When Less Is Better: A Comparison of Bach Flower Remedies

and Homeopathy
ROBERT A. HALBERSTEIN, PHD, ALICIA SIRKIN, RDH, BFRP,
AND MARIA M. OJEDA-VAZ, MPH, MSN

PURPOSE: Homeopathy and Bach Flower Remedies (BFRs), historically-related complementary

healing modalities classified as prescription/nonprescription drugs and over-the-counter homeopathic
nutritional supplements, respectively, are compared with respect to indications, dosage philosophies,
associated procedures, reported outcomes, safety profiles, and the possible operation of the placebo effect.
METHODS: Original data and published research reports, including case studies, retrospective
meta-analyses, and double-blind clinical trials are compiled and evaluated for both healing systems.
RESULTS: Homeopathy and BFR therapy both feature highly diluted natural medicinal substances, flexible dosage schedules tailored to individual patients, and energy-based healing action. They differ with
respect to practitioner training and certification, number and types of medicinal source materials, remedy
combinations and applications, and potential toxicity or other side-effects.
CONCLUSIONS: Extensive testing has produced mixed or equivocal results regarding the efficacy of
both of these health care systems. While a variety of positive outcomes have been frequently recorded
with Homoeopathy and BFR treatments, it is likely that the placebo effect operates to a significant extent
in both approaches.
Ann Epidemiol 2010;20:298307. 2010 Elsevier Inc. All rights reserved.
KEY WORDS:

Homeopathy, Bach Flower Remedies, Complementary and Alternative Medicine.

INTRODUCTION
The safety and effectiveness of ingestible medicinal
substances for healing and health maintenance are being researched on several fronts (1, 2). Special attention is being
focused on potential hazards in the use of unregulated
complementary and alternative medicine (CAM) treatments, because as Bayles (3) points out: Complementary
and Alternative Medicine now constitutes the fastest
growing sector of the American health care system. As
a result of this trend, many CAM methods are now being
rigorously tested in carefully controlled clinical trials.
Many of the medications applied in CAM modalities are
labeled natural (derived from sources in nature and minimally processed without artificial additives such as colorings
or chemical preservatives) and/or organic (produced
without fertilizers or pesticides and free of toxins or residues), rather than synthetic or technologically modified.
Medicinal plants, therapeutic animal products, vitamins

From the Department of Anthropology at the University of Miami in

Coral Gables, FL (R.A.H.); Sirkin Creative Living Center, LLC, Miami,
FL (A.S.); and Mt. Sinai Medical Center, Miami, FL (M.M.O.-V.).
Address correspondence to: Dr. R. A. Halberstein, Department of
Anthropology, University of Miami, P.O. Box 248106, Coral Gables, FL
33124-2005. Tel.: 305-284-2535; Fax: 305-284-2110. E-mail: R.Halber
stein@Miami.edu.
Received August 11, 2009; accepted November 21, 2009.
2010 Elsevier Inc. All rights reserved.
360 Park Avenue South, New York, NY 10010

and minerals, and various health foods have all been successfully used in the treatment of diseases, injuries, and other
adverse conditions (47).
In contrast to the typically strict prescription regimens assigned to conventional allopathic medications, natural
medicines are sometimes prescribed in variable dosage
quantities and schedules. For example, the amount of raw
material used in medicinal plant preparations differs considerably across cultures and individual healers, even in the
treatment of the same condition such as dental pain or
high blood pressure (8, 9). The minimum daily requirement
and recommended daily allowance of essential nutrients are
likewise characterized by variability across published sources. For example, recommendations for the optimal intake
of vitamin C range from 30 mg to 10,000 mg per day (10).
Megadoses of various natural medications and nutrients
have been tested as well, sometimes leading to harmful
outcomes including poisonings and deaths, such as those
associated with Ephedra species products and coca plant
(Erythroxylon coca) extracts. Another distinguishing factor
between natural and allopathic medicines is that the latter
are often highly concentrated preparations of one or two
active ingredients (which also contributes to their greater
propensity for toxicity), whereas natural medicines contain
any number of ingredients in less concentrated forms that
generally produce milder and more subtle therapeutic
effects (4).
1047-2797/10/$see front matter
doi:10.1016/j.annepidem.2009.11.006

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Selected Abbreviations and Acronyms

CAM Z complementary and alternative medicine
BFR Z Bach Flower Remedy
FDA Z Food and Drug Administration

Although the majority of medications, whether natural or

synthetic, are often prescribed in sizeable and/or repeated
doses to quickly achieve and sustain their desired therapeutic
effects, a few are recommended in highly diluted or infinitely
small doses for maximum results. Homeopathy and Bach
Flower Remedies (BFRs) are two such healing systems that
embody the smaller-is-better dosage principle. Like
many other natural/alternative treatments, BFRs are sold
without prescriptions in health food stores, pharmacies,
and supermarkets. Some homeopathic medicines require
prescriptions, while others are sold over-the-counter. By
using original data and previously published findings, in
the present article we compare these two modalities with
regard to indications, dosage philosophies, associated procedures, reported outcomes, safety profiles, and the possible
operation of the placebo effect.

BACH FLOWER REMEDIES

The BFRdalso known as Bach Flower Essencedhealing
system was originally developed by British homeopath and
physician Edward Bach, and his work is currently carried
out by the Dr. Edward Bach Centre in England (www.
BachCentre.com). Pioneering books he authored in 1925
and 1931 (11, 12) provided a ground-breaking framework
for the analysis of psychological and emotional correlates
of physical diseases. Bach experimented with the highly
diluted derivatives of 37 species of wildflowers obtained by
boiling the flowering sprays, leaves, and twigs in natural
spring water (the boiling method) or placing flower heads
and spring water in direct sunlight (the sun method). The
boiling method involves filtering the remaining liquid.
Bach practitioners believe that in both procedures the
water captures the essence (also referred to as vibratory
imprint or energetic signature/blueprint) of the flower
and potentizes its innate healing power. In a 1940 book
Bachs assistant describes the spring water as becoming
magnetized with power (13). The resulting plant-water
mixture, combined with an alcohol-based preservative, is
called the mother tincture. The final diluted over-thecounter productsdlabeled flower essences and flower
remediesdare administered with specific dosage schedules
orally in drop form or topically in liquid or cream form for
applications to pulse points, as skin compresses, and as
whole-body baths. The over-the-counter drops can be
placed directly onto the tongue, put in a glass of water and

Halberstein et al.
COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

299

sipped frequently, diluted in a mixing bottle, or sprayed

over the head and body with an atomizer. Dosage amounts
and schedules do not vary according to the age, gender, or
weight of the recipients.
Bach practitioners believe that BFRs exert a positive
effect on the human energy field, thereby correcting
emotional imbalances. BFRs are taken for specific shortterm emotional stresses (e.g., essence of mustard plant
flowers for sudden unexplained bouts of depression or melancholia and essence of pine tree flowers for guilt), as well as for
managing or controlling long-term emotional discomforts or
personality imbalances (e.g., essence of walnut tree flowers
for protection from ongoing negative influences and essence
of white chestnut tree flowers to help eliminate persistent
worrying or repetitive unwanted thoughts). BFRs are also
used by consumers as a prophylaxis for anxiety and stress.
BFRs are described as nontoxic, and Bach specialists note
they produce no side-effects. The remedies have been safely
and successfully used with children, plants, and pets
(including dogs, cats, fish, reptiles, birds, rabbits, and horses),
and practitioners indicate that they do not interact with any
collateral medications (1419). Although there have not
been any extensive clinical trials demonstrating their safety,
an official representative of the BFR bottling and distribution company has stated that records dating back to 1970
indicate .there have been no reports of serious adverse
effects directly related to Bach Flower Essences or negative
interactions with other medicinal products (20).
The quality control of official BFR products is regulated
in the United Kingdom by the Medicines Control Agency,
and they are accepted for sale in the United States by the
U.S. Food and Drug Administration. A number of other
competing companies offer flower essence products that
are not endorsed by the Bach Centre (21). One such
company is based in Hereford, England, which produces
Five Flower Remedy (Healing Herbs Ltd.: www.
healingherbs.co.uk),and another is located in Nevada
City, California (Flower Essence Service: www.fesflowers.
com). A manufacturer of flower essences in Winona Lake,
Indiana, called Traditional Flower Remedies Inc. carries
a variety of products, including Calming Essence, available at www.traditionalflowers.com. Bailey Essences (www.
baileyessences.com) are a set of 45 flower essences
developed by a company in Yorkshire, England. The New
Millennium company in New Zealand (www.nmessences.
com) offers a range of flower essence and essential oil
products.
In the BFR system a plants unlocked energy is considered
as therapeutically important as its biodynamic chemical
components. BFRs are typically indicated for stress-related
emotional disorders ranging from chronic depression and
personality imbalances to extreme panic. The essences of
particular flowers are prescribed for such conditions as fear

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Halberstein et al.
COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

of the unknown (aspen), uncontrollable emotional

outbursts (cherry plum), absent-mindedness (clematis), irritability (impatiens), nervousness (mimulus), physical and
mental fatigue or exhaustion (olive), nightmares (rock
rose), debilitating bereavement or emotional shock and
trauma (Star of Bethlehem), indecisiveness and mood
swings (scleranthus), excessive worrying about loved ones
(red chestnut), unbearable anguish and despair (sweet
chestnut), and lack of self-confidence (larch) (19, 22, 23).
BFRs have also been administered for emotionally based
and stress-related physical disorders. On the basis of case
study reports, anecdotal information, and a handful of scientific clinical trials, several authors have suggested that the
following physical conditions can be successfully managed
with flower essence formulas: back pain, hypertension, attention-deficit hyperactivity disorder, migraines, drug and alcohol
addictions, eczema, temporal-mandibular joint dysfunction,
motion sickness, allergies, insomnia, asthma, bed-wetting,
difficult teething, and stuttering (17, 18, 22, 2427). In
a recent review of 384 case studies, investigators found that
BFRs were effective for pain management in 88% of all
subjects tested (28). According to Sirkin (19), By offering
relief from the burden of negativity, the essences in effect
can work to prevent stress-induced physiological breakdown.
Rescue Remedy is a BFR combination liquid formula
consisting of five flower essencesdcherry plum (Prunus cerasifera), clematis (Clematis vitalba), impatiens (Impatiens glandulifera), Star of Bethlehem (Ornithogalum umbellatum), and
rock rose (Helianthemum nummularium)dwhich together
are believed to act synergistically to reduce or eliminate
severe stress. In the years since its creation in the 1930s.
Rescue Remedy has been reported to help users manage
emergencies and control acute distress resulting from fear,
panic, and emotional trauma and shock (2931). It has
been recommended for such situations as air travel, school
examinations, job interviews, auto accidents, public
speaking, and doctor/dental appointments.
Rescue Remedy Cream is applied to pulse points for
stress relief or elsewhere on the skin to aid the healing of
burns, insect bites, sprains and minor lacerations. Rescue
Remedy liquid has also been successfully used with pets to
help control fear of loud noises, separation anxiety, and
trauma caused by mistreatment or loss of a companion
(17, 18, 23). Figures 1 to 5 illustrate the five flowers used
in the preparation of Rescue Remedy.
A number of investigations have been conducted on the
potential effectiveness of Rescue Remedy and other Bach
products. The present authors carried out a double-blind
clinical trial in which 53 individuals who ingested several
measured standard doses of Rescue Remedy were compared
with 58 control subjects who received placebo preparations
with respect to responses on a standardized questionnaire
eliciting indicators of stress levels. Although the placebo

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FIGURE 1. Cherry plum (Prunus cerasifera). Photo by Andreas

Bock. Courtesy of Mechthild Scheffer, The Encyclopedia of Bach
Flower Therapy, Healing Arts Press. This figure is available in
color online at www.annalsofepidemiology.org.

effect appeared to operate in both groups, Rescue Remedy

significantly outperformed the placebo in reducing stress in
the subsample characterized from test scores as experiencing
a high level of anxiety (20). The results of this and similar
studies are summarized in Table 1 (16, 19, 2628, 3234).

HOMEOPATHY
The term homeopathy is a combination of two Greek
words: homoios (meaning similar) and pathos (suffering).
Homeopathy is a holistic medical system designed to stimulate the human bodys own internal healing mechanisms
through the administration of naturally occurring remedies.
Homeopathy was first established by German physician

FIGURE 2. Clematis (Clematis vitalba). Photo by Andreas Bock.

Courtesy of Mechthild Scheffer, The Encyclopedia of Bach
Flower Therapy, Healing Arts Press. This figure is available in
color online at www.annalsofepidemiology.org.

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FIGURE 3. Impatiens (Impatiens glandulifera). Photo by Andreas

Bock. Courtesy of Mechthild Scheffer, The Encyclopedia of Bach
Flower Therapy, Healing Arts Press. This figure is available in
color online at www.annalsofepidemiology.org.

Samuel Hahnemann in 1790. Hahnemanns major documentary work The Organon of the Healing Art was published
in 1810, and between 1811 and 1821 his 6-volume set
Materia Medica Pura appeared.

FIGURE 4. Rock rose (Helianthemum nummularium). Photo by

Andreas Bock. Courtesy of Mechthild Scheffer, The Encyclopedia of Bach Flower Therapy, Healing Arts Press. This figure
is available in color online at www.annalsofepidemiology.org.

Halberstein et al.
COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

301

FIGURE 5. Star of Bethlehem (Ornithogalum umbellatum). Photo

by Andreas Bock. Courtesy of Mechthild Scheffer, The Encyclopedia of Bach Flower Therapy, Healing Arts Press. This figure is
available in color online at www.annalsofepidemiology.org.

Homeopathy is a healing method that uses highly diluted

but therapeutically active micro-doses of biochemically
neutral, toxic, or even poisonous substances derived from
plants, animals, and minerals to activate the natural defense
mechanisms of the body. Homeopathic remedies are based
on the principle of the Law of Similars (similia similibus
curantur, or like treats like), which postulates that
substances that produce negative disease symptoms in
a healthy person can be applied therapeutically in minute
dosages to stimulate (aggravate) a sick persons own
internal curing mechanisms. A similar theory was proposed
by the Greek physician Hippocrates in the fourth century
B.C. (35). A classic example is the use of the quininecontaining bark of the cinchona tree (Cinchona officinalis)
to treat a fever. Quinine causes fever and chills in a healthy
person, but in highly diluted form it cures these symptoms in
a malaria patient. In a similar scenario, digitalis can
cause arrhythmia in large doses or cure it in homeopathic
doses (36).
The multi-volume Homeopathic Pharmacopoeia Repertory,
an index of disease symptoms and their suggested remedies,
was originally developed in the early 1800s by Hahnemann
and continues to be augmented and revised by homeopathic
specialists. The 1989 edition of The Homeopathic Pharmacopoeia of the United States lists more than 2000 remedies and is
the official standard reference for preparations and prescriptions. The various substances that comprise homeopathic
medicines have been determined by the Law of Provings,

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TABLE 1. Clinical results of Bach Flower Remedy (BFR) research

Reference
Sirkin32 (2001)

Walach et al.33 (2001)

Mehta26 (2002)

Armstrong and Ernst34 (2002)

Masi16 (2003)

Pintov et al.27 (2005)

Howard28 (2007)

Halberstein et al.20 (2007)

Study design

Results

Treatment of fibromyalgia patient with six individual

Bach remedies plus Rescue Remedy in a clinical case
study trial
BFRs were compared with placebos in 61 subjects with
respect to scores on the Test Anxiety Inventory (TAI)
BFRs and placebos were randomly assigned to 10 ADHD
patients ages 512 in a clinical case study trial

Elimination of headaches and neck pain, improved

sleep, increased energy; discontinued use of
analgesics, anti-depressants, and tranquilizers
No significant differences found between treatment and
placebo groups on test scores
BFRs were more efficacious than placebos in reducing
inattention and hyperactivity as measured by the
Childhood Attention Profile (CAP) and Columbia
Impairment Scale
No significant differences found between or within
groups with respect to post-test stress levels

Double-blind study of Five Flower Remedy compared

with placebos in 45 subjects experiencing anxiety as
measured by the Spielberger Anxiety Inventory
Administration of combination BFR remedy formulas to
two subjects experiencing chronic major depression
and undergoing psychotherapy
Prospective double-blind study of BFRs versus placebo
administration to 20 children ages 711 diagnosed
with attention deficit-hyperactivity disorder
Retrospective meta-analysis of case studies of 384
subjects ages 772 provided BFRs or placebos for pain
relief
Double-blind clinical trial of BFR Rescue Remedy in
111 subjects ages 1849 experiencing anxiety as
measured by the Spielberger Anxiety Inventory

which involves the painstaking testing of individual

materials for their potential healing effects (37).
Some of the plant materials used to produce homeopathic
medicines include herbs (e.g., comfrey), spices (e.g., cayenne
pepper), resins (e.g., amber), and various poisonous mushrooms. Mineral sources include metals (e.g., lead), salts (e.g.,
calcium sulfate), acids (e.g., hydrochloric), and elemental
substances (e.g., sulfur, iron and mercury). Animal-based
homeopathic medicines are derived from venoms (e.g., snake
poisons), secretions (e.g., squid and cuttlefish inks), various
glandular and tissue extracts (e.g., hormones), and disease
by-products (e.g., pus obtained from an abscess) (38).
One of the most frequently used sources of homeopathic
medicines is the European arnica plant (Arnica montana),
also known as leopards bane and mountain tobacco.
Native to 18 European countries, it has been applied homeopathically in the management of the symptoms of a wide
range of conditions including cancer, heart disease, urinary
disorders, fevers, influenza, and gastrointestinal problems. It
has also been used to minimize pain, bleeding, and swelling
after surgery (39). Among the 10 most prescribed diluted
derivatives of plant species in the homeopathic repertory
are arsenic (Arsenic album) for insomnia and nervous disorders, strychnine (Strychnos nux vomica) for indigestion and
headaches, poison ivy (Rhus toxicodendron) for skin irritations, and deadly nightshade (Atropa belladonna) for fevers
and inflammations. Curare (Chondrodendron tomentosum),
historically used as a poison applied to spear points and

Significant decrease in frequency and duration of

symptoms, as well as renewed social interest and
increased pleasurable feelings
BFRs and placebos showed no significant differences
with respect to test performance after 3 months
Pain relief and reduction of negative emotions reported
by BFR sub-sample at a greater frequency than placebo
group
Significant reduction of acute anxiety in sub-sample
receiving Rescue Remedy compared with placebo

arrowheads, has been employed homeopathically as

a diuretic, febrifuge, and anesthetic.
Homeopathic remedies have also been derived from
other natural sources. Apis, a honeybee derivative, is
prescribed to reduce swelling, pain, and allergic reactions
to stings by bees, wasps, hornets or scorpions. Ferrum phosphoricum, made from iron phosphate, is recommended by
homeopathic physicians for fever, sore throat, and other
cold symptoms (38, 40).
Homeopathic remedies are produced by repeated, cumulative serial dilutions of the aforementioned and other toxic
and nontoxic substances mixed with pure water and shaken
vigorously after each dilutiond a process termed succussion. The homeopathic law of minimum dose (also
known as the law of infinitesimals) states that the greater
the dilution of a homeopathic medicine, the more potent is
the resulting mixture in its healing effects on the body. According to homeopathic principles, only the memory or
vibration of the original substances remains in the water
in the form of electromagnetic frequencies after numerous
cumulative dilutions. The resulting solution is considered
to be capable of enhancing the bodys own defense mechanisms and self-healing capacity against a disease or physiological imbalance in a similar fashion as a vaccination or
allergy immunization (4143).
Traditional Homeopathys law of single remedy stipulates that the practitioner must choose the one single medication that most appropriately fits the patients symptom

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COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

303

TABLE 2. Clinical results of double-blind homeopathy research

Reference
Kainz et al.49 (1996)

Lamont50 (1997)
Jacobs et al.51 (2000)

Smith et al.52 (2002)

Bonne et al.53 (2003)
Stevinson et al.54 (2003)

White et al.55 (2003)

Bell et al.56 (2004)

Frei et al.57 (2005)

Kim et al.58 (2005)

Steinsbekk et al.59 (2005)

Frass et al.60 (2005)

Jacobs et al.61 (2006)
Brinkhaus et al.62 (2006)

Fisher et al.63 (2006)

Jacobs et al.64 (2007)
Robertson et al.65 (2007)

Study design

Results

Randomized, placebo-controlled clinical trial of 60 children

age 6 to 12 receiving homeopathic treatment for warts on
the hand for 8 weeks
Homeopathic medicines were compared with placebos in
a study of treatment of 43 children with ADHD
Randomized, placebo-controlled study of 116 children from
Nepal age 6 months to 5 years with a history of diarrhea
Oral homeopathic mineral therapy tested against placebo
during the course of 10 weeks in 41 dermatitis patients
10-week randomized, placebo-controlled study of 44
patients with diagnosed anxiety disorder
Randomized, placebo-controlled trial of homeopathic
Arnica montana in 64 adults undergoing carpal tunnel
surgery
Homeopathy compared with placebo during the course of 12
months in asthma treatments for 96 children
Placebo-controlled, 4-month trial of homeopathy treatment
for fibromyalgia in 62 patients with a mean age of 49
83 children ages 616 with diagnosed attention deficithyperactivity disorder were treated with homeopathy or
placebos for 6 weeks.
Clinical study comparing homeopathic preparations with
placebos in 40 subjects age 2663 diagnosed with seasonal
allergic rhinitis
Randomized, placebo-controlled trial of homeopathic
treatment of respiratory infections in 251 children
younger than 10 in Norway
70 hospital patients with severe sepsis received homeopathic
treatments or placebos for 6 months
Randomized, placebo-controlled study of homeopathic
treatment for diarrhea in 292 children in Honduras
Placebo-controlled clinical trials on the effectiveness of
homeopathic Arnica montana preparation for swelling and
pain following knee surgery or joint implantation; N Z
227
Randomized, placebo-controlled trial of homeopathic
treatment in 75 dermatitis patients
Placebo-controlled study of homeopathic and analgesic
medicines in 60 dengue fever patients in Honduras
Randomized, placebo-controlled trial of homeopathic
treatment in 190 tonsillectomy patients age 1837

profile and healing plan (36, 38, 44). If the selected remedy
proves to be ineffective, alternative preparations are generally
tested or administered individually, although in recent years
some practitioners have experimented with combining
multiple remedies (45). The homeopathic pain-reliever
called Traumeel, for example, contains blended ingredients
derived from five different plants (46).
Homeopathic treatments have been credited with benefitting patients with the following conditions: allergies, arthritis,
asthma, constipation, respiratory and ear infections, dysmenorrhea, digestive disorders including food poisoning, insomnia,
sinusitis, urinary tract infections, motion sickness, insect

No significant differences found between the effects of

homeopathic therapy and placebo preparations
Statistically significant differences indicated that
homeopathic treatment was superior to placebo
Statistically significant decrease in frequency and duration
of diarrhea in sub-sample receiving homeopathic
treatment
Statistically significant improvement in dermatitis scores in
treatment group versus placebo
No significant difference between homeopathic treatments
and placebos in rate of improvement of mental symptoms
Homeopathic preparation showed no advantage over
placebo in reducing pain, bruising, or swelling following
hand surgery
No significant differences found across subsamples in
symptom improvement, medication usage, or adverse
reactions
Pain and other health indicators significantly improved in
homeopathy sub-sample compared with placebo
Homeopathy was more effective than placebo in
improvement of several behavioral and cognitive
functions.
Significant positive improvement
in homeopathic group compared to placebo after 4-week
treatment
No significant difference between placebos and
ultramolecular homeopathic medicines in treatment of
infections
Survivorship significantly greater in homeopathy subsample
and no adverse effects were observed
No significant difference between placebo and treatment
samples in resolution of symptoms
Homeopathic sub-group showed non-significant trend
toward less operative swelling compared with placebo

Symptom severity measure for dermatitis showed no

significant differences between subsamples
No significant differences between subsamples in fever, pain,
complication rates, or analgesic usage after 1 week
Patients receiving homeopathic Arnica montana extract had
significantly lower subjective pain scores but similar usage
of analgesics as placebo subgroup

stings/bites, incontinence, headaches, eczema, influenza,

drug and alcohol overdose, minor physical injuries such as
sprains, hypertension, psychological disorders, and a variety
of other acute and chronic health conditions (35, 40, 46).
The effectiveness of homeopathic treatments has been
extensively investigated for many years through individual
case studies, clinical trials, and double-blind experiments.
The results of this research have been mixed. A 1991 review
of 105 controlled trials of homeopathy protocols of variable
quality conducted world-wide discovered that 81 (77%)
produced positive results, whereas 24 (23%) yielded no statistically significant positive outcomes. The authors note that 26 of

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COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

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TABLE 3. Comparison of homeopathy and Bach Flower Remedies

Characteristics
Remedy preparation
Remedy combinations
Application/administration
Contraindication
Source material
Toxicity
Pharmacological action
Adverse side-effects
Drug classification
Dosage
Overdosing possibility
Number of remedies in the system
Prescription
Healing route
Indications
Mode of action
Interactions with drugs or medications
Use with pets
Practitioner education

Homeopathy

Bach Flower Remedies

Complete dilution; Succussion

Traditional application: no combinations
Oral (sublingual) or topical; not taken with food
Alcohol sensitivity to some products
Plant, animal and mineral
Some sources toxic and potentially poisonous
None known
Rare
Prescription and nonprescription drugs
Limited
Rare
More than 2,000
Self-prescribed or prescribed by expert
certified practitioner
Energetic
Physical, psychological and emotional disorders
Aggravate condition to stimulate immune
system and/or psychological rebalancing
None
Several preparations
Diploma and doctoral degree programs at
certified schools

the trials involved the testing of combinations of homeopathic

substances rather than single medications (45). A later metaanalysis evaluated the results of 19 review articles covering
a total of 509 randomized and nonrandomized trials of homeopathic treatments. Less than one half of the examined studies
produced statistically significant results in favor of homeopathy
(47). After reviewing a large number of well-controlled scientific investigations, Freeman (48) concluded that homeopathic
treatments show promise for the following conditions:
migraines and other chronic pain syndromes, pollen-induced
allergies, asthma, chronic otitis media, fibromyalgia, influenza,
chronic fatigue, rheumatoid arthritis, and childhood diarrhea.
The latter author also noted positive results in homeopathic
treatments for hepatitis B and traumatic brain injury.
The present writers surveyed the literature for more
recent double-blind, placebo-controlled scientific studies
of homeopathic treatments. The results of 17 such investigations with substantial sample sizes are compared in Table 2
(4965). The publications exhibit a nearly even split
between statistically significant (47%) and nonsignificant
(53%) differences in the outcomes of homeopathic therapies
versus placebos.
Some adverse side-effects have been reported with
homeopathic medications. In reporting on the outcomes
of 335 consecutive treatments at a homeopathic clinic in
Italy, Endrizzi et al. (66) point out that 2.7% of the patients
suffered unfavorable negative reactions. The authors
concluded that Adverse events to homeopathic drugs exist
and are distinguishable from homeopathic aggravation. In
a recent internet article Baum and Ernst (67) go further and

Potentized dilution; No succussion

Single or combined
Oral or topical; may be taken with food
Alcohol deterrents
Plant
Nontoxic plants
None known
None
Homeopathic medicine
No limit
None
38
Self-administered or guided by qualified practitioner
Energetic
Emotional and mental imbalances
Correct emotional and mental imbalances; assist in
correcting emotionally-based physical disorders
None
All useful
Certificate of completion of required curriculum and
registration through The Dr. Edward Bach
Foundation

criticize .the overtly false and regressive concepts of

homeopathy and conclude that The totality of the
evidence from 200 years of inquiry remain unconvincing
as to homeopathys efficacy. The latter authors believe
that any successful outcomes of homeopathy are actually
the result of the placebo effect or the action of concurrently
administered medications.

COMPARING THE MODALITIES

A comparison of traditional homeopathy and the homeopathic-like BFRs provides an instructive example of the evolutionary diversification of historically related complementary
health care modalities. The founder of the Bach remedies
was a practicing conventional homeopathic physician who
integrated basic and modified homeopathic principles into
a newer method that features a much smaller set of 38 preparations that focus upon mental imbalances. Today the labels
on the BFR containers in the United States still say a homeopathic remedy because of the inclusion of the flower species
in the Homeopathic Pharmacopoeia of the United States.
Formerly listed by the Food and Drug Administration
(FDA) as nutritional supplements, BFRs are now FDA
approved as homeopathic medicines, and they continue to
be sold without a prescription or governmental pharmaceutical regulation in health food stores and supermarkets. This
is a significant revision in BFR status because, as Gelles (68)
points out, Unlike pharmaceutical drugs, nutritional supplements do not have to be approved by the FDA. Instead,

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April 2010: 298307

supplement makers agree to only use ingredients already being

used in other dietary supplements. In contrast to the prescription homeopathic medicines, the BFRs and nonprescription
homeopathic medications are not required to meet any
specific pharmaceutical standard, and the FDA accepts the
over-the-counter sale of both in the United States. By the
same token, the use of vitamins, minerals, animal parts and
other nutritional elements as medicines is an ancient, and
generally unregulated, cross-cultural practice that is
increasing in popularity today (5, 6972).
Basic characteristics of homeopathy and BFR therapy are
compared in Table 3. Both methods use diluted preparations
derived from a concentrated mixture of natural materials
called the mother tincture. The healing power of both
systems is considered to be primarily energetic, and each
features medications which may produce favorable
biochemical and/or psychological changes.
Although the majority of modern biomedicines exhibit
increased effects with higher dosages or concentrations,
minute amounts of various bioactive substances can
produce substantial bodily changes. For example, severe
and even fatal allergic reactions have been recorded in
susceptible subjects consuming very small quantities of
peanut protein products, sometimes requiring emergency
treatment and management with epinephrine injections
and oral antihistamines (73). A number of hypertension
medications produce substantial physiological effects in
low dosage for some patients, whereas other individuals
may require four to five times as much to experience
the same results. Furthermore, like other medications,
a blood pressure drugs potency is influenced by how
quickly it reaches the target organ and its rate of metabolism by the liver and kidneys (74). Another study (75)
has also shown that miniscule amounts of synthetic medications can lead to major benefits, or conversely to serious
side-effects, in young pediatric patients. In addition,
medicinal plant extracts are typically diluted and boiled
to release and enhance their bioactive phytochemicals
while simultaneously reducing their toxicity (4, 8, 9).
In addition, positive healing reactions from extremely
small amounts of active energetic ingredients in homeopathic and BFR preparations may result in the direct or
secondary activation of the immune system by these
substances. According to the National Center For Homeopathy in Alexandria, Virginia (76), Homeopathy is recommended as an important way of bolstering ones immune
system. A similar principle also applies to one of the historically successful approaches to allergy desensitization. By
exposing patients to small doses of allergens, it is possible
to gradually reduce the severity of their future allergic
reactions to the same materials (36).
The concept of flexible dosages tailored to individual
patients, found in both homeopathy and BFR therapy, is

Halberstein et al.
COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

305

similar to the conventional allopathic practice of assigning

unique titrated dosages of medicines in accordance with the
recipients age or body weight. The variable outcomes of
controlled clinical investigations of both modalities point
to the necessity of further research on the extent of their
actual and potential degrees of potency.
The majority of the controlled trials of BFR therapy and
Homeopathy suggest that the placebo effect operates to
a significant degree in both modalities. This finding is not
surprising, considering the substantial rates of successful healing that have been attributed to placebos in both conventional
biomedical and alternative/complementary health care treatments (7785). As early as 1953 an investigation revealed that
32% to 40% of sampled postoperative surgical patients
reported significant pain relief with placebos alone (86).
BFR therapy and homeopathy modalities differ in professional training programs and credentials. Qualified BFR
practitioners are placed on an international register maintained by The Dr. Edward Bach Foundation in England after
the completion of a set number of hours of standardized
education. Registered practitioners with additional
advanced training are authorized to conduct instructional
seminars for consumers and to educate health product
retailers. Homeopathic colleges, on the other hand, vary
in educational programs and degrees offered. Hahnemann
College, originally founded in 1835 in Allentown, Pennsylvania, and currently headquartered in Ottawa, Canada,
offers a DPh (Dynamic Philosophy) degree in a 3-year
program and an honors degree (DHPh) requiring an extra
year of training (87). However, American University of
Complementary Medicine (88) in Beverly Hills, California,
offers a PhD in Homeopathic Medicine in addition to its
basic Diploma in Homeopathic Medicine (DHM). BaileyLloyd (89) describes the Doctor of Homeopathy degree
program (DHom) available at a number of natural healthoriented colleges in the United States and Canada.
As seen in Table 3, and as noted in the recent comparative study by van Haselen (44), homeopathy and BFR
therapy vary with respect to remedy preparation methods
and dilution formulas, remedy combinations, modes of
application and administration, number and types of medicinal source materials, dosage schedules and limitations,
potential toxicity, and the possibility of overdosing or side
effects. Usage with animals and plants is more restricted in
homeopathy. The latter author points out that the use of
conventional drugs, coffee, certain foods, and various other
ingestible materials may neutralize homeopathic remedies,
but this is not the case with BFRs (44).
Further research on both homeopathy and BFR therapy is
warranted to further clarify the mechanisms of action,
potential health benefits, and possible limitations of both
modalities. Additional double-blind trials would be especially recommended to narrow down the list of health

306

Halberstein et al.
COMPARISON OF BACH FLOWER REMEDIES AND HOMEOPATHY

problems that are significantly benefited by these and other

energy-based healing systems.
It is well known that stress and anxiety often produce or
exacerbate physical symptoms (90). Because it has recently
been estimated that stress-related disorders account for 70%
to 90% of all patient visits to primary health-care providers
(91), the continued testing and validation of safe and
effective complementary interventions will be even more
important in the future.
Vivian Padron-Fajardo, PhD, ARNP, FNP and Lydia DeSantis, PhD, RN,
MPH, FAAN, both of the University of Miami School of Nursing and
Health Studies, participated in the research. Ulli Jonsson of the Nelsonbach
Company in England provided helpful information and advice.

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