Homeopathic preparations are referred to as "homeopathics"[11] or "remedies". Practitioners rely on two types of reference when prescribing: materia medica and repertories. A homeopathic materia medica is a collection of "drug pictures", organized alphabetically. These entries describe the symptom patterns associated with individual preparations. A homeopathic repertory is an index of disease symptoms that lists preparations associated with specific symptoms. In both cases different compilers may dispute particular inclusions.[73]The first symptomatic homeopathic materia medica was arranged by Hahnemann. The first homeopathic repertory was Georg Jahr's Symptomenkodex, published in German in 1835, and translated into English as the Repertory to the more Characteristic Symptoms of Materia Medica by Constantine Hering in 1838. This version was less focused on disease categories and would be the forerunner to later works by James Tyler Kent.[74][75] Repertories, in particular, may be very large.
Homeopathy uses animal, plant, mineral, and synthetic substances in its preparations, generally referring to them using Latin or faux-Latin names. Examples include arsenicum album (arsenic oxide), natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), opium, and thyroidinum (thyroid hormone).
Some homeopaths use so-called "nosodes" (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue.[74] Conversely, preparations made from "healthy" specimens are called "sarcodes".
Some modern homeopaths use preparations they call "imponderables" because they do not originate from a substance but some other phenomenon presumed to have been "captured" by alcohol or lactose. Examples include X-rays[76] and sunlight.[77]
Other minority practices include paper preparations, where the substance and dilution are written on pieces of paper and either pinned to the patients' clothing, put in their pockets, or placed under glasses of water that are then given to the patients, and the use of radionics to manufacture preparations. Such practices have been strongly criticized by classical homeopaths as unfounded, speculative, and verging upon magic and superstition.[78][79]
Preparation
Hahnemann found that undiluted doses caused reactions, sometimes dangerous ones, so specified that preparations be given at the lowest possible dose. He found that this reduced potency as well as side-effects, but formed the view that vigorous shaking and striking on an elastic surface – a process he termed Schütteln, translated as succussion – nullified this.[80] A common explanation for his settling on this process is said to be that he found preparations subjected to agitation in transit, such as in saddle bags or in a carriage, were more "potent".[54]:16 Hahnemann had a saddle-maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair.[81]:31 Insoluble solids, such as granite, diamond, and platinum, are diluted by grinding them with lactose ("trituration").[54]:23
The process of dilution and succussion is termed "dynamization" or "potentization" by homeopaths.[9][82] In industrial manufacture this may be done by machine.
Serial dilution is achieved by taking an amount of the mixture and adding solvent, but the "Korsakovian" method may also be used, whereby the vessel in which the preparations are manufactured is emptied, refilled with solvent, and the volume of fluid adhering to the walls of the vessel is deemed sufficient for the new batch.[54]:270 The Korsakovian method is sometimes referred to as K on the label of a homeopathic preparation, e.g. 200CK is a 200C preparation made using the Korsakovian method.[83][84]
Fluxion and radionics methods of preparation do not require succussion.[54]:171 There are differences of opinion on the number and force of strikes, and some practitioners dispute the need for succussion at all while others reject the Korsakovian and other non-classical preparations. There are no laboratory assays and the importance and techniques for succussion cannot be determined with any certainty from the literature.[54]:67–69
Dilutions
Three main logarithmic potency scales are in regular use in homeopathy. Hahnemann created the "centesimal" or "C scale", diluting a substance by a factor of 100 at each stage. The centesimal scale was favoured by Hahnemann for most of his life.
A 2C dilution requires a substance to be diluted to one part in 100, and then some of that diluted solution diluted by a further factor of 100.
This works out to one part of the original substance in 10,000 parts of the solution.[85] A 6C dilution repeats this process six times, ending up with the original substance diluted by a factor of 100−6=10−12 (one part in one trillion or 1/1,000,000,000,000). Higher dilutions follow the same pattern.
In homeopathy, a solution that is more dilute is described as having a higher "potency", and more dilute substances are considered by homeopaths to be stronger and deeper-acting.[86] The end product is often so diluted as to be indistinguishable from the diluent (pure water, sugar or alcohol).[10][87][88] There is also a decimal potency scale (notated as "X" or "D") in which the preparation is diluted by a factor of 10 at each stage.[89]
Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060).[9] Hahnemann regularly used potencies up to 300C but opined that "there must be a limit to the matter, it cannot go on indefinitely".[41]:322
In Hahnemann's time, it was reasonable to assume the preparations could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized.
The greatest dilution reasonably likely to contain even one molecule of the original substance is 12C.[90]
Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies.[91]Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times.[92][93] Another example given by a critic of homeopathy states that a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans",[92][93] which is approximately correct.[94] One-third of a drop of some original substance diluted into all the water on earth would produce a preparation with a concentration of about 13C.[91][95][96] A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name Oscillococcinum. As there are only about 1080atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 more universes to simply have one molecule in the final substance.[97] The high dilutions characteristically used are often considered to be the most controversial and implausible aspect of homeopathy.[98]
Not all homeopaths advocate high dilutions. Preparations at concentrations below 4X are considered an important part of homeopathic heritage.[99] Many of the early homeopaths were originally doctors and generally used lower dilutions such as "3X" or "6X", rarely going beyond "12X". The split between lower and higher dilutions followed ideological lines. Those favouring low dilutions stressed pathology and a stronger link to conventional medicine, while those favouring high dilutions emphasized vital force, miasms and a spiritual interpretation of disease.[100][101] Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond that of a placebo.[102][103]
Provings
A homeopathic "proving" is the method by which the profile of a homeopathic preparation is determined.[104]
At first Hahnemann used undiluted doses for provings, but he later advocated provings with preparations at a 30C dilution,[9] and most modern provings are carried out using ultra-dilute preparations in which it is highly unlikely that any of the original molecules remain.[105]During the proving process, Hahnemann administered preparations to healthy volunteers, and the resulting symptoms were compiled by observers into a "drug picture".
The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation.[106]
After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms.
Provings are claimed to have been important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine.[107] The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence that nitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time.[108] The first recorded provings were published by Hahnemann in his 1796 Essay on a New Principle.[109] His Fragmenta de Viribus(1805)[110] contained the results of 27 provings, and his 1810 Materia Medica Pura contained 65.[111] For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 preparations underwent provings and newer substances are continually added to contemporary versions.
Though the proving process has superficial similarities with clinical trials, it is fundamentally different in that the process is subjective, not blinded, and modern provings are unlikely to use pharmacologically active levels of the substance under proving.[112] As early as 1842, Holmes noted the provings were impossibly vague, and the purported effect was not repeatable among different subjects.[38]
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