Pharmaconomy :

- Sumit Goel.

The various homoeopathic dosage forms can be introduced into the body through a variety of routes. PHARMACONOMY is the subject that deals with the route of administration of medications.

In 5th edition of Organon of Medicine, Hahnemann gives the following instructions, regarding the routes of administration of homoeopathic medicines -

Aph. 288 - The action of medicines in the liquid form upon the living human body takes place in such a penetrating manner, spreads out from the point of the sensitive fibres provided with nerves whereto the medicine is first applied with such unconceivable rapidity and so universally through all parts of the living body, that this action of the medicine must be denominated a spirit like (a dynamic virtual) action.

Aph. 289 - Every part of our body that possesses the sense of touch is also capable of receiving the influence of medicines and of propagating their power to all other parts.

Aph. 290 - Besides the stomach, the tongue and the mouth are the parts more susceptible to the medicinal influences; but the interior of the nose is more especially so, and the rectum, the genitals, as also all particularly sensitive parts of our body are almost equally capable of receiving the medicinal action; hence also, parts destitute of skin, wounded or ulcerated spots permit the powers of medicines to exercise as penetrating an action upon the organism as if the medicine had been taken by mouth or still better by olfaction or inhalation.

Aph. 291 - Even those organs which have lost their peculiar sense, e.g., a tongue and palate that have lost the faculty of tasting, or a nose that has lost the faculty of smelling, communicate the power of the medicine that acts first on them alone not less perfectly to all the other organs of the body.

Aph. 292 - Even the external surface of the body, covered as it is with skin and epidermis, is not unsusceptible of the powers of medicines, especially those in a liquid form, but the most sensitive parts are the most susceptible.

In 1832, Hahnemann began experimenting with olfaction of remedies, having the patient smell a moistened pellet as a dose. He described this in his preface to Boenninghausen's List of Symptoms of the Antipsoric Medicines and again in detail in the 5th edition of the Organon (in the footnote to aphorism 288) in 1833. He experimented extensively with olfaction in 1832 - 1833, but although he continued to use it as a dosing option into his later years, it did not catch on well among his colleagues. For several years Hahnemann employed this process of inhaling for all his patients without exception. Even in the year 1837, his confidence in the inhalation of remedies was strong as is evident from the preface to the third part of Chronic Diseases. It was only towards the end of his life did his preference for olfaction abate. This is evident from the modified paragraphs in the sixth edition of Organon.

In 6th edition of Organon of Medicine, Aph. 284, Aph. 285, Hahnemann rewrote the entire section of the 5th edition and clarified about the parts of the body that are more or less susceptible to the influence of the medicines.

" Besides the tongue, mouth and stomach which are most commonly affected by the administration of the medicine, the nose and respiratory organs are receptive of the action of medicines in fluid form by means of olfaction and inhalation through mouth. But the whole remaining skin of the body clothed with epidermis is adapted to the action of medicinal substances, especially if the inunction is connected with simultaneous internal administration.

In this way, the cure of very old diseases maybe furthered by applying externally, rubbing it in the back, arms, extremities, the same medicine he gives internally and which showed itself curatively. In doing so, he must avoid parts subject to pain, spasm and skin eruption."

The nature of the dosage form must be in consonance with the intended route of administration for maximum effectiveness and convenience of handling and administration. The following are the various routes or channels through which the homoeopathic medicine can be introduced into the human system -

I. ORAL ROUTE

Oral route is the most important of all the routes of administration. The oral dosage forms include (i) solid dosage forms like globules, powders, tablets and cones; and (ii) liquid dosage forms like medicated distilled water, mother tinctures and syrups. These act via the oral route on the entire human organism. They may also act locally on the oral mucous membrane.

Homoeopathic medicines are generally administered singly and orally. The medicines given orally seem to act effectively and promptly. The potentized medicines seem to act not by a process of digestion, but through the nervous system.

"Such a globule, placed dry upon the tongue, is one of the smallest doses for a moderate recent case of illness. Here but few nerves are touched by the medicine. A similar globule, crushed with some sugar of milk and dissolved in a good deal of water and stirred well before every administration will produce a far more powerful medicine for the use of several days. Every dose, no matter how minute, touches, on the contrary, many nerves." (Aph. 272)

Sub-lingual administration of medicines may also be adopted.

For local action, gurgles are advised. Gurgles are aqueous solutions intended to be used after dilution with warm water. They are intended to bring the medicament into contact with the mucous surface of the throat and pharynx. The gargle is kept in throat and air from lungs is forced through for the solution to come in contact with the above membranes.

II. BY OLFACTION AND INHALATION

It is especially in the form of vapour by olfaction and inhalation of the medicinal aura that is always emanating from a globule impregnated with a medicinal fluid in a high development of power and placed dry in a small phial that the homoeopathic remedies act most surely and most powerfully. The olfactory nerve is directly connected to the brain (bypassing digestive system) and is an interesting avenue for the ingestion of dynamic remedies. Hence the remedy reaches the brain and higher centers directly.

Olfaction It is a method of administering medicine to a patient through the nose and mouth by the act of smelling.

For this, globule is moistened with the medicinal fluid and placed dry in a small phial. The homoeopathic physician allows the patient to hold the open mouth of phial first in one nostril, and in the act of inspiration draw the air out of it into himself and then if it is wished to give a stronger dose, the patient is asked to inhale the same vapor with the other nostril, more or less strongly, according to the strength intended. (footnote to Aph. 288, 5th edition of Organon of Medicine)

If both the nostrils are stopped up by coryza or polypus, the patient should inhale by the mouth holding the orifice of the phial in between the two lips. In little children it may be applied close to their nostrils while they are asleep with the certainty of producing an effect. The medicinal aura thus inhaled comes in contact with the nerves in the walls of the nasal cavities and thus produces a salutary influence on the vital force, in the mildest yet most powerful manner.

The interval of repeating the olfaction should be same as that of oral route. This method is usually applied for idiosyncratic patients and when it is not possible to administer the medication orally as in cases of epilepsy, hysteria, lock-jaw, etc.

Inhalation Inhalations are solutions of medicaments administered by nasal or respiratory route, intended for local or systemic effects. Inhalations are applied in form of vapors that are to be inhaled alongwith breath from the surface of hot water.

Vehicles preferred are normal saline and other water based liquids. 1tsp of medicine is poured to 1 pint of hot water, not boiling water.

Respiratory tract is known to be an excellent system for introduction of the medication for systemic effect. This capacity of the respiratory tract is yet to be exploited.

III. BY APPLICATION TO SKIN

The homoeopathic physician will derive all the benefit from a well-selected remedy, which can be obtained in any special case of chronic disease by doses given through the mouth.

But if the diseased organism is affected through this remedy, at the same time, in sensitive spots other than the nerves of the mouth and the alimentary canal, i.e. if this same remedy that has been found useful is at the same time in its watery solution rubbed in into one or more parts of the body that are most free from morbid ailments (e.g. on an arm or on the thigh or leg, which have neither cutaneous eruptions, nor pains, nor cramps) - then the curative effects are much increased. In order to introduce change and variation, one limb after the other should be used, in alternation, on different days, (best on days when the medicine is not taken internally). A small quantity of the solution should be rubbed in with the hand, until the limb is dry. Also for this purpose, the bottle should be shaken five or six times.

The drugs applied to the skin in the form of lotions, liniments, ointments, poultices, plasters, etc. are meant to exercise local action in adynamic diseases and expedite cure in chronic dynamic derangement.

Rubbing or friction (Inunction or Epidermic)

Friction through the whole cutaneous surface of the body, wherever the epidermis is sound as epigastrium, inner parts of the thighs, lower part of the abdomen, back, arms, etc.

E.g. application of lotions, ointments, liniments Rubbing-in appears to favour the action of medicine only in this way that friction makes the skin more sensitive and the living fibres thereby more capable of feeling, as it were, the medicinal power and of communicating to the whole organism this health-affecting sensation.

Enepidermic

In this method drugs are simply kept in contact with the unbroken skin without friction or rubbing.

E.g. plasters, poultices

IV. OTHER ORIFICES OF THE BODY

The drugs meant for application to the mucous membranes as those of eyes, ear, rectum, vagina, urethra, etc. have requirements that are highly specific depending on the site of application.

* Ear

Ear drops are often aqueous solutions, sometimes glycerin or alcoholic, intended for instillation into ear e.g. Mullein oil

* Eye

Eye drops, which are aqueous or oily solutions of drugs and eye ointments are intended for instillation into eye. E.g. Cineraria eye drops

The ophthalmic products are generally meant for instillation into the space between the eyelids and the eyeballs.

* Rectal route

The rectal route is generally used for administration of drugs meant to have local action on the rectal tissues. The usual forms of rectal administration are solutions, ointments and suppositories. The rectal dosage forms must be absolutely free from irritant action. Consistency of rectal ointments has to be thinner and softer than skin ointment to easily pass through the fine holes of rectal nozzle

* Vagina, Urethra

Medications intended to be delivered locally may be injected into the vagina or the urethra, as per the need.

V. PARENTERAL ROUTES

The parenteral placement of the homoeopathic medicines into various tissues at various depths including the blood stream is a field that has not been explored and studied. Since all studies of the action of homoeopathic medicines on healthy humans is done by oral or olfactory route, sufficient literature to lay down the guidelines for parenteral introduction remains unavailable.

VI. PLACENTAL ROUTE AND VIA MILK OF MOTHER

"The power of medicines acting upon the infant through the milk of the mother or wet nurse is wonderfully helpful. Every disease in a child yields to the rightly chosen homoeopathic medicines given in moderate doses to the nursing mother and so administered, is more easily and certainly utilized by these new world-citizens than is possible in later years. Since most infants usually have imparted to them psora through the milk of the nurse, if they do not already possess it through heredity from the mother, they may be at the same time protected antipsorically by means of the milk of the nurse rendered medicinally in this manner. But the case of mothers in their (first) pregnancy by means of a mild antipsoric treatment, especially with sulphur dynamizations, prepared according to the directions (Aph. 270), is indispensable in order to destroy the psora - the producer of most chronic diseases - which is given them hereditarily; destroy it both within themselves and in the foetus, thereby protecting posterity in advance. This is true of pregnant women thus treated; they have given birth to children usually more healthy and stronger, to the astonishment of everybody. A new confirmation of the great truth of psora theory discovered by me." (Footnote no.164, Aph. 284)

SELF ASSESSMENT

* Describe the various routes through which homoeopathic medicines can be administered.

QUIZ

1. The parts of the body that are more or less susceptible to the influence of the medicines is discussed by Hahnemann in the 6th edition of Organon of Medicine in

(a) Aphorism 284

(b) Aphorism 272

(c) Aphorism 270

(d) Aphorism 264

2. The same medicine that the physician gives internally, in certain cases, can be applied externally on

(a) Parts subject to pain

(b) Parts subject to spasm

(c) Parts subject to skin eruption

(d) Avoid parts subject to pain, spasm and skin eruption

ANSWERS: 1 (a); 2 (d).

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