Students Corner

Sep 22 2008

DRUG PROVING by Dr. Mujeeburahman Thekkethodika

The drugs have been used since antiquity for curing of the disease but without any proper basis. At that time for the application of drugs, ‘Doctrine of Signature’ were followed founded on the belief that each member of the plant kingdom carried with in itself the likeness of some organ or the part of the economy, as a sign that this particular plant was applicable to disturbances of the organ. That was probably most consisted method among all the ancient systems of applying drugs.

Paracelsus (1493-1541) gained considerable insight in to the action of drugs, and Halle, the Swedish physician, was a fore runner of Hahnemann in his experiments to discover the nature of certain medicines. These attempts were not coordinated, and made little impression up on the medical world. Needless to say, Hahnemann was the first to adduce scientific proof of the truth of Homoeopathy. He and his colleagues tested the effect of some 90 odd drugs up on themselves and others. This genuine process of ascertaining the pure and peculiar effects of medicine is known as ‘DRUG PROVING’. Besides Hahnemann, great and immortal Albrecht von Haller (1708-1777) saw the necessity of this.

Definition of Drug-Proving

Drug proving is the process of acquiring knowledge of instruments intended for the cure of the natural diseases ($105)

It is the systematic and orderly way of investigating the pathogenetic power of a medicine on a healthy person. By ‘drug proving’ we mean the positive effects of drug up on living organism, i.e., to know the pathogenetic effects of the drug. Drug provings are experiments with drug substances on healthy human beings to note the disease- producing powers known as ‘curative powers’ of the particular drugs.

Evolution of the Concept of Drug Proving

According to Hahnemann, it was Albrecht von Haller, who besides himself saw the necessity of this genuine mode of testing medicines for their pure and peculiar effects in deranging the health of man, in order to learn what morbid state each medicine is capable of curing [footnote to aphorism 108].

Haller said – “Indeed, a medicine must first of all be assayed in a healthy body, without any foreign admixture. When the odor and taste have been examined, a small dose must be taken and attention must be paid to every change that occurs, to the pulse, the temperature, respiration and excretions. Then having examined the symptoms encountered in the healthy person, one may proceed to trials in the body of a sick person.”

Not one single physician, during the previous two thousand five hundred years before Hahnemann who saw the importance of such an exercise and was the first to open up this path that demanded perseverance, with a perfect conviction of truth.

Hahnemann had studied different languages and his eight translations from English, French and Italian into German included works of considerable significance. Dr. Cullen was an authority on Materia Medica. In Cullen’s Materia Medica was established the first milestone on the road of development of the new method of treatment. When Hahnemann commenced upon this translation, he did not have any particular medical theories, but only a growing disgust for the medical fallacies of the day.

The first edition of Cullen’s work appeared in 1773, the second followed in two volumes: in the year 1789, under the title “Treatise of the Materia Medica”. Hahnemann used these for his translation. In the second volume Cullen devoted twenty pages to Cinchona bark (Cortex Peruvianus).

Regarding the question of medicinal effect of Peruvian bark, Cullen defended the old opinion of the efficacy of this remedy through its “tonic effect on the stomach”.

Cullen remarked – “I have endeavored to explain, in my first outlines of practical medical science, that the bark in this instance acts through its tonic effect on the stomach, and I have found nothing in any writings which could make me doubt the truth of my statements.”

Hahnemann became indignant over the affected, theoretical explanations of the antipyretic power of cinchona bark that Cullen was asserting. Hahnemann attacked this opinion vigorously in his notes – “By combining the strongest bitters and the strongest astringents we can obtain a compound which, in small doses, possesses much more of both these properties than the bark, and yet in all eternity no fever specific can be made from such a compound. The author should have accounted for this. This undiscovered principle of the effect of the bark is probably not easy to find.”

The researches of Cullen induced Hahnemann to make experiments upon himself with this remedy. Hahnemann therefore resolved to ascertain, by the natural method of experience, wherein lay the power of cinchona bark to allay intermittent fever.

“Let us consider the following: Substances which produce some kind of fever (very strong coffee, pepper, arnica, ignatia bean, arsenic) counteract these types of intermittent fever. I took for several days, as an experiment, four drachms of good Cinchona twice daily. ‘My feet and finger tips, etc at first became cold; I became languid and drowsy; then my heart began to palpitate, my pulse became hard and quick; an intolerable anxiety and trembling (but without a rigor), prostration in all the limbs, then pulsation in the head, redness of the cheeks, thirst; briefly, all the symptoms usually associated with intermittent fever appeared in succession, yet without the actual rigor.

To sum up: all those symptoms which to me are typical of intermittent fever, as the stupefaction of the senses, a kind of rigidity of all joints, but above all the numb, disagreeable sensation which seems to have its seat in the periosteum over all the bones of the body – all made their appearance. This paroxysm lasted from two to three hours every time, and recurred when I repeated the dose, not otherwise. I discontinued the medicine and I was once more in good health’.”

Hahnemann remarked, in opposition to Cullen – “If the author had detected that the bark had the power of producing artificial, antagonistic fever . . . certainly he would not have held so firmly to his mode of explanation. Peruvian bark, which is used as a remedy for intermittent fever, acts because it can produce symptoms similar to those of intermittent fever in healthy people.”

The “Cinchona experiment” brought out not only the exact physiological effects of the bark; it had shown him that those effects were apparently the same as the symptoms of the disease for which it was used (ague).

Does the bark produce the same symptoms as it removes?
Does it alike produce and cure ague?
Is the “Specific” curing power of drugs founded on such a principle?
Do they all uniformly excite a counterfeit disease to that which they remedy?
Drug after drug, specific after specific was tested by Hahnemann on himself and on his family and friends, all with one result – each remedy of recognized specific power excited a spurious disease resembling that for which it was considered specific.

He verified his discoveries and observations by exploring volumes of recorded experiments on Materia Medica and history of poisonings.

Hahnemann here sensed a law that taught him to recognize, that, in the effect that a substance has on the healthy organism is to be found its curative power for similar disease symptoms, because he could not doubt that here prevailed more than a simple coincidence.

Hahnemann had, thus, recorded the effects of a drug administered to a healthy person. This led Hahnemann to a six-year study of different drugs on himself and others. The results were published in his work Fragmenta de Viribus Medicamentorum Positivis sive in sano corpore humano observatis in 1805. The first part contained twenty-seven drugs; symptoms cited in it were those of the provings and of the observations from the work of others and at the end of each remedy, he gave the effects recorded by previous observers in cases of poisoning. It was the first collection ever made of provings of medicines upon the healthy body.

But many more symptoms than that diagnostic of any one disease resulted from almost every medicine. These uncommon, peculiar, non-diagnostic symptoms produced after the employment of a drug to a healthy prover was confirmed over series of experiments.

This is how Hahnemann traveled from the realm of “specifics” into the realm of “individualization” which formed the actual reason and basis of homoeopathic drug provings – determination of the more striking, singular, uncommon and peculiar (characteristic) signs and symptoms rather than the common, diagnostic (specific) symptoms of diseases.

In 1806, he published his essay, Medicine of Experience, in which he mentioned that, for ascertaining the pure and positive effect of the drug it is necessary to give a single dose to a normal healthy person. Gradually Hahnemann started collected disciples around him.

Hahnemann then published his provings in Materia Medica Pura in six parts from 1811 to 1821.

Hahnemann’s Provings and His Prover’s Union

The provers whom Hahnemann selected and who appeared worthy to him (he was very strict in his selection) he invited into his family and so attached them to himself in a personal and friendly way. Franz Hartmann was a member of the Provers’ Union along with Stapf, Gross, Hornburg, Franz, Wislicenus, Teuthorn, Herrmann, Rückert and Langhammer.

The initial provings were carried out with simple substances and tinctures. For at that time Hahnemann had scarcely thought, if at all, of the original causes of chronic diseases and of the infinite dilution of medicines and their effect in the highest dilutions on the healthy body.

Provings were carried out according to an exact system and from detailed instructions. Sometimes those engaged in the provings had to provide for themselves the medicinal substances, particularly the herbal ones. By this means they learned to recognize herbaria by habitat, period of bloom, etc. They learned to dry them methodically or to obtain a tincture from the fresh plant. The observations of the results, which every individual had to make on himself at definite times, were entered up in carefully prescribed manner. After that, the comparative relationships of the medicinal effects observed by the individual provers were taken, and the power of a medicine was only established after comparison of different participants.

Dr. Franz Hartmann, a member of Hahnemann’s Provers’ Union gave a detailed account of Hahnemann’s provings:

During a proving, Hahnemann absolutely forbade coffee, tea, wine, brandy and all other heating drinks, as well as spices, such as pepper, ginger, also strongly salted foods and acids. He cautioned against close and continued application to study, or reading novels, as well as against many games that exercised not merely the imagination, but which required continued thought, such as cards, chess or billiards, by which observation was disturbed and rendered untrustworthy. Hahnemann did not recommend idleness, but advised moderate labor only, agreeable conversation, with walking in the open air, temperance in eating and drinking and early rising. For a bed he recommended a mattress with light covering.

The medicines that were to be proved were supplied by Hahnemann himself. The vegetable drugs were in the form of essence or tincture, the others in the first or second trituration. Hahnemann never concealed from his provers the names of the drugs that were proved and it was his wish that they should, in the future prepare all the remedies whose effects they had tried.

Hahnemann, for the most part, had previously proved the drugs upon himself and his family, and was sufficiently acquainted with their strength and properties to prescribe for each prover according to his individuality, the number of drops or grains with which he might commence, without experiencing any injurious effects.

The dose to be taken was mixed with a great quantity of water and was taken early in the morning, fasting, and nothing was taken for an hour. If no effect was experienced in three or four hours, a few more drops were to be taken; the dose might even be doubled and the reckoning of time was to be from the last dose. If, upon the third repetition, no change was remarked, Hahnemann concluded that the organism was not susceptible to this agent and did not require the prover to make any further experiments with it, but after several days gave him another drug to prove.

In order to note down every symptom that presented itself, he required each one to carry a tablet and lead pencil with him, which had this advantage that they could describe with precision the sensation they had experienced at that time. This precision might be lost if these sensations were noted down at some subsequent period. Every symptom that presented itself must be given in its connection. After every symptom, they had to specify in brackets, the time of its occurrence, which time was reckoned from the last dose. It was only when one or two days had passed without the occurrence of any symptoms that Hahnemann supposed the action of the drug to be exhausted. He then allowed the system a time to rest before another proving was undertaken. Hahnemann always reviewed the symptoms once with the provers to be sure that they had used just the right expressions and signs and had said neither too much nor too little.

At first it often happened that there were errors, but these became fewer with every proving and finally there were none at all. Proving is an art and it is not easy as it appears. It requires a particular type of attention to grasp properly the symptoms that could only be felt faintly and these are often just the most important, the really characteristic ones and of much greater significance than those which set in more violently. The former set is as a rule only after small, delicate doses, while the latter owe their onset to the stronger doses.
The provers had to be as healthy as possible and keen to explore the high truths that one is expecting to find, with a strong sense of conscientious honesty, without expecting the slightest worldly advantage, not even the honor of being publicly mentioned as a prover.

Hahnemann had condemned a physician, Fickel, who invented all the printed symptoms in his so-called proving of Osmium, which he had never seen, just for the sake of snapping up a bookseller’s fee.

Hahnemann recounts -

Each one of them was interrogated daily or every two or three days on the symptoms experienced by them, partly in order to enquire if any one of them had previously experienced similar sensations (that this might be put in brackets when printing as not altogether due to the medicine), partly that the exact character of his sensations and observations might be compared with the words written down, and perhaps afterwards be able to choose with his consent more definite expressions. All the important secondary considerations of any value were mentioned at the same time together with the symptoms under which they occurred.

As regards my own experiments and those of my disciples every possible care was taken to insure their purity. They were performed on people as healthy as possible and under regulated external conditions as nearly as possible alike. But if during the experiment some extraordinary circumstance from without happened that might be supposed to be capable of altering the result – e.g. a shock, vexation, a fright, an external injury of sufficient severity, dissipation or overindulgence in something or other, or any other circumstance of importance – from that time no symptom that occurred in the experiment was registered. They were all rejected to remove any suspicion of impurity about it. If some little circumstance happened during the experiment, which could hardly be expected to interfere with the effects of the medicinal action, the symptoms subsequently noticed were enclosed within brackets as not certainly pure.

With respect to the duration of action ascribed to each medicinal substance, which I endeavored to determine by repeated experiment, I should state that it was only learned from the experiments on the healthiest possible persons.

Proving Guidelines as per Organon of Medicine – Sixth Edition

For the selection of a suitable homoeopathic remedy for the natural diseases, the whole pathogenetic powers of medicines must be known. All the morbid symptoms and alterations in the health that each medicine is capable of producing in a healthy individual must first be observed before administering the similimum. [aphorism 106]

As Hahnemann’s observations on the action of drugs were confirmed by earlier writers who noted the toxicological effects of many drugs used in large doses (though they had no idea of their therapeutic indications), he concludes that the pathogenetic effects or pharmacological actions are produced according to fixed, eternal laws of nature and by virtue of these they produce certain reliable disease symptoms each according to its own peculiar character. [aphorism 111]

Object of Proving

Every plant species differs in its external form, mode of life and growth, in its taste and smell from every other species and genus of plant; so also every mineral and salt differs from all others in its external and internal physical and chemical properties.

Each of the medicinal substances that are derived from these sources also differs and diverges among themselves in their pathogenetic and therapeutic effects.

They produce alterations in the health of human beings in a peculiar and different, unique and determinate manner. Hence is essential for determining their peculiar therapeutics so as not to confound one with another.

As the selection of the similimum is based on the homoeopathic philosophy of Totality and Individualization, it is the peculiar technique of drug proving that provides the true, complete ‘portrait of the drug’ that can be compared with the portrait of the disease. Anyone understanding this basic principle will never resort to ‘surrogates’ or substitutes in prescription. [aphorism 119]

Hence medicines, on which depend man’s life and death, disease and health, must be thoroughly and most carefully distinguished from one another and tested by careful, pure experiments on the healthy body for the purpose of ascertaining their powers and real effects, in order to obtain an accurate knowledge of them. It is only then, can a correct selection of them can be made for the permanent restoration of the health of the body and of the mind. [aphorism 120]

Selection of Prover

(A) Animal proving

(a) Disadvantages;

Proving on lower animals should not be done due to following defects;

1.      Subjective and mental symptoms cannot be studied as they cannot express themselves by speaking.

2.      Modalities and finer sensations are lacking to make a symptom complete.

3.      The effect of same drug on animals and on humans is different.

4.       Proper individualization of knowledge of drugs is never possible on animal provings.

5.      The question of susceptibility and idiosyncrasy is difficult to judge from animal provings.

(b) Advantages

1. The drug may be proved in any quantity, but not possible in human proving due to toxicological effects of drugs.

2. The drug may be proved for any length of time, but not possible in human proving due to fear of poisoning.

3. We may go to ultimate pathology and dare to lose the prover.

4. Proving with unknown substance may give a first hand information with regards to action on living organism.

5. To assay the physiological action of drugs.

(B) Human proving

Proving in Sick and Healthy Individuals

Medicines, even though singly and alone, must not be administered to sick persons because little or nothing precise is seen of their true effects, as those peculiar alterations of the health to be expected from the medicine are mixed up with the symptoms of the disease and can seldom be distinctly observed. [aphorism 107] There is no other sure, possible and natural way in which the peculiar effects of medicines on the health of individuals can be accurately ascertained than to administer the medicines in moderate doses to healthy individuals. [aphorism 108]

(a) Proving on sick persons ($107)

Should not be done because;

1. The true effects of medicine can seldom be distinctly observed as the symptoms of natural disease and the peculiar alterations of medicines are mixed up, even though they are administered singly and alone.

2. In disease state the person may be hypersensitive or hyposensitive and so the intensity of the symptoms may be increased or decreased accordingly.

3. If accidentally the symptoms of the medicines are similar to his disease, he will be cured or partially relieved. Neither the symptoms of the disease nor of the drug shall be visible externally.

4. If the drug used is of opposite nature to his disease, it shall bring temporary relief.

5. If the drug is dissimilar to the disease, either there will be no effect or will form a complex disease.

(b) Proving on healthy human being ($108)

The best possible way of ascertaining the pure and peculiar effects of medicine is to make a proving by administering several medicines experimentally, on healthy human beings, in moderate doses.

Advantages;

Except the negligible amount of disadvantages, human proving serves all our purposes. They are;

1.      Subjective and mental with their modalities and concomitants may only be recorded in human proving.

2.       From such proving we get pure and accurate pathogenetic effects of medicine which help to cure the natural disease on the basis of symptom similarity.

3.      Administration of medicine in healthy human being gives response properly according to full capability of vital force.

4.      Peculiar and characteristics of the drug-the rare unusual symptoms that distinguish it from all others is only possible during human proving especially from this susceptible one.

Qualities of Human Prover

1. Ideal prover;

The qualities of an ideal prover are;

a) Healthy;

The prover must posses sound health, free from disease, and individual     can determine the effects of medicines very distinctly.

b).Intelligent

c).Delicate, irritable and sensitive ;( $121)

d).Lover of truth, temperate in all respects of delicate feelings, who can direct the       minutest attention to his sensations ($137). He must avoid all over exertions of mind and body, disturbing passion and distractions.

2. Best prover;($141)

The healthy unprejudiced and sensitive physician himself is the best   prover.

3. Idiosyncratic prover;

The idiosyncratic person is a best possible prover of the substance to which he is idiosyncratic.

Choice of Prover.

The medicine must be tested on both sexes-males and females, in different ages,    and many individuals with various constitutions.

1. Both males and females ;( $127); Drug proving must be done in both sexes, because of the following causes;

a.      in order to reveal the alterations of health they produce in the sexual sphere.($127)

b.      Males and females are different in anatomical, physiological and psychological sphere. So to treat the disease of both sexes, we must know the pathogenetic power of medicine in sexual sphere.

c.       More over there are certain diseases which are specific for male and some for females. So for treatment of specific diseases, we must know the effects of drugs through drug proving , on both sexes.

2. Different ages; Drug should be proved in persons of different ages because                                                 of the following reasons;

a.      Physical appearance, anatomical development and functions vary according to the age. We have to treat the patients of different age groups. So we must be certain of the curative powers of medicine in different age groups.

b.      There are diseases which are more common in certain age groups, e.g., measles, whooping cough, rheumatic fever, are common in children, where as, enlarged prostate, cataract are common in aged individuals.

c.      Susceptibilities and physical irritability varies with age.

3. Many individuals ($136); Drug proving must be done on many individuals. All the symptoms peculiar to a medicine do not appear in one person , nor all at once, nor in the same experiment, but some occur in one person chiefly at one time, others again during a second or third trial($134). So in order to get the whole pathogenetic power of a medicine, proving should be done on many different individuals, varying in their corporeal and mental constitutions ($136)
Action of Drugs in Relation to their Doses

Hahnemann observed the following facts regarding the action of drugs in relation to their specificity and the varying doses in which they are to be administered to healthy human beings.

1. Administration of drugs in excessively large doses leads to production of certain symptoms during the initial stage that are followed later by symptoms that were of an exactly opposite nature to those that first appeared. The first set of symptoms constitutes the primary action of remedies and the following set of symptoms is the reaction of the vital force of the organism and constitutes its secondary action. [aphorism 112]

2. Administration of drugs in moderate doses seldom or hardly ever produces the least trace of secondary actions. Only their primary action is observed.[aphorism 112]

3. Administration of drugs in small doses does never produce secondary action. [aphorism 112]

4. In the homoeopathic curative operation, the living organism reacts from these only so much as is requisite to raise the health again to the normal healthy state. [aphorism 112]

5. An exception is in case of narcotic medicines. Even with moderate doses the narcotic medicines have been observed to produce secondary action in the form of increased sensibility and greater irritability. In their primary action these narcotic medicines take away sometimes the sensibility and sensation, sometimes the irritability of the healthy organism. [aphorism 113]

6. With the exception of narcotic substances, the primary actions of the medicines are to be noted. [aphorism 114]

7. Among the symptoms of the primary action of drugs administered in moderate doses, there occur in the case of some medicines not a few which are partially or under certain conditions, directly opposite to other symptoms that have previously or subsequently appeared – which represent the alternating state of the various paroxysms of the primary action and are termed alternating action. [aphorism 115]

8. Referring to the symptoms produced by a medicine, it has been noted that (a) some symptoms are produced more frequently, i.e. in many individuals; (b) others more rarely or in few persons; (c) some only in very few healthy bodies. [aphorism 116]

Symptoms are the manifestations of the actions of the drug on the vital force and the reaction of the vital force to the same drug. So they are, in all cases, the product of their actions and reactions. The variability in the manifestation of symptoms depends on the inherent power of the influencing substance and the capability of the vital force that animates the organism to be influenced by it.

In case of some symptoms appearing only in very healthy bodies, the condition is called idiosyncrasy. Though the state of idiosyncrasy implies a peculiar constitution, but this must also be ascribed to the influencing drug in which must lie the power of making the same impression on all human bodies, yet in such manner that but a small number or healthy constitution have a tendency to allow themselves to be brought into such an obvious morbid condition by them. [aphorism 117]

9. As each man differs from another man in their individual aspects, so each drug differs from another in their pharmacological properties and each of these substances produces alterations in the health of human beings in a peculiar, different, yet determinate manner, so as to preclude the possibility of confounding one with another. [aphorism 118] Ascertainment of Doses of Medicines   for Proving

1. Strong medicines are liable even in small doses to produce changes in the health even in robust persons. [aphorism 121]

2. Those of milder power must be given in more considerable quantities. [aphorism 121]

3. In order to observe the action of the very weakest medicines, the subjects of experiment should be healthy persons who are delicate, irritable and sensitive. [aphorism 121]

Method of Preparation of Drugs for Proving

The purity, genuineness and energy of the medicines must be thoroughly assured, and for this purpose [aphorism 122] -

1. Each of the medicine must be taken in a perfectly simple, unadulterated form. [aphorism 123]

2. The indigenous plants in the form of freshly expressed juice must be mixed with a little alcohol to prevent its spoiling. [aphorism 123]

3. Exotic vegetable substances must be prepared in the form of powder or tincture prepared with alcohol when they are in the fresh state and afterwards mixed with a certain proportion of water. [aphorism 123]

4. Salts and gums should be dissolved in water just before being taken. [aphorism 123]

5. If the plant can only be procured in its dry state, an infusion of it may be made by cutting the herb into small pieces and pouring boiling water on it, so as to extract its medicinal parts.

Immediately after its preparation, it must be swallowed while still warm as all expressed vegetable juices and all aqueous infusions of herbs without the addition of the spirit pass rapidly into fermentation and decomposition whereby all their medicinal properties are lost. [aphorism 123] Precautionary Measures to be taken during Proving

1.Regarding the medicine to be proved

Every medicinal substance must be employed quite alone and perfectly pure without the admixture of any foreign substance and without taking anything else of a medicinal nature the same day, or yet on the subsequent days, or during all the time, the effects of the medicine are to be observed. [aphorism 124] 2. Regarding the prover

(a) During the whole period of the experiment the diet of the prover must be strictly regulated – it should be as much possible destitute of spices, of roots and all salads and herb soups. The diet should be of a purely nutritious and simple character, consisting of green vegetables. Young green peas, green French beans, boiled potatoes and in all cases carrots are allowable, as the least medicinal vegetables. [aphorism 125]

(b) The drinks are to be those usually partaken of, as little stimulating as possible. The prover must either be not in the habit of taking pure wine, brandy, coffee or tea or he must have totally abstained for a considerable time previously from the use of these beverages, some of which are stimulating, others medicinal. [aphorism 125]

(c) The prover must be pre-eminently trustworthy and conscientious. [aphorism 126]

(d) During the whole period of proving he must avoid all overexertion of mind and body, all sorts of dissipation and disturbing passions. [aphorism 126]

(e) He should have no urgent business to distract his attention. [aphorism 126]

(f) He must be self-observing and not be disturbed whilst so engaged. [aphorism 126]

(g) He must possess a sufficient amount of intelligence to be able to express and describe his sensation in accurate terms. [aphorism 126]

(h) The medicines must be tested on both males and females in order to ascertain especially the changes in the sexual sphere. [aphorism 127]

Determination of Dosage and its Difficulties – Mode of Administration

Drug proving is not so simple and easy  matter for the following reasons -

Medicinal substances, in their crude state, do not exhibit nearly the full amount of the powers that lie hidden in them, which they do when they are taken in high dilutions. In this manner, one can investigate the medicinal powers even of substances that are deemed weak. [aphorism 128] Medicine should be given to the prover, on an empty stomach, daily from four to six very small globules of the thirtieth potency, moistened with a little water or dissolved in more or less water and thoroughly mixed and this is continued for several days. [aphorism 128] If the effects of this dose are but slight, a few more globules may be taken daily, until they become more distinct and stronger and the alterations of the health more conspicuous. [aphorism 129] All persons are not affected by a medicine in an equally great degree. On the contrary, there is a vast variety in this respect. An apparently weak individual may be scarcely affected by moderate doses of a medicine known to be of a powerful character, whilst he is strongly enough acted on by others of a much weaker kind. [aphorism 129] On the other hand, there are very robust persons who experience very considerable morbid symptoms from an apparently mild medicine and only slighter symptoms from stronger drugs. [aphorism 129] As this cannot be known beforehand, it is advisable to commence in every instance with a small dose of the drug and, where suitable and requisite, to increase the dose more and more from day to day. [aphorism 129] If at the very commencement, the first dose administered is sufficiently strong, it is advantageous in a way that the experimenter learns the order of succession of the symptoms and can note down accurately the period at which each occurs, which is very useful in leading to a knowledge of the genius of the medicine, for then the order of the primary actions and alternating actions is observed in the most unambiguous manner. [aphorism 130] A very moderate dose even often suffices for the experiment, provided only the prover is sufficiently delicate and sensitive and is very attentive to his sensations. [aphorism 130] The duration of a drug can only be ascertained by a comparison of several experiments. [aphorism 130]

Rules for an Exhaustive Proving of Drug

The drug must be proved, both in dilutions and in massive doses.
If the same medicine is given to the same person to test for several successive days in ever-increasing doses, the various morbid states that the medicine is capable of producing in a general manner is learnt, but not their order of succession; and the second dose often removes curatively, some of the symptoms caused by the previous dose, or develops in its stead an opposite state. Such symptoms should be enclosed in brackets, to mark their ambiguity, until subsequent purer experiments show whether they are the reaction of the organism and secondary action or an alternating action of the medicine. [aphorism 131] But when the object is only to ascertain the symptoms, especially of a weak medicinal substance and not the sequential order of symptoms, or the duration of action of the drug, then it is to be administered for several successive days, increasing the dose every day. In this manner, the action of an unknown medicine, even of the mildest nature, will be revealed, especially if tested on sensitive persons. [aphorism 132] On experiencing any particular sensation, the exact nature of symptoms needs to be determined, as for example – to observe whether, by moving the affected part, by walking in the room or open air, by standing, sitting or lying the symptom is increased, diminished or removed and whether it returns on again assuming the position in which it was first observed – whether it is altered by eating or drinking, or by another condition, or by speaking, coughing, sneezing or any other action of the body and at the same time to note at what time of the day or night it usually occurs in the most marked manner. In short, what is peculiar to and characteristic of each symptom will become apparent. [aphorism 133] All the symptoms peculiar to a medicine do not appear in one person, nor all at once, nor in the same experiment, but some occur in one person chiefly at one time, others again during a subsequent trial. In another person, some other symptoms may appear; moreover they may not recur at the same hour. [aphorism 134] The greatest care should be exercised in verifying symptoms by repeated experiments, in order that “imaginary” symptoms as well as chemical and mechanical symptoms may be excluded.

When a Medicine can be considered to have been thoroughly Proved

A medicine is regarded to have been completely proved when

Numerous observations are made on suitable persons of both sexes and of various constitutions. [aphorism 135] Subsequent experiments can notice little of novel character from its action. [aphorism 135] During reproving only the same symptoms are noticed as had been already observed by others. [aphorism 135] The symptoms are recorded complete with regard to their sensations, localities, modalities and concomitant factors so that a complete individual picture of the drug disease has been ascertained.
Although a medicine on being proved on healthy subjects cannot develop in one person all the alterations of health it is capable of causing, but can only do this when given to many different individuals, varying in their corporeal and mental constitution, yet the tendency to excite all these symptoms in every human being exists in it. [aphorism 136]

Relative Merits of Employing Large and Moderate Doses of Medicine in Proving

(A) Disadvantage of Employing Large Doses of Medicine Proving

If excessively large doses are used, there occur at the same time not only a number of secondary effects among the symptoms, but the primary effects also come on in such hurried confusion and with such impetuosity that nothing can be accurately observed. [aphorism 137]

(B) Advantages of Employing Moderate Doses of Medicine Proving

The more moderate the doses of the medicines – so much the more distinctly are the primary effects developed, and only these occur without any admixture of secondary effects. [aphorism 137]

Other sources besides Drug – Proving to know the curative properties of drugs.

Drug proving is the only reliable source to know the curative properties of drugs, but however, we can acquire knowledge about the drugs to some extend through ;

1. Histories of poisonings, narcotics or any toxic substances (toxicology)

2. Emperical sources;

3. Chemistry.

4. Biochemistry.

1. Poisonings;

The symptoms collected from the cases of poisoning have been of immense value. They have great curative properties. They are occupied in materia medica as ‘clinical symptoms’. They give information about the sphere of action, chemical action and common symptoms of a drug. Even poisonous substances when used in minute quantity produce finer symptoms. The knowledge of a toxic effect of a substance helps in the identification of power of power of a drug but not in obtaining complete knowledge of curative properties of it. Many dreadful poisons like Lachesis, Crotalus and other snake poisons, Arsenic,Stramonium,Croton tig etc. are found to be very useful Homoeopathic medicine when they are given on their toxicological symptoms in minimum doses.

2. Emperical;

Empirical knowledge gave only superficial view and did not help in acquiring the complete and rational knowledge about the curative power of drugs.

3. Chemistry;

From the chemistry we got the general information about the authenticity, standardization and active principle of drugs. Chemical action of a drug is different from its dynamic action. Chemical action produces only the common symptoms of the medicine. But it does not give knowledge about dynamic properties of a drug.

4. Biochemistry;

It gives information about the biochemical actions of drugs, which deals with the sphere of actions of drugs on one or two systems or organ. As a result this knowledge is suitable only for palliative treatment. In Homoeopathy, only few drugs have been included because of their biochemical action.

Recording of Proving

All the sufferings, accidents and changes of the health of the prover during the action of a medicine are solely derived from the medicine that is being proved and must be regarded and registered as belonging peculiarly to this medicine, as symptoms of this medicine, even though the experimenter had observed, a considerable time previously, the spontaneous occurrence of similar phenomena in himself.

The reappearance of these during the trial of the medicine only show that this individual is by virtue of his peculiar constitution, particularly disposed to have such symptoms excited in him. In this case they are the effect of the medicine; the symptoms do not arise spontaneously while the medicine that has been taken is exercising an influence over the health of the whole system, but are produced by the medicine. [aphorism 138]

The Day – Book

The prover would do well to give first a description of himself-age, sex, temperament, former ailments or diseases, habits and the influence which changes in the weather have to him. Next, a full description of the substance or drug proved, how and where it was obtained and how it was prepared. Next mention the dose and the time of the day. This self-examination should be as carefully conducted as the examination of a sick person. A daily journal should be kept, in which nothing is omitted; some symptoms, or groups of symptoms, may often reappear, they should be very distinctly related again, as these frequently recurring disturbances, however long they may continue, often denote the most characteristic symptoms of the substance or drug prove. And, as in the examination of the sick, so in proving, the experimenter should describe very minutely under what circumstances certain symptoms appear. Also state whether food, changes in the weather, exercise or rest in certain position, cause new, or aggravate, or ameliorate old symptoms.

(A) Symptoms to be recorded during proving;-

(1) Except narcotics; Symptoms produced by primary action of all medicines are recorded, except narcotics ($114)

(2) Narcotic substances; In case of narcotic substances symptoms of secondary action are to be recorded. ($113)

(3) Alternating actions; which are produced by some medicines are also to be noted. ($115)

(4) Modalities ;( $133); In order to determine the exact character of symptoms the modalities are recorded which mean slight intensification or decrease of symptoms in relation to time, position, weather etc, by various factors.

(5) Any alterations from normal health; should be recorded.

(6) Proving on sick persons ($142, F.N-2) Symptoms which, during the course of disease, might have been observed or never before, consequently new ones, belonging to the medicines.

(B) Noting down of Symptoms;

1. The physician may take other persons on whom the drug is administered.

(a) The prover must note down distinctly the sensations, sufferings, accidents and changes of health, he experiences at the time of their occurrence, mentioning the time after the ingestion of the drug when each symptom arose and if it lasts long, the period of its duration, and to keep a day book for the purpose. [aphorism 139])

(b The physician looks over the report in the presence of the prover immediately after the experiment is concluded; or

(c) If the experiment is continued for a long period of time he inspects the day book of the prover daily while everything is still fresh in his memory and questioning him about the exact nature of every one of those circumstances, write down the more precise details and makes each symptom precisely complete with regard to its sensation, localities, modalities and other concomitant factors. [aphorism 139]

(d) If the prover is illiterate and cannot note down his alterations in health, he must inform the physician every day of what has occurred to him, and how it took place. What is noted down as authentic information must be chiefly the voluntary narration of the person who makes the experiment, nothing conjectural and not derived from answers to leading questions, to ensure authenticity. [aphorism 140]

2. The physician may prove the medicine on himself. The best provings are those that the healthy, unprejudiced and sensitive physician institutes on himself [aphorism 141]

Advantages -

(a) He knows with the greatest certainty the things he has experienced in his own person.

(b) The great truth that the medicinal virtue of all drugs lies in the changes of health he has himself undergone from the medicines he has proved becomes for him an incontrovertible fact.

(c) By such self-observation the physician will be brought to understand his own sensations, his mode of thinking and his disposition and he will also get trained to be a good observer.

(d) The uncertainty about the exact changes in the health of others produced by a drug ceases entirely when a physician proves the drug on himself. The experiments on himself give him a reliable knowledge of the true value and significance of the medicinal agents.

(e) He who makes the trials on himself knows for certain what he has felt and each trial is a new inducement for him to investigate the powers of other medicines.

(f) He thus becomes more and more practiced in the art of observing, by continuing to observe himself.

(g) Experience shows that the organism of the prover becomes, by the frequent attacks on his health, all the more expert in repelling all external influences inimical to his system and all artificial and natural morbific noxious agents and becomes more hardened to resist everything of an injurious character by means of these moderate experiments on his own person with medicines. His body resistance against all sorts of infections is increased, health becomes more unalterable and he becomes more robust.

Symptoms that, during the whole course of the disease, might have been observed only a long time previously or never before, consequently new ones, belong to the medicine. [Foot note to aphorism 142]

Proving of medicines to unknown persons at a distance, who are paid for their work is uncertain in its results and loses all its value, as the proving demands the greatest moral certainty and trustworthiness that is doubtful in such a case. [Foot note to aphorism 143]

Building up of the Materia Medica

If tests with a considerable number of simple medicines have thus been carried out on healthy individuals, and a careful and faithful recording of all the disease elements and symptoms that they are capable of developing is done, then only a true Materia Medica can be built up.

This will be then a collection of real, pure, reliable modes of action of simple medicinal substances, a volume, wherein is recorded a considerable array of the peculiar changes of the health and symptoms ascertained to belong to each of the powerful medicines, as they were revealed to the attention of the observer, in which the likeliness of the (homoeopathic) disease elements of many natural diseases to be hereafter cured by them are present, which, in a word, contain artificial morbid states, that furnish for the similar natural morbid states the only true, homoeopathic, that is to say, specific, therapeutic instruments for effecting their certain and permanent cure. [aphorism 143]

From such a Materia Medica,. Everything that is conjectural, all that is mere assertion or imaginary should be strictly excluded.

Everything should be the pure language of nature carefully and honestly interrogated. [aphorism 144]

Of a truth it is only by a very considerable store of medicines accurately known in respect of these their pure modes of action in altering the health of man that we can be placed in a position of discover a homoeopathic remedy, a suitable artificial (curative) morbific analogue for each of the infinitely numerous morbid sates in nature, for every malady in the world.

Few disease remain for, which a tolerably suitable homoeopathic remedy may not be met with among those now proved as to their pure action, which without much disturbance, restores health in a gentle, sure and permanent manner infinitely more surely and safely than can be effected by all the general and special therapeutics of the old allopathic medical art with its unknown composite remedies, which do but alter and aggravate but cannot cure chronic diseases, and rather retard than promote recovery from acute diseases and frequently endanger life. [aphorism 145]

We thus build a complete Materia Medica.

Hahnemann called it Materia Medica Pura, because it consisted of the collective statements of the positive and perceptible reactions of the healthy human body recorded in the words of persons acted upon by drugs and admits no misinterpretations with changing medical terminology, altered biological concepts and newer scientific developments.

It is to borne in mind that the daybooks are not the Materia Medica. Not until the masses of symptoms have been analyzed, sifted, classified.

Methodology for Drug Proving

a.      Drug proving will be started with 1st quota and the prover will be asked to take 4-6 globules of the coded drug (quota) dry on tongue or dissolved in a little quantity of distilled water, four times a day daily for fourteen days. (Total of  56 doses).

b.      Drug administration will be suspended as soon as any change is felt by the prover after taking the drug or any sign(s)/Symptom(s) develop during the trial. Prover will note down these sign(s)/symptom(s) in the Prover’s Day Book Proforma  in sequence of their appearance, number of doses after which the symptom(s) appeared, time of onset and duration of the symptom(s), as well as the details of location, sensation, modalities and concomitants, if any. If no symptom is observed, the prover will note this fact as ‘No Symptom’ with date and time of intake of the respective dose of the drug daily.

c.      In the prover where sign(s)/Symptom(s) develop, the drug administration shall remain suspended till the sign(s)/symptom(s) totally disappear and this will be followed by a further rest period (no drug) of 7 days.

d.      The administration of the drug (remaining doses) will be started again in the same dose schedule as above (a) and in case of appearance of new sign(s)/Symptom(s) or re-appearance of the earlier sign(s)/symptom(s) the same procedure as stated above (b & c) will be followed till the quota is completed.

e.      Before commencing the administration of the next quota of the drug, the prover would be put on a rest period for 14 days and same procedure as mentioned above (item No. a, b, c & d) will be adopted for administering and suspending the administration of the subsequent quota.

f.      The provers will be called by the Proving Master or Proving Associate every day or as the need be for the purpose of interrogation whereupon details of each sign and symptom noted by the prover, viz. location, sensation, modality, concomitants, extension and duration will be recorded in ‘Symptoms Elaboration Proforma for any change(s) in the physical/mental/generalities of the provers by the Proving Master/Proving Associate’. Care should also be taken to record the intensity of symptom(s).

g.      Pathological tests will be performed to facilitate observation of any correlation between the subjective and objective changes. During the course of proving, the prover may also be referred for specific laboratory investigations to rule out any cause other than the drug pathogenesis. The expert opinion of the Honorary Consultant(s) may also be taken, if needed.

h.  Provers will be advised to maintain a spontaneous diary notation to note down any changes observed during the trial by them, to prevent errors due to memory lapses. Same changes should be reflected in Prover’s Day Book on the same day.

i.  After completion of all the quotas, the provers will undergo the prescribed ‘Terminal Medical Examination’ (TME).

The Effect of Provings.

The purpose of proving is primarily to find the pictures of new remedies, or to deepen the understanding of old ones. There are, however, many important side effects. New remedies have helped many patients, who might never have been so deeply cured if remedies like Chocolate, Hydrogen and Scorpion had not been understood.
Several provers found that the proving had a substantial effect that seemed to help other remedies to work much better. Provings are not always pleasant; some of the symptoms experienced can be painful or uncomfortable. It is important that provers have the support of the proving structure and of an experienced homoeopath. Sometimes the prover will become stuck in some part of the proving state and he will need another remedy, an antidote, to bring him out of it. However, almost all provers come out of the experienced unchanged, or more often, healthier, stronger and wiser.
Provings are also a powerful pedagogic tool. They help
students to learn and understand the process, through which the remedies they use came to be understood. They also help students to better understand what symptoms are and what they feel like. We all become so used to our own selves and our own symptoms that we do not see them clearly in ourselves or in our patients; a proving forces homoeopaths to look very closely at symptoms and so to understand what exactly a symptom is and what it means.

Research on Drug Proving

1. Proving of new drugs;

Proving of antibiotics, steroids and other modern drugs should be done over healthy human beings, in potentised form, to get many valuable data. These drugs may be effective in curing many obstinate and complicated chronic diseases. When well selected medicine fail to produce any favorable effect, in continued fever, chloromycetine (i.e. chloramphenicol ) cured the patient. In vertigo potentised streptomycin are very useful. Equally good results are obtained from Aspirin in acute migrainous headaches. So, we should get the full proving picture of these Isode groups of drugs, if we get full picture of these drugs (i.e. steroids, antibiotics) we can easily combat the iatrogenic diseases coming from allopathic system.

2. Proving and reproving of nosodes and sarcodes

The nosodes and sarcodes which are not proved at all or partially proved and are empirically used require thorough reproving or new proving. The nosodes and sarcodes have great role in curing chronic complicated and incurable diseases. Even in acute diseases, complete cure is unnecessarily delayed unless a dose of the indicated nosode administered. The drugs like Thyroidinum, Insilin, Carcinosin, Lyssin, Scirrhinum, X-ray and bowel nosodes require proper proving and re proving.

3. Proving on lower animals.

Homoeopathic drug proving is not continued up to the stage of organic changes on healthy human being. Because, it may be hazardous on the life of a prover to continue proving till the end of organic changes. But to get a complete picture of a drug pathogenesis , we should know the various structural changes in different organs. So, there is no other alternative than to prove the medicines on lower animals. Only well proved and fully proved drugs should be used for proving on lower animals to find out the organic changes (organic pathology), where the picture of dynamic pathology is known to us.

. The Relevance of Proving Today
During his life Hahnemann proved at least a hundred different remedies and built the basis of the Materia Medica, that is used today. During the hundred and fifty years since, some two and a half thousand remedies have been added, some through rigorous provings, others through noting the effects of accidental poisonings. Some homoeopaths feel that there are now more medicines than we need and that new provings are a waste of time; others feel that there are still many important medicines to be discovered and that old remedies need to be reproved both to clarify their symptoms and to bring them into focus in the light of the changes in society over two hundred years.
An example of this is; Sepia is the brown pigment that results from drying cuttlefish ink. It was proved by Hahnemann after he observed that one of his patients, a painter, was in the habit of licking his paintbrush whenever he was using a sepia paint. The proving brought out a clear picture of the remedy and it became one of the most important homoeopathic remedies. The picture of Sepia that emerged through the Nineteenth and the first half of this Century was of the worn out housewife. Kent, the great American homoeopath working at the turn of the century, describes her as “A woman who is not built well as a woman.” She becomes the housewife and mother because that is the only role open to her, she is “dragged down” by domestic toil and she resents it. During the last thirty years the role of women in western society has changed dramatically. The woman with a Sepia susceptibility would no longer be forced to stay at home; she can go out into the world and get a job, a high flying one if she wants. The situation is now reversed; the Sepia woman is out working in a man’s world and she is “dragged down” by the fact she is a woman and the pressures that this puts on her. These can be the pressures of having children and running a household, or they can be the physical pressures of being a woman, pressures such as menstruation and menopause. Sepia is such a large and well-known remedy that it is not too difficult to recognize it on some of its more idiosyncratic features and so this modified picture has developed over recent years. However, there must be many other remedies that have a modern picture that is different from that which they revealed when they were proved more than a century ago and, because the details of their pictures are less well known, only new provings will fully reveal the pictures that are relevant today.

The Problems in Contemporary Provings.

Hahnemann was, among his many skills, what we would call today a research scientist and the provings that he conducted were of a very high standard. Sadly not all those that followed him were as scrupulous and many very poor provings were conducted over the years. Over the last twenty years there has been enormous growth in professional homoeopathy all over the world. Provings have now become much more common and the way in which they are conducted is much more rigorous than it was just a few years ago.
Provings should be conducted on healthy individuals; however, very few people would claim to be a hundred per cent healthy and this is one of the many areas where compromises have to be made. No proving is perfect, but if it is well conducted the imperfections are above board and can be taken into account when it is interpreted. Most of the provings done today are done by student homoeopaths, just as they were in Hahnemann’s time. As most students are women, at least ninety per cent, and some classes contain no men at all, there is a gender imbalance in the results. This is the reverse of the situation in conventional medicine. In medical research, whether it is on drugs or of an epidemiological nature, the use of women subjects is thought to introduce too many variables, childbearing, hormonal changes, etc., and, unless it is on a gender specific disease such as breast cancer, research is conducted exclusively on men. Thus although heart disease kills many more women than breast cancer does, there has been almost no research at all on heart disease in women.

Dr. MUJEEBURAHMAN THEKKETHODIKA