Prüfungen in der Homöopathie.
Vergleich: Siehe: Provings + Vergleich traditionelle Prüfungen von Borax mit Verreibungsprüfung von Borax + Integrated methodology: C4, Sherr and Dream provings of Protea cynaroides
[Dr. P. Strub, Dr. P. Mattmann, Dr. B. Bichsel]
Für die Verschreibung eines homöopathischen Medikamentes ist nach den Regeln der Homöopathie die Ähnlichkeit zwischen Krankheitsbild und dem Arzneimittelbild maßgebend. Ähnlichkeit bezeichnet die Übereinstimmung im Wesen, die anhand von charakteristischen, eigenheitlichen und besonderen Symptomen gefunden wird.
In homöopathischen Kreisen wird zwar immer wieder darüber gestritten, ob das Arzneimittelbild neben der Symptomenreihe seine Berechtigung habe und vor allem, ob das Arzneimittelbild „hahnemannkonform“ sei oder nicht. Er selber spricht zwar im Organon öfters von Krankheitsbildern und dem Aufsuchen von ähnlichen Gegenbildern in der Materia medica, nie aber explizit von Arzneimittelbildern. Wie auch immer Hahnemanns Auffassung darüber gewesen sein mag, wer den Begriff “Ähnlichkeit” ernst nimmt und zwischen “ähnlich” und “gleich” so wie auch zwischen “Bild” und “Abbild” zu unterscheiden weiß, der wird einsehen, dass die Homöopathie nicht ohne Arzneimittelbilder ausgeübt werden kann. Unbestritten bleibt meist auch, dass die Homöopathie einer phänomenologischen Betrachtungsweise entspricht. So hat die Einsicht, dass eine Ähnlichkeit nur zwischen Bildern gefunden werden kann, immer wieder Homöopathen dazu motiviert, die gegebenen Symptomenreihen zu einem allgemein gültigen Bild zu beleben.
Die meisten zeitgenössischen HomöopathInnen arbeiten mit sog. „Essenzen“, die das Wesen der Arznei zu beschreiben versuchen. Für die phänomenologische Betrachtung ist die philosophische Frage, ob einer Substanz ein Wesen zukommt, d.h. ob sie Bedeutung und Sinn hat, müßig, denn hier gibt es erkenntnistheoretisch keine vom Subjekt unabhängige objektive Welt. Diese entsteht allein im Bewusstsein des erkennenden Subjekts, das stets intentional ist, d.h. auf einen äußeren oder inneren Gegenstand ausgerichtet ist. Wir können die Dinge gar nicht erkennen, ohne ihnen eine Bedeutung, einen Sinn zu geben.
Gespräche unter dem Eichenbaum am Seminarort
So suchen die meisten Autoren aus der Fülle der Symptome die -von ihrer Sicht aus- “auffälligsten, sonderlichsten, usw.” Symptome auf, um von diesem Standpunkte aus, die übrigen darum herum in Themen zu ordnen und zu interpretieren. Dabei ergibt sich meist ein einleuchtendes Bild, sofern man gewillt ist, den Standpunkt des Autors einzunehmen. Doch nur schon die Bildung von Themen ist ein heikler Versuch, im Chaos der Symptome Ordnung zu schaffen, denn das Ordnen setzt eigentlich schon die Übersicht voraus, durch die dieses Ordnen eben erst ermöglicht werden sollte. Hier besteht die große Versuchung, dass der Mensch sich gerne auf unbewusste Themen stützt, die ihm nahe stehen (“Lieblingsthemen”). So findet jeder Autor seine eigenen Themen wieder, auf denen er sein Gedankengebäude aufbauen kann.
Die Feststellung, dass von ein und derselben Substanz viele, oft sehr verschiedene Arzneimittelbilder entworfen werden können, sollte jedoch eine Aufforderung sein, die Methodik zu hinterfragen, denn ein eindeutiges und allgemein gültiges Bild darf nicht vom Standpunkt eines Autors abhängen, sondern einzig von der Substanz selber. Es muss also eine Methode gefordert werden, die die Symptomenreihe eines Arzneimittels nach der Wirklichkeit der Substanz ordnet.
Die Arzneimittelbild-Forschung, die vom argentinischen Homöopathen Dr. Alfonso Masi-Elizalde entwickelt wurde, war eine Antwort auf diese unbefriedigende Situation. Masi bezeichnete die heutige Homöopathie als ein „nouveau-né“, ein Neugeborenes: Die Methode steckt noch in den Anfängen. Wir kennen zu wenige Arzneien ihrem genauen Wesen nach. Masi beschäftigte sich auch mit weniger bekannten Mitteln (Oligochresten) und entwickelte eine wissenschaftliche Methode, um -jenseits tradierter Arzneimittelbilder und Essenzen- zu einem neuen Verständnis des Wesens
der erforschten Arzneien zu gelangen.
Die wichtigsten Elemente dieser Methode sind: Rückkehr zu den Quellen (Wortlaut der Arzneimittelprüfungssymptome), Themenbildung abgeleitet aus der Gesamtheit aller Prüfungssymptome, Beizug von Symbolik, Wissen über die Substanz, Linguistik usw., Essenzbildung mittels der scholastischen Philosophie des Thomas von Aquin und der Theorie der Primärpsora, die auf der Idee
eines spirituellen Mangels beruht.
Seminarteilnehmer / Kalium carb. / Febr. 2007
Die frühere Zürcher Masi-Gruppe, die sich neu „Interessengemeinschaft Homöopathie und Geisteswissenschaftlich erweiterte Hausarztmedizin“ nannte, wandelte die Methodik von Masi in zwei Punkten ab:
Die spekulative Hypothese von der Primärpsora wurde aufgegeben. Es war wenig plausibel, dass die Arzneien ihre Heilwirkung basierend auf einem spirituellen Defizit entfalten sollen. Von nun an betrachtete die Gruppe das Bild jeder Arznei als ein in sich vollkommenes Wesen. Wir versuchten von den negativ gefärbten Beschreibungen, wie sie in tradierten Arzneimittellehren nachzulesen sind, wegzukommen und positive Formulierungen zu finden. Zudem zeigte es sich, dass eine Methode, bei der die Betrachtung und das Erleben der Substanz in der Gruppe ins Zentrum gerückt wird, den Zugang zu den erforschten Arzneien öffnete, auch dort, wo dieser früher verschlossen geblieben war.
Im September 2006 veranstaltete die IG ein Theorie- und Methodik-Seminar in der Toscana. Das Ziel dieses Seminars war es, Klarheit über methodologische Probleme zu schaffen und die Ausformulierung der Methode zu realisieren. Dabei erkannten wir, dass die Methode, die wir ohne methodologisch-philosophische Reflexion in den Seminarien von 1997 bis 2006 entwickelt haben, in der phänomenologischen Philosophie exakt beschrieben wird.
Phänomenologie lässt sich kurz wie folgt zusammenfassen:
Es ist der Versuch, Zugang zu einer Sache zu bekommen,
– indem die Forschenden vom unmittelbar Gegebenen (Erscheinenden) ausgehen
– ihre Subjektivität miteinbeziehen
– sich Vorurteilen enthalten
– die imaginative Variation anwenden (Beobachtung auf verschiedenen Ebenen und aus verschiedener Perspektive)
– das Wesen einer Sache beschreiben oder erklären.
Die Erfahrungen aus unserer langjährigen Arzneimittelforschung zeigen, dass eine Substanz sich auf drei verschiedenen Ebenen ausdrücken kann: auf der Ebene der Substanz, auf der Ebene der Wirkung auf den Menschen und auf der Ebene der Symbolik und anderen Überlieferungen. Die dabei wahrnehmbaren Erscheinungen dieser drei Ebenen sind untereinander kohärent, entziehen sich aber jeder causalen Erklärung. Die in unserer Arbeit verwendeten Ebenen sind folgende: die Ebene der Substanz (chemische und physikalische Eigenschaften, Botanik, Zoologie); die Ebene der Arzneimittelprüfungen (Symptome beim Menschen); die Ebene des geisteswissenschaftlichen Materiales (Synonyma, Etymologie, Mythen und Geschichten). Man vergleiche dazu den Anhang über das praktische Vorgehen bei der Arzneimittelforschung.
Die Wichtigkeit der Betrachtung der drei Ebenen wird u.a. durch die nachfolgenden Gedanken zur Bedeutung der Symptome erklärt. Die Symptome einer Arzneimittelprüfung sind Reaktionen der menschlichen Lebenskraft, die offensichtlich nicht nur in verschiedenen Bereichen wirkt (z.B. Wachstum, Fortpflanzung, Gefühlsbildung u.a.), sondern zusätzlich auch individuell verschieden reagieren kann (mit Tumorbildung oder Entzündung, Destruktion, Depression, Aggression usw.), so dass ein bestimmter Reiz auf die Lebenskraft eine unüberblickbare Fülle von verschiedenen Symptomen der menschlichen Pathologie bewirken kann und umgekehrt ein bestimmtes Symptom von den unterschiedlichsten Substanzen erzeugt werden kann. Der Schluss ist nahe liegend, dass die Ordnung nicht in den Symptomen gefunden werden kann und dass die Symptome eigentlich nur interpretiert und eingeordnet werden können, wenn das Wesen der Arznei bereits erkannt wurde.
Ein weiteres Problem der Symptome liegt darin, dass Symptome meist nur eine Pathologie ausdrücken. Die philosophische Erkenntnis, dass das Böse (Pathologie) lediglich ein Mangel an Gutem (Gesundheit) ist, macht deutlich, dass die Pathologie allein nicht geeignet ist, das Wesen einer Arznei zu beschreiben. Das Arzneimittelbild muss vielmehr als Teilaspekt der Gesundheit verstanden werden können, so wie die Substanz selber ja auch ein „Sein“ und nicht ein „Mangel“ auf Erden ist.
Zur Überwindung dieser eben geschilderten Schwierigkeiten haben sich während unserer Arbeit folgende methodische Ansätze bewährt, die im Wesentlichen den Forderungen der phänomenologischen Forschung entsprechen.
1. Die Erscheinungen einer Substanz auf den drei Ebenen werden als gleichwertige Informationen betrachtet und gleichzeitig betrachtet.
2. Das Ordnen der gesammelten Symptome, Signaturen und Überlieferungen zu Themen muss als Gruppenprozess durchgeführt werden. Dadurch kann die Ebene des subjektiven Erlebens multipliziert werden, was zusätzliche Schnittstellen der Variation ergibt.
Die Zusammenarbeit in der Gruppe von mehreren Menschen hat sich bei der Erforschung eines Arzneimittels in vielen Beziehungen als besonders fruchtbar erwiesen. Die Gemeinschaft hat ihrem Wesen nach die Möglichkeit, individuelle Lieblingsthemen, Anschauungen und Meinungen (blinder Fleck) zu hinterfragen und nötigenfalls immer wieder aufzulösen. Die erneute Formulierung muss dann allerdings wieder vom einzelnen Menschen vorgenommen werden, so dass in der Gruppe ein Gleichgewicht der Gemeinschaft und Individualität angestrebt werden muss.
Die Gruppenarbeit hat zudem deutlich gemacht, dass es in der Forschung unabdingbar ist, sich auf klar definierte Grundlagen beziehen zu können. Dazu gehören nicht nur die Definitionen der Begriffe, sondern auch die eines Menschen- und Weltbildes. Die Erkenntnis, dass die Symptome nicht nur in sich auf körperlicher, seelischer und geistiger Ebene beim Menschen, sondern auch mit den Signaturen (der Minerale, Pflanzen und Tiere) in der Natur kohärent sind, legt ein Welt- und Menschenbild nahe, in dem die Substanz ein Teil des Menschen darstellt. So haben die bisher erforschten Arzneimittel immer einen ganz bestimmten Aspekt des menschlichen Daseins dargestellt, eine Voraussetzung, die beim Menschen erfüllt sein muss. Die Substanz selber verkörpert diesen Aspekt in vollkommener Art und Weise; der kranke Mensch drückt ihn als Gesundheit oder als Pathologie aus.
3. Das intuitive Denken erhält neben dem kausal-analytischen Denken gleichwertigen Raum. Abhängig vom Wesen eines Bildes und im Unterschied zum Gegenstand erfolgt das Erkennen des Arzneimittelbildes nicht linear entlang der gefundenen Fakten, sondern ist geprägt von einem stetigen Wechsel zwischen Erfassen und Auflösen, einem Ausformulieren und Verwerfen des angestrebten Bildes. Auch hier hält die Gruppe von verschiedenen Menschen den Prozess in Gang. Für das Verständnis dieses Prozesses kann auf die Monographie über das Kochsalz (Natrium muriaticum) verwiesen werden, denn es entspricht dem “solve et coagula”, dem fortschreitenden Prozess von Auflösen und Ordnen. Hier zeigt sich auch deutlich das Grundproblem jedes konkreten Festhaltens und Ausformulierens eines Wesenhaften: Der Begriff ist beschränkt und entspricht nur der halben Wahrheit, jedoch ohne Begriff kann das Wesen nicht erfasst und vermittelt werden.
Das Wesen kann nicht in einem gemeinsamen, auf einem Gruppenkonsens beruhenden Text beschrieben werden, weil es auf dem intentionalen Bewusstseinsakt eines jeden einzelnen Subjektes basiert. Worüber jedoch sinnvollerweise ein Konsens erzielt wird, sind die Themengruppen. Sie legen ein grobes Rohmuster, von dem aus die einzelnen Forschenden ihre individuelle Wesensbeschreibung herleiten können. Aus diesen Gründen wird auf eine zusammenfassende Ausformulierung des Wesens innerhalb der Gruppe verzichtet und die einzelnen Berichte nebeneinander stehen gelassen.
Praktisches Vorgehen bei der Arzneimittelforschung
1. Erste Begegnung mit der Substanz
Aufsuchen der Substanz (falls möglich in der Natur)
Betrachtung der Substanz
Beschreibung der Substanz
Genaue Beschreibung und Herkunft der für die Verreibung verwendeten Substanz
Anschließend Verreibeprüfung mit diesem Material bis zur C3 (ev. C4).
Gemeinsames Aufschreiben des während der Verreibung Erlebten, wobei die Äußerungen unzensuriert geäußert und möglichst wörtlich aufgenommen werden.
2. Betrachtung des naturwissenschaftlichen Materiales (Materia physica)
Vorkommen, Morphologie, Stellung in der Evolution, Verhalten, physikalisch-chemische Eigenschaften, Verwendung usw.
Auffälliges, Spezielles, Individuelles der Substanz erfassen und diese Stichworte in der Themenliste der Materia physica festhalten
3. Betrachtung des geisteswissenschaftlichen Materiales
Namen der Substanz und deren jeweilige Bedeutung, Mythologie, andere Geschichten oder Überlieferungen, Sprichworte, Bibelzitate, Symbole und deren Bedeutung, alchemistische Betrachtung usw.
Erstellen der geisteswissenschaftlichen Themenliste mittels der auffälligen Begriffe
4. Erstellen der Themenliste der Materia medica
Protokoll der Verreibeprüfung
Themen aus bekannten homöopathischen Arzneimittelprüfungen
Andere medizinische Quellen
Erstellen der Themenliste der Materia medica aus den medizinisch-toxikologischen Quellen
5. Bildung der Themengruppen
Die Themengruppen werden aus dem naturwissenschaftlichen und geisteswissenschaftlichen Material und aus der Themenliste der Materia medica erstellt.
Eine Themengruppe ist eine Zusammenfassung von Themen, welche in sich wesensverwandt sind. Die Erstellung des Zusammenhanges muss unvoreingenommen und im Konsens der ganzen Gruppe erfolgen.
Versuch, die einzelnen Themengruppen miteinander zu verbinden im „Solve et coagula“-Prozess. Stehenlassen der Betrachtungen der einzelnen Teilnehmer nebeneinander. Die Synthese sollte dem Leser ermöglichen, den erlebten Prozess in der Gruppe nachvollziehen zu können.
[Lize de la Rouvière]
CHAPTER TWO Review of the related literature
2.1.1 Introduction Provings may be defined as: „..clinical trials designed to investigate the effects of the exposure of human volunteers, in good health, to potentially toxic or pathogenetic substances, diluted and serially agitated according to homeopathic pharmacopoeial methods, with a view to providing data to inform their use as homeopathic substances.’ (Dantas, Fisher, Walach, Wieland, Rastogi, Teixeira, Koster, Jansen, Eizayaga, Alvarez, Marim, Belon and Weckx, 2007a:5) Riley puts it more simply: „In a homeopathic drug proving a homeopathically prepared substance is administered to healthy volunteers in order to produce the symptoms specific to that substance and thereby reveal its inherent curative powers”. (Riley, 2007:231) The symptoms so produced create
a particular symptom complex unique to that substance which forms the basis for the prescription of that substance to patients in accordance with one of the fundamental tenets of homeopathy:
„Let like be cured by likes”. This method of ascertaining the medicinal value of a substance was discovered and developed by the German physician, Dr. Samuel Hahnemann, in 1790 (Morrel, 2006). Hahnemann termed the process of administering the substance to healthy individuals, and the recording of the subsequent symptom complex, a „Prűfung” meaning test or assay (Gaier, 1991), which was transliterated to the English proving. Scholten (2007) explains the double meaning of the word „prove”: one is to prove, to establish a fact; the other, to experiment or test.
Provings aim to „produce valid and useful data concerning the subjective and objective changes’ (Dantas, 1996:230) that any substance produces in healthy volunteers.
H. (1982) clearly explains in aphorisms 21 and 101 of the Organon, the
medicinal power of a substance cannot be determined by a priori speculation, or
by analysing the substance grossly or chemically, but only through provings.
Sherr (1994:7) states that the use of the doctrine of signatures and
toxicological data also cannot substitute for the precise information obtained
from provings. If a substance is given in toxic doses, the symptoms produced
will be too gross to be of use in homeopathic prescribing, as subtle general,
mental and emotional symptoms will be lacking (Vithoulkas, 1980:145).
2.1.2 History and development Samuel Hahnemann (1755-1843) was the first person to carry out systematic provings of drugs (Riley, 1996a). However the idea of experimenting on healthy subjects with medicinal substances was not original to Hahnemann (Morrel, 2006). Paracelsus alludes to the conducting of physiological experimentation on healthy subjects, but gives no instructions as to how this is to be conducted (Dudgeon, 2000). Albrecht von Heller expressed the idea clearly in 1771 in his Pharmacopoeia Helvetica (Morrel, 2006), and indeed, Hahnemann (1982) gives him credit for this in a footnote to the Organon. Anton Stőrk experimented on himself with pharmaceutical substances (Walach, 1994:129), and William Alexander made a proving with Camphora in 1766 (Morrel, 2006).
What differentiated Hahnemann was his systematic approach and his diligent noting down of the symptoms produced for later application to the sick (Walach, 1994). He further provided a reliable scientific basis for these experiments and developed a „comprehensive therapeutic index’ (Riley, 1996a:4). The first drug proving conducted by Hahnemann with the bark of Chincona officianalis was designed by him, not so much to study the effect of the bark on the human system, but to investigate a claim made by Cullen that Chincona was active as an anti-malarial remedy because of a bitter effect on the stomach, which Hahnemann wished to prove by experimentation on himself (Morrel, 2006). The remarkable result of this experiment was that Hahnemann produced in himself symptoms broadly similar to those of malaria. The implication of this first proving, and consequent experimentation with other substances, led to the formulation of a fundamental tenet of homeopathy: „Similia similibus curentur” - the law of similars, or, „Let like be cured by likes” (Morrel, 2006). Again it should be mentioned that Hahnemann was not the originator of this idea. In fact we notice this insight already in the work of Hippocrates, the „Father of Medicine’, who was the first to espouse the idea (Gaier, 1991:400). Paracelsus also enunciated this principle: „What makes jaundice, that also cures jaundice and all its species.’ (Dudgeon, 2000). At the time of his first breakthrough experiment in 1790, Hahnemann had spent ten years translating medical texts and doing historical research (Morrel, 2006). He must thus have been well acquainted with the teaching of Hippocrates, as well as that of Paracelsus.
While others enunciated the law of similars, no one before Hahnemann applied it therapeutically, because they had failed to adjust the dosage sufficiently (Close, 1924). Hahnemann also started by using substantially high dosages on his patients. But as these generally produced severe aggravations, he began to experiment with progressively smaller dosages by diluting the substances he administered. These, however, proved to have limited therapeutic effects. It was only when he submitted each successive dilution to vigorous shakes, that he found this increased the remedial action of the remedies (Banerjee, 1987:26). By 1805, when Hahnemann published his Fragmenta de Viribus Medicamentorum Positivus, he had proven 27 drugs fully. The Materia Medica Pura, published in 1811-13, contains the provings of 65 drugs, 66% of them different to those in the Fragmenta. His later work, The Chronic Diseases of 1829, contains 48 drugs, 60,4% of them new (Morrel, 2006). It is thus clear that Hahnemann was constantly expanding the homeopathic materia medica by conducting provings. 2.1.3 Proving methodologies Hahnemann developed the method of doing provings further, giving detailed instructions in aphorisms 121-148 of the Organon (Hahnemann, 1982). The basic rules, according to Walach (1994:129) are: the use of potentised substances, healthy provers, cessation of administration as soon as symptoms appear, and precise, verbatim documentation of symptoms. Aspects of Hahnemann’s instructions, such as dilution and posology, are, however, open to interpretation (Signorini, Lubrano, Manuele, Fagone, Vittorini, Boso, Vianello, Rebuffi, Frongia, Rocco and Pichler, 2005). Modern analysis of Hahnemann’s methods found many flaws, leading to overestimation of homeopathic drug effects (Dantas et al, 2007a). Hahnemann did not use any placebo control in his experiments. Nevertheless, the provings conducted by Hahnemann, with his insistence on reliability and rigorous scientific method, were of a high standard.
Unfortunately many provings conducted after him were of very poor quality (Fraser, 1998). Many provings conducted in the 20th century were of a less than satisfactory standard (Sherr, 1994:9).
For example, newer provings, such as those conducted by Julian, lacked detailed mental symptoms (Sherr, 1994:9). In addition, many of these provings show an enormous discrepancy in the dosage in posology applied in historical provings (Sherr, 1994). This has led to the inclusion of many unreliable symptoms in the materia medica and unfortunately there appears to be no effective system for the identification and removal of these errors (Scholten, 2007). And this, despite the importance of the validity and reliability of the information from provings for the successful use of these remedies in practise (Dantas et al, 2007a). Sherr (1994) says that in order for the materia medica to be expanded on a sound basis, one good proving is worth ten superficial ones. Mortelmans (1997:201) emphasises the importance of the reliability of information collected in provings, as prescriptions based on wrong materia medica or wrong additions in the repertory will not help the patient. Attempts have therefore been made to develop a sound standard for conducting provings (Dantas, 1996). For instance, Sankaran (1995) has set out a protocol for provings. Riley (1996a) has written an article giving clear guidelines for proving methodology, while Sherr (1994) provides possibly the best practical framework for conducting modern provings (Thomson, 2004). Dantas et al (2007a) systematically reviewed provings conducted between 1945 and 1995 in six different languages, and found that they were generally of low methodological quality, producing wide variation in methods and results. Sample size and trial duration was very variable. Most studies had serious design flaws, relating to absence of randomisation, blinding, placebo control and analysis of results. They found that trials with better methodology produced fewer pathogenetic effects. Sherr and Quirk (Sherr and Quirk, 2007: 273) find it disappointing that the aforementioned study by Dantas et al only analyzed provings from this period, as it is „well known as the weakest period of homeopathic provings.’
Sherr et al (2007:275) also make clear that the goal of a proving is not to produce every possible symptom, but rather enough quality symptoms so that a meaningful totality can be perceived. Indeed, the repetition of a proving may not produce identical results, but the essential meaning will be the same.
Sankaran (1994) explains that this is due to the fact that a remedy produces a state of being in a proving, first at the level of mind and generalities, and later, depending on the level of sensitivity of the provers, on the physical level. A well proven remedy, if proven further, may yield more particular symptoms, but not more generals. In a proving, the group acts „as if one’ (Norland, 2001), and while each individual reveals only some of the symptoms, the group as a whole reveals most. Riley (1996b:122) asserts that if the symptoms of provings were reduced to toxicological effects and those symptoms forthcoming from double-blind placebo controlled trials, most of the materia medica would be eliminated. Furthermore, the randomised controlled trial has been designed to eliminate the individual characteristics of drugs so necessary to homeopathic prescribing, in favour of statistically significant but broad, clinically meaningless symptoms. In a reproving of Bryonia alba that he conducted using 120 subjects, the only statistically significant symptom was low back pain (Riley, 2007). Walach (1996:124) confirms this by stating that it is precisely the nature of useful symptoms that they are rare single occurrences. Often the most important symptoms are produced by one or two sensitive provers, with the common symptoms being filled in by the other provers (Sherr, 1994). The greater the symptom range, the greater the clinical usefulness of a proving. Walach (1996:124) is in favour of double-blind controlled methodology, but analysis must be qualitative. Signorini et al (2005), in a reproving of Plumbum metallicum and Piper methysticum, with comparison to previous classical proving symptomatology, found 30 and 8 symptoms, respectively, concordant with the classical proving, corresponding to about 10% and 45% of the significant total symptoms produced. Placebo
The first placebo controlled proving was conducted in 1835, making it one of the first double-blind controlled trials in the history of medicine (Dantas et al, 2007a). Placebo has only consistently been used in clinical trials since 1950 (Riley, 2007). Despite the fact that most 19th century provings had no placebo control, they have delivered clinically useful remedies that have stood the test of time (Sherr, 1994:57). One cannot dismiss historical provings for not using control measures which were not the historic norm (Riley, 2007:231). A study by Green (1964) found various effects in placebo subjects: pre-existing symptoms were highlighted in some volunteers, new symptoms were elicited in others, pre-treatment symptoms may be relieved, adverse effects may be experienced, and the incidence of symptoms is higher in females than in males. Conditioning and expectancy play a great part in the reporting of symptoms (Dantas et al, 2007a:13). Walach, Sherr, Schneider, Shabi, Bond and Rieberer (2004), conducted a double-blind placebo-controlled study with a 30ch potency of Cantharis, an existing homeopathic remedy, and found an increase in typical and atypical symptoms in both the verum and placebo groups. Walach (1994:130) feels that placebo control is unnecessary in provings, unless used in an intra-individual manner, i.e. cross-over design, which is his preferred design. He considers parallel designs invalid, due to the large number of variables affecting the demonstration of individual symptoms, which would require large numbers of participants to be eliminated by randomisation. Koster, van Haselen, Jansen and Dicke (1998), ran a double-blind, placebo controlled proving using a cross-over design. They found that there were not proportionally more mind and general symptoms in the verum phase, and that there were more dreams in the placebo phase. They also observed more symptoms occurring in the first phase, whether that was placebo or verum. They concluded that a crossover design as applied in this study has serious problems associated with the described period effect. A problem with the cross-over design is that the effects of many homeopathic remedies last much longer than the wash-out period, thus the interpretation of the results will be complicated by the carry-over effect (Sherr, 1994:38).
Riley (1996a:5) says that the intended heterogeneity of the volunteer group used in a proving make inter-individual comparison between placebo and verum groups less useful, and prefers intra-individual control. A further advantage of the placebo run-in period, according to him, is the differentiation between true proving symptoms and the anticipated symptoms produced when medication is taken at the beginning of a trial. Sherr (1994:57) ensures that provers take care in reporting symptoms by giving 10-20% placebo in a randomised way, making this well known to volunteers. Riley (1996a) agrees that the use of placebo promotes a self-critical attitude in the volunteers and the investigator. Many researchers have found that subjects receiving placebo still produce proving symptoms (Sherr, 1994:57). Grinney describes it as a „common phenomenon (Grinney, 2001:173). Walach (2000:129) says it is an „open secret that true homeopathic symptoms, meaning specific clear-cut symptoms known to belong to the remedy, can also be observed with placebo, albeit normally only in the context of a homeopathic remedy proving’. The question of whether or not to include these symptoms in the remedy picture has been the subject of heated debate amongst homeopaths. Dantas et al (2007b:276) use the simple formula „symptoms with medicine - symptoms without medicine = symptoms due to medicine’. Riley contends that the placebo response has never been proved to be consistent and linear, as is implied by this reasoning (Riley, 2007). Vithoulkas (2001) feels strongly that symptoms arising in placebo subjects do not belong to the remedy but to environmental, circumstantial or psychological conditions. He warns against the inclusion of such symptoms, as it will lead to much confusion about the action of the substance.
There are also different opinions about how the placebo control should be prepared. Dantas (1996:232) feels that all placebo should be diluted and succussed to eliminate variables. Signorini et al (2005:165) point out that serial succession and dynamisation changes the biochemical and biophysical properties of water, rendering it active and capable of producing symptoms. They therefore caution against the use of succussed water as control measure. Norland (2001) ran a proving of placebo at the Devon School of Homeopathy, to determine the effects of the group consciousness on the provings conducted there. They found that no theme emerged in this proving. He also discovered that if a proving is run within a group context, individuals who did not take the substance and wished to remain outside of the proving, are nevertheless affected. Milgrom (2002) explains the concept of entanglement - i.e. the interaction between patient, practitioner and remedy- as it applies
to homeopathy, and Walach (2000) also uses it to explain such non-local effects. Lewith, Brien and Hyland (2005) found that certain subjects, who reported true proving symptoms during a placebo run-in period on their proving of Belladonna, were more likely to report symptoms during the treatment period, and describe these subjects as „presentiment provers’. Sherr (1994:57) states that provings do not conform to Cartesian thinking, in that the experimenter becomes part of the experiment. Number of provers Vithoulkas (1980:152) envisages that a thorough proving needs to include 50-100 provers. Sherr (1994:45) argues that this number is far too large, resulting in an over-proved remedy that produces an excess of common symptoms, overcrowding lesser proved remedies in the repertory. Sherr (1994:45) found that 5 provers were enough for a small project, and that 15-20 provers produce a complete proving picture. Riley has conducted a large number of provings using 35 subjects in a double-blind, placebo controlled cross-over design with run-in period (Riley, 2007:231).
Group or seminar provings, in the form of dream provings, were started at the Bad Boll seminars by Jürgen Bekker (Dam, 1998). In dream provings, dreams are the main focus of the proving,
which is usually conducted in a very limited time (15 minutes to a week), often in a group, with allowance for dose adjustment by provers, and with very few inclusion criteria and restrictions placed on participants (Dam, 1998:128). Pillay (2002) found great similarity in a comparison of a dream proving of Bitis arietans arietans with a conventional Hahnemanian proving done by Wright (1999). Koster et al (1998:187) feel that an advantage of seminar provings is that it seems easier to motivate people in a group for a short experiment than for a longer double-blind placebo controlled cross-over trial, which may lead to large drop-out rates. Sankaran has conducted many dream provings at seminars. He found that dream provings did in fact reveal the characteristic mental and emotional states of the remedy but it seemed to lack solid data, and finds a protocol midway between seminar provings and classical Hahnemanian provings most useful (Sankaran,1995:15). Norland has conducted group provings at the Devon School of Homeopathy since 1991 (Norland, 2001:10), using a variety of methods: material doses; looking at or holding the substance; meditating on the substance. All methods have yielded results. However, in published provings, they have used material doses prepared in the Hahnemanian manner. At the School, they observed that the proving of a substance in a coherent group tends to amplify the effects of the remedy (Norland,1999).
Scholten (2007) emphasises the importance of the attention of the provers, which he considers crucial. According to him, this attention could be ensured by e.g. frequent contact with the supervisor, and also by meditation on the substance. His experience is that meditation provings provide reliable information, and often the information obtained from them expresses the essence of the remedy. He concedes that there is a possibility for personal interference, and that they do not deliver the full remedy picture, but weighs these drawbacks up against the low investment in time. He considers clinical verification the only possibility of validating proving symptoms. Sherr et al (2007: 275) agree with this: „The proof of provings is first and foremost their clinical usability and reliability.’
2.1.4 Contemporary provings There has been a renaissance in homeopathic
provings following the publication of Sherr’s Dynamics and methodology of
provings in 1994, which set exacting standards for conducting provings and
interpreting the results. Sherr personally conducted more than thirty provings
(Sherr et al, 2007), including Hydrogen, Germanium, Adamas, Chocolate and
Scorpio, all of which have proved clinically very useful. Sherr (1994)
emphasises the importance of the publication of new provings as a means to
announce the latest developments in homoeopathy. A list of more than 180 provings,
conducted by him and other well-known homoeopaths, was provided in his above
mentioned book. More recently, Sherr (2006) has developed an online database of
more than 1000 provings, with information of recent provings available to all
homoeopaths. Wichmann (2007) also created such a database. Misha Norland and
Peter Fraser of the Devon School of Homeopathy in
The systematic proving of substances indigenous to
Towards an Integrated Methodology: C4, Sherr and Dream Provings of Protea cynaroides
Homoeopathic provings form the experimental base of clinical homoeopathy. Provings are conducted through the administration of homoeopathically prepared medicine to healthy volunteers in
order to elicit disease symptoms. The symptoms are collated to formulate the materia medica of the substance.
AIM of this study was to compare the most commonly employed proving methodologies, the C4 trituration, the Sherr and the Dream proving methodology, by application in order to ascertain
the validity of the claims made in terms of the efficiency of the method to elicit reproducible symptoms. This study sought to follow the existing methodologies exactly as set out by the original developers with the aim of developing an integrated methodology. The order in which the three groups were assigned followed a logical sequence that ensured that the maximum efficiency would be obtained, and that the blinding process would not be compromised.
The claims were investigated based on the hypotheses proving symptoms are reproducible when applying identical proving methodologies in consecutive years, that different methodologies yield different numbers, types and quality symptoms, that differences exist between the symptoms yielded by the placebo and the verum groups within the same methodology, and that an integrated methodology could be developed based on the study of the relative efficiency of the respective methodologies.
The rubrics produced in each group were statistically analysed. The results reflected a reasonable level of reproducibility, proving the first hypothesis, but highlighted the fact that different provers would result in different symptoms due to their individual susceptibility and sensitivity to the proving substance. This effectively proved the hypothesis that the proving effect was reproducible in consecutive years through the application of the same methodology.
The result of the data collection was the formulation of 1.373 rubrics utilised for analysis purposes, resulting in 881 verified rubrics, that comprise the repertory for Protea cynaroides. From the
data, it was evident that the C4 trituration and the Sherr proving methodologies yield the most rubrics. Not only do they yield a large number of rubrics, but they also yield a much larger number
of rubrics than produced by the placebo portion of the Sherr proving methodology. In the Dream proving methodology group there is much less rubrics present at each rubric level than yielded by
the C4 trituration and the Sherr proving methodologies. Strong chapter affinities were observable when applying the C4 and Sherr proving methodologies. The C4 methodology seem to favour the chapters dealing with the senses, evident in the Ear, Eye, Hearing, Mouth, Nose, Skin and Vision chapters where the C4 rubrics were more prevalent than the Sherr rubrics. The Sherr methodology was evident in the remainder of the chapters, indicating the wide applicability of this methodology. This proved the hypothesis that some proving methodologies are more effective than others.
The hypothesis of difference between the placebo and verum groups within the Sherr proving methodology was proven as it was evident in the number of rubrics produced by each section.
The verum portion elicited 63% of the total rubrics compared to the placebo portion which only elicited 28%. Placebo provers thus elicit fewer symptoms during the proving process than verum provers, demonstrating that homoeopathic drug provings are not a placebo response, but that the administration of the medicine results in the development of clearly observable symptoms in the participants.
As originally assumed, the proving did produce clearly observable symptoms in healthy provers. The symptoms gathered through the application of the methodologies were also comprehensive enough to develop a complete materia medica and repertory for Protea cynaroides.
From the data presented in the study, one can thus conclude that in order to elicit symptoms representing all 38 chapters present in the Protea cynaroides proving, the C4 trituration proving and
the Sherr proving methodologies would have to be combined. Although Group two is able to elicit the majority of symptoms, it would be even more effective when it is combined with the
C4 proving methodology, hence leading to the development of an integrated methodology combining these methods, proving the final hypothesis. The suggested integrated methodology thus comprises of firstly conducting a C4 trituration proving using at least 10 predominantly experienced C4 provers. This proving would serve to highlight the major themes. These themes can then
be confirmed through secondly conducting a proving according to the Sherr methodology, in a group comprising of at least 17 provers, including a 10% placebo in the group. Repeated oral doses would be administered to the participants in this. At the conclusion of the second proving stage, all the data would be collated and formated into a materia medica and repertory.
It would, however, be important to prove the integrated methodology‘s usefulness through practical application, leading to the recommendation that the methodology be tested. Page | vi
Similia similibus curentur1 is the fundamental principle upon which homoeopathy is built, although the notion was first expressed by Paracelsus around 300 years earlier (Ball, 2007). In order to practically apply this principle,
the nature of disease and the nature of medicine need to be understood. Hahnemann (1999: 187-8), in aphorism 105, tasks every homoeopath with the mission:
1 Likes are to be cured by similar things (Winston, 1999); the biological law of equivalents (Gaier, 1991).
The second point of business of a true physician relates to acquiring a knowledge of the instruments intended for the cure of the natural diseases, investigating the pathogenic power of the medicines, in order, when called to cure, to be able to select from among them one,…as similar as possible to the totality of the principal symptoms of the natural disease sought to be cured.
Gray (2005b: 5) quotes a conversation in which Campbell remarks:
…if the similimum had not yet been discovered, those patients must die if we had not the remedy sufficiently similar to bring them to a certain stage of improvement. Then it follows that we must still go on developing remedies, for the similimum still remains undiscovered for some diseases.
This observation highlights the importance of new provings, with the aim of developing a more comprehensive materia medica.
The development of a remedy picture is not based on provings alone. Provings are but the first step in the process and give an indication of the drug‘s possible use (Bodman, 1977). The picture must then be verified by comparing the proving symptoms with any available toxicological data and finally prove its effectiveness in clinical use (Belon, 1995). Sherr and Quirk (2007) believe that a good proving is not about producing every possible symptom, but rather about producing good quality symptoms indicating a meaningful totality open to clinical verification.
The aim of this study was to compare the most commonly employed proving methodologies in order to ascertain the validity of the claims made by their respective developers. Each originator favours the method and describes the method as superior in terms of efficiency and quality of symptoms produced. In studying each of these methods individually, an informed decision could be made based on the merits of each method.
Despite being called - unhomoeopathic and not understandable (Dellmour, 1998: 223-89) the C4 proving methodology is followed extensively in Germany, the Netherlands and the U.S.
1. Trituration provings are generally conducted in groups of 5 to 25 participants and are carried out during a trituration process. Participants record all the symptoms experienced during the trituration, and discuss these
experienced during a - wrap-up conversation after the trituration process is completed. Each trituration level reveals a different level of experience, contributing to the development of a complete symptom picture. This methodology was selected as the first methodology to be tested. The trituration process carried out during the application of this methodology also completed the first stage of production, according to the German Homoeopathic Pharmacopoeia (GHP) (Benyunes, 2005) of Protea cynaroides 30CH utilised by the second and third methodologies.
2. The second methodology identified was the Sherr methodology, as it is the most common method followed in provings conducted at the Durban University of Technology‘s Department of Homoeopathy. This methodology utilises healthy volunteers as provers, in a group comprising of between 15 and 20 provers. The provers are required to ingest the remedy over a period of two days until symptoms arise. Placebo controls are utilised and the participants are unaware of whether they are taking the active or placebo set of powders.
3. the Dream proving methodology which cover a limited time span and focus mainly on the provers‘ emotional responses to the dreams. There is no set protocol for the administration of the doses and no placebo control utilised. Sherr (1994: 16-7) feels that the larger totality of physical, general and long-term symptoms may be missed using these methods, which this study investigated.
Every methodology was also tested twice: in two consecutive years and during the same months to eliminate seasonal influences. At the conclusion of the study, an integrated methodology was also developed, which focused on the strengths evident in each methodology and strove to minimise the weaknesses.
This study thus investigated whether the different methodologies yield different symptoms, both relating to the quantity and quality of prover experiences. It also aimed to investigate the reproducibility of symptoms elicited during consecutive provings of the same substance, utilising the same methodology. If the proving methodologies proved reproducible, it would negate the need for the re-proving of existing remedies. Lastly, this study investigated whether differences exist between the symptoms yielded by the placebo and the verum groups within the same methodology.
As a consequence of the proving process, a description of prover experiences emerged, which, when collated, yielded a complete homoeopathic materia medica and repertory for Protea cynaroides. This data are presented in Chapter 4 and further discussed and analysed in Chapter 5.
With the aims discussed above in mind, the following hypotheses were formulated:
Proving symptoms are reproducible when applying identical proving methodologies in consecutive years
Some proving methodologies are more effective in yielding proving symptoms than others, in terms of number, type and quality of symptoms elicited.
A distinct difference exists between the symptoms yielded by the placebo and the verum groups within the same methodology
In studying the relative effectiveness of proving methodologies it is possible to develop an integrated methodology
Every art has only a few principles and has many techniques
Dale Carnegie, quoted in (Scholten, 2007: 397)
Provings, from the German Prüfung2, are the pillars upon which homoeopathic practice stands (Sherr, 1994: 7). It is important to conduct thorough and comprehensive provings to understand the nature of disease and cure (Signorini, Lubrano, Manuele, Fagone, Vittorini, Boso, Vianello, Rebuffi, Frongia, Rocco & Pichler, 2005). A large part of homoeopathic materia medica3 is based on the data obtained from a drug proving (Walach, 1997).
2 Examination or consideration (Collins, 2004)
3 A reference book documenting the pathogenic effects of medicine and its uses. It deals with the origin, composition and properties, origin and preparation and clinically established characteristics and indications of the drugs (Gaier, 1991; Hughes, 1912).
4 Potentisation is a physical process through which latent curative powers of medicines are aroused, although these powers may not be evident in the crude state of the drug. It involves quantitative deconcentration of the drug substance combined with succussion5 (Gaier, 1991).
During a homoeopathic proving, or a homoeopathic pathogenic trial (HPT), a homoeopathically prepared substance is administered to healthy volunteers with the aim of eliciting disease symptoms (Walach, 1997). The symptoms experienced when taking the potentised4 medicine show distinct similarities to the symptoms elicited when taking the crude substance, but the symptomatology is more differentiated and specific, especially with respect to the emotional, mental and modality characteristics when utilising the potentised proving substance (Whitmont, 1993). The symptoms are carefully noted for therapeutic purposes and collated to formulate the materia medica of the substance (Walach, 1997). Classifying a medicine as a homoeopathic Chapter 2 Page | 8
remedy, because it has been prepared according to homoeopathic principles and procedures, is invalid. Such a medicine can only be called a homoeopathic remedy after it has undergone a valid proving (Schuster, 1998). Homoeopathically prepared medicines only imply that the medicine is manufactured using a process of serial dilution5 and succussion6. A valid proving, however, provides the medicine with a remedy picture, indicating its possible uses in clinical practice. Provings thus form the experimental base of clinical homoeopathy (Signorini et al., 2005) and every prescription should be based on a comparison between the symptoms the patient is presenting and the symptoms elicited during the proving (Dantas, 1996).
5 Serial dilution is a process of quantitative deconcentration of a drug substance according to a set dilution ratio – 1 part drug substance to 99 parts of diluents (usually alcohol-water mixtures or milk sugar) – for centesimal potencies (Gaier, 1991).
6 Succussion is the vigorous shaking up of a liquid dilution of a homoeopathic medicine in its bottle, where each stroke ends with a jolt, by pounding the hand engaged either against the other palm or an elastic object like a leather bound book (Gaier, 1991; Hahnemann, 1999).
Investigating medicine through practical experimentation was one of the keystones of Paracelsus‘ teachings (Ball, 2007), and taking part in a proving is thus a ―more direct experiential side of homoeopathy (Sherr, 1994: 10). There may be a fear of provings, where the individuals are reluctant to take part for fear of damaging their health. But Sherr (1994) found that 80 to 90% of provers felt that they benefited from the experience. In participating, the provers learn more about themselves and gain new life experiences.
In 1790, Samuel Hahnemann conducted the first proving on himself when he took several doses of Cinchona officinalis to ascertain why it was effective in treating intermittent fevers. Hahnemann compared the similarities between the symptoms he observed in his own body after administering the dosages with the symptoms of the intermittent fever it was said to be able to cure (Cook, 1989; Hughes, 1912; Resch & Gutmann, 1987).
His findings led him to formulate the ―Law of similars7 and resulted in the birth of homoeopathy (Haehl, 2003a).
7 A principle in homoeopathic medicine that draws a parallel between the toxicological effect of the substance and the therapeutic powers thereof. It states that a drug capable of producing morbid symptoms in a healthy person will cure similar symptoms occurring as a manifestation of disease (Gaier, 1991; Norland, 2003b).
8 A non-medicated substance that is relatively inert pharmacologically (Gaier, 1991).
9 The active medicinal substance tested during the proving or trial.
Hahnemann continued to experiment with other natural substances and developed a method of testing a remedy with the help of healthy volunteers. He called this process a proving. It requires knowledge of both the test person and the substance, for according to Hahnemann, health can be scientifically understood, but disease can only be perceived in a healthy person, because it is a deviation from a state of health. Disease is chaotic and as a consequence not directly accessible to scientific investigation. A healthy person can thus offer a familiar basis for the experiment and by comparing the results of the effect of the remedy on the healthy body to the symptoms of a patient, it is possible to ascertain what the disease is (Resch & Gutmann, 1987). Fuller Royal (1991) points out, however, that there exists no completely healthy individual – some are simply less ill or healthier than others.
Placebo-controlled double-blind studies are required to illustrate whether the symptoms produced are the effect of the remedy administered, or simply a placebo effect. During such trials, randomisation is carried out by a third party, and participants are given either the active verum9 or an inactive placebo without anyone involved in the study being aware of who received which (Walach, 1997). The first double blind placebo controlled proving was conducted in 1835. This was the first double blind placebo controlled trial in the history of medicine (Fisher, 1995).
The use of blinding in provings is controversial and even the type of blinding is a hotly contended topic. Wieland (1997) points out that the use of a placebo control in conventional clinical trials serves to illustrate the
effectiveness of the drug in the treatment of a specific ailment. The purpose of a homoeopathic drug proving is however to produce symptoms and not to illustrate the effectiveness of the drug in question. The question Wieland (1997) poses is whether symptoms that appear during a proving, while taking placebo, are examples of the ―pure placebo effect. He implies that modern scientific investigation techniques may hinder the pursuit of provings to find medicines that may prove beneficial cures, as opposed to assisting the investigators in obtaining the goals. Smith (1979) also suggests that Hahnemann and his followers were aware of the effect of suggestion, but saw it as inconsequential and chose to ignore it. Given the small number of volunteers, Jansen (2008) is of
the opinion that it would be more efficient to give all participants verum.
The entanglement10 theories try to explain a prover‘s susceptibility to producing symptoms during the proving. Lewith, Brien and Hyland (2006), Milgrom (2007) and Walach, Sherr, Schneider, Shabi, Bond and Rieberer (2004) suggest that there has to be a buy-in into the therapeutic intent from both the researcher and the subject. The prover would have to believe that the substance possesses the ability to elicit symptoms and the researcher needs to record and analyse the symptoms at face value first, before discarding any information as incidental or circumstantial. Entanglement theory further explains why the placebo also elicits proving symptoms similar to that of the verum in some provers, as all the provers within the group are
10 The idea of quantum entanglement originated in physics and is an algebraic argument to explain how related entities may interact. ―Entangled entities behave as one inseparable holistic unit, whose totality cannot be deduced from any of its parts (Milgrom, 2007). entangled regardless of the double blinding and placebo control. Hyland (2005) suggests that the remedy does not provide the symptom information, but rather that the symptoms are produced purely as part of the entangled state.
Many scientific trials have been conducted to investigate the role of placebo and blinding in provings. Walach et al. (2004: 182) investigated whether the proving symptoms were the result of local, non-local or placebo effects and concluded, that what was experienced during the proving was different from mere background noise. He also advocated the importance of using both qualitative
and quantitative methods when designing the trial and suggests the use of a double blind, placebo controlled study (Walach, 1997).
Smith (1979) suggests that the concept of double blind trials and placebo was introduced by Bellows in 1906 during the re-proving of Belladonna, whereas DeMarque (1987) believes that Bellows only perfected the technique.
A two-stage crossover trial yields the best results, according to Bayr (1986), for it allows for the verification of specific individual symptoms within a prover. This method eliminates the limitation of the double blind study
and introduces a useful intra-individual control (Walach, 1994). He is also of the opinion that the strict control during the proving and the validation of the symptoms during clinical practice should provide adequate validation of the process. The question arises as to whether placebo blinding only serves to eliminate bias or if the process itself may introduce new unintended bias (Kaptchuk, 1996).
Signorini et al. (2005) investigated the difference between placebo controlled trial and traditional trials and found a lower number of mental symptoms in the placebo group compared to the verum group, and that 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 and Waissen-Priven (2006: 216) found that there are significant differences between the narratives of the placebo and verum groups. The group taking the active substance …tend to use expressions such as “I‘ve never felt that before”, “Those weren‘t my symptoms” and “My headache is completely different”.
Provers from the placebo group seem to have vaguer descriptions and are not able to describe the symptoms and modalities clearly during cross-examination. This lead the researchers to emphasise the importance of personally verifying each of the symptoms elicited during the proving.
Jansen (2008) concludes that 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.
Recording and validation of the symptoms experienced is thus paramount to the proving process. Only reliable symptoms should be used to construct the materia medica picture (Dantas, 1996).
In 1870 before beginning the proving, Dunham advised his provers to record in a notebook …a statement of her age, temperament, the sicknesses which she has had and those to which she has an inherited or acquired tendency (Dunham, 2004: 353).
This notion contributed to the use of a pre-observation run-in period to prepare the volunteer was suggested in 1895 (Dantas, Fisher, Walach, Wieland, Rastogi, Teixeira, Koster, Jansen, Eizayaga, Alvarez, Marim, Belon & Weckx, 2007: 5).
Provings in the 19th century were collected by Allen in his Encyclopedia of Pure Materia Medica and Hughes in Cyclopedia of Drug Pathogenesy. These provings were however uncontrolled and
the symptoms were unverified. Dosage and potencies were also not standardised (Fisher, 1995).
Bellows conducted the first multi-centre double-blind proving which was published in 1906 (Dantas et al., 2007).
In the following paragraphs the different methodologies will be examined.
Hahnemann held the belief that a true materia medica should be the collection of authentic, pure, reliable symptoms of the medicine itself, free from conjecture, fabrication or assumption. He minimised bias by selecting trustworthy and conscientious healthy human volunteers (Dantas et al., 2007). A standardised proving protocol was formulated as the method of obtaining the symptom picture from a substance. Hughes (1912) expressed his doubts that all Hahnemann‘s observations were only made on the effect of the medicine on healthy provers. He claims that some may be
based on observations made of the effect of the remedy during the treatment of the sick.
Hahnemann wanted the symptoms to be unadulterated and controlled the variables by setting strict rules about the diet and lifestyle of the provers (Dantas et al., 2007; Hahnemann, 1999; Raeside, 1962). Provers were only
allowed to eat vegetables with the least medicinal power, e.g. green peas, green French beans, boiled potatoes and carrots. The participants were not allowed to drink pure wine, brandy, coffee or tea. Koppers (1987) refined this
list by allowing the consumption of milk, fruit teas, barley coffee, water and fruit juices containing no preservatives. He mentioned that the food should be as non-irritant as possible, and devoid of large numbers of additives.
The provers also had to avoid over exertion of the body and mind and had to have no urgent business to distract them (Hahnemann, 1999; Nagpaul, 1987). The participants have to live
…in contentment and comparative ease. When an extraordinary circumstance of any kind… supervened during the proving, then no symptoms were recorded after such an event (Hughes, 1912: 40-1).
Hahnemann insisted that the participants devote themselves to careful self-observation and be in a good state of health. They also had to be able to express and describe the sensations and symptoms accurately (Hahnemann, 1999). To ensure this, Hahnemann insisted on personally verifying every symptom elicited to ascertain the true nature of the symptom (Hughes, 1912; Rosenbaum & Waissen-Priven, 2006).
Hahnemann felt that he never wanted to deceive his provers (Haehl, 2003b) and always informed them what substance they were taking. There was thus no utilisation of placebo or blinding during his trials. He also believed
that he first had to test the medicine on himself so that he would know what he is exposing his provers to.
As far as potencies were concerned, he initially utilised the substance in tincture form or in the first or second trituration13 (Haehl, 2003b; Walach et al., 2004). Later on, in the 6th edition of the Organon14, he advocated the
use of the 30CH potency, to be taken on an empty stomach daily. He also wanted the dry dose (four to six globules) to be dissolved in water and thoroughly mixed before it was taken orally (Hahnemann, 1999).
13 A process of homoeopathic drug preparation, whereby a drug substance (raw material) is ground with a neutral, diluting substance (usually lactose) using a mortar and pestle. This process serves
to reduce the drug to a fine powder whilst amalgamating it thoroughly with lactose and attenuating it (Gaier, 1991; Hogeland & Schriebman, 2008).
14 A body of methodological doctrine comprising principles for scientific or philosophical procedures or investigation (Winston, 1999).
Hahnemann recorded all the proving data and published it in his Materia Medica Pura during 1825-1833 (Fisher, 1995).
It is questionable whether it is feasible to attempt application of this methodology taking the twenty-first century lifestyle into account. It is thus understandable that certain adaptations were made
to the methodology to render it practicable in modern times, as seen in the methodology advocated by Sherr (1994).
Kent15 (1995) believed in the importance of self-examination prior to the commencement of the proving. He insisted that the participants devote a week preceding the proving to careful examination of all the symptoms that they normally suffer from. This would yield knowledge of the individual in their healthy state. The proving substance would then be administered to the participants, but they would be unaware of the name and nature of the substance (Kent, 1995). He emphasised that not all provers will produce symptoms from potencies, and that the physician should select the provers carefully. This is done
15 James Tyler Kent (1849-1916).
16 Susceptibility represents the individual‘s capacity, proneness or disposition to be affected by certain disease states (Gaier, 1991).
…by studying the natural traits of their life;…see their weaknesses and make use of them (Kent, 1994: 443).
This sentiment was shared by Roberts (1936) and Schadde (1997). This means that not all the individuals will produce symptoms during the proving, because they have different susceptibilities16
to diseases. If certain symptoms exist in the toxicology of a substance, provers prone to those diseases will most likely produce strong symptoms and that knowledge can be used to select sensitive provers.
The substance would be administered in tincture or potentised to the 30th centesimal potency, distributed as a single dose in a separate vial for each participant. Repetition of the dose was up to the discretion of the proving co-ordinator. If the first dose does not elicit a response, sensitivity to the substance would be created by administering the substance, dissolved in water, every two hours for 24 to 48 hours or until symptoms develop. The provers were also requested not to discuss their experiences with their fellow participants, but only to carefully note these symptoms. No great emphasis was to be placed on crude drug provings, for these are believed to only produce temporary effects (Kent, 1995).
Kent (1995) advocated the reproving of remedies to obtain greater knowledge of the substance. He also emphasised the long term health benefits of provings, in that it
…will improve the health of anybody; it will help to turn things into order (Kent, 1995: 187).
This correlates with Sherr‘s (1994) statement that provers observed that they benefited from the experience.
Very few provings were conducted in the first half of the 20th century, but the latter part saw a revival in the interest in provings. These later provings include randomisation, blinding and control groups, although the application of these scientific methods was variable (Fisher, 1995).
Dream Proving Methodology
Becker started conducting dream/group provings about 30 years ago in the Bad Boll seminars (Dam, 1998). These were single-blind studies that cover a limited time span and focus mainly on the dreams of the provers.
There are, however, some physical symptoms present. There is no set protocol for the administration of the doses — the provers can decide how they would like to be exposed to the medicine.
They can take it orally, by olfaction, hold it in the hands for a period of time, sleep on it, touch another prover who took it or be in the same room as the other provers (Dam, 1998). During these
trials no placebo control were used. Pillay (2002) utilised one administration method (a single oral dose taken sublingually at bedtime) to be used by all provers to ensure standardisation. She also utilised a double blind placebo controlled methodology. The result of this study showed a 93% correlation to the symptoms produced during the Hahnemannian proving of the same substance,
carried out by Wright (1999).
Briggs (1996) is of the opinion that dream provings are much safer and more feasible than other proving methods. He views the provers‘ emotional responses to the dreams as important, as the dreams have the ability to illustrate the provers‘ uncompensated feelings and reactions. Gray (2000) feels that dreams are fruitful sources of information, especially when the most sensitive people are selected as provers.
In contrast, Sherr calls the dream provings partial provings and feels that it is only advantageous in being a short cut to an inner essence of the remedy. He feels that the larger totality of physical, general and long-term symptoms may be missed using these methods (Sherr, 1994: 16-7). Signorini (2007) believes that the dream provings conducted in the Netherlands were of very low quality and that they result in greatly inflated estimates of the number of mental symptoms. He feels that they are not homoeopathic pathogenic trials and that the definition of such trials should be modified to exclude them. Scholten (2007) feels that meditation provings are more accurate than dream provings in giving the essence of the remedy, but emphasised that the remedy picture obtained through such methods are not complete and that it may be incorrect in parts. He is hesitant using the data obtained through dream provings in his publications unless the data is verified through clinical cases.
In order to accurately investigate the methodology, the researcher decided to utilise the methodology as developed by the original scholar (Becker). The methodology for dream provings would resemble that explained by Dam (1998) as opposed to the one set out by Pillay (2002), for Pillay utilised a methodology that integrated the Dam (1998), Sankaran (1995) and Sherr (1994) methodologies.
The Vithoulkas Methodology
Vithoulkas (1998) developed a methodology published in 1980 wherein he insists that a substance is only fully proven when the substance is proven using toxic, hypotoxic and highly potentised doses. Symptoms must be recorded drawn from all three levels of the organism: mental, emotional and physical. He insisted that the participants comply with the following requirements:
They must be well acquainted with homoeopathic methodology and symptomatology, they must be aged between 18 and 45 years, they should not be hysterical or anxious people. This is in contrast with Kent, who believed that individual susceptibility to the substance was important in selecting provers, regardless of their normal state. Vithoulkas also felt that provers must be able to appreciate the seriousness of the experiment and they must lead a life as normal as possible during the course of the experiment. He further elaborated that the normal life should include definite time for sleep, walking and eating. The food must be free of chemicals, refined products, spices and stimulants. They must have stability in relationship, family
and work and avoid excessive influences.
The lifestyle described by Vithoulkas is much more defined than the requirements set out by Hahnemann, who emphasised self-observation through the avoidance of any activities that may distract the prover. Hahnemann also emphasised the importance of personal verification of every symptom, which Vithoulkas does not advocate. According to Vithoulkas (1998), the experimental proving must always be conducted with a double-blind format and 25% of the provers are to be given placebo. The tested substance and the placebo must be packaged identically. Provers are to be given strict instructions not to communicate with each other about their symptoms or circumstances. The prover group consist of 50 to 100 provers.
The medicine is administered 3x daily for a full month or until symptoms appear. The medicine is firstly given in the toxic dose (1X to 8X)17, then in a 30C18 potency when all the symptoms disappeared and finally a single dose of a 10M or 50M19 a year later to provers who produced symptoms immediately and were the most sensitive to the remedy. Fuller Royal (1991: 123) added
to this, by stating that:
17 1X is equal to a deconcentration level of 10-1 of the original substance present in the dilution; 8X is equal to 10-8.
18 30C is equal to a deconcentration level of 10-60 of the original substance present in the dilution.
19 10M is equal to a deconcentration level of 10-20 000 of the original substance present in the dilution; 50M is equal to 10-100 000.
…high potency provings should only be done under the direction of a highly qualified homoeopathic physician to reduce the risk of long term reactions.
This stands in contrast to the views of Kent and Sherr, who felt that provers stand to benefit from the proving experience and that the proving process does not endanger the health of the provers.
Vithoulkas (2008) speaks out strongly against the new ideas concerning proving methodologies and slates them as the reason why the credibility of homoeopathy is brought into question. He feels that provings should mirror phase one clinical trials, thus fitting into the scientifically verifiable medical model.
The Sherr Methodology
The most common method followed in provings conducted at the Durban University of Technology‘s Department of Homoeopathy, is the method developed by Sherr (Moore, 2007; Somaru, 2008; Taylor, 2004; Wright, 1999), also known as the standard Hahnemannian proving (Hogeland & Schriebman, 2008: XV). Sherr‘s definition of a Hahnemannian proving is a proving that include the whole totality of symptoms and is closely supervised over a sufficient period of time. These provings are double blind, non prejudiced and exacting (Sherr, 1994: 6), in contrast to Hahnemann‘s
belief that his provers should not be deceived. Sherr feels that it is important to continue with the 21st century lifestyle, for these external influences are but obstacles to cure, thus eliminating Hahnemann‘s strict dietary and lifestyle restrictions. Sherr (1994) believes that it is essential to perceive the core, which remains
the same regardless of the outside influences.
The methodology according to Sherr (1994) is a follows: The provers are the healthy individuals who volunteer to participate in the study. They must be honest and conscientious, as well as diligent to be able to supply the accurate information required from the proving. The group of provers normally comprise of between 15 and 20 provers. Provers are required to keep notes of their normal
state for one to two weeks prior to commencing the proving.
When the proving begins, the prover ingests the remedy (six doses over two days) and stops taking further doses as soon as symptoms arise. When no further symptoms arise for three or four weeks, the proving process is considered to be complete. The participants are unaware of whether they are taking the active or placebo set of powders. Dantas (1996) suggests that all the medicines utilised
in the trial should be manufactured in the same manner and should look the same. He thus insists that the placebo is prepared utilising serial dilution and succussion of the alcohol/water mixture, as opposed to the utilisation of unprocessed alcohol/water mixtures.
The Sankaran Methodology
Sankaran follows a protocol midway between the seminar dream provings of Becker and the classical Hahnemannian provings. The provings are also single blind studies, but the people observe and record all physical and emotional symptoms, as well as dreams, incidents and observations of others. This method is very similar to Sherr‘s method — and can be viewed as the halfway method standing between the Sherr and dream methodologies.
He pays particular attention to the symptoms that are peculiar and characteristic. The group size is between five and 25 volunteers and the remedy is usually distributed as a single dose in the 30C potency (Sankaran, 1998: 2). Sankaran, however, feels that giving placebos to some provers may not serve any purpose, as most people in the group develop symptoms irrespective of whether they take the remedy or not (Sankaran, 1995). In presenting the proving, he deliberately leaves out any summary or conclusions, for he believes that any ideas are his own interpretation and he does not wish the readers to get fixated on his ideas of the proving, for this may lead to prejudice, where the need to be objective and faithful is paramount (Sankaran, 1998). This view is shared by Sherr (1997), as he believes that it may cast a shadow on other possible facets awaiting discovery.
The ICCH Methodology
In an attempt to standardise proving methods globally to enable consistent interpretation of results, the International Council for Classical Homoeopathy (ICCH) recommended guidelines for good provings (International Council for Classical Homoeopathy, 1999: 33). They consider what they term a full Hahnemannian proving as a standard proving and make mention of the non-Hahnemannian provings stating that all symptoms derived from such provings should be recorded as additional interesting information as the acquisition of this data falls outside of their perceived scientific method.
Their interpretation of a Hahnemannian proving differs somewhat from the guidelines laid down by Hahnemann, especially with regards to their definition of a healthy prover, the pre-proving case history, the number of provers required and the inclusion of a placebo control. Their guidelines for a good proving include (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
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.
School of Homeopathy Methodology
The School of Homeopathy base their methodology on the protocol laid out by Hahnemann in the Organon of Medicine and take into account the comments and clarifications made by Kent in Lectures on Homoeopathic Philosophy, The Dynamics and Methodology of Homoeopathic Provings and Provings Volumes I and II. The difference in their methodology arose from their observation of the dynamics of the group proving (School of Homeopathy, 2004).
This methodology is based on the premise that the whole group is involved in the proving, not only those who take the remedy. This rules out the use of a placebo control group, for they would also prove the remedy based on the above assumption (School of Homeopathy, 2004).
Because of the field effect (or morphic field resonance), a single dose is administered and no repeat doses dispensed. The School also feel that this ensures that the primary and secondary proving effects, which refer to the primary effect of the remedy on the prover and the secondary effect of the vital force in opposition to the administered medicine, are not confused or the remedy administered anti-doted (School of Homeopathy, 2004).
Experiences are recorded immediately after the proving commences. Images, feelings, sensations, thoughts and concepts are noted immediately after the stimulus is received. The stimulus is introduced orally (usually in a 30C or 200C potency), by looking at it, by meditating upon it or by one participant mentally visualising an image of the substance. The phenomenon is viewed as similar to an epidemic contagion, where the influence overwhelms the individuals, submerging the participants‘ symptoms temporarily, whilst expressing that of the substance (Norland, 1999).
The requirements to be a prover are as follows (School of Homeopathy, 2004):
Healthy in spirit, emotions, mind and body
Not currently liable to severe acute episodes or suffering from severe degenerative chronic states
Avoid the use of substances (for instance food and drugs) which can have a medicinal effect
Be currently in the process of homoeopathic treatment with an experienced prescriber, so that issues that are of the prover rather than the proving can be discerned in the context of current treatment
Provers are also required to study the proving process and the output generated from completed provings (School of Homeopathy, 2004). This is achieved mainly by allowing third year students at the School of Homeopathy to participate in a proving during their study year (Norland, 2008).
A pre-proving diary is kept for a month prior to the proving, containing entries adding up to at least 14 days. Participants are also urged to keep the diary with them at all times (at night so that they may note down dreams immediately). The symptoms should be noted down accurately, in detail and concisely in the prover‘s own language (School of Homeopathy, 2004). The diarising is maintained for 3 - 4 months after the proving (Norland, 1999).
A supervisor is also assigned to assist the prover in examining the symptoms (School of Homeopathy, 2004). Supervision is viewed as essential, in order to have an objective view of the symptom changes (Norland, 1999).
The Herscu Methodology
Herscu (2002) describes one way of conducting a proving as a guideline to others who are interested in conducting provings. His methodology suggests a group size of 15 to 40 people, preferably closer to 30. This number makes allowances for placebo controls and potential dropouts. He emphasises the fact that the prover‘s predisposition, i.e. sensitivity to the proving substance, should be considered when selecting the provers in order to assure that the proving group comprise of different constitutional types. This is in contrast to Kent (1994) who believes that the substance proven should match the susceptibility of the prover, thus only including provers of a certain sensitivity.
The potency of choice according to this methodology is 30C, for Herscu feels that enough people are sensitive to this potency and there is no danger of toxicity. Higher potencies require more specific prover susceptibility, whereas lower potencies increase the chances of toxicity. The dose will only be administered repeatedly if necessary, with a maximum of three doses in the case of a toxic substance in 30C potency. If there is no response, a single dose of 200C or 1M potency will be administered (Herscu, 2002).
Herscu (2002) feels that the use of placebo control is paramount and rejects the concept of a collective consciousness or group dynamic as described by Norland (1999). Herscu (2002) feels that individual provers would only produce proving symptoms when the active substance is administered and that all symptoms manifested by placebo provers are resultant from environmental effects during the proving process and should thus be excluded when reporting the symptoms experienced by the active provers. As a result Herscu (2002) advocates the inclusion of about five placebo vials in every 40 provers.
The pre-trial phase, consisting of four days to two weeks diarisation of normal symptoms, acts to clearly record the prover‘s normal state and how they respond to the normal world. This also allows for the identification and elimination of unsuitable provers. To diminish the Hawthorne Effect,20 evaluation of symptoms should commence before the administration of the substance. This should
be done for a period of between $ days and 2 weeks.
The provers should be healthy individuals over the age of 18 and not pregnant. Herscu‘s definition of healthy means a steady state that does not shift too easily, does not change constantly
(Herscu, 2002: 103). The provers should follow a lifestyle that is not being traumatised, changed, or unduly stressed (Herscu, 2002: 105). Their current diet should be maintained and limited to foods they are accustomed to. The use of recreational drugs is prohibited, as is taking homoeopathic treatment in the preceding three months.
20 A concept based on an experiment conducted by Western Electric in Hawthorne, Illinois in the 1920‘s. It states that by showing interest, you are intruding on the experiment, changing the behaviour of the individuals involved in the study, because they know that they are being observed. It is different from the placebo effect, for the participants are not so much trying to please the observer, as they are paying extra attention and becoming more aware of their internal state (Herscu, 2002).
Nature Care College
Gray (2005a) has been conducting provings with his students since 1997. He attempts to develop standards to ensure the quality of modern provings and also verify the findings of older provings. His methodology essentially follows Sherr‘s guidelines, but also incorporates the observations made by Herscu regarding current methods employed. Gray (2006a: 6) experimented with different methodologies and comments that: …rigid right wing Hahnemannian trials often lack richness. It‘s hard to say just what the remedy is really about...the most boring and dissatisfying to the participants was the triple blind trial conducted using the strictest modern controls and blinding and cross over methodology.
The proving design normally comprised of a double blind trial, where neither the provers nor the coordinator knew the name of the substance proven, usually with no placebo control, although
in some provings placebo was employed. The base line was established through case taking and a two week journal run in. Data was collected using a journal and supervisors contact the provers
daily, either in person or by phone. The inclusion criteria were that the persons were over the age of 18 years and in a general state of good health. This was ascertained by the routine evaluation. Participants agreed in advance to comply with the instructions for keeping the journal and had to prove capable of doing so. The provers were not allowed to engage in any elective medical treatments and should not undergo major life changes for the duration of the proving. If they were found to fit the criteria, they completed and signed an informed consent document.
Prospective participants were excluded if they were undergoing current medical treatment or if they experience acute exacerbations of their chronic diseases. They were not allowed to use birth control pills in the preceding three months or to have undergone surgery in the preceding six weeks. They were also excluded if they were pregnant, nursing, if they failed to show competence in
the process or if they failed to complete the journal in the pre-proving observation period.
The proving lasted a maximum of eight weeks and neither the coordinator nor the provers were aware of the substance taken until the unblinding. The remedy was administered twice daily as five drops sublingually, taken away from food and drink, until symptoms developed. If no symptoms developed within three days, the prover stopped taking the remedy, but continued to record symptoms in their diaries (Gray, 2005a, 2005b, 2006a, 2006b).
In an attempt to reconcile the diverse views of the homoeopathic community on provings, he provides three versions of each proving in his books. The first includes only the primary action symptoms. The second includes all the symptoms listed in the first, but also includes the dreams and thoughts of the provers and supervisors, fleshing out the symptoms. This section also includes the experiences of people outside the proving as a result of the group dynamic. The third section is a brief chronology highlighting the first few days‘ experience of the major provers, their immediate response to the remedy (Gray, 2005a).
Meditative provings are carried out by individuals or in groups (Scholten, 2007) and is most of the time carried out blind (Evans, 2005b). Evans (2005a) carried out her provings by having up to four groups of provers sitting in meditation circles. Each circle had between 6 - 12 members; one group all female and the other three mixed. The potencies utilised varies from 30C to 10M (Evans, 2005b).
During meditative provings all the information was intuited or channelled whilst the group is sitting in a circle meditating. The groups have been working together for at least two years prior to the provings to develop a bond and group karma. They had spent time on their chakras removing any blocks which may prevent the reception of information. It yields symptoms on the physical level, mental and emotional level and in dreams directly before or after the provings — if they corroborate with the proving (Evans, 2005a).
The Guild of Homoeopaths, under the guidance of Micallef, developed meditative provings from an informal tutorial to two-year postgraduate courses. The protocol for their provings involves the establishment of a meditation circle, who meet once a month. Water and Rescue Remedy23 are provided for use by participants during the proving. The remedy for the session is placed in the centre of the circle as a bottle of pills or tincture, together with a crystal that would serve as a channelling device and offer protection. Sessions last up to four hours, during which participants are not permitted to leave, as this would break the circle. The session starts with prayers for healing, peace and preparations of the chakras for receiving the information from the remedy. The remedy is then distributed to the participants, who either take the dose orally, or hold it in their hands. The meditation then commences, initially guided by Micallef. Care is taken during the meditation to limit the use of adjectives or adverbs which may influence the images conjured up. This guided meditation is followed by 20 minutes of silent meditation, after which participants are encouraged to share their experience. The sharing session is recorded by dedicated scribes. Lastly Micallef discusses the core issues of the remedy as channelled through her. The session ends with further prayers for protection and peace, and closing down the chakras. Sometimes participants would be instructed to take the remedy for the following month and record any changes noted (Griffith, 2007).
In Australia, Tumminello (2005) tries to keep the meetings as natural as possible, and thus starts off by meeting and interacting like colleagues. After this initial bonding, the circle is formed and the leader would call for relaxation and encourage the participants to free themselves from their daily concerns. He would also invoke protection of the group and the integrity of each individual.
An oral dose of the medicine is then taken, followed by an individual meditation lasting 20 minutes. The participants would note down all their experiences first, and then share it in the group.
23 Rescue Remedy is a special combination of five Bach flower essences created for emergency stress relief. Clematis addresses dizziness or loss of consciousness, or a feeling of being not completely here; Cherry plum loss of mental and/or physical control, breaking down in despair; Impatiens emotional tension, stress and/or pain; Rock Rose acute fear, panic and terror; and Star of Bethlehem emotional or physical trauma, shock and/or grief and loss (Hasnas, 1997; Krämer, 1995: 91).
Ross and Campbell (2002) feel that while meditative provings are far from scientific, these provings provide a new dimension to homoeopathy worthy of further research. In researching the process, they found that there is a range of meditative provings which vary in quality and in information gained. They feel that these are best done by sensitive provers, who do not know the identity of the remedy and who do not discuss their symptoms in public and the process needs to be followed up in the same way as a Hahnemannian proving — by careful validation of the symptoms. Meditative provings can offer a partial picture, but not the completely objective insight gained through Hahnemannian provings, leading Ross and Campbell to suggest combining the two methods.
Tumminello (2005) favours meditative provings for the following reasons:
The meditation process maximises the awareness of the symptoms
The experiences are deeper and more grounded, especially for sensitive provers
The risk of aggravation is lessened through the support of the different energetic make-ups of the participants
There exists a strong support system if aggravations occur
The method combines the tribal practice of being a conscious receptacle to receive the messages, with the Hahnemannian practice of taking a medicine to find its effects
Scholten (2007) is hesitant about using the data obtained through meditative provings in his publications unless the data is verified through clinical cases. The data generated during these provings have no scientific basis and could be discarded as prover imagination or as manifestations of the meditation guide‘s direction during the meditation process.
The C4 Proving Methodology
In 1993, Ehrler investigated the notion of C4 trituration through self experimentation (Hogeland & Schriebman, 2008), which resulted in the emergence of a new methodology known as the C4-trituration provings (Becker & Ehrler, 1998). During a trituration process, Ehrler experienced symptoms, physical and psychological, and got inner pictures and ideas concerning the substances triturated. He found that each step opened up a completely new dimension of the remedy, and started to triturate to the C4 level, instead of the traditional C3 described in the Organon
(Becker & Ehrler, 1998; Brinton & Miller, 2004; Hogeland & Schriebman, 2008).
They argue that each trituration stage (apparently) reveals a different level of experience. C0 is used to describe the level of the physical substance in its raw, material form. At this level some substances have little or no action (O'Brien, 2006). Symptoms of the C1 are mainly experienced on the physical realm, C2 on the emotional realm, C3 show the psychic and mental and C4
expresses the spiritual aspects (Becker & Ehrler, 1998). C5 is the level of the collective unconscious – a connection to the past generations (O'Brien, 2006). It is important to note that the ‗C‘
does not indicate that it is a potency prepared on the centesimal scale (although the triturations are prepared using the centesimal dilution ratio), but rather that it refers to one of the eight carbon
levels of existence from Ehrler‘s cosmology (Hogeland & Schriebman, 2008: 7).
Trituration provings are defined by the fact that they are generally conducted in groups, during a trituration process. The trituration is carried out by hand, in a mortar usually 10 to 18 centimetres
in diameter, and the person grinding the substance experiences the symptoms of the remedy (Hogeland & Schriebman, 2008). The symptoms experienced by the participants are fairly consistent
even when a large group of people participate in the grinding sessions (Timmerman, 2006). Participants record all the symptoms they experience during the trituration, and discuss these experienced during a wrap-up conversation after the trituration process. The participants are usually not aware of the substance being triturated (Shore, Schriebman & Hogeland, 2004: 172-89).
Timmerman‘s groups consist of 15 to 20 members, in order to establish a strong resonance within the group. It usually takes her group five or six days to complete the proving. Every group starts
with the trituration of Lac humanum to enable members to open up and increase the group resonance. The second remedy is that of the child, Calc., followed by the successive triturations of Sil., Alum. and Nat-m. (Brinton & Miller, 2004). It was the researcher‘s experience, while attending the International Seminar 2008 of the Hahnemann Institute, that this sensitisation process does not take place when C4 provings are conducted during seminars. This does not impact on the experience and even inexperienced provers experience intense symptomatology.
This method is mainly followed in Germany (Schultz‘s provings of Columba palumbus and Vulture gryphus) and the Netherlands (Timmerman at the Hahnemann Institute), but can also be seen in the remedies discussed by Shore et al. (2004) and Herrick (1998) from the United States of America.
Shore et al. (2004) believe that homoeopathy is a science that stands as a bridge between the visible and the invisible. According to Shore et al. (2004), provings open the doorway into the invisible world. Following a specific methodology is thus a critical component of the process. Shore et al. followed the following protocol for their bird provings: Provers were supplied with a mortar, pestle and pre-weighed Saccharum lactis, equal to a ratio of one part of substance to 99 parts of lactose. The lactose was divided into three parts equating to 33 parts each. The feathers (proving substance) were finely cut and ground to make it unrecognisable. A group of seven to ten provers sat around a table, each taking turns to triturate for two to three minutes before passing the mortar on to the next prover. After seven minutes of grinding, the bowl was scraped for three minutes. At the end of 30 minutes of triturating, one gram of triturate was removed and mixed with an additional
99 grams of Saccharum lactis. The process was repeated 4x to reach a C4. The provers were free to talk, eat and to move around the room or to go outside. They were instructed to take notes of
any symptoms experiences, recorded according to each trituration level. The entire process was videotaped. At the conclusion of the process, each prover related their experience.
He then provided each prover with a 30C potency, prepared from either the C3 or the C4 triturate, of the remedy one week later which they could choose to take and they met 10 to 14 days later
to give an account of their experience.
Hogeland and Schriebman (2008) attribute the following benefits to the C4 proving method:
Continuous experimentation akin to that of the founding father, Hahnemann
Remedy information is gathered in the current language and psychosocial framework
Development of a close relationship with nature
Information is focused and direct, providing a solid framework for the study of materia medica
Symptoms clarify existing remedy information
Experience of the different levels of the remedy take place in a stepwise manner
Insight into the pace and intensity of the substance
The triturator become more perceptive of him/herself and the fellow triturators
Increased sensitivity leads to better resonance with potential patients
In depth understanding of the remedy
Development of a non-polarised world view, free from judgement
Personal development and therapeutic benefits
Symptoms like spacey or drugged feelings, itchiness of the eyes, nose and skin and time distortions are common symptoms experiences during C4 provings and should thus not be over emphasised, but documented especially if they exhibit an unusual quality (Hogeland & Schriebman, 2008).
There are, however, those who are sceptical of the C4 method. Dellmour (1998: 223-89) calls these potencies unhomoeopathic and not understandable and suggests that these provings not be included into the materia medica or repertories. In studying the list of benefits, it does seem like personal development is paramount to the C4 experience and it is questionable whether novice C4 provers would be able to experience the different levels of the remedy. As with meditative provings, it seems that an experienced group of provers is required. Experience would also assist in identifying unique symptoms and evaluating the importance of commonly experienced symptoms.
Grouping of methodologies
In studying the methodologies presented above, a summary of which is presented in Table 1, the methodologies were grouped together and three main groups identified to be the focus of the study.
The C4 proving was identified as the first group as it allowed for the manufacture of the oral dose during the proving process. It contained some elements of the meditative provings as well. It was chosen to represent the methodologies in which no oral dose of the proving substance is administered to provers. Provers are also described as more intuitive and the duration of the proving shorter than conventional proving.
The second group was classified under the Sherr methodology, as it represented a modernisation of the Hahnemannian and Kentian methodologies. It was selected to represent scientifically acceptable proving methodologies. This gold standard (European Committee for Homeopathy, 2004, 2008; International Council for Classical Homoeopathy, 1999) proving encompasses a double blind proving methodology which is verifiable in terms of phase one clinical trials. It also complies with the International Council for Classical Homoeopathy guidelines for conducting provings (International Council for Classical Homoeopathy, 1999).
The last group represented the unblinded studies of meditative provings and the School of Homeopathy, grouped under the Dream proving methodology. This group represented the more intuitive provings where an oral dose of the proving substance was administered. The duration of these provings is also than shorter that of the Sherr proving methodology.
Ethical guidelines for conducting provings are a topic barely addressed in literature. In a book review of Sherr‘s The Dynamics and Methodology of Homoeopathic Provings, Treuherz (1995) mentions that a discussion of ethics is one of the areas the book lacks, and he suggests the creation of an ethical framework to protect provers and volunteers. He however commends the book on explaining ethical protocols.
The European Committee for Homeopathy (ECH) (2004) gives a description of the ethical considerations they see pertinent to the conduction of provings, in accordance with the World Medical Association (2005) regulations:
Safety of the volunteers must be ensured, hence all risks and burdens must be compared to the benefits to the subjects or others. The risk to proving participants are minimal, due to the utilisation
of high dilution, hence low toxicity. Any effects are also reversible on cessation of the administration of medicine
Subjects must give informed consent in writing. They have to be informed of the procedure and possible risks, inconveniences and benefits of the trial before the study commences
Kumar (2007) suggests the following ethical considerations:
The subject or prover should be in such a mental, physical and legal state as to be able to exercise fully his or her power of choice
Consent should be obtained in writing from the subject
Nature and purpose of drug proving must be explained to the provers
Proving should never be done in toxic doses – such data should be obtained from toxicological literature
Investigators should discontinue the proving if in their judgment it would be harmful to the subject if it were continued,
Care must be taken to ensure that nothing which may ruin the health of the participants is proposed in the proving methodology.
Homoeopathic provings need to be differentiated from conventional clinical trials despite the fact that the two processes superficially resemble each other. The phase one of clinical trials is normally conducted on a small number of healthy volunteers to ascertain the dosage required to elicit a response in the human body as well as any toxicological effects. Participants are paid for their participation (European Committee for Homeopathy, 2008; World Medical Association, 2005). The aim of homoeopathic provings, conducted at a non-toxic24 level to eliminate the possibility of toxicological effects is to provoke symptoms of artificial disease, which is reversible after discontinuation of the tested substance. These symptoms are collated and distributed throughout the homoeopathic community for clinical verification through successful prescription to sick patients. Participants do not receive remuneration in exchange for their participation (European Committee for Homeopathy, 2004, 2008).
The Value of Provings in our understanding of remedies and disease.
...One remedy will not do for another, and we are always thrown back on the actual symptoms of the provings as our only sure guide... (M.L.Tyler 1952)(A§118).
Our job is to match the symptom picture of the remedy to the patient. Our knowledge of the Materia Medica and the action of remedies can come from various sources.
The main, and most rigorous source is from classical full provings. Another important source is from shared clinical experiences - cases. Recently data from dream or meditative provings have been published. In Dr. Sankaran's seminars each member of the group simply places the remedy under their pillow and then reports back to the group. Meditative provings can be as simple as just handling the substance and contemplating the thoughts and feelings that arise. Any sceptic could try handling a vial of Plut-n. It is notorious for introducing chaos and destruction into our lives! On the face
of it these methods may seem unreliable or even fanciful but many key symptoms have subsequently been confirmed by full provings, so they too have a "provisional" place in our literature.
A contemporary variation on Hahnemman's original method was the proving questionnaire developed by Brian and Lewith. It comprised a selection of predefined remedy specific symptoms.
Its purpose was to validate original provings.
Another method of evaluation of remedy data, which is being developed in Homeopathy is the Randomised Controlled Trial which tries to measure the effectiveness of homeopathic treatment of diseases upon trial subjects. Problems using the traditional scientifically accepted type of trials arise from the idea that homeopathy operates according to a paradigm that is different from conventional “allopathic”medicine which usually treats disease (a pathogen) as if it is an entity which must be killed or destroyed.
Homeopathy treats the totality of symptoms - the person not the disease. In both paradigms the goals are similar and the assessment of the efficacy of a medicine in both cases is evaluated by measuring the outcome as a healing response and some degree of resolution of the chief complaint.
Objectives of a Proving
A proving is the traditional method for evaluating the medical properties of a substance. The proving trial initially focuses on the question of whether the homeopathic remedy has any effect of any sort; it is a question directed at the thesis that there may not be anything substantial, or “real,” in homeopathic remedies in the first place.
The first proving was conducted in 1790 by Hahnemann on Cinchona bark because some of the symptoms sounded similar to malaria. The only way to ascertain the validity of this was by direct experience, which means to ingest the substance and record the subsequent symptoms. Provings do not usually go as far as producing serious physical pathology - although many stalwart Homeopaths have done this E.g. Herings poisoning from the Bushmaster (Lachesis).
Suitable subjects (A§126)
During the proving process, Hahnemann administered remedies to healthy volunteers. His rationale was that a substance that produces symptoms in healthy subject can be used to help the sick (A§108). The healthy volunteers should include sensitive trained observers, because as Hahnemann says in the organon, they will provide the largest amount of symptoms. Sherr's MOPMEC scale
can be used to measure both health and sensitivity. Should we include less healthy subjects? These can provide us with valuable curative results but are less useful in determining the pure action
of the substance (A§107). As long as the limitations and parameters are known, variety is acceptable in a proving (authors supposition!). The proving would yield some symptoms common to the group. These would be the "common ground" of the substance. Then there would be the idiosyncratic, odd and curious symptoms - perhaps some of these make up the modalities and S.R.P.s of the substance (A§117).
A Standardised Methodology
Preparation, Hahnemann says you have to be objective and become the unprejudiced observer: Aphorisms §105 and §145 (double-blind). Traditionally we do not give either supervisors or provers
a preconceived idea about the remedy. We don't go into the proving looking for things - it is treated as a "tabla-rasa" (clear slate). That is also the approach in drug trials - anything else in considered to be unscientific. Some rigorous provings use a placebo control group.
The roles of the group and protocols are established. We always use a pure substance. If we mix two substances no one will know which substance produced which symptom. A highly reactive mixture of Potassium and Iodine (!) is not the same as the compound Kali-i.
The remedy must be potentised and triturated (A§123). In the case of a liquid the substance is diluted by 1 drop to 100. Alcohol is sometimes used as it has preservative qualities. So to make a 3C potency add one drop to 100ml, one drop is taken from this 100ml solution and added to the next 100ml. You then succuss by banging the test tube on your Bible (x10). Repeat once more to get 3C. If the substance is a solid it is usually crushed up with Sach-lac. using mortar and pestle. The dilution can be done by weighing out one gram and adding it too 100g.
Proving: Provers take the remedy until symptoms are experienced (A§131). Usually one or two doses will suffice to challenge the Vital Force. Prover and supervisor then maintain daily contact and both take notes. Daily contact enables us to differentiate primary and secondary action. Many authors insist that the secondary action produces important symptoms toward the end of the proving (De Schepper), this may be because some substances have a longer cycle - compare Aconite and Causticum.
Extraction - Groups go through notes to extract valid mental, emotional and physical symptoms. The group meets to discuss their experiences. What needs to be noted (after Boger-Boeninghausen)
is the location, direction, speed, time and intensity of each symptom. Next modalities, concomitants and periodicity. These are collated to determine the characteristics on the basis of symptom totality. Then we highlight the keynotes and ideally describe the whole as a sequential development in time.
Repertorisation: Symptoms are graded according to their spread through the group. I believe Grade 1 means everyone experienced it, although Vithoulkas says Grade 1 is for cured symptoms (which is indeed the case for qualification as Genus Epidemicus).
Repertory submissions are collated and organised by chapter. Large common rubrics need qualifying to give precision - but if they are over-qualified there is a danger that the repertory will be filled with too many highly specific symptoms with only one remedy indicated, as happened with the Falcon proving.
The modern repertories of Scholten, Mirilli and van Zandvoort include information which groups symptoms with remedies conceptually (Periodically/Phylogenetically)
or thematically. Conceptual grouping gives these repertories an underlying structure by associating symptoms to their roots or origin e.g. Kingdom, Family, Species or Periodic hierarchy. Mirilli's thematic grouping associates remedies linguistically, which gives us an additional level of overlying structure. Jose says, "symptoms are severed by being classified alphabetically". Theoretically crossing rubrics from different sections should bring the picture back together again as a whole, but ultimately interpretation still relies on the user.
Publication -The substance is described in detail to give Homeopaths some idea of its Doctrine of Signatures, e.g. physical properties and raw toxological virulence (taking 30c of Plutonium is not the same as taking 30c of gently acting remedies like Saffron (Colchicum). There is also a chapter on Materia Medica which gives an account of the actual experiences - it is coded so that we can tell which prover developed the symptom and when.
Self-Reflection and Discussion - Problems of Affinity and Polarity.
Homeopathy already recognises that people and symptoms are unique. A wide range of experiences can be a good thing if our main object is to get a vision of the widest and deepest range of symptoms a substance can produce. Normally this is what we want from a proving.
Perhaps what we really need is a group of subjects who's suitability is defined by their probable affinity for the substance under consideration. How would we set that one up? Perhaps a preliminary test could be carried out on the substance by an experienced Homeopath who would be able to give some preliminary guidelines about the nature of the substance. Or, maybe we could predict some of its expected parameters using the doctrine of signatures combined with our understanding of the Families or Stages? Assume we have done some assessment of this nature and we are satisfied that we have at least some understanding of the substance. Next we match our subjects to these parameters.
Lets take an substance that is not so well known, say Lutetium (Stage 17) as a hypothetical example. To determine its clinical benefit we need a subject who would be likely to respond to it favourably... that's someone diagnosed with "Stage 17 Syndrome", for the arguments sake, say the profile fits a subject who's lost or abandoned their sense of inner power and feels resigned to taking an early retirement.
This subjects experiences would absolutely resonate with the substance and give us the depth of information that would be clinically useful. We would learn more about "Stage 17 Syndrome" and about the substance. We would be able to think about a Genus Epidemicus qualification for Lutetium - perhaps at level 4 - curative in at least one case. A good starting point for further investigation.
Polarity of Substance and Symptom
Now lets give Lutetium to another prover; someone at the peak of their career - perhaps our (Aurum) College Director! What are they likely to report? Perhaps dreams of giving up their job and flying away, or perhaps a feeling that their work is done on this Eartly plane?
The question then comes, is that a characteristic of Lutetium? It makes you want to escape into retirement? Well the fact that we know it was our Director gives us a frame of reference from which we can evaluate the response. Logically you could say that if your are at the peak of your career you could experience indifference to work on taking Lutetium. So you want to submit the rubric...
"Indifference, business to"
Wait a moment, consider the first subject with "Stage 17 Syndrome" who was about to take early retirement... would they report a change of heart? So much so that their experience was summed up by the rubric...
"Enthusiasm, business for"
Which rubric would you submit?
What we are looking at are the so-called POLARITIES of Lutetium. It is the lower extreme of the polarity that was curative. The higher polarity was damaging (at least to our Director).
Perhaps, at the very least, we should annotate the rubric to signify the polarities as either high or low... but you have to know the prover to do that. If our Director joins in the proving anonymously the frame of reference is gone and the both rubrics get published.
Then we study the rubrics and then start wondering if, clinically it will produce indifference or enthusiasm!
Meditative and Dream-provings
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.
MEDITATIVE PROVINGS A FORM OF GNOSIS
By C.Wansbrough published in Prometheus Unbound Vol.3 No 1 Autumn 1996
The pursuit of meaning is undoubtedly the hallmark of the human mind. Such a quest covers all aspects of the human condition and spirals in an ever increasing fashion towards knowledge. Knowledge in turn takes us beyond the particular towards the general, clarifying the workings of reality and allowing us in turn to fuel our desire for power and the domination of our cosmos.
B. Lancaster: parallel between types of knowledge and the story in Genesis of the first brothers Cain and Abel.
The physicist Eddington made a clear distinction between these two form of knowing, calling the former symbolic and the latter intimate knowledge.
While many authors may well have drawn similar distinctions, there is a certain amount of agreement on the distinguishing characteristics. The first mode is 'dualistic, ego enhancing and proceeds through conceptualisation: the second is direct and associated with a lowering of ego boundaries-- even feeling ourselves fuse with the object'.(2)Cain therefore comes to characterise very much the former mode, motivated by the desire to acquire and to distinguish clearly his own territory, and his relation to all objects. While Abel, signifying breath may imply the possibility of a direct ,unsullied contact with the world. Moreover these dissimilar modes which clearly
divides the scientist from the mystic, have found to be not, merely a question of speculation, but to be based on distinct neurological functions of our right and left brain hemispheres. It has become clearly established through much research, especially with the Split Brain experiments done on epileptics in the 1960's, that the left
hemisphere has been found to be predominantly involved with analytic processes, especially with the production of speech and appears to process input in a sequential manner. The right hemisphere, on the other