Mastering Homeopathy 1 - Accurate Daily Prescribing for a Suucesful Practice

Review

Reviewed by: Alastair Gray

It's an average Monday morning for me. I have, spread out on my desk, the array of cases still unsolved and left over from the previous weeks practice days. It's carnage. I am pulling my hair out. There is a man with insomnia and IBS. There is a woman with absent libido after a termination. There is an 11 year old with eczema on his wrists. What is characteristic about these cases is that I have prescribed at least 6 remedies to them over the past year. There have been some changes and movements. But they are all unresolved. It's hardly aphorism two: gentle, rapid and permanent. There comes a time to admit that the strategy you have adopted in a certain situation has to change. One of the things I have clarity about in these three cases is that I have been prescribing remedies on a still unclear profile of the totality of the patient and the symptoms. There is still a lack of definition in the case. It's like wearing someone else's glasses while looking at an archery target and trying to nail the gold. My strategy today involves reaching for Jon Gamble's new book.

My first experience of Jon's clinical work was a case in 1998. I had successfully treated a woman for her asthma. She was moving back to the UK but her child came down with an ear infection. Qantas was refusing to allow the child to fly. I gave this and that over the next week. Nothing. In desperation I sent her to the Children's Ear Clinic and the mother later mailed me from London thanking me for the referral. The ear had resolved immediately with a therapeutic medicine prescribed by Jon on the basis of the pathology.

In Mastering Homeopathy Jon has provided a therapeutics book which addresses so many of the presentations into a busy homeopathic practice. There are chapters on children; ears, tonsils, headaches and others: women; candida, mastitis, cystitis and others: general conditions such as allergies, chronic fatigue and glandular fever, skin conditions, hyperthyroidism etc. The practical advice and the remedies suggested are beyond useful. I am thinking of the cases of pterigyum which came to my practice and went unresolved, of cases of warts which came and went that could have benefited from the suggestions made here. What is also presented, and before any suggestions for medicines, is information on the clinical presentations of each condition and a differential diagnosis.

But what excite me most about the book are the immediate things it does better than other therapeutic texts. First is Jon's clarity in describing what we are doing when prescribing therapeutically. In some cases, we are looking to create change in the health, structural and functional change, through understanding the pathology of the symptom and prescribing accordingly. It is identifying those pathological changes which may have come about due to the chronic disease that will help us begin and quite possibly complete the cure.

The next useful thing in this book is tables laid out for quick reference in many therapeutic presentations. The section on posology and the reasons for the choice of specific potencies are really valuable. It’s especially valuable for a practitioner like myself who was not trained or versed in any of the more therapeutic and pathological systems. The practical advice, nutritional and otherwise for acne, preventing ear infections and asthma are excellent. There are clear influences from the files and teachings of Parimal Banerji in India and Alan Jones, but this remains an original and creative work. It runs to 176 pages, burst bound and soft covered.

What about what's not there? In the Men's health section we have just benign prostatic hypertrophy. I want more. What about the rest of the conditions that our gents turn up in the clinic presenting. It begs for a volume two. For me the only things missing from the book are those things that are beyond its brief. For example the section on anxiety is limited to the possible pathological causes, when we know that there are many other different ways to examine the condition – say pyschodynamically.

I have loved reading and reviewing this book. It's a book that says what it is going to do and then delivers it. We know that therapeutic protocols are not successful every time. But what they do provide is another tool and a measure of flexibility in practice when one approach is failing you. Its value lies in that it represents a different strategy to employ when you have had no success with another strategy. Its value is when there is not the opportunity to, in a leisurely way, delve into a larger totality of symptoms; or where the indicated remedy has failed you; where you are attempting to establish a ball park of possibilities for your patient. Its value is often in needing to establish a result quickly. Such a swift result is almost always followed by the return of your patient. In terms of building a busy practice this is an invaluable strategy. It's crucial also for that certain percentage of your patients, especially men, anxious and reluctant patients who don’t want to spend two hours doing homeopathic archeology on themselves.

One of the things Jon Gamble and I have in common is a frustration at the current levels of confidence in our homeopathic colleagues. Good practitioners and great new graduates are never busy enough quickly enough it seems. One way to build a practice (but not the only strategy) is to ensure you keep your patients while you go hunting for that grand simillimum. What has clearly helped Jon develop his busy practices has been to master some therapeutic protocols which, when employed well, make an immediate impact on the patient’s presenting symptoms.

This book of therapeutic protocols is intended to assist the practitioner to have the patient improving rapidly whilst the practitioner has time to familiarize him/herself with the case and find that constitutional remedy.

So the value of Jon's use of these therapeutic protocols is twofold; by using them you have the flexibility of method when another one is not successful, and also to make an impact immediately with the patient's symptoms while also hunting for the chronic simillimum.

I can think of 20 philosophical reasons why therapeutics books have their limitations. I can't think of one practical reason. And I know for sure my patients don't care. They want to get better. I can think of plenty of sinusitis cases or herpes cases that were resolved by remedies other than the therapeutic suggestions made here. Therapeutics alone is not enough to run a successful practice, but it is a hugely beneficial tool to have.

Mastering Homeopathy is not high brow philosophy. It's therapeutics suggestions are not necessarily curing our patients aphorism nine style, 'for the highest purpose of our existence'. But it is practical, accurate and useable and user friendly. It's on my desk now. The therapeutics texts of Lilienthal, Dewey, Morrison, Kansal and Clarke are in danger of being relegated back to the bookshelf.

This book review is reprinted from Homeopathy, Volume 94, Number 3, July 2005, with permission from Peter Fisher, Editor.

Reviewed by Mollie Hunton

The preface says that this book is intended for 'competent and fully trained homeopaths who are familiar with the homeopathic aggravation, the primary and secondary response triggered by a medicine, and Hering's Law of Cure. Also, one should be familiar with the common symptomatologies of disease'. This is good advice, as the homeopath is often asked to examine the patient with an otoscope or sphygmomanometer and diagnose pneumonia, bronchitis, glue ear, breast lumps, etc. These are all subjects covered in this book.

Gamble originally studied arts/law and went on to study homeopathy after being successfully treated himself. He has run a busy practice in Woolagong, NSW Australia, since 1987, also participating in the Sydney Ear Clinic which led to the writing of this book. The idea is to have a desk top reference to the common problems that come our way in G.P. Each condition has one or two pages devoted to it and lists of remedies to try are given. The regimes are described as 'pathological prescribing' because they focus on the particulars, not the generals.

The layout reminds me of Dr Noel Pratt's book 'Homeopathic Prescribing' (Beaconsfield 1980), which I used a lot when I first introduced homeopathy into General Practice. You look up the condition and find a list of remedies that might help. Dr Pratt, however, gave no advice about potency, so at first I always followed Dr Jack's advice about using 30C for most situations until I got to know it. There is no general advice about potency in Jon Gamble's book. Instead for each condition a list of remedies is given with a suggested potency. For example, for otitis media the list is:

Belladonna 3: red drum;

Ferrum phos 200: pink drum;

Hepar suIph 200: ear pain from tonsillitis;

Chamomilla 30: ear pain with teething;

Aconite 4X: ear pain after exposure to cold

wind + restlessness; Arsenicum 3: Ear pain unresponsive to other remedies.

Six remedies are suggested for chronic bronchitis, five in the 200C potency and one (Tub Bov) in the 1M.

This book mainly concentrates on acute prescribing, which can be difficult at the best of times. Having said that, I think most people end up with a group of remedies they tend to use under certain circumstances, which work for them. The question is does everyone have the same list for the same conditions? There has been no research into this aspect of prescribing. Jon Gamble's list is often different to mine. His list on page 97 for shingles does not contain Ranunculus bulb which I find the most helpful remedy. This may reflect the fact that he works in Australia and I in the UK.

I was confused by Gamble's advice on the use of the different potencies. There is no explanation as to why they, have been chosen. It would mean asking the pharmacist to keep a large range of potencies in stock, or keeping them yourself.

Hahnemann discusses potency and repetition of the dose in the Organon (para 128 and following). Very high potencies are advised if the problem is mainly in the mental sphere. There is no explanation in Gamble's book why certain potencies are used, eg for acute thrush Candida 20M is advised bd for 10 days. This is a potency I have never used, but I find Candida 30C usually works. There is no explanation why this unusual potency is preferred.

Part 2 is 13 pages long and devoted to 'illnesses in women'. There are an interesting two pages on oestrogen dominance with clinical presentation, differential diagnosis and treatment. This condition is described as iatrogenic, resulting from H.R.T., oral contraceptive and ingestion of xeno-estrogens and associated with hypothyroidism. Thyroidinum 200 is advised with Follicu/inum 30 which is said to be a specific for removing synthetic estrogens although the rational is not stated.

However, advice is given about chronic prescribing, or at least the repetition of the dose. 6C, 30C, or 200C is given every second or third day and 1M weekly. Potencies are also mixed, for example for asthma, Bryonia 30 and Arsenicum 3 are mixed and taken for many months. The patient is advised not to withdraw the medication until improvement occurs. In my experience of treating chronic asthma the correct remedy improves the symptoms right from the introduction of the remedy, and it is usually not necessary to keep taking it for months, as this indicates a poor choice of remedy.

One section deals with gallbladder stasis and advises using Cholestero/inum 1M bd for 4 weeks followed by lemon juice and olive oil. Gamble says that he has never had a stone get stuck in the common bile duct with this regime, but he does not say how many patients he has treated. It would have been nice to have had some serious outcome studies from this work but you get the feeling that this is a book written about impressions of outcome. Anecdotal evidence is the start of research.

Finally there are eight case histories described. One of hyperactivity, three of asthma, one each of middle ear effusion, chronic otitis externa, hypothyroidism and chronic fatigue syndrome. They illustrate different aspects of prescribing including the layered approach, paucicity of symptoms to prescribe on and the relationship between the physical and mental symptoms.

A useful book to keep by you for a quick guide to a choice of remedy. If all the G.Ps in the country had a copy and a rudimentary knowledge of homeopathy prescriptions for antibiotics would decline considerably.

Mollie Hunton Stourbridge, West Midlands, UK