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Translating a nonlinear systems theory model for homeopathy into empirical


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ORir.INAI RESEARCH

TRANSLATING A NONLINEAR SYSTEMS THEORY


MODEL EOR HOMEOPATHY
INTO EMPIRICAL TESTS
Iris R. Bell, ML), MD (ii), PhU, Carol M. Baldwin, UN, I'hn. and Gary E. Schwartz, pw

Iris R. Bell is associated with the Program in Integrative energy medicine. Prior research has focused on the nature of the
remedies and/or their clinical effects on specific conditions iden-
Medicine; the Departments of Psychiatry, Psychology, and
tified by conventional medical diagnoses. However, homeopathy
Family and Community Medicine; and the Bioenergetics Core
is claimed to exert widespread effects on the person as a whole,
of the Pediatric Center for Complementary and Alternative
regardless of the presenting complain! or diagnosis.-' For exam-
Medicine at the University of Arizona, as welt as the
ple, a person seeking treatment for chronic recurrent headaches
Department of Psychiatry, Southern Arizona Veterans Affairs
may experience resolution over the course of treatment not only
Health Care System, Tucson, Ariz. Carol M. Baldwin is with
of the headaches but also of concentration difficulties, depressed
the Department of Psychology at the University of Arizona,
mood, cardiac arrhythmias, digestive problems, and skin erup-
the Southern Arizona Veterans Affairs Health Care System,
tions—all from the single homeopathic remedy. During homeo-
and the Arizona Respiratory Center, Tucson, Ariz. Gary E. pathic constitutional treatment (treatment centered on the
Schwartz is affiliated with the Departments of Psychiatry, person, not on the disease), many patients (perhaps as many as
Psycholog)', Neurology, Medicine, and Surgery at the 20%') also report dramatic changes in how they address life
University of Arizona, Tucson, Ariz. issues with significant others, family members, friends, and in
relation to jobs or career directions and hobbies.'' Positive
responses are reported by people who have failed to respond to
Vtirhnis hm'sligators have proposed ihdl mwlincar syslenis theory. both conventional and other forms of CAM therapy.'
miUibly thaos and complexity theory, provides a hcuristicnlly useful
model for conceplualizmg the way in which complmentary ami alterna- These changes reportedly occur nnder homeopathic treat-
tive medicine therapies, whieb purport to modify subtle etur^ies. ejfectment that involves one in-depth initial interview (for 1 to 2 hours)
change throughout the individual us a whok. In this paper we apply this and briefer follow-up appointments at 2- to 3-month intervals."
theory to classical homeopathy and outline an empirical approach jor The pace of the interactions with the homeopath is much less
testing the resultant hypotheses. Such research may advance understand- intensive than psychotherapeutic encounters, in which treatment
ing of the mechanisms of homeopathic remedy effects and provide a might entail 1-hour sessions 1 to 3 times per week over many
direction for homeopathic research thai expands the previous emphasismonths or even years (an increasingly less available treatment in
on clinical trials and the remedies themselves. In rifocusing attention onAmerican heahhcare). Thus, even ihough nonspecific benefits of
the dynamics of the patient a.s a nonlinear complex system, the proposedattention may play a role in patient responses to homeopathic
research program is consistent with the homeopathic emphasis on the treatment, the extent of the improvement appears to be dispropor-
individual rather than the disease. This approach may have additional tionately greater, broader in form (not on!y psychiatric and social,
applications that can elucidate similar ijfects of other energ,> medicine bul also medical and pathological), and longer in duration than
modalities (eg, acupuncture) on the healing process of the person as a those typically reported by patients in extended psychotherapy.
unifedwhok (Altern TherHealthMed.2002;8(3):58-66) In contrast to practitioners of conventional medicine or
psychiatry, homeopaths claim that the process of healiiig follows
an ordered pattern.' According to Hering's Law of Cure, symp-
toms resolve from the inside out (from more important to less

C
lassical homeopathy (using 1 remedy for the total-
important organs), from above downward (head toward toes).
ity of a person's symptoms) is a 2U0-year-old
and in reverse order in time of their original appearance. A
system of alternative medicine developed hy the
corollary of Hering's Law states that treatments that block the
German physician Samuel H a h n e m a n n . '
expression of symptoms in a less important organ are suppres-
In the field of complementary and alternative
sive and ultimately lead to the emergence of problems in more
medicine (CAM), homeopathy falls within the broad category of
important organs. For example, steroid creams on a skin rash
would eliminate the rash, but the person might develop depres-
Reprint requests: tmwVhhii ComiimmcaUnm. 169 Saxotiy Roml. Suite 104. Bidnilas. CA 92024:
)6X39Wmiii!.a!hTNiUm\th,riipmin)im^^ sion, a brain-related condition. Lesions or dysfunctions in any

stems 'I'lieitry Model for 1 Imneopathy


58 AtJtRNATlVE THF.HAPIES. MAY/|UNE 2002, VOL 8, NO. 3
one subsystetn ofthe body are manifestations of a single, alheit in quality; that is, the output is disproportionate to the input." To
complex, energetic disturbance ofthe person overall, not ofthe label the effect nonlinear does not presume any particular mecha-
body part in isolation. In other words, homeopaths see the per- nism by which the remedy achieves this effect. Mechanisms could
son as a unified whole.'' The pattern of response to classical include biomagnetic, biochemical, physical, placebo, attentional.
homeopathic treatment typically involves the resolution of a psychosocial, or other mediators. What is important for the cur-
problem in a more important organ (eg, better mood), with tem- rent model is the nonlinearity ofthe host's responses.
porary emergence of a problem in less important organs (eg, In this model the "host" or individual patient is viewed as a
more joint pains, then more skin rashes) before the gradnal dis- living system comprised of subsystems (organs, cells, molecules,
appearance ofthe difficulties in all of these areas (Figure 1). atoms) that are embedded within larger .social systems (families,
The scope of changes claimed by homeopathic practitioners communities, societies, biosphere)." By definition, a system is "a
can elicit as much skepticism as do the questions concerning tbe set of interacting units with relationships among them," in which
nature ofthe active principles in homeopathic remedies (given "the state of each unit is constrained by, conditioned by, or
their highly diluted forms). Nevertheless, findings suggest that dependent on the state ofthe other units."" When introducing
homeopathy is unlikely to reflect simply a placebo or an attention the biopsychosociai model to conventional medicine, Engel"
(Hawthorne) effect.'^" These findings are based on a converging pointed out, long ago, that change introduced at any level of a
body of clinical research hterature, the patterning of changes in .system will induce change in all other levels of organization,
symptomatology during treatment, numerous anecdotal reports of above and below (Figure 2). This type of systems thinking paral-
persistent multidimensional improvements for years after cessation lels the t)'pes of changes outlined ahove for the course of respons-
of treatment, animal studies, and even in vitro cell preparations. es to homeopathic treatment. However, Engel did not address 2
Whatever the mechanisms, the changes in biopsychosocial additional concepts from systems theory thai subsequent theo-
and spiritual phenomenology that the homeopathic modality reticians have found essential for more realistic modeling ofthe
claims to catalyze pose a challenge to researchers.-'" The pur- person as a system: complexity and self- organization.'^
pose of this paper is to expand on previously proposed syslenis Complexity is defined as "a type of dynamical [changing
models for homeopathy"'"" to outline an empirical approach for with timel behavior in which many independent agents interact
testing nonlinear systems theory as a framework for understand- in novel ways, spontaneously organizing and reorganizing them-
ing these clinical phenomena. selves into larger and more complicated patterns over time."''''"*•*•"
A variety of conventional medical and psychological investiga-
USING SYSTEMS THEORY TO CONCEPTUALIZE tors have pointed out that human beings are complex living
HOMEOPATHIC PHENOMENA
In the homeopathic treatment process a small stimulus,
given at widely-spaced intervals, induces large eftects that evolve
over long periods of time throughout the host and even within y
the host's environment. By definition, such effects are nonlinear Cullurf-Suhtultiire
t(inimunit\'
Familv
wo person
Person
NL'rvciussyslem
Phobias and suicidal depression Organ/Organ system
Tissue
Neurological symptoms Cell
Organdlu
Irritability
.Male
cule
I.ivprriy.sftini:rign

Skin eruption

FIGURE 1 Uia'ctitin of cure ihrougli mental, emotional, and physi-


cal levels in a hypothetical patient treated with classical homeopathy
FIGURE 2 Continuum of natural systems
Reprinted with permission from Vithoulkas G. The Science of
Reprinted with permission from American Journal ofPsyehiatry.^'
Homeopathy.- Copyright 19S0, Grove VVeidenfeld.
Copyright 1980, American Psychiatric Association.

Nonlinenr Systcni.s Tiieory Model fur I loincopalhy ALTERNATIVH THERATILS, MAY/IUNE 2002, VOL. 8, NO. 3 59
systems whose pliysiulogy and individual as well as social behav- of Cure, in which the person-system heals in a hierarchical pat-
ior fiinction in a nonlinear fashion."'"" Complex systems are tern. Moreover, the reported changes in the person's social envi-
capable of exhibiting emergent properties. An emergent proper- ronment during homeopathic treatment are consistent with the
ty of a given system is unique to its level of organization and is conventional mental health concept of the individual as part of a
not predicted by the properties of the parts or subsystems within larger social system (Figure 2).'^"'^''-"''
the larger system. For example, individuals are capable of gener-
ating behaviors within tbeir environment, a capacity not predict- NONLINEARITY, CHAOS, AND CHANGES IN SYSTEMIC
ed by studying the brain, heart, liver, kidneys, or other organs in COMPLEXITY IN HEALTH AND DISEASE
isolation. These organs constitute the subsystems that together The apphcation of systems theory to homeopathy raises the
enable the emergence of the person as a larger, living system. possibility of designing an empirical program for testing the
In homeopathy, both the behavior of the organism (the model and identitying nonlinear correlates of the healing process.
patient) and the behaviors of component organs are the symp- The overarching construct is that homeopathy addresses the per-
toms reported in the clinical interview." I'rom this perspective, son as a unified, dynamical, nonlinear, complex living system.
symptoms are emergent properties of component organ subsys- Much evidence suggests that the normal behavior of complex bio-
tems and of the overall person-sy,stem, expressed at each level of logical systems (such as brain,"" heart,-" nasal cycle,'" biochemical
organization. In homeopathic terms, the ultimate emergent prop- reactions,'' and immune system"') exhibits aspects ot nonlineari-
erty of the person-system is the "essence" of the patient." This ty. such as chaotic dynamics (ie, past history and new input are
essence reflects tbe synthesis of key life issues: mental or psycho- predictive of future status),'"-' Chaos is a "sustained and random-
logical profile, appetitive behaviors (eg, desires and aversions tor like (but not actually random) long-term evolution tin the behav-
food, drink, sex), and generalities held by tbe person that are ior of a system] that satisfies certain mathematical criteria"'^''*"''
often expressed at lower levels of organization in specific symp- and exhibits marked sensitivit)' to initial conditions. Small differ-
toms or organ dysfiinctions. For example, Natrum Carbonicum ences in the starting points for a chaotic system lead to progres-
tiiay be prescribed lo treat a sense of being forsaken by others at sive amplification of divergence and extremely different outcomes
the mental level; aversion to company at the emotional level; and over time. In lay terms, chaos is the butterfly efrect"": when a but-
poor assimilation at the physical level, resulting in diarrhea from terfly flaps its wings in South America (tiny change in initial con-
specific foods such as milk. 'I'he homeopathic notion of generality ditions), the weather changes in Chicago (large eflect).
is paralleled by another concept from nonlinear systems theory: Compared to healthy people, individuals with a range of
fractality, the property of self-similarity at every level of scale.''''' diseases generally exhibit constrained patterns of nonlinear
Another homeopathic concept, the "central delusion'"' ot the behavior within their subsystems, such that their adaptability to
case, is a type of emergent property, a way of conceptualizing tlie environmental change over time is compromised.'"" '•' That is,
essential way in which the person, as a whole system, perceives and people with various diseases lose nonlinearity or complexity in
experiences his or her life issues. For example, a person may view the behavior of their system and subsystems. Applying the math-
himself or herself as an outcast from family, friends, and society, ematical methods of deterministic chaos research reveals the dis-
with a delusion of "division between himself and others," as treat- ease-related disturbances. For example, patients with bipolar
ed by Natrum Carbonicum.'"'''"" In a dynamical, interactive way, disorder'"' or clinical depression''' exhibit extreme shifts of mood
the person-system inflises the behaviors of his or her environment that appear highly variable. However, nonlinear analyses of their
(stiprasystem) and his or her subsystem organs'" with the emer- daily mood ratings over periods of months reveal that the pat-
gent propert)' of this central delusion. Thus homeopaths ofren use terns of the mood variations are more organized, ordered, and
systems thinking without labeling their approach as such. less complex than those of affectively more stable individuals.
Self-organization is one of the emergent properties of a Other studies have demonstrated a loss of complexity in (1)
complex system.'--" Self-organizalion refers to the spontaneotts tht? electroencephalographic activity of individuals with
tendency of a new organizational macroscopic pattern to form epilepsy.^" schizophrenia,'' Alzheimer's disease,'^ and the sons of
out of the "collective interactions between a large number of SJETI- ak-oholics'"; and (2) in heart rate variability (IIRV) in relation to
pler, usually microscopic objects |,siibsystemsl."'"''"'' Some sys- age (Figure 3)'"; or the presence of any of the following condi-
tems theoreticians have shown that artificial life may be an tions: cardiac disease,'"' stroke," diabetes mellitus,''^ obesity,^'
emergent properly of the interactions among various physico- systemic hipiis erythematosus," tnultiple sclerosis,'' panic disor-
chemical subsystems.-'"" Given that the larger complex "living" der,^" posttraumatic stre.ss di.sorder,'' depression,'" fibromyal-
system develops far from a state of equilibrium, the patterns that gia," '" ambient air pollution exposures,^' and sudden infant
it forms reflect a self-organization that is shaped by the interac- death syndrome.'^ Indeed, a reduction in IIRV was a predictor of
tion between the system's emergent properties and the pressures all-cause mortality in the Franiinghani study.'
of natural selection from the surrounding ecosystem. The In regard to cardiac function, clinical observers first noted
process of sclt-organization has inherent yutocatalytic and hier- that changes in interbeat intervals preceded changes in heart rate,
archical properties.-'-' The hierarchical quality of the self-organi- per se. as a biornarker of adverse events. Subsequent research
zation is paralleled by the homeopathic concept tif Hering's Law examined various methods of measuring changes in HRV as a

60 ALTERNATIVi; THI^RATIES. MAY/IUNF 2002, VOL 8, NO, 3 Nonlinear Systems 'rhi-ory MmicI for Homeopathy
predictor of clinical outcoines.''' These approaches include (1) fre- than do spectral analyses alone.'''' From a .systems perspective, nonlin-
quency domain methods to assess the balance between the sympa- ear measures of complexity iti waking EEG depict cortical network
thetic and para,sympathetic nervous systems (eg, power spectral functioning and coordination between different neural networks bet-
analyses, derived from fast Fourier transform IFI'TI of the data, ter than do spectral or linear analyses.'" in short, nonlinear analyses
reflecting the distribution of the variance/power in interbeat inter- are better suited overall to testuig integrative, systemically oriented
vals as a ftmction of frequency); and (2) time domain methods (eg, hypotheses about the dynamics of human subsystems and the per-
mean interval for time from each EKG-recorded R-wave spike to son as a whole than are spectral and other linear analytic approaches.
the next; or mean standard deviation of the beat to-beat intervals) In classical homeopathy, disease is considered to be a loss of
that reflect cyclical elements responsible for variability in the adaptability, an undue constraint on the capacity for creativity in
dataset. In addition, researchers have applied nonlinear mathe- the individual as a whole.' Vithoulkas defined health as freedom at
matics to interbeat interval data to calculate variables that capture all levels of organization within the person—mental, emotional,
additional qualities of the dynamics of the data over time (eg, and physical. Vjthoulkas uses the individuals capacit)' for creative
approximate entropy or the correlation dimension; see Figure 3 expression in life as a yardstick of clinical recovery during homeo-
and description below). The correlation dimension of interbeat pathic treatment.^ In a different context, Cofley" pointed out that
intervals provides an even more reliable, individually specific pre- htmian creativity itself is an emergent property of complex living
dictor of, for example, lethal ventricular fibrillation outcomes in systems. If this is true, then the availability of validated scales (such
high-risk cardiac patients than do spectral analyses of HRV.^' as those for assessing everyday creativity)'"" and the increased com-
Similarly, other investigators have found that noiilinear analy- plexity in nonlinear EEG variables during creative thinking'" make
ses of sleep EEC data add better discriminatory capacity for sleep it feasible to test the systems theory-driven hypothesis that effec-
stages and different psychophysiological states in normal people tive homeopathic treatment leads not only to subsystem improve-
ments but also to changes in organism-level emergent properties,
such as enhanced creativity and its neurophysiological correlates,

PROPOSED EMPIRICAL APPROACHES


The following hypotheses are based on the considerations
discussed above.
ilypothesis 1. Across diagnostic categories of disease, nonlin-
ear analysis of time series data for the behavior patterns of the
person and the behaviors (functions) of his or her subsystems
will reveal disturbances (eg, reduced nunhnearity or complexity
1 2 3 4 5 6 7
at rest, or suboptimal reactivity of subsystems to acute stressors).
Hypothesis 2. In the course of clinicai improvements during
homeopathic treatment, the person and his or her subsystems
will exhibit parallel improvements at the nonlinear level. These
improvements would include (a) increased nonlinearity or com-
plexity in resting values and in 24-hour average values of mea-
sured variables, and (b) optimization in complexity of
short-term biobehavioral reactivity by subsystems during acute
challenge tests (ie, complexity decreases when pretreatment
responses are overly constrained and increases when pretreat-
ment responses are overly disorganized).
1 2 3 4 5 6 7 8 Hypothesis :i. The patterning of clinical improvements will
Time mill follow a hierarchical course of self-reorganization, with a sequen-
tial recovery of nonlinear dynamics, beginning at the person's
FIGURE 3 Lo,ss ofheart rate complexity in older individuals mental level and emergent behavior (eg, creativity in problem
solving) and proceeding through emotional and physical subsys-
Heart rare rime .series for a 22-year-old female subject (top panel) and a 7,1->ear-
old male subject (bottom panel). Heart beals per minute are on the y axis. The
tems, from head toward lower extremities.
mean heart beals per minute for the young subject was 64,7, SIl :i9; approxi-
mate entropy, 1,09, The mean lieari beats per minute fur ihe old suhjeci ivys Nature and Scope of Outcome Variables
64.5, SD 3,8; approximate entropy, 0,48. Approximate entropy is a measure of
"noniinear complexity," Despite the nearly identical means and SDs ofheart
First, this empirical approach requires repeated and concur-
rare for the 2 time scries, the "complexity" of the ,sign:il from the older subjecr rent measurement, within-subject, of multiple variables over
is markedly reduced, iieprinted with peniiissiiin from ihejourrkilofllw time. Experimental designs must include controls for time of
Ammaiii MedicalAssodaliim (1992;267:]fia64809), Copyright 1992, AMA. day''-' and the behavioral state of the individual."" Studying a
dynamical system requires the ability to measure motion or

Nonlinear Systems Theory Model tor Homeopathy ALTLRNAnVF THERAFILS, MAY/|UNE 2002, VOL. 8, NO. 3 b\
trajectory over time—a greater challenge than measuring static Nonlinear Analyses and Patterning of Change
states. To measure behavior at the each level of organization, Prior research on nonlinearity in health and disease suggests
researchers can synthesize and adapt methodologies from a that certain types of computations on the time series data gath-
range of previous studies in the nonlinear systems literature. For ered on the above variables will be most useful for studies of
example, the variables for which researchers can collect time nonlinearity in homeopathy. These computations, found in many
series data for nonlinear analyses include a hierarchical combi- papers on dynamical systems in behavior and physiology,'^'"
nation of subjective and objective measures, 'fo minimize the include approximate entropy,'" the fractal dimension (Dy),'" the
risk of disrupting the natural course of change in the person, the correlation dimension (D^).''*'' and the Lyapunov exponent
following measures should be as noninvasive as possible: (L.).'''•'""• The first 3 approaches offer estimations of the complex-
• self-ratings of daily well-being (global organismic level)"' ity of a nonlinear system; L, provides quantification of the sensi-
• 24-hour physical activity monitors (global organismic tive dependence of the system to initial conditions—that is, the
energy level)''" degree of chaos in the dynamics of a process.
• self-rated everyday creativity'"' and FEG correlates during Thus, for the 3 hypotheses specified above, reduced com-
creative thinking tasks''*' (emergent, organismic level) plexity would translate into smaller values for approximate
• computerized cognitive task performance style (mental entropy, the fractal dimension, or the correlation dimension. For
level/organismic behavior)"' example, one study suggested that a homeopathic remedy can
• daily mood ratings (emotional level)*-' alter HRV in healthy animals."' Homeopathic theory predicts
• waking or sleep electroencephalography (brain biology that the remedy would also modify the nonlinearity tif IIRV—for
level)'»"^' example, it would reduce the approximate entropy computed
• daily ratings of symptom intensity (physical level)"*' from interbeat interval data in healthy people (Figure 3). In sick
• 24-hour electrocardiogram (heart rate variability' at viscer- individuals who show clinical improvements, the values of
al biology level)"'^'•"' approximate entropy, the fractal dimension, or the correlation
• electromyography (musculoskeletal activity)'"'^" dimension would increase. Similarly, changes in L, would reflect
• skin blood flow (photoplethysmography)"'' or electroder- modifications in the degree of chaos in the system.
mal activity (eg, skin conductance, skin level)'" Previous research supports the possibility that improve-
Timing and duration of measurements are relevant. Most ments in nonlinear measures can parallel clinical recovery. Eor
reliable nonlinear analyses require a large number of consecutive example, investigators have reported the recovery of EEG com-
data points in a time series for analyses.''''' For assessments that plexity during treatment for depression,''" as well as improve-
do not focus on specific emotional or cognitive states, sleep stud- iTients in certain FIRV measures."" In animal and in vitro models,
ies may be useful. Sleep EEG and EKG recordings generate longer researchers have also shown that it is possible to control cardiac
duration time series of data in relatively .stable psychophysiologi- arrhythmias*' or reduce overly periodic firing bursts of neuronal
cal states (eg, runs of minutes in specific sleep stages) than are networks related to epilepsy'" by giving electrical signal interven-
possible in waking recordings, with their ofren second-to-second tions timed on the basis of chaos-derived calculations.
fluctuations of consciousness and attention.^' It is heyond the scope of this paper to discuss the relative
From a homeopathic perspective, the brain, with its mental, advantages and disadvantages of each computational approach.
emotional, and behavioral output, is the highest level of physical However, many resources are available on this topic."'"'•^'"•'^
organization (Figure 1).'' In addition to nonlinear analysis of EEC Investigators in nonlinear systems continue to seek refinements
signals at multiple leads, various functional neuroiinaging tech- and alternatives to the most commonly used nonlinear variables
niques may prove useful in certain types of homeopathic to improve the sensitivity and reliability of the approach under
research, as they have in conventional studies,'"' Of the choices, various experimental conditions.'' '-"-
low-resolution electromagnetic brain tomography (LORETA) The direction and pattern of changes in nonlinearity
analysis of EEG currently offers a low-cost, law-risk, noninvasive depend on the duration of data collection, the level of systemic
approach for repeated measurements of brain regions involved organization assessed (eg, 1 EEC electrode site vs behavioral out-
in homeopathic remedy responses. LORETA is a 3-dimensional put during a task), the nature of the patient's initial state, and the
analysis technique for determining intracerebral distribution of task. In other words, the operating setpoint for a subsystem or
electrical activity; it can be applied lo typical, multilead EEC whole person may have shifted (according to 24-hour record-
datasets derived from electrode cap recordings from a person ings) to a point of lowered complexity because of disease,'"''" but
seated in a comfortable chair.'^ Other neuroimaging techniques, the operating range of the system may still vary in the short-term
while better at spatial localization, require probes that liinit the toward either increased or decreased complexity around the set-
number of repeated images obtained and could disrupt homeo- point as a function of short-term internal and external events
pathic remedy responses; these include the strong magnetic and task demands. For example, a higher resting correlation
fiekls for functional magnetic resonance imaging (fMRl), the dimension. D,, (with eyes open), at a specific electrode site (mid-
radioactive tracers for positron emi.ssion (PET), and the single- parietal region, Pz) was shown to correlate with higher IQ.. a trait
photon emission computerized tomography (SPECT) methods. measure." However, different cognitive tasks and different

b2 ALTERNATIVE THLI!j\I'iES, MAY/|L)N E 2002, VOL, S, NO, 3 t'ar Systems riieory ,M(.>dcl tor I Itiiiienpythy
problem-solving strategies produced either increased or decreased found that affectively unstable and impulsive borderline patients
D^ values transiently over certain other EEG recording sites.''"^" (homeopathic remedies might include Hyoscyamus Niger,
Cimlcifuga, or Lyssinum) exhibited larger values of V (a measure
Laboratory and Field Studies: Methodological of global entropy) and smaller l.yapunov characteristic exponents
Considerations la measure of local entropies) in the way they performed the task.
A key research design consideration is that psychophysio- In contrast, the obsessive-compulsive patients (possibly treated
logical measures have both tonic and phasic features; that is, homeopathically witb Arsenicum) wbo showed clinical global
respectively, long-term background levels of activity (the sys- overcontrol and local indecisiveness exhibited smaller values of V
tem's setpoinl) and short-term state changes in response to a (global entropy) and larger Lyapunov values (local entropy).
specific internal or external stimulus (within the operating range The Mandell and Selz study"' supports the idea that more
of a system around its setpoint). Tonic levels are also context- complexity is not always better in every subsystem or under all
dependent, in that "resting" or unstiinulated states differ as a circumstances.^" On the contrary, it may be preferable for people
function of setting—be it home, work, or laboratory."'' Past stud- with borderline or obsessive-compulsive disorder (and their asso-
ies of EEG noniinearity and of HRV have demonstrated phasic ciated homeopathic remedy types) to change their nonlinear pat-
changes in the outcome measures during laboratory evocation of terns in opposite directions at the global versus local behavioral
positive, neutral, or negative emotional states''"*" and during evo- levels ot systemic organization. From a nonlinear theory perspec-
cation of different types of cognitive activity/""" tive, excess dimensionality (complexity) of a system or subsystem
Research on noniinearity in homeopathic remedy responses can lead to noise, whereas deficient dimensionality of a system or
will need to borrow from methodology previously developed in subsystem can lead to too much order and inflexibility.
psychophysiology and functional neuroimaging to control for Nonlinear analytic techniques fall between qualitative and
the expected flux of states in a living system. The approach is (|uantitative methods in their approach to characterizing phenom-
multifaceted. In the laboratory, it Includes systematic determina- ena. Purely qualitative research methodologies"""' can help identify
tion of the duration of a resting period before taking a "baseline" and characterize the qualities of the response to homeopathic
data sample"'; deliberate evocation of relaxation or specific emo-
tional states, using imagery instructions or emotionally valenced
videotapes or movies^"""; and the deliberate manipulation of
instructional sets for problem solving in cognitive tasks."'
In field research, psychophysiologists perform 24-hour
monitoring of autonomic and physical activity variables while
using event markers for subjects to record the time and nature of
particular thoughts, moods, and activities in electronic or writ- THE BRITISH INSTITUTE OF
ten diaries througbout their everyday lives."""" The 24-hour
recordings permit examination not only of circadian patterns HOMEOPATHY
and real-life reactivity to stress but also of setpoint levels aver- AND
aged over the shorter-term fluctuations within a day. Twenty-
four-hour recordings are more likely than short-term recordings COMPLEMENTARY MEDICINE
(eg, 5-20 minutes) to collect representative information on the
overall adaptability of the individual across multiple transient www.britinsthom.com
moods or phasic stimuli. During and after treatment, clinicians
follow changes in how well their chronically ill patients adapt to
environmental stressors or stimuli and task demands in their
lives (eg, mental clarity, emotional reactivity to daily events), not
merely their condition at rest. Homeopatbs look for overall, sus-
tained (rather than momentary) improvements in everyday liinc-
tioning after administering a remedy.^ Both laboratory and field
methods are well-suited to homeopathic research.
In view of the strong emphasis that many classical home-
opaths give to personahty patterns in determining the patient's
essence for remedy selection/''' it should be possible, for exam-
Home Study Courses in Complementary Medicine,
ple, to adapt Mandell and Selz's''' approach to psychiatric Homeopathy • Clinical Nutrition • Herbology
patients for characterizing different homeopathic remedy types. Women's Health
Mandell and Selz" examined the nonhnear patterns of perfor-
mance on a computerized drawing task in young adults with
obsessive-compulsive or borderline personality disorder. They For a free Prospectus, call
1 -609-927-5660
remedies. For example, we (Bell et al, submitted) asked a group At each se.ssion, pretreatment, and every 2 months, variables
of classical homeopaths to suggest possible questions for such as resting EEC, F,KG, and leg EMG would be recorded simul-
patients undergoing changes during constitutional treatment taneously for 20-minute periods in the laboratory and for 24
for chronic disease. Systematic analysis ofthe emergent themes hours in the field. As healing proceeds over months, a patient
included categories with items on "freedom" (eg, "ability to with initial complaints of poor concentration and heart palpita-
move on—not stuck"), "adaptiveness," and "coping" (eg, "Have tions, for instance, might show progressively increased 24-hour
there heeii changes in how you handle stress?"). From such and laboratory resting EEC D^ values before recovery of increased
information, nonlinear systems theory then predicts that if D., values for resting cardiac Interbeat intervals (center of gravity
homeopathy moves people out of unproductive or destructive of disease moving down the body). As the functioning ofthe
patterns in their lives at all levels of organization, as it claims, it brain, then heart, improves (reflected by a decrease in symptoma-
should be possible to detect, compute, and describe the geomet- tology and in the measurements of nonlinear variables), this
ric (fractal) qualities of shifts in nonlinear dynamics after treat- patient might develop an old symptom, such as muscle cramping
ment. As a precedent, researchers have demonstrated in the calves (center of gravity of disease moving from inside out.
fluctuating but identifiable patterns of nonlinearity in autonom- from more important to less important organs, and down the
ic dynamics coupled with psychological shifts related to specific body; associated with a parallel reduction in the values of nonlin-
content themes over the course of individual psychotherapy ear variables derived from EMG recordings). As a given subsys-
treatment sessions.^' At the other extreme, purely quantitative tem (in this case, muscles), recovers clinically, the nonlinearity of
statistics may he best suited to describing the static endpoints of EMG recordings would increase as well.
treatment, as in conventional medicine. Many well-documented laboratory procedures could be
used to assess the system's operating range. Tests of cognitive
Testing Hering's Law: System Setpoints and Operating Ranges function, for example, could include adaptations ofthe EEG and
In proposing a phenomenology of the healing process in cognitive performance test procedures already developed for
homeopathy, Hering's Law of Cure translates into an emphasis nonlinear research.•''"'"''^'*'^ Similarly, it should be possible to use
on gradual shifts in the operating setpoint (lessening disease ten- physical challenge tests from conventional medicine, such as car-
dency) aiid operating range (improving adaptability to environ- diac treadmill stress tests or drug provocation challenges during
mental stressors) ofthe whole person as a system. When testing pulmonary function tests, to study changes in operating capacity
setpoint shifts via Hering's Law, the recovery of n on linear it)' over of specific bodily subsystems. Even for assessment of creativity,
24-hoiir and laboratory resting recordings of a given individual repeated administration ofthe Molle et aV task procedures for
would occur in hierarchical fashion, with global measures pre- creative (divergent) thinking, convergent thinking, and relax-
ceding those of specific subsystems, and then following down the ation at each evaluation should show within-subject changes in
body and out tow^ard the muscles and skin. When testing operat- the capacity to sliift fluidly into and out of creative states. The
ing range shifts, patients should exhibit improvements in their selection of challenge tests for studies of operating ranges would
acute reactivit)' to external stressors. For example, a homeopath- depend on the individual's clinical history and course.
ic patient with a center of gravity at the lungs, with asthma,
might report a gradual lessening ofthe number and severity of CONCLUSION
attacks (setpoint shift) as well as increased tolerance for environ- Although several previous papers have described points of
mental allergens or exercise (better operating range). intersection between various aspects of homeopathy and chaos
Constitutionally treated homeopathic patients often have theory,"'"" none to date has translated these concepts into sys-
"layers" that need different, complementary remedies; for exam- temically t)riented, testable hypotheses for clinical research. A
ple, a Sulphur type might phase into a Calcarea Carbonicum nonlinear complex systems approach to studying host responses
type, or a Staphisagria into a Causticum type. As patients gradu- to homeopathic treatment is consistent with the whole-person
ally shift from one remedy picture (personality) Into another, the orientation of classical homeopathy. This approach would per-
nonlinear patterning of their behavioral output on tasks (similar mit researchers to follow patients through changes in the status
to the Mandell and Selz test^') should change in parallel over a of all conditions from present or past experience—for example,
similar time frame. In addition, during a positive early response current depression, with a history of asthma. The essence ot
to the correct remedy, patienls report feelings of increased well- deterministic chaotic systems—that "future events are causally
being and improved energy.^ These subjective experiences set by past events"''—is mirrored in the replay of past symp-
should correlate with increases In correlation dimension (D^) toms, which are typically reported by homeopathic patients dur-
values on relevant measured variables—for example, serial val- ing constitutional treatment.
ues on the Arizona Integrative Outcomes Scale''' and 24-hour Data from this type of research may also provide more clues
data from whole body physical activity recordings taken from a as to how to direct future studies on the nature of homeopathic
Mini-Mitter™ Mini-Logger ambulatory device''' (which can also remedies. A better understanding ofthe phenomenology of rem-
record 24-hours of EKG and core body tevnperature concomitant edy responses may point to host mechanisms and eventually to
with activity levels). how those mechanisms are mobilized.'*''"'' In addition, the capacity

64 ALTERNATIVE THERAPIES. MAY/|UNr 2002, VOL 8. NCI 3 tiir Systems Theciry Model for lionieopathy
of comp]ex systems tn generate emergent properties—that is, patients reportedly exhibit in the course of treatment. Such
novel developments tor the organism and computations of Lj (a research will require multidisciplinary collaborations among
mar]ier of sensitivity to initial conditions in chaotic systems)— homeopathic clinicians, psychophysiologists, and nonlinear
might provide a starting point for understanding the difficulties complex systems researchers. This type oi research is now feasi-
in reproducibility that have dogged much previous homeopathic ble and promises to open valuable new directions for the scientif-
research, both basic and clinical."'"' ic study of homeopathy and other energy medicine systems.""""
One possible rea.son why conventional medicine has not yet Afknowledgnients
embraced nonlinear systems approaches to studying health and Tliis research was supported in part by NIH K24 ATOOO.57-01, R21
disease is its focus on discrete, categorical disease entities and ATOO:il5-01, NIH Pr)O AT00008-02. and VA tlSIl PCC-9SO,13-1, as well ys NIH
NHLBl cooperative agr('cmeni supplement U0tHL5.^9:58-O8.'il,
episodic events during chronic illness as a means of deterniiiiing
diagnosis and treatment. At this time, conventional medicine
does not have a way to use the information available from com- References
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66 AlTERNATIVli THERAI'IES, MAY/|UNIi 2002, VOL, 8, NO. 3 Nonlinear Systems Theory Model fiir Houieopathy
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