Treatment of hyperactive children: Increased efficiency through modifications of homeopathic diagnostic procedure

Homeopathy may be the art of the infinitesimal but there has been an escalating trend in the last two decades towards bigger and bigger repertories. Authors, editors and publishers seem more proud of the number of additions of rubrics and remedies than their accuracy or validity. But in recent years there has also been an opposing trend: to return to earlier sources such as Boenninghausen's Therapeutic Pocketbook. In contrast to the latest repertories, the original Pocketbook is a trim volume containing only 125 remedies in less than 3000 rubrics.

Boenninghausen saw that incomplete symptoms could be completed by comparison with other symptoms from a proving. A complete symptom consists of location, sensation or complaint, and modality. If a remedy caused various head pains but not burning pain, for example, but caused burning pains in other locations, Boenninghausen reasoned that it was valid to assume that with a complete proving burning head pain would appear, especially if burning pain was common in many other sites, and more so, if the remedy showed many head pains generally. Similarly, if a remedy caused various symptoms better from walking, then the modality “walking ameliorates” could be applied to symptoms in which this modality had not appeared in provings. This idea seemed to work well in practice and led him to design the Pocketbook in seven sections: Mind & Sensorium, Parts of body and organs, Sensations and Complaints, Sleep, Fever, Changes of state (modalities), and Concordance. Dimitriadis has shown that it is possible to reconstruct original complete symptoms in The Chronic Diseases of Hahnemann by working backwards from the Pocketbook.[ ¹ ] Since the original edition of the Pocketbook in 1846, various editions have appeared, the best known in English being TF Allen's translation with additions of new remedies, first published in 1891.

In 2000, Dimitriadis published an English edition[ ² ] with additions taken only from Boenninghausen's other works. This work is reviewed elsewhere in this issue of the journal. The RADAR program has a module consisting of the unmodified 1846 original with an English translation by Peter Vint. Otherwise, most recent use of the Pocketbook has been in the German-speaking world, and it is among this work that the paper on ADHD by Frei et al, also published in this issue, belongs.[ ³ ]

The paper describes the steps the authors took to improve the success rate in treatment of ADHD, the report of the trial itself was published last year.[ ⁴ ] Apart from the successful use of Boenninghausen's method, the paper is instructive in showing how it proved necessary to break with the homeopathic principle of taking all the individualising features of the case into account. Instead Frei et al found that certain symptoms which would normally be considered useful, such as “fear of storms” or “dictatorial” in fact lead to failed prescriptions. It seems the unreliable symptoms cannot be predicted: they had to be discovered by review of failed cases. Thus “touch aggravates” proved useful but “talking aggravates” did not, to take one pair of examples. Frei et al do not suggest this excluding approach is necessary in regular homeopathic practice, quite the reverse. ADHD is a special case, though there may be others.

ADHD or Attention Deficit Hyperactivity Disorder is on the increase. In the UK 0.1% of children are diagnosed with “Hyperkinetic Syndrome”, but the figure in the US is 5% or more. There is said to be a genetic component; it is difficult to explain the rapid increase in apparent incidence.

The mainstay of conventional treatment is the use of sympathomimetic amines such as amphetamine and methylphenidate (Ritalin). In the US it is estimated that 2.5 million children now take stimulants for ADHD, including nearly 10% of all 10-year-old boys. Even more strikingly, 1.5 million adults in the US now take such stimulants on a daily basis, with 10% of users older than 50 years of age.[ ⁵ ] The diagnosis of “adult” ADHD is a relatively recent phenomenon and has resulted in the most rapid growth in the use of such agents. Great concern about the cardiovascular toxicity of these agents has caused the FDA recently to warn of dangers and try to limit their use.[ ⁶ ] It is interesting to note, in passing, that this use of stimulants is a crude example of the simile principle.

Another feature of Frei's paper is of particular interest. This is the use of “polarities” in case analysis. This is explained in the paper but briefly the term applies to the subtraction of a remedy's score for a modality opposite to the modality expressed by the patient. For example Rhus, has 4 for “motion ameliorates.” and 1 for “motion aggravates.” so in a case where the former prevailed the score would be reduced to 3. This is based on Boenninghausen's idea of contraindications, a way of thinking we are all familiar with when we say, for example, “the symptoms fit Pulsatilla but the patient is chilly, averse to open air”, etc. The use of polarities was found to increase the success rate.

A homeopathic paper on ADHD is timely, given the hazards and limitations of the conventional treatment. The approaches demonstrated in this paper open up a new area for homeopathic research, which might be called “evidence-based” homeopathy.

• References

• 1 Dimitriadis G, Homeopathic Diagnosis, Hahnemann through Boenninghausen. Sydney: Hahnemann Institute, 2004; ISBN: 0-646-43380-6.
• 2 Dimitriadis G, editor. The Boenninghausen Repertory, Therapeutic Pocket Book method. Sydney: Hahnemann Institute, 2000; ISBN: 0-646-396943.
• 3 Frei H., von Ammon K., Thurneysen A. Treatment of hyperactive children: increased efficiency through modifications of homeopathic diagnostic procedure. Homp 2006; 3: 163-170.
• 4 Frei H., Everts R., von Ammon K. et al. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled trial. Eur J Ped 2005; 164: 758-767.
• 5 Nissen S.E. ADHD drugs and cardiovascular risk. N Engl J Med 2006; 354: 1445-1448.
• 6 Food and Drug Administration. Drug Safety and Risk Management Advisory Committee Meeting, February 9 and 10, 2006: table of contents, at http://www.fda.gov/ohrms/dockets/ac/06/briefing/2006-4202_00_TOC.htm.