CEQ Pharmacist Continuing Education
This lesson is supported by an educational grant from
By: June Riedlinger, Pharm.D., former director of
the Center for Integrative Therapies in Pharmaceu-
tical Care at the Massachusetts College of Pharma-
cy and Health Sciences
Contributors: Thierry Boiron, president, Boiron, USA;
John P. Borneman, MS, MBA, chairman and chief ex-
ecutive officer, Standard Homeopathic Co. and presi-
dent, Hyland’s Inc; John A. Borneman, III, RPh, chair-
man, Homeopathic Pharmacopia Convention of the
United States; Leandra Even, ND, Technical Director,
Dolisos America; Eric L. Foxman, RPh, independent
pharmaceutical consultant and secretary, AAHP;
Joseph Lillard, MPA, owner, Washington Homeopath-
ic Products manufacturing pharmacy; Mark S.
Phillips, PharmD, president and chief executive offi-
cer, Standard Homeopathic Co.; Mary Beth Watkins,
BS Chem., MS BioChem, director of research and de-
velopment at Botanical Laboratories Inc.
Universal Program Number: 026-401-04-023-H01
Initial release date: May 1, 2004
Planned expiration date: May 1, 2007
Successful completion of this program is worth
four contact hours (0.4 CEUs).
Target Audience
Pharmacists in community-based practice
Program Goal
To provide the pharmacist with an overview of home-
opathy describing its history, regulation, methods of
manufacture, the terminology used to designate a med-
ication’s strength and research. The pharmacist also
will learn the homeopathic methodology used to identify
correct medications and manage patients appropriately.
Learning Objectives
Upon completion of this program, the pharmacist
should be able to:
1. describe the scope and regulation of homeopathic
practice in relation to consumer and practitioner
populations and the marketplace in the United
States and internationally.
2. discuss theories being investigated to determine a
mechanism of action for homeopathic drugs.
3. demonstrate the ability to use basic homeopathic
methodology and reference texts to
identify appropriate drug therapy for common ail-
ments.
4. formulate counseling guidelines and management
strategies for patients’ using homeopathic prod-
ucts.
5. identify resources for further information.
To obtain credit: Answer the questions at the end of
this lesson on the answer sheet provided. If you are
submitting your answers by mail or fax, completely fill
in the circle corresponding to your answer with a
black pen (no pencils or blue pens please). A state-
ment of credit will be sent to participants achieving a
minimum score of 70 percent correct responses.
Statements of credit are issued within seven days of
receipt if submitted by mail or fax and immediately if
submitted online.
Questions regarding statements of credit and other
customer service issues should be directed to
Angela Sims at (800) 933-9666.
There is no charge for this lesson. If you are a Drug
Store News enrollee, please use your enrollee num-
ber. If you are not a Drug Store News enrollee, please
use promotion code 008-04-0023.
Fax to (813) 626-7203 or mail completed answer
sheet to DrSN/CEQuarterly. P.O. Box 31180, Tampa,
FL 33631-3180. Programs also may be completed on-
line at www.drugstorenews.com.
The Massachusetts College of Pharmacy
and Health Sciences and Drug Store News
are accredited by the Accreditation Council
for Pharmacy Education as providers
of continuing pharmacy education.
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A practical guide
to homeopathy
HISTORICAL PERSPECTIVE1,2,3
The origin of the homeopathic prac-
tice of medicine is credited to Samuel
Hahnemann (1755–1843), a German
physician and chemist, though some
of the original principles can be traced
back to the time of Hippocrates.
Hahnemann believed that the medical
practices of his day, such as bloodlet-
ting and the use of mercurial emetics,
were somewhat barbaric, made for
poor patient compliance and did not
cure disease.
He coined the term allopathy (allos
is Greek for opposite, and pathy
means disease) to describe the action
of such treatments as suppressing the
symptoms of disease. Rather than con-
tinuing to practice the medicine of his
time, Hahnemann began to use his flu-
ency in eight languages to translate
medical texts.
While translating “A Treatise on
Materia Medica” by Scottish physician
William Cullen, Hahnemann read that
cinchona bark was useful in treating
malaria because of its astringent na-
ture. Hahnemann knew of stronger as-
tringents that had no effect on malari-
al symptoms. Thus, he decided to
investigate the effect cinchona bark
would have on his own body. Upon
ingestion of an extract of cinchona
bark, he found it produced a symptom
profile much like that of a person suf-
fering from malaria. Over the next 10
years, Hahnemann systematically re-
searched the symptom profile that var-
ious substances produced in healthy
individuals and recorded his findings.
He named that process a prufung,
or “proving,” a test of the effects of an
ingested substance on a healthy per-
son. The resultant symptoms were con-
sidered indicators of the therapeutic
use of the substance as a medicine.
When substances were subse-
quently administered to individuals
ill with symptoms similar to those of
the “proving,” there was, in fact, a
health improvement.
In 1810, Hahnemann published the
Organon of the Medical Art, which
became the foundation for modern
homeopathy. The sixth edition, com-
pleted a year before Hahnemann’s
death, is now available in a definitive
new translation for contemporary read-
ers and includes an in-depth index.
During his lifetime, Hahnemann
proved 106 homeopathic drugs. In
1811, he began a formal compilation of
the first homeopathic materia medica,
a reference book of remedies—and the
symptoms for which they are useful.
Since then, many others have produced
additional reference materia medicas
based on subsequent provings, toxico-
logical data and clinical reports. In the
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TABLE 1
Historical facts on homeopathy
• Most pharmacists in the 1800s and early 1900s were familiar with the
compounding of homeopathic medicines.
• At the turn of the century 10 percent to 15 percent of the physicians trained
in the United States were homeopathic physicians.
• In 1900, there were 22 medical schools training doctors principally in
homeopathy.
• Many herbal reference texts originally were based on homeopathic refer-
ences, such as American Medicinal Plants by Millspaugh.
• Prominent American users of homeopathic medicines during homeopathy’s
period of flourishing included: inventor Samuel Morse, U.S. Presidents
Garfield, Arthur & McKinley, Senator Daniel Webster, Secretary of State
William Seward, industrialist John D. Rockefeller, attorney William Bryant,
publisher Horace Greeley, inventor Peter Cooper, author Harriet B. Stowe.4
current Homeopathic Pharmacopoeia ic practice in the United States. AMA
of the United States, there are 1,286 members were not permitted to prac-
monographed substances. tice homeopathy and were not allowed
Part of homeopathy’s methodolo- to consult with homeopaths. In 1910,
gy is conducting a thorough interview a report issued by the Carnegie Foun-
with the patient to gather information dation, known as the Flexner report,
about all of the influences that might established guidelines for medical
be affecting the patient’s condition. schools that made it extremely diffi-
Hahnemann believed that a combina- cult to include training in homeopathic
tion of proper diet, hygiene, exercise, medicines. In order to receive funding
coping with family, work and spiritu- from the Carnegie Foundation and
al stress, as well as environmental fac- other charitable trusts, medical schools
tors, all played a role in one’s health. were required to adhere to the Flex-
He wrote about the impact genetics ner Report guidelines. Of the 22 home-
had on health before genetics was a opathic colleges operating in 1900,
respected science and identified con- fewer than a handful still were teach-
ditions (miasms, or diatheses) that can ing homeopathy in 1923. Those facts,
manifest after infectious diseases are combined with disagreements on phi-
contracted. Hahnemann was truly a losophy and other issues within the
forerunner in the concept of holistic homeopathic community, led to the
health and medicine. near demise of homeopathy. By 1955,
Homeopathy continued to devel- no medical schools in the United States
op in Europe and was introduced to were still teaching homeopathy.
the United States in the 1820s. In 1835, While homeopathy’s popularity
Constantine Hering founded the first declined in the United States, it es-
American homeopathic medical col- sentially flourished in Europe and
lege in Allentown, PA. The first na- throughout the rest of the world.
tional medical association, the Amer- However, in the last two decades,
ican Institute of Homeopathy, was homeopathy has made a remarkable
established in 1844. The oldest homeo- resurgence in the United States. In-
pathic pharmaceutical firm in the creasing numbers of physicians are us-
United States, Boericke & Tafel, was ing homeopathic medicines in their
founded in 1835 in Philadelphia and practices; sales of homeopathic drug
continues to manufacture homeo- products are rising each year and the
pathic drug products. Until the early overall acceptance of homeopathy
20th century, between 10 percent and continues to expand.
15 percent of physicians in the United Homeopathy has had a strong im-
States were trained in homeopathy, at pact on the practice of medicine. These
one time numbering in the neighbor- key statistics reflect the popularity of
hood of 14,000 physicians. Other homeopathic therapy in Europe alone:
homeopathic physicians, such as • The top-selling cold and flu
James Tyler Kent and William Boer- medicine in Europe is a homeo-
icke, led the way in the growth of pathic product.
homeopathy at the turn of the 20th • The No. 1 selling motion sickness
century. (See Table 1.) product in Europe is homeopathic.
The founding of the American • Forty-two percent of the medical
Medical Association (AMA) in 1846 doctors in England value home-
was one of the first events that con- opathy and refer patients to
tributed to the decline of homeopath- CONTINUED ON PAGE 4
Spring 2004 3 ●
CEQ Pharmacist Continuing Education

A practical guide to homeopathy

CONTINUED FROM PAGE 3 the phenomenon can be found in mod- PATIENT SCENARIO 1
homeopathic practitioners. ern pharmacology.*
• There are three homeopathic hospi- Examples include:
tals in Britain. • Aspirin is used to lower fever, yet one Jennifer is a 33-year-old woman who approached the pharmacist at East Road
• One-third of French physicians con- of the signs of its toxicity is fever. Pharmacy complaining of periods of difficulty in falling asleep. Jennifer, a sales
sider homeopathy valuable and uti- • Nitroglycerin is used to treat angina, manager for a midsized computer distributor and mother of two small children,
lize it, and thirty-six percent of the but in toxic doses it causes angina. typically experiences difficulty in falling asleep and waking in the early morning
French citizens use homeopathy. • NSAIDs are used to treat arthritis, but during periods of increased stress or with approaching project deadlines.
• The German Commission D mono- under long-term use they can cause Jennifer has had a full evaluation for the problem with her family physician. A de-
graphs contain information on the use the destruction of joints. tailed physical exam was within normal limits and revealed normal neurological
and dosage of hundreds of homeo- • Fluoride is added to the water supply and musculoskeletal function. Screening lab tests demonstrated normal com-
pathic medications; those monographs in amounts of a few parts per million plete blood count, liver enzymes, electrolytes and thyroid and adrenal function.
were prepared by a joint govern- to harden dentin; in higher concentra- Her doctor prescribed zolidem tartrate (Ambien®) 10 mg immediately before
ment/industry working group and tions, fluoride softens enamel. bedtime. Jennifer found zolidem tartrate reduced her sleeplessness, but made
published by the German equivalent • Digoxin is used for cardiac arrhyth- her dizzy.
to the Food and Drug Administration. mias, yet it will cause fatal arrhyth-
• Ten percent of Germany’s physicians mias in toxic doses. Instead of returning to her physician for additional conventional intervention, she
are trained in natural therapies, in- The Principle of Similars can be un- has decided to try a more natural approach. After reading up on some of the nat-
cluding homeopathy. derstood as three complementary aspects: ural treatments for sleeplessness, Jennifer took a course of valerian (Valeriana of-
• Homeopathy is part of the national • Any pharmacologically active agent ficinalis), followed by a trial of melatonin. She finds melatonin makes her groggy
health care system of several Euro- will create a characteristic set of upon waking in the morning. While helping her to relax, in Jennifer’s case, valer-
pean countries, and the majority of symptoms when it is administered to ian did not induce sleep onset.
pharmacies in Europe stock homeo- healthy individuals (i.e. the results of The pharmacist suggested she consider homeopathy because of its effective-
pathic medicines. a proving). ness and relative lack of side effects. Common homeopathic medicines often em-
• Two meta-analyses involving more • Individuals who are ill display a specif- ployed for the treatment of insomnia include Aconite napellus, Avena sativa,
than 200 separate studies have vali- ic set of symptoms; homeopaths con- Chamomilla, Coffea cruda, Ignatia amara and Phosphoric acidum. (See Table 5.)
dated homeopathy. sider those symptoms as the expression The pharmacist recommended to Jennifer a homeopathic OTC sleeplessness
• The WHO reports that homeopathy is of a person’s effort to heal an imbal- product that contained a combination of some of those single ingredients. He
the second most widely used medical ance, referred to as an illness or disease. counseled her to take the product as directed on the label. The pharmacist ex-
modality for primary health care • The curative agent for the ill individ- plained that the decision of which one of the single medicines to take alone is a
around the world. ual is the one that creates the same process requiring more knowledge of her general condition.
characteristic set of symptoms in a
THE PRINCIPLE OF SIMILARS proving; it is given in an appropriate
In practice, when Hahnemann saw a pa- homeopathic potency to effect a safe, Potential homeopathic drugs
tient, he conducted a physical exam and swift and gentle cure. In other words, Aconite napellus: Helpful if there is a sudden onset of feelings relating to anxi-
questioned the individual thoroughly a cure and/or healing process may be ety, restlessness or fear. The patient may have anxious dreams and sleepless-
about his or her general health, outlook on evidenced by the disappearance of ness with restlessness and tossing about. Insomnia in the elderly population is
life and the symptoms being experienced. some or all of the symptoms induced typical of aconite because it can be helpful for a person with an overwhelming
Hahnemann then attempted to match the by the homeopathic drug, which has terror of death.
patient’s symptoms to the profiles and ad- a symptom profile (known from the Avena sativa: Excellent for sleeplessness, especially if it is due to worry and
ministered a minute dilution of the proving) that matches the symptoms there is exhaustion and physical weakness. There may be mental exhaustion as
matched compound. He called this “similia of the ill person. well.
similibus curantur,” or “Let likes be cured Hahnemann knew that giving even
by likes”; it is referred to as the Principle small material doses of some substances Chamomilla: Useful if there is drowsiness in a cranky or whiny patient who can-
of Similars (sometimes mistakenly titled could have deleterious effects, so he not get to sleep. The medicine is also useful in someone who has had excessive
The Law of Similars). developed a system of dilution and suc- amounts of coffee. Pain may be an element of the sleeplessness, as well as rest-
Upon initial thought, that may sound cussion that takes advantage of the cura- less sleep and waking often.
counterintuitive; however, on inspection, tive properties of a homeopathic drug Coffea cruda: Can be used if there is an element of mental excitability with the
insomnia. Individuals needing coffea lie awake listening to a flood of ideas or
thoughts. The person tends to awaken from the slightest noise.
TABLE 2 Ignatia amara: Typically indicated if there is light sleeping and waking with every
sound. There also may be an element of emotional behavior with the medicine,
Quick facts—worldwide trends in homeopathy today such as restlessness, misery, fear of being alone and weepiness. The person
who needs Ignatia experiences sleeplessness from grief or bad news.
• The World Health Organization (WHO) reports that homeopathy is the second most
Phosphoric acid: Will be helpful if there is daytime sleepiness with nighttime
widely used medical modality for primary health care worldwide. Allopathic medi-
cine is a distant fourth.
wakefulness. Individuals needing the medicine are typically mentally fatigued be-
cause of intellectual stress and may be homesick. The patient may experience
• In a recent U.S. survey, 84 percent of the individuals who used a homeopathic sensations of heat during the night.
medicine stated they would buy it again.
• Sixty-nine percent of U.S. chain pharmacies and more than 3,000 independents
stock homeopathic drugs.
without causing side effects. Hahnemann’s still be narrowed down in order to decide
• Thirty-six percent of the French population use homeopathic medicine.
reliance on rigorous, scientific and accu- which homeopathic drug will have the de-
• Thirty-three percent of French physicians consider homeopathy to be effective and rate methods for making medicines was a sired therapeutic effect. There may be sev-
use it in their practices. forerunner for today’s quality control eral homeopathic choices for a patient
• Twenty-one of the 24 Colleges of Pharmacy in France teach homeopathy, and methods and Good Manufacturing Prac- symptom profile; the choice must be se-
homeopathic doctor visits are reimbursed by the national health plan. tices (GMP). lected based on the individual patient. It
• Forty-two percent of British physicians refer patients to homeopathic practitioners. The concept of finding the one correct
• Twenty-five percent of Germany’s natural health practitioners use homeopathy.
homeopathic medicine and giving that
*The Arndt-Schulz law of pharmacology states:
medicine in the appropriate homeopathic • Small or minute doses stimulate function.
• In Canada, 70 percent of homeopathic sales are through pharmacies. potency is the basis for what is termed • Moderate doses inhibit function.
• India has more than 100 medical schools providing rigorous training for physicians classical homeopathy. The process uti- • Large or crude doses block or destroy
in homeopathic medicine. An estimated 100,000 homeopathic medical doctors are lized, called repertorization, requires the function.
practicing in India. In his book dedicated to research work on
enumeration of all the patient’s symptoms this similarity phenomenon, Walter A. Heiby
• Homeopathy has a strong presence in Mexico, Argentina and Brazil, including and then selection of the homeopathic documents this activity in nature.29 Termed
schools and advanced training available to physicians. drug that fits the patient’s overall symp- “hormesis,” this occurs when toxic substances
toms. (For more details, see page 7 and are diluted to levels of just a few parts per mil-
• The popularity of homeopathy is rising in Sweden and the Netherlands. lion (ppm), or even less, and are administered
Appendix 4).
• More than two and a half million Americans use homeopathy.5 to stimulate the body’s ability to cope metabol-
Computer software is available to ically with toxins more effectively and to im-
facilitate the process. But the choice must prove enzyme function.

4 Spring 2004
●
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CEQ Pharmacist Continuing Education
requires a great deal of time and training
to become proficient at classical homeo-
pathic prescribing. Fortunately, when
homeopathic medicines are chosen incor-
rectly, there is little risk to the patient, but
also little benefit.
Today, homeopathic medicines are
available for symptom-specific situations,
such as headache, even though it is clear
they will affect the chemistry of the entire
body. That occurs because homeopaths
observed that certain single homeopathic
drugs affect specific conditions or situa-
tions. Therefore, it is possible to select
homeopathic agents based on the condi-
tion or symptoms without extensively
repertorizing the individual’s symptoms.
Not only was it determined that those
principles were applicable based on clini-
cal presentation, but some medicines were
developed that included several ingredi-
ents, each being included for its specific
effect on a given symptom or aspect of a
condition. That combining of several
homeopathic drugs is called complex
homeopathy with the medications being
called combinations, or complex medi-
cines. Today, both single and complex
homeopathic medicines are valuable tools
for health care professionals.
Appendix 3 introduces common home-
opathic drugs for a representative group of
self-treatable complaints. The medications
could be a stand-alone treatment or used
in a combination (complex) product. The
information is meant to be a quick refer-
ence guide rather than a complete train-
ing program.
REGULATORY ASPECTS
OF HOMEOPATHIC DRUGS
In order to fully appreciate the quality and
professional stature of homeopathic med-
icine in this country, it is important to un-
derstand both homeopathy’s regulatory
status in the United States and the home-
opathic manufacturing practices.
Status of homeopathic products
and drugs
Homeopathic products are classified as
drugs within the meaning of the Food,
Drug and Cosmetic Act as amended6 and
may be prescription or nonprescription
products. That may be confusing to the
pharmacist because many associate home-
opathy with herbal and nutritional sup-
plements, which are regulated by the Di-
etary Supplement Act (DSHEA).7 Key dif-
ferences exist between homeopathy and
dietary supplements.
Over-the-counter homeopathic medi-
cines must have a drug claim on the prod-
uct label for self-limiting, self-diagnosable
conditions. That is in contrast with dietary
supplements for which only a structure/
The Homeopathic
Pharmacopoeia Convention
of the United States has the
following structure:
• Board of directors
• Standing committees:
– Monograph review committee
– Pharmacopoeia revision committee
– Council on pharmacy
– Standards and controls committee
• Ad hoc committees:
– Publications
– Finance
– Bibliography
Drug Store News
function claim can be made. In other words,
dietary supplements may not make claims
for the diagnosis, relief, cure or mitigation
of symptoms of a given condition or illness.
Homeopathic medicines must have a ther-
apeutic indication on their labels.
The Food and Drug Administration
does not regulate homeopathic drugs in
precisely the same way as other drugs. In-
stead, in 1988, the agency developed a
Compliance Policy Guide (CPG)8 that
gives specific regulatory guidance for the
marketing of homeopathic drugs. The
CPG states:
“Nonprescription homeopathics may
be sold only for self-limiting conditions
recognizable by consumers … labeling
must adequately instruct consumers in the
product’s safe use.” Just as for products
that meet the requirements of the USP and
NF, a product’s compliance with the
Homeopathic Pharmacopoeia of the Unit-
ed States (HPUS) alone does not establish
that it has been shown by appropriate
means to be safe, effective and not mis-
branded for its intended use. However, as
discussed below, measures are in place to
ensure that safe, effective and properly
branded homeopathic drugs are marketed
in the United States.
Allopathic drugs may not be marketed in
the United States unless they are deter-
mined to be safe and effective and are
proven by at least two double-blind, cross-
over studies. To do that, the manufacturer
must submit a New Drug Application
(NDA) or Abbreviated New Drug Appli-
cation (ANDA) to the FDA. The process is
expensive, costing many millions of dollars.
The reward for that expense for the pioneer
company is the exclusive marketing of the
product for the life of the patent, which may
generate billions of dollars in revenue.
In contrast, homeopathic medicines are
considered part of the public domain. That
means that any formula or ingredient is
available to all manufacturers, resulting in
product prices that are considerably low-
er than those for allopathic drugs. The
FDA’s present policy does not require
homeopathic medicines to go through the
NDA process. Instead, homeopathic prod-
ucts can be marketed because:
1. the homeopathic ingredient(s) mono-
graphed in the Homeopathic Pharma-
copoeia of the United States have
been reviewed for homeopathic effi-
cacy, toxicology, adverse effects and
clinical use.
2. the historical safety record with the
use of homeopathic drugs, some for
close to 200 years. The FDA drug
monitoring process does not reveal
any significant instances of problems
with homeopathic drug products, thus
establishing a positive safety profile.
Homeopathic Pharmacopoeia of the
United States/revision service
(HPUS/RS)9
Homeopathic medicines have official com-
pendial status in the United States. Royal
Copeland, M.D., a homeopathic physician
and U.S. senator from New York, was the
principle author of the federal Food Drug
and Cosmetic Act of 1938. Copeland un-
derstood the need for a separate homeo-
pathic compendium owing to the differ-
ences between homeopathic and allo-
pathic medicine.
Since that time, the HPUS/RS has the
same official status as the USP/NF. If a
drug appears in both pharmacopoeias,
it is subject to the requirements of the
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TABLE 3
Some prescription homeopathic drugs
Anhalonium lewinii Apomorphinum
Bacillinum Pulmo BCG
Cannabis sativa Chloralum
Cocainum Muriaticum Codeinum
DDT Thioproperazinum
Erythroxylon coca Hippozaeninum
Vaccinotoxinum Medorrhinum
Morphinum Morphinum
Narcotinum Opium
Phenobarbitalum Psorinum
Sulphonalum Syphilinum
Tuberculinum Tuberculinum Bovinum
USP unless it is distinctly marketed, la-
beled and offered for sale as a homeo-
pathic drug. It would then be subject to
HPUS/RS requirements.
The HPUS/RS was first published in
1897 and is currently updated through a
Revision Service. The Revision Service is
published by the Homeopathic Pharma-
copoeia Convention of the United States
(HPCUS), a private, not-for-profit organi-
zation developed exclusively for charita-
ble, educational and scientific activities.
The HPCUS membership includes phar-
macists, physicians, biochemists, botanists
and other professionals. The HPCUS con-
sists of several committees to guide the fu-
ture direction of homeopathic medicine.
The HPUS/RS contains 1,286 mono-
graphs of homeopathic ingredients. A typ-
ical monograph includes:
• name of the drug
• chemical formula and molecular
weight of the ingredient
• botanical classification
• description (color, solubility, toxicity
or botanical description)
• standards for preparation
• dilution requirements for nonpre-
scription and prescription use
• quality control tests and standards,
which are being added to mono-
graphs as part of an ongoing revi-
sion process.
The HPUS/RS specifies which drugs
in what dilutions are for prescription only
use. For example, hawthorn is an herb that
can be sold as a dietary supplement. When
it is manufactured according to HPUS/RS
standards and labeled as a homeopathic
drug (Crataegus oxycantha), it is available
by prescription only. Other examples may
have both acceptable prescription and
nonprescription dilution levels, but all la-
beling must follow the guidelines set forth
by the HPUS/RS and the Compliance Pol-
icy Guide.
For a drug to be eligible for inclusion
in the HPUS, the HPCUS must determine
its safety and efficacy. It must be manu-
factured according to HPUS/RS require-
ments. The appropriate documentation
must be submitted to the HPCUS show-
ing the therapeutic use of the drug has
been established according to at least one
of the following criteria:
1. through a proving that is acceptable
to HPCUS
2. through long-term and documented
clinical use
3. by at least two adequate and well-
controlled double-blind clinical
studies using the drug as a single
intervention
Apomorphinum Muriaticum
Cannabis indica
Cocainum
Crataegus oxyacantha
Diphtherinum
Lyssin
Monotropa uniflora
Muriaticum Narceinum
Pennicillinum
Reserpinum
Tribulus terrestris
Yohimbinum
4. through data that have been collected
clinically through a symptom picture,
pre- and post-treatment and subjective
or objective data; or the data has been
published in conventional or homeo-
pathic medical literature subject to fur-
ther verification. (Note: the symptom
picture is the proving or the symp-
toms that appear after repeated dosing
of the agent under investigation.)
An extensive review of all the available
documentation by several committees of
the convention is necessary before a new
monograph is accepted for publication.
The HPCUS then decides at which dilu-
tion level the agent should be nonpre-
scription or prescription.
A vast majority of homeopathic medi-
cines on the market in the United States
are marketed as nonprescription products.
That is due to the safety for self-medica-
tion that exists with homeopathic drugs.
Some homeopathic drugs that are labeled
prescription only may be indicated for
conditions that are not amenable to self-
treatment, such as diabetes or cardiovas-
cular disease (e.g., Crataegus oxycantha).
Others are restricted to prescription sta-
tus because of their potential for toxic ef-
fects. Those generally, though not exclu-
sively, apply to the lower potencies (2X or
3X). A representative listing of prescrip-
tion-only homeopathic drugs is contained
in Table 3; a complete list can be found in
the HPUS. Just as for any prescription
drug, a prescription homeopathic product
must be labeled in accordance with the ap-
propriate FDA regulations.
In addition, the FDA’s CPG provides
that homeopathic drugs may contain only
ingredients that are generally recognized”
as homeopathic. Publication of a mono-
graph in the HPUS/RS is one acceptable
criterion for being generally recognized
as homeopathic.
However, as long as other official doc-
umentation exists in support of general
recognition, a homeopathic drug ingredi-
ent does not necessarily have to be in the
HPUS/RS to be marketed in the United
States. Such homeopathic drugs are con-
sidered non-HPUS/RS ingredients, or
nonofficial homeopathic drugs; the man-
ufacturers are responsible for the docu-
mentation to FDA’s satisfaction.
(As previously stated, homeopathic
drugs are not the same as herbal products,
although a large number of homeopathic
medicines are made from botanical sub-
stances. About 60 percent of HPUS/RS
monographs are plant derived. Other sub-
stances are derived from the animal king-
CONTINUED ON PAGE 6
Spring 2004 5 ●
CEQ Pharmacist Continuing Education
A practical guide to homeopathy
CONTINUED FROM PAGE 5 fy homeopathic action with the concept of
dom (honeybees, cuttlefish ink, snake and
spider venoms and others) and the min-
eral kingdom (calcium, graphite, iodine,
lead, sulfur and others). Some recent
homeopathic agents are made from syn-
thetically produced substances. Substances
that may be toxic in a crude drug strength
can become therapeutic agents by prepar-
ing them through the homeopathic dilu-
tion and succussion process.
The concept of using toxins in dilution
to stimulate positive biological activity is
well documented and can be explained by
the Arndt-Schulz law. Studies have sup-
ported the use of toxins in parts per mil-
lion—and in higher dilutions—to strength-
en the body’s ability to deal with toxins.
For example, a homeopathic product that
contains arsenic can safely provoke a pos-
itive healing response when prepared to
the HPUS/RS-specified OTC potency.
There are several classes of homeo-
pathic drug products in the HPUS. Some
are based on the physical properties that
determine the manufacturing process to
be used; others are based on the type of
source material. Some of the more spe-
cialized categories include:
• Sarcodes: Preparations derived from
healthy glandular or other tissue ma-
terial. They include extracts from thy-
roid, liver and adrenal tissue; also
physiologically active substances,
such as NAD, cytokines, epinephrine
and enzymes.
• Nosodes: Preparations derived from
disease-causing microbes, diseased
tissues and exudates. They include
preparations that contain viruses,
bacteria, parasites, fungi, ova and
yeasts. Those pathogens are killed
and sterilized before the homeopathic
manufacturing process, so there is no
risk of contracting an infection. The
concept of using nosodes has been
compared with allopathic vaccines,
toxoids and antitoxins.
• Allersodes: Preparations made from
allergy-causing agents. The most
common agents in the category in-
clude pollens, molds, dust, foods
and chemicals.
• Isodes: A general term for prepara-
tions made from botanical, biological,
chemical or synthetic substances, in-
cluding drugs, excipients or pollutants
that have been absorbed into the body
of an individual and are the cause of
the condition or symptoms the patient
is experiencing. They could include
pesticides, industrial pollutants, plas-
tics or petrochemical derivatives.
Some health care professionals identi-
DIAGRAM 1 (703) 229-4343, fax: (703) 229-4343
The homeopathic
attenuation process
1 part
Tincture
= 1X
9 parts
Diluent
2X
6 Spring 2004
●
allergy desensitization, as in the use of
allersodes, or in the use of a nosode with
its similarity to vaccination procedures.
However, the mechanism of action of
homeopathic drugs still is being re-
searched. The concept of the law of simi-
lars, however, make it possible to under-
stand the use for all classes of homeo-
pathic medicines.
In conclusion, for those and other
classes of homeopathic drugs, the
HPUS/RS defines the appropriate start-
ing material, the manner in which it is to
be manufactured and its classification
as a prescription or nonprescription
drug depending on its safety, intended
use and legal status.
HOMEOPATHIC DRUG MANUFACTURING
Homeopathic medicines are prepared in
accordance with the HPUS/RS. The
HPUS/RS, currently in its ninth edition,
is the official compendium for homeo-
pathic pharmaceuticals in the United
States. Like any other drugs, homeo-
pathic pharmaceuticals must be manu-
factured in accordance with Current
Good Manufacturing Practices (CGMPs)
defined in Section 211 of the Code of Fed-
eral Regulations. In addition, the
HPUS/RS defines additional CGMPs
that are specific to the manufacture of
homeopathic pharmaceuticals. Manu-
facturers also must meet state board of
pharmacy requirements for manufactur-
ing medicine.
Sources of starting materials
Homeopathic pharmaceuticals are man-
ufactured primarily from botanical sub-
stances; many mineral substances and a
few zoological substances also are uti-
lized. Monograph specifications include
macroscopic identification, microscop-
ic identification and appropriate geo-
graphic regions to collect the starting
material. For starting materials of botan-
ical origin, the appropriate time for col-
lecting the plant to maximize specific
plant constituents, as well as the part of
the plant used, also is specified. All
plant material should be free from pes-
ticides, herbicides and chemical fertil-
izers. For mineral substances, addition-
al specifications, such as wet chemistry
identification, loss on drying, heavy
metals and assay methods, often are in-
cluded. The appropriate manufacturing
processes for the starting material are
included in the monograph, with the
solubility of the starting material often
determining the steps in the manufac-
turing process.
1 part 1 part 1 part
9 parts
9 parts
3X 4X
Tincture preparation and testing
For homeopathic pharmaceuticals pre-
pared from botanical origin, the fresh plant
is cleaned, finely chopped and mixed with
the appropriate quantity of ethyl alcohol
and water as specified in the HPUS/RS.
This mass then is macerated for 14 days
to 28 days with daily stirring to maximize
exposure of the plant material to the men-
struum (liquid used for extraction). The
liquid is decanted from the plant material.
The plant material then is pressed to ex-
tract all menstruum. Finally, the liquid is
filtered to yield the tincture (sometimes
referred to as the mother tincture).
Tinctures are tested against quality con-
trol specifications in the HPUS/RS, in-
cluding organoleptic and chemical iden-
tity tests, dry residue and alcohol content
determinations, as well as positive identi-
fication by thin layer chromatography
(TLC). Once manufactured to HPUS/RS
SERVICES, ORGANIZATIONS,
AMERICAN ASSOCIATION OF
HOMEOPATHIC PHARMACISTS (AAHP)
3741 Mitford Lane, Clinton, WA 98236
Phone/fax: (800) 478-0421
www.homeopathicpharmacy.org
Established 1923. Organization for phar-
macists, manufacturers and distributors of
homeopathic products. Provides a liaison
function for the homeopathic industry with
regulatory agencies
HOMEOPATHIC PHARMACOPOEIA
CONVENTION OF THE UNITED
STATES (HPCUS)
P.O. Box 2221
Southeastern, PA 19399
www.hpcus.com
Publishes the HPUS, the officially recog-
nized reference book of standards for
homeopathic drug products
NATIONAL CENTER FOR
HOMEOPATHY (NCH)
801 North Fairfax, Suite 306
Alexandria, VA 22314-1757
(703) 548-7790, fax: (703) 548-7792
www.homeopathic.org
The largest homeopathic organization in
America, providing general education to
the public about homeopathy and specific
education to homeopaths. Publishes a
monthly magazine.
AMERICAN INSTITUTE OF
HOMEOPATHY (AIH)
801 North Fairfax, Suite 306
Alexandria, VA 22314-1757
(703) 246-9501
Organization of medical professionals who
practice homeopathy, established 1844.
Publishes a quarterly journal
COUNCIL ON HOMEOPATHIC
EDUCATION (CHE)
13 Dutchess Terrace, Beacon, NY 12508
e-mail ched@igc.org www.chedu.org
Provides information about accredited
homeopathic programs and conferences
HOMEOPATHIC ACADEMY OF
NATUROPATHIC PHYSICIANS (HANP)
12132 S.E. Foster Place
Portland, OR 97266
1 part (503) 761-3298, fax: (503) 762-1929
e-mail hanp@igc.org
www.healthy.net/hanp
9 parts
9 parts
Publishes quarterly journal Simillimum.
Awards the DHANP
(Diplomate of HANP). Sponsors an Annu-
al Care Conference
5X 6X
www.drugstorenews.com
standards, the tincture is stored in a tem-
perature-controlled environment protect-
ed from light.
The tincture most often has the home-
opathic potency of 1X, indicating that the
tincture contains 1 part by weight of the
fresh plant material (calculated by its dry
weight) in 10 parts by volume of the com-
pleted solution.
Trituration of insoluble substances
For starting materials that are insoluble in
alcohol and water, the homeopathic phar-
maceutical is prepared by diluting 1 part
by weight of the starting material with 9
parts by weight of lactose. The mass then
is triturated in a mortar and pestle for a
specific period of time. A triturated pow-
der prepared in that way has the homeo-
pathic potency of 1X.
Subsequent attenuations then are pre-
pared from this 1X trituration.
LITERATURE
HOMEOPATHIC NURSES
ASSOCIATION
Lia Bello, RN
HC81, Box 6023, Questa, NM 87556
(505) 586-1166, fax: (508) 223-1801
e-mail wellnessnurse@5pillars.com
www.homeopathicnurses.org
A support organization for nurses studying
and integrating homeopathy into their
practices
NATUROPATHIC COLLEGES
(see section on Homeopathic Education
for further information)
BASTYR UNIVERSITY
14500 Juanita Drive, NE
Bothell, WA 98011
(425) 823-1300, fax: (425) 823-6222
www.bastyr.edu
NATIONAL COLLEGE OF NATURO-
PATHIC MEDICINE LIBRARY
049 SW Porter, Portland, OR 97201
(503) 499-4343, fax: (503) 219-970
www.ncnm.edu
SOUTHWEST COLLEGE OF NATURO-
PATHIC MEDICINE
2140 East Broadway Road
Tempe, AZ 85282
(480) 858-9100, fax: (480) 858-9116
www.scnm.edu
OTHER PROFESSIONAL TRAINING
PROGRAMS (see section on Homeo-
pathic Education for further information)
COLORADO INSTITUTE FOR
CLASSICAL HOMEOPATHY
2955 Valmont Rd, Ste 100
Boulder, CO 80301
(303) 440-3717, fax: (303) 440-6525
e-mail info@homeopathyschool.org
www.homeopathyschool.org
Two-year program leading to certification
as a classical homeopath. Certification is
for previously licensed health profession-
als approved by the state of Colorado.
QVIUS SCHOOL OF HOMEOPATHY
Quantum Veritas International University
Systems
77 W Underwood St, Suite 100
Orlando, FL 32806
(407) 422-2273, (310) 645-0443
fax: (310) 645-1814
e-mail homeopathy@qvius.edu
600-Hour Professional Postgraduate Pro-
gram in Classical Homeopathy. Program
is certified by the National Board of Home-
opathic Examiners
Drug Store News
CEQ Pharmacist Continuing Education

THE ATTENUATION PROCESS10,11 As illustrated in Diagram 1, 1 part by

The attenuation process prepares a very volume of the tincture (designated as 1X TABLE 4
small dose of the starting material in such homeopathic potency) is combined with
a way that the inherent properties can trig- 9 parts by volume of diluent and then suc- Key advantages to homeopathy
ger the body’s healing mechanisms. The cussed; that results in 10 parts of the 2X
attenuation process is a twofold process potency. One part by volume of the 2X po- • gentle acting with no known side effects or drug interactions
comprising serial dilution in a defined ra- tency is combined with 9 parts by volume • generally less expensive to consumers than patented and trade name products
tio and succussion or trituration at each of diluent and then succussed, creating 10 • variety of dosage forms suitable for use by the entire family, including young
dilution step. Succussion is the process of parts of the 3X potency. That process is re- children
vigorously shaking with impact to trans- peated until the desired potency is reached.
• ideal for those who do not wish to medicate with traditional allopathic nonprescrip-
fer energy of the starting material to the tion medicines for self-care
resultant homeopathic pharmaceutical. Homeopathic potency designation:
Trituration utilizes friction to facilitate that X vs. C vs. M vs. LM • ideal for treating self-limiting symptoms in patients with conditions for which nonpre-
transfer of energy. Rather than labeling a homeopathic med- scription ingredients are contraindicated
Diluents appropriate for use in the icine with a gram or milligram quantity, For example:
manufacture of homeopathic pharmaceu- which becomes impractical for the higher • Nonprescription decongestants (sympathomimetics) may be harmful in patients
ticals include ethyl alcohol, purified wa- homeopathic potencies, the homeopathic with the following conditions, but homeopathic drugs are not: diabetes, enlarged
ter and glycerine for soluble substances strength, or potency, designations indicate prostate, heart disease, hypertension, thyroid disease
and lactose for insoluble substances. Those the number of steps and the type of dilu- • Nonprescription allergy remedies, antiemetics and sleep aids (containing antihista-
diluents typically are used, as they are con- tion ratio used in the manufacture of the mines) may be contraindicated in patients with the following diseases, but homeo-
sidered inert vehicles. homeopathic drug. The letter designation pathic drugs are not: angle closure glaucoma, enlarged prostate
• Aspirin may be harmful in patients with the following diseases, but homeopathic
PATIENT SCENARIO 2 drugs are not: diabetes (high-dose ASA), gout, peptic ulcer
• Homeopathic drugs can be used for treating self-limiting symptoms in patients tak-
ing prescription drugs with which nonprescription medications may interact
Marvin is a 62-year-old man visiting his grandchildren. He decided spontaneous-
For example:
ly to take his family on a river cruise, which is leaving in an hour, and he is con-
cerned about a problem he has with seasickness. He stopped in at the Wright • Antihistamines reportedly interact with CNS depressants MAO inhibitors, protease
River Pharmacy to ask the pharmacist for something to keep him “from getting inhibitors, serotonin reuptake inhibitors, tricyclic antidepressants
sick on the boat.” Being as he is leaving in an hour, he needs something that is • Aspirin reportedly interacts with antidiabetic agents, methotrexate, probenecid,
fast-acting, and he prefers a natural product. Above all, he would like a product Warfarin
that does not cause drowsiness. • Cimetidine reportedly interacts with dozens of drugs including: anticoagulants, an-
The pharmacist on duty determined that Marvin is taking a number of post-my- tidiabetics, benzodiazepines, beta blockers, Ca. channel blockers, carbamazepine,
ocardial infarction medications, including warfarin sodium (Coumadin) 4 mg cisapride, phenytoin, theophylline, tricyclic antidepressants
daily. Ginger (Zingiber officinalis) is a popular herbal alternative for motion sick- • Nonsteroidal anti-inflammatory drugs, reportedly interact with anticoagulants and
ness, but it has been shown to potentiate anticoagulant effects. For that reason, lithium salts
the pharmacist suggests a homeopathic medicine. • Pseudoephedrine reportedly interacts with antipsychotics, guanethidine and gua-
Single homeopathic medications for motion sickness include Borax, Cocculus in- nadrel, theophylline, tricyclic antidepressants
dicus, Nux vomica, Petroleum, Tabacum and Theridion. (See below.) In summary, published reports of adverse drug interactions of homeopathic drugs
The pharmacist suggested to Marvin that he try an OTC product for motion sick- with allopathic medications are extremely rare.
ness containing several of those single homeopathic ingredients. She suggested
that Marvin should take the labeled dose as soon as he starts to experience the
symptoms and continue taking this product every hour while he was on board un- denotes the dilution ratio used in the at- tion represents a complex attenuation
til his symptoms subside. She counseled him to abstain from food and beverages tenuation process; the number before the process in which the starting material is
as much as possible, especially if the possibility of motion sickness appeared letter indicates the number of steps the serially diluted in a ratio of 1:50,000. That
likely. She explained that determining which single homeopathic drug product starting material has been taken through in method is distinctly different from the 1:10
would be effective would be a much longer process than he had time for. Given the attenuation process. dilution ratio used for X potencies and
his time constraints, she suggested that the combination OTC product would be The designation X (the Roman numer- 1:100 dilution ratio used for C and M po-
ideal for his needs. al 10) represents the 1-in-10 dilution ratio tencies. The HPUS/RS has complete de-
utilized in the Decimal Potency (also iden- tails on that unique method of manufac-
tified as D potency in many European ture. Some practitioners feel the method
Potential homeopathic drugs countries). In the example above, the 3X results in a homeopathic medicine that
Borax: Indicated where there is vertigo from a downward or upward motion or potency indicates the starting material has supports the body’s healing effort in an
rocking. The vertigo may be accompanied by a sensation of fullness in the head. been diluted in a ratio of 1:10 three suc- even more gentle fashion, though there are
A sensitivity to sudden noises may accompany the vertigo. Borax is especially cessive times using either trituration or no studies that elaborate the differences
useful for seasickness. succussion at each step. A 6X potency in- in therapy between LM potencies and oth-
Cocculus indicus: One of the most valuable homeopathic motion sickness med- dicates the starting material has been di- er homeopathic attenuation methods.
icines, as it treats the nausea, vomiting and severe dizziness. Patients have luted in a ratio of 1:10 six successive times.
symptoms associated with great weakness and typically will feel better lying The result is 1 part of the original materi- Attenuation methods: Hahnemannian
down, want to be immobile and be left alone. Nausea intensifies at the mere al to 1 million parts of the diluent. and Korsakovian
thought or smell of food or on watching moving objects. Homeopathic drugs also can be pre- The two principal methods for manufac-
pared as C potencies. The designation C turing homeopathic liquid pharmaceuti-
Nux vomica: Especially helpful when vertigo is the key symptom. All symptoms
represents the Centesimal Potency (the Ro- cals are the Hahnemannian and the Kor-
are made worse by exposure to light, odors and the open air. The person is irrita-
man numeral for 100). Centesimal poten- sakovian Methods of Attenuation. The
ble and has a constant urge to vomit, but is unable to do so.
cies are produced by the same serial dilu- Hahnemannian method utilizes a new
Petroleum: Especially valuable for seasickness relief as it will help to resolve tion process with succussion or trituration, container for each attenuation step, re-
nausea, vomiting and vertigo resulting from swinging motion. The person may but utilize a 1:100 dilution ratio with trit- quiring the measurement of 1 part of the
feel intoxicated, is worse standing and feels better with eyes closed in a dark uration or succussion at each step. previous homeopathic potency and the
place. The designation M also appears as a appropriate amount of the diluent to cre-
Tabacum: Indicated in seasickness if a sinking feeling is felt at the pit of the strength designation on homeopathic ate the next homeopathic potency after
stomach. The patient needing that medicine also will feel better with his eyes medicine labels. However, the M is not a succussion (9 parts for X or D potencies,
closed in fresh, open air. The patient is often pale and weak. separate dilution ratio; it is merely short- 99 parts for C potencies). Homeopathic
Theridion: Useful when nausea with vertigo is a key component of motion sick- hand for 1,000C. The further attenuation drug products manufactured by that
ness. The nausea that is worse with the least amount of motion or may occur of a 1M (=1.000C) potency would include method may include the letter H in the
when closing the eyes during motion. Individuals are very sensitive to noise; if serial 1:100 dilutions to 1,001C, 1,002C, potency designation, e.g. 6DH or 9CH to
they feel better when drinking warm water, that product may be indicated in 1,003C … until the 2,000th C potency is indicate that the Hahnemannian method
homeopathy than he now has. He stated that this preparation provides many of reached, which is designated 2M. M po- has been employed.
the key homeopathic drugs for her health concern, but may not necessarily con- tencies usually are reserved for use by The Korsakovian method utilizes the
tain the one single medicine she needed. If that combination product did not help trained homeopathic physicians. same container for each attenuation; it typ-
her sleeplessness, he could provide a referral to a homeopathic While LM, or Fifty Millesimal, poten- ically is used with the centesimal scale of
specialist who works closely with the pharmacy. cies have a 150-year history, their use in attenuation. That requires emptying the
contemporary homeopathic medicine is container so that 1 part of the previous
relatively new. The LM potency designa- CONTINUED ON PAGE 8

Drug Store News www.drugstorenews.com Spring 2004 7 ●

CEQ Pharmacist Continuing Education
A practical guide to homeopathy
CONTINUED FROM PAGE 7
homeopathic potency adheres to the wall
of the container.
By adding 99 parts of diluent to the
container, the next serial 1:100 dilution is
created for succussion. Homeopathic drug
products manufactured by this method in-
clude the letter “K” in the potency desig-
nation, e.g. 3CK.
Dosage forms
Once attenuated to the desired potency,
homeopathic pharmaceuticals can be
processed into a variety of dosage forms
including: triturate tablets, compressed
tablets, medicated tablets, lozenges, cap-
sules, powders, medicated pellets (glob-
ules), oral liquids, syrups, ophthalmic so-
lutions, nasal sprays, ointments, creams,
gels, injectables and suppositories. The
most common dosage forms are tablets,
pellets and liquids.
Triturate tablets are manufactured by
adding a binder (typically alcohol and
natural gum acacia or sucrose) to the trit-
urated powder and molding the moist-
ened powder into the shape of a tablet,
which is then dried, much like a nitro-
glycerine tablet. The soft triturate tablets
typically utilize only lactose as the base of
the tablets and do not require other ex-
cipients to which the patient may be sen-
sitive. Triturate tablets dissolve almost
instantly in the saliva of the mouth, fa-
cilitating sublingual absorption. Because
of their friable nature, triturate tablets are
currently exempt from FDA tablet im-
printing requirements.
Compressed tablets are produced by
mixing the triturate powder with other ex-
cipients and then using pressure to stamp
the mixture into a hard tablet that may be
swallowed or chewed and dissolved in the
mouth. Additional excipients may be re-
quired to facilitate powder flow through
the machine (e.g., magnesium stearate)
and to enhance disintegration of the tablet
(e.g., starch). Compressed tablets must in-
clude an imprinted code on their surface to
identify the manufacturer and homeo-
pathic nature of the tablet.
Medicated tablets can be prepared by
applying a homeopathic medicated so-
lution to saturate the surface of an un-
medicated compressed tablet. The tablets
are dried, leaving the homeopathic med-
icine in the surface layer of the tablet. As
an alternative, the homeopathic compo-
nent can be added to the tablet mass be-
fore compression.
The medicated pellet or globule is prob-
ably the most extensively used homeo-
pathic dosage form. First, an unmedicated
pellet is formed by accumulating sucrose
and lactose solutions onto the surface of a
seed crystal in a rotating coating pan un-
til it reaches the desired diameter or size.
Then, the pellets are prepared by apply-
ing the homeopathic medicated solution
of specific potency to saturate the surface
of the unmedicated pellet. Medicated pel-
lets are designed to be dissolved in the
mouth for sublingual absorption of the
homeopathic medicine.
Medicated Pellets are manufactured in
various sizes e.g. #10 pellets (very small),
#20 pellets (small), #35 pellets (regular)
and #55 pellets (large). While the diameter
of the medicated pellet differs from size
to size, the dose delivered by each pellet is
8 Spring 2004
●
PATIENT SCENARIO 3
Barbara, a 45-year-old woman came to Natural Ways Pharmacy because of seasonal allergies. Every year she had problems
with sneezing, watery eyes and a runny nose during the fall. In the past year, those symptoms had worsened. Because the
symptoms were no longer tolerable, she went to her family physician, who diagnosed her with seasonal allergic rhinitis (hay
fever). She was prescribed fexofenadine hydrochloride (Allegra) 60 mg twice per day. She discontinued taking the fexofena-
dine hydrochloride after finding that it made her excessively drowsy and fatigued.
She now is seeking a natural solution to her problem, preferably one without side effects or interactions. She also is taking
levothyroxine sodium USP 50mcg daily.
The pharmacist on duty discussed how homeopathy is renowned for not having any known side effects or drug interactions.
She explained to Barbara that homeopathic medicines are selected based on the symptoms presented. She asked Barbara to
tell her more about her symptoms. Barbara states the worst part of her hay fever is her runny nose. There is an extensive burn-
ing nasal discharge that drips like water from a nose that is difficult to breathe through. Her nose is substantially better indoors,
especially if the room is warm. She also sneezes excessively, especially in the morning. Her eyes water and itch but feel better
when a cold towel is applied to them. She is sensitive to light. She really feels worse when her husband mows the grass. Further
questioning from the pharmacist does not reveal any additional concerns.
The pharmacist was familiar with several homeopathic products that could work for the treatment of Barbara’s symptoms.
Based on the symptoms Barbara mentioned, the pharmacist believed the most helpful homeopathic drug product would be
one of the three following choices: Allium cepa because of the similar nasal discharge and sneezing, and the correlation of
light sensitivity also may indicate that medicine; Arsenicum album because of the nasal discharge and stuffiness, improve-
ment of symptoms in the warmth and sneezing in the morning; and Pulsatilla because of the eye and nasal symptoms and
improvement indoors.
The pharmacist was unable to obtain more specific information that might have narrowed the choice still further; so a
homeopathic allergy relief combination product that contained all three of the above homeopathic drugs was recom-
mended. The pharmacist knew that if Barbara obtained relief from the combination product, the ideal single homeopath-
ic drug could be determined at a later time. The pharmacist counseled Barbara on how to take the product as directed
on the package. Barbara returned to Natural Ways Pharmacy a couple of weeks later to buy more of this OTC combina-
tion homeopathic product. She stated that she was feeling much better, and the product helped to control her symp-
toms, though she still needs to take it from time to time.
One month later, Barbara returned to the pharmacy to pick up more of the homeopathic allergy relief combination product. The
pharmacist discovered that she has been using the homeopathic product continuously several times daily. Barbara states it still
is working, but not as well as before. The pharmacist suggests that she see one of the homeopaths who consult with patients
who are customers of the pharmacy. Barbara was told that, with hay fever episodes, symptoms can respond to acute care ini-
tially, but can benefit from individualized constitutional prescribing by a professional homeopath who could evaluate and
choose the correct single medicine in order to relieve her ongoing condition completely. The pharmacist further explained that
the constitutional homeopathic drug, often given at a higher potency, would act on deeper levels to alter her constitutional pre-
disposition to react to airborne allergens.
Barbara had a one-hour constitutional homeopathic intake consultation and was given Pulsatilla 200C, one dose. At Bar-
bara’s next visit to the pharmacy, a month later, she reported that her symptoms had improved immediately after
taking Pulsatilla, and she was enjoying her summer more than she had in many years.
Potential homeopathic drugs
Allium cepa: Burning, excessive watery discharge that typically drips like a faucet is the prominent feature of this homeopathic
medicine. The eyes burn and typically there is excessive lacrimation that is bland. Violent sneezing also is common. A sensitivi-
ty to light also may be present.
Arsenicum album: That medicine has symptoms of burning, watery nasal discharge that drips. The nose is typically obstruct-
ed. Sneezing may occur in the morning. All symptoms are better in a warm room. Usually, all eye symptoms are burning in na-
ture, with acrid lacrimation.
Kali iodatum: That medicine is useful when the nose is stuffed and a burning watery nasal discharge is present. Rawness in-
side the nose is typical, and sneezing in the morning upon waking may occur. A key symptom is the pain that the patients feel
on sticking out their tongues because of the discomfort of the throat.
Natrum muriaticum: There is copious discharge, eventually becoming a stuffiness that makes breathing difficult. There is a lot
of sneezing present, especially in the early morning. There is often a loss of smell or taste with the allergic symptoms. The eyes
may be watery, especially upon exposure to light.
Nux vomica: That homeopathic product has excessive amounts of nasal discharge with nasal congestion in bed at night. It is
also well known to treat sneezing in the morning, especially on getting out of bed. Symptoms are better indoors. The nose typi-
cally runs more in a warm rooms. Usually the nose is also itchy. There are no allergic eye symptoms.
Pulsatilla: That medicine has thick yellow nasal and eye discharges as key allergy symptoms. All eye and nasal discharges are
bland. With hay fever, the patient typically feels better inside especially in cool rooms. Patients needing that product also may
comment on being thirstless and having changeable stools.
Sabadilla: Tremendous, exhaustive sneezing is the central component of treatment with that medicine. There is excessive nasal
discharge and nasal obstruction. With every sneeze, there is more tearing from the eyes. All symptoms are worse outdoors and
better inside. Patients needing the product are typically worse after being exposed to flower pollen.
considered equivalent. The different sizes in a base of 20 percent ethanol. While 87 ucts must comply with FDA labeling re-
are made available to accommodate per- percent alcohol dilutions also are offered, quirements for alcohol content declara-
sonal and professional preferences, such their alcohol bite on the tongue makes tion, they are exempt from FDA alcohol
as very small pellets for children or pets them better suited for further attenua- content limits. This is due to the minute
and regular pellets for ease of counting out tion applications. The alcohol in that amount of alcohol delivered when this
the dose. dosage form is used as a diluent in the dosage form is used in four-drop to 10-
Oral liquid dosage forms, often re- attenuation process and also functions as drop quantities and the HPUS/RS re-
ferred to as dilutions, are prepared by the preservative system for the dosage quirement for alcohol in the attenuation
dispensing the homeopathic attenuation form. While liquid homeopathic prod- process. Glycerine also can be used in
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CEQ Pharmacist Continuing Education
lieu of alcohol for some liquid homeo-
pathic dilution formulations.
Additional dosage forms such as topi-
cals, powders, capsules, ophthalmic solu-
tions, injectables and suppositories are
manufactured in much the same way as
allopathic drugs, with the use of the home-
opathic attenuation as the active ingredi-
ent. The same excipients and preservative
systems are used with similar cGMP
compliant manufacturing processes and
quality control specifications.
HOMEOPATHIC PRACTICE
Homeopathy: the methods
When strictly defined, the practice of
homeopathic medicine utilizes only a
single medicine for intervention accord-
ing to the Principle of Similars; there are
a number of therapies that incorporate
the use of homeopathic drug products.
Among those therapies are Classical
Homeopathy, Clinical Homeopathy,
Complex or Combination Homeopathy
and Homotoxicology.
Classical homeopathy
The classical homeopathic method entails
taking a thorough case history through an
in-depth interview with the patient, often
lasting an hour or more. Likes and dislikes,
fears and modifying influences that make
the symptoms better or worse are dis-
cussed and documented.
Modifying influences, known as
modalities, can include temperature, lat-
eralities (right or left sides), time of day,
weather (damp or dry), heat or cold and
movement, as well as a variety of other in-
fluences. Those modalities help to create
the similarity picture. The classical home-
opath takes into account an individual’s
constitution or physical and personality
characteristics, as well. All of that infor-
mation is used to score the case by looking
in a repertory or computer program for
analysis. A repertory is an index of the
body and associated symptoms (rubrics)
by major categories. Category headings in
a repertory include such things as mind,
head, eye, nose, face, mouth, stomach, ab-
domen, chest and extremities. The reper-
tory works, in effect, as an index to the ma-
teria medica that is categorized by indi-
vidual homeopathic ingredients. That
process, repertorization, is the enumera-
tion of the patient’s symptoms, the scor-
ing of potential homeopathic medicines
and then the choice of the homeopathic
drug that fits the patient’s overall symp-
toms. (See also Appendix 4.) Most reper-
tories have the homeopathic medicines
weighted as to their likely effectiveness for
a given symptom.
In the popular Kent’s Repertory, home-
opathic drugs are scored as follows: three
points for a substance listed in bold
print two points for those in italics and
one point for those in regular print. Af-
ter referencing the materia medica, the
most appropriate, or similar homeo-
pathic drug is then selected. It is com-
mon practice in classical homeopathy
for only one homeopathic drug to be
given at a time. Sometimes, the use of
more than one homeopathic drug prod-
uct may be indicated. That approach is
the most time consuming of the meth-
ods for prescribing homeopathic drugs.
Classical homeopathy is patterned after
the method Hahnemann laid out in the
Organon of Medicine. (See also Sug-
gested Books.)
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Clinical homeopathy
The clinical homeopathic method of pre-
scribing, sometimes called Keynote Pre-
scribing, is symptom driven. The selection
of a drug is based on the predisposing fac-
tors or symptoms. Generally only a single
drug is used; although occasionally more
than one drug may be given at the same
time. With that approach, a drug is select-
ed because it has a particular affinity for
the patient’s chief complaint, condition or
symptom. That type of homeopathy may
be combined with nutritional and herbal
supplements, as well as other comple-
mentary therapies.
Complex homeopathy
In complex or combination homeopathy,
several synergistically acting homeopath-
ic medicines are combined into one for-
mula to create a desired effect. In general,
the medicines in a complex formulation
tend to be below 24X and are usually
below 12X.
It is a convenient method to use
because it takes less time to select the ap-
propriate homeopathic drug product, and
good results can be achieved owing to the
product’s broad spectrum of activity.
Complex or combination products can be
used as a bridge to the clinical and classi-
cal methods. Depending on the way in
which the complex is formulated, many
times the combination product easily can
be used to get the appropriate homeo-
pathic medicine. That can be helpful when
the health care practitioner does not have
the full knowledge of the homeopathic
method needed to distinguish among in-
dividual homeopathic medicines that have
similar general effects.
Homotoxicology
The homotoxicology method of home-
opathy was developed by the German
homeopath Dr. H.H. Reckweg in the
1950s. Dr. Reckweg designed a system of
looking at how the body deals with tox-
ins and the progression of disease as it re-
lates to symptoms.
When the body no longer effectively
deals with the elimination of toxins, phys-
iologic changes occur that eventually cause
anti-metabolic activity and cellular de-
generation. Those changes culminate in
the progression of symptoms that may
lead to a disease state.
Reckweg used complex homeopathic
drug products designed to restore enzyme
and organ function and to eliminate toxins.
One of the types of products Reckweg de-
veloped was the homaccord, or a homeo-
pathic drug that contains several dilutions of
the same ingredient. For example, Phospho-
rus homaccord contains several potencies of
Phosphorus, such as 6X, 12X, 30X and 200X,
all in the same product. The approach is based
on the assumption that the various dilutions
contain different resonant characteristics that
will affect the body differently, yet with an
overall harmonious effect.
Other methods of using homeopathic
medicines are little known in the United States,
but are more widespread in Europe. As tech-
nology brings the world ever closer, the phar-
macist should be familiar with the nomen-
clature to help inquiring patients understand
the growing field of complementary thera-
pies. Brief descriptions of some other meth-
ods the pharmacist may encounter are de-
scribed in the glossary (see Appendix 6).
PATIENT COUNSELING
When one is counseling patients interested
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in using homeopathic medicines, the fol-
lowing are important points to consider:
• Patients should inform their doc-
tors of their decision to use homeo-
pathic therapy.
• Only when prescribed by a medical
doctor should homeopathic drugs be
used for serious, life-threatening
conditions. As with any health care
modality, delay in using the most
appropriate care in urgent condi-
tions is a serious concern that must
be avoided.
• Homeopathy can be complementary
with standard emergency treatment
for accidents or serious life-threaten-
ing illnesses.
• Patients starting on homeopathic
therapy should not abruptly dis-
continue previously prescribed
medications, unless their doctors
direct otherwise.
• If directed on the label, homeopathic
oral dosage forms should be allowed
to dissolve in the mouth, preferably
under the tongue. Adequate time
should be allowed for the dosage
form to dissolve completely and the
dose to be absorbed.
• If relief of symptoms does not occur
within the time period stated on the
product’s labeling, or if symptoms
clearly worsen or new symptoms de-
velop, the homeopathic drug should
be discontinued. The patient should
be advised to consult the appropriate
health care professional.
• Patients also should be instructed
that a mild—and very temporary—
worsening of symptoms might occur
soon after beginning therapy. That
homeopathic aggravation is a positive
sign that the therapy is beginning to
take effect, and the discomfort will
subside shortly.
• Homeopathic medicines should be
stored in a cool, dry location and be
protected from high heat, moisture
and direct sunlight. Some dosage
forms should not be subjected to
freezing conditions.
• Some homeopathic literature sug-
gests that the patient’s mouth should
be as clean as possible when the dose
is taken and that the medication
should not be taken with food. In ad-
dition, some literature indicates that
products containing alcohol, caffeine,
nicotine or mint should be avoided
during homeopathic treatment; how-
ever, there appears to be no reliable
clinical evidence or published reports
to support those restrictions.
HOMEOPATHIC EDUCATION12
Practice and education issues
Homeopathic medicines are classified by
the FDA as drugs; most of them are avail-
able over-the-counter; some are prescrip-
tion only. In order to practice homeopa-
thy in the United States, one must typi-
cally be a licensed health-care provider.
In all states, the only professions that
are allowed to diagnose and treat illness
are medical doctors (MDs) and osteo-
pathic doctors (DOs). In addition, sever-
al states (Alaska, Arizona, Connecticut,
Hawaii, Maine, Montana, New Hamp-
shire, Oregon, Utah, Vermont and Wash-
ington) license naturopathic physicians
(NDs) to diagnose and treat illness.
Other health care providers, such as nurse
practitioners, physician assistants, den-
tists, veterinarians, chiropractors, licensed
acupuncturists, nurse midwives and po-
diatrists, may be allowed to use home-
opathy within the scope of their licenses,
depending on the laws of the state in
which they reside.
Three states have homeopathic licens-
ing laws: Arizona (1982), Connecticut
(1892) and Nevada (1983). MDs and DOs
practicing homeopathy in Arizona or
Nevada and MDs practicing in Connecti-
cut must be licensed by the state homeo-
pathic licensing board.
There are many training programs and
courses in homeopathy in both the United
States and abroad. However, no diploma
or certificate from any school or program
currently is recognized as a license to
practice homeopathy in the United States.
Certification of competency to practice
classical homeopathy is available to MDs
and DOs through the American Board
of Homeotherapeutics (DHt), to NDs
through the Homeopathic Academy of
Naturopathic Physicians (DHANP) and to
all professionals through the Council for
Homeopathic Certification (CCH).
Professional training programs
Three U.S. naturopathic colleges—Bastyr
University in Bothell, WA, National Col-
lege of Naturopathic Medicine in Port-
land, OR, and Southwest College of
Naturopathic Medicine in Tempe, AZ,
offer four-year programs leading to an
ND degree. Those with an ND degree
are eligible to obtain licenses in the states
mentioned above. Those colleges pro-
vide extensive training in homeopathy.
Prerequisites for admission are on a par
with premedical requirements. (See Ap-
pendix 9 for additional information.)
There are many programs offered at var-
ious locations around the country. Sev-
eral part-time programs offer from 200
hours to 500 hours of training in home-
opathic methodology. Some programs
are for health care professionals only and
can provide the necessary training for
certification by the Council for Homeo-
pathic Certification.
Nonprofessional training
For consumers seeking to learn how to use
homeopathy for themselves, their families
and animals, the National Center for
Homeopathy (NCH) can be a good source
of information and education. Study
groups are also good sources of training
in homeopathy. Many training programs
listed in the NCH Education Directory
admit nonprofessionals.
See the National Center for Homeo-
pathy Web site’s (www.homeopathic.org)
education directory for more informa-tion.
CONCLUSION
The centuries-old practice of homeopathic
medicine is making a comeback in the
United Sates, and more patients are re-
questing homeopathic medicines and in-
formation from their pharmacists. This
lesson has presented an overview of the
history, methodology, regulatory and
manufacturing issues, prescribing and
dosage form information, in an effort to
provide the pharmacist with a greater
knowledge of homeopathy. Homeopathy
is ideal for patients who have diseases for
which prescription drugs may be con-
traindicated or are taking prescription
medications that may interact with non-
prescription drugs.
CONTINUED ON PAGE 10
Spring 2004 9 ●
CEQ Pharmacist Continuing Education

A practical guide to homeopathy: appendices

CONTINUED FROM PAGE 9
APPENDIX 1: Other homeopathaic drugs

MEDICINE USE17,18,19
Aconitum napellus Chills, fever, dry skin, anxiety, intense thirst, agitation, fright palpitation. If taken at the early onset of flulike symptoms, it may prevent development of
symptoms or decrease intensity or duration of symptoms.
Aesculus hippocast. Hemorrhoids.
Allium cepa Head cold with acrid watery nasal secretion, tearing, sneezing, hay fever, common cold.
Alumina Constipation with inertia of rectum.
Antimonium crudum Nausea/vomiting after excessive intake of food with sour wine. Warts in children.
Antimonium tartaric. Cough with rattling and shortness of breath, mucus accumulation with little expectoration and a desire to sip water frequently .Nausea/vomiting.
Apis mellifica Insect bites and stings. Irritated skin. Sore throat.
Argentum nitricum Burning pains in the stomach, craving for sugar and eating too quickly. Sensation of a splinter in the throat or elsewhere.
Arnica montana Mild trauma (sprains, blows, stings, etc). Bruising, muscle aches and discomfort from physical exertion. Muscle/joint injury.
Arsenicum album Gastric disturbances, diarrhea, indigestion, nausea/vomiting. Hay fever where there is a thin, watery, burning discharge.
Baptisia tinctoria High fever. Coughing and dark red face.
Belladonna Inflammatory conditions (violent, rapid and improves with heat application). Patient is usually thirstless, does not want to be moved and cannot toler-
ate bright light. Accompanied by headache, toothache, fever, boils and dry sore throat with painful swallowing.
Bryonia Flulike symptoms with body aches worsened by movement. Joint inflammation accompanied by constipation and intense fatigue, dry cough.
Cantharis Minor burns with blisters / itching vesicles. Urinary tract inflammations.
Carbo vegetabilis Lack of vitality. Patient wants fresh air or to be fanned. Digestive disturbance associated with belching, fullness, colicky pains and stomach gas. Indi-
cated when milk, meat or fatty foods cannot be tolerated.
Chamomilla Gum irritation, pain, mild fever and diarrhea in teething children. A useful homeopathic product for children who have colic or who are irritable.
Cinchona officinalis General weakness with a loss of body fluids (e.g., nose bleed, menstrual bleeding and diarrhea). Also ringing of the ears and faintness.
Cocculus indicus Motion sickness aggravated by food odors and lack of sleep. Also stress-induced sleeplessness.
Coffea cruda Restlessness or sleeplessness caused by excitement or joy. Sleeplessness brought on by drinking coffee.
Colocynthis Abdominal complaints. Better from pressure.
Drosera rotundifolia Dry cough with nausea/vomiting.
Dulcamara Effects of chills in moist, humid, foggy weather
Euphrasia officinalis Mild inflammation of eyes and tearing. Head cold, itching, hay fever. Eye wounds.
Ferrum phosphoricum Fevers and sore throat with a flushed face and red cheeks. Patient feels better with cold applications. Children: frequent nosebleeds.
Gelsemium sempervir. Flulike symptoms characterized by weakness, shivering, heavy limbs, aching around eyes, no thirst. Nervousness or restlessness before a scheduled
event, such as surgery or an examination; stage fright. Tension headache with sensation of a band around the head,
Hepar sulfuris calc. Skin eruptions, ear problems, sore throat and early stages of croupy cough. In most instances there is pus development. Swelling of glands.
Hypericum perforatum Pain caused by irritation or injury to a nerve, especially bruised fingers or toes.
Ignatia amara Headache, indigestion, motion sickness, mental and physical exhaustion or symptoms caused by anxiety or emotional excitement (fright, grief
or disappointment).
Ipecacuanha Persistent nausea/vomiting, abdominal pain, diarrhea or indigestion usually caused by overindulgence in food or drinking. Relieved by vomiting.
Paroxysmal cough/gagging followed by vomiting.
Kali bichromicum Runny nose, discomfort at the base of the nose. Nasal discharge is yellow/green, viscous and may form a crust. Sinusitis, presence of thick,
sticky mucus.
Ledum palustre Pain caused by minor wounds. Following surgery or for insect bites.
Lycopodium clavatum Flatulence with lower abdominal distension, gastric symptoms, which increase in the evening.
Magnesia phosphorica Menstrual cramps, uterine spasms, and leg and foot cramps.
Mercurius solubilis Sore throat, mild fever, thirst, shivering, excess salivation.
Nux vomica Intestinal discomfort, abdominal pain, diarrhea, indigestion, travel sickness associated with overindulgence in food or drink. Also, hemorrhoids.
Phosphorus Dry, hard racking cough with fever associated with chest cold, which develops rather quickly. Sudden, minor nosebleeds; heavy menstrual periods.
Patient craves cold water, which then is vomited.
Pulsatilla Earache, flatulence, thick nasal discharge, menstrual disorders, toothache.
Rhus toxicodendron Pains from strain and overexertion, rheumatism, neuritis and achy flulike symptoms. Skin eruptions looking like a vesicle, eczema, herpes and the
like. Arthritic stiffness/pain improved by motion.
Ruta graveolens Injury characterized by overexertion. Sore area is located where the tendon is attached to the bone. Also, dental problems (dry socket); eyestrain
followed by headache.
Sambucus nigra Cough with dry head cold. Aggravation about midnight.
Silicea Skin eruptions and abscesses. Chronic sinusitis.
Spongia tosta Croupy, dry hacking or barking cough or difficult breathing; laryngitis; burning feeling in throat and nose.
Sulfur Recurring eruptions, which itch and burn; recurring boils. Also for hot flashes caused by change of life.
Symphytum officinale Pain and injured or broken bones.
Tabacum Travel sickness. Faint feeling with nausea.
Veratrum album Vomiting associated with painful diarrhea and cramps alternating with extreme exhaustion and cold sweats. Chills extend from head to feet. Limbs
are cold.
TINCTURE
Calendula tincture Mild burns, insect bites and superficial skin irritations. Cuts, scrapes. Mouth/throat gargle.
CREAMS
Arnica montana To stimulate the healing of wounds, soreness, spasms and bruises.
Calendula officinalis Mild burns, insect bites and superficial skin irritations. Cuts, scrapes.

10 Spring 2004
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APPENDIX 2: HOMEOPATHY—
COMMONLY ASKED QUESTIONS
In what forms are homeopathic products avail-
able?
Homeopathic drugs are available as:
– Capsules – Lozenges
– Creams – Nasal sprays
– Eye drops – Ointments
– Gels – Pills
– Granules – Tablets
– Injectables – Suppositories
– Liquids – Syrups
When and how should I take homeopathic
drugs?
Homeopathic pellets and tablets should be
allowed to dissolve in the mouth, preferably
under the tongue. Adequate time should be al-
lowed for the dosage form to dissolve com-
pletely and the dose to absorb.
Some of the homeopathic literature states
that the patient’s mouth should be as clean
as possible when the dose is taken for home-
opathic medications to work properly, and
that homeopathic medications should be
taken 15 minutes before or after meals. How-
ever, there appears to be no reliable clinical
evidence or published reports that support
such restrictions, and the patient is better
served by eliminating needless constraints.
That is also the case with the widespread,
but unsubstantiated limitations on the concur-
rent use of products containing alcohol, caf-
feine, nicotine or mint.
Homeopathic drugs offer relief for common
acute health care complaints and also offer an
integrative approach to overall medical care.
Under the care of a physician trained in home-
opathy, homeopathic medications can be used
for serious, life-threatening conditions.
Patients should use standard emergency
treatment if they become seriously ill. In addi-
tion, homeopathic medicines can be used along
with those other treatments until a physician
can be consulted.
What is the correct dosage for homeopathic
drugs?
The dosage is specific for each product. Read
the label and follow the manufacturer’s direc-
tions for the correct dosage.
Can I give homeopathic drugs to babies or very
young children?
Yes. Homeopathy can be used when you are
seeking gentle-acting relief for common ail-
ments.
What should I do if the symptoms do not im-
prove?
If relief of symptoms does not occur with-
in the time period stated on the product’s la-
beling, or if symptoms clearly worsen or new
symptoms develop, the homeopathic medi-
cine should be discontinued. The patient
should consult a health care professional.
However, a mild—and very temporary—
worsening of symptoms might occur soon
after beginning therapy. That “homeopath-
ic aggravation” is a positive sign that the
therapy is beginning to take effect and will
subside shortly.
Are there any substances I should avoid when
taking homeopathic drugs?
It has often been stated that coffee, mints
and products containing camphor may inter-
fere with the action of homeopathic drugs.
However, there is no evidence to substantiate
those restrictions other than anecdotal state-
ments from isolated individuals.
How should homeopathic drugs be stored?
Homeopathic medications should be stored
at room temperature in a dry place
protected from high heat and direct sunlight.
Some dosage forms need to be protected from
freezing temperatures.
Can I take homeopathic drugs as well as tradi-
tional drugs?
Patients receiving conventional treatment
should inform their physician of their deci-
sion to try homeopathic therapy. Patients
starting on homeopathic therapy should not
abruptly discontinue previously prescribed
medications without first consulting a doc-
tor. It should be noted that contra-indications
are extremely rare.
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APPENDIX 3: ACUTE HOME CARE
For acute and home care, homeopathic medi-
cines can be used in a potency range of 6X to
30C (e.g., 6X, 12X, 30X, 3C, 6C, 12C, 30C). Please
see the discussion of potencies in the text for
further information on the difference between
decimal (X) and centesimal (C) attenuations.
Dosage forms are typically compressed
tablets, tablet triturates (soft tablets), pellets and
liquid dilutions. Administration of the medi-
cine is generally the first dose at onset of symp-
toms, a second dose 15 minutes to 30 minutes
later and additional administrations as much
as four times daily until symptoms are relieved
or are exacerbated (a homeopathic aggravation).
If symptoms persist for more than seven days
or worsen, a licensed health care practitioner
should be consulted.
If the medicine appears to work well and
then wears of or ceases to work, the health care
practitioner should observe the patient to see if
the symptoms themselves have changed from
the original presentation. If the symptoms have
changed, a different homeopathic drug may be
required. If the symptoms are the same, a high-
er potency or more frequent repetition of the
dose may be required.
The use of the correct homeopathic medicine
is far more important than the quantity of the
medicine used. Each manufacturer has deter-
mined the most appropriate dosage for its prod-
uct; please see the label accompanying the prod-
uct. Each label may be different, but a general
guideline for patients, in the absence of other
information, would be 3 to 5 pellets, 2 to 3 tablets
or 4 to 10 drops of liquid dilutions at a time.
APPENDIX 4: THE CLASSICAL HOMEO-
PATHIC PRACTICE—TAKING THE CASE
In the Classical Method of homeopathic prac-
tice, the symptoms exhibited by the patient are
not the disease itself, but are indications of how
the body is adjusting to the stress placed upon
it by the disease. The proper homeopathic med-
icine will stimulate that natural effort to com-
plete the adjustment and recovery from the
stress (the healing process) successfully. While
a patient may have the same disease as other
patients, the overall symptom picture is unique
to each individual. Thus the symptoms are eval-
uated by the practitioner to determine the prop-
er homeopathic prescription for the individual
patient and course of action to be taken. That
symptom picture is a detailed account, gath-
ered by the health care practitioner, of all of the
symptoms the patient experiences. In classical
homeopathy, the goal is to match, as accurate-
ly as possible, the patient’s symptom picture
with that of the remedy picture—the collection
of symptoms produced by the drug in its prov-
ing and subsequent clinical use, as delineated in
the Materia Medica.
The health care practitioner’s observations
are therefore very important; one wants a pic-
ture of the differences in the symptoms of the
patient in the ill state from those in their nor-
mal state of health. Gathering information is
not always easy. Clear, strongly marked symp-
toms are important; vague, “well … sometimes”
symptoms are not usually helpful.
Certain symptoms are always present in any
given disease and are reflected in the disease
name, e.g., cystitis, eczema, conjunctivitis.
Homeopathy does not treat the labeled disease
alone—the cystitis, the eczema, the conjunc-
tivitis; but rather treats the individual who is
sick. Every patient experiences symptoms
unique to that individual; they differ from an-
other case of the same disease. It is the individ-
ual characteristics in the patient that are the
guide to the right homeopathic medicine.*
Simply noting “headache” or “cough” is
not enough. If one researches either of those
symptoms in a repertory, many possible home-
opathic drug matches will be found. It is the
particular characteristics of the patient’s
headache or cough that narrow down the
choice of medicines, to individualize the case.
One person with a headache, for example, will
have a throbbing forehead that feels better with
fresh air, while another will have sharp pains
in the temples that are better with warmth and
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Initially use open ended questions, try to elicit specific or definitive
answers without prompting the patient.
General
How are you feeling?
When did you first notice the sadness?
Can you describe the pain?
What makes it better or worse?
Can you tell me some more about what happened?
Is there anything else that makes you or your symptoms feel better or worse?
lying down. Those two patients most likely
will need different homeopathic medicines.
To get these individual symptoms, questions
initially should be open-ended to elicit the per-
son’s own description of their condition. Atten-
tion should be given to the first impressions the
health care provider has of the patient: They are
an important and often reliable source of infor-
mation. If particular homeopathic medicines do
come to mind while the health care practitioner
is taking a case, he or she should not ignore them,
but should make a note; those initial impressions
are often useful keys to the selection of the prop-
er drug. Generally, the decision of the particular
drug is not made during the case taking, but
rather it is part of the analytical step that follows.
While remaining receptive to what the patient is
saying, the health care practitioner also uses his
or her own senses to pick up clues from what the
patient is doing, or from the overall condition,
which might not even be apparent to the patient.
Odor may be one of the first things the practi-
tioner notices upon walking into a sick person’s
room or while conversing with the person: Does
the perspiration smell sweet, sour, salty, musty or
offensive? If the breath smell is strong and can
be described clearly, the health care practitioner
may use it as a symptom.
The facial color and expression also are not-
ed. In the case of an accident, has the color
drained from the face of a shocked person, or
does he or she appear flushed and look anx-
ious? The health care practitioner also looks for
other clues: aversion to liquids, or drinking by
sipping or gulping; blankets piled high or, al-
ternatively, kicked off; restlessness; log-like pa-
tients who groan if someone sits on the edge of
the bed and disturbs them; and so on. Often the
patient is not aware of those important indi-
vidualizing symptoms.
The health care practitioner also may observe
the patient’s sounds. Some sick children moan
in their sleep; others might whine for attention
if they think no one is listening to them and stop
when someone enters the room (or the reverse).
The tone of the voice also is revealing. Is it re-
signed? Anxious? Sad? Angry? Even the brux-
ism of a child, either during the day or in sleep,
can be a valuable symptom. All of those symp-
toms are a more detailed accounting of the pa-
tient’s specific condition than is normally record-
ed by a person not homeopathically trained; yet
they may provide valuable clues to the selection
of the proper homeopathic medicine.
The patient should be encouraged to talk, with-
out any interruption if possible. That in itself can
be healing and also can provide information. For
example, the Lachesis patient talks incessantly,
jumping from one subject to another, while the
Bryonia patient may not want to speak at all.
Some patients reply negatively when asked
about themselves or their symptoms: “I’m not
well”; “He’s not bad”; “It isn’t much better”;
“It doesn’t hurt that much”. Those replies do
*In a typical pharmacy setting, the pharmacist
may encounter homeopathic formulations that
are a combination of more than one homeopathic
medicine and that may be labeled with a typical
disease designation (e.g. hayfever). Those
formulations are intended to address a range of
related symptoms that are experienced by a
broad spectrum of the general population. Such
combination products may or may not be used
within a classical homeopathic medical practice,
but are helpful additions to a pharmacy’s
product assortment.
Type of response
I am feeling sad.
It began after I gave birth to my second child.
It is throbbing.
It is better from heat.
not reveal what actually is happening. Ques-
tions like “How are you, then?” and “What are
you feeling?” sometimes can help the health
care practitioner gain a clearer understanding
of actual symptoms. For patients who are shy
or speak in negatives, careful questioning may
help to reveal a clearer symptom picture. In re-
ponse to “it doesn’t hurt that much,” they
might be asked “Is the pain stopping you from
doing anything?” (that is, “How serious is it?”)
If necessary, after listing different types of pain,
the patient may alight on one, saying “That’s
it!” All those steps are necessary for a health
care practitioner to “take the case” properly.
The health care practitioner should not dis-
count any symptom in the taking of a case.
What other information is available about that
Founded in 1923, the American
Association of Homeopathic Phar-
macists (AAHP) is a not-for-profit
corporation of the Commonwealth
of Virginia functioning as a trade
association of the homeopathic
pharmaceutical industry. It repre-
sents the opinions and interests of
homeopathic product manufactur-
ers and distributors to the FDA, oth-
er regulatory agencies and other
trade associations. With 35 mem-
bers representing more than 70 per-
cent of the homeopathic manufac-
turing community, the AAHP is the
largest organization of its kind. The
association promotes high stan-
dards in manufacturing and dis-
tributing, communicates regulato-
ry changes to member companies
throughout a regular newsletter,
Network News, and promotes pro-
fessional communication, education
and research within the homeo-
pathic community.
The AAHP provides educational
opportunities to its members through
its Compliance Through Education pro-
grams and seminars. Outreach to the
pharmaceutical profession and the
public at large is accomplished
through a regular series of press re-
leases and notices published in na-
tional magazines, as well as the jour-
nals of state, regional and specialty
pharmacists’ organizations.
With the goal of a better under-
standing and appreciation of home-
opathic medicines by both pro-
fessionals and consumers, the AAHP
sponsors continuing education cours-
es for pharmacists.
American Association of
Homeopathic Pharmacists
3741 Mitford Lane Clinton, WA
98236
Toll-free phone and fax:
(800) 478-0421
www.homeopathypharmacy.org
CONTINUED ON PAGE 12
Spring 2004 11 ●
CEQ Pharmacist Continuing Education

A practical guide to homeopathy: appendices

CONTINUED FROM PAGE 11
person? What has been going on in his or her
life lately that might be part of why the person
is feeling sick now? What can be verified by get-
ting information (with the patient’s permission)
from a close friend or family member.
Of course, enough cannot be said about the
importance of a thorough patient history. A com-
plete medical history of the patient’s health and
that of his or her parents and family members
should be obtained and can make it much easi-
er to evaluate the patient’s needs. Histories can
serve to point out health trends, the unique pre-
disposition to disease, any underlying patholo-
gy for each individual and to provide key indi-
cations for the selection of a course of treatment.
The use of a family tree to plot important risk
factors such as alcoholism, heart conditions, high
blood pressure, cancer, diabetes, depression, al-
lergies and arthritis also may be useful. Many of
the steps described above are those that phar-
macists regularly perform in providing good
pharmaceutical care to their patients.
Classifying the symptoms
Having “taken the case,” there are three basic
steps to select a homeopathic medicine: choose
the symptoms, repertorize, differentiate.
Choose the symptoms
Note all the symptoms that stand out clearly and
strongly. The etiology is an important rubric
(symptom category). Obtaining at least three
strong symptoms, each from a different symp-
tom group— general, physical and mental/emo-
tional —can be very helpful. A stress symptom
also can be of great assistance in choosing the
right medicine. In the end, the more symptoms
that fit the remedy picture the better. The practi-
tioner may or may not repertorize every symp-
tom; those not used may be used later to confirm
the selection of a homeopathic drug.
Repertorize
Look up each symptom that has been
chosen in a repertory. List the medicines that
occur under each symptom. With a complete
list, it will be clear which homeopathic drug(s)
occurs most often—i.e., which contain most of
the symptoms on your list. Several computer-
ized repertories are available (for both Win-
dows- and Macintosh-based computers) that
can make the process much easier.
Differentiate
In some cases only one homeopathic drug will
contain all the symptoms. However, it is im-
portant to remember that simply having all
the symptoms does not automatically mean
that the medicine should be selected. More of-
ten, the repertorization will indicate several
homeopathic drugs that come close to the pa-
tient’s combination of symptoms. The practi-
tioner needs to look at some of the related
drugs in the materia medica—noting match-
ing symptoms that are unusual, or strongly in-
dicated, determining which remedy picture in
the materia medica best matches the symptom
picture of the case. Choosing among the possi-
ble homeopathic drugs can be difficult and is
one of the skills that makes a competent
homeopathic practitioner. At this point the
health care provider will check to see if he or
she has overlooked any symptoms or missed
any more likely homeopathic drugs. Over the
course of treatment, the patient must be recon-
sulted in order to make appropriate case man-
agement decisions.
Note-taking
The trained health care practitioner realizes
it is essential to document patient care inter-
ventions. Along with standard general med-
ical information, the patient’s symptoms
and their intensity are noted, as well as a
record of the repertorization, the homeo-
pathic preparation prescribed and the result
of treatment. A follow-up plan also may be
included in the documentation.
Repertory terminology
The following terms are helpful to
understand the repertorization process proper-
ly. All are defined in the glossary: causation;
aggravation; amelioration; concomitant;
modality; generality, particular; strange, rare
and peculiar.
APPENDIX 5: THEORETICAL
CONSIDERATIONS
To date, there is no substantiated explana-
tion for the mechanism of action of homeo-
pathic medicines that is supported by exper-
imental data. Since many homeopathic
drugs are at levels of dilution that exceed
the limits of Avogadro’s number, the likeli-
hood of a single molecule of starting materi-
al in those dilutions is statistically unlikely.
However, practitioners of homeopathy
know that those medications are neverthe-
less effective for a wide variety of ailments.
That causes a conundrum for those seeking
to understand how homeopathic drugs exert
their effect and is the basis for an ongoing
controversy among those seeking to discred-
it homeopathy.
The following information is presented to
stimulate the readers’ thoughts on how such
dilute remedies might achieve their effect.
However, it is to be emphasized that none of
the research presented here is definitive, and
a theory for the mechanism of action still
eludes consensus.
Many of the concentrations used in home-
opathic drugs are so dilute as to have no pos-
sible physiological effect by chemical means.
But compare them with the normal concentra-
tions of endogenous substances; concentra-
tions in lymphatic fluid and serum can be as
low as 10g/ml to 3 g/ml; hormone concentra-
tions range from 10 to 6 g/ml to 10 to 18 g/ml
depending upon the hormone and the tissue
where it is being measured. The lower home-
opathic attenuations may correspond with
those natural physiological concentrations of
compounds found in the body. Higher home-
opathic attenuations, corresponding to ex-
tremely low concentrations, may utilize
mechanisms of actions not yet understood.
There is research indicating that those
very highly diluted solutions do have physi-
ological effects on a variety of living sys-
tems. In a series of experiments continued
over 35 years, Kolisko20 reported that wheat
seed growth was promoted by low homeo-
pathic dilutions of various metallic salts, in-
hibited by somewhat higher dilutions and
stimulated again at dilutions higher than
Avogadro’s number.
Another experiment 21 tested the effects
of sodium chloride on guinea pigs in daily
doses prepared in 30X, 200X, 400X, 600X,
800X, 1,000X, 1,200X and 1,400X dilutions
(all well past the limits of Avogadro’s num-
ber). The trial, lasting six months, was re-
peated two years in succession. Controls re-
ceived distilled water. Test animals lost
weight and appetite, had dull shaggy coats
and dull watery eyes, were less active than
controls, gave birth to young weighing less
than the controls, and had higher mortality
and lower reproduction rates than the con-
trols. Clinical evidence of the effect of home-
opathic drugs and the physiological changes
created by homeopathic medicines in the
body have been measured. The theoretical
basis that attempts to explain the mechanism
of action of homeopathy, however, may be
incomplete. Modern molecular biology still
is lacking in the concepts and paradigms to
complete our understanding of that complex
phenomenon. However, the realm of theoret-
ical physics might provide insights in that
direction. A number of such theories have
been attached to homeopathy in an attempt
to explain how these dilute solutions work.
Some researchers have postulated that the
length of the bond between molecules
increases with repetitive succussion steps.
The kinetic energy of the succussion process
may become transformed into potential en-
ergy held within the molecules in the form
of molecular bonding. Other researchers
have theorized that structures are formed in
water molecules that can store electromag-
netic signals; some research supports this
theory because measurable electromagnetic
signals have been discerned in homeopathic
medicines that are specific for each sub-
stance tested.22,23
The reader may be aware of research
done in a different field that seems to indi-
cate that water may support “stable (non-
melting) ice crystals” that can maintain an
electric field and are very stable even after
repeated heating and agitation. They appear
to have been created when a substance was
diluted in distilled water, vigorously agitat-
ed and repeatedly diluted and agitated. The
initial research suggested those stable struc-
tures are maintained at extremely low dilu-
tions, which seem akin to homeopathic at-
tenuations.24 No additional testing has been
done to date; thus it is premature to specu-
late that the crystallinelike structures and
their associated electric fields may be in-
volved in the mechanism of action of homeo-
pathic drugs. Yet that is another example of
new research that is expanding our under-
standing of phenomena that up to this time
remain unexplainable.
A similar thesis involving stable zwitterion
water complexes provides a coherent conceptu-
al basis for interpreting the dilution/succussion
process and resultant formation of an active
complex even below the dilution threshold rep-
resented by Avogadro’s number.25 Further pa-
pers have also focused on micro-structures of
water/solvate systems and their ability to store
information to elucidate how homeopathic
medications may work.26,27 The collaborative
efforts of heretofore unorthodox interdiscipli-
nary research might provide new understand-
ing of the perplexing properties of homeopathic
drugs; for instance, the work of an immunology
professor and a philosophy professor points to
a nonmaterialistic way of comprehending the
remedial action of homeopathic products.28
Those are a number of attempts to lay a
theoretical basis for understanding how
homeopathic medicines may exert their thera-
peutic effects. It must be repeated: there is no
substantiated explanation for a mechanism of
action for homeopathic drugs that is support-
ed by experimental data. The mechanism of
action for homeopathic drugs continues to be
a matter of speculation and interest in the sci-
entific community. Within the medical com-
munity, those who work with homeopathic
drugs know they are effective, even if the
mechanism of action has yet to be elucidated.
CONTINUED ON PAGE 14

References
1. Winston, Julian. The Faces of Homeopa-
thy . Tana N.Z. Great Auk
Publishing, 1999
2. Coulter, Harris. A Divided Legacy , Vol. 1-
3. Berkeley CA: North Atlantic Books, 1982.
3. Dooley, Timothy, N.D. M.D. Homeopathy,
Beyond Flat Earth Medicine. Timing Publica-
tions, 1995
4. Coulter, H.
5. Eisenberg, D.M., et al. “Unconventional
Medicine in the United States. Prevalence,
Costs, and Patterns of Use.” N Eng J Med
328(4), Jan 1993, pp. 246-252.
6. Federal Food, Drug, And Cosmetic Act of
1938, as amended by the FDA Modernization
Act of 1997; text available at www.fda.gov/opa-
com/laws/fdcact/fdctoc.htm
7. Dietary Supplement Health and Education
Act of 1994, Public Law 103-417, 103rd Con-
gress; text available at
www.fda.gov/opacom/laws/dshea.html
8. U.S. Food and Drug Administration. Com-
pliance Policy Guide (CPG) 7132.15, “Condi-
tions Under Which Homeopathic Medicines
May Be Marketed” Rockville, MD. 1988. Sec-
tion 400.400 of the US F.D.A. Compliance Poli-
cy Guide Manual.
9. Homeopathic Pharmacopoeia Convention
of the United States. Homeopathic Pharma-
copoeia of the United States/Revision Service
(HPUS/RS). Washington, D.C. 2000.
10. HPUS/RS
11. Kayne, Steven B. Homeopathic Pharma-
cy, an Int roduction and Handbook, New York.
Churchill Livingstone, 1997
12. Reprinted with permission from the Na-
tional Center for Homeopathy, www.homeo-
pathic.org
13. Gemmell, David. Everyday Homeopathy,
A Safe Guide For Self Treatment. Beaconsf
ield, England. Beaconsfield Publishers, Ltd.,
1987.
14. Rose, Barry. The Family Health Guide to
Homeopathy . Berkeley, CA. Celestial
Arts.1992
15. Murphy, Robin. Homeopathic Remedy
Guide. Blacksburg, VA. H.A.N.A. Press, 2000.
16. Murphy, Robin. Homeopathic Medical
Repertory, 2nd Edition. Blacksburg, VA.
H.A.N.A. Press, 1998
17. Lockie, Dr. Andrew. Encyclopedia of
Homeopathy . New York, NY. Dorling Kinders-
ley 2000
18. Boericke, William, M.D. Pocket Manual
of Homeopathic Materia Medica. New York,
NY. Boericke & Runyon 1927
19. Clarke, John Henry, M.D. A Dictionary of
Practical Materia Medica, Vol. 1-3. New Delhi,
India. B.Jain Publishers, Ltd. 1995
20. Kolisko, L. Physiologisher und
phyikalisher Nachweis der Wirksamkeit klein-
ster Entitaeten (Physiological and physical re-
sults of the effects of diluted entities) 1923-
1959 Arbeitsgemeinschaft anthroposophisher
Aertze, Stuttgart, 1959). Abstracted as: A
Physiological Proof of the Activity of Smallest
Entities. Mercury 11, Journal of the Anthropo-
sophical Therapy and Hygiene Association;
Chestnut Ridge, NY (1991)
21. Stearns, Guy Beckley, “Experimental
Data on one of the Fundamental claims in
Homeopathy,” Journal of the American Institute
of Homeopathy, 18 (1925), 433-444, 790-792.
22. del Giudici E, Preparata G: “Superradi-
ance: a new approach to coherent dynamical
behaviors of condenses matter, Frontier Per-
spective”; Philadelphia, PA., Temple Universi-
ty, Center for Frontier Sciences; 1990.
23. Rubic B: “Frontiers of homeopathic re-
search, Frontier Perspectives ”; Philadelphia ,
PA. , Temple University, Center for Frontier
Sciences; 1991.
24. Lo, Shui-Yin, Lo, Angela Lo, and Chong
Li-Wen et al: “Physical properties of water with
Ie structures,” Modern Physics Letter, 19:909,
(1996).
25. Anick David J: “Stabile Zwitterionic Water
Complexes: The Active Ingredient in Home-
opathy?” Journal of the American Institute of
Homeopathy, Vol. 92 No. 3: 129-135, (1999).
26. Matsumoto J: “Molecular Mechanism of
Biological responses to Homeopathic medi-
cines,” Medical Hypothesis (1995) 45: 292-296.
27. Schwartz Gary, and Russek, Linda: “The
Plausibility of Homeopathy: The Systemic
Memory Mechanism”; Integrative Medicine
(1998) 1:53-59.
28. Bastide Madeleine, and Lagache, Agnès:
“A Communication Process: A New paradigm
Applied to High Dilution Effects on the Living
Body”; Alternative Therapies in Health and
Medicine (1997) 3(1):35-39.
29. Heiby, Walter A. The Reverse Effect :
How Vitamins and Minerals Promote Health
and Prevent Disease. Deerfield, IL. Medi-
Science, 1st edition, 1998.

12 Spring 2004
●
www.drugstorenews.com Drug Store News
CEQ Pharmacist Continuing Education
APPENDIX 6: GLOSSARY OF COMMON HOMEOPATHIC TERMS AND RELATED MEDICAL MODALITIES
Acute remedies – the value of these
medicines is essentially limited to acute
and/or urgent situations, such as shock.
Aggravation – physical condition in the
patient’s environment that makes symp-
toms, sensations or general condition
worse. Among common factors that may
be aggravations are time of day, season
of the year, location (e.g., at the seaside),
fears, foods, fresh air or lack of it. Aggra-
vations are pointers to the indicated rem-
edy. In a Repertory, the symbol < is used
to mean “worse for.” See also Homeo-
pathic Aggravation.
Allopathy – medical treatment oriented
to the suppression of symptoms. “Allos”
in Greek means “other than” or “differ-
ent from,” and “pathy” means “disease”
or “suffering.”
Amelioration – physical conditions in the
patient’s environment that make the
symptoms, sensations or general condi-
tion better. For example, a sore throat im-
proving from a hot drink or a change of
position easing a pain are ameliorations.
Ameliorations are pointers to the indicat-
ed remedy. In a Repertory, the symbol >
means “better for” while the symbol <
means “worse for.”
Anthroposophical Medicine – founded
by Rudolf Steiner, anthroposophical
medicine intends to look at a human be-
ing as a whole entity within the art of
healing. In evaluating health, illness and
healing, the anthroposophical physician
bases his/her considerations not only on
the physical laws of natural scientific
medicine but also takes into considera-
tion those aspects that can not be en-
compassed by natural science. Anthro-
posophy perceives the human being as
consisting of four essential elements:
the physical body, the organization of vi-
tal forces, the organization of feelings
within the soul and the spiritual organi-
zation of the ego. Health is understood
as a state of equilibrium—requiring con-
tinual reinstatement—among the influ-
ences exerted by those various ele-
ments of the human being. A distur-
bance in the interrelation of those forces
initiates illness. In addition to therapy
with homeopathically produced anthro-
posophical preparations, anthroposophi-
cal treatment also incorporates other
modes of therapy and medication. Every
patient receives comprehensive infor-
mation, enabling him or her to partici-
pate actively in the healing process.
Those measures help to activate the
self-healing powers within the patient.
Arndt-Schulz Law – the observation
that small doses of substances in-
crease function, medium doses inhibit
function and strong/crude doses block
or destroy function.
Astringent – an agent that causes con-
traction of tissues.
Attenuation – serial dilution with succus-
sion or trituration.
Avogadro’s number – 6.022257x1023 –
the number of molecules of a substance
per mole (weight in grams numerically
equal to its molecular weight). In home-
opathy, the 12c or 24x dilutions are the
dilutions beyond which it is said the sta-
tistical probability of a molecule of original
substance remaining in the final product
is zero.
Causation – classifies the causes of cer-
tain symptoms. For example, a Repertory
will help to differentiate between an attack
of diarrhea caused by food poisoning or
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one that is caused by apprehension (a
visit to the dentist, an examination or fear
of flying, etc.). The treatment of diarrhea
from two such causes may be different.
Centesimal – Hahnemann’s potency
scale based on the ratio of 1 in 100 (des-
ignated by C or CH).
Combination drug – a homeopathic
product that contains more than one
homeopathic drug.
Concomitants – symptoms that seem to
appear together. For example, when the
patient gets a migraine he or she almost
always becomes constipated.
Decimal – potency scale based on the
ratio of 1 in 10 (designated by X or D), ini-
tially tied by C. Hering in 1833 and further
developed by Samuel Dubs about 1838.
Diathesis (miasm) – modern term for a
tendency, predisposition or susceptibility
to a condition.
Dietary Supplement Health and Educa-
tion Act of 1994 (DSHEA) – a federal
law that regulates labeling format and
content and advertising claims for dietary
supplements; its provisions do not apply
to homeopathic drugs.
Dilution – a homeopathic medicine in liq-
uid (typically alcohol); sometimes used as
an alternative term to indicate homeo-
pathic attenuation or potency.
Dr. Schüssler’s Biochemistry –
Schüssler, a homeopathic physician, de-
veloped a method of biochemical therapy
that has been utilized since 1872. He
found that certain minerals were concen-
trated in healthy parts of the body.
Schüssler’s theory interprets illness as the
result of an imbalance of those minerals.
After identifying the body system(s) affect-
ed, one or more of his 12 “homeopathical-
ly” prepared mineral remedies is selected
to stimulate the body to bring itself back
into balance. Like Hahnemann, Schüssler
viewed his form of treatment as a stimula-
tion therapy that helps the body to regain
its regulatory capabilities, thereby restor-
ing it to a state of good health. The 3X po-
tencies often are used as “supplements,”
and the higher potencies are used for
stimulation of a healing response.
Generality – statement made by the pa-
tient that relates to the whole person
rather than a part of the person. For in-
stance, if a person says, “I am hot,” this
symptom normally is viewed as a gener-
ality; if the person says, “My feet are hot,”
this statement would be viewed as a “par-
ticular” (a symptom about a part of the
patient, not the whole person).
Hering’s law – the postulate that states
symptoms disappear in a particular order
during the course of homeopathic treat-
ment. Specifically, symptoms improve
from above downward, from vital to less vi-
tal organs, from the inside out and in re-
verse order to their appearance. While
those observations seem clear, there are
internal conflicts; e.g., the last symptom to
arise may not be life threatening and
therefore not the first symptom to improve.
With experience/common sense those
apparent conflicts easily are understood.
Homaccord – multiple potencies of the
same substance combined together to
form one homeopathic medicine.
Homeopathic Aggravation – the pa-
tient’s initial and over response to a rem-
edy—a healing crisis. It is typically tem-
porary and mild in nature and indicates
the remedy is having the intended effect.
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Homeopathic Pharmacopoeia of the
United States (HPUS) – the official U. S.
compendium that lists homeopathic drugs,
methods of manufacture, safety levels
and quality control testing methods.
Homeopathy – a field of medicine
based on the concept of micro-doses
and the Principle (or Law) of Similars
(Like Cures Like).
Homeotherapeutics – the therapeutic
application of homeopathic drugs.
Homotoxicology – a branch of home-
opathy relying on metabolic catalysts to
facilitate detoxification.
Hormesis – the small dose effect.
Infinitesimal dose – a dilution that is
regarded in homeopathy to be beyond
Avogadro’s number.
Isopathy – a procedure similar to
desensitization, whereby a potentized
substance from the patient’s own envi-
ronment or produced by the patient is
attenuated and given to the patient. In
the strictest sense, isopathic medicine
involves direct employment of the path-
ogenic substance, in a homeopathic at-
tenuation, to treat the illness it has
caused. In a broader sense, the patho-
genic substances act by means of
stimulating reactive processes within
the organism.
Law of Similars – see Principle of Similars.
Materia Medica – a book listing homeo-
pathic agents with provings (testing) and
toxicological information. In some Materia
Medica, clinical experience also is used.
Taken from Latin, meaning “materials of
medicine.”
Meta-analysis – a statistical method
used to verify results by looking back at
data from previous studies; data often are
pooled from previous studies, and the
aggregate information then is analyzed.
Miasm (diathesis) – homeopathic term
for a tendency, predisposition or suscepti-
bility to a condition.
Modality – whatever makes the symp-
toms better or worse. For example, a
patient is better from applying heat or a
symptom is worse from motion. Modali-
ties can be an aid to choosing the right
medicine. No matter how unusual or pe-
culiar the information the patient gives,
modalities are worth considering. A
strong modality might be just the clue
needed in making the right selection
between two medicines.
Mother tincture – a term used in the
British, French and German Pharma-
copoeias to indicate the initial alcoholic
liquid used as the base for homeopathic
attenuations. Because of the manufac-
turing ratio, mother tinctures made ac-
cording to those foreign pharmacopoeias
are generally not equivalent to a 1X. See
also Tincture.
Nosode – a homeopathic drug prepared
from a product of disease or diseased tis-
sue and made into a safe medicine used
to treat or prevent that disease.
Organotherapy – treating a disease by
using small quantities of organ extracts
taken from healthy animals. (Sarcodes)
Particular – symptom that a patient
can locate specifically, e.g., my leg
hurts, head aches, toe itches, etc. Op-
posite of Generality.
Phytotherapy – the therapeutic appli-
cation of medicinal herbs; also called
“herbal medicine.” That form of therapy
does not use substances prepared using
the homeopathic pharmaceutical process
of dilution and succussion.
Polychrest – a homeopathic drug that
has widespread use based on its prov-
ings and clinical applications.
Potency – a number assigned to a
homeopathic drug that indicates its pre-
cise level of dilution. For example, a 6X
would signify a homeopathic drug that
has been diluted sequentially (in the ratio
of 1 part to 9 parts diluent) and suc-
cussed at each step. It can be said that
each patient has an ideal potency—the
potency to which he or she best re-
sponds. In other words, the term “poten-
cy” should not be confused with the idea
of being stronger or weaker, but rather as
the most appropriate potency for the indi-
vidual in his condition.
Potency chord – see Homaccord.
Potentize – the act of dilution and suc-
cussion of a homeopathic drug.
Principle of Similars – similia similibus
curentur—the principal tenet of homeo-
pathy, which states “let likes be cured
by likes,” that is, a substance that caus-
es effects in large doses will alleviate
those same symptoms when adminis-
tered in a micro-dose.
Proving – homeopathic process in which
a substance is given to a healthy individ-
ual and all of the physical, emotional and
psychological changes are noted. Those
“symptoms” become predictors of the
substance’s possible use as a medicine.
Repertory – an index of symptoms and
systems of the body with homeopathic
remedies that affect the symptom or sys-
tem listed under each heading.
Rubric – a symptom or characteristic
found in a homeopathic repertory to
which remedies have been associated.
Sarcode – a homeopathic drug made
from a healthy glandular or tissue extract.
Serial dilutions – continued dilution of a
homeopathic drug.
Similia similibus curentur – “Let likes be
cured by likes.” This is the Law of Similars,
one of the basic tenets of homeopathy.
Strange, Rare and Peculiar – an unusu-
al sign, symptom or sensation, which the
patient describes or which becomes ap-
parent during the interview. It may be the
most useful discovery that can be made.
It individualizes a patient. It can be relat-
ed to his or her disease or be a part of
the general make-up of the person as a
whole. Examples: “I am always hungry at
11 A.M.”, “I am very thirsty, but drinking
disgusts me”.
Submolecular level remedy – a remedy
diluted beyond Avogadro’s number.
Succussion – the process of potentiza-
tion by shaking with impact.
Tincture – an alcohol/water liquid pre-
pared from a botanical substance, usually
in the ratio of 1 part plant to 10 parts fin-
ished tincture. A tincture is therefore anal-
ogous to the 1X attenuation. (A few ex-
ceptions are noted in the HPUS, in which
the ratio is 1 to 100, or 1 to 1000; in these
cases, the tincture is analogous to the 2X
or 3X attenuations, respectively.)
Trituration – the process of reducing a
substance to a minute state by continued
rubbing or grinding, typically with a mortar
and pestle.
Vital force – the energy or life force that
sustains an individual.
Spring 2004 13 ●
CEQ Pharmacist Continuing Education
A practical guide to homeopathy
CONTINUED FROM PAGE 12
SUGGESTED BOOKS FOR FURTHER
READING:
Beginner and Introduction to Homeopa-
thy Reference Books
Everybody’s Guide to Homeopathic Medicine
by Stephen Cummings, M.D., & Dana
Ullman
First Aid and Acute Care: The NCH Study
Guide
Healing With Homeopathy by Wayne Jonas,
M.D., & Jennifer Jacobs, M.D.
Homeopathic Medicine at Hom, by Panos &
Heimlich
Successful completion of “A practical
guide to homeopathy” (lesson 026-401-04-
023-H01) is worth four contact hours of
credit. Mail completed answer sheet to
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1. Homeopathy was first systematized
by:
a. Arndt-Schulz.
b. Hahnemann.
c. Cullen.
d. Flexner.
2. At the turn of the century ______
percent of physicians trained in the
United States were homeopathic
physicians?
a. 3 percent to 5 percent
b. 7 percent to 9 percent
c. 8 percent to12 percent
d. 10 percent to15 percent.
3. The Flexner report:
a. established accepted homeopathic
practices.
b. established guidelines for medical
schools.
c. resulted in the founding of the
American Medical Association.
d. required that AMA members be
capable of practicing homeopathy.
4. Homeopathy was first introduced
into the United States in:
a. 1755.
b. 1820.
c. 1843.
d. 1923.
5. An event that led to the decline of
the practice of homeopathy in the
United States is the:
a. publication of the “Organon of the
Medical Art.”
b. establishment of the American
Institute of Homepathy.
c. founding of the American Medical
Association (AMA).
d. opening of the Boericke & Tafel
Pharmaceutical Firm.
6. Select the true statement regarding
the history of homeopathic medicine.
a. Few pharmacists were familiar
with the compounding of homeo-
pathic medications in the 1800s.
14 Spring 2004
●
Homeopathic Pharmacy by Stephen Kayne
Homeopathic Treatment of Small Animals by
Christopher Day
Homeopathy for Pregnancy, Birth and First
Year by Castro
The Family Guide to Homeopathy by Dr.
Andrew Lockie
Intermediate and Advanced Reference
Books
Materia Medica with Repertory by Dr.
William Boericke
Homeopathic Remedy Guide by Robin
Murphy, N.D.
Medical Repertory by Robin Murphy, N.D.
Learning Assessment
b. In 1900, there were no medical
schools training physicians in
homeopathic medical practices.
c. In 1923, there were 22 medical
schools training doctors principally
in homeopathy.
d. The first American homeopathic
medical college was founded in
Allentown, Pa., in 1835.
7. The Arndt-Schulz law of pharma-
cology states:
a. Small or minute doses of drug
stimulate function.
b. Moderate doses of drug destroy
function.
c. Large doses of drug inhibit
function.
d. Toxic doses of drug can be diluted
to stimulate function.
8. Select the correct fact regarding
worldwide trends in homeopathy
today.
a. In Canada, 30 percent of homeo-
pathic sales are through pharmacies.
b. In Germany, 25 percent of natural
health practitioners use homeopathy.
c. In France, 69 percent of the popula-
tion use homeopathic medicine.
d. In India, an estimated 1 million
homeopathic medical doctors are
practicing.
9. Which process is defined as the
enumeration of all of the patient’s
symptoms in order to choose a
homeopathic drug?
a. diathesis
b. homaccord
c. attenuation
d. repertorization
10. The postulate that states that symp-
toms disappear in a particular order
during the course of homeopathic
treatment is called:
a. Steiner’s Law.
b. Law of Similars.
c. Hering’s law.
d. Dr. Schussler’s Biochemistry.
11. The process of potentization by
shaking with impact is referred to as:
a. attenuation.
b. serial dilutions.
c. succussion.
d. trituration.
www.drugstorenews.com
Hahnemann Revisited by Luc de Schepper,
M.D.
Homeopathic Care for Dogs and Cats: A Com-
prehensive Guide by Donald Hamilton,
DVM
The Organon of Medicine by Hahnemann;
translated by Brewster-O’Reilly & Decker
The Science of Homeopathy by George
Vitoulkas
Dictionaries
Yasgur’s Homeopathic Dictionary and Holis-
tic Health Reference by Jay Yasgur, R.Ph.
International Dictionary of Homeopathy by
Dr. Jeremy Swain
12. An over response to a homeopathic
remedy that results in the worsening
of a patient’s symptoms is called:
a. aggravation.
b. amelioration.
c. causation.
d. calibration.
13. A typical monograph of a homeo-
pathic medicine contains all of the
following except:
a. the name of the drug.
b. adverse effects.
c. standards for preparation.
d. dilution requirements for nonpre-
scription and prescription use.
14. A homeopathic preparation derived
from disease-causing microbes is
called a(n):
a. allersodes
b. isodes
c. nosodes
d. sarcodes
15. Homeopathic pharmaceuticals are
manufactured primarily from:
a. botanical substances
b. minerals
c. zoological substances
d. marine substances
16. Which designation represents the
1-in-10 dilution ratio utilized by the
decimal potency?
a. X
b. C
c. M
d. LM
17. Which of the following dosage forms
is prepared by applying a homeo-
pathic medicated solution to saturate
the surface of an unmedicated com-
pressed tablet?
a. triturate tablet
b. compressed tablet
c. medicated tablet
d. mediated pellet
18. According to the popular Kent’s
repertory, how many points is a
homeopathic drug given if it is listed
in italics?
a. one
b. two
c. three
d. four
U.S. Journals
The New England Journal of Homeopathy
Journal of the New England School of
Homeopathy
Journal of the American Institute of Home-
opathy
Simillimum – Journal of the Homeopathic
Academy of Naturopathic Physicians.
Homeopathy Today – Publication of the
National Center for Homeopathy
For a complete list of references,
visit www.cedrugstorenews.com.
19. How many states have homeopathic
licensing laws?
a. two
b. three
c. four
d. five
20. Which homeopathic organization
provides certification of competency
to practice classical homeopathy to
all health care professionals?
a. Council for Homeopathic
Certification
b. American Board of Homeothera-
peutics
c. National Center for Homeopathy
d. Homeopathic Academy for
Naturopathic Physicians
21. Homeopathic drugs may be either
prescription or nonprescription.
a. true
b. false
22. The FDA’s current policy does not
require homeopathic medicines to go
through a NDA process.
a. true
b. false
23. The Homeopathic Pharmacopoeia of
the United States/Revision Service
(HPUS/RS) is published by:
a. the United States Pharmacopeial
Convention.
b. Royal Copeland.
c. the Homeopathic Pharmacopoeia
Convention of the United States.
d. the FDA.
24. The various types of homeopathy
include:
a. Classical homeopathy.
b. Complex homeopathy.
c. Homotoxicology.
d. all of the above.
25. Hommaccord refers to:
a. multiple potencies of the same
substance combined together to
form one homeopathic medicine.
b. a homeopathic product that con-
tains more than one homeopathic
drug.
c. symptoms that seem to appear to-
gether.
d. the act of dilution and succussion
of a homeopathic medicine.
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