Prüfungen in der Homöopathie.
[Izel Botha]
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
The 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.
CONCLUSION
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 Page
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proving stage,
all the data would be collated and formatted 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.
HYPOTHESES
With the aims discussed above in mind, the following
hypotheses were formulated:
Reproducibility:
Proving symptoms are reproducible
when applying identical proving methodologies in consecutive years
Relative effectiveness:
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).
Kent’s
Methodology
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 three times 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, especially 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 three to four 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
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.
|
Table 1 C4 |
(Becker &
Ehrler, 1998; Brinton & Miller, 2004; Hogeland & Schriebman, 2008;
O'Brien, 2006) |
15-20 |
Single blind |
No |
No protocol |
No protocol |
Group discussion
|
C1 to C4 |
None |
Trituration
process |
Lac Huma-num
sensitisa-tion |
|
|||||
|
Medita-tive |
(Evans, 2005a, 2005b; Griffith, 2007; Tumminello,
2005) |
6-12 |
Single blind |
No |
No protocol |
No protocol |
Group discussion
|
30c to 10M |
Single |
Touch or orally |
Two years
Meditation experience |
|
|||||
|
Nature Care
College |
(Gray, 2005a,
2005b, 2006a, 2006b) |
No definite
(min1) |
Double blind |
No |
Yes |
Normal habits |
Yes |
6C, 30C or 200C |
2 times a day for 3 days or until symptoms appear |
Orally |
Diary – 2 weeks |
|
|||||
|
Herscu |
(Herscu, 2002) |
15-40 |
Double blind |
5 out of 40
(12.5%) |
Healthy – steady state that does not constantly
change |
What they are accus-tomed to – not unduly stressed |
Yes |
30C, else 200C
or 1M |
Up to 3 |
Orally |
Diary – 4 days
to 2 weeks |
|
|||||
|
School Of
Homeo-pathy |
(Norland, 1999; Norland, 2008; School of Homeopathy,
2004) |
Group |
No protocol |
No |
Healthy, but in the process of homoeo-pathic
treatment |
No protocol |
Yes |
30CH or 200CH |
Single |
Orally, looking at it, meditating on it |
Diary and under homoeopa-thic treatment |
|
|||||
|
ICCH |
(International Council for Classical Homoeopathy,
1999) |
8-20 |
Double blind |
10-30% |
Yes |
Normal habits. No anti-doting factors |
Yes |
2 – 3 potencies |
Up to 6 doses (3 a day) |
Orally |
Diary and comprehensive case record |
|
|||||
|
Sankaran |
(Sankaran, 1995,
1998) |
5-25 |
Single blind |
No |
Yes |
No protocol |
Yes – video
recorded |
30CH |
Single |
Orally |
Pre-proving
meeting |
|
|||||
|
Sherr |
(Sherr, 1994) |
15-20 |
Double blind |
10-20% |
Yes |
Continue as
normal |
Yes |
Single potency: 6C, 9C, 12C, 15C, 30C or 200C |
3 times a day for 2 days or until symptoms appear |
Orally |
Diary |
|
|||||
|
Vithoul-kas |
(Vithoulkas,
1998, 2008) |
50-100 |
Double blind |
25% |
Yes |
As normal as
possible |
Yes |
Toxic, hypotoxic and highly potentised |
3 times a day for a month or until symptoms appear |
Orally |
Diary |
|
|||||
|
Dream |
(Dam, 1998;
Gray, 2000; Sankaran, 1995) |
Group |
Single blind |
No |
No protocol |
No protocol |
Group discussion
|
No protocol |
No protocol |
Orally,
olfaction, touch |
No protocol |
|
|||||
|
Kent |
(Kent, 1994,
1995) |
No definite (min
1) |
Single blind |
No |
Known diseased
state |
No protocol |
Yes |
30CH |
Single, thereafter dissolved in water two-hourly |
Orally |
Observation of the individual‘s disease state |
|
|||||
|
Hahne-mann |
(Haehl, 2003a;
Hahnemann, 1999; Hughes, 1912) |
No definite (min
1) |
No |
No |
Yes |
Controlled |
Yes |
30CH |
Dissolved in water, definite regime |
Orally |
No protocol |
|
|||||
|
Reference |
Number Of
Provers |
Blinding |
Placebo |
Healthy
Volun-teers |
Diet And
Lifestyle |
Symptom
Verifica-tion |
Potency |
Dose |
Admin. Route |
Pre-proving |
|||||||
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).
Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.