Provings, Phenomena and Practice: The Evolution of Homeopathic Knowledge
by Richard Pitt, CCH
Knowledge of medicines - as taken from Hahnemann’s 3rd aphorism - is a key in our development as homeopaths. The evolution of our materia medica is perhaps the clearest example of how our knowledge has evolved in the last 100 hundred years. From 80 remedies in Hahnemann’s and Boeninghausen’s time, to 200 remedies by the time Hering practiced, to today’s total hovering between 2,000 – 3,000 remedies, this is a key area in which homeopathic knowledge has grown. However, the quantity of information does not always relate to quality. One of the main tasks we face as practitioners is navigating our way through this sea of information and hopefully finding some solid ground to prescribe on. As classical homeopaths, we mostly agree with the fundamentals of homeopathic philosophy laid down by Hahnemann – one remedy, minimum dose, the whole person, integrating mind and body – this we know and we hold true, yet when concerning the knowledge of medicines, we have seen a wide divergence in thinking and practice. Exploring the reasons for this development reveals interesting things about homeopathy and each of our contribution to its evolution.
The Significance of Provings and Clinical Verification
Provings have been the cornerstone of our homeopathic science. This is how homeopathy began and it has continued to define the methodology of “knowledge of medicines.” While so much of conventional medicine has shifted ground over the last 200 years, homeopathy has stayed true to these principles and methods laid down by Hahnemann. As homeopaths we recognize the genius of Hahnemann even if we don’t know exactly what led him to initiate provings, and provings remain the basis of our investigation into the healing power of nature.
However, the quality of provings in Hahnemann's time needs to be seen in the same light as we look at today’s provings. How good were they really? How objective were the results gleaned? How can we extract from provings clear information to use in our practices? Homeopaths practicing today are fortunate in that the knowledge from the early provings has been cultivated, sieved, refined, dissected and integrated into a shape and form that we can now have confidence in the truth of the information documented. In spite of the inevitable subjectivity in the evolution of a remedy from its inception in a proving to its flowering in clinical practice, we now have great confidence in our knowledge of many remedies, especially the so-called polycrests. They are a great example of the integration of proving knowledge with that of clinical knowledge. This is why they continue to be used in daily practice. However, in spite of that, it can be fairly stated that some of the original proving data that Hahnemann and other early provers established has been questionable in its accuracy. This subject was discussed in detail in an article by Frans Vermeulen in the journal, The California Homeopath, Volume 11, Series 2 (New Series), published by the California Homeopathic Medical Society.
It is important to recognize that knowledge from provings does not easily evolve into clinical knowledge and many remedies have not been fully developed because of a lack of clinical verification.
The full development of a remedy only takes place through clinical experience. The knowledge gained from the application of medicines is the necessary next step to flesh out the dry, one dimensional information that a proving gives. It is possible to expand the information from a proving through a nuanced interpretation of its symptoms, which can help in the transition of a substance’s evolution from a seedling to a full flower. However, it is only after its use by many homeopaths that the knowledge fully blossoms.
Some homeopaths feel that greater emphasis needs to be placed on the knowledge gleaned from clinical practice, from careful observation of cases well taken and where the action of the remedy has been clearly perceived. However, just as with proving data, clinical information can also be fraught with subjectivity and possible projection from both the practitioner as well as the patient. But focusing on the clinical affect of medicines - not just the provings - has always been an essential part of a homeopath’s study, which is reflected in the differences between Allen’s Materia Medica and Hering’s Guiding Symptoms, the latter emphasizing clinically verified data. Many modern homeopaths are stressing the need to focus on good clinical experience to develop our knowledge of materia medica, with or without provings, to back this knowledge up.
Phenomenologically derived knowledge
Another source of knowledge of medicines comes from the phenomenological perspective - the nature of the substance, including its shape, color, form, function/behavior and its interaction with humans. This includes such controversial areas as the Doctrine of Signatures, and the tendency to extrapolate anthropomorphic comparisons when studying remedies. This area has perhaps caused more contention and dispute than any other in the development of knowledge of medicines. Hahnemann himself spoke about this, challenging the use of a Doctrine of Signatures as a means of developing a knowledge of medicines.
Broadly speaking there can be said to be three levels of phenomenologically derived knowledge:
Form: The shape, color and identity of a substance.
Function: The behavior of a substance, whether plant, mineral or animal. This includes chemical analysis and toxicity of substances, already included in our materia medica.
Relationship: This includes the connection between the substance and the patient (or human beings in general) and also the relationship between other substances. Included in this are the systems of looking at homeopathic remedies from a more relational and integrated perspective.
The orginal contention of the implausibility of the Doctrine of Signatures arose from interpretations taken from the first 2 levels. More recently, the introduction of systems of relationship has led to a revival of this debate.
In recent years, some homeopaths have focused on looking for more inclusive ways to understand our materia medica and also to seek a deeper understanding of how to interpret information in the case taking process. This has involved developing certain “theoretical” models to explore a more complete understanding of new and old remedies, attempting to fill in some of the huge gaps in materia medica knowledge. Jan Scholten and Rajan Sankaran are two thinkers who’ve developed theories of knowledge and systems of relationship that have possibly opened up the traditional vistas of homeopathic knowledge. Jan Scholten has postulated a clinical relationship of minerals used in homeopathy through the prism of the chemical Periodic Table. Most homeopaths are familiar with his ideas. What is interesting is that if one simply uses the model he created, using the vertical and horizontal levels of the periodic table to directly interpret a case and justify a remedy, then traditional knowledge of remedies from provings and also clinical experience can possibly be subordinated to this model. Scholten has attempted to merge existing knowledge into his new system, but also has exampled how the system itself is a potentially complete method of analysis. He has attempted to back this method up with clinical cases but the question remains whether the clinical knowledge has yet been consistent enough to validate the model he has established.
His model of using the Periodic Table as a template or model that can directly lead to the choice of a remedy, removed from proving data or verified clinical knowledge has led his theory to being challenged by some homeopaths. It opens itself up to criticism because it seems so abstract, a theoretical model of remedy relationships based on an organizational structure of minerals that is two dimensional at best. In the American Journal of Homeopathic Medicine, Volume 99, Number 2, Summer 06, Dr.Joel Shepperd MD makes a serious and well documented critique of Scholten's model, stating that “The use of the periodic table of chemistry has serious limitations. The periodic table does not adequately predict the medicinal qualities of homeopathic remedies. The shortcomings of grafting a paradigm of chemistry onto homeopathy are evaluated using the writings of Hahnemann and other observers of the scientific method. The manifold provings law continues to be the correct scientific method for testing homeopathic medicines.” It is worth reading his article to gain a good critique of this model, whether you agree with all his conclusions or not. However, as with many thinkers in medicine, philosophy and other disciplines, those who create a new paradigm sometimes go out onto a limb in order to clarify their point. The truth of his theory does not have to be seen in how far someone like Scholten takes his own argument but in analyzing the basic premise. Is there a connection or not?
Levels of Knowledge and Verification
One could argue that within the three levels of knowledge -- provings, phenomena and practice, one needs to have very clear and transparent effects on at least two of these levels. If the proving data is flimsy or totally missing, then the other two levels of knowledge need to be very synchronous and well developed. Otherwise, using predominantly one level leaves a question as to its accuracy and truth. This is especially the case with the 2nd two levels – phenomena and practice. Justifying a remedy only on the shape, color or function of a substance is risky, according to most homeopathic thinking. Similarly, choosing a remedy only on the basis of Scholten’s theory of chemical relationships is also risky. However, if a remedy works according to normal homeopathic criteria - however the remedy is found - is that not still homeopathy? Some people would say no. It’s not homeopathy. However, if the remedy works, surely that is the bottom line, even if the choice of remedy was made by the most arcane and esoteric analysis. The fact remains that information leading to the correct remedy can come from many sources. This is the art of homeopathic prescribing. Why should we be limited by the strictures of existing knowledge? Are we not allowed to think outside the box every now and again? If the case is well documented and shows clear action, it can help validate the theory behind the choice of remedy. The clinical verification becomes the key here. It is in consistent clinical application that any theoretical model is validated, depending also on the ability of the practitioner to explain their methodology to others, so even retroactively one can analyze the process of evaluation involved.
However, justifying a remedy choice based solely on the phenomenological approach is open to speculation and it can be argued that much liberty has been taken in this area. The goal is to find consistent knowledge that can add to the quality of information that makes up our materia medica. The problem often stems from extrapolating big general conclusions from just a small amount of information. If the small amount of information happens to be the core of the case, then the remedy will work; if not it won’t. As with any case analysis, the choice of the information is key.
It has to be noted though that when dealing with certain animal remedies, the study of the behavior of animals of similar species can be very useful in distinguishing which remedy can be indicated. This is very much the case in looking at snake, spider and insect remedies. It can be very difficult to differentiate between remedies of the same species based on existing proving and even clinical data and it therefore makes total sense to look at the behavior of these animals; surely the consciousness of these animals is reflected through their behavior and therefore will be recognized in human experience. Provings mostly do not give us this distinction, and clinical data and behavioral study can help us in this differentiation. This is generally much more difficult to do in studying plants and also in minerals and metals. However, when looking at minerals and metals, studying the toxicological and chemical action of these substances can be very useful. And interestingly, much detail of provings comes from toxicological data. This is for both plants and minerals. It is surprising how much data in provings comes from such information. This brings to light the interesting confluence between proving data and more functional knowledge of many substances. This is often forgotten when critiquing the so-called Doctrine of Signatures. Our materia medica is full of information taken from toxicological sources, herbal and folklore, obtained by observational and empirical methods. William Boericke’s materia medica is full of such information.
Systems and Models of Relationship
Rajan Sankaran has also devised a theory of relationship and a model for remedy choice through making connections between plants of the same botanical family and connecting this to his theory of miasmatic strategy, offering some “new” miasmatic categorizations to assist in this. He often focuses on one remedy that is well-known within one botanical family and looks for confirmation and repetition of symptoms in remedies of the same family. He then seeks to find unique data for each remedy that may fit his miasmatic classifications. While he has admitted that this is a work in progress, some homeopaths have chosen to accept it at face value and it has already become an unquestioned body of knowledge for many practitioners. However, like Scholten’s ideas, it falls into the phenomenological area of information in that certain information is taken and then postulated in a way to justify prescriptions primarily using this model. Of course, some proving and clinical data is used as a foundation to build this theoretical model, but the model still becomes the dominant paradigm. The question again is whether clinical data can be significantly gleaned to confirm this, or not, and it is perhaps too early to state. There has however, been some interesting critiques of this model, questioning the accuracy of using botanical classifications in relation to the clinical relationship of our remedies. Some families seem clinically quite related, while others are much more questionable. In an interesting article in Homeopathic Links, Volume 18, Winter 2005, Julia Schiller questions the accuracy of using existing botanical classifications as a method of analysis and comparison of remedies. She particular draws attention to the Conifer, Violales, Hammamelidae, Magnolianae and Lilliflorae groupings, stating that as they are composed of plants sharing higher taxa in common than the botanical family, they are seen to have potentially premature generalizations and other problems. Other botanical classifications can also be questioned as to their homeopathic relevancy clinically and therefore it would seem appropriate to be cautious in accepting such theories. Also, there is a new botanical classification based on studying the DNA of plants which may lead to a restructuring of many plant classifications.
Sankaran’s attempt to explore this area has challenged many homeopaths to look outside the box of the usual suspects of remedies that we use and similar to Scholten has focused our attention on the gaps in our knowledge of remedies and the challenge to make less known remedies more accessible. One further and important aspect of Sankaran’s schema is that he has introduced not one but two interweaving structures. The second of these, an extended miasmatic schema, adds to the level of abstraction of using any model or structure as a means of remedy justification and as such requires clinical verification from other homeopaths over a period of time.
Other authors, like Frans Vermeulen are seeking to explore the relationship of remedies based on the chemical action of substances and seeing whether the botanical classifications can be verified by plants having a similar chemical analysis. This is one other area of phenomenological knowledge that has not been studied enough, mostly reduced to herbal knowledge and by toxicological data found in early provings and accidental poisonings. In studying elments in the periodic table, there is already ample information to make assumptions of the similarities of certain elements, for example, that between Ferrum, Manganum and Cobaltum, and as such it does not seem to be a huge jump to make that there could be some clinical similarities. This type of analysis is more in keeping with existing use of knowledge found in our materia medica and less “theoretical” than whole systems that superimpose themselves on our knowledge of medicines.
The Quest for Scientific Truth
The concept of establishing a more generalized and schematic theory of knowledge, in this case our materia medica, was discussed by Jan Scholten in Homeopathic Links, Volume 17, Autumn 2004. He begins by questioning the definition of Science. He quotes: - “Science is theory, based on facts.” “Science is a structure based on facts.” He continues to say that Science is the search for general, universal principles in different situations and quotes that “The strength of scientific knowledge lies in its very ability to theorize” and “This is how scientific knowledge strives for universality: the concrete example itself is not of paramount importance, but the intellect proceeds from the specific case to the general principle.” He argues that the quest for a generalized, universal theory of knowledge is the essence of science, and it is a quest for simplicity and elegance in understanding the way of things. He then defines levels of scientific development, beginning with simple facts to the description of these facts – which he defines as the phenomenological perspective, somewhat more narrow than the broader phenomenological description this article is applying. He proceeds to describe further levels, from the observation and categorization of facts into a broader theory of potential connection, which can then be tested – in our case, through clinical practice. The movement of this development is to create a more comprehensive, universal theory. This is the goal of this process, but one which is connected to reality, to facts, to truth. This process toward a universal theory of things is a natural evolution of the development from facts to phenomena to understanding and truth. As Scholten develops this argument he states that science needs just two paradigms or axioms. The Order paradigm is stated as “the world has an innate order” and it makes generalizations possible. The second is the Truth paradigm: “There is such a thing as truth.” Without them, science is not possible.
He then describes the evolution of homeopathic knowledge, from the knowledge gleaned from provings and clinical verification. He states: “Provings are methods of induction. Clinical information is a form of confirmation.” However, he also states that the process of development from fact to generalization in homeopathy has led to confusion in the process of making certain generalizations. He also critiques Hahnemann as confusing fact and generalization when Hahnemann quotes in aphorism 138 that ”each symptom or occurrence during a proving belongs to a remedy. In this way he gives each symptom general value and avoids the difficult problem of induction.” Another way of stating this is that it can be critiqued that quite a lot of the symptoms produced in Hahnemann’s provings were intrinsic to the person (secondary effect), and not primarily that of the remedy (primary effect).
This leads Scholten to make the claim that of the classification methods that have been part of homeopathic development in the last decade or so, the most accurate is the chemical and biological classification. Here, “the best classification on one level will have a high chance of being the best classification at other levels.” He then makes the case that using methods of classification to ascertain “knowledge of medicines” has distinct advantages over provings and clinical knowledge, both of which take much time and energy. He states that it enables the prediction of remedy pictures, and can add new remedies more quickly to our knowledge base. It further reduces the number of essential symptoms needed to prescribe a remedy, making differential diagnosis clearer and simpler and therefore allowing a greater number of remedies to be used and remembered.
Scholten feels that using a classification such as the periodic table and the generalized theory of its interconnectedness has greatly enhanced our knowledge of new medicines, simplifying our ability to choose appropriate remedies based on the law of similars. However, when reading Joel Shepperd’s article one gets a very different view of the value of the periodic table as a model or theory of relationship, both to the elements themselves and the jump to the homeopathic materia medica. Scholten would say that the proof of any theory is in its truth, in other words, how is it applied and does it work. The major question that may remain about Sholten’s thinking here is whether it is possible to make such generalized, universal theories when dealing with the complexity and subtlety of human consciousness and its application into a model of healing such as homeopathy, one that has such an intrinsic, subjective and artistic expression. Further, how can a model such as the Periodic Table be so universally applied as a map of the possibilities of human consciousness. Has Scholten taken too large a leap of imagination in making this connection?
The Significance of Clinical Verification in Validating An Idea
This brings us right back to clinical information. Scholten in his conclusions implies that clinical verification is needed to validate the probability of the theory, but once that has been established, the model, theory, abstraction and generalization is validated. However, it may be argued that substantial clinical verification has not taken place yet, not enough to confirm the “probable truth” of the clinical homeopathic relationship of remedies to that of the chemical periodic table.
Although one may feel that there is a real risk that Scholten is taking by making such an abstraction away from traditional knowledge, one can also say that Sheppard’s complete dismissal of this idea is also risky. What if Scholten and Sankaran’s models have some validity. What then? Is taking a fixed position regarding the methods of ascertaining “knowledge of medicines” really scientific? Does the exclusive focus on proving knowledge blind us to the possibilities of other forms of knowledge?
Like many theories, Scholten’s and Sankaran’s being good examples, there is no doubt SOME truth to the basic concepts. Chemical relationships and botanical classifications have some truth to them. If they are intrinsically true then they can help homeopathy in its attempts to create classifications and models of relationship of our remedies. It can be argued though that the theories have been accepted prior to the level of clinical confirmation needed. It is interesting to look at how Scholten developed his thinking, outlined first in his book “Homeopathy and Minerals” and then in “Homeopathy and Elements”. One aspect in the first book is his work on understanding the relationship between the component parts of remedies, both the anion and cation. By understanding the unique “identity”, “theme”, “image” of each of these elements, one can see more clearly the exact remedy needed, using both compounds of the remedy. This way of prescribing has been used by many homeopaths, from Kent to Nash to Grimmer. Although Kent was criticized for taking this too far, one can see that it has often been part of homeopathic thinking. What Scholten (and Sankaran and others) did was to elucidate it further and allow a clearer image of each theme to be seen. However, even this has been criticized by Shepperd, who says that “the popular synthetic remedy pictures are artificially built, based mostly on his perception of his case rather than a study of the provings.” “This is a serious breach of homeopathic method.” “There is no excuse to teach this totally repudiated short cut.” “Clinical observations can only be validated after they are compared to the known and verified manifold provings.” There is no doubt some truth in his argument that the unique combination of two elements is more than the sum of its parts. However, it can also be said that proving and clinical data actually confirms that a synthesis of two elements together actually does reveal a correspondence of the two elements put together. If one studies the Kali family, one clearly identifies aspects of Phosphorous and Iodine in the remedies Kali phos and Kali iodatum. Ferrum phos is an interesting remedy, with no real proving data, and traditionally reduced to acute prescribing and information produced as one of Schussler’s salts. Yet it consists of two elements that are major chronic remedies with complex homeopathic pictures. Surely, identifying the unique dimensions of each can help us identify when this remedy is needed. If clinical confirmation can help validate this concept, is that not enough? Does the repudiation of a theory based on a lack of proving and/or clinical information invalidate it? Is that not just a reductionistic analysis, putting far too much credence on homeopathic provings as the source of all our knowledge?
Using the periodic table as a means of homeopathic analysis and remedy evaluation, or using the combination of elements that make up a remedy as a measure of analysis are both examples of a phenomenological approach to homeopathy. They are attempts to identify and understand characteristics of remedies that build on existing knowledge from provings and clinical knowledge. However, there are distinct differences between the two approaches. The former, similar to Sankaran’s miasmatic and botanical classifications represent a level of abstraction or generalization much beyond the mere synthesis of different elements in a particular remedy. Therefore, they require much more clinical corroboration before they can be accepted as any kind of general, “universal” theory, as stated by Scholten. Whereas, the synthetic methodology is much more connected to existing knowledge of remedies, the knowledge of which has been substantiated clinically for a long time. While it is true that Scholten and a few others have taken “synthetic” prescribing to much more abstract levels, many homeopaths use this form of analysis to refine their choice of remedies.
The Tension Between Doctrine, Practice and Truth
Shepperd’s absolute dismissal of this approach begs the following question:
Is he interested in the preservation of a specific homeopathic doctrine which as he stated requires the sole determination of the knowledge of a remedy to be based on a study of provings? If that is the case, then he will not be able to prescribe confidently on much more than 100 remedies. Even Hering’s Guiding Symptoms are a mixture of proving and clinical data, this clinical data often building on scanty proving data. The fact is that the evolution of the knowledge of a remedy has been influenced as much by clinical knowledge and empirical and toxicological data as it has from provings. The attempt to always put provings on a pedestal at the expense of any other kind of “knowledge of medicines” seems more of an attempt to protect a particular doctrine of thinking than in seeking to expand our knowledge.
In this argument, Scholten makes a good point by comparing homeopathy to other scientific systems in which the creation of more “comprehensive theories” can be a key in the evolution of knowledge and truth. However, as Scholten stated himself: “The second aspect of science is that it has to true. Its statements and theories have to tally with reality, agree, and be right and true.” However, to strike a middle position in the polarities posited by Shepperd and Scholten, any generalized system, structure or theory is only useful as a map to unravel an understanding of the human condition and in our case, homeopathic remedies that may be the most similar to the patient’s condition. As with any system when applied to the dynamic unpredictability of the human condition, its application is conditional. It won’t work all the time. It is one more tool that will aid in our analysis, that opens up the possibilities of new remedies – proven or not – as they belong to a wider systemic totality. The weakness of such systems is the attempt to apply them all the time, to rigidify the analysis of a case by some kind of grid system. This is where both Scholten’s and Sankaran's models lack depth, falling into the two dimensional approach that Shepperd mentions. It is not to say they are wrong but as with anything can be wrongly applied and are not universally applicable They are still relative concepts, with questionable assumptions of connection and are removed one further step from the primary knowledge that comes from provings and from established clinical confirmation.
One important point is that the whole purpose of this discussion is merely an attempt to explore the way we work in defining what information we can use to help us find the right remedy. The focus has been on the methods of establishing “accurate” information, - “truthful data”. It has not focused on the dynamics of how this information is gleaned, the “gestalt” of the case taking process that reveals what is needed to be cured. That is the other part of this discussion, when attempted to explore the dynamics of the art of homeopathy.
However, the debate forces us to make some kind of distinction about how we define homeopathy. Is homeopathy a system of medicine based on the Law of Similars or is it a system of medicine that applies the Law of Similars and the knowledge of medicines only from homeopathic provings as the sole basis of it’s action. These definitions are not necessarily exclusive but the first one does subsume the second. It is a larger perspective in that it accepts that homeopathic provings are not the sole means to define “knowledge of medicines.” It accepts that other forms of knowledge, even theoretical ones, can help us in classifications of our knowledge and can add upon existing knowledge derived from homeopathic provings.
The argument needs to be made that one can get stuck in any place along the road of knowledge. Sticking to a doctrinal view that only provings are valid criteria for a remedy to be given, as stated by Shepperd, is restrictive and narrow, however valid the attempt may be to curtail dubious information and theoretical speculation. Similarly, the imposition of speculative groupings and analysis based on a variety of theories and abstract generalizations can also be a trap and another rigid system can be superimposed on the fluid dynamics of human consciousness. There is always a tendency when suggesting new theories to codify them in absolute terms, to make them seem water tight. Even though Sankaran and Scholten have stated their models of classifications and miasms as a work in progress, many people take them at face value and as with other homeopathic concepts they become concretized into homeopathic knowledge merely by their acceptance by some of the homeopathic community. Relative truths become absolute very quickly, an issue that has afflicted homeopathy since Hahnemann first put his thoughts to paper. However, over time, the truth of all these ideas will ideally be validated or not in the light of our experience. The importance is more on being willing to lean forward and seek new ways of perceiving than just leaning back on the past and dismiss them all as “not homeopathy”.
Richard Pitt CCH
Richard is the Director of the Pacific Academy of Homeopathy, San Francisco. He lives and works in San Francisco.