Nature Cure Clinical Pearls – Notes From the Field: February 2022
JARED L. ZEFF, ND, VNMI, LAC
The following is not an article prepared for a medical journal. Not every statement of fact is cited or referenced. This is a commentary on the medicine, a running set of observations about practice in the field. It’s not meant to be a peer-reviewed presentation; rather, these are notes and thoughts from a practicing naturopathic physician, a primary care doc in general practice.
Homeopathy in Early Practice
I began practicing naturopathic medicine as a primary care physician a little over 42 years ago. As I grew in practice and encountered the kinds of things a small family practice doc sees, I began to sort things out. I learned some simple patterns or formulas, or what today we refer to as algorithms, for commonly encountered maladies. Besides my growing obstetrical practice (all Oregon naturopathic physicians were licensed to deliver babies in those days), I saw moms and kids, grandparents and occasionally dads. I saw lots of farmers and loggers, and all the sorts of things a doctor sees in a family practice. Although, as a naturopathic doctor, I viewed my patients as unique individuals with their unique patterns of illness, I also noticed that illnesses fell into obvious categories. There were the common things moms brought me, like kids with ear infections. Then the moms’ own concerns: mostly menstrual difficulties and fatigue. There were colds and flus, sinus infections and digestive problems. There was the occasional odd problem that required a deeper diagnostic dive, like an autoimmune disease or a cancer, an unusual infection or degenerative illness. Slowly, as I saw more and more kinds of pathology, I began to see some of the similarities and differences across a wide range of conditions. In general, my basic treatment was to address the acute concern, usually with homeopathy, botanical medicine, and my manipulative skills. Then, I would treat chronic manifestations with dietary changes, hydrotherapy, and appropriate botanicals.
Lab tests or imaging studies were often necessary for my patients. I began practicing before the Clinical Laboratory Improvement Amendments (CLIA) rules came into effect, and my partner and I did extensive laboratory testing in our clinic. We had been trained in this in school, where students operated the school’s clinical lab under the direction of a lab tech or pathologist. At my clinic, we performed complete blood counts, serum chemistries, gram stains, and various cultures. We had an incubator in our clinic, like we had at school, and a collection of various culture media on petri dishes. We also had some rather sophisticated laboratory equipment, most of which was outlawed after the CLIA regulations came into effect. But, until then, we did most of our own lab work at our clinic. Some of this was necessitated by the fact that a nearby lab in the town where we had established our practice, owned by local medical doctors, refused to take samples from us. In their opinion, we were medical heretics and should not have even been allowed to practice. If necessary, we would drive essential test samples to a lab in Portland that would take our work – about an hour away.
Aside from seeing my patients and doing lab work, I also did plenty of research. Before the days of personal computers and the internet, I subscribed to various medical journals. I often drove up to the medical school library in Portland where there were more journals. I eventually developed a medical library of my own to facilitate research.
There were fewer of us in those days. In 1980, the National College of Naturopathic Medicine (NCNM), which is now called the National University of Natural Medicine, did a survey and discovered that there were around 200 licensed naturopathic physicians in North America at the time. There were implications to that small number; we were called upon to do more than just clinical practice. In my 2nd year of practice, I was elected vice president of the Oregon Association of Naturopathic Physicians (OANP). I attended monthly OANP meetings, usually with 6 or 7 other doctors. Together, we monitored and wrote legislation and lobbied for or against it in Salem. Don Walker, ND, our legislative chairman, knew the ropes and guided us in our efforts. And, of course, we taught. Most of the teachers at NCNM were naturopathic doctors who were called upon to teach or who volunteered because teachers were needed. I eventually held a half-time teaching position along with my full-time clinical practice.
I loved clinical practice; it was the center of my professional life. I loved my patients, even the difficult ones, and my great joy was seeing them heal. My great frustration was when I did not know how to help them. The desire to assist those I did not yet know how to treat drove the rest of my professional aspirations. Filled with lab work, legislative activity, and teaching, I was trying to learn how to do it all better. This was my life 40 years ago, and I delighted in it.
As I gained more experience, I continued to develop my methods of practice. In general, the sequence would be to get the diet right, begin hydrotherapy treatments, prescribe appropriate botanicals, use my hands to correct the body’s structure, and find an appropriate homeopathic remedy. Homeopathy was truly a marvel. When I first encountered it in school, I thought of those who advocated for it as a self-deceived placebo cult. But when I had to use it in the school clinic and saw amazing (and nearly instantaneous) results, I was confounded, then amazed, then increasingly curious. How could this be? How could this little nothing of a sugar pill work so well? I learned more and more to rely upon it. Arnica, Ruta, or Ledum worked for traumatic injury. Cantharis, Equisetum, or Berberis worked for bladder infections. And menstrual pain or difficulty usually melted away with the application of the correct remedy: Belladonna, Magnesia Phosphorica, Cimicifuga, Sepia, or Sabina.
We had a busy practice. There was a time when I was seeing 25 or more people a day. I had 20- to 30-minute visits along with a few hydrotherapy treatments, manipulations, or other physical medicine. When I began practicing and saw maybe a few patients in a week, I could spend a couple of hours trying to repertorize a patient. But as I got busier, I needed quicker ways to prescribe. I read books by James Tyler Kent, Elizabeth Wright Hubbard, and Roger Newman Turner. I discovered Allen’s Keynotes. I relied heavily on Clarke’s Dictionary of Practical Materia Medica. I used Boericke’s Therapeutic Index in his Homeopathic Materia Medica and Repertory. I was constantly looking for guides to rapid prescribing. Using these resources, I slowly developed a knowledge of each remedy and learned how to arrive at a good remedy more quickly. There is little more satisfying in clinical practice than giving the correct remedy and seeing the patient transform in a matter of minutes. The right remedy will open the lungs of an asthmatic, ease the pain of an ear infection, clear the sinuses, settle the stomach, or soothe pelvic cramping, and I could see it happening before my eyes, time and again, to the patient’s relief and amazement (and mine too).
In the early days, I would turn to Boericke’s Therapeutic Index and be guided by what I found there. Then I would read about the remedies in Boericke or Clark and find the right medicine. For instance, Boericke lists the rubric for biliary stones as: “Calculi (biliary) – China, Berberis, Chelidonium.” For renal stones, he lists the rubric as: “Calculi (renal) – Berberis, Pareira, Sarsaparilla.” Using these, I could quickly read about each remedy, see which one fit the case, then give it to the patient. In this way, I learned small but valuable keynotes. For bladder infection, I would try Cantharis if there was “intense burning.” With blood in the urine, however, Berberis would likely work better. If the problem was related to sexual activity, I would use Staphysagria. If pain was “splintery” or “needlelike,” I would consider Nitric Acid. If there was pain or itch after urination, Sarsaparilla might work. If the problem was mostly increased frequency, Causticum was most likely to be effective.
Even with all of my training and experience with homeopathy, prescribing for cough was tough. I found it to be one of the most difficult aspects of practicing homeopathy in those early days. I could make a good, useful botanical formula, but I could not get a handle on treating coughs with homeopathy. The simple rubrics and keynotes could not guide me accurately to good remedies (at least initially). In his Therapeutic Index, Boericke lists more remedies for cough than for any other entry. The typical entry has just 3 to 5 medicines. But for cough, there are 44 remedies listed under 7 distinct categories. It took me a long time to develop enough knowledge and experience to be able to make more rapid prescriptions. There are, however, some useful keynotes and simple rubrics that can quickly indicate a good remedy for a person suffering from cough. The following clinical pearls are what I found most useful in developing my homeopathy prescribing. This little collection is not comprehensive but is a place to start.
My wife managed the care of our 5 children for the most part, and one of her favorite resources in this endeavor was Panos and Heimlich’s health care guide, Homeopathy at Home. Using this book, she taught me that croup will usually resolve to a dose of Aconitum, repeated in 10 minutes, then followed by a dose of Spongia. For potency, the 30C was most often a good choice. If Spongia is not effective, then one can try Hepar sulph, or alternate them. The Spongia cough is hard, dry, barking, and may have a ringing or metallic sound to it. In contrast, Hepar sulph has a wet, croupy, hoarse cough, often with choking and yellow/green phlegm. There is often a sinus infection with Hepar sulph, for which it is usually an excellent remedy.
Other cough keynotes:
- A dry, persistent tickly cough made worse or brought on by talking usually resolves with Phosphorus. This cough usually comes from irritation in the trachea. The phlegm may have a bit of blood in it.
- A spasmodic, dry cough usually resolves with Drosera.
- Bryonia is excellent if chest pain accompanies the cough. A keynote of Bryonia is that the pain improves if the patient holds the part or lies on the part that hurts, immobilizing it. Bryonia is also an excellent medicine for pneumonia, as is Phosphorus.
- If the cough is phlegmy, with stertorous breathing or rattling sounds on auscultation, Antimonium Tartaricum is usually effective. This cough is loose and rattly with little expectoration. Antimonium Tartaricum is also an excellent asthma remedy.
- If there is phlegm that is stuck or very difficult to expel, then try Kali Bichromicum. Its cough is metallic and barking, but the keynote is the mucus: a hard, rubbery, white mucus usually in little plugs. I often mix Kali Bichromicum and Antimonium Tartaricum together or alternate them in cases of asthma with the characteristic mucus as a symptom.
- If there is nausea or gagging with the cough, it usually resolves with Ipecacuanha.
- The cough of Rumex originates in the suprasternal fossa, is aggravated or brought on by cold air, and is relieved by warm air.
Homeopathy is an elegant and amazing system of medicine. It must be kept in mind that medicines are not “homeopathic” due to the method of their manufacture, but are “homeopathic to the case,” as Jim Sensenig used to teach. The correct homeopathic medicine matches the symptoms, and therefore will most precisely stimulate the vital force to throw off the disease. We often refer to homeopathic remedies as medicines that are serially diluted and succussed, but the true value and meaning refers to the specific application of similarity to the picture of illness presented.
When I give a remedy, I expect a response very quickly. Often, I give a remedy to my patient sitting across from my desk. In a few minutes, I ask if they feel any different. Any pain should be improving. Breathing should be easier. The patient should be more relaxed and more present. In such cases, the patient will often comment that it seems brighter in the room. This is how I know that the medicine was effective. I rarely send a patient home with a remedy without giving it in the office first and gauging their response to it. These medicines work very quickly and should be obviously effective if correct. If not, then I pick the next best choice and try it. With a cough, the patient should be able to breathe more deeply without coughing, or at least with an obviously lessened cough. Then I know that the remedy was correct. In general, I will use a 30C or 200C initially.
To go beyond what I have provided here, check out Dewey’s Practical Homeopathic Therapeutics. It is one of the best guides I have ever found. Also, Thomas Kruzel wrote an excellent acute prescribing guide, now called The Homeopathic Emergency Guide. Clarke’s Dictionary of Practical Materia Medica is also available for free online. Finally, with any difficult conditions and especially for coughs, if you are unsure of the remedy, try checking it out in Clarke and then reading through the corresponding symptoms.
Jared L. Zeff, ND, VNMI, LAc
Jared L. Zeff, ND, VNMI, LAc is a licensed doctor of naturopathic medicine and a licensed acupuncturist. In addition to functioning as Medical Director at the Salmon Creek Naturopathic Clinic in Vancouver, WA, Dr Zeff taught on the faculty at National University of Natural Medicine in Portland, OR, where he was also Dean from 1988 to 1993, and holds a professorship in Naturopathic Medicine. Dr Zeff is a graduate of the University of California, NCNM, and the Emperor’s College of Traditional Oriental Medicine. He, along with Pamela Snider, is the author of the AANP’s Definition of Naturopathic Medicine, and the Therapeutic Order concept.