THE THEORETICAL FOUNDATIONS OF MECHANISM OF ACTION OF HOMEOPATHIC MEDICINES.

1. I.Ya. HORBACHEVCHY TERNOPIL STATE MEDICAL UNIVERSITYDepartment of Pharmaceutical SciencesLection № 3 THE THEORETICAL FOUNDATIONS OF MECHANISM OF ACTION OF HOMEOPATHIC MEDICINES. TECHNOLOGY OF BASIC HOMEOPATHIC MEDICATIONS (ESSENCE, TINCTURE, SOLUTIONS, TRITURATIONS).

2. THE THEORETICAL FOUNDATIONS OF MECHANISM OF ACTION OF HOMEOPATHIC MEDICINES Homeopaths treat people based on genetic and personal health history, body type, and current physical, emotional, and mental symptoms. Patient visits tend to be lengthy. Treatments are "individualized" or tailored to each person – it is not uncommon for different people with the same condition to receive different treatments. Let us now turn to a traditional hypothesis of how homeopathy might work. While allopathic treatment is based on theory, logical deductions or generalisations from experimental evidence, homeopaths derive their clinical knowledge purely from observing the action of remedies on live patients. Underpinning homeopathy (and other complementary disciplines) is a vitalist philosophy, according to which the living organism is subject to ‘laws’ that are very different from those found in physics, chemistry or the biological sciences. These laws have also been determined by observation, not by deduction from theoretical principles.

3. 1. Vital force Homeopathy is a vitalist philosophy that interprets diseases and sickness as caused by disturbances in a hypothetical vital force or life force. It sees these disturbances as manifesting themselves as unique symptoms. Homeopathy maintains that the vital force has the ability to react and adapt to internal and external causes, which homeopaths refer to as the law of susceptibility. The law of susceptibility implies that a negative state of mind can attract hypothetical disease entities called miasms to invade the body and produce symptoms of diseases. However, Hahnemann rejected the notion of a disease as a separate thing or invading entity and insisted that it was always part of the "living whole". Hahnemann believed that the body contains an innate power to heal itself; he called this the vital force. He believed that when a person is ill this force becomes disordered and that homoeopathic medicines are able to restore it in a unique way. The choice of medicines depends on the symptoms that are present and is called the symptom medicine. Homeopaths consider disease to be an expression of the ‘vital force’ of each individual. Since all individuals are quite different in their expression of the vital force, patients are treated according to their idiosyncratic, rather than their common, symptoms. The symptoms are important only in that they act as an indicator for the selection of an appropriate remedy. The essential concept of homeopathy is ‘self-recovery’.

4. Vitalism According to vitalism, the body comprises a hierarchy of parts – cells, tissues, organs – systems that are all fully interdependent in both ascending and descending order, and whose relationship to one another is controlled by a steering entity – the vital force. Under normal conditions, the vital force is thought to be responsible for the orderly and harmonious running of the body and for coordinating the body’s defenses against disease. It is believed that the vital force operates on three different vibratory levels or planes, listed below in order of importance: 1. mental: where changes in understanding and consciousness are recorded; examples are confusion, delusions, lack of concentration, lethargy, absent-mindedness 2. emotional: where changes in emotional states are recorded; examples are anguish, anxiety, apathy, envy, fear, irritability, joy, love, sadness 3. physical: where changes to the body’s organs and systems are recorded; examples are organ malfunctions and disease, injuries, sex, sleep.

5. Interrelationships of the vibrational planes The three planes may be depicted as a set of concentric circles with the mental plane, the most fundamental, being represented by the innermost circle. A person can survive with a physical infirmity or if emotionally disturbed, but without a measure of mental health the normal functions within the community are impossible. Sheila and Robin Gibson have identified a fourth level, the spiritual, as represented in Figure .

6. 2. Placebo effect. Pseudoscientific concepts Homeopathy's efficacy is unsupported by the collective weight of modern scientific research. The extreme dilutions used in homeopathic preparations usually leave none of the original material in the final product. The modern mechanism proposed by homeopaths, water memory, is considered implausible in that short-range order in water only persists for about 1 picosecond. Pharmacological effect without active ingredients is inconsistent with the observed dose-response relationships of conventional drugs, leaving only non-specific placebo effects or various novel explanations. The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics, such as the law of mass action.

7. 3. High dilution. The extremely high dilutions in homeopathy have been a main point of criticism. Homeopathic remedies are usually diluted to the point where there are no molecules from the original solution left in a dose of the final remedy. Homeopaths contend that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active remedy, in contrast to therapeutically inert water. Practitioners of homeopathy contend that higher dilutions produce stronger medicinal effects. This idea is inconsistent with the observed dose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body. The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 1024).

8. 4. The constitutional type. In any given population the following may be observed: 1. People react to homeopathic remedies with different levels of intensity. 2. Some people respond especially well to a particular remedy. 3. Among people in this unique group, certain physical and mental characteristics appear to be common (e.g. skin texture, hair colour, height and weight). Further, these people also tend to suffer from similar complaints (premenstrual syndrome). 4. Parallels can often be drawn between certain characteristics shared by people in this group and the physical or chemical properties of a remedy.

9. Examples of homeopathic constitutional remedies are: A. Phosphorus persontends to be volatile, tall and slim, often with freckles and red hair. They tend to ‘explode’ on occasions when they are under mental strain – a bit like phosphorus bursting into flame if not kept under the right conditions. Despite this possibility, an Indian doctor has suggested that a man would be very lucky to marry a woman with a Phosphorus constitution. She would be good looking, fastidious, sensitive, sympathetic and loving. In addition she would be romantic, sociable and sexy! B.Pulsatilla personis said to be very changeable. The remedy comes from the ‘wind flower’, a plant so named because it sways in the wind from one side to another, changing its direction frequently. This characteristic is often reflected in uses of the remedy; for example, Pulsatilla can be used to treat a cough that tends to be dry at night but productive in the morning, or hoarseness that comes and goes – two conditions that may be described as being changeable. C. Natrummur persontends to be ‘pear-shaped’, likes lots of salt and often suffers from constipation. They often have a withdrawn or introverted personality and a liking for their own company. D. Sepia personmight be portrayed as being a tired mother on a washing day with a painful back, perspiring profusely and with a headache. She is tall and slim with a sallow complexion. One of her five children is screaming but she takes no notice; when her husband appears home and tries to give her a kiss she turns away. E. Sulphur personis characterized by: a lean body and stooping shoulders; likes fresh air and hates tight clothes; has cold feet and warm head; hot sweaty hands. ‘Absent-minded professor’ image.

10. Borland’s classification of children’s types(in each case the first-named remedy represents the main constitutional type)

11. 5. Miasms There is also a constitutional response associated with miasms. The miasms are not always associated with specific diseases, but rather with types of constitutional states that affect the way a person experiences disease. For example, people with syphilitic miasms tend to suffer from ulcers in the stomach, duodenum or mucous membranes, bone and tissue deformities and be prone to alcoholism. Constitutional prescribing will stimulate the total reserve of vital energy of the person. It increases resistance, improves well-being, increases the possibility of avoiding relapses and helps recovery from diseased states.

12. Examples of constitutional remedies

13. THE TECHNOLOGY OF BASIC HOMEOPATHIC PREPARATIONS (essence, tincture, solutions, triturations) Homeopathic preparations are prepared of basic homeopathic remedies with certain contents of active substances. The basic homeopathic remedies are including: • Essences (homeopathic mother tinctures) (45%): the juices from fresh plants or mixture of parts of juice and 90% alcohol for canning; • Tinctures(23%): the raw material – dried and powdered plants, animals or insects (bees, ants). Then raw material has extracted with 90, 60, 45% alcohol depending on kind of plant by maceration or percolation (like as usual tinctures). Thebestsolventis 70% w/v alcohol. • Solutions(10%): the raw material – soluble minerals, salts or acids, then it has dissolved in 45, 60 and 90% alcohol or water; • Triturations (22%): the raw material – insoluble minerals, salts, triturated powder from plant’s or parts of them (roots, seeds). Then it has mixed with milk sugar and triturated in mortar during an hour.

14. The liquid basic materials (essences, tinctures, solutions) are called "mother tinctures"; The solidsbasic materials are called "mother substance". In a prescription all of them designated as Ø and dissolved with excipients (water, alcohol, milk sugar, lactose, sucrose) according to certain rules of HPh.

15. The technology of essences by § 1 W. Schwabe’s manual The herbals, that don’t content resin, essential oil or compounds of camphor and after comminuting and pressing them we can obtain more than 60% of juice, are converted to essences by mixing equal mass-parts of juice and 90% ethanol. The algorithm of technology: Fresh vegetable materials with content more than 60% of juice • Comminute the herbal drug • Expression the juice • Weighing Preparing 90% ethanol • Mixing equal parts of juice and ethanol • Decantation during 8 days • Filtration • Preparing essence with content ½ of juiceand 45% ethanol (Ø) • Quality control • Packaging

16. The technology of essences by § 1 W. Schwabe’s manual Finished essence must be ‘crystal clear’ – transparent. The content of active substance into the essence is equal 1/2; and concentration of ethanol – 43-45%. The nomenclature of some fresh vegetable materials that used for preparing homeopathic essences by § 1 W. Schwabe’s manual: Aconitum napellus L., Conium maculatum L., Lilium candidum L., Allium cepa L. (bulbs), Senecio cineratia DC, Lilium tigrinum Ker-gawl., Arctium lappa L. (roots), Colchicum autumnale L., Menyanthes trifoliate L., Aristolochia clematitis L. (grass), Digitalis purpurea L. (leafs to blossoming), Momordica balsamina L. (ripe fruits), Arundo donax L. (sucker of rhizome), Solanum dulcamara L. (young suckers with leafs), Cannabis sativa L. (the ends of caulis), Asparagus officinalis L. (underground suckers), Ecballium elaterium L. (unripe fruits), Cicuta virosa L. (rhizomes and roots), Avena sativa L., Equisetum hiemale L., Plumbago europea L., Atropa belladonna L., Equisetum arvense L. (caulis), Rumex crispus L. (roots), etc.

17. The technology of essences by § 2 W. Schwabe’s manual The herbals, that don’t content resin, essential oil or compounds of camphor and after pressing them we can obtain less than 60% of juice, are converted to essences by § 2 W. Schwabe’s manual. First of all you must determine a quantity of juice in herbal drug. Thereto, determine the degree of humidity of mass (comminuted raw material) under the 1000 C. If we have succulent plants, we must squeeze out a little of juice and after filtering determine the content of dry residue under the 1000 C. If the comminuted mass has a lot of mucilage or too little of juice, we must add to investigated raw material the equal mass-part of water, carefully and energetically stir, leave for 24 h and then filter out and determine the content of dry residue under the 1000C in it. The content of active substance into the essence, that prepared according § 2,is equal 1/2; and concentration of ethanol – 43-45%.

18. The technology of essences by § 2 W. Schwabe’s manual Fresh vegetable materials with content less than 60% of juice • Comminute the herbal drug • Evaluation the humidity of mass under the 1000C • Expression the juice • Evaluation the dry residue of juice under the 1000C • Evaluation the content of juice in the mass • Weighing Preparing 90% ethanol • Addition ½ parts of 90% ethanol and mixing to pulp • Addition 90% ethanol to obtaining mass that equally mass of herbal’s juice • Maceration during 8 – 10 days • Expression the juice • Decantation during 8 days • Filtration • Preparing essence with content ½ of juiceand 45% ethanol (Ø) • Quality control • Packaging

19. The technology of essences by § 3 W. Schwabe’s manual If the herbal drug contain resins, oils, camphor’s compounds and less than 60% of juice, the essences is prepared according to § 3 of W. Schwabe’s manual: one weight-part of quantity of juice and two weight-part of 90% ethanol. First of all, determine the humidity, dry residue and then calculate the quantity of juice in herbal drugs. Finished essence must be transparent. The content of active substance into the essence is equal 1/3, the concentration of ethanol – 57-60%. The nomenclature of some fresh vegetable materials that used for preparing homeopathic essences by § 3 W. Schwabe’s manual: Artemisia abrotanum L. and absinthium L., Acalypha indica L., Aesculus hippocastanum L. (purified seeds), Tsuga canadensis L. (cortex and the ends of branch), Artemisia vulgaris L. (rhizomes and roots), Citrus aurantium L. (rind of fruits), Baptisia tinctoria R. Br. (root), Ocimumbasilicum L. (leafs), Selenicereusgrandiflorus L. (young stems and flowers ), Dieffenbachia seguina L. (rhizome, stem, leafs), Clematis recta.

20. The technology of essences by § 3 W. Schwabe’s manual Fresh vegetable materials with content less than 60% of juice, resins, oils, camphor’s compounds •  Comminute the herbal drug • Evaluation the humidity of mass under the 1000C • Expression the juice • Evaluation the dry residue of juice under the 1000C • Evaluation the content of juice in the mass • Weighing Preparing 90% ethanol • Addition ½ parts of 90% ethanol and mixing to pulp • Addition 90% ethanol to obtaining mass that equally double mass of herbal’s juice • Maceration during 8 – 10 days • Expression the juice • Decantation during 8 days • Filtration • Preparing essence with content 1/3 of juiceand 60% ethanol (Ø) • Quality control • Packaging

21. The homoeopathic tinctures In homeopathy the alcohol tinctures are prepared three ways: • from essences that were prepared according to § 1 - 3 of W. Schwabe’s manual; • from dry vegetable and fresh animal material (§ 4); • from fresh herbal drugs and their parts.

22. The technology of tinctures from essences by § 1 - 3 W. Schwabe’s manual • In accordance with § 1 – 2 for preparing alcohol tincture from essence is taken 2 parts of essence and 8 parts of 45% ethanol and thoroughly mixed. Finished tinctures are corresponded to the first decimal dilution – (X1 or D1) • In accordance with § 3 for preparing tincture from essence is taken 3 parts of essence and 7 parts of 60% ethanol and thoroughly mixed. Finished tinctures are corresponded to the first decimal dilution – (X1 or D1)

23. The technology of tinctures from dry vegetable material and fresh animal material by § 4 W. Schwabe’s manual For such tinctures is used method of two-day maceration with following percolation: 1 part of dry material and 10 weight-part of ethanol (i.e. correlation 1:10). The alcohol strength depends on directions of Pharmacopoeia or W. Schwabe’s manual. In case of inability of percolation, the alcohol tincture is prepared with method of maceration. Finished tinctures are corresponded to the first decimal dilution – X1 (i.e. content of active substance 1:10). The nomenclature of some vegetable and animal materials that used for preparing homeopathic tinctures by § 4 W. Schwabe’s manual: Aconitum napellus L. (roots), Vitex agnus castus L. (ripe fruits), Aloe Africana Mill. (etc.), Physeter catodon L. (ambergris), Doremaammoniacum D. (resin), Amygdaluscommunis L. (fresh seeds), Semecarpusanacardium L. (ripe fruits), Apismellifica L., Mygaleavicularis L., Araneadiadema L., Calendula officinalis L., LyttavesicatoriaFabricius, Capsicum annuum L., Castor fiber L. (wastes of musk glandules), etc.

24. The technology of mother tinctures from fresh herbal drugs and their parts A mother tincture is a solution of a botanical substance and alcohol made according to standards set by the HPUS (Homeopathic Pharmacopeia of the United States). Since the process of preparing juice for essences is very laborious and time-consuming, it is currently from fresh herbal drugs or their parts homeopathic pharmacies prepare the mother tincture in the ratios indicated in § 2 and 3 of W. Schwabe’s manual. The common feature of this technology is a determination of quantity of juice in herbal drugs, as stated at § 2, and distinctive feature is a using for maceration a high strength ethanol (90%). The content of active substance in these mother tinctures is equal 1/2 or 1/3 according to § 2 or 3. In following potentisation such mother tinctures are reputed 100% (unity) and designated as Ø (theta).

25. Aqueous and alcohol solutions The basic homeopathic aqueous and alcohol solutions are prepared from mineral substances and chemical compounds according to § 5a, 5 b and § 6a, 6 b of W.Schwabe’s manual. The technology of basic aqueous solutions by § 5 W. Schwabe’s manual The features of preparing some substances are described in Special Articles. For example, aqueous solutions D1 (X1) of natrium muraticum, kalium nitricum, borax etc., preparing with 1 part of substance and 8 parts of purified water and 1 part of 90% ethanol, because these solutions are prepared for stocks.

26. The technology of acid solutions In these cases acid is a unit depending on it density and percentage, that is indicated for each acid in appropriate article of W. Schwabe’s manual. The aqueous solutions are immediately used for preparing dose forms. If the solution is to storage, in the label must be designated “aqueous”, the date of prepare, the name of medicine and its dilution. The nomenclature of some substances that used for preparing aqueous solution by §5 of W. Schwabe’s manual: Acidum (Ac.) aceticum, Ac. formicicum, Ac. hydrochloricum, Ac. hydrocyanicum, Ac. hydrofluoricum, Ac. lactium, Ac. nitricum, Ac. phosphoricum, Ac. sulfuricum, Alumen, Ammonium benzoicum, Argentumnitricum, Arsenicum album, Aurum muraticum, Barium chloratum, Borax, Bromum, Cadmium sulfuricum, Calcium aceticum, Ferrumcitricum, Kaliumarsenicosum, Lithium carbonicum, Magnesium sulfuricum, Naja (venom), Pilocarpinum, Tartarusstibiatus, Uranium nitricum, Zincumphosphoratum, etc.

27. The technology of basic alcohol solutions by § 6 W. Schwabe’s manual For preparing alcohol solution of alcohol-soluble substance is used 90, 60, 45% ethanol depending on solubility of substance. The features of preparing some substances are described in Special articles. There is designated the name of medicine, its dilution, an alcohol concentration and the date of prepare in the label of aqueous-alcoholic solution. The nomenclature of some substances that used for preparing aqueous solution by §6 of W. Schwabe’s manual: Abiesnigra, Ac. benzoicum, Ac. carbolicum, Ac. oxalicum, Ac. picrinicum, Ac. salicylicum, Amyliumnitrosum, Arseniumiodatum, Atropinumsulfuricum, Barium iodatum, Calcium iodatum, Glonoinum, Iodum, Kaliumaceticum, Magnesium muraticum, Mercuriuscyanatus, Naphthalinum, OleumTerebinthinae, Petroleum, Strichninumnitricum, Zincumvalerianicum, etc.

28. Basic homeopathic powder triturations Homeopathic triturations are the mixes of medicine substances, essences, tinctures, solutions or their dilutions with milk sugar (lactose) or other excipients. Homeopathic triturations are prepared of dry substances (mineral, animal material, chemical compounds) and of liquids different origin (aqueous, alcohol solutions, essences, tinctures) according to § 7-9 of W. Schwabe’s manual.

29. Mortar and pestleused for grinding insoluble solids, including quartz and oyster shells, into homeopathic remedies.

30. The technology of basic powder triturations of dry substances by § 7 W. Schwabe’s manual In this case the certain quantity of medicine substance is thoroughly comminuted with milk sugar exclusively in porcelain mortar; it is inadmissible to use metallic mortar. The pulverulence of dry substances (including metal) and excipients are tested with sieve analysis or with determination value of outer specific surface. The triturating and mixing are made during an hour (according to W. Schwabe’s manual) for increase “the force of medicine” – effective potentisation. Hygroscopic substances must be comminuted only in warm mortar. The generally algorithm of technology of basic powder triturations of dry substances is shown at figure 3.8. The nomenclature of some vegetable and animal materials that used for preparing homeopathic powder triturations by § 7 W. Schwabe’s manual: Aloe africana Mill., Ostrea edulis L., Cinnamomum camphora L., Corallium rubrum L., Indigofera tinctoria L., Lycopodium clavatum L., Sepia officinalis L., etc. The nomenclature of some mineral substances and chemical compounds that used for preparing homeopathic powder triturations by § 7 W. Schwabe’s manual: Ac. benzoicum, Ac. carbolicum, Ac. oxalicum, Potassium alum, Argil burnt, Ammonium benzoicum, Antimonium arsenicosum, Argentum metallicum, etc.

31. The technology of basic powder triturations of liquid matters by § 8 W. Schwabe’s manual The technology of basic powder triturations of aqueous or alcohol solutions has analogy with technology of § 7. But the first decimal dilution (D1) don’t prepare or prepare very seldom, cause of smearing of milk sugar and necessity of drying of mix over a long period of time, so such trituration is prepared starting from second decimal (D2) or first centesimal (C1) dilution. When preparing dribble trituration is taken 2 drops of aqueous solution or 3-4 drops alcohol solutions (depending on density of solution and strength of alcohol) of basic remedy (it’s consist 0.1 g medicine) and comminuted with 9.9 g of milk sugar. In the issue is obtained first centesimal (C1) or second decimal (D2) dilution. The similar dilution is obtained from mixing 1 g of liquids and 99 g of milk sugar.

32. The technology of basic powder triturations of essences by § 9 W. Schwabe’s manual According W. Schwabe’s guidelines powder triturations of essences and tincturesis prepared in three ways: • it’s taken 2 weight-part of essence or mother tincture that were prepared by § 1 and 2, comminuted with 99 weight-parts of milk sugar (by § 7) and in the issue is obtained first centesimal (C1) or second decimal (D2) dilution; • it’s taken 3 weight-part of essence or mother tincture that were prepared by § 3, comminuted with 99 weight-parts of milk sugar (by § 7) and in the issue is obtained first centesimal (C1) or second decimal (D2) dilution; • it’s taken 1 weight-part of mother tincture that were prepared by § 4 (of dry herbal drugs), comminuted with 99 weight-parts of milk sugar and in the issue is obtained first centesimal (C1) or second decimal (D2) dilution.

33. Thank you for attention!