Controversy is no stranger to homeopathy, nor is change. Most of the debate seems to be over the gospel according to homeopathy's founder, or who is the valid interpreter of the legacy. The danger is that in trying legitimately to preserve the integrity of Hahnemann's insights into health and disease we risk setting homeopathy into a concrete mould, one which Hahnemann himself never accepted.

Hahnemann was more of an experimentalist than a theorist. Like Claude Bernard after him, he preferred the path of clinical verity to that of theoretical purity (although he could be critical, like many scientists, of discoveries made by others in his field, as we shall see). Hahnemann's persistent spirit of inquiry and experimentation led him to continually evolve his approach to applying the fundamental principles of homeopathy. These changes engendered considerable controversy within the ranks of homeopathy right from the beginning, first over the use of higher potencies beyond Avogadro's Constant, then over the theory of miasms, and later over the use of LM potencies and the explicit "vitalist" approach of the 6th Edition of the Organon.

Today we face the same challenge as Hahnemann: How to remain open to ever more effective means of applying the principles of homeopathy (the law of similars, the totality of symptoms, the minimum dose) without negating these principles. Because we are not Hahnemann, the challenge is undoubtedly more difficult and open to controversy.

The current debates between various schools that call themselves homeopathic are evidence of lively inquiry, but not always of open minds. There are low potentists, classicists, Kentists or unicists, users of biotherapies and drainage, homotoxicologists, organotherapists, etc. which cause inevitable, but regrettable confusion for the aspiring and practising homeopath of today.

I believe that this proliferation of approaches is partly due to the difficulties of cure in our modern age as a result of the unprecedented use, on a mass scale since the 1940's, of allopathic drugs and vaccinations (even for mild childhood diseases), and of the chronic stress of life in the fast lane. The suppressive and disease-causing effects of these factors is well set out in George Vithoulkas' book A New Model for Health and Disease.

I have a classical homeopathic training and tend to be conservative as regards evaluating different approaches to applying homeopathy. I see in much of the new work coming out of Europe, relating to the use of nosodes and various other new preparations (gemnotherapy, oligotherapy, lithotherapy, and organotherapy) not so much homeopathy, as new therapies using homeopathic potencies (usually very low). Much as the use of tissue salts is not homeopathy, but replacement therapy, the new so-called biotherapies in France and Germany (where it is best-known in the form of homotoxicology and the Reckeweg system) are, for me, more in the way of therapies for detoxification at the cellular and tissue level than an application of potencies based on the totality of symptoms, the true basis of homeopathy (these therapies can, however, be compatible but more research needs to be done).

Equally, I tend to see in the electronic side of homeopathy more the application of certain homeopathic remedies to specific meridian blockages, much as is done in acupuncture. Thus, homeopuncture or the Voll system and its successors, such as the Dermatron, Vegatest, and Interro systems, may be valid therapies in their own right but are not, in my mind, homeopathy.

Having said all this, I will now further muddy the waters by offering a new approach to classical homeopathic therapeutics in this article. The approach is called "sequential therapy", and was developed some 15 years ago by a Swiss doctor and homeopath, Dr. Jean Elmiger. However, I firmly believe that this approach is fully consistent with the letter and spirit of Hahnemann's work and thought and helps to bring homeopathy into the next century.

This new approach takes as its base classical homeopathy, which was developed and operated for the most part in an agrarian society, and adapts it to meet the challenges to the rapid, gentle and permanent cure posed by our recent chemical/electronic age. By chemical I mean primarily the mass use of vaccinations, of chemical drugs on an unprecedented scale. By electronic I refer to radiation stress and also the emotional stress of life in the fast lane in our information culture.

I propose first to set out the outlines of this new approach to homeopathy, which has not yet been made available to English-speaking audiences, then to discuss how it is consistent with fundamental homeopathic principles and why, in my view Hahnemann would likely have developed a similar approach, had he lived this long. Part of the presentation will, perforce, require a digression into the history and use of nosodes and "specifics" in homeopathy and how their use by Sequential Therapy is fundamentally different from that of other approaches referred to earlier. Finally, I will give some indication of its clinical use and my own (to date still) limited experiences.

What is Sequential Therapy?

Dr. Elmiger calls homeopathy "the royal road" to health. He is the seventh generation in his family to practice medicine. However, over 20 years ago he had a crisis of "faith" in the ability of allopathic medicine to cure and searched for a better way. His search led him to first to Chinese medicine, with its emphasis on the bi-polar nature of life energy (Yin and Yang) and then to homeopathy. For Dr. Elmiger, homeopathy alone has the power to affect the deepest layers of being and treat serious chronic problems. While the life force follows the meridians, any therapy based on measuring energy flow through the meridians can only be a partial therapy, whereas homeopathy, in his view is truly holistic in considering the totality of symptoms.

Dr. Elmiger's reaction to reading the Organon was one of anger that such a logical and incisive view of health and disease was not part of his earlier medical training. Effectively, he had to abandon what he had previously learned in medical school and start anew. But for him it was a wondrous voyage of discovery and renewal of faith.

A strong early influence in Dr. Elmiger's homeopathic training was the method developed by the German, Dr. Voll. Voll found, in studying meridians, that certain substances would modify the electrical resistance of the meridian tested if introduced into the circuit and that this effect was all the more pronounced when homeopathic potencies of suspected allergens were used. From this Voll proceeded to give to patients homeopathic dilutions of suspected allergens or of other suspected causes of energy blockages such as vaccinations (which are generally referred to as isotherapics or nosodes) and saw that the energy through previously blocked meridians flowed freely once again.

However, while accepting the premise of Voll, that nosodes could be used systematically to remove energy blockages, Dr. Elmiger questioned the effectiveness of the method. He observed that once a substance had opened up a blocked meridian, any other substance would also test "positive" even though there was no reason for this to be the case. He posed two criticisms based on his own research: first, the problem of the observer influencing the observed object, an effect well-known to quantum mechanics (and likely to be operative at the quantum level of bio-energy), and second, the problem of time or the sequencing of the tested substance and the occurrence of the traumatic event in the patient's time-line.

Vital energy, for Dr. Elmiger, is very much a system of energy working in time, as well as space. Indeed, this is the foundation for Hering's celebrated law of true healing. Dr. Elmiger sees Hahnemann's vital force as a superior system of energy operating in a specific space-time continuum that controls the organism's inferior space-time continuum. And, as with the Hahnemann of the 6th edition of the Organon, disease for Dr. Elmiger is nothing more than a destabilisation of the vital force due to some shock which is then reflected in a certain symptomotology.

Thus, for Dr. Elmiger, modern physics accords well with bio-energy therapies and homeopathy in particular, much as it does for some modern physicists such as Fritjof Capra (The Tao of Physics) and David Bohm (Wholeness and the Implicate Order). Homeopathy is the most systematic and profound of the bio-energy therapies, but this therapy must be based on the fundamental principles not only of the totality of symptoms and the minimum dose, but also of the space-time continuum. In our modern age, there are so many shocks inflicted on the organism, each of a different frequency, that the classical approach of using one remedy, or of using the plant, animal and mineral based potencies is no longer sufficient.

As we will see, there have been various attempts to introduce the use of nosodes to deal with situations where the "well-indicated" remedy does not act or only feebly, but the use of nosodes to date has been more or less haphazard, much as the application of the principle of similars was before Hahnemann founded homeopathy.

Homeopathic remedies are essentially, for Dr. Elmiger, the densification of time-energy that makes them "little space-time bombs". But they must be used in a manner that respects the patient's individual space-time continuum, marked by certain shocks at certain times. To this extent, Dr. Elmiger's views are but a modern rendition of Hahnemann's own observations, with this difference, that of the importance of time. Dr. Elmiger also accepted the truth of Hahnemann's theory of chronic diseases and of the inherited miasms or predispositions to disease with the addition of the tubercular miasm.

Dr. Elmiger began to determine the precise sequence of shocks that could have affected a patient and then to treat each of these events, in the precise reverse order of their occurrence. For him, the art of healing consists in recalling each of the suspected shocks, in identifying the main ones responsible and in removing the blockage in the energy flow caused by these shocks. The shocks are removed by a homeopathic dose of the same shock. For this he avails himself of both normal homeopathic remedies such as Arnica, Natrum sulph., Opium, Ignatia, Nux vomica, and Natrum mur., as well as of well-established nosodes, such as for the vaccinations, anaesthetics, and well-known drugs (penicilinum, cortisone).

Dr. Elmiger's careful experiments over several years led him to determine that there was a classical repertory of shocks for almost everyone. This includes: 1. Events at birth: prolonged labour, induced labour, use of forceps and anaesthetics etc., lack of oxygen, caesarean section, and insufficient shaping of the baby's head during contractions; 2. natural childhood illnesses which are not properly dealt with (due to weakened resistance); 3. Vaccinations: too many at one time and too soon, and long-term effects (especially from smallpox, pertussis, and MMR series - which remove the ability of the immune system to mature); 4. Traumatic life events - emotional (fright, fear, loss), physical (surgery, concussions, spinal injuries etc.); 5. Prolonged use of drugs, anti-biotics, anti-depressives, cortisone, gold salts, stimulants (chronic drug users are permanently in shock like alcoholics); 6. Venereal disease, malaria, tuberculosis, mononucleosis, typhoid, cholera, hepatitis.

While certain shocks may be enormous, they can leave little trace, while small, seemingly insignificant shocks can have disastrous consequences which poison one's health forever, depending on the individual's constitution and genetic inheritance. Much of this can be found in the classical literature, but nowhere, in my view, has it been systematised and placed into a coherent therapeutic approach within homeopathy until Dr. Elmiger's book.

Dr. Elmiger has found that children are able to better handle this treatment, given their higher level of reserve energy, whereas adults usually go through periods of fatigue and aggravation (a replay of previous complaints). While the treatment is safe for pregnant women, it is better to temporarily suspend treatment in the first three months of pregnancy in order to avoid a painful increase in fatigue during this particular phase. Nosodes and other isotherapics should not be given to women during or just before their menstrual cycle as this will only serve to unnecessarily aggravate.

In addition to treating events in one's lifetime, Dr. Elmiger has also developed a more systematic and coherent approach to treating the chronic miasms we all carry. While treating for inherited or acquired miasms, Dr. Elmiger discovered that everyone possessed each of the four miasms to greater or lesser degree and therefore proceeded to treat them all. He also determined that there was a definite sequence to the appearance and existence of the miasms, namely psoric, tubercular, sycotic, syphilitic. From careful observation, involving the children born to treated patients, he has come to the conclusion that only the classic "polychrest" nosodes (psorinum, tuberculinum, medorrhinum, luesinum), used in high potency, are able to act upon the genetic code in a manner to correct the miasmic taint or blockage.

Finally, he found that each of the miasms was associated with a season (he attributes this discovery mainly to Dr. Nebel of Switzerland who was also the one responsible for establishing the tubercular miasm). While the use of up to 10M potency could be done regardless of the season, once the 50M potency was given, it required matching the miasm to the season, i.e. giving psorinum in the fall, tuberculinum in winter, medorrhinum in spring and luesinum in summer. For serious cases, Dr. Elmiger also uses certain oligo-elements for each miasm to moderate the healing reaction and promote elimination via the various organs based on the diatheses developed by Dr. Menetrier.

From his clinical work and observation, Dr. Elmiger has been convinced that the higher the potency, the higher and more subtle the level of energy being affected, including up to and beyond the genetic code. Thus, when he uses the higher potencies he prepares the patient by first giving lower potencies, from 30C and up. He generally does not go beyond 10M except for very serious cases that have not fully responded, and then only up to 50M. He warns against those who would use high potencies too often, whether of nosodes or more common remedies.

In essence, for Dr. Elmiger, one cannot expect the proper healing reaction from the normal homeopathic remedies, even if well-indicated, so long as the vital force remains mutilated by numerous shocks of our modern age and has not been liberated by the correct treatment in the proper sequence. As well, he places emphasis on a proper diet and lifestyle as well as on various manipulation therapies (particularly that of the cranium) as forming the foundation of continued health. He believes with Still and Sutherland that the majority of osteopathic cranial lesions are obstetrical in origin and that crooked teeth are the result of such problems - placing braces on a child only forces this disturbed energy flow through the cranium to reveal itself elsewhere (I have seen several cases of this myself).

Is This Homeopathy?

Dr. Elmiger has been critical of and in turn been criticised by the more classical homeopaths, called "unicists" in Europe, for his departure from orthodoxy. For his part, Dr. Elmiger claims that Hahnemann would have been the first to adopt his approach had he lived in our time. Essentially, the debate seems to be over the use of nosodes and the introduction of a systematic approach to time in treatment. The classical approach generally does not take time into account, this being considered unimportant. This may have been sufficient in simpler times, where patients generally had less complicated medical histories, but we are now faced with incredibly complex cases where the symptom picture is confused because of the myriad of modern shocks caused by artificial means, mainly drugs and vaccinations and surgical interventions.

Indeed, it is difficult to establish what exactly "classical" homeopathy consists of. First, there is a history of acceptance of certain normal remedies for specific traumatic events (Ignatia/Natrum mur. for loss; opium for fright; china for loss of bodily fluids; Nux vomica for anaesthetics; Arnica/Natrum sulph. for head injuries; Ammonium carb. for oxygen debt to the brain). There are also "specifics" for many epidemic type-diseases. Even Hahnemann recognised the "genus epidemicus". While the idea of specifics can be taken too far, it does form part of classical homeopathy.

What about nosodes? Again, certain nosodes have become an accepted part of homeopathy, even for the "unicists". However, their use seems to be a little discussed anomaly in the application of homeopathic principles. Some homeopaths have taken the idea of equality or "aequalia aequalibus curentur" (expression of Lux, a contemporary of Hahnemann) much further and seek to found a new therapy thereon (most developed in the "dynamised micro-immunotherapy" of O.A. Julian). As a result of pursuing the idea of identity rather than analogy or similars there remains a debate in philosophical terms as to the acceptability of the former in homeopathy.

Hahnemann put great emphasis on "similia similibus curentur". When Hering and others began the use of nosodes or isopathics, Hahnemann's reaction varied. In the fifth edition of the Organon he writes "one may admit in fact a fourth method of using medicines against disease; the 'isopathic method', the method of treating a disease by the same miasm that has produced it". However, in Hahnemann's mind, the idem becomes the similia when it is altered by the homeopathic method of preparation and "the cure in that case will be effected only by opposing similimum similimo". This is also Hering's view.

In the 6th Edition, however, Hahnemann seems to have turned against isopathy: "To desire to cure thus, by a pathogenic power rigorously equal (per idem) is contrary to common sense and even to all experiences". He repeats this criticism in his Chronic Diseases. Some observers attribute Hahnemann's reticence to pride of a founder towards dissident disciples (such as Freud to Jung, or Pasteur to Koch). Another explanation is that in his later years, Hahnemann was more and more inclined to a "vitalist" explanation of disease and the idea of isopathy seemed to suggest rather a material cause of disease.

To the modern founder of isopathy in Europe, O.A. Julian, the necessity in reality to go beyond the strict dictates of "similars" occurred with Hahnemann's discovery of the chronic miasms and the need to oppose to each, at least in its early stage, specifics: Sulphur, Thuja and Mercury. However, he feels that Hahnemann covered this strategic retreat from the strict principles of individualisation and similars by a greater intransigence on "the absoluteness of the law of similars in the narrow sense of the word".(Julian, O.A., Treatise on Dynamised Micro Immunity, Second Revised Edition, 1985, B. Jain Publishers, New Delhi).

Hahnemann's change of heart in the 6th Edition had little negative effect for much of the history of homeopathy, as it did not appear until well after its golden age. In the meantime, the attraction of isopathic remedies or nosodes continued and was developed further, founded mainly on Hering's work, tuberculinum, medorrhinum, luesinum, diphtherinum, lyssin, pyrogenium etc. In 1910, Allen's The Materia Medica of the Nosodes appeared which codified all this research and work. In Europe, Drs. Nebel and Vannier promoted the use of nosodes around the same time.

Despite certain doctrinal debates, the clinical use of these nosodes continued, but for practitioners even today, their use within classical homeopathy remains vague and confusing. The other offshoot of isopathy, the biotherapy schools in Germany and France have developed a systematic use of various remedies (allergens, toxic substances, organ tissues), prepared as with homeopathic remedies, but these approaches are, in my view fundamentally different from classical homeopathy.

Indeed, there is a great deal of confusion at present between the terms nosode (Hering's contribution), isopathics (from the veterinarian homeopath and contemporary of Hahnemann and Hering, Dr. Lux), sarcodes, organotherapics, autotherapics (made from one's urine, faeces, blood). While not definitive, a broad line can be drawn between those isopathic remedies that have been drawn from specific miasms of disease states and then established in provings, which are generally referred to as nosodes (argument advanced by Dr. Schmidt of Geneva), and the others. The former can be reasonably considered to have been part of mainstream homeopathy for over a century and a half and are part of the Hering legacy. A further distinction can be drawn between the major nosodes or "polychrests" (such as for the four miasms) and the minor nosodes, for more specific epidemic disease states.

Dr. Elmiger's sequential therapy, in my view, is fully consistent with the line of thought of Hahnemann and Hering, that specific remedies, either purely analogous and based on common substances or derived from morbid tissue in the case of infectious disease conditions, can be deployed against specific aetiologies in a patient's history. The problem to date, however, has been a lack of a systematic basis for prescription, much the same situation Hahnemann found with the principle of similars before homeopathy was founded. Dr. Elmiger's careful clinical work over some 20 years has removed the prevailing confusion and has also the merit of cautioning us as to the tremendous power of the higher potencies and the potential to do mischief if abused or improperly applied, particularly in the case of the "polychrest" nosodes: psorinum, tuberculinum, medorrhinum, luesinum.

Some Cases in Sequential Therapy

Female of 10 years

December 9, 1983: suffering from severe case of puritis of the vulva. First doctor gave her some vermifuges, thinking the cause was worms, with no result. Case taking reveals usual types of natural and iatrogenic shocks: small-pox vaccinations, mumps, rabies vaccination, measles, German measles, antibiotics for scarlet fever.

Treatment: (each step takes one month) Varicellinum, Parotidinum, Lyssin, Rubeolinum, Morbillinum, Penicillinum. At this point, June 1984, the patient experiences a strong reaction: difficult movement, painful urination, with a scarlet red vulva, ulcerations on the lips. This indicates that the suppression of the scarlet fever by the antibiotics are the root of the problem. The patient is given Scarlatinum and the condition improves dramatically. Then the patient is treated for the four inherited miasms with no dramatic problems, but continual improvement.

Female (middle-age)

January 1982: Patient immigrated to Switzerland from Hungary. Case of Crohn's disease. Multiple shocks: pneumonia, operations, mumps, scarlet fever, measles, multiple vaccinations, renal failure, amebiosis, heavy emotional/psychological shocks, cortisone treatments, various chemical treatments. Following a sequential treatment of the various destabilising forces, the patient improves enormously. The diarrhoea and intestinal pains quickly lose their accustomed strength, even though the patient decided to give up from the start the drugs prescribed by the gastro-enterlogist. After a year, the miasmic treatment is commenced and the few remaining symptoms that reappear three or four times a year are dealt with easily by means of acute remedies.

Male (35 years of age)

April 1980: Patient has disseminated lupus erythematosis (detected at age of 24). Gradually, despite orthodox medical treatment, the skin, kidneys, and other organs have been affected. Acupuncture treatment provides a lessening of pain and a remarkable stabilisation of the condition. The sequential treatment is undertaken to remove the effects of vaccinations and drug treatment. After three months, the patient can take a bath, the skin being no longer covered in purulent ulcers. The nephritic syndrome (kidney infection with serious loss of albumin) disappears and the general state of health is excellent. The next twelve months are taken up in treating the miasmic inheritance. The patient is very fatigued as a result, but improves at each stage. The seriousness of this case requires two cycles of treatment with the miasmic nosodes up to the level of 50M during the second cycle. In the end the patient is able to recommence his activities as a businessman, director of a company and administrator.

Female (61/2 years of age)

January 1984: Muscular dystrophy diagnosed in 1980. Signs and symptoms very pronounced. Treatment attacks the usual vaccinations and antibiotics. The BCG is the main shock, producing the greatest reaction and requiring trace elements in homeopathic form to help moderate (Manganese-Copper). By September, the patient is completely different. She has not been ill since January, but still presents a clear facial asymmetry, the left eye being less open than the right. An osteopathic correction clears this up. Sulphur 30 and 200 is then used, followed by a remedy especially prepared by Dr. Elmiger designed to reinforce the genetic inheritance. Then come the miasmic treatments. At the end, there is a new child.

I have reserved the sequential treatment for my most serious cases. Given the time frames involved, I have not yet completed them. However, I will give the history and results to date of two particularly difficult cases:

Female (mid-thirties)

April, 1992: Patient, who is a single parent, calls in a panic because she cannot get back into her house due to allergic reaction to "something" (feels she is being poisoned). She has been treated for 6 years for candida problem, which keeps getting worse, despite Nystatin and macrobiotic diet. Patient is given Sulphur 200 followed by 1M 8 hours later (constitutional remedy) which results in immediate improvement in mental/emotional state and in ability to re-enter house. Sulphur 1M four weeks later, then Sac lac follow this at the next consultation. It is clear that major improvement has occurred but that problem is deep-seated.

At this point, discussion reveals a series of strong emotional, physical and mental shocks, many vaccinations (both as child and teenager -due to international travel), and eczema from birth. Patient agrees to undergo sequential treatment. Treatment has covered all of emotional/mental and physical shocks in patient's life to this date. Each treatment has enabled her to come to terms with the events (previously suppressed or still disturbing her in the present) and to "mature" (to use her term). Her health has increased immeasurably, she is able to eat foods previously allergic to, and she has had many physical reactions (particularly fatigue, worsening and amelioration of the eczema, loss of fingernails etc.). Treatment for the shock of a caesarean birth and epidural resulted in her undergoing the whole birth process, including the back pain, contractions, bearing down sensations (the patient described it as being able to experience what she wasn't allowed to before — due to shock of acrimonious separation from father and young age).

Female (32)

May 1991: Patient came for treatment of extreme vertigo and cold (could not drive even a block in a vehicle or be exposed to cold without suffering terribly — and had even moved to within a block of her work place as a result). It transpired that she had also been found to be suffering from a condition which had quickly destroyed 30% of her bone mass. Her specialist had suggested exploratory surgery but she wished to avoid this if possible. Treatment commenced with her constitutional remedy - Silica 1M, followed by one dose each of 1M in July and August. A further bone mass measurement in November (12 months after the first) revealed that her condition had stabilised - which was already evident in her complexion, increased energy, reduced sensitivity to cold and ability to ride in a vehicle with little discomfort. All in all, already a changed woman.

However, consultation had revealed several severe emotional shocks as a result of having been raised in a dysfunctional family. As well, this constitution is particularly sensitive to vaccination shock and the bone loss problem also must lie in the miasmic inheritance. Patient also had spinal meningitis at 12 years of age, late development, no appearance of wisdom teeth and frequent bladder infections (possible connected to sexual abuse).

Sequential treatment has reached the miasmic stage. Various healing reactions have occurred at each stage. Treatment for the emotional shocks resulted in progress with her psychotherapy ("where I was just inching along, after the remedy it was as if the dam burst and I was able to move ahead by leaps and bound"). Just recently, she was able to undertake a honeymoon trip by car across North America with no feeling of nausea — she could even read and write while riding in the car, a miracle for her! She is searching for a specialist in her new home to have the bone density test performed again, although comparisons are problematic if performed by different specialists and we will have to wait another year to see if the body has managed to restore some of the lost bone mass.

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