It is to Dr. A. Nebel that we owe the idea of Drainage and its corollary Canalisation, one of the most important principles of Homoeopathic therapeutic. Our colleague of Lausanne is no doubt the uncontestable father of Drainage. He came to that idea through his clinical experiences following some researches in the field to histology. Later on he found out, and he explains it in this journal how drainage was practised since Hippocrates up to our time by Rademacher, by Hahnemann himself and finally by Burnett.
It is only since a few years that we have understood how it was possible to study drainage practically as one of the superior means to develop the possibility of Homoeopathy, to make its therapeutic process more sure and above all to gain time in treatment. We, therefore, consider a great step forward has been made in the Hahnemannian therapeutics, thanks to drainage when it is well applied and we should first of all explain and define the terms Drainage and Canalisation, before giving practical suggestions for their application :
We, therefore, propose here:
1. To define Drainage and Canalisation.
2. To indicate clearly the principles in order to understand them better according to the total observation of the fundamental laws of therapeutics.
3. And finally to show the superiority of Homoeopathy with drainage over the other principles of prescriptions.
1. Definition of Drainage and Canalisation :
When we speak of drainage, we should distinguish well the theory from the practice. In order not to run the risk of being reproached as builders of purely theoretical systems, we will speak here only of the results obtained from the practice of drainage and canalisation, the theory having, in our opinion, only explanatory value, a value of simple orientation.
However, we should give a theoretical definition of drainage before speaking about its practical application.
How then is the drainage defined?
The theory of drainage is intimately bound up with the idea of making the organism free from morbid energies. If we understand an organism as composed of many spheres, we will understand that it is necessary to give one or more medicines acting simultaneously on the successive organic spheres.
But, a single remedy, even highly diluted, cannot always act in a sure and complete manner on all the spheres, and generally the high dilutions help to obtain a superior action on the most subtle and higher planes, particularly on the sphere of sympathetic system.
It is therefore, necessary to help the Similimum remedy by judicious application of Simile remedies.
It is said that in each pathological case, there exists, in Homoeopathy, a single Similimum and many Simile and the first idea that comes to mind, is to apply uniquely the Similimum with the exception of Simile remedies that seem to be palliatives. In reality. very soon one understands that the rigorous application of the Similimum, remedy is not always followed and is not necessarily followed by an amelioration. If we can prepare the organism by the application of a remedy called satellite, or the remedy which by analogy has the symptoms culled from the patient, it happens very often that the Similimum may be applied afterwards without aggravation and it seems even to act more rapidly and more deeply.
The theory of drainage is, therefore, before all a theory of purification of the intoxicated organism that shows symptoms which may be classified according to the successive spheres of the organism and the disappearance of these symptoms can not be caused in a complete and rapid manner but by the application, generally, of many remedies simultaneously or successively.
The theory of drainage is, therefore, a theory of purification. Besides, the term Drainage, so often used in surgery, is understood better when one is only on the material plane. There is no doubt that when there is a suppuration in the organism, it is necessary to eliminate the formed pus, except in some cases where it is possible to obtain a complete resorption.
It is, therefore, necessary to purify the organism of the patient by eliminating the toxin. It is necessary to drain.
But drainage considered from the point of view of practice is much more important than from the point of view of theory. The drainage is before all a practice justified by results. The theory of drainage like all theories is seducing but it is rather easy. We need not find out up to what point it may be true, according as one represents it in such and such manner but it is necessary before all to insist on this fact that it is Fecund and that this Fecundity is the only justification that we require. The practice of drainage consists in following or in preceding the principal indicated remedy by the application of one or more satellite remedies with the aim of facilitating the toxic elimination in a given morbid state, to check medicinal aggravation and to obtain more rapid and sure results.
Experience shows that systematic and rational application of antidotes and complementaries of Hahnemann, side by side with the principal remedy, forms the real key to the practice of drainage. It is thus that Dr. Nebel has shown to us by attractive examples the value of drainage. He has for example shown to us that before Calcarea carbonica is applied to a patient who has its symptoms, one may obtain good results, and can check all aggravations in a tubercular patient. by giving at first Pulsatilla which is a real drainer of Calcarea carbonica.
In other cases when there is an acute and temporary febrile condition Belladonna may be a satellite of Calcarea carbonica and which is necessarily indicated before the ground remedy. Sometimes the satellite may be Dulcamara or Chamomilla etc…
Let us now speak of Canalisation.
We should also understand Canalisation from the theoretical and practical point of view.
From the theoretical point of view the principle of canalisation rests on the idea of the local elective actions of most of the remedies used in homoeopathy.
It appears then that the principle of Canalisation is a corollary of the principle of Drainage. To canalise means to direct the action of a remedy as well in space as in time. This is why Dr. Rouy has said with reason, after Dr. Nebel, that Drainage and Canalisation consist in the real study of the physiopathologic action of remedies.
To canalise is to direct the effects of a medicinal substance and to orient its action When we speak of the local elective action of a remedy, it is necessary to speak precisely here, that most of the remedies may have, from spatial point of view, some elective actions, either on the tissues, on the organs, or on a topographic region oriented along the nervous system or very often according to a metameric segmentation. There exists, therefore, three kinds of local elective actions which rule canalisation. In practice, to give canaliser is to give a satellite which will have for aim to canalise and orient the effects of the principal remedy, and that action becomes naturally in part a real check. When we give to a patient a dose of high dilution of Sulphur according to the symptoms (while the patient has also the tendency to suppuration), we may do some good to the general condition, but at the same time we may have some dangerous local effects, by increasing the tendency to suppuration. If, on the contrary, we know how to canalise the too centrifugal, violent and general action of Sulphur, on such and such parts of the organism, we will surely obtain good action of this remedy, either by giving Fumaria, Saponaria for the skin, Hypericum for the nerves, Nux vomica for small intestines, Aloe for the rectum etc… In this case we may say that these different remedies are the Canaliser of Sulphur, because they canalise its effects and orient its action and helps to obtain more sure and rapid results from the curative point of view.
The traditional Homoeopaths are wrong to believe that the strict observation of the law of Similars, without trying to understand it, is always good for the patient. The pathogenesis are really, says Dr. Nebel, some physiopathologic studies of remedies. We should understand the homoeopathic remedies as having physiological actions which may not in practice always give curative actions. Canalisation is the art of determining the orientation of the physiopathological action of the principal remedy by the prescription of the one or more clearly defined satellite remedies.
Now we understand that the rational direction given to Homoeopathic treatment, by observing the Law of Similars in a really scientific sense, will give to him who will understand its principle an unconstestable superiority on a too traditional Homoeopathy practised without taking into account the Drainage.
After defining thus the Drainage and Canalisation from the point of view of theory and practice we will try not to show their value on the basis of the fundamental laws of therapeutics.
DRAINAGE & CANALISATION ON THE BASIS OF THE LAWS OF THERAPEUTICS
1. The Principle of Drainage, Corollary of the Law of Similars :
The principle of drainage is a necessary corollary of the complete observation of the law of similars in therapeutic. In fact, in most cases, a patient does not present only the symptoms of a single remedy. By complete observation we may find in him some symptoms that indicate other remedies. It is necessary then to choose, and the choice is difficult for the adepts of unicist school who give only one remedy very rarely repeated.
There is, therefore, a Similimum and some Simile. Consequently, Homoeopathy requires good valorisation, i.e., to say hierarchisation of symptoms and the medicines related to them. Why then should we not solve the difficulties by giving, according to a direction known in a advance, such satellite remedies or Simile which will prepare the organism for the action of Similimum. This is how one can explain drainage.
Let us refer to our scheme of successive planes of an organism and of the degradation of the morbid energy; we will understand and in practice we will be able to act in that manner. The idea of the degradation of morbid energy, as we have formulated it, seems to us necessary to explain drainage. In order to drain out the toxins, it is necessary that we should first of all degrade the morbid energies which exist and which are interiorised in the organism. We may find, in clinic, numerous examples in support of that theory.
When an intoxicated organism tries to debase that morbid energy, it should, in a chronic case, drain out the toxins always through mucous secretion. A mucous membrane presents anatomically some pathological transformations, ulceration or other, following which there will appear a flow. That flow is at first more or less excoriating, burning, painful, fetid like that of Iodium, Arsenicum album or Kreosotum.
If we apply one of these remedies, what will happen? Will the flow stop? Yes, only after changing the character : it will become non-corrosive, more thick, creamy yellow, more homogeneous and the patient will enter into the field of Pulsatilla which will cause the end of the flow, sometimes in the field of the action of Silicea, which is closely related to Pulsatilla and is its chronic counterpart, its analogue of the mineral kingdom.
This is one of the typical example of the degradation of the toxins explaining drainage.
2. The Law of Infinitesimal Dose and the Drainage :
Now we come to the law of infinitesimal dose which will help us to understand still better the value of drainage because to be an adept of drainage and canalisation, it is to reply to the questions that Homoeopaths of all schools and of all countries pose.
These are the questions : Should one, while treating a patient, give one for more medicines? Should one apply lower or higher potency? Should one, while applying more than one medicine, mix them or not? In a word should we rally with the School of Unicism or with Pluralism and finally to Homoeopathic complexism.
The principal argument put forward by those colleagues who are not partisans of Drainage is that traditionally well studied Homoeopathy claims the unique medicine. Generally, the Homoeopaths who argue thus invoke as their principal authority the master himself, Hahnemann.
Dr. Nebel has shown us that Hahnemann was a partisan of drainage. Hahnemann understood well: it is necessary to eliminate the toxins if it is not possible to neutralise them completely. What did he do when he came to see a patient? After having said not to take any medicine, specially allopathic medicine, even before prescribing a Homoeopathic medicine, he advised the patient in acute cases to drink as much water as possible. Was it not to dislodge the humors, in order to disintoxicate and to help elimination. It is impossible to believe that had Hahnemann lived up to out time, he would not have rallied to the practice of drainage, which is really rational and in no wies goes against the principles of Hahnemann.
The Unicists believe that when we give more than one medicine to a patient, we do a work of idleness, because we hesitate between several medicines and that in our hesitation between several medicines, we prefer to give to the patient the indicated remedies rather than doing a work of discrimination.
But this is erroneous. A homoeopath, an adept of the theory of drainage, should always look for the Similimum, and the proof is that we know certainly better than those who are the followers of other schools, specially of the old school, to hierarchise the medicines.
One should not think that any Homoeopathic remedy may be given in whatever dilution when it is indicated in a patient. Practice shows the contrary. There are some remedies which may be used in all the dilutions, there are others that should be applied only in high dilutions, there are still others that should be applied only in lower dilutions. It is thus that we arrive at the hierarchisation of the remedies according to the dilutions in which they should be applied as ground remedies, functional remedies and drainage. Pluralism then is the theory that can be practically in direct relation with the principle of Drainage.
Systematic complexism or the use of complex remedies is a practice which should be on the contrary avoided and which may be dangerous. Acting as complexists, we may obtain good results in some cases, but it is not possible to ascertain what the action of the remedies used is. On the contrary, in order to obtain a drainage and rapid and logical canalisation, we may apply several remedies. It will be always preferable not to mix them in advance… In reality, the practice of drainage leads very often to medicinal pluralism, and also leads to the real and conscious hierarchisation of remedies ground remedies, functional remedies, lesional remedies, bioendocrinological remedies, poly- drainers etc..
Let us recall here briefly the law of infinitesimal dose and its corollaries :
The first is the following :
A high dilution acts slowly, deeply and in a prolonged manner. A lower dilution acts rapidly, superficially and for a short duration.
Here is the corollary :
The high dilution will be indicated in chronic cases, the medium or lower dilutions in an acute case or for drainage.
The lower dilution is satellite to a higher dilutions; the lower dilution of a medicine may act as a canaliser of the medicine used in higher dilution.
The second law is as follows:
The high dilutions act rather on higher and subtle sphere of the organism, the lower on the lower spheres, on the viscera and on the mechanical plane.
Thanks to the above laws, we understand still more clearly the value of drainage which should be effected on all the spheres of the organism.
When we wish to drain in a material plane, by the digestive tract, by the principal viscera and through the emunctories, we should use lower dilutions.
When we wish, on the contrary, to have a drain age action, a debasement of the morbid energy on the higher or subtle spheres of the mentality, of the central or sympathetic nervous systems, we should use remedies in dilutions.
3. Law of Contraries and the Principle of Drainage :
We should now ask ourselves if the Law of Contraries may help us to understand the principles of Drainage and Canalisation.
Really speaking, as we have already said, the Law of Contraries, more important than it is not believed by some Homoeopaths, should be invoked only when it is not possible to follow the Law of Similars, i.e. to say when it is necessary to make palliative treatment, or when regimen and modalities are to be observed.
But precisely here, the Law of contraries may sometime be observed in some rare case as a means of check to some Homoeopathic remedies given according to the law of Similars in different dilutions, specially in high dilutions.
It is logical to use a check when it is necessary as well as an accelator in a given sense.
In some cases one may make the same reproach to Homoeopaths which they make themselves to the followers of the Official School. We say that the allopaths often observe without knowing, the law of similars. Similarly some Homoeopath very frequently observe the Law of Contraries, though not aware of it, when they use some medicines in ponderable doses or in lower dilutions used by our School. In such cases it is necessary to watch the patients closely, if these medicines are used for a long time, for a real pathogenesis of the medicine used.
The Law of Contraries should be observed only in very definite cases when its use would seem to be quite rational.
4. The Law of Compensations and Drainage :
It is by the observation of the Law of Equilibrium in its different aspects and following its numerous corollaries that we can understand better the value of the principles of drainage and canalisation.
When we recently studied the law of equilibrium we first of all considered the laws of compensations formulated by our friend Dr.Balland. That law of compensation is necessary in order to understand the series of remedies. In fact when we have to treat a chronic case we should not only know the basic remedy indicated by the patient and what are the satellite remedies that will be necessary to apply, but we should also know what were in the past the stages representing the homoeopathic remedies of which the patient has shown the symptoms.
Thus, for example, we should know that a Sepia patient having, at the age of 30 years, has passed formerly at the age of two or three, through the stage of Calcarea fluorica, followed at the age of ten by the stage of Natrum muriaticum which was at the age of 18 years followed by the stage of Pulsatilla and after several pregnancies which caused portal hypertension and ptosis, and atony of the different small organs of the lower abdomen, she has come into the stage of Sepia. But she will not remain a patient of Sepia. She may move towards Lachesis, Phosphorus, Lycopodium and we should know exactly to which one she is moving. The knowledge of the series of remedies makes the Homoeopaths uncontestably superior who know the Law of Equilibrium and its corollary the Laws of Compensation. In fact, a patient who is not treated may remain, for some years, suitable to a single remedy, so long as it is possible to maintain more or less stable equilibrium of the organism. At a given time that equilibrium will be broken and he will pass to another remedy. It is thus that one may understand the series of remedies according to the age, sex and the living conditions of the patient.
5. The Law of the Least Effort and the Drainage:
We have also studied formerly the physical law of the least effort or the law of inertia. It has helped us to understand how the nature should be guided towards the obligation of the reaction. The law of the least effort guides us to the limits of Homoeopathy. When Homoeopathy is no more applicable, it should leave its place to surgery and to other therapeutic methods. It is often by the application of drainage and of canalisation that we may let the patient pass from one method of therapeutics to another, without any inconvenience for him.
6. The Principle of Polarity and Drainage :
We should know this law in relation to the principle of drainage and canalisation. It is in fact necessary to consider the organism as formed of multiple to consider the organism as formed of multiple poles which may react one upon the other. It is thus one will be brought, in some cases, to some rational practice such as centrotherapy or other methods of reflexotherapy. But even in Homoeopathy when one wishes to treat a patient one should know the action of an infinitesimal dose in time and space. In space the group of remedies are generally remedies of high dilution that have a triple character : medicine of universal action, polycrest and long-ranger remedies.
The satellites that we give generally in lower dilutions or medium dilutions are localisers : they have a local elective action.
But we should consider this classification with an open mind. A medicine which generally acts as ground remedy, Thuja for example, may sometimes in some cases be a satellite or localiser of another remedy (Sulphur or sometimes of Arsenic). In such a case we may say that this ground remedy has become the canaliser of another remedy.