Homeopathic Aggravations Research Articles

P04.17. Adverse effects of homeopathy, what do we know? A systematic review

Purpose Homeopathy has few legal regulations acting as gatekeepers. The remedies may be in widespread use despite unclear mechanism of effect and safety assessment. Uncontrolled studies of homeopathic practise document consistently strong therapeutic effects and sustained patient satisfaction however, cases of adverse effects have also been reported. According to homeopathic theory transient worsening of patients symptoms (aggravations), are understood as a wanted reaction to the medication. To date, systematic information is lacking on how commonly adverse effects and homeopathic aggravations are reported in RCTs, observational studies and surveys.

Homeopathic aggravation with Quinquagintamillesimal potencies

Homeopathic aggravation is the exacerbation of some symptoms or the whole pathological situation, followed by improvement of the patient's conditions. To evaluate the typology, intensity and frequency of homeopathic aggravation, especially with Quinquagintamillesimal (Q, LM) potencies and its prognostic value. The homeopathic prescription strategy evaluated consists in the administration of a single homeopathic medicine in Q dilutions, starting with 6Q, then a progressive scale of Q potencies. Patients whose symptoms could be attributed to a wrong and inappropriate prescription, according to the criteria previously described, were excluded. Data was collected on 1108 patients consecutively visited from 3rd October 2002 to 31st December 2007, and 441 cases followed for at least 2 months (40% of total cases). 63 of these cases (14%) reported homeopathic aggravation: 7% reported 'slight', 5% 'medium', 2% 'intense' and 0.4% 'very intense' aggravation. Homeopathic aggravation was present in 21% of paediatric patients (≤ 14 years). About 50% of the cases manifested homeopathic aggravation 1 or 2 days after the prescription and for 67% of patients the symptoms lasted 1 week or less. Patients with aggravation of the original disease had significantly greater improvement than those patients showing the aggravation of other, new or different, symptoms or conditions, or no aggravation. These data show that homeopathic aggravation with Q potencies is quite frequent in homeopathic clinical practice and seems to be associated with better treatment outcome.

Is It Possible to Distinguish Homeopathic Aggravation from Adverse Effects? A Qualitative Study

Background: Homeopathic aggravation is a temporary worsening of existing symptoms following the administration of a correct homeopathic prescription. The aim of this study was to explore and compose criteria that may differentiate homeopathic aggravations from adverse effects. Material and Methods: A qualitative approach was employed using focus group interviews. 2 interviews, with 11 experienced homeopaths, were performed in Oslo, Norway. The practitioners have practiced classical homeopathy over a period of 10–32 years. Qualitative content analysis was used to analyze the text data. The codes were defined before and during the data analysis. Results: We found that aggravations were subtle and multifaceted events. Moreover, highly skilled homeopaths are required to identify and report aggravations. Adverse effect may be defined as an ‘undesirable effect of a remedy’. This definition is pragmatic, flexible, and more in line with the holistic paradigm that the homeopaths represent. 8 criteria that distinguish aggravation from adverse effect were found. Highly sensitive persons hold a unique position regarding safety, as it is important to identify these patients in order to treat them correctly and avoid undesirable effects of the treatment. Conclusion: This study rigorously explored homeopaths’ views and experience on aggravation and adverse effects. The 8 criteria developed in this study may ensure patient safety and support therapists in identifying an ‘undesirable effect of a remedy’.

Prospective observational study of 42 patients with atopic dermatitis treated with homeopathic medicines

Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin disease which usually develops during childhood. Despite being a condition frequently treated with homeopathy, the evidence is still insufficient to define homeopathic treatment's efficacy and the best therapeutic strategies. To evaluate the effectiveness of homeopathic treatment of AD in a general homeopathic practice setting. Patients spontaneously seeking homeopathic treatment meeting Hanifin and Rajka's criteria were prospectively treated. Severity of disease was evaluated by Rajka and Langeland's score and a set of four Visual Analogue Scales (VAS) evaluating disease severity, itch, general and psychological wellbeing and quality of sleep. Assessed outcomes were: change in AD extension, change in VASs, and a categorical scale for global subjective perception of evolution. Forty two patients were eligible. Twenty-one had other atopic comorbidities and 28 (66.7%) were moderate or severe cases. Sixteen (38.1%) patients dropped out. Significant differences were found comparing first and last consultations in mean percentage (95%CI) of affected skin area, 21.1% (10.9; 31.4) versus 5.5% (1.3; 9.7) respectively, P=0.002, and in the change or the four VASs: [mm (95%CI)] AD 31.1 (20.6; 41.7), P<0.0001; Itch 35.0 (23.6; 46.4), P<0.0001; General wellbeing 11.1 (1.2; 20.9), P<0.0188, and Sleep 17.4 (5.0; 29.8), P<0.0073. Homeopathic aggravations were reported after 29.8% of prescriptions. Twelve individualized homeopathic medicines were prescribed; Sulphur accounted for 60% of cases with good treatment response. This study suggests that in a general medical practice setting, homeopathic treatment could be regarded as an effective choice for patients with AD.

Posology of homeopathic medicine

Basic principle of homeopathy is individualized therapy, which finds application also in posology of homeopathic medicines. Posology in homeopathy depends on the state of the patient. Hahnemann's 'Organon', which presents important instructions for correct homeopathic treatment, was published in six editions. Homeopathic medicines are most often prepared in two scales - decimal and centizimal (ratio 1:10 and 1:100), but they also get prepared in M and LM scale (ratio 1:1000 and 1:50 000). Homeopathic aggravation is not necessary confirmation of action of medicine. Evolution of conclusions on posology of homeopathic medicine had a crucial moment: in the forth edition of 'Organon' Hahnemann said that medicines should be administered in form of several granules, while in the fifth edition he introduced the main correction in posology, that medicines should be adminstered in water solutions. In the sixth edition of 'Organon' Hahnemann confirmed this postulate by adding new ones about the use of LM potencies. In order to dose homeopathic medicine correctly, it is necessary to have thorough knowledge of classical homeopathy, requiring sometimes, for the sake of patient's benefit, corrections in already well established posology practice.

Frequency of homeopathic aggravation using LM (Q) potencies

Frequency of homeopathic aggravation using LM (Q) potencies

Individualized homeopathic treatment of dermatological complaints in a public outpatient clinic

This study sought to assess the effectiveness of individualized homeopathic treatment on dermatological complaints in a public outpatient clinic. Children and adults spontaneously seeking for homeopathic treatment for dermatological complaints were prescribed single individualized remedies and followed up for a minimum of 3 months; assessment was clinical and recorded graphically. Forty-nine patients met the inclusion criteria. Outcomes were positive (59%); no effect (4%); drop-out (37%), from which 6% was due to homeopathic aggravation. No manifestations of suppression were observed. Outcome studies are useful to point out to the effectiveness of individualized homeopathic treatment in dermatological complaints. Outcomes suggest that actions focusing on pathological categories do not lead to homeopathic suppression.

Q-Potenzen: Verdünnungen für übersensible Patienten

As observed by Hahnemann, homeopathic aggravations can also occur during repeated Q potencies, especially with hypersensitive patients. In such cases, Hahnemann advises the reduction of the dose, through dilutions of the homeopathic medicine. These watery dilutions should be renewed every day by the patient, what is not very practical nowadays. The authors report their experience in Brazil with Q potencies dilutions which were stabilized with alcohol in the pharmacy, making their use and transportation easier for the patient.

The truth about homeopathy

In this issue, Paris et al.[1] report a clinical trial showing that homeopathy is not better than placebo in reducing morphine consumption after surgery. Proponents of homeopathy would object to this statement. Even though the study was well-made, it did only suggest that a certain homeopathic remedy fails to be effective for a certain type of pain. Other homeopathic medicines might be effective and other types of pain might have produced different results. There are hundreds of different homeopathic remedies which can be prescribed for thousands of symptoms in dozens of different dilutions. Thus we would probably need to work flat out for several lifetimes in order to arrive at a conclusion that fully substantiates my opening statement.

The use of homeopathic combination remedy for dengue fever symptoms: a pilot RCT in Honduras

A double-blind, placebo-controlled randomized trial of a homeopathic combination medication for dengue fever was carried out in municipal health clinics in Honduras. Sixty patients who met the case definition of dengue (fever plus two ancillary symptoms) were randomized to receive the homeopathic medication or placebo for 1 week, along with standard conventional analgesic treatment for dengue. The results showed no difference in outcomes between the two groups, including the number of days of fever and pain as well as analgesic use and complication rates. Only three subjects had laboratory confirmed dengue. An interesting sinusoidal curve in reported pain scores was seen in the verum group that might suggest a homeopathic aggravation or a proving. The small sample size makes conclusions difficult, but the results of this study do not suggest that this combination homeopathic remedy is effective for the symptoms that are characteristic of dengue fever.

The Harmful Cure Observed by Hering and Kent in Contrast to Hahnemann's Concept of Gentle Restoration of Health

Introduction: the “laws of cure” for chronic diseases have been Hering's most significant work for generations of homeopaths. Kent endorsed Hering's laws and their ultimate progression up to skin lesions, and included “severe aggravations, revival of past symptoms and eliminations” among the expected results during the homeopathic treatment of chronic diseases. Despite the claims of Hering and Kent to be Hahnemann's followers, the cure standards established by them seem quite harmful and contrary to Hahnemann's gentle restoration of health ideal. Objectives: to ascertain if Hering and Kent based their arguments and procedures on Hahnemann's principles when inferring and observing those harmful cure standards. Methodology: Analysis of Hering's propositions in relation to his laws of cure and Kent's remarks about severe homeopathic aggravations compared to Hahnemann's writings. Conclusions: 1) Hering's “laws of cure” cannot be justified upon Hahnemann's premises, since according to Hahnemann internal and external symptoms should improve together, without a specific order of direction. The only point of convergence between Hahnemann and Hering's laws is the observation that the latest symptoms that have been added to a chronic disease are always the first to yield in an antipsoric treatment. 2) Misapplying Hahnemann's recommendations, Kent was careless with dosage; admitted as pathway to cure severe and long homeopathic aggravations, return of all past symptoms, exteriorisations and eliminations, which were considered by Hahnemann as organism defences against dose excess or incorrect prescriptions. 3) Hering and Kent did not follow Hahnemann's principles and the harmful cure they observed was probably a result of their own procedures in homeopathy, deviating from the objective of gentle restoration of health.

Harm in homeopathy: Aggravations, adverse drug events or medication errors?

Background The assessment of harm arising from the use of homeopathic medicine is much discussed, but there is little published data on the subject. Aim To study prospectively adverse drug events related to homeopathic medicines. Setting The data were gathered between 1 June 2003 and 30 June 2004 during follow-up visits consecutively carried out at the Homeopathic Clinic, Campo di Marte Hospital, Azienda USL 2, Lucca (Italy). They refer to effects following the administration of a homeopathic medicine, prescribed according to the classical homeopathic method. Methods Reports collected by a homeopathic doctor (not the prescribing doctor) on the nature and intensity of the effect, dose and frequency of administration, time relationship between the drug use and the adverse events, challenge, unchallange possible concomitant factors, causality (improbable, unlikely, possible, probable, certain). Results Out of 335 homeopathic consecutive follow-up visits between 1 June 2003 and 30 June 2004, nine adverse reactions were reported (2.68%) including one case of allergy to lactose, excipient of the granules. Conclusions Adverse events to homeopathic drugs exist and are distinguishable from homeopathic aggravations, but are rare and not severe.

Homeopathic aggravations: a systematic review of randomised, placebo-controlled clinical trials

Homeopathic aggravations have often been described anecdotally. However, few attempts have been made to scientifically verify their existence. This systematic review aimed at comparing the frequency of homeopathic aggravations in the placebo and verum groups of double-blind, randomised clinical trials. Eight independent literature searches were carried out to identify all such trials mentioning either adverse effects or aggravations. All studies thus found were validated and data were extracted by both authors. Twenty-four trials could be included. The average number of aggravations was low. In total, 50 aggravations were attributed to patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies. We conclude that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.

Homeopathic aggravations: a systematic review of randomised, placebo-controlled clinical trials

AbstractHomeopathic aggravations have often been described anecdotally. However, few attempts have been made to scientifically verify their existence. This systematic review aimed at comparing the frequency of homeopathic aggravations in the placebo and verum groups of double-blind, randomised clinical trials. Eight independent literature searches were carried out to identify all such trials mentioning either adverse effects or aggravations. All studies thus found were validated and data were extracted by both authors. Twenty-four trials could be included. The average number of aggravations was low. In total, 50 aggravations were attributed to patients treated with placebo and 63 to patients treated with homoeopathically diluted remedies. We conclude that this systematic review does not provide clear evidence that the phenomenon of homeopathic aggravations exists.