As clinical practitioners especially as homoeopaths we have more than often patients who are already on one or more than one allopathic medicines when they first come to us. The number of such patients over the decades has been rising. Of course the majority of patients who come to a homoeopath also have an allopathic mind set meaning thereby that they would want to get rid of a single symptom or a disease. Very few are homeopathically oriented i.e. that they would like to be cured in the real sense of the word. Much of the time spent by a classical homoeopath is to convert the patient’s mind set from allopathic to homeopathic before starting constitutional therapy.
In this process we are faced with the challenging task of withdrawal of allopathic drugs before starting the constitutional therapy. In those whom we are successful, the indicated homoeopathic remedy / similimum administered in a correct potency should act in its fullest vigor; where as in others in whom allopathic medications for a particular ailment cannot be stopped, homoeopathic potencies may not have their full extant of working.
So here comes the debate, Is it an essential prerequisite for stopping all symptomatic drugs (allopathic or otherwise) before the patient is put on constitutional treatment with dynamic medicines? So should we or should we not stop the allopathic drugs before homoeopathic treatment? Many would say that there is no rationale of stopping allopathic drugs and homoeopathy can be given concurrently, since homoeopathic potencies act on a dynamic plane where as allopathic drugs act on a physio-chemical level. This question is unique for our times. A point of caution over here is that Allopathic drugs of modern era cannot be compared with those of Hahnemann’s time. During those days, the drugs used were mostly in crude form and their undesired effects lasted for a short period only. This probably was an important reason for the birth of homoeopathy. Majority of allopathic drugs of today are basically toxic in character and have deep constitutional effects and have their own side effects. The composition of the drugs has changed, so also the administration, dosage, reliability and rapidity of action. Due to these drugs, modern medicine rules the roost throughout the globe. But this is not our question.
The protagonists for the first question will put forth the justification that Dr. Hahnemann has not even allowed the use of stimulants as rich diets, strong odors, etc when partaking homoeopathic remedies. So the question of homoeopathic remedies with allopathic drugs does not arise. All material drugs need to be stopped and homoeopathy should be started after a detailed case taking. This may although not seem practical but it is fairly logical for the following reasons.
1. Material drugs palliate or suppress most of the symptoms of the disease and so in a homoeopathic case taking a false portrait is conjured up.
2. Many material drugs like hormonal preparations, chemotherapeutic agents, 4th generation antibiotics, etc. develop a miasmatic stigma of their own type when given for long time and drug diseases are practically incurable or very difficult to cure even after stopping the drug.
Objectives of Treatment – Every physician comes across different types of patients in his daily practice. For rational management, all the true chronic (non- surgical) cases can be classified as follows -
1. Case Type I – These are true Natural chronic disease caused due to chronic Miasms (aphorisms 76 &78). They are curable in nature, hence to be treated with deep acting anti-miasmatic remedy in moderate potency at infrequent intervals. The drug selection is based on the essential totality, constituted by mental and physical generalities. The curative process is based on Herings Laws. In this Case Type, no other symptomatic remedy from any system of medicine – homoeopathy, allopathy or otherwise is to be permitted.
2. Case Type II – These are incurable cases in which the pathological processes in the target organs have crossed the reversible stage. Hence they are either difficult to cure or incurable. In these cases the patient presents with pathological symptoms only. The symptoms are distressing and at times life endangering. True surgical diseases, congenital disorders/diseases and even drug diseases belong to this class. The objective of the treatment is to palliate the symptoms only. In such cases the presenting (distressing) symptoms have to be settled first along with reducing or even stopping other symptomatic (allopathic) drugs he/she is on. If successful, then curative treatment can be opted as in Case Type I. If not then the patient may remain on palliative drugs in low potencies.
3. Case Type III – These are those cases which present with few or more incomplete symptoms. They are termed as one-sided diseases. In them the sickness is constitutional but the presentation is scanty. Such cases have to be managed with broad spectrum polycrests like Nosodes. No allopathic treatment oral or local should be permitted because it hampers the evolution of the sickness which is expected after the nosode.
4. Case Type IV – These are the patients suffering from constitutional diseases like Hypertension, Diabetes mellitus, Bronchial asthma, Epilepsy etc. and are on maintenance doses of allopathic drugs for long. Their clinical manifestations have been controlled. Even the pathological investigations are within normal limits. They are called settled cases. In such case types, gradual reduction of the symptomatic (suppressive) drugs has to be done before any constitutional treatment is resorted. Unfortunately, in majority of patients total cessation of these drugs is not possible. Hence, even with few allopathic drugs on, the case is reassessed and appropriate homoeopathic treatment is given. It has been observed that after sometime it becomes possible to stop the palliative drugs under the actions of dynamic treatment.
Let us focus on how to withdraw certain allopathic prescriptions for (Case Type IV) chronic metabolic disorders. As an example, we consider a case of a 49 years male who is suffering from systemic hypertension, hyper-cholesteremia with chronic stable angina. Now such a patient is expected to be on the following allopathic drugs
A] Anti hypertensive (s), B] Anti anginals / nitrates
C] Aspirin D] Clopidogrel E] Statins
If such a patient wishes to take constitutional homoeopathic therapy then before starting it, I would withdraw the above drugs in the following order -
Statins – Nitrates – Clopidogrel - Anti hypertensive (s) - Aspirin
The tricky part comes when we are withdrawing Anti Hypertensives. Many patients are so much psychologically bound to consume the drug that in spite of best counseling they prefer to take homoeo and allopathic anti-hypertensives together. On stopping the drug even if the blood pressure is in a normal range, yet the anxiety of not taking medications causes symptoms of hypertension like heaviness of the head, chest discomfort, easy fatigue etc.
Another case is of a girl aged 13 years suffering from Grand-Mal Epilepsy since the age of 3 years and is on anticonvulsants. Normally anticonvulsants are stopped if the patient has a seizure free period of 3 years or more. If that is the case then the tapering of those drugs is easy but monitoring is required. Many such innumerable examples can be quoted but they would fill the pages and in reality is out of scope of this article. Certain drugs cannot be completely stopped even during homoeopathic management. Some of them are
A] Insulin in IDDM patients
B] Folic acid in patients of sickle cell anaemia
C]Antidepressants in paranoid schizophrenics
D]Neostigmine in myasthenia gravis.
5. Case Type V – Mixed Cases. These cases present with multiple types of symptoms. Some are primary (miasmatic), some are secondary (due to maintaining factors), some artificial (due to environmental influences like occupation, habits etc.) and some side effects of the drugs one is taking. If the patient is well oriented to homoeopathic methods then the treatment can be resorted on the lines of Case Type I. As an example, consider a 60 years old post menopausal female who is a known Insulin dependent Diabetic. Here, gradual tapering of insulin should be done starting with not more than two units scale down per fortnight. Here the replacement of homoeopathic drugs that have an organic action in physiological doses like Cephalandra, Abroma augusta etc do help
In Fine - The continuation of allopathic drugs along with homoeopathic remedies totally depend upon the type of cases a physician is handling at a particular point of time and what is his objective. Mind you all systems have their limitations and even homoeopaths have our own. All diseases are not curable, but all are manageable with homoeopathy.
This is the view of The National Academy of Homeopathy, India. The topic is open for debate and I invite the healthy opinion of not only the readers but also the editor on this topic.