ANOTHER aspect of Hahnemann’s approach to practical therapy deserves mention. This was his insistence on the giving of just one remedy at a time. In a sense this was called for by the fact that the materia medica provings were carried out with single drugs and not mixtures.
But it was also necessary on the assumption that the prescribed remedy was activating a curative response in the body. He argued that to throw in an additional drug stimulus would tend to confuse the issue and interfere with the selected remedy’s specific effect.
This seems sound reasoning but at the time it was regarded with suspicion and incredulity, and met with active and violent hostility, especially from the apothecaries. That was an age in which poly-pharmacy was the order of the day, the mixtures prescribed containing often a fantastic array of ingredients.
This sort of haphazard prescribing which was not based on any rational hypothesis, was anathema to Hahnemann’s penetrating mind. He was concerned with the body’s reaction to the stimulus of a single remedy.
The simultaneous incursion into the body of multiple medicaments could only result in metabolic confusion. Moreover it would be impossible to attribute any effects produced to the action of any particular ingredient, thus making accuracy in prescribing an impossibility.
If more than one drug is given in one prescription the possibility of synergistic action cannot be ruled out, but it cannot be argued that the effect will be the sum total of the effects of the separate drugs. Rather will the combination function as a single drug.
The ingredient drugs may supplement one another or may antagonise one another, they may even result in inter-reactions that have adverse effects in the body.
Hahnemann was quite convinced in the matter as evidenced by his statements, q.v. Organon para. 234, 235, 236.
“In no case is it necessary for cure to use more than one single simple medicinal substance at a time.”
“It is difficult to conceive how there could ever be the smallest doubt that it is more logical and reasonable to prescribe a single tested medicine for a disease than a mixture of several”.
“For the rational physician finds at once all that he can desire in quite simple medicines given singly, which by their homoeopathic strength can overcome, extinguish and radically cure natural disease. Therefore, he will always act according to the general maxim-Quod fieri potest per pauce non debet fieri per plura-and he will never use as remedies anything but single simple medicines.”
“It is wholly unknown how two or more medicines mixed together may hinder and alter one another in their actions on the human body ; on the other hand a simple medicine used in diseases whose symptom-complex is exactly known will cure if it is exactly and homoeopathically adapted to the case.”
The predilection for combining more than one drug in a single prescription dies hard. Even as recently as the British Pharmaceutical Codex of 1934 a prescription known as “Warburg’s Tincture” was listed as containing no less than 19 ingredients : aloes, elecampane, rhubarb, angelica, saffron, fennel, chalk, gentian, zedoary, cubebs, myrrh, agaric, opium, black pepper, cinnamon, ginger, quinine, camphor and alcohol.
There may be music and poetry in such a list of names but as to therapeutic effects these would surely be highly unpredictable.
An interesting echo in the twentieth century of Hahnemann’s viewpoint is provided by a physician, a pharmacist and a professor of pharmacology writing in the Lancet-January 1954 :
“The historian who records the changes in medical practice during the twentieth century will, without doubt, comment on the remarkable variety and quantity of remedies prescribed. The reason for this apparent boom in drugs is not obscure ; for there has been an enormous increase not only in the number of new drugs but also in the presentation of information about them.”
“But this does not mean that the therapeutic use of drugs today has reached a high peak of effectiveness or of safety. Indeed there is evidence that the simple principles which govern the action of a drug, its absorption, distribution and elimination are not appreciated as they should be.”
“Since our knowledge of the action of various drugs on man is limited, and likely to remain so for some time, it is not difficult to understand how the habit has grown of combining as many effective remedies as possible in one bottle or tablet. Many of the common expectorant mixtures are examples.”
“This time-honoured tradition of combining numerous drugs complicates any attempt to assess the value of any lone component of the mixture ; and such individual assessment is essential for rational therapy”.
“In recent years there has been a g rowing tendency to combine haphazardly everything that can be combined, amphetamine and aspirin, atropine and amidopyrine, iodine and theobromine. This trend has now become absurd in its effects. Even drugs which antagonise each other are combined.” (Herzheimer, Whittet and Wilson.)
Since this was written a further complication has a risen, namely, the possibility of one type of drug potentiating the effect of another drug when these are given concurrently, sometimes with lethal result.
This new danger called forth the following comment in the Lancet: “We should show more respect for our ignorance of the effects of drugs in combination. The risk of harmful effects from drugs given concurrently is a further argument against polypharmacy, in a wider sense, if one is needed.”
These statements show that modern opinion vindicates and confirms the contention of Hahnemann that the ideal way of prescribing is to administer one drug at a time.
The homoeopathic remedies were proved singly, and the materia medica was built up on the observed effects of drugs given singly, either in planned provings or in accidental provings. Only in this way is it possible to obtain the knowledge of how the living body will probably react to the absorption of any particular drug.
Not only do different species of living organisms react differently to the same drug but different individuals in the same species may show wide differences in their individual reactions.
It is necessary not only to know from a study of the materia medica the probable effect of administering a particular remedy in indicated circumstances, but to watch the particular response of the individual concerned.
This again calls for the employment of one remedy at a time for accurate observation and assessment of progress.
It is a matter of experience that certain groups of drugs, grouped chemically, botanically or biologically, may possess the power to evoke somewhat similar effects on the tissues. While each member of the group has its own individual character and genius yet the similarity of action shared in some respects may make the members complementary to one another.
Such complementary remedies given in sequence, and possibly in differing potencies, appear at times to enhance the curative effect, but they are always to be given singly and not in the same dose. A mixture of more than one remedy in a single dose would constitute a new remedy which would require to be proved as such for a proper estimate of its probable effects.
It can be concluded with some fairness that Hahnemann’s advice to employ one single simple remedy at a time is therapeutically both sound and safe.