A Critical Examination of the Homeopathic Treatment of Chronic Fatigue Syndrome

April 7, 2011 by Gill Graham

-with particular reference to the reliability of the randomised controlled trial as a method of measuring its efficacy in practice Abstract The aim of this study is to evaluate whether or not homeopathy is an effective treatment for Chronic Fatigue Syndrome (CFS). Highly complex in its nature, CFS is a challenge to physicians of every discipline, thus guidelines as to the efficacy of treatment are warranted. µChronic Fatigue Syndrome is a symptom-defined condition in which physical and mental fatigue, usually made worse by activity, are the core symptoms¶ (Sharpe 2004) A literature search on the subject of Chronic fatigue/ME was undertaken, both on-line and through the Glasgow Homeopathic Library. An investigation into the allopathic treatment of the condition has been undertaken, documented and critically reviewed. Randomised Control Trials, the function of µthe placebo effect¶ and what constitutes Evidence Based Medicine were discussed to put the research into context. Homeopathic treatment and approaches were then evaluated by referring to published case studies, whilst analysing the different methodologies of individual homeopaths. In addition, different concepts and individual schools of thought were studied to highlight any particular successes or failures in approaches to their cases. Two RCT¶s have been analysed (Awdry 1996, Weatherley-Jones 2002) and other treatment protocols namely, Peter Chappell¶s CFS trial in Leuven (2004) and Harthoorne¶s in South Africa (1997). There is a positive response to homeopathic treatment in most trials and cases based on observation and outcome. However this study concludes that the focus on current methods of measuring the efficacy of homeopathy, namely randomised control trials, is not an appropriate or balanced assessment of the evidence. Other methods of measuring the efficacy of homeopathy such as observational studies (Rawlins, 2008) are more suited to adapting to the homeopathic paradigm. This study suggests that there are many aetiologies for CFS and it is evident from the literature that the cure is often dependant on these facts. Treatment is individualised and

problems caused by a biochemical neural network dysfunction¶ which is a . an unexplored territory where few men enter. also describing the condition as neurasthenia.¶ He also referred to fatigue as µThe Central Africa of Medicine. whilst endeavouring to present the optimum approach to the condition.¶ Deale and Adams. pseudo-quantitative. Almost one hundred years later. including the rationale behind various trials and protocols. but that it had come right off the hook¶. methodologies and philosophy will be discussed. referred to the condition as µneurasthenia¶. Because the efficacy of homeopathy is judged largely on the rigours of the Randomised Controlled Trials (RCT). (1894) concurred with Beard. after treating several young women for an illness with many similarities to CFS. From very early studies. An in-depth analysis of the homeopathic treatment of CFS. describes it as a µneurosomatic disorder. so this too will be discussed. It is the intention of this study to give an in-depth insight into the homeopathic treatment of Chronic Fatigue Syndrome (CFS). 1996). Jay Goldstein MD. which according to Professor Sir Michael Rawlins. gastro-intestinal disturbances and subjective sensations of all kinds. It is recommended in this study that research into CFS should continue to refine the optimum approach. Beard. with µenfeeblement of the nervous force. History of Chronic Fatigue Syndrome (CFS) to the present day Descriptions of a disease not dissimilar to CFS were found on a piece of Egyptian papyrus dating back to 1900 B. While statistical analysis may have some value. µIt¶s about integrating individual clinical expertise and the best external evidence¶ (Sackett et al. The researcher is therefore using the study of the homeopathic treatment of CFS as a framework to explore these wider issues. through the analytical and critical research of published cases and trials. appraised and criticised by the researcher. a concise allopathic literature review will link into the homeopathic perspective on CFS. the µarchitect¶ of the RCT in stating µAny belief that the controlled trial is the only way to go would mean not that the pendulum had swung too far.C. To complete this study.ongoing to match µthe state¶ of the patient. the Chairman of National Institute for Health and Clinical Excellence (NICE). µDe Testimonio¶ he cites Hill. assessment of the quality of available evidence. where homeopathic philosophy will be seen to relate to some allopathic concepts including psychoneuroimmunology. a large section of the research in this study concentrates on the viability of the RCT. 2008). He defined this as µa condition of nervous exhaustion. it is clear that professional judgement reinforced by longitudinal observation is a much stronger approach for correctly evaluating the success of treatment. What constitutes µEvidence Based Medicine¶ (EBM) is highly significant to the credibility of this study. the purpose being to inform the reader at the highest level. He goes on to say: µHierarchies attempt to replace judgment with an over simplistic. a psychiatrist. which may have all degrees of severity¶. characterised by undue fatigue on the slightest exertion. clear aetiologies for this condition were evident and will be discussed at length in this study. For this reason the placebo concept will be similarly analysed and placed in appropriate context. does not deserve its elevated place in the hierarchy of evidence (Rawlins.¶ Most trials alluded to in this study are µdouble or triple blind against placebo¶. a specialist in CFS. In the Harveian Oration of 2008. both physical and mental «. the chief symptoms are headache. (1869).

(Chief Medical Officer¶s Working Group report on CFS/ME. time has not offered the gift of great insight or cure which is µthe gold standard in our research that has to be validated¶ (Rutten et al. Hotopf and Sharpe 1999:19) An outbreak of an apparent disease at the The Royal Free Hospital 1955 was the defining situation for the beginning of acceptance of CFS. described the situation in the British Medical Journal in 1970 as µbeing caused by mass hysteria¶ (McEvedy and Beard. (Goldstein. Predisposing factors which result in people becoming more susceptible 2. 2006). 2003). debilitating fatigue which accompanies normal activities and is not relieved by bed rest and cannot be explained by another medical condition. with either physical or psychological interventions. after years of controversy and debate. Feb 2002:4). (Afari and Buchwald. Thus do the caregivers themselves contribute to their patients¶ somatic fixations. it is generally acknowledged that CFS is a three stage illness which encompasses: y 1. Some of these patients never recovered. Clearly. except that what is required is a µmultidimensional approach¶ (Wessely.¶ (Bateman. sufferers presented symptoms such as problems with brain function. It often comes on suddenly with no obvious cause. It is thus an area of study that will be useful in practice. Events which subsequently stress the immune system and thus prompt the onset . 2003:221. remained cynical. In this. (1999). It is a syndrome that affects twice as many women than men and can last for months or years and it is envisaged that even more people will present with it in the years to come. The Central nervous system had been affected in 74% of cases (Parish. 1978. It was only in 1998 that the Chief Medical Officer finally recognised the illness. Some remain cynical however. blurred vision and unusual skin sensations. 1970).µnovel paradigm. plunging youthful and productive individuals into careers of disability. who in large. confounding researchers and physicians alike¶. 1999). What is Chronic Fatigue Syndrome? Chronic Fatigue Syndrome (CFS) is a disorder that presents with profound.1996:2).¶ He subsequently suggested it should be called µBenign Encephalomyelitis.) It is also sometimes referred to as ME (Myalgic Encephalomyelitis). Post Viral Fatigue Syndrome and Immune Dysfunction Syndrome. and views such as those of Shorter (1995) are still frequently voiced: In every community there will be at least one physician willing to play up to his patients¶ need for organicity.¶ Two psychiatrists however. Shepherd. Dr Lucinda Bateman who serves on the board of CFIDS Association of America opened a fatigue consultation clinic in 2000 and has since had to evaluate more than 1000 patients: µIn my clinical experience. Sadly. Dr Melvin Ramsay who was the consultant physician at the infectious diseases unit at the time was compelled to publish a report in the Lancet (1956) describing the disease as µA New Clinical Entity. headaches. According to Shepherd. this had a profound effect on the medical community. I have found that CFS is among the most difficult conditions to improve at all.

an osteopathic doctor. 2007).¶ . 1990). sensitivity to climatic change and excessive sweating Cerebral dysfunction. Factors that contribute to perpetuating the symptoms and consequent disability Young women (average age 32) are 3 times more likely to get CFS than men (Dowsett. cognitive difficulties. including deterioration in memory and concentration. based on what is found. emotional or infections lead to an overstrain of the sympathetic nervous system. y y y Muscle Fatigability with tenderness. but the discovery will take time to be absorbed and accepted by the medical community as a whole. and the Oxford Criteria for CFS (Appendix 3) but as Wessely et al (1999) have discovered. However. Other authors remain as bemused as to the exact origin of the condition. The reason for this is multifaceted and Shepherd (1999) suggests that this is likely to occur for the following reasons: y y y y Possibly a hormonal link with CFS (Harlow et al. based on the theory that µdifferent stress factors whether physical.3. the µcurrent classification for CFS stands inadequate and unresolved. (Appendix 1). (Perrin. It would appear that this could be revolutionary as regards treatment of the condition. It is clear that the Royal Free Outbreak and the symptoms currently listed by the NHS are referring to the same illness thus adding credence to the views of those who fought for its recognition as far back as 1955. sleep disturbance and mood change The current NHS µsymptoms¶ are less succinct but essentially similar. Appendix 2). diagnostic criteria has been set out by various bodies including Centre of Disease Control (CDC. In the meantime. Mostert (1999:72) states that there are no tests to confirm or refute a diagnosis of CFS. Shepherd again states that during pregnancy women with CFS often see an improvement in their symptoms Mothers and women of young children may be more exposed to infection It is harder for mothers and women with domestic and family commitments to take time off when they should be resting Women are more knowledgeable about CFS thus more likely to get a diagnosis Allopathic Criteria for diagnosing CFS The following diagnostic criteria are from Dr Melvin Ramsay who was The Royal Free Hospital¶s infectious diseases specialist during the outbreak in 1955. Raymond Perrin has developed a technique for diagnosing CFS. 1996).¶ He goes on to suggest that a build up of toxins in the fluid around the brain and spinal cord are the result of a nervous system overload. He has discovered definite physical signs common to all CFS sufferers and has developed a physical examination with a definite diagnosis at the end. twitching and spasms Circulatory Impairment encompassing cold extremities. There have been numerous other definitions since then (NICE guidelines run to over 50 pages) but µDr Ramsey¶s original work remains the best clinical description to date¶ (Shepherd:1999: 7). allergies. recently.

Wessely. hormones. concluding as a clinical guide µThat there is insufficient evidence to recommend homeopathy as a treatment in chronic fatigue syndrome¶. The results showed that 47% of the patients in the treatment group showed significant improvement compared to only 28% of the placebo group. Drug therapies have included anti depressants. where the methods of prescribing and case analysis are so clearly different. Similar problems presented with the analysis of a trial undertaken by Awdry (1996). In response to the same study. Research has concluded that these approaches have not been significantly effective: µThere is no pharmacological treatment or cure for CFS/MEµ (National Institute for Health and Clinical Excellence) Homeopathic Research and the requirement for Evidence Based Medicine (EBM) in relation to the credibility of the Randomised Control Trial Significantly. She used a triple blind design (patient and homeopath blind to group assignment and data analyst blind to group until after initial analyses to reduce the possibility of bias due to data analyst) in a trial where patients were randomly assigned to homeopathic medicines or placebo. They stated that the internal validity was µquestionable and insufficient to render reliable results¶. The study had two outcome measures: a daily wellness graph and a self-assessment chart to be completed at the end of the trial ± his results are summarised overleaf.Much research has been conducted in terms of conventional medical treatment for CFS. with the difficulty in performing homeopathic research trials under the same µconditions¶ as allopathic trials. One hundred and three patients meeting the Oxford criteria for CFS were recruited to two specialist hospital outpatient departments in the UK and attended monthly consultations with professional homeopaths. Here the different paradigms of allopathic and homeopathic medicine are clearly indicated. corticosteroids. Outcomes were assessed at six months using the Multidimensional Fatigue Inventory (MFI). The study certainly hasn¶t conclusively answered the question of whether the effects are purely due to placebo or if there is a specific homeopathic component in homeopathic remedies. Awdry considered the results to be encouraging. 2004:211). Hotopf and Sharpe (1999:387) were sceptical in their opinions even though the study data suggested a 33% improvement in the group taking homeopathic medicines as opposed to a 3% improvement in the placebo group. the British Medical Journal¶s Clinical Evidence (2007) interprets the research differently. In conducting a statistical analysis of the data collected in the study. considering Awdry¶s study to be of poor quality and stated the outcome as µinconclusive¶ This once more demonstrates the difficulty in . 2003:229). antiviral medications as well as immunologically targeted drug treatments. Awdry¶s trial was a randomized double blind trial involving 64 participants each of whom attended at least 12 clinic visits over a 12 month period. (Afari & Buchwald. Fatigue Impact Scale and the Functional Limitations Profile (FLP). (Walach. (Weatherley-Jones. Another author appraised this trial concluding. Afari and Buchwald (2003:228) concurred. Ninety two patients completed the trial (47 simillimum treatment and 45 placebo). 2004) The trial was published in of the Journal Psychosomatic Research (2004) concluding that ¶There is weak but equivocal evidence that the effects of homeopathic medicine are superior to placebo¶. much of the recent specific homeopathic information available on CFS highlights an RCT carried out by Dr Elaine Weatherley-Jones at the University of Sheffield.

which took many years to understand. then it would conform to known principles in physics. or maintain itself¶ (Hahnemann 2003:15). living or not has added great weight to his ideas. 2006) Clearly. states that evidence based medicine is µabout integrating individual clinical expertise and the best external evidence¶ Sackett et al (1996). Disraeli (1804-1881) was aware of the dangers of basing judgement on pure statistics : µThere are three kinds of lies: lies. but this does not mean that the therapy is not effective. not suited to the homeopathic paradigm. Kent refers to Vital force as µsimple substance¶ µenergy is not energy per se. creating an immediate bias before any research is undertaken. Director of the UK Cochrane Centre. Vithoulkas in the Science of Homeopathy (1980) looks at the Vital Force in more scientific terms and suggests that it can be viewed in terms of the electromagnetic energy. When this energy is disrupted by illness µThe Vital force is unable to feel. limited methods. and µIt is only the pathological untuned vital force that causes disease¶ (Hahnemann. Aphorism 10. (cited in House of Lords report on CAM 2000). although this is still somewhat controversial. before a therapy is to be advocated. requiring lower standards of proof for conventional medical treatments than they do for CAM. 2001). 1996) An article in The BMJ. The House of Lords report on Complementary and Alternative Medicine (2000) states that there are several types of evidence that is required. but it is a powerful substance. Sir Ian Chalmers. Aphorism 12.¶ (Disraeli. Many researchers a priori see homeopathy as scientifically implausible. y y y y Evidence that the therapy is efficacious above and beyond the placebo effect Evidence that the therapy is safe Evidence that the therapy is cost effective Evidence concerning the mechanism and action of the therapy . Central to homeopathy is Hahnemann¶s idea of The Vital Force. 2003:19). something that is inherent in all living things. He goes on to discuss that should the vital force be synonymous with the electrodynamic field in the body. cited by Rutten et al. The advent of Kirlian photography where the electrodynamic field surrounding all objects.measuring homeopathic µsuccess rates¶ by conventional. 1990:61). the results of these trials are sufficient proof to homeopaths of the success of the research given that µmore people in the homeopathic group showed clinical improvement on all primary outcomes¶. and is endowed with intelligence that is of itself a substance¶ (Kent. damned lies and statistics. (Walach. suggests that conventional Medicine is biased against Complementary and Alternative Medicine (CAM). (Awdry. Homeopathic views such as these may be difficult in concept to grasp. A similar example is the action of aspirin. Some of the theories put forward to explain the µmechanisms¶ of homeopathy can indeed be confusing to both the homeopath and allopath. which the researcher sees as a spirit like essence animating an undefined energy which is capable of fuelling a living organism. even though a clear understanding or exact hypothesis as to its mechanism (or that which is adapted to the scientific paradigm) still eludes us. act. though was still used and its effectiveness applauded.

homeopathy is more than just the placebo effect. this method of assessing evidence has huge limitations. ³The finding of significant differences between the effects of placebo is consistent with a recent meta-analysis of placebo controlled clinical trials in homeopathy in which the authors concluded that their results were incompatible with the hypotheses that clinical effects of homeopathy are completely due to placebo. Hotopf and Wessely. Linde. 1997). the translator. Given that the¶ Power of the Placebo¶ is constantly being used as a measure against homeopathic remedies and in homeopathic RCT¶s. 2007. at least in the near future.¶ Hrobjatsson and Gozsche (2001) state: µPlacebo is difficult to define satisfactorily.6 % of CFS patients improved from placebo. stating that the placebo effect can be demonstrated under appropriate conditions. Cho. Jerome. The following quotation is encouraging to the homeopath. As discussed in the introduction to this study. but the conclusion of these reviews clearly stated that µwe found little evidence that placebo had powerful clinical effects¶. urinary tract infections and heart disease. (2005) in a recent review and meta-analysis showed that 19. In clinical trials placebos are generally control treatments with a similar appearance to the study treatments but without their specific activity. The word placebo originates from the Latin µI Will Please¶. stated that the placebo effect does work in µperipheral disease processes such as asthma. We therefore defined placebo practically as an intervention labelled as such in the report of a clinical trial¶ Hrobjartsson and Gozsche conducted studies in 2001 and 2004 which analysed clinical trials µcomparing placebo with no treatment¶.The researcher must affirm that contrary to popular belief. Meissner et al. compared to the widely accepted figure of about 30% for other illnesses. It is clear that RCT¶s will continue to be used in both homeopathic and allopathic trials. For instance. even though he is allowing allopathic testing to set the criteria for homeopathy (albeit incompatible). Similarly Barford (2005) concurs. It was found that in studies with a binary outcome (ie: improved or not improved) µplacebo had no significant effect regardless of whether these outcomes were subjective or objective¶. One of the most significant recent developments regarding the thinking as µto what is evidence¶ was delivered by Sir Michael Rawlins. There was a small beneficial effect in the treatment of pain however.´ (Linde. is clearly stating that even under these circumstances. accurate definition and research into this concept is warranted. translates this as µI will please the Lord in the land of the living. This could be explained by the already low expectations of the patient due to disappointing treatment outcomes in the past. Criticism of their meta-analysis following this conclusion ensued on the basis that their control group covered a highly mixed group of conditions. chairman of NICE µOn the Evidence for Decisions about the use of . It was originally seen in Latin text in the bible µPlacebo Domino in Regione Vivorum¶ (Psalm114: 1-9). here. patients with CFS have a lower rate of response to placebo than many other illnesses. hypertension etc¶ but not for processes reflecting physical diseases such as Crohns. Two meta-analyses were undertaken involving all 156 clinical trials in which an experimental drug or treatment was compared to a placebo/untreated group.

time and energy. A recent study of 153 trials completed in 2005 and 2006 showed a median cost of over £3 million with one trial costing £95 million Often carried out on specific types of patients for a relatively short period of time. similarly observational studies have defects but they also have merits. Interim analyses of trials to assess whether the treatment is showing benefit are now common. with much of the µsuccess¶ of the therapy being evident through case studies and observation. It is clear that what he is purporting is highly significant to the homeopath. stating that they are: Table 1. µContrary to a recent claim. an integral part of this study. It was clear that Rawlins highly-rated observational studies. Sir Michael outlined the limitations of RCTs in several key areas.Therapeutic Interventions¶. particularly historical controlled trials and case-control studies. Rawlings cited Jadad 2007 stating that µHierarchies place RCT¶s on an undeserved pedestal. this speech was delivered before the fellows of The Royal College of Physicians (Rawlins. only observational studies can realistically offer the evidence required for assessing less common or latency harms¶ (Rawlins. passionate and erudite in its content.¶ This is the fundamental essence of the speech which clearly has implications for any physician. allopathic or homeopathic and for this reason the key points of his speech are summarized in order to contribute to the understanding of trials in relation to research. which leads to misinterpretation of the results. ( according to Sir Michael Rawlins) Impossible in treatments for very rare diseases where the number of patients is too limited Unnecessary when a treatment produces a dramatic benefit Often stopped early. Lionel Milgrom (2009) in alluding to Rawlins¶ speech. but the possibility that an interim analysis is a µrandom high¶ may be difficult to avoid. Limitations of RCT¶s. It is ground breaking and thought provoking in its delivery. became the µcollective voice¶ of the homeopath. especially as there is no consensus among statisticians as to how best to handle this problem Expensive in terms of money. although the technique has advantages it also has significant disadvantages. 2008). He begins his address noting that both Rene Descartes (15961650) and Thomas Hobbes (1588-1679) regarded observation to be the most appropriate . 2008:33). Known as one of the lectures for µThe Harvein Oration¶. when he stated: No doubt Sir Michaels¶ words will be music to the ears of those in homeopathy and CAM struggling to get their healing message heard against the cacophony of sceptical µheavy metal¶ being pumped out by a largely hostile media. whereas in clinical practice the treatment will be used on a much greater variety of patients and for much longer. but other forms of observational data can also reveal important issues.

a remedy¶s action is evident in a more holistic way. Jay Goldstein. there appears to be methodological problems in their application to homeopathy (Kaptchuk 1998. and ends it stating that Charles Darwin (1809-82) µconceived the theory of evolution as a result of close observation. Kaptchuk 2002). (Rawlins 2008) Homeopathy and the RCT Homeopath Given that for now at least.¶ (Goldstein: 1991) It is significant from an allopathic perspective that there is a µshift¶ from a µsingle-cause approach. some RCT¶s have nonetheless shown that µhomeopathy can be efficacious. stating µNo particular line of treatment seems to be consistently effective so a broadbased holistic and multi-disciplinary approach would at present seem appropriate. California states that there is an increasing consensus that the illness (CFS) is µa virally induced. the interpretation of µactual proof¶ is questionable. so would be generally attributed to the placebo effect (Kaptchuk. such as a virus. Fibromyalgia. Director of the Chronic Fatigue Institute in Beverley Hills. as even if the clinical effect is positive as in the Weatherley-Jones et al (2004) trial. 2006. Many researchers concur that we must µredirect our energies to whole systems healthcare¶ (Long et al. to a multicausal approach. with improvement seen in mental and emotional symptoms and in many secondary physical symptoms. RCT¶s are the gold standard of medical research. MD. Because homeopathy stimulates the body¶s healing mechanisms. cytokine-mediated psychoneuroimmunologic disorder¶ that occurs in genetically predisposed individuals.¶ The Multifactored Perspective and the Homeopathic Link: Psychoneuroimmunology as Scientific Evidence. They are designed to test those medications which target specific areas in the body. (See Figure 2. 1998). the exact mechanism of action could be considered irrelevant. the focus of the µcure¶ does not lie in one specific organ. He sees four µinfluences¶ which are responsible for the development of neurosomatic illness. There is often no way of measuring this in an RCT.¶ The essence of this speech is summarized in the following quotation: For investigators to continue to develop and improve their methodologies. Smallwood 2005. He cites over 50 conditions that belong to this same µgroup of diseases¶. research must focus on whether a patient¶s symptoms can be controlled by homeopathy. Mason et al 2002). despite the shortcomings outlined above. if only the mechanism of action were more plausible¶ (Kleijneet et al 1991). Thus its way of achieving efficacy is non-specific. yet as Rawlins (2008) states µthe technique has important limitations and imperfections¶. for decision makers to avoid adopting entrenched positions about the nature of evidence and for both to accept that the interpretation of evidence requires judgment.¶ (Goldstein 1996:2). Essentially. Despite the incompatibility of homeopathy to this method of testing. Goldstein refers to CFS as µneurosomatic disorder. Irritable Bowel Syndrome and Premenstrual Syndrome to name but a few. it is clear that on analysing the literature surrounding RCT¶s. . Lilley). the RCT will continue to be used.approach. 2008). Homeopathically. The problems of methodology are complex. (Tyler. Jenkins 1989 concurs. therefore having a specific effect.

1996) Agents. A Typical Neurosomatic New Patient Treatment Protocol (Goldstein.1 % gtt T OU Nitroglycerin 0.y y y y Genetic susceptibility and µExpression of the trait¶ Developmental issues in childhood Viral encephalopathy and genetic susceptibility An increased susceptibility to environmental stressors.04 mg sublingual Nimodipine 30 mg po Gabapentin 100-300 mg Badofen 10 mg Oxytocin 5 -10 UIM QD or BID or Synlocinon 1 ± 2 pufls TID Onset of action 2-3 seconds 2 .¶ Con¶t. Goldstein¶s results are inevitably disputed ± for Wessely. allopathic drugs are seen as suppressors of The Vital Force. (1999:399) disagree stating that: µNo pharmacological agent has yet been shown to be convincingly helpful for CFS. He calls this method of prescribing µcontraria contrariis¶ (Aphorism 57). Hotopf and Sharpe. tried sequentially Naphazoline HCL 0.¶ (Engel. Goldstein¶s treatment protocol (see fig 3) is shocking to a homeopath: µI administer multiple medications sequentially in the same office visit until one has time to exert its effect before trying the next¶.¶ The fact that µusing this protocol most patients are dramatically improved in 1-2 office visits¶ (Goldstein 1996:17) makes one wonder how long this µcure¶ lasts. The multi-causal perspective represents a `historic shift in how the medical world thinks about what determines health and illness.¶ (Hahnemann S. the opposite of treating µlike with like..L:1997). Figure 3. more life threatening ailments are created in its place.3 minutes 20-40 minutes 30 minutes 30 minutes 15 minutes to 72 hours Duration of action 3-6 hours 3-6 hours 4-8 hours 8 hours 8 hours 12 -24hours . Hahnemann states in Aphorism 37 that: µIf the disease is treated with violent allopathic drugs. 2003:34). other graver. one is clearly sceptical from a homeopathic perspective. Homeopathically. (Goldstein 1996) The summation of the first three points results in impaired flexibility of the brain relating to the concept of µallostatic load` described as `The price the body pays for containing the effects of arousing stimuli and expectation of negative consequences` (Goldstein 1996:75). G.

5 ± 75 mg BID Glycine powder 0.20 mg HS Sertraline 25 ± 50 mg QAM or Paroxetine 10 ± 20 mg QAM Biipropion lOOmgTID Nefazodone 100 ± 300 mg BID Venlafaxine 37.2 weeks Lidocaine 200 ± 300 mg in 500 ml normal saline infused over 2 hours Base d on Gold stein ¶s publi catio ns.5 mg Pindolol 5 mg BID Lamotrigine 25 ± 50 mg QD Sumatriptan 3 ± 6 mg SQ Ranitidine 150 mg BID Doxepin HCL elixir 2 .8 weeks 4-6 hours 6-12 hours 6-8 hours 4-6 hours 8 ± 12 hours 12 hours 24 hours 16 hours 12-24 hours variable 1. But how far can this conv erge nce be seen to com .25 ± 0. there seem s to be a meet ing of mind s amo ngst the hom eopat hs and allop aths regar ding the psyc hone uroi mmu nolo gical basis of CFS.Pyridostigmine 30 ± 60mgpo Hydralazine 10-25 mg po Mexiletine 150 mgpo Tacrine 10 mg Risperidone 0.2 days 30 minutes ± 8 weeks 2-8 weeks 1-4 weeks 1 hour 8 24 hours 24 hours 24 hours 24 hours 30 minutes 6 ± 8 hours 2hours .4 Gm/Kg/day in juice or Cycloserine 15 ± 50 mg QD Felbamate 400 mg 30 minutes 30-60 minutes 30-45 minutes 30 minutes 45-60 minutes 15 minutes to 7 days 30-45 minutes 15-30 minutes 1 hour ± 1 week 1 1 hour 1 hour.

the outer image expressing the inner essence of the disease. 2003:12) Aphorism 7. As both are highly trained in orthodox medicine. In treating the underlying cause of illness. In homeopathy. puzzling and elusive. in March 2009. Many of the diseases Vithoulkas refers to as µnew diseases¶ (1991) are ironically seen by Goldstein to be part of neurosomatic group which would benefit from his µtreatment protocols`. their cause unknown. Similarly. the neurosciences. µIndeed numerous studies conducted over the past 30 or so years have demonstrated that a wide variety of stressors can alter many aspects of the immune response¶ (Maier et al. Asthma. this once more demonstrates a shift in allopathic thinking to a more integrated approach Thus. µHow responsible for this phenomenon were the chemical drugs we were using? Is it possible that there is a connection between the practice of drug overuse and the inability of our immune system to prevent the appearance of these alarming new diseases?¶ (Vithoulkas 1991:4). received the prestigious Mani Bhaumik award. ReichenbergUllmann (1995). Dr Herbert Benson. Are the so-called medications used to µcure¶ disease by the likes of Goldstein actually causing them? PNEI Axis as Evidence Given that one has established that CFS is a multi-systemic disease.ply within the confines of EBM? Psychoneuroimmunology is described by Rober Ader (2007) as a µconvergence of disciplines. The concept has effectively grown from the realization that the immune system does not operate autonomously and research in this field in recent years has proved that the brain and immune system represent a single. to effectively attempt to create homeostatis. a cardiologist and associate professor of The Harvard Medical School and Director Emeritus of The Benson Henry Institute for Mind Body Medicine at Massachusetts General Hospital. the totality of symptoms deems that the mind state is at the top of the hierarchy µand the deepest core of an individual¶s health¶ (Ullmann 1991:16). namely the behavioural sciences. 1994). Watkins A (2007) and Ader et al (1995) concur.¶(Hahnemann. integrated system of defence. Herein lies the ultimate dilemma. endocrinology and immunology. Dr David Felton. Chappell (1997). anatomical and physiological evidence that the body¶s systems as outlined. as a pioneer in Mind Body Medicine. are those which need to be explored in order to treat a patient successfully. This is irrefutable and is clearly demonstrated above. 2003:73) Vithoulkas groups CFS together with Cancer. who heads up the Department of Neurobiology and Anatomy at the University of Rochester Medical Centre in New York. ie: of the disturbed vital force¶ (Hahnemann S. engage in an interactive dialogue. Ullmann (1991). MS etc as µnew diseases. has been awarded several prestigious grants for his growing work in the field of psychoneuroimmunology (PNI). it important as part of this study to discuss the way in which the homeopath can treat the condition based on the philosophy of those such as Sankaran (1997). Hahnemann clearly states in Aphorism 74 that µAmong chronic disease we must unfortunately include all those widespread illnesses artificially created by allopathic treatments. the homeopath .¶ (Ader 2007). the evidence suggests that those ideas central to homeopathic philosophy. stating that there is biochemical. µthe totality of symptoms.

essentially a sensation connecting mind and body. hypochondria. These include µneurasthenia. Sankaran sees multi-systemic disease on a psychoneuro-endocrine-immunological axis. Sankaran considers this state to be µmaladaptive¶ (1999:11-15) and refers to it as µdelusion¶. endocrine and the immunological system. it is interesting to observe that fundamentally they agree on the interaction of all systems in the body. the mind acts on the body through three systems. emotional and physical ± though complex in nature. Sankarans¶ theories sit very well in unfurling the µcentral disturbance¶ which is often elusive. Both Vithoulkas (1991) and Scholten (1993) and Chappell¶s (1997) views are in accordance with those of Sankaran in that the µmind state¶ is dominant and intrinsically linked with the other systems in the body. These three planes interact with extreme intelligence and react to any stimulus in a concerted manner that is always consistent with their own idiosyncrasies¶ (Vithoulkas 1991:59). depending on susceptibility. hormone production. 1995:16-17). (Hahnemann 2003:78). and the immune response¶ Hahnemann and Chronic Disease With reference to CFS. hysteria. Dimitriadis (2005) analyses this work and explains that Hahnemann in referring to Chronic Disease is relating to every disease which is neither acute. idiocy.¶ was first published in four volumes (1828-1830) the second edition of five volumes (1830-1835). He goes on to say that µthe homeopathic physician must still piece together the perceptible symptoms and peculiarities of the chronic (psoric) disease . even if the symptoms are physical. targeting the µcentral disturbance¶ which could appear anywhere on this axis. Vithoulkas has essentially created a model which recognises the uniqueness of the individual and their particular susceptibility.¶ (Sankaran 2005:10). Although vastly different in their approach to treatment. Given that CFS is multi-systemic. Where Sankaran looks as CFS as a multi -systemic disease on PNEI axis. constitute distinct and separate entities that differ essentially in their vibrational frequencies and informational patterns. and disease too is a false perception of the present. the nervous. begins with a mental or emotional trauma. epidemic. allowing flow of energy between each of the systems.µwill often find that the root of illness. (as previously shown) this correlates with Jay Goldstein¶s (1996) thinking of CFS as µpsychoneuroimmunologic disorder µthe study of how emotional and other psychological responses influence the biochemistry of the brain. He calls this µThe Vital Sensation¶ which can be brought out of the patient through in. madness. epilepsy and all kinds of fits. µA delusion is a false perception of a reality. mania. The homeopath then searches for µthe state¶ of each individual that allows the person to be susceptible to particular symptoms¶ (Ullmann.deficiency of the senses and every type of pain¶. sporadic nor chronic venereal disease. Reichenberg-Ullmann. Sankaran maintains his belief in this system but has subsequently extended the µdelusion¶ idea. Although Vithoulkas is one of the most classical homeopaths and Sankaran of a newer breed.depth case taking. it is fundamentally essential to consider how Hahnemann views chronic diseases. A remedy will act on the Vital Force through this axis. inferring that there is a deeper underlying state which also manifests on the physical sphere. µEach of these three planes ± the mental. softening of the bones«. It is kept in homeostasis by the Vital Force. Essentially the PNEI axis is like an energy grid. Aphorism 80. melancholia. he refers to as PNEI (Sankaran 1999:52). In short. His original and unique work on Chronic Disease µDie Chronischen Krankheiten. He states also in this Aphorism that psora is the true underlying cause. The whole mental state of a person is an expression of this false perception.

Classical Method: The Weatherley-Jones et al trial (2002) and that of Awdry in 1996 are similar in that the approach to their cases was essentially classical or Kentian `taking the whole person into account as far as this is possible and treating the person simultaneously on all levels. This reflects Hahnemann¶s fundamental belief and the challenge that CFS presents to the homeopath. It is based on the premise of µlike cures like¶ (Similia Similibus curanter. S. 2003:125). followed by Physical General Symptoms and disease symptoms or Physical Particulars (Kramer. as so many common symptoms are presented with CFS and one is searching for those symptoms which are µstriking. Clearly.¶ (Hahnemann 2003:91). mental and emotional` (Watson.being treated just as carefully as before to form an indicative picture.¶ According to de Schepper (2004). what makes it so. there are different approaches as discussed to measuring the ¶success of treatment¶. 2004:12). each of which will be explored. because no true cure of a psoric disease can take place without the strict individualization of every case. Awdry 1996). it cannot be prescribed upon unless there is a µconcomitant from another sphere¶ (Sankaran. the success measured in recovery. physical. to enable future prescribing and case management to be more effective. He states that this is the basis of Boenninghausen¶s doctrine of concomitance and µthe concomitant is to the totality what modality is to the symptom: it is the differentiating factor¶. it is essential to discover which methodologies were used in prescribing. 2002. It follows that a particular case of disease can be destroyed and removed most surely. concomitant symptoms. 2006). Aphorism 95. and which had the most success in treatment in relation to CFS. The homeopath. Methodologies Through the analysis of published cases and trials. Specific methodologies will be highlighted and critically analysed as to effectiveness in practice. in using this method of prescribing is searching for the µsimillimum¶. and what is the optimum method of administration? It is hoped that a consistency of approach can be determined in those cases that have been successful. This principle was first introduced by Paracelcus (1493-1541) and is outlined in Aphorism 27 in The Organon µThe curative virtue of medicine thus depends on their symptoms being similar to the disease but stronger. published case studies and homeopathic literature including commonality in remedies.). swiftly and permanently only by a medicine that . both Boger and Boennninghausen base their repertories on Aphorism 95. (with reference to the research question). which states: µpatients become so accustomed to prolonged suffering that they no longer pay much if any attention to the many smaller. An evaluation of the evidence of homeopathic treatment as seen in two RCT¶S (Weatherley Jones. unusual or peculiar¶ (Hahnemann. Sankaran¶s views of µmodalities reflecting the central disturbance¶ is reflected here also. Aphorism 153. Mental and Emotional symptoms (including delusions) are given priority. stating that if the specific mental state is discovered. with a view to suggesting the optimum approach to a case. thoroughly. This helps to further understand that if homeopathy is successful in the treatment of CFS. methodologies and philosophy. 1999:68). strange.

As with other homeopaths. this should still be the focus of the homeopathic enquiry. the straw that broke the camel¶s back.¶ (Hahnemann 2003: 28). Harthoorn (1997) sees viruses as being a main aetiology and in a trial of 219 case histories. These together with bowel nosodes added up to 8% of cases. steers clear of the polychrests.¶ Aetiological prescribing Awdry (1996b) states that overwork is a strong aetiology. in contrast who has worked with many cases of CFS. regardless of methodology used. De Schepper (2004) concurs stating that µalthough often the problem cannot be rectified by a single medication. µThis method is a variation on the aetiological method. Hoover (1998). are like trying µto fit a square peg in a round hole with mediocre results¶ and often µchooses remedies on materia medica knowledge. more than one was given. but probably not a remedy that would have appeared on a repertorisation sheet. similarly where viruses and vaccinations were seen as µthe cause¶.can make a human feel the totality of symptoms most completely similar to it but stronger. refined by Harthoorn was initially used in relation to a number of hepatitis cases which responded well to the following protocol: y The virus in question (in this case hepatits A or B) was administered in high homeopathic potency. the constititutional approach was supported by part patient or miasmatic prescribing in conjunction with lifestyle changes. and reaches a constitutional prescription of onosmodium µa small remedy rarely prescribed by means of µcareful repertorisation and materia medica work. the appropriate antidoting remedy was given. it can be controlled by a total approach. Aphorism 27.¶ In the case he is discussing. where there is evidence of a sequence of causative factors (traumas that have systematically contributed to the patient¶s current state of disease¶ (Kramer 2005:58). he prescribes µscutellaria¶ which is very specific to the patient¶s symptoms. most responded well to viral therapy. seeing the virus infection as µmerely the final straw which serves to dismantle an already shaky status quo. however. mainly single remedies were prescribed but where remedies were prescribed sequentially. This approach. use the constitutional method exclusively in their trials.¶ In contrast. 17% of the cases required an aetiological prescription of carcinosin as µa specific antidote to glandular fever¶. And most often. Both Weatherley-Jones (2002) and Awdry (1996) did not. stress was the ultimate triggering factor. Similarly. Scholten 1998 In the Weatherley-Jones trial. Dimitriadis (1991). taking in the totality of symptoms and applying the constitutional method. Case management predicted when the remedy should be changed and the most common potency prescribed (to avoid aggravation) was Lms. Klein (1998) finds that polychrest prescriptions particularly for CFS. emphasises that µsome cases are not suitable for polychrests¶. it is the single cause of relapse.¶ Other constitutional prescribers are Allen (1993) Hoover (1998) Klein (1998). it is still µthe simillimum¶ that is sought. The remaining 75% of cases were prescribed polychrest remedies.¶ De Schepper (2004) mirrors this theory stating: µIn every CFS patient that I have seen in my practice. . It is important to note that even if the constitutional method of prescribing is not used.

the results are based on observation and µcure¶ with comments such as µI had been dead for 10 years and now I am alive again. it has been used with other viruses such as herpes zoster and herpes progenitalis amongst others. Blood tests show the three most commonly implicated viruses in CFS/ME to be: Coxsackie. particularly remedies aimed at supporting the liver and kidneys. causing our bodies to react to stress. but my impression is that it ranges from as little as a day or two up to a month or longer. I am unsure how much time is allowed to elapse between each prescription. Epstein Barr and Cytomegalo. 1995). particularly in bacterial infection. applied as above and µcomplete recovery occurred in 81. Organ support. but if the exact virus present can be identified-by orthodox or complementary methods-high potency preparations of that virus may be more successful¶. anti-fungal medication. abdominal discomfort and excess flatulence¶ as part of their condition and he strongly advocates support of the gastro-intestinal system. This trial was undertaken in Africa and it was not possible to conduct double-blind procedures in the environment of practice. Jenkins recommends this approach. Dr Julie Allen (1993) uses Isopathy µdesensitising her patient suffering from intolerance to wheat¶. The above protocol. (Harthoorn. bacteria toxins. Isopathy.y y y Organ therapy (the liver was treated in these cases) to induce regeneration of the tissues and function Immune system boosters given Constitutional remedies given in addition to remedies for hepatitis. vaccinations and chronic stress. including the gestation period.¶ being muted by grateful patients. Similarly.74% of cases treated¶. 1997) Dowson (1993) states: µThe use of generalized homeopathic anti-virals may be beneficial. Yet again. He also recommends µspecific nosodes. Watson defines this as . he suggests an anti-candida diet. depending on the severity of the shock being treated. Weatherley-Jones (2004) also employed the use of bowel nosodes µprepared remedies from non lactose fermenting bacilli from the intestinal tract¶ (Kramer 2006:68) in eight percent of her cases in the trial. Remedies are then given in reverse order which are known clinically to be capable of neutralising the effects of each. and on the potencies being used. He suggests an effective approach to chronic complex cases (like CFS) that traditional homeopathic methods have failed to cure. Allen (1992) concurs stating: µIt is thought that viruses alter our immune systems. Tautopathy Dowson (1993) discusses that patients with CFS complain of µaltered bowel action. often because the picture was confused by drugs. Like Awdry (1996). Such was the success of this trial in relation to hepatitis. A different approach to aetiological prescribing is taken by Rudolph Verspoor in his book Homeopathy Renewed (1995). The method is sequential therapy and is outlined below by Ian Watson: It involves taking a detailed case history and determining the nature and exact sequence of all shocks and traumas that have occurred in a person¶s life. often seen in combination. Organ support ¶involves identifying weakened organs in the system and prescribing remedies that are known to have an affinity for those organs in order to bring about improved function¶ (Kramer 2006: 64). (Watson. chemicals and the like¶. combined with homeopathic drainage and renal stimulation¶.

a granule of PC CFS (the remedy name) dissolved in water and to be taken daily after vigorously shaking. another µprotocol¶ to try and get to the root of the condition. Awdry. He extended his thinking to chronic diseases. (Ullmann 1991:13). The remedy was designed as discussed with an emphasis on the pathology. other µC¶ notes reverberate.µprescribing a remedy made from the supposed causative agents or products of a disease to a patient suffering from that same disease¶ (Watson 2004:34). the results discussed with Chappell to formulate µthe identity of the disease¶. the differentiating factor from isopathy being that it focuses on a drug or toxin taken by the patient that appears to have caused the symptoms (Kramer. which has the ability to memorize and store information. (Chappell. It was another variation away from constitutional prescribing. nosodes and tautopathy in his trial. which are made by imprinting specific information into water. as is the case for all homeopathic remedies diluted beyond Avogrado¶s number. This is mirrored by other homeopaths (Vithoulkas 2004. did have a level of success. Due to the high number of antibiotics given to many suffering from ME. Chappell is a controversial figure who went to Ethiopia in 2001 to help find a homeopathic solution to AIDS. Most of the aggravations faded away and were followed by an amelioration. Chappell refers to his remedies as µresonances¶ to distinguish them from being µexactly homeopathic¶. referring to the remedies as µthe second simillimum¶. because it is ahead of the science and because the terms aren¶t there to explain it within the science¶. which he sees as µslow running epidemics based on bacteria and viruses¶. 2006). candida is thought to be a causative factor by several authors. (Balch 1993. Aug 07). Much research was done before by the homeopaths involved. Realising the normal homeopathic approach was not viable due to µlack of information in the homeopathic information set¶. Scholten1993. he developed a method of reverse engineering a remedy µfrom the totality and essence of the pathology¶. Chappell (1997) refers to a state of µstuckness¶ which has µfeeling and physical components acting together synchronously¶. Harthoorn (1997) uses organ therapy. dengue fever. Verspoor 1995). Alzheimer¶s and MS amongst others. His remedy for AIDS was known as PC1 and he generalized the approach to other epidemic diseases (malaria. 1991). CFS being accompanied by remedies for Parkinson¶s. µC¶ notes still have a hypersensitivity to the µC¶ resonance. Individual treatment ensued with some . Ullman clarifies the idea of resonance with an analogy to music: µIt is commonly known that when one plays a µC¶ on the piano. Chaitow. Like other approaches (WeatherleyJones 2002. All the patients suffered immediate aggravations and were advised to discontinue the remedy until their next consultation. The rationale behind Peter Chappell¶s CFS trial Sankaran alludes to µcentral disturbance¶ and the connection between mind and body and how one µvital sensation¶ expresses the fundamental state. the trial although small. who looked at over 50 cases treated constitutionally. diphtheria and gonorrhoea). there is a basic principle that two things resonate if and only µif¶ they are similar¶. (including homeopathic) had failed. The rationale behind Chappell¶s trial was clearly to find a cure for CFS. 2002). Chappell is controversial as he does not reveal the content of his remedies: µI am very reluctant to explain something fully which would leave the whole situation open to ridicule. In music theory (and physics). Even on a piano at the other end of the room. similar to those discussed already by the researcher. 1996). where so many other methods. These became known as µGenus chronicus¶. (Sankaran.

half the group showed µremarkable improvements¶ and the final conclusion for 50% was that they were able to be prescribed a constitutional remedy because the picture had been cleared. indeed embracing a diversity of approaches. are denigrated due to lack of understanding as to the method. that current methods of ascertaining the efficacy of homeopathy are inadequate.¶ He is convinced from experience that that it is wrong to replace judgement with µmore robust approaches¶ such as the RCT.) This concurs with Rawlings theory that case studies and observations should be given weight as evidence of cure. better with the PC remedy than with any other treatment they had had before¶ (Vervarcke 2005. they were an unbiased cross-section of the available evidence because not every case was cured. resistant to any cure. µOur mechanistic society tends to overestimate the value of apparatus. Awdry. the researcher would like to see in practice that which Rawlins (2008) proposes: µthat hierarchies of evidence should be replaced by accepting. who have had real successes in terms of µcure¶. this study has comprehensively demonstrated that observation and judgment must consistently take precedence over statistical analysis alone. 1996) as demonstrated were open to interpretation. based on observation. depending on who was critiquing them. These will be more suited to the homeopathic paradigm. Thus. Researchers at Sheffield University are currently developing new and rigorous research models that will better fit the homeopathic paradigm in all its aspects.) CONCLUSIONS AND RECOMMENDATIONS It is clear from the research involved in this study. that the hierarchy of evidence as is now stands for all methods of assessing the evidence is inappropriate. On balance however µPC CFS could offer a solution in many cases. Most of the cases analysed in this study have positive outcomes. The RCT has obvious limitations as demonstrated by Sir Michael Rawlins (2008) who has been Chairman of NICE for the last ten years. Simply. It could bridge the state of µno reaction¶ on homeopathic remedies and fill the gap in our therapeutic approach. This appears to echo the opinion of Rawlins and other experts in the field of research. it is hoped that more trials are undertaken in the form suggested by Dr Elaine Weatherley-Jones (2004). a small number of the participants either had no reaction or had an aggravation to the remedy µwithout subsequent improvement¶.patients after 6 months µameliorating dramatically. In this sense PC CFS remedy is a solution and success. Dr Elaine Weatherley-Jones. To conclude. based on the findings of this study. Homeopathy is complex and cannot be assessed in a simplistic way. . Too often homeopaths such as Chappell. (Rutten et al. holistic approach. in her paper µPlacebo Control Trials in CAM¶ (2004) concludes that it is time to redirect our energies into a µwhole systems healthcare¶ and µdesign more relevant pragmatic studies of comparative effectiveness¶.¶ (Vervarcke 2005. and there were those highlighted that seemed. 2006). After one year. so far. The results of the trials (Weatherley-Jones 2002. but epidemiology teaches us this is not correct in medicine¶. thus delivering a fair assessment of the evidence. However. based on a multidimensional. As regards research into CFS specifically. Sadly.

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