Treating through Conventional Medication

 

Hahnemann clearly cautioned us to avoid any hybridization of homeopathy and allopathic practice - in The Organon, §52, "Each mode is diametrically opposed to the other. Only a person who does not know both could surrender to the delusion that they could ever approach one another, let alone ever let themselves be united. Only such a person could make himself so ridiculous as to practice sometimes homoeopathically and sometimes allopathically, according to the pleasure of the patient. Such a practice may be called a treasonous betrayal of divine homeopathy."

Even as we might strive to keep "divine homeopathy" pure, we often find ourselves working with persons who choose to combine our homoeopathic treatment with allopathic approaches; perhaps with conventional allopathic medications, or with other "alternative" treatments that are based on an allopathic model of health and disease. These folks may present us a challenge in coordinating their homoeopathic treatment with the allopathic medications on which they are depending. And so although I may temporarily join the ranks of Hahnemann's "bastard physicians" in adding homoeopathic treatment to their current regimen, I do so not in "treasonous betrayal" of homeopathy, and I console myself with the knowledge that my goal is to find a way to get my patient off of their allopathic medications and on the road to healing in the "shortest, surest, least harmful way," consistent with our founder's highest ideal of cure.

Some typical examples of the kinds of challenges I see in everyday practice include:
A 6 year-old child with recurrent ear infections. His family consults me to address the chronic/recurrent nature of his complaint, but is not as yet confident enough in homeopathy to rely on it to treat his high-fever, middle-of-the-night acutes, and so relies on the local emergency room and antibiotics for these.
An 8 year-old child with mild asthma, recurrent ear infections, and difficult eczema, relying on corticosteroid creams to prevent open & oozing skin eruptions.
A 10 year-old child with asthma who uses nebulized cromalyn and corticosteroids palliatively, and adds a nebulized bronchodilator when his peak flow readings drop or when symptomatic.
A 45 year-old woman with a 15-year history of rheumatoid arthritis, still symptomatic but palliated significantly on prednisone, methotrexate, plaquenil and a nonsteroidal antiinflammatory drug, using tagamet to palliate the stomach irritation from her other medications; she's concerned with several side-effects and the cost of her $90/week regimen.
A 48 year-old woman with chronic migraine, who has been successfully palliating terrible perimenopausal hot flashes with wild yam (dioscorea) cream and chasteberry tincture.

I often meet folks in such situations who have previously avoided homoeopathic treatment because they were told they had to stop their other medications first, a step they did not feel capable or confident to make. I feel it's our responsibility to such patients to move past an overgeneralized declaration that our treatment is absolutely incompatible with their current regimen, and carefully examine the manner in which allopathic medications affect the picture of disease available to the homoeopath and the process of healing invited by the homoeopathic precription.

Of course, it is certainly easier to treat homoeopathically without the interference of other treatments. When patients trust their ability to discontinue conventional medication without dangerous or unmanageable results, this is generally preferable to attempting to overlap approaches. I am impressed at how rarely my patients fall into this category. Those who do, I encourage to stop their current medications well in advance of beginning homoeopathic treatment, both so that I have the full advantage of viewing their unsuppressed symptom picture, and so that we are not confused as to whether an increase in their symptoms is do to homoeopathic aggravation or discontinuation of palliative medication.

Allopathic treatment can complicate homoeopathic management at three junctures. First, it can alter and complicate the original case, making it difficult to find the patient's simillimum. Second, it can interfere with the process of healing invited by homoeopathic treatment. Third, it can mask or obscure the symptoms of the patient, making it difficult for us to know whether there is a healing response to our prescription.

The "allopathic" drug can sometimes be the simillimum

Now it would be remiss to omit (and God forbid we should mention it), that "allopathic" medications can occasionally cure. For example, colchicine is used in a routinist fashion by allopathic physicians to treat patients with gout; and is coincidentally the simillimum in a decent percentage of these cases. All we need to do when this is the case, is to ascend the potency scale as the case demands - from the crude doses used allopathically to the homoeopathic potencies intended by Constantine Hering when he introduced this remedy, which was only later taken up by allopathic practice. Similarly, I have seen a few patients who I believe were truly cured by their conventional antidepressant medication; the allopathic misapplication in these cases was in the routinist administration of these medications at non-minimal dose.

It is unusual, however, that an allopathic prescription is similar to the disease of the patient. In aphorisms 34-42, Hahnemann discusses the meeting of two dissimilar diseases in one person. Here, we can view the effect of allopathic medication as a medicinal disease which is dissimilar to the natural disease of our patient.

Confusion of the case by allopathic treatment

Allopathic medications most often affect the picture of disease in one of two ways - they can palliate suppressively, or interact with the natural disease to create a complex disorder, dividing the economy of the body between the partially suppressed older natural disease and the newer medicinal disease. Each of these can present a unique set of obstacles in, first, our ability to understand the case of a patient, and secondly, in interfering with a curative response to the correctly-chosen simillimum.

Probably the most common response in chronic illness is the creation of a complex disease, where some of the symptoms of the natural disease are suppressed or altered, and some new symptoms appear which are attributable to the medication. These two disease states then coexist in the patient, dividing up the economy of the body in ways that are not always clearly distinguishable, and requiring independent treatment - the natural disease with its simillimum, and the medicinal disease usually with discontinuation of the medication when the patient is able to tolerate this. The art here is in disentangling the picture of the natural disease from the chimeric disorder it forms with the medicinal disease. Somewhat less common in chronic illness, but more often seen with acute illnesses, is a purely suppressive response, where the symptoms of the natural disease are replaced by those attributable to the medication. Either of these responses may result in a very confusing case, in which it may be difficult to recognize the picture of the disease that requires treatment. Fortunately for our work, most allopathic drugs are just "not that good" at suppressing chronic symptoms - it is seldom that the presenting complaint is totally suppressed or palliated, so portions of the case still persist as clues for us to prescribe upon.

In unravelling cases such as these, I find that Boenninghausen's concept of the 4 dimensions of a complete symptom comes in handy. Boenninghausen proposed that a complete symptom has the dimensions of locality, sensation, modality, and concomitants. When suppressed or altered by medication, it is rare that all of these 4 dimensions of a symptom are lost. I find it rare that locality is altered much; but unfortunately, this is usually the least characterizing aspect of a symptom. Most often, I see the modalities lost or altered. Occasionally characteristic sensations are lost, becoming more nondescript - e.g., burning pain becoming "just pain." Concomitant symptoms - symptoms accompanying, but seemingly unrelated to the presenting complaint - are very rarely altered by allopathic treatment, and often provide our best clue to the nature of the unaltered symptom picture.

Often the lost aspects of a symptom can be claimed from history. Prior to treatment, a patient with rheumatoid arthritis was severely aggravated by approaching cold fronts. This had become only a faint memory after many years on aggressive allopathic treatment, and came out only after careful and direct questioning. Knowing to look for "masked" modalities in the history helped me (along with some other symptoms) to dredge out Rhododendron as her simillimum. Another rheumatoid arthritis patient recalled that her early episodes were ameliorated by sticking her feet in buckets of icewater. Allopathic treatment had long since eliminated the striking modalities of cold. Finding the modality of >cold in the history prior to suppression, along with the interesting concomitant of aversion to constraint (Mind: Delusion, narrow, everything is too), which was unaltered by her treatment, revealed Guaiacum as her simillimum.

Allopathic treatment may also create symptoms that are misleading. A woman presenting with apathetic depression and lack of sexual drive doesn't necessarilly need Sepia; decreased libido is a common side effect of many antidepressant drugs. I see many kids with asthma "well controlled" on corticosteroids and bronchodilators who are referred for learning difficulties in school, which can be attributed to their medications. Relying on these mental/emotional symptoms as concomitants to their asthma is misleading, as they belong to the medicinal disease component of the chimeric complex disorder.

Modalities may be altered in misleading ways by allopathic medications. Many patients with difficult asthma "managed" allopathically have the striking modality of "worse 6 hours after the last use of inhaled bronchodilator," as their symptoms re-emerge after suppression wears off from their bedtime dose. Now 9pm plus 6 hours is 3am, so unless we are careful, we will mistakenly prescribe a lot of Kali-c for these folks without effect. Similarly, the times of aggravation of heartburn will become unreliable modalities for patients using one of the many stomach-acid blocking drugs. Many chronic headache patients begin using minor analgesics such as acetominophen or aspirin or ibuprofen on a routine basis, so time modalities for headache can become unreliable if these reflect the time of the last dose wearing off. Headache in the morning on waking, an otherwise useful rubric, . Anxiety at morning waking may be seen in patients taking beta-blockers for hypertension or migraine prophylaxis - again, this is from overnight beta-blocker withdrawal. I once had a seemingly convincing "Lachesis" case of a man who slept into aggravation of panic with palpitations - it was actually his short-acting propranolol wearing off in the middle of the night. Understanding the drugs we are dealing with can help us to correctly interpret these kinds of symptoms in our patients.

Allopathic suppression of one set of symptoms may result in the disease re-expressing in a totally different manner. A 17 year-old girl presented with an apathetic depression of gradual development over the previous 2 years. Her depressive symptoms were rather nondescript on her antidepressant medication. She had started taking oral contraceptive pills at age 15 for severe menstrual cramps, which had felt like a sagging weight in her pelvis; these were eliminated on the pill. This historical/suppressed concomitant, along with an unaltered concomitant, desire for vinegary foods, pointed to Sepia as her simillimum.

Suppression of normal menstruation by oral contraceptive pills seems to be a common source of allopathic medicinal disease. A search of The Complete Repertory for symptoms related to menstrual suppression reveals 119 rubrics, encompassing 206 remedies. I very often see histories that suggest suppressed dysmenorrhea progressing to PMS, migraine, or depression. Knowing to look for such changes in health in the history can be helpful in unravelling the confusion of the case as it rests today.

Interference with response to the remedy

Kent compared the response to the first prescription to a "bud during its hourly changes to the rose in its bloom." Unfortunately, concurrent use of allopathic medications often robs us of being able to observe the gradual unfolding of cure, and obscures the observations we often depend upon for effective case management. The centisimal dry dose wait & watch approach can be very difficult in these cases. I first began using LM potencies, with repetition during gradual amelioration, specifically to address the difficulties I found in case management of patients on allopathic treatment. It is my impression that the gentle and persistent nudging allowed by LM dosing is one of the clues to successfully treating through allopathic medications.

An 8 year-old child presented with recurring ear infections on prophylactic amoxicillin and eczema using daily corticosteroid cream, a convincing Calc-c case overall. Thirty hours (11pm) after a single 200C pellet, he spiked a fever to 104.6 with severe right ear pain. His parents took him to the emergency room, where he was treated with cef-du-jur, and he recovered over the following 3 days. They returned at 4 weeks, relating this story. Nothing in the case had changed. Although they were very interested in homeopathy as an approach to addressing the chronic nature of his complaints, the mother was equivocal and the father totally unconvinved that it could be trusted for his acutes. I waited 2 months, only to hear of 2 more acute ear infections. So I gave Calc-c 30C, one pellet. Back to the ER within 48 hours again. They came back for one more try a month later, still with no progress in the case. I started him on Calc-c LM1, 1 pellet in 4oz water, 1/2 tsp diluted through 3 successive 4oz glasses, and 1/2 tsp from the third glass for a dose; one dose, wait one week, then three doses/week if no aggravation or striking improvement. He did well on this regimen, with no further ear infections, and after 3 months began seeing gradual disappearance of his eczema. His parents discontinued the corticosteroid cream as no longer needed, and stopped the amoxicillin with his overall improvement.

Suppression of eruptions by corticosteroids is another very common form of allopathic medicinal disease. A search of The Complete Repertory for symptoms related to suppressed eruptions reveals 58 rubrics, encompassing 105 remedies. The observation of suppressed eczema progressing to recurrent otitis media and/or asthma is nearly too common to comment on.

Seeing progress through allopathic medication

Concomitant symptoms often provide the clearest indication of response to our remedy when the "target" symptoms of the patient are altered or suppressed by medication. A young woman presented with chronic depression, presently doing very well on Zoloft, but with lack of libido (a common side-effect of this drug) and a wish to be independent of a rather expensive daily medication. History and concomitant symptoms provided her simillimum - but how were we going to know whether & when she was responding to homoeopathic treatment, and when it would be safe to discontinue the allopathic drug that did effectively palliate a really terrible depression? We were able to follow two concomitant symptoms, neither of which she felt needed medical attention - a chronic aching about the left scapula, and menstrual cramps occuring the first day of bleeding, easing with decreased flow (I'll let you find the remedy). The lack of libido belonged to the medicinal component of the chimeric disease, and needed to wait for discontinuation of her antidepressant to improve. She was given her simillimum in LM1 potency three times weekly, and as the two symptoms concomitant to her depression both disappeared over a few months, we both felt confident that she was responding well, and could taper off her allopathic antidepressant drug.

While allopathic treatment may present obstacles to our ability to easily provide homeopathic care, these obstacles are usually not insurmountable. Understanding these obstacles can allow us to make the adaptations needed to provide care to patients who would otherwise be inaccessible to our healing art.