Conclusion

Provings have only a few principles: remedy, prover sensitivity and prover attention. This leads to many techniques such as intoxications, full provings, dream provings and meditation provings.

In each of these, many variations or completely new forms can be designed. Examples are bath provings (dissolving an essential oil of a plant in a bath and sit in it), image provings (looking at a plant or an image of it and meditating on it), thought provings.

None of them can guarantee complete and accurate results. Some homeopaths have the idea that dream or meditation provings cannot give correct results. This can be refuted with an example.

In both Cerium provings at the end of "Secret Lanthanides", the symptom of being in a bell-glass was experienced. This symptom has been verified in many Cerium cases.

All provings have advantages and disadvantages and I’ve placed some of them in the table below.

For me the meditation proving is often the most convenient and helpful. It gives results fast and with little effort. The disadvantages are that the picture will not be complete and can be incorrect in parts. But that can also be the case with other provings. In my experience, meditation provings often are quite reliable and give the essence of the remedy, more so than dream provings. For others the opposite can be true.

When used with care, the information in the meditation provings in "Secret Lanthanides" can be and has been very helpful in the development of the remedy pictures. I publish them so that the reader can have a fuller picture of that development.

Provings
Intoxication	Reliable symptoms	Disease producing
	Physical symptoms	Unethical
	Attention independent
	Strong impression
Full proving	Standardized	High cost in time and energy
	Full picture (?)	Attention dependent Event disturbance Personal disturbance
Dream proving	Reasonable cost in time	Attention dependent Event disturbance Personal disturbance Partial picture
Meditation	Low cost in time and energy Full attention Little event disturbance Full tuning	Meditation disturbance Personal disturbance Partial picture

[Victoria-Leigh Schönfeld]

Historical Perspectives of Provings

Samuel Hahnemann, the founder of homeopathy, was the first to experiment with provings.

In the year 1790, Hahnemann was contracted by a physician of the time, named Cullen, to translate “A Treatise Of Materia Medica” written by Cullen into the German language. As he was reading through the material, he disagreed with Cullen’s explanation regarding the mechanism of action for the treatment of malaria using the bark of the Cinchona tree. Cullen had claimed that the curative

action of Cinchona officinalis (an existing treatment for malaria) was due to its bitter taste. Hahnemann, disagreeing decided to experiment with the substance by ingesting the bark himself.

After taking it for several days; Hahnemann began to experience symptoms similar to that of a malarialinfection.

Once he stopped taking the Cinchona bark, his symptoms ceased and his health returned to what it was prior to its ingestion. Soon afterwards, Hahnemann experimented with other substances in a

Similar manner and came to the conclusion that a substance can cure the symptoms it induces, or “like cures like” (De Shepper, 6 2005:27) therefore discovering The Law of Similars.

H. continued experimenting with many other drugs on both himself and 64 other volunteers, determining the therapeutic potential of 101 remedies (Louw, 2002:23). Modern provings are still conducted largely according to the basic methods of Hahnemann. Sherr, a contemporary international authority on homoeopathic proving currently bases his methodologies largely on the principles of H., but has modified them to relate to modern science (Sherr, 1994).

Even though the “Law of Similars” was said to be discovered by H., treatment by ‘similars’ was hypothesised significantly before Hahnemann’s time.

Hippocrates was involved with a similar theory in ancient times (Walach, 1994:129), as well as Galen in the 2^nd Century A.D. who tested his medicines on the sick and on the healthy. Paracelsus too, in the 16^th Century observed the effect of substances on healthy people to determine their therapeutic properties however neither Paracelsus nor Galen undertook these activities systematically as did H. (Coulter, 1975:442). Vithoulkas (1980:97) states that provings are the introduction of a substance into the (human) organism which is very high in dilution, in order to disturb and mobilize the defense mechanism. According to Taylor (2004:5), in response to the proving drug “the defense mechanism of the individual produces a variety of symptoms on the mental, emotional and physical levels. ” This variety of symptoms is then characteristic of the peculiar and unique nature of the substance.”

The curative response occurs when the corresponding substance is given in a highly diluted format, which causes the individuals immune system to remove the morbific picture of symptoms (i.e. the symptoms of the disease), and in doing so the induced process does not harm or compromise the patient’s immune system any further. Vithoulkas (1986:97) suggests that in order for symptoms to be produced, the exciting cause should be strong enough to mobilise the defense mechanism and the person should be sufficiently sensitive to the unique vibratory frequency of the substance.

The medicine is given in subtle doses where the morbific symptom picture is lifted without harming or weakening the patient further.

Proving methodology

Although H. was the first to formally conduct homoeopathic drug provings establishing the foundation on which contemporary provings are based, he did not incorporate any form of control or blinding into these experiments.

Although H.’s experiments yielded reliable results, his proving methodology would not be considered to be reliable by modern standards for clinical trials, in addition the expectations of provers following the H.n proving methodology would be considered unrealistic in modern times, as he insisted that his provers follow a strict diet and lifestyle, so as not to taint the action of the remedy (Wieland, 1997:229).

Even though H.’s basic methodologies are still valid, modifications have been made to the original methodology in keeping with the requirements of modern scientific standards of experimentation.

Riley (1997) states that the value and quality of homoeopathic drug provings will be improved if a consistent, systematic and scientific methodology is utilized when conducting provings. Contemporary provings now take the form of placebo controlled trials and incorporate double or even treble blinding in order to control variables (Sherr, 1994). The concept and principles of blinding

was introduced first by Gerstel in 1843 whilst proving Aconitum napellus and double-blinding was introduced in 1906 by Bellows whilst he was reproving the remedy Atropa belladonna

(Demarque, 1987). The concept of double-blinding in a homeopathic proving implies that the researcher and provers are unaware of the proving substance and is a means of protecting against any bias from both parties (Sherr, 1994:36). Riley (1996) also states that the use of placebo control and double-blinding promotes a self-critical attitude in both the provers and the investigator.

Vithoulkas (1980) describes an extensive and rigorous regime for the process of a proving. He prescribes a method that includes the provers relocating to a more natural environment to optimise their health; in addition he requires the provings to involve a large number of provers (50-100), of which 25% are to form a placebo group. Vithoulkas’ prescribed time frame is extensive, and the potency

applied is that of many ascending potencies over a protracted period of time.

Vithoulkas’ method requires the experiment to take place involving three different nationalities of provers comprising three different groups, in three different geographical locations (Vithoulkas 1980:149-152). To follow this methodology would prove to be unrealistic and prover compliance in modern times would be very poor, in addition such a proving would prove very costly and time

consuming.

More contemporary proving methods known as ‘dream provings’ have become popular in the last 30 years, and were first conducted by Becker (Dam, 1998).

There are no strict standardisations for dream provings, and they are usually single blinded studies that focus mainly on dreams the provers experience in response to the proving substance, although physical symptoms during these provings do occur (Botha, 2011:16). Pillay (2002) conducted a comparative study of two proving methodologies of the same proving substance Bitis arietans arietans;

the research showed a result of 93% correlation to the symptoms that were produced in the H. proving of the same substance, Bitis arietans arietans conducted by Wright (1999). Pillay (2002) standardised the proving by administering one single dose of the remedy taken sublingually at bed time (Botha, 2011:16). The provers were to then record any dreams or other symptoms that occurred thereafter. Even though a number of dream provings have taken place recently, Sherr (1994) refers to the dream proving as only a “partial proving” as he believes that it is a short cut into the inner essence of a remedy, and that the totality of symptoms as well as long term symptoms are missed by using these types of methods (Sherr, 1994:16).

Sanakran follows a protocol that is said to be seated between the methodology of dream provings, and classical Hahnemannian provings (Botha, 2011:21). These provings are single blinded provings, the symptoms that he concentrates on are the physical and emotional symptoms, as well as dreams. According to Botha (2011), these provings are viewed to be similar to Sherr’s methods, and are

considered to be a “halfway method” that lies between the Sherr and dream proving methodologies.

Subsequently Sherr, (1994) published guidelines for provings, these methodologies are an add on to the classical Hahnemanian method. Sherr (1994) believed that it was important to maintain the modern lifestyle, as they are only obstacles for cure, in contrast to Hahnemans strict conditions regarding diet and lifestyle throughout the period of a proving. Sherr’s methodology includes a

double blind, non prejudiced trial (Sherr, 1994:6), and is amongst the most popular methodology applied at the Durban University of Technology (Botha, 2011:20).

The International Council for Classical Homoeopathy (ICCH, 1999) attempted to standardise the conducting of homoeopathic drug provings. Their guidelines included (International Council for Classical Homoeopathy, 1999: 33): Healthy volunteers that use no drugs, have no mental pathology and have been clear of any homoeopathic remedies for at least three months Participants must be over the age of 18 and pregnant and breast-feeding women are excluded

A comprehensive case history must be recorded prior to the trial detailing all past symptoms and states

The group must consist of homoeopaths or homoeopathic students, but may also include provers from a non-homoeopathic background to balance the group. The number of provers must be between 10 and 20.

The substance must be sourced from a natural source free from pollution. The precise origin of the substance should be carefully detailed, including when, where and how it was obtained, the name, species, gender, family and other pertinent data

ICCH (1999) recommend using two to three potencies during the proving, as well as using a placebo control (10 – 30%) as a means to increase provers’ attention (Botha, 2011:22).

It is according to these guidelines, as well as Sherr’s methodologies that the current proving of Bitis atropos was conducted.

2.3.1 Introduction of placebo and double-blinding

The use of the placebo control in homoeopathic provings is a controversial topic (Sherr, 1994:56) and not all homoeopaths agree on the use thereof. According to Reaside (1966: vol 55), good provers are difficult to come by and he considered it wasteful to give good provers a placebo. Placebo control however is generally accepted as an essential component of a proving; which are essentially drug

trials using a homoeopathic remedy and are used as a comparison for symptoms of the remedy. One good reason for the use of placebo is to ensure that provers are extra careful when they are relating their symptoms (Sherr, 1994:57). Sherr (1994) states that he uses 20% - 30% of his participants as placebo, the rest receive verum.

The proportion of placebo provers in provings conducted at Durban University of Technology (DUT) have decreased over the years, an average of 50% of provers on placebo has recently decreased to an average of 20%. Even though there has been a significant decrease of placebo provers, the numbers of provers on verum have remained constant (Ross, 2009).

Double-blinding is the process whereby the researcher and the provers are unaware of which provers are administered verum, and which provers are administered placebo. This method is used to eliminate bias and ensure accurate results within a proving. The standard practice for proving at DUT in this regard includes randomisation and preparation of placebo and verum powders by an

independent party. Both medicines are made to resemble one another, even to the extent of impregna ting the placebo powders with unprocessed ethanol.

Randomisation lists are withheld by an independent person and the identification of placebo and verum provers are only made once all prover journals are collected for data capture (Ross, 2009).

[Bruce Thomson]

Provings are the logical extension of the law of similars, an idea known in the west at least as far back as Hippocrates in ancient times (Walach 1994:129).

Galen in the 2^nd Century A.D. tested his medicines on the sick and on the healthy. Paracelsus in the 16th Century observed the effect of substances on healthy people to determine

their therapeutic properties, but neither he nor Galen undertook these activities systematically (Coulter 1975:442). In the East the court of Emperor Shen Nung is thought to have seen the first known provings of remedial agents on healthy people, circa 3000 BC (Little 1998:1).

Hahnemann probably took his lead from Paracelsus but he also offers credit to the efforts of Albrecht Von Haller (1708 - 1777), who in the preface to the Pharmacopoeia Helvet (1771) proposed the testing of pure medicines on the healthy and then applying the results to the sick (Little 1998:1).

He further gives credit to Anton Storck (1731 - 1803), Alexander, Menghini and Fontana who experimented with the method before him (Walach 1994:129; Stephenson 1960:47-49).

PROVING METHODOLOGIES

The reliability of most of these early provings has been called into question especially as they were largely uncontrolled (Fisher 1995). However, the concept of controls is not a recent introduction to homoeopathy. For example blinding was introduced into Homoeopathic provings in 1843 by Gerstel when he was proving Aconitum napellus (= the provers were unaware of what they were proving). Bellows introduced the double-blind technique in 1906 when reproving Atropa belladonna (= provers unaware of what substance they are taking and observer does not know who has been given what) (Demarque 1987). The double-blind placebo controlled proving method has become the method of choice in recent years (Vithoulkas 1986; Nagpaul 1987).Raesides treble-blind technique (1972) has been used by both Sherr (1994) and Riley (1995a,b) (= a placebo control, the observer is blind and the substance is unknown to both prover and observer).

There has been much debate about the best protocols to be used for provings.

The growth in interest in provings and the need to present a consistent front to a sceptical scientific community has led to attempts to develop general guidelines and minimum standards for drug proving protocols, such as the effort by the Drug Provings Group of the European Committee for Homoeopathy at five symposia since 1992 (Wieland 1997:231). The aim is to produce a scientific standard for good homoeopathic drug provings (Wieland 1997:229). Walach (1997:223) has suggested that an attempt at quantitative analysis of the raw data is required as opposed to the traditional qualitative analysis, not to negate qualitative analysis, but in order to further the scientific debate and clarify the foundations of homoeopathy. Nonetheless, as Wieland (1997:230) points out, the purpose of the proving is primarily to generate symptoms of quality not quantity.

Of note in terms of contribution to the literature on proving methodology are the following authors:

Vithoulkas (1986:143 - 156) in a chapter of his “Science of Homeopathy”; Demarque (1987); Nagpaul (1987); Bodman (1987); Koppers (1987); Sherr in his “Dynamics and Methodology of Homoeopathic Provings” (1994) (providing probably the best structure on which to plan a proving); Riley (1996,1997) has further contributed to developments in the field.

[G. Vithoulkas] Kritik.x

A proving of Thiosinamine

A few days ago I received ‘A Proving of Thiosinamine’ from Tony Grinney, in which I read the following unbelievable passage:

‘Prover 105, the placebo, produced a lot of symptoms which also seem to fit with the overall remedy picture.

This at first hand seems unusual, but may be explained in that those involved in the proving were students from the college.

Sankaran has talked about ‘communal consciousness’ and the students were known to each other and met at college monthly, so there was a communal experience

in which the provers and the supervisors were involved.

It is possible in such a situation that despite the fact that was given placebo, she may have developed symptoms of the proving by being part of the group and college

community involved in the proving.

All information on the placebo is included as anecdotal evidence rather than within the main proving.’

It is unbelievable that, in our times due to ideas put forward by new teachers people have come to believe that white is black.

When, in a proving, you have the same or similar symptoms with placebo as with the remedy, the logical conclusion should be that such symptoms do not belong to

the remedy but rather to environmental, circumstantial or psychological conditions (hysteria, suggestion, anxiety etc.) but surely not to the remedy!

It is most regrettable that somebody managed to persuade novices in homeopathy that placebo symptoms can belong to the proving of the remedy through a metaphysical

medium which is the communal consciousness!

The damage of such papers is double

a. When serious people in medicine or health authorities hear such absurdities nobody can blame them for resisting and distancing themselves from us.

b. Every remedy, when proven in a proper way, will give a group of symptoms.

But a false proving with imaginary symptoms will cause tremendous confusion as to what symptoms belong really to the remedy.

Here are some examples from the ‘Proving of Thiosinamine’:

‘I noticed the sense of depression that I used to get briefly on cooking has not been there since taking the remedy.’

‘I feel I am getting lots of useful information from unexpected sources at the moment.

For example the dog’s being unwell and I thought she must have eaten something, then went for a walk to the park and chatted to two council workmen who told me

they’d just found a huge pile of curry (!) under a tree where a dog had been nosing around yesterday.’

‘Quite excited at the thought of going away for the weekend.’

The ‘Proving of Thiosinamine’ claims that the theme of the remedy is waiting patiently or wasted time.

Here prover 104 (actually the provers were 9 and one placebo).

‘Two patients haven’t shown this morning, so I’ve had two hours of waiting for them with no time to get on with anything else. That’s wasted time.’

‘I feel I have been waiting for something dramatic to happen with the proving but it is not and I need to reconcile myself.’

How can such reactions be noted down as proving symptoms?

Under these circumstances, anybody would react in the same way!

The bulk of the ‘recorded symptoms’ are of similar quality and obviously belong to the circumstances and the psychological state of the provers at that moment.

When such events are announced with a ‘press release’ (as this publication was) as if they were important events for homeopathy, it is time that some critical voices were raised.

[Hahnemann]

The Organon of Medicine presents basic guidelines for ascertaining the medical actions of a substance. These are listed below:

The medicinal substance must be known for its purity;

Provers should take no medicinal substances during the proving;

The provers diet must be simple, nutritious and non-stimulating;

Provers must be reliable, conscientious, able to clearly and accurately record their symptoms while being in a relatively good state of health;

Provers must be both male and female;

The proving substance should be in the 30^th centesimal potency;

All symptoms need to be qualified in terms of the character, location and modalities;

To prove a substance multiple provings should be done on the substance including provers of both genders and various constitutions;

Moderate proving doses yield better results and are safer than large doses;

During the proving all ailments and alterations should be attributed to the proving substance;

Provers should keep detailed proving journals;

Provers should be interviewed daily by the supervising physician.

Many authors have considered that since the Hahnemannian era, provings have deteriorated in quality and methodology (Sherr, 1994; Vithoulkas, 1998; Walach, 1994).

Sherr believes that provings carried out in the 20^th century have lacked the refinement of earlier provings. As a result he asserts that there are few refined provings, the rest of the

materia medica containing partial provings or toxicological reports (Sherr, 1994:9).

There has been great debate about the best protocols to be used for provings today. The growth in interest in provings and the need to present a consistent front to a sceptical scientific world has led to attempts to develop general guidelines and minimum standards for drug proving protocols, such as the efforts by the Drug Provings Group of the European Committee for

Homoeopathy at five symposia since 1992 (Wieland, 1997:231). The aim is to produce a scientific standard for good homoeopathic drug provings (Wieland, 1997:231).

In 1994, Jeremy Sherr published the 1^st edition of his book entitled

The dynamics and methodology of provings. This book covers every topic that is relevant to a good proving protocol. Herein is found clear and detailed guidelines to conduct a proving.

The International Council of Classical Homoeopathy (ICCH) (1999:35) also recommends Sherr‟s proving methodology to perform a thorough and reliable Hahnemannian proving.

materia medica.

According to the ICCH the aim of the homoeopathic drug proving is to gain knowledge about the innate character of a drug thus obtaining a remedy picture which is of good

quality. The symptoms are then collated and communicated to the homeopathic community so that they can be clinically verified.

This means that a symptom which has occurred in a drug proving can now, if occurring in a sick patient, be alleviated by the proved remedy, which produced the proving symptom after the administration of it. Vithoulkas (1998:97) mentions that during a proving, one introduces into the organism a substance that is sufficiently high in concentration that disturbs the organism and mobilises its defence mechanism. The defence mechanism then produces a spectrum of symptoms on all three levels of the organism i.e. mental, emotional and physical. The symptoms thus produced characterise the unique nature of the substance. In order for a drug to be fully proved it should first be tried on healthy persons in toxic, hypotoxic, and highly diluted and in potentised doses.

The symptoms produced from the drug are recorded on all three levels.

The proving methodology for this proving was adapted from the proving methodology of Sherr (1994).

Toxicology

While not official provings per se, toxicological information has always been included in the materia medica. New chemicals and drugs are producing new remedy pictures, with symptoms

on the gross material plane as well as on the subtler mental/emotional one. Records of poisonings with arsenic and strychnine, or observations of those under alcohol and other drugs, have

contributed much to the clinical picture of these remedies.

Shore (2004:167) is of the view that that each level of materiality contributes information that goes to make up the totality of the image of the remedy.

A wealth of information is found from the study of the toxicology of substances used as homoeopathic remedies.

For instance, precise records of the effects of a poisonous snakebite gives picture of the possible action of a homoeopathic version of that substance. A poisoning may be seen as a

„crude proving‟ and may be regarded as invaluable based on the homoeopathic law of similars (Taylor, 2004:21).

Hahnemann believed that the noxious and poisonous character of these substances were distinct revelations of the power of these drugs to extinguish curatively similar symptoms occurring in natural diseases, that their pathogenetic phenomena were imitations of their homoeopathic curative action (O’Reilly, 1996).

Venoms are at least 90% protein (by dry weight), and most proteins found in venoms are enzymes, of which proteolytic enzymes, phospholipases and hyaluronidases are the most common types. Proteolytic enzymes catalyse the breakdown of tissue proteins, dissolving cells and tissue at the bite site and cause local pain and swelling.

Phospholipases may be mildly toxic or highly destructive of musculature and nerves and the hyaluroneridases dissolve intercellular materials and hasten the spread of the

venom through the prey’s tissue (Taylor 2004:21-22).

Doctrine of Signatures

The doctrine of signatures has been used in the past to postulate the effects a remedy will have and the systems it will have an affinity for. The Swiss physician, Paracelsus von Hohenheim,

?first? had the notion that a plant’s external nature gave an indication of the ailments it could cure, a theory which became known as the doctrine of signatures.

For example, Chelidonium majus was used treat the liver and the gallbladder as the yellow juice of the plant resembled bile (Lockie and Geddes, 1995:11).

According to Goel (2002:465) the doctrine of signatures infers the nature of the actions of the substance from its physical appearance and properties, i.e. its form and colour. There are various applications of the doctrine of signatures to plants and fungi, e.g. the testicle shaped Orchis root to restore manly vigour; yellow turmeric powder to treat jaundice; the red juice of crushed

Hypericum perforatum flowers for treatment ofwounds and haemorrhages.

The doctrine of signatures may assist in revealing the intrinsic nature of a substance and thus facilitate the accurate prescribing of the remedy. It may also highlight many themes in the remedy and explain relating symptoms (Taylor, 2004:23).

Vergleich:

Vergleich.x traditionelle Prüfungen von Borax mit Verreibungsprüfung von Borax

Theory. Comparison - Dream Proving Methodology - Sherr Proving Methodology - C4 Proving Methodology

Siehe: Terms in Homöopathie

[Izel Botha]

C4 trituration provings are a somewhat controversial method of uncovering the therapeutic value of homoeopathic remedies. The key advantage of this method over traditional proving methods is that a substance can be proved in a matter of hours, rather than weeks or months. However there is a lack of research to show whether the results of the two methods are comparable. AIM The aim of this study is to establish whether symptoms elicited in a C4 trituration proving are comparable to symptoms produced in traditional provings of the same substance. If a similarity can be demonstrated -even on a single substance- it may encourage further studies to determine the extent to which C4 provings can be used in association with, or instead of, traditional provings as a means of developing homoeopathic remedies. METHOD Ten triturators were recruited from an existing group of experienced triturators to prove an unknown substance. Data were harvested from debriefing sessions and from notes kept by triturators during the sessions, and these were transcribed and converted to rubrics. An unprejudiced repertorisation was undertaken in an (unsuccessful) attempt to identify the substance before unblinding. After the substance was revealed to be Borax, the rubrics from the C4 proving were statistically compared to rubrics associated with Borax in Radar 9.0, the electronic version of the repertory Synthesis: Repertorium Homoeopathicum Syntheticum (2004), which reflects traditional provings of this substance. The statistical comparison of rubrics was performed in SPSS; a Pearson Chi-Square test was applied to establish statistical significance; and a Cramer's V test was used to determine the strength of that association. RESULT The comparison failed to find a significant correlation between the rubrics from the C4 proving of Borax and traditional provings of the same substance. At a chapter level, there were significant associations between symptoms relating to Hearing and Kidneys but, for reasons discussed at length in the report, these results must be treated with circumspection. CONCLUSION While C4 provings are faster than the traditional method, as refined by Sherr, in view of the above findings it cannot be recommended that C4 provings be considered as a means of developing homoeopathic remedies instead of traditional provings, because C4 provings would not produce a complete symptom picture. RECOMMENDATIONS Recommendations arising from the study include that the exercise should be repeated with a different substance and group of provers, preferably with confidential debriefing of participants (as opposed to group debriefing, which is the norm for C4 provings), to verify these findings.

[Carroll Dunham]

The eminent Dr. Carroll Dunhan gives directions to the women who proved Lilium Tigrinum

The object in proving a drug is to ascertain the changes which the drug is capable of producing in the functions and organs of the healthy body. It is very important that each prover should know and be able to recognize the various sensations and variations of function to which she may, by peculiarity of constitution, be subject when in average health, so that she may not, while proving a drug, mistake such natural variations for effects of a drug.

The prover should have at hand, at all times, a notebook, in which to record the times of taking the drug and the doses, as well as the symptoms as they occur. The record should be made as soon as the symptom is perceived, and the time of its occurrence and the circumstances of the prover at the time should be recorded.

Before beginning the record of a proving, the prover should inscribe in the note-book a statement of her age, temperament, the sicknesses which she has had, and those to which she has an inherited or acquired tendency; also whatever pains or sensations she may be habitually subject to; also any peculiar susceptibilities she may possess to external influences of any kind, or to mental or moral or emotional excitements, depressions, or perversions. Her constitutional peculiarities respecting the menstrual function should be carefully recorded, regarding frequency, quantity, character, and whatever inconveniences is experienced.

The prover should find out by experiment, and should carefully state what circumstances aggravate or ameliorate the pain (or other symptom), and note its periodical recurrence, because periodicity is a very important element in the history of the action of drugs. For example: is the pain worse when the prover stands, or sits or lies down, worse during exercise and better during rest, worse on first waking, worse in the cold and relieved by heat, worse or better from touch or pressure, etc. All such conditions of aggravation or amelioration should be carefully recorded. If the pain moves from one part of the body to another, the fact and the course of the pain should be recorded. The sides of the body on which symptoms occur should always be stated.

The times of occurrence, aggravation, and amelioration are very important elements (morning or afternoon; at night, before or after midnight, or waking from sleep, just before or after eating, etc.)

Changes in the quantity, quality, and appearance of the natural secretions should be carefully described. The urine, for instance, should be measured, and the quantity per day recorded. It should

be tested for acid and albumen and whatever sediment it may deposit should be carefully described. Modifications of the menstrual functions should be most carefully recorded, such as its greater

or less frequency or quantity, alterations of color and consistency, whether acrid or not, pains and discomforts of body or mind which precede, accompany, or follow it.

Secretions not observed by the prover when in health - such as leucorrhoea, unusual perspirations, etc. should be described, as to color, consistency, odor, nature, whether bland or acrid, times of occurrence, and circumstances which increase or diminish them, and symptoms which accompany them.

If organic symptoms occur, such as eruptions or suspected enlargements or displacements of organs, it is well to consult a physician in order to ascertain the exact condition, which should be carefully described.

The records should be full and minute. It is better to be obliged to erase something afterward, than to risk the loss of an important symptom by aiming at brevity.

The dose should be taken at a time when the prover can rest, in mind and body, for a half hour after taking it. The early morning is the best time, for then the prover will have a chance to observe the action of the drug for fifteen to eighteen hours without interruption by sleep. It is better to begin with a small dose, gradually increasing it until effects are recognized, and then to cease taking the drug until these effects have ceased. It may then be repeated in a somewhat larger dose. No danger of permanent illness is incurred by this mode of proving drugs.

During a proving, the prover should abstain from the use of medicines, cosmetics and perfumes, but should make no marked deviation from her usual diet and regimen.

Habits of so long standing as to have become “second nature“ should be continued in moderation, since to break them off suddenly is to institute at once a morbid state.

[Jan Scholten]

I started doing dream proving in a study groups. In dream proving we took the remedy the evening before the meeting and then put our attention on the dreams that following night and all other experiences and events. Those proving often were quite nice but they're fragmentary and seldom led to a correct prescription.

Then I started with meditation proving during seminars, letting the participants of the seminar hold the remedy in their hand and meditate on it for about 10 minutes. The advantage is that they

were short, taking little time. But the result was very inaccurate, containing a lot of noise. It was very difficult to find out the valuable symptoms in between of them. The change to picture proving made little difference. In picture proving a picture of the remedy, mostly a plant, is shown to the participants, mostly of a seminar, and they meditate on it for about 10 minutes. Also picture provings produced much noise and some valuable in symptoms in between, but difficult to recognise.

Bath proving

By accident I discovered the bath proving. I once did too much of an essential oil in one of my baths. The smell and other impression were so intense that I got all kinds of symptoms. I started doing them more regularly. But they mostly gave a kind of atmosphere, a kind of sensation and emotion and some physical symptoms. An essence was lacking. In hindsight I think it was because my lack of knowledge of the essential aspects of proving.

Classical provings were always an option. One reason to keep me from doing them is the amount of time and energy that go into them. Classical provings from other homeopaths also showed noise and many symptoms with a lack of coherence. The repertories got filled with symptoms of such proving without giving a real understanding.

Trituration provings

The next step was doing trituration proving, where 3 to 5 provers triturate a remedy to a C3 potency during 3 to 4 hours and meditate on it. I had heard good results from them from several sources such as Jonathan Shore.

The proving seminar On Lamu, an island in front of the coast of Kenya, was very revealing. We did a proving of 16 remedies with very good results. For the first time I had the impression that the proving result was quite reliable and good prescriptions could be made on those pictures later on. In the Lamu proving I also discovered the 3 phases of provings and that many prove nags get stuck in Phase 1, the expression phase.

That expression phase gives a lot of symptoms that are only expression. They gives a chaotic, fragmentary picture that doesn't make sense. One has to go to the next phase, the problem phase to understand the problem. Than the picture gets meaning, becomes a whole. I also learned that one can facilitate that transfer form expression phase to problem phase. It is fairly easy for provers to reach the third phase of solution after reaching the problem phase. The next proving seminar in Kenton on sea, a city on the coast of South Africa, benefited very much form this understanding and the provers were grown into the way of those proving. The results were even better but especially achieved with less effort. The result of those two proving seminars are publish in "Lamu provings" and "Kenton provings".

Sense provings

In the same period that I started with the Trituration proving I started also with the sense proving. A story triggered it. I read about a shaman who was disappointed in his herbalism and almost give up but then suddenly got the idea that he could talk to the plants to know what they could heal and for which patient they were needed. From then on he had good results again. I realised that one can get a picture by doing a simple kind of proving by just smelling, tasting, experiencing and looking at a plant. Sense proving can give a good result in quite a short time. One can do them alone

or with others.

The realist depends on how deep one can go into the proving. Also here on has to go one level deeper, from expression phase to problem phase. When that is successful, the result is also quite good, good enough to get successful prescriptions.

Result

Since that time the Sense and Trituration proving have been my main source of proving information. In this book Sense proving one can find the sense provings, some trituration provings and the bath, dream and picture provings. They can be used as sources for later research and comparison.

Conclusion

The experience with different kinds of proving have learned me several things.

1^st the form of the proving is not very relevant. The main thing is the focus, the attention of the prover on the remedy. In Trituration and Sense proving the attention is very high, the focus is only on the remedy. In classical proving that is the opposite, there is very much diversion.

2^nd Provers have to trust the process to set their critical personality aside during the proving. The critic is a very helping personality in general, but during the proving detrimental, killing all the symptoms.

3^rd one has to dive one level deeper than the expression level to get an idea of what the remedy is really about.

Proving: Chetna Shuckla Mangifera.x

term used in homoeopathy that defines an experiment in which a substance or medicine is taken repeatedly, by a volunteer subject, and its effects

carefully documented (Ullman & Reichenberg - Ullman, 2000:101).

According to the European Institute for Homoeopathy (2004) a homoeopathic proving must include the following:

• The symptoms must be systematically observed and recorded by volunteers.

• The symptoms must be produced by the administration of a potentially homoeopathic substance that has yet to be proved homoeopathically.

• The potential homoeopathic substance is to be administered to only healthy volunteers (provers).

The fundamental theoretical basis for the proving of drugs on healthy persons was an idea expressed originally by Samuel Hahnemann. In Aphorism 21, he describes the basic principle:

“Now, as it is undeniable that the curative principle in medicines is not in itself perceptible, and as in pure experiments with medicines conducted by the most accurate observers, nothing can be observed that can constitute them medicines or remedies except that power of causing distinct alterations in the state of health of the human body, and particularly in that of the healthy individual, and of exciting in him various definite morbid symptoms; so it follows that when medicines act as remedies, they can only bring their curative property in to play by means of this their power of altering man’s state of health by production of peculiar symptoms; and that, therefore, we have only to rely on morbid phenomena which the medicines produce in the healthy body as the sole possible revelation of their in-dwelling curative power, in order to learn what disease-producing power, and at the same time what disease-curing power, each individual medicine possesses”(Vithoulkas, 1980:142).

Thus it can be seen that the purpose of conducting a proving of a remedy is to “record the totality of morbid symptoms produced by that substance on healthy individuals”; and that totality will

then be the curative indications upon which it is to be prescribed (Vithoulkas, 1980:142-143). Essentially provings help to establish the therapeutic potential of a proved medicinal substance.

Proving methodologies

Hahnemann did not begin with a set methodology, but changed and developed his methods several times (Wieland, 1997:229). Hahnemann’s provings have displayed reliable results; although the methodology he used would not be considered reliable by present standards for clinical trials (Wieland, 1997:229). Most serious flaw would be that his trials were uncontrolled (Fischer, 1995:129). The incorporation of standardized scientific research methods used in ‘modern’ provings has improved on Hahnemann’s methodology of homoeopathic drug provings (Riley, 1997:225). It is therefore essential that good proving methodology should ideally adopt modern design technology such as blinding randomisation and placebo control.

In homoeopathic drug provings not only should provers be blind with respect to who receives verum or placebo but they should also not be aware of the identity of the proving substance either (European Committee of Homoeopathy, 2004:17).

Blinding:

De Schepper (2001): the prover must not have any preconceived ideas regarding the proving and thus in order to achieve this they must not know the name of the remedy in advance. Most of the original homoeopathic provings were conducted with the remedies being known to the prover, however the majority of all homoeopathic provings are currently conducted using a double-blind methodology (Sherr, 1994:36).

Homoeopathic researchers became among the first to adopt the blinding procedure to test drugs. In a recent study of the history of provings,

Demarque provides a quote concerning an Aconitum napellus re-proving done by Hahnemann’s followers in 1843. The quote states that all the volunteers were unaware of the name of the medicine being studied and that test vials were indistinguishable from each other.

The idea of blinding was thus applied in homoeopathic circles as early as the 19^th Century and was considered as routine procedure even in some early homoeopathic provings (Kaptchuk, 1996:239).

Meditative and Dream-provings

[Madeline Evans]

In a meditation "proving" the prover holds a vial of the remedy and meditates upon the substance and then reports his/her "images”.

In a dream "proving" the prover is given the remedy (or sometimes just puts it under their pillow) and reports the content of their dreams for that night or a few nights. Meditation provings have been around a long time. Until Jeremy Sherr did a proving of adamas (Diamond), the only proving information about diamond was developed by Berhardt Fincke in an "Inductive Proving" when he had some very sensitive people hold a diamond or a 5M potency and then report their sensations-- this was in 1898.

Proving

A translation of the German ‘Prüfung’, meaning test or examination (Gaier, 1991:390). It is the systematic procedure of determining the medicinal or curative properties of a substance (either in crude form or in potency) on healthy human beings (Vithoulkas, 2002:96).

The scientific process whereby the medicinal properties of a homoeopathic remedy are established by administering the remedy to provers who report any morbid symptoms elicited. These symptoms are collated and recorded in a materia medica (Yasgur, 2004)

Non-traditional provings

For the purposes of this research, non-traditional provings include methods such as dream, meditation and C4 provings which do not require a remedy to be taken orally.

Historical Perspectives of Provings

The principle of „similia similibus curentur‟ can be noted as far back as Hippocrates‟ times (460: 350 BC), where he wrote “By like things a disease is produced and through the application of the like

it is cured” (Cook, 1989:1, W alach, 1993:129).

Galen (b:129 - 200 A.D) was an allopath who insisted that all drug trials be tested on both healthy and sick individuals, and Paracelsus (b: 1493 A.D) observed the effects of substances on healthy

individuals in order to determine their therapeutic properties (Cook, 1989:1). Hence it can be noted that the concept of provings has existed for many years before Hahnemann.

The term, as used in this research, refers to the proving method developed by Hahnemann and followed by his successors, in which doses of a remedy are taken orally.

Traditional provings are taken to include refinements to Hahnemannian methods introduced by Sherr, including placebo controls and blinding of participants, but to exclude methods such as dream,

meditation and C4 provings.

Hahnemann proved nearly a hundred remedies upon their similar illnesses during his life time (Vithoulkas, 1998:95). A proving is a systematic process of administering substances to healthy individuals, in order to learn the alterations, signs and symptoms of the action of the substance upon an individual (O’ Reilly, 1996:144). Human beings are the preferred subjects for provings because symptoms in the mental and emotional planes are required, which cannot be obtained from animals or plants.

When a proving substance is administered, it stimulates the organism and its defence system to produce mental, physical, general and peculiar symptoms.

These symptoms represent the specific manifestations of the defence system (Vithoulkas, 1998:97).

Similarly, when the symptoms of a patient are recorded, the specific manifestations of the defence system are recorded (Vithoulkas, 1998:144). By matching the symptom of the remedy to the symptoms of the patient, a patient’s symptoms can be alleviated or cured (Vithoulkas, 1 998:96). Therefore, provings reveal invaluable, precise and accurate knowledge of a substance through the actual experience of a prover (Sherr, 1994:4).

Proving Methodologies

Although Hahnemann‟s experiments yielded reliable results his proving methodology would not be seen as reliable by modern standards for clinical trials (Wieland, 1997:229).

Hahnemann used a group of 64 provers, all of whom received the proving substance and none of whom formed a placebo control group.

Since Hahnemann initiated homoeopathic drug provings vast improvements have been made by incorporating scientific research methods which are used today, namely placebo controls , randomisation, blinding, double blind and cross-over experimental designs (Webster, 2002:9). The principles of blinding and double blinding were initially introduced by Gerstel during the proving of Aconitum napellus, and by Bellows whilst he was reproving Atropa belladonna (Demarque, 1987). Blinding implies that the provers are unaware of the proving substance that they will be taking.

Double blinding implies that there is a placebo control, the provers are unaware of the nature of the proving substance although it is known to the observer, and the observer does not know which of the provers have received the proving substance and which have received placebo.

The treble blind design was introduced by Raeside (1972) in which there is a placebo group, the researcher and the provers are blinded, and the proving substance remains unknown to both the researcher and the provers.

The treble blind method is used extensively by both Riley (1995) and Sherr (1994).

George Vithoulkas (1980) published “The Science of Homoeopathy”, wherein he spoke extensively about the proving process. He describes a pain staking method which would involve an expensive and very time - consuming exercise!

To note a few of these methods: Vithoulkas insists on at least one month’s pre-proving journaling; a proving observation period of at least 3 months; conducting the proving in low potency, later in higher potency, and then still later in an even higher potency.

Vithoulkas also believes it to be most beneficial to conduct the proving in the form of three separate experiments, in three separate locations, on three different nationalities (Vithoulkas, 1986:150 - 152). Very few could ever conduct such a proving!

In 1994 Sherr published “The Dynamics and Methodology of Provings” that up until now has contributed greatly to homoeopathic provings worldwide.

Seminar provings

[Jan Scholten]

Every art has only a few principles and has many techniques” Dale Carnegie

What are provings?

1. Remedy

The remedy, or any other influence, is the signal. The signal has to be strong enough to be received. In provings the signal can be made stronger in several ways. One obvious way is to give the remedy in a crude form, as is done in intoxications. This has the danger of overloading and ruining some parts of the receiver, it makes the prover ill.

2. Prover sensitivity

Sherr stresses the importance of sensitive provers in the proving: “One sensitive prover can make a whole proving, bringing to light the most profound aspects of the remedy in a most beautiful way” and “Often the most important proving symptoms are brought mainly by one or two sensitive provers, the others serving to fill out the bulk of common symptoms.” One 'master prover' in his provings has been crucial; some provings only made sense after she joined in again.

Another way to amplify the result of the proving is to involve many provers. Many provers can receive more information than one and different aspects of the remedy. Another way is to repeat the provings, in different times and circumstances, with different provers and in different cultures. This aspect will also be discussed below in the 'Prover attention'.

3. Prover attention

The attention of the prover is crucial. The attention of the prover can be compared with the tuning of the receiver. A radio receiver will only amplify what it’s attuned to; other senders will not be amplified and heard. When the attention of the prover is not focused on the remedy, all kinds of other influences can present during the proving. It’s like a receiver that has to be tuned to the right signal. Hahnemann was already very much aware of this fact, as he shows in Ã‚Â§ 126 of the Organon: “During the whole time of the experiment he (the prover) must avoid all overexertion of mind and body, all sorts of dissipation and disturbing passions. He should have no urgent business to distract his attention. He must devote himself to careful self-observation and not be disturbed while so engaged.”

There are several techniques to enhance the attention of the prover. Frequent talks with a supervisor are a good help and according to Sherr indispensable. Another technique is meditation. Then, almost all the attention is directed to the remedy, although it’s by no means a guarantee that other influences will not come in.

A nice example is a proving by Sankaran of Ferrum metallicum. Many provers were dreaming about marriage, but it was not because Ferrum as such has anything to do with marriage, but that the symptom “being forced to” of Ferrum is connected to marriage in the Indian culture.

Disturbances

Disturbances can be seen as the consequence of being out of tune, or being attuned to something else, other than the remedy we want to “measure”. Several kinds of disturbance can be recognized:

1. Event disturbances.

One of the problems is to discern if the event belongs to the remedy or not, if it’s accidental or synchronicity. There’s no way beforehand to know for sure which of the two is the case.

2. Personal disturbance

Group states can also be of influence. An example is the proving by JÃƒÂ¼rgen Becker of Ferrum phosphoricum, which produced the symptoms of transvestism. In my experience that symptom doesn't belong to that remedy. I haven’t seen it in my own and other homeopaths' cases and it doesn't fit in with the Element theory.

Every prover brings with him a lot of themes. They can arise from himself, but can also arise in these cases from his family, the group that he works in, his culture or the history of the world.

It’s hardly possible to discern during the proving whether symptoms belong to the remedy or not. Even when a symptom is typical of the prover it might be that the remedy has that symptom too and that might be the reason it could be triggered so easily.

Conclusion

Provings have only a few principles: remedy, prover sensitivity and prover attention. This leads to many techniques such as intoxications, full provings, dream provings and meditation provings. In each of these, many variations or completely new forms can be designed. Examples are bath provings (dissolving an essential oil of a plant in a bath and sit in it), image provings (looking at a plant or an image of it and meditating on it), thought provings.

None of them can guarantee complete and accurate results. Some homeopaths have the idea that dream or meditation provings cannot give correct results. All provings have advantages and disadvantages and I’ve placed some of them in the table below.

When used with care, the information in meditation provings can be and has been very helpful in the development of the remedy pictures. I publish them so that the reader can have a fuller picture of that development.

Table 1

5.1 GROUP 1 - C4 PROVING METHODOLOGY

The C4 proving methodology was the second most effective methodology in eliciting symptoms during the proving process. It yielded 841 out of the total number of rubrics (1.373) elicited during the study, which amounts to 61%. It also yielded significantly more symptoms than the placebo portion of Group two, proving that symptoms can be elicited during a proving in the absence of the administration of repeated oral doses.

Reasonable reproducibility can be observed when applying this methodology, reflected in low odds ratios. It is interesting to note that the majority (nine of the top 10) of the chapters that reflected a high reproducibility in Table 6 were also those that yielded missing results when calculating the odds ratio observable in Table 7. This was mostly due to the fact that the rubrics did not occur at all in either year for nine of the 14 chapters. This emphasises the fact that the high reproducibility in these chapters were based on the absence of all the rubrics in the chapter rather than their presence.

As expected, the similarity of rubric occurrence at a particular rubric level, as illustrated in Table 4, is the highest at main rubric level in this group, diminishing when it gets to sub-rubric and sub-sub-rubric levels, where there is a greater chance of variation due to the specificity of the symptoms.

Table 5 also reflected that symptoms were more likely to occur in 2009 when applying the C4 proving methodology. This is despite the fact that more of the participants in 2008 underwent the Lac humanum trituration sensitisation process. The higher likelihood of symptoms occurring in 2009 can thus not be attributed to the sensitisation process. This phenomenon is most likely due to the presence of four provers that form part of a regular C4 trituration group, thus having developed a group dynamic and resonance. This leads to the conclusion that this methodology would be most effective if the process is carried out by experienced provers who have worked together on provings for a longer period of time.

Despite this tendency of rubrics to occur more likely in 2009, it is observable, as illustrated in Table 10 that significant differences can only be found to exist between the 2008 and 2009 data in seven of the 38 chapters, namely Chest, Dreams, Generals, Mind, Mouth, Stomach and Throat. All of these chapters contain large numbers of rubrics and the significant differences observed can be attributed to the difference in the individual prover susceptibility between the two years. It also insinuates that these chapters show the largest variability within the methodology and may prove to be a weakness in the C4 methodology.

When studying the odds ratios regarding the likelihood of a rubric occurring in Group one, it can be noted that rubrics were more likely to occur than not, as illustrated in Table 12. This indicates the effectiveness of the C4 trituration methodology in producing symptoms, negating Dellmour‘s (1998) misgivings about the methodology. It also brings Herscu‘s (2002) belief that provers only produce symptoms upon oral administration of the remedy into question. Whether these symptoms have a particular chapter affinity is important to investigate. In section 5.4 a chapter by chapter analysis of the results obtained when studying the data obtained in each group can be found. This analysis strives to investigate whether symptoms belonging to certain chapters have a greater likelihood to be elicited when applying the C4 Chapter 5 Page | 168

methodology than others. This would ensure that, when developing the integrated methodology, every effort is made to ensure the combination of methodologies that would yield an overview of the symptoms totality without the exclusion of certain types of symptom.

It is interesting to note that all the symptoms Hogeland and Scriebman (2008) mentions as commonly occurring during C4 provings (spacey or drugged feelings, itchiness of eyes, nose and skin and time distortions) occurred not only during the C4 component of the trial, but also during the subsequent Sherr and Dream proving stages. For that reason, they were not excluded in the final symptoms list, but verified as belonging to the proving of Protea cynaroides.

5.2 GROUP 2 - SHERR PROVING METHODOLOGY

The Sherr proving methodology consisted of 30 provers, 20 of whom were dispensed verum powders and 10 placebo powders. The dose was repeated three times per day for a maximum of two days in the 30th potency and discontinued when proving symptoms developed.

In order to discuss the results, the group needs to be divided into those who received the active proving substance and those who received the inactive powders. This would facilitate the inquest into the effectiveness of the verum group as well as its relative effectiveness to the placebo group.

5.2.1 Verum Group

The verum portion Sherr proving methodology proved to be the most effective methodology in eliciting symptoms during the proving process. It yielded 63% of the rubrics (868 out of 1 373). In comparing the verum and placebo groups of Group two it is evident that the verum portion yielded significantly more symptoms than the placebo portion, which yielded only 28%.

Of the three groups, Group two reflects the lowest reproducibility, due to the large range observed in the odds ratio values. In contrast to Group one, however, only one of the top 10 chapters that reflected a high reproducibility in Table 6 yielded missing results when calculating the odds ratio observable in Table 7. Out of all 38 chapters, only one did not yield symptoms in both years. The apparent low reproducibility of this group is thus due to the high incidence of rubrics, in one or both years.

It is yet again observable in Table 4 that the similarity of rubric occurrence at a rubric level is the highest at main rubric level in this group, diminishing when it gets to sub-rubric and reaching its lowest level at the sub-sub-rubric levels, where there is a greater chance of variation due to the specificity of the symptoms. The values are lower than those observed in both Groups one and three due to the high incidence of rubrics in this group.

It is evident from Table 5 that symptoms were more likely to occur in 2008 when applying the Sherr proving methodology. A possible explanation for this phenomenon is that the majority of provers in 2008 were senior homoeopathic students (four) and homoeopathic practitioners (three), where in 2009 the majority were undergraduate homoeopathic students (five). This may indicate that provers with more homoeopathic experience should be favoured. On the other hand, this variation may have occurred due to the difference in prover sensitivity and susceptibility to the substance. The sensitivity is evident in the fact that three verum provers received an antidote in 2008 compared to two in 2009.

Despite this tendency of rubrics to more likely occur in 2009, it is observable, as illustrated in Table 10, that significant differences can only be found to exist between the 2008 and 2009 data in seven of the 38 chapters, namely Chest, Dreams, Extremities, Generals, Rectum, Stomach and Teeth. Four of these chapters are the same as those reflecting significant differences in Group one 2008 and 2009 comparisons. All but one of these chapters, Teeth, contains large numbers of rubrics and the significant differences observed can be attributed to the difference in the individual prover susceptibility between the two years. The high incidence of symptoms elicited during the application of this methodology increases the likelihood of variation between provers. The reproducibility of the symptoms is thus sacrificed in favour of larger numbers of rubrics produced.

When studying the odds ratios presented in Table 12, it is evident that rubrics were more likely to be elicited when applying this methodology than of being absent. The chapter affinity of this methodology would be analysed in section 5.4.

Placebo Group

As discussed in Chapter two, Rosenbaum et al. (2006) feel that the symptoms elicited in the placebo group differ from that in the verum group by being vaguer descriptions of symptoms, lacking specificity. In discussing and analysing this section, it is thus important to compare and contrast the quality of the symptoms produced in the placebo group in order to ascertain the relative effectiveness of the active methodology compared to its placebo counterpart.

The placebo section was the least effective in producing symptoms during the proving process. It yielded 388 of the total 1.373 rubrics (28%). As mentioned in 5.2.1, it is evident that the verum portion yielded significantly more symptoms than the placebo portion.

When studying the odds ratios regarding the likelihood of a rubric occurring in the placebo section of Group two, it is evident that rubrics are more likely to be absent. The tendency to be absent

is also more pronounced than in Group two, leading to the conclusion that the active proving substance does yield more symptoms than the placebo.

In utilising a placebo, prover confidence also decreased, as illustrated during the proving of Protea cynaroides. Provers made observations like:

I thought after the proving that I wasn‘t on the substance at all, but then I read over my diary this morning and suddenly I thought, “Why did I think I wasn‘t?” I had a lot of symptoms, but they... I don‘t know why but I kept thinking that there was another cause for them. and I am also making myself remember that this could be placebo so I mustn‘t get too neurotic as that would be embarrassing.

The threat of placebo could cause provers not to report strange symptoms due to fear of embarrassment. This self-consciousness also could lead to provers not participating in future provings due to the fear of looking foolish.

In section 5.4 a chapter by chapter analysis of the results obtained when studying the data obtained in each group can be found. This would strive to investigate whether certain chapters have a greater likelihood to be elicited in placebo provers. The fact that a small%age of proving symptoms were experienced by placebo provers, indicated that both Norland‘s (1999) and Sankaran‘s (1995) observations regarding the group phenomena ringing true for this proving. This leads the researcher to concur with Jansen‘s (2008) recommendation that prover‘s symptoms should be compared with their own pre-proving baseline observations, thus negating the necessity of placebo prover inclusion in the sample group.

5.3 GROUP 3 - DREAM PROVING METHODOLOGY

The Dream proving methodology was the least effective of the verum methodologies in eliciting symptoms during the proving process. It yielded a mere 42% of the rubrics, representing 579 of the total 1 373 rubric elicited during the study. This methodology yielded only marginally (14%) more symptoms than the placebo portion of Group two, bringing into question the timing and frequency of doses needed to elicit a proving response, as only three doses were administered 24 hours apart in Group three, compared to six doses in 48 hours administered in Group two. The fact that this methodology produced the least number of symptoms through its application, supports Sherr‘s (1994: 16-7) observation that they are partial proving, thus not eliciting the full complement of symptoms.

High reproducibility can be observed when applying this methodology, with only an eight% variation between the 2008 and 2009 data reflected in Table 5. The odds ratio has a range of 0.166 to 6.515, which is larger than that in Group one, but smaller than that in Group two. A large proportion (seven of the top 10) of the chapters that reflected a high reproducibility in Table 6 were also those that yielded missing results when calculating the odds ratio observable in Table 7. This was mostly due to the fact that the rubrics did not occur at all in either year in six of the 14 chapters.

This emphasises the fact that the high reproducibility in these chapters were based on the absence of all the rubrics in the chapter rather than their presence.

A strange trend is observable in Table 4 regarding the similarity of rubric occurrence at a rubric level. This is expected to be the highest at main rubric level in this group, diminishing when it gets to sub-rubric and sub-sub-rubric levels, but in this group it is highest at the sub-sub-rubric level and diminishes as it moves up to the main rubric level. The highest incidence of congruency between the years can be seen at the sub-rubric level where 1.184 of the 1.373 rubrics are identical. This is due to the absence of the rubric in both years as opposed to the rubric‘s presence in 2008 and 2009.

Table 5 also reflects that symptoms are more likely to occur in 2008 than in 2009. A difference in prover experience cannot explain this trend, though, as the majority of provers in 2008 were members of the public (50%). In 2009 the majority of provers were senior students (60%) and based on the conclusion drawn in 5.2.1 one would expect a higher likelihood of symptoms to emerge in 2009. One possible explanation is that the provers in 2008 may have been more familiar with the process, because 40% of the 2008 provers have participated in a proving before compared to 30% in 2009. Another explanation could lie in prover sensitivity to the verum powders. If the provers were not susceptible to the remedy, it could explain the low number of symptoms elicited. The third possible reason can lie in the posology of the remedy employed. A larger number of doses more frequently would lead to the development of more intense symptoms, thus increasing the likelihood of symptom development.

Despite this tendency of rubrics to more likely occur in 2008, it is observable, as illustrated in Table 10, that significant differences can only be found to exist between the 2008 and 2009 data in seven of the 38 chapters, namely Chest, Generals, Mind, Mouth, Nose, Rectum and Throat. All of these chapters contain large numbers of rubrics and the significant differences observed can be attributed to the difference in the individual prover susceptibility between the two years. In this case it also insinuates that these chapters show the largest incidence of rubrics within the group, hence allowing for variability that would not exist if the rubrics were absent. This will be evident

in the chapter by chapter analysis presented in section 5.4.

2.1.4.4 C4 Trituration provings

The C4 trituration provings are carried out in groups during a trituration process where the trituration is carried out by hand. Provers grinding the proving substance experience the symptoms of the remedy although the identity of the substance is kept hidden (Hogeland and Schriebman, 2008). A recent C4 trituration proving of the Protea cynaroides by Botha (2010) was conducted at the Durban University of Technology. Botha (2010) gathered clear and verified data in this trituration proving so as to evaluate the effectiveness of the methodologies employed during the trituration.

Randomised controlled trials (RCT) and provings

statistical significance. The key components of a RCT is the double blinding, placebo control and crossover technique (Dantas, 1996).

probable pathogenetic effects can be properly associated with the presence of the original substance in the preparation. Placebo control is accomplished by administering a dose of the placebo

which is identical to the verum, in both gustatory and visual sense, to a percentage of the placebo group thus to accurately evaluate which symptoms are produced due to the verum or the

placebo.

Sherr (1994:37) believes that the placebo has three major benefits:

1. It distinguishes the pharmacodynamic effects of a drug from the psychological effects of the drug itself.

2. It distinguishes the drug effects from the fluctuations in disease that occur with time and other external factors.

3. It avoids „false negative‟ conclusions i.e. the use of placebo tests the efficacy of the trial itself.

Vithoulkas (1998) states that the double blinding or masking technique ensures that the codes identifying the verum and placebo groups remain hidden from both the researcher and the provers.

control, double blinding and crossover.

[Jan Scholten]

Table 1

Vorwort/Suchen Zeichen/Abkürzungen Impressum