Provings - With a Proving of Alcoholus Volume One
By Paul Herscu, ND
Amherst, Massachusetts: The New England School of Homeopathy Press $24.00; 351 pages. Paperback. 2002. (ISBN 0-9654004-4-1)

Reviewed by George Guess, MD, DHt

Paul Herscu has written another tantalizing book, this one on homeopathic provings. It is a timely book, given the rash of new provings lately, and it addresses many extremely important issues pertaining to that topic. The author thoroughly explores his subject He provides insights into the mechanism of homeopathic provings that correlate closely with our observations in clinical homeopathic practice. Dr. Herscu proffers his scheme for well-conducted provings, constructively criticizes many questionable practices employed in many current provings, and, finally, illustrates his thesis admirably with a fine proving of the remedy Alcoholus.

Dr. Herscu begins by equating the homeopathic medicinal influences that generate proving symptoms and curative reactions in patients - both are considered stress responses (which he terms "Strain"), the stressor in each case being the homeopathic medicine. Provers' and patients' organic bodily systems' reactions to such stressors are responsible for the responses that result It is a simple theory, with important ramifications, for it lays the groundwork for Herscu's subsequent emphasis on drawing parallels between the phenomena we witness daily in clinical practice and those observed in provings; parallels are further extrapolated to include clinical case analysis methods and proving symptom analysis.

One of the first recommendations based on the above understanding is that there need be no distinction between primary and secondary symptoms; since both are in actuality reactions to the stress imposed by the remedy, they should all be recorded together.

Another recommendation, one that strikes this reviewer as eminently practical, is that it is a good strategy to take each prover's case prior to the beginning of the proving to determine his or her "constitutional" remedy(ies).This important step can yield valuable information - remedy relationships become more clear, symptoms cured by the remedy being proved are more readily identified,etc.

Some of the history of provings is included. Along the way, Herscu also defends homeopathy ably; he even suggests that we adopt a more aggressive posture when defending or promoting our ideas and methods. A case in point is his recommendation that we make our allopathic colleagues more aware of the significance of our contributions to medical science in general. For example, we can be proud of the fact that homeopathy was the first medical system to introduce blinded, placebo-control drug studies to medical science. Also, homeopathy's medical testing protocols pre-date allopathy's by 40-80 years. He goes on to suggest that homeopathic provings share a resemblance to Phase One clinical trials, and could be so employed to the benefit of orthodox allopathic medical research. For instance, an early proving of a new allopathic drug in development could help to safely identify those systems and organs of the body which might be most affected by the drug. Herscu's perspective on the potential alliance between homeopathic and allopathic forces that might be attained is refreshing.

In Chapter 5 Herscu lists some of the fallacies he has identified in many current proving strategies and methods; such as: lack of blinding and placebo control; excessive emphasis on dreams; failure to take into account the "Hawthorne effect" (how a patient's focusing on his symptoms can cause even more, imagined symptoms to arise); the inclusion of symptoms noted by those participants taking placebo. This last criticism seems especially well taken. Herscu's argument is that we can't tell what we are testing; for instance, when a proving is conducted at a conference or among a close-knit group of homeopaths, and when all symptoms - those of the actual provers and placebo-takers - are incorporated into the proving and discussed among the participants, it becomes impossible to determine what is being tested - a remedy or the conference/ group experience. Another fallacy is the inclination to extrapolate the proving to include extraneous world events; such an approach leads logically to a limitless proving, with no end of symptoms.

All the above have led, according to Herscu (and this reviewer must agree) to some recent provings containing too many and widely disparate symptoms, rendering the proving relatively useless clinically. No discernible image of the medicine surfaces. Needless to say, if many of our provings were to be so afflicted, our clinical accuracy would suffer. As a case in point, consider the computer-based repertories currently in vogue. Often, when a comparative listing of symptoms is performed between some of the newer, just proved and barely utilized remedies and several tried and true, mid-level remedies, the symptomatology of the newer remedy vastly surpasses in quantity that of the older, established medicine. Can this observation be accurate? reliable? One might argue that past provings of the older remedies were inadequate and failed to reveal all of those medicines' symptoms. However, it seems one must pause and consider the possibility that, given the well-known history of the older remedies and the fact that, despite decades of use, their symptomatology has not been expanded, the symptoms catalogued for these newer remedies are excessive and misleading. If true, such a trend becomes very disturbing, threatening the long-standing validity of our knowledge base.

Herscu calls these extraneous symptoms "noise;' and he focuses throughout the book on strategies to minimize such noise. Following is an abbreviated listing of some of his recommendations for conducting provings, which this reviewer would heartily recommend to anyone contemplating conducting a proving in the future:

I.A major innovation: Herscu suggests that we catalog provers' constitutional types at the time of the proving, which can lead to many benefits; e.g., easy ability to identify the related remedies. (One could also try to accumulate a variety of constitutional types for the proving, which would increase the chance of developing more symptoms in the proving.)

2. Herscu suggests conducting provings/accumulating symptoms in three phases, so to speak. Phase One is represented by the substance's toxic symptoms. Phase Two is conducted with the 6C, 12C, or 30C potencies (expected to produce more general symptoms). Phase Three-a critical, final step is conducted with 200 or 1M potencies, which are given to only those provers who in the earlier phase were identified as being sensitive test subjects.

3.very specific guidelines are provided for remedy administration-potency and frequency of repetition-during a proving.

4.An extremely important step, Herscu advises that the proving investigators collect symptoms of only those provers who demonstrate a definite sensitivity to the substance. This is recommended as a strategy to eliminate noise in the proving and to focus the collection of data upon only those symptoms which are clearly products of the remedy and which are better defined and qualified, thus increasing their later clinical utility. This step strikes this reviewer as one fraught with potential difficulties. How exactly such a strategy can be accurately employed remains in doubt, especially since Dr. Herscu doesn't describe his method of identifying non-sensitive provers. However, he promises to cover this issue in a subsequent book.

5. Herscu recommends the use of placebo controls during provings both as a means of keeping the investigators honest and as a means to minimize the proliferation of imagined symptoms. This last recommendation brings up an important issue.

A number of recent provings have included symptoms arising in those individuals who did not take verum during the proving; such persons either took placebo or no substance at all. For the symptoms of these latter participants to be incorporated as representative of the symptomatology of the remedy being tested is very troubling and perplexing. If such spontaneous symptoms are valid and actually do represent the accurate symptom profile of the medicine, then some heretofore unidentified mechanism is at work. Perhaps such a mechanism does exist (see Dr. Iris Bell's comments on this possible phenomenon in her article "Evidence-Based Homeopathy',' appearing in this issue). But another, in this reviewer's opinion, even more likely possibility is that such symptoms are inaccurate, the products of a group experience, imagination, or some other influence. Because doubt about this question cannot possibly be eliminated, in the interests of good science, the symptoms of those who take placebo in these experiments should be excluded. Failure to do so risks undermining the integrity of the information upon which practitioners make critically important clinical decisions.

Herscu puts this issue in proper homeopathic context when he asserts that it is literally impossible for all those involved in a proving - verum and placebo takers - to manifest legitimate symptoms of the proved substance. Such an occurrence would refute the very bedrock of homeopathy - the idea of individual sensitivity, which underlies the Law of Similars.

The concerns, criticisms, and recommendations, some of which have been described in this review, that Dr. Herscu offers in Provings are vital food for thought for every homeopath and, especially, for every proving investigator. As such, it is a must read. I cannot recommend the book strongly enough. But wait, the book doesn't stop there.

After 139 pages of discussion about proving methodology, a detailed (171 pages) proving of the remedy Alcoholus follows. This proving was very extensive. It consisted of five separate provings, each conducted on 15-40 provers, over the course of five years. The results were consistent and reproducible. Much of the proving methodology that Herscu lays out in Provings was employed in this proving. The resulting symptoms were subsequently arranged into groupings consistent with Herscu's understanding of the "Cycles and Segments" of the remedy as revealed during the proving. A description of ethanol and its pathophysiology and toxic symptomatology begins the proving report; preparation and dosage methods are clearly described; next appears the materia medica of Alcoholus as interpreted by Herscu. The principal themes of the remedy seem to be: Exhilaration - with loss of inhibition (sense of floating, laughter, loquacity, desire to enjoy oneself, practical joking, immaturity), deception (lying, stealing, absence of moral feeling) and rage (aggressive, hurtful); Sensory acuity - entranced by sensory stimuli or very disturbed by same, heightened sensation, increased sex drive; Confusion - misunderstanding, forgetfulness, and motor incoordination; Desire to be alone - either because of the sensory sensitivity or due to the confusion; Depression sadness that their life is not playing out as it should; Desire for stimulation - craving caffeine, alcohol or drugs; seeking stimulation through loud music or fast driving, etc. After this thorough and easily assimilable materia medica chapter, Herscu proceeds to offer a short case of Alcoholus, a lengthy listing of the rubrics of the remedy, and, lastly, detailed individual prover's reports.

The book is well organized, well written, indexed, and has an attractive paperback cover. Once again, it is an important work. All homeopaths should make

themselves familiar with the ideas on provings it promulgates; further, the proving of Alcoholus provides a fine blueprint for provings in general and important information about the remedy itself.