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‘Paradoxical pharmacology’: therapeutic strategy used by the ‘homeopathic pharmacology’ for more than two centuries - Part 1

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  • School of Medicine University of Sao Paulo

Abstract

Using the empirical or phenomenological research method by observing the effects of drugs in the human physiology, Samuel Hahnemann proposed the homeopathic treatment. He synthesized modern pharmacodynamic in the ‘primary action’ of the drugs and in the consequent and opposite ‘secondary action’ or ‘vital reaction’ of the organism. Noting that drugs with ‘contrary’ primary action to the symptoms of the diseases caused worsening of the symptoms after its withdrawal, as a result of secondary action of the organism, Hahnemann proposed using this vital reaction (secondary action) in a curative way, administering to sick individuals the drugs that caused ‘similar’ symptoms in healthy individuals (therapeutic use of the similitude principle). According to the clinical and experimental pharmacology, this secondary action (vital reaction) of the organism is observed in the ‘rebound effect’ or ‘paradoxical reaction’ of several classes of drugs, which is the scientific basis of the ‘homeopathic pharmacology’. In the last decade, exponents of modern pharmacology have suggested the therapeutic use of the paradoxical reaction (‘paradoxical pharmacology’), proposing the use of drugs that cause an exacerbation of the disease in the short term to treat these same diseases in the long-term. In this review, we compare the various aspects between the ‘homeopathic pharmacology’ and the ‘paradoxical pharmacology’, reinforcing the validity of homeopathic assumptions and expanding the knowledge to optimize both proposals.
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THERAPEUTIC STRATEGY USED BY THE
'HOMEOPATHIC PHARMACOLOGY'
FOR MORE THAN TWO CENTURIES
'PARADOXICAL
PHARMACOLOGY'
Marcus Zulian Teixeira
School of Medicine, University of São Paulo, São Paulo, Brazil
ABSTRACT
U s in g t h e e m p i ri c al o r
phenomenological research method by
observing the effects of drugs in the
human physiology, Samuel Hahnemann
proposed the homeopathic treatment.
H e s y n t h e s i z e d m o d e r n
pharmacodynamic in the 'primary action'
of the drugs and in the consequent and
opposite 'secondary action' or 'vital
reaction' of the organism. Noting that
drugs with 'contrary' primary action to
the symptoms of the diseases caused
worsening of the symptoms after its
withdrawal, as a result of secondary
action of the organism, Hahnemann
proposed using this vital reaction
(secondary action) in a curative way,
administering to sick individuals the
drugs that caused 'similar' symptoms in
healthy individuals (therapeutic use of
the similitude principle). According to
th e c lini cal an d expe rim ent al
pharmacology, this secondary action
(vital reaction) of the organism is
observed in the 'rebound effect' or
'paradoxical reaction' of several classes
of drugs, which is the scientific basis of
the 'homeopathic pharmacology'. In the
last decade, exponents of modern
8
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Reprint Article,
Reproduced with permission from Editor, High Dilution.
Published at http://www.feg.unesp.br/~ojs/index.php/ijhdr/article/view/714/740
Vol: 22 No: 1 Visit us:www.ihma.in
pharmacology have suggested the
therapeutic use of the paradoxical
reaction ('paradoxical pharmacology'),
proposing the use of drugs that cause an
exacerbation of the disease in the short
term to treat these same diseases in the
long-term. In this review, we compare
the various aspects between the
'homeopathic pharmacology' and the
'paradoxical pharmacology', reinforcing
the validity of homeopathic assumptions
and expanding the knowledge to
optimize both proposals.
Keywords: Homeopathy; Pharmacology;
P ha r ma co d yn a mi c A c ti o n o f
Homeopathic Remedy; Secondary Effect;
Rebound Effect; Paradoxical Reaction;
Paradoxical Pharmacology.
Introduction
In the ancient Greece, Hippocrates
recommended treatment of diseases by
the principles of 'contraries' (contraria
contrariis curentur) or 'similar' (similia
similibus curentur), teaching that
“whatever evil and from where come,
you might want to always treat or by
contrary or by similar(Liber de locis in
h o m i n e) . B a s e d o n C o r p u s
Hippocraticus, several exponents of the
old medical schools spread these ways to
treat [1].
The 'principle of contraries', which
is applied to a large percentage of
conventional modern therapeutic,
employs medicines with contrary
(enantiopathic, antipathetic, opposite or
palliative) action to the signs and
symptoms of the diseases, in order to
mi ni mi ze o r n eu tr al ize th ei r
manifestations. On the other hand, the
'principle of similars' or 'principle of
similitude', systematized by the
homeopathic therapeutic, employs
drugs that possess the property of
exhibiting signs and symptoms similar to
those manifested by diseases, in order to
stimulate the organism to react against
their own disturbances.
The homeopathic method of
treatment is based on four pillars:
'principle of therapeutic similitude',
'proving of medicinal substances on
healthy individuals', use of 'serially
diluted and shaken (dynamized)
medicines', and prescription of
'individualized medicines'. Although
great importance was attributed to
'dynamized medicines' (infinitesimal or
ultrahigh-diluted doses), which were
introduced later in the homeopathic
model to minimize the possible
'aggravation of the diseases' in the
application of the similitude principle,
the first two pillars are the proper
foundation of the homeopathic
epistemological model, remaining to
'individualized medicine' the essential
condition for awakening the therapeutic
response.
In the last decade, exponents of
modern clinical and experimental
pharmacology have suggested a
therapeutic strategy similar to the one
propagated by homeopathy for more
than two centuries, called 'paradoxical
pharmacology', proposing the use of
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conventional drugs that cause an
exacerbation of the disease in the short-
term to treat this same disease in the
long-term.
In this review article, we propose
identi fying the conceptual and
functional similarities between the
' ho me op at hi c ph ar ma co lo g y'
(therapeutic use of the similitude
principle) and the 'paradoxical
pharmacology' (therapeutic use of the
paradoxical reaction), reinforcing the
validity of homeopathic assumptions
before the modern scientific rationality
and expanding the knowledge to
optimize both proposals.
Similitude in homeopathy 'Law of
similars'
During the development of the
homeopathic methodology, Samuel
H a h n em a n n m a i n t ai n e d a n
ex pe ri me nta l p os tu re , u si ng
phenomenological research method to
describing the effects of dozens of drugs
in the human health and correlating his
observations with evidences from
medical literature.
In the work that inaugurated the
homeopathy (Essay on a new principle
for ascertaining the curative power of
drugs, 1796) [2] and in the introduction
of the Organon of medicine [3] he cited
several reports of an opposite
'secondary action of the organism' after
a 'primary action of the drug' described
in your observations and in hundreds of
bibliographical references. These
descriptions were illustrated with
'examples of accidental homeopathic
cure' reported by doctors of all times,
supporting a scientific rationale for the
principle of homeopathic cure:
“The seeds of the poison tree
(Strychnos nux vomica) are very
powerful; but the morbid symptoms it
produces are not yet accurately known.
The most I know concerning them is
derived from my own observation. The
primary action produce vertigo, anxiety,
febrile rigour, and in their secondary
action a certain immobility of all parts, at
least of the limbs, and a spasmodic
stretching, according to the size of the
dose. Hence they are useful, not only, as
is already known, in intermittent fever,
but in cases of apoplexy. In their first
direct action the muscular fiber has a
peculiar mobility imparted to it, the
sensitive system is morbidly exalted to a
species of intoxication, accompanied by
fearfulness and horror. Convulsions
ensue. The irritability seems to exhaust it
itself during this continued action on the
muscular fiber, first in the animal, then in
the vital functions. On passing into the
indirect secondary action, there occurs a
diminution of the irritability, first, in the
vital functions (general perspiration),
then in the animal, and lastly in the
natural functions. In the latter, especially,
this secondary action lasts several days.
During the secondary action, there is a
diminution of sensibility. Whether in the
primary direct action the tonicity of the
mu scle s is di mini shed , to be
proportionately increased in the
10
secondary action, cannot be accurately
determined; this much, however, is
certain, that the contractility of the fiber
is as much diminished in the secondary
action, as it was increased in the direct
action”. (Essay on a new principle for
ascertaining the curative power of
drugs)
Arsenic, whose effects are so
powerful upon the human economy that
we cannot decide whether it is more
hurtful in the hands of the fool-hardy
than it is salutary in those of the wise, -
arsenic could never have effected so
many remarkable cures of cancer in the
face, as witnessed by numerous
physicians, among whom I will only cite
Fallopius, Bernhardt, and Roennow, if
this metallic oxide did not possess the
homeopathic power of producing, in
healthy persons, very painful tubercles,
which are cured with difficulty, as
witnessed by Amatus Lusitanus; very
deep and malignant ulcerations,
according to the testimony of Heinreich
and Knape; and cancerous ulcers, as
testified by Heinze. The ancients would
not have been unanimous in the praise
which they bestowed on the magnetic
arsenical plaster of Angelus Sala against
pestilential buboes and carbuncles, if
arsenic did not, according to the report
of Degner and Pfann, give rise to
inflammatory tumours which quickly
turn to gangrene, and to carbuncles or
malignant pustules, as observed by
Verzascha and Pfann. And whence could
arise that curative power which it
exhibits in certain species of intermittent
fevers (a virtue attested by so many
thousands of examples, but in the
practical application of which, sufficient
precaution has not yet been observed,
and which virtue was asserted centuries
ago by Nicholas Myrepsus, and
subsequently placed beyond a doubt by
the testimony of Slevogt, Molitor, Jacobi,
J. C. Bernhardt, Jiingken, Fauve, Brera,
Darwin, May, Jackson, and Fowler) if it
did not proceed from its peculiar faculty
of excit ingfever, as almost every
observer of the evils resulting from this
substance has remarked, particularly
Amatus Lusitanus, Degner, Buchholz,
Heun, and Knape. We may confidently
believe E. Alexander, when he tells us
that arsenic is a sovereign remedy in
some cases of angina pectoris, since
Tachenius, Guilbert, Preussius, Thilenius,
and Pyl, have seen it give rise to very
strong oppression of the chest;
Gresselius, to a dyspnea approaching
even to suffocation; and Majault, in
particular, saw it produce sudden attacks
of asthma excited by walking, attended
with great depression of the vital
powers”. (Organon of medicine,
“Examples of accidental homeopathic
cure”) With these several evidences,
Ha hn em an n gat he re d 's tr on g
arguments' that enabled him to induce a
physiological mechanism to explain this
'biphasic' or 'bidirectional' action of
drugs on the organism:
“Every agent that acts upon the
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11
vitality, every medicine, deranges more
or less the vital force, and causes a
certain alteration in the health of the
individual for a longer or a shorter
period. This is termed primary action.
[…] To its action our vital force endeavors
to oppose its own energy. This resistant
action is a property, is indeed an
automatic action of our life-preserving
power, which goes by the name of
secondary action or counter-action”.
(Organon of medicine, paragraph 63)
He exemplifies this biphasic action
(primary action of the drug followed by a
secondary and opposite action of the
organism) in the non-pharmacological
i n t e r v e n t i o n s a n d i n t h e
pharmacological effects of antipathic
treatments used at that time:
“[…] A hand bathed in hot water is
at first much warmer than the other
hand that has not been so treated
(primary action); but when it is
withdrawn from the hot water and again
thoroughly dried, it becomes in a short
time cold, and at length much colder
than the other (secondary action). A
person heated by violent exercise
(primary action) is afterwards affected
with chilliness and shivering (secondary
action). To one who was yesterday
heated by drinking much wine (primary
action), today every breath of air feels
too cold (counteraction of the organism,
secondary action). An arm that has been
kept long in very cold water is at first
much paler and colder (primary action)
than the other; but removed from the
cold water and dried, it subsequently
becomes not only warmer than the
other, but even hot, red and inflamed
(secondary action, reaction of the vital
force). Excessive vivacity follows the use
of strong coffee (primary action), but
sluggishness and drowsiness remain for a
long time afterwards (reaction,
secondary action), if this be not always
again removed for a short time by
imbibing fresh supplies of coffee
(palliative). After the profound stupefied
sleep caused by opium (primary action),
the following night will be all the more
sleepless (reaction, secondary action).
After the constipation produced by
opium (primary action), diarrhea ensues
(secondary action); and after purgation
with medicines that irritate the bowels,
constipation of several days' duration
ensues (secondary action). And in like
manner it always happens, after the
primary action of a medicine that
produces in large doses a great change in
the health of a healthy person, that its
exact opposite, when, as has been
observed, there is actually such a thing, is
produced in the secondary action by our
vital force. (Organon of medicine,
paragraph 65)
Describing the sad results of the
indiscriminate palliative (antipathic,
en antio pat hi c) em plo yme nt of
medicines (Organon of medicine,
paragraphs 56-61), Hahnemann alerts to
the risks of this undesirable secondary
action (vital reaction) of the organism
that can produce “more serious disease
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12
or frequently even danger to life and
death itself. This way, negating the
efficacy of the conventional or palliative
treatment (principle of contraries),
Hahnemann validates the homeopathic
treatment (principle of similitude)
through the hypothetical syllogism or
classical deductive logic “modus tollens”
('mode that affirms through negation' or
'indirect proof'). Through various
examples, he concludes that “after such
shor t an ti path ic amel io ration ,
aggravation follows in every case
without exception (Organon of
medicine, paragraph 58), i.e., after a
primary action of palliative medicines
occurs a secondary action of the
organism, with worsening of symptoms:
Im po rta nt s ympt om s o f
persistent diseases have never yet been
treated with such palliative, antagonistic
remedies, without the opposite state, a
relapse - indeed, a palpable aggravation
of the malady - occurring a few hours
afterwards. For a persistent tendency to
sleepiness during the day the physician
prescribed coffee, whose primary action
is to enliven; and when it had exhausted
its action the day - somnolence
increased; - for frequent waking at night
he gave in the evening, without heeding
the other symptoms of the disease,
opium, which by virtue of its primary
action produced the same night
(stupefied, dull) sleep, but the
subsequent nights were still more
sleepless than before; - to chronic
diarrheas he opposed, without
regarding the other morbid signs, the
same opium, whose primary action is to
constipate the bowels, and after a
transient stoppage of the diarrhoea it
subsequently became all the worse; -
violent and frequently recurring pains of
all kinds he could suppress with opium
for but a short time; they then always
returned in greater, often intolerable
severity, or some much worse affection
came in their stead. For nocturnal cough
of long standing the ordinary physician
knew no better than to administer
opium, whose primary action is to
suppress every irritation; the cough
would then perhaps cease the first night,
but during the subsequent nights it
would be still more severe, and if it were
again and again suppressed by this
palliative in increased doses, fever and
nocturnal perspiration were added to the
disease; - weakness of the bladder, with
consequent retention of urine, was
sought to be conquered by the antipathic
work of cantharides to stimulate the
urinary passages whereby evacuation of
the urine was certainly at first effected
but thereafter the bladder becomes less
capable of stimulation and less able to
contract, and paralysis of the bladder is
imminent; - with large doses of purgative
drugs and laxative salts, which excite the
bowels to frequent evacuation, it was
sought to remove a chronic tendency to
constipation, but in the secondary action
the bowels became still more confined; -
the ordinary physician seeks to remove
chronic debility by the administration of
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13
wine, which, however, stimulates only in
its primary action, and hence the forces
sink all the lower in the secondary its
primary action, and hence the forces
sink all the lower in the secondary
action; - by bitter substances and
heating condiments he tries to
strengthen and warm the chronically
weak and cold stomach, but in the
secondary action of these palliatives,
which are stimulating in their primary
action only, the stomach becomes yet
more inactive; - long standing deficiency
of vital heat and chilly disposition ought
surely to yield to prescriptions of warm
baths, but still more weak, cold, and
chilly do the patients subsequently
become; - severely burnt parts feel
instantaneous alleviation from the
application of cold water, but the
burning pain afterwards increases to an
incredible degree, and the inflammation
spreads and rises to a still greater height;
- by means of the sternutatory remedies
that provoke a secretion of mucus,
coryza with stoppage of the nose of long
standing is sought to be removed, but it
escapes observation that the disease is
aggravated all the more by these
antagonistic remedies (in their
secondary action), and the nose
becomes still more stopped; - by
electricity and galvanism, with in their
primary action greatly stimulate
muscular action, chronically weak and
almost paralytic limbs were soon excited
to more active movements, but the
consequence (the secondary action) was
complete deadening of all muscular
irritability and complete paralysis; - by
venesections it was attempted to
remove chronic determination of blood
to the head, but they were always
followed by greater congestion; -
ordinary medical practitioners know
nothing better with which to treat the
paralytic torpor of the corporeal and
mental organs, conjoi ned wit h
unconsciousness, which prevails in many
kinds of typhus, than with large doses of
valerian, because this is one of the most
powerful medicinal agents for causing
animation and increasing the motor
faculty; in their ignorance, however, they
knew not that this action is only a
primary action, and that the organism,
after that is passed, most certainly falls
back, in the secondary (antagonistic)
action, into still greater stupor and
immobility, that is to say, into paralysis of
the mental and corporeal organs (and
death); they did not see, that the very
diseases they supplied most plentifully
with valerian, which is in such cases an
oppositely acting, antipathic remedy,
most infallibly terminated fatally. The old
school physician rejoices that he is able
to reduce for several hours the velocity of
the small rapid pulse in cachectic
patients with the very first dose of
uncombined purple foxglove (which in its
primary action makes the pulse slower);
its rapidity, however, soon returns;
repeated, and now increased doses
effect an ever smaller diminution of its
rapidity, and at length none at all - indeed
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14
- in the secondary action the pulse
becomes uncountable; sleep, appetite
and strength depart, and a speedy death
is invariably the result, or else insanity
ensues. How often, in one word, the
disease is aggravated, or something
even worse is affected by the secondary
action of such antagonistic (antipathic)
remedies, the old school with its false
theories does not perceive, but
experience teaches it in a terrible
manner”. (Organon of medicine,
paragraph 59)
Despite this secondary action of
the organism be clearly observed after
the primary action of the medicines in
moderate-large doses (Organon of
medicine, paragraphs 65, 112), as an
instinctive and automatic mechanism of
sel f-regula tio n of t he i nte rna l
enviro nm ent (ho me ostas is ), i n
homeopathic (small) doses, as result of
weak primary action of the medicine, is
not perceived an “obvious antagonistic
secondary action ” (Organon of
medicine, paragraphs 66, 68, 112). In
this situation, the organism “employs
against it only so much reaction
(secondary action) as is necessary for
the restoration of the normal condition”,
and may be curative or not if the
therapeutic similitude principle is
observed. In this case, it is worth
mentioning that although little
significant (non “obvious”, “reacts only
so much as is requisite”, “so much
reaction as is necessary, “any more
considerable reaction than will suffice”,
“little effort is required”), the secondary
action (vital reaction) of the organism
manifests itself and is perceived through
their curative effects:
“[…] And in like manner it always
happens, after the primary action of a
medicine that produces in large doses a
great change in the health of a healthy
person, that its exact opposite, when, as
has been observed, there is actually such
a thing, is produced in the secondary
action by our vital force”. (Organon of
medicine, paragraph 65)
“In those older prescriptions of the
often dangerous effects of medicines
ingested in excessively large doses we
notice certain states that were produced,
not at the commencement, but towards
the termination of these sad events, and
which were of an exactly opposite nature
to those that first appeared. These
symptoms, the very reverse of the
primary action (§ 63) or proper action of
the medicines on the vital force are the
reaction of the vital force of the
organism, its secondary action (§ 62-67),
of which, however, there is seldom or
hardly ever the least trace from
experiments with moderate doses on
healthy bodies, and from small doses
none whatever. 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”. (Organon of
medicine, paragraph 112)
“A n ob viou s an tago ni sti c
secondary action, however, is, as may
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15
readily be conceived, not to be noticed
from the action of quite minute
homoeopathic doses of the deranging
agents on the healthy body. A small
dose of every one of them certainly
produces a primary action that is
perceptible to a sufficiently attentive;
but the living organism employs against
it only so much reaction (secondary
action) as is necessary for the
restoration of the normal condition”.
(Organon of medicine, paragraph 66)
“In homoeopathic cures they
show us that from the uncommonly
small doses of medicine (§ 275-287)
required in this method of treatment,
which are just sufficient, by the
similarity of their symptoms, to
overpower and remove from the
sensation of the life principle the similar
natural disease there certainly remains,
after the destruction of the latter, at
first a certain amount of medicinal
disease alone in the organism, but, on
ac co un t of th e ex trao rd inary
minuteness of the dose, it is so
transient, so slight, and disappears so
rapidly of its own accord, that the vital
force has no need to employ, against
this small artificial derangement of its
health, any more considerable reaction
than will suffice to elevate its present
state of health up to the healthy point -
that is, than will suffice to effect
complete recovery, for which after the
extinction of the previous morbid
derangement but little effort is required
64, B)”. (Organon of medicine,
paragraph 68)
Pr op osing t o a pp ly su ch
'secondary action' in a curative way
(curative secondary action or effect),
awakening a 'vital reaction' of the
organism against its own disorders,
Hahnemann suggested employing
medicines that in their 'primary action'
produce symptoms similar to the ones of
natural disease, thus widening the
notion of the 'curative similitude'
(homeopathic method of treatment):
every substance capable of provoking
certain symptoms in healthy individuals
(due to the primary action of the drug),
can be used to cure similar symptoms in
the sick (through the curative secondary
action of the organism), according to the
therapeutic similitude principle.
(Organon of medicine, paragraphs 24-
28) In summary, in the exemplification
of the harmful effects of the use of
moderate-large doses in accordance
with the a ntipathic t reat ment,
Hahnemann reports that such secondary
action (vital reaction) of the organism
(opposed in character to the primary
action of the drug) is evidently observed
(Organon of medicine, paragraphs 58-61,
112). In the homeopathic treatment
(minimal doses), Hahnemann reports
that the curative secondary action of the
organism reacts to the primary action of
the homeopathic doses “only so much as
is requisite to raise the health again to
the normal healthy state” (Organon of
medicine, paragraphs 66, 68, 112). As will
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be shown below, Hahnemann also
employed the principle of therapeutic
similitude with massive (ponderable)
doses of medicines, awakening a
curative secondary action of the
organism to conduct a complete
recovery. Thus, noting its manifestation
in the most diverse situations,
Hahnemann raises the principle of
therapeutic similitude (an opposite
curative secondary action of the
organism after the primary action of the
medicine) to the level of “natural law of
cure” or “law of similars” (Organon of
medicine, paragraphs 26-28, 50-53),
regardless of the doses, since the
symptomatic individualization is
respected:
“The curative power of medicines,
therefore, depends on their symptoms,
similar to the disease but superior to it in
strength 12-26), so that each
individual case of disease is most surely,
radically, rapidly and permanently
annihilated and removed only by a
medicine capable of producing (in the
human system) in the most similar and
complete manner the totality of its
symptoms, which at the same time are
stronger than the disease”. (Organon of
medicine, paragraph 27)
“As this natural law of cure
manifests itself in every pure experiment
and every true observation in the world,
the fact is consequently established; it
matters little what may be scientific
explanation of how it takes place; and I
do not attach much importance to the
attempts made to explain it. But the
following view seems to commend itself
as the most probable one, as it is
founded on premises derived from
experience”. (Organon of medicine,
paragraph 28)
As me nt io ned pre vi ou sl y,
although Hahnemann used in the early
stage of the homeopathic therapy
ponderable (massive) doses of drugs in
accordance with the therapeutic
principle of similitude, the infinitesimal
or ultrahigh-diluted doses have
emerged in order to allow the organism
to react to the primary stimulus of the
drugs without the possible toxicological
disorders, observing later that they
awakened and healed different
symptoms of the substantial doses,
enlarging the therapeutic approach.
S i m i l i t u d e i n m o d e r n
ph ar ma co log y ' Home op at hi c
pharmacology'
Building a bridge between the
principle of similitude and the modern
ph ar ma col og y ( 'h ome op ath ic
pharmacology'), one can find countless
reports in pharmacological compendia
and clinical and experimental trials
published in the scientific media
describing the secondary reaction of the
organism opposed to the primary action
o f th e d ru g, w hi c h co nf ir m
Hahnemann's theory. Such secondary
action of the organism to preserve
organic homeostasis is known as
' re bo un d e ff ec t' by m od er n
pharmacology [4-15].
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17
To be continued in next issue
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