主题：一个化学家对顺势疗法的简要看法

乔·施瓦兹（Joe Schwarcz, Ph.D.）

我对顺势疗法很疑惑，要接受它的理论我必须放弃对已从事了30多年的化学的理解。不存在的分子会有疗效一点不符合化学理论。当然，我也不能仅仅因为顺势疗法声明的作用机制未被现代科学观点接受，就推论顺势疗法无效。毕竟人们一度普遍相信，由于地球是弯曲的，无线电波沿直线传播，所以无线电不能传过大西洋。因而意外发现了无线电波可以通过大气反射。无论如何，在重新审议我们有关分子的理论之前，我们有必要调查顺势疗法是否真的起作用。

顺势疗法之父塞缪尔·哈内曼接受过当时的规范医学训练，在1700年代末开始在德国行医。他很快便不再迷信当时他学到的治疗方法。放血、水蛭、抽气罐、泻药和砒霜看起来对人体的伤害大于其益处。哈内曼于是不理睬他所受的教育，开出了当时非常革命的养生处方：新鲜的空气、个人卫生、锻炼以及有营养的膳食。由于仅依靠推介这个养生法难以维持生计，他利用他精通八门语言来挣钱：翻译医学课本。在翻译过程中，他接触到了一个为何奎宁会治愈疟疾的解释——奎宁在胃里构筑了防御工事。

出于兴趣，哈内曼自己吃了一些奎宁以观察是否真的有这种作用。结果没有，但是他很快就感到发热：脉搏加快、四肢发冷、头脑颤动。由于这些症状极像疟疾，他推理出奎宁能够治愈疟疾是因为发热治愈发热，换句话说就是“同类可以治愈同类”。顺势疗法（Homeopathy）这个源于希腊语 homoios'（相似）和pathos（患病）的单词从此诞生了。

哈内曼更进一步，开始在健康人身上系统地试验各种自然物质的效果。这些“验证”导致他得出结论，例如颠茄能够用来治疗喉咙痛因为颠茄导致健康人喉咙发紧。顺势疗法会因此而危险吗？绝对不会。哈内曼还有个主意，他建立了剂量越小效力越大的理论，因为物质会激活人体的“生命力”以抗拒疾病，所以通过重复稀释提取物以减少处方剂量。

稀释是非常极端的，至于经过高度稀释后实际已经没有原始物质残留，哈内曼并不担心。他声称治疗溶液的效力不是来自活性成分的存在，而是来自原始物质已经通过某种方式在溶液中留下了自己的印记。换句话说，经过数次稀释之后，水仍“记忆”了被溶解的物质。这个印记的过程必须要非常小心的操作，仅仅是简单的稀释是不够的。溶液瓶必须在一个特制的皮垫上敲击固定的次数才会成为“活力态”（dynamized）。

当时的主流医生对这些奇特做法很不友好。实际上1846年美国医学会的成立主要是因为要反对顺势疗法，其成立宗旨之一就是废除顺势疗法行业。

然而顺势疗法没有消亡，其支持者兴奋地指出在同等评价的科学杂志上的研究显示其有效果。不过，请稍慢。对这些研究的仔细的综合分析没有得出令人信服的结论。对于很少的一部分症状的治疗，顺势疗法的疗效报告为比安慰剂稍微好一点，但是没有应用意义，只是吸引了学术兴趣。没有活性成分存究竟为什么会有阳性的结果呢？出版偏倚是一个解释。“阳性”的研究结果比阴性的研究结果更可能被报道，基于平均律，如果进行足够多的研究，迟早会显示阳性结果。报道那些处于沉默状态的阴性发现能够打碎效力的幻象。

有几个大型的顺利疗法综述已经发表了，有的由支持者完成，有的由怀疑者完成，都同意不能证实顺势疗法对任何临床症状有明显的效果。

原文：
A Chemist's Brief Look at Homeopathy
Joe Schwarcz, Ph.D.

I have a problem with homeopathy. To accept its principles, I must cast aside the understanding of chemistry that I have developed over 30 years. Therapy based on nonexistent molecules just does not fit the model. But, of course, I cannot conclude that homeopathy does not work just because its proposed mechanism of action is unacceptable to the current scientific view. After all, was once widely believed that due to the curvature of the earth, radio transmission across the Atlantic would never be possible because radio waves traveled in straight lines. Then it was accidentally discovered that these waves bounce off the atmosphere. However, before reconsidering our theories about molecules, we have to investigate whether homeopathy really does work.

The father of homeopathy, Samuel Hahnemann, was trained in the standard medicine of his day and began practicing in Germany in the late 1700s. He quickly became disillusioned with the treatments he had learned. Bleeding, leeches, suction cups, purges, and arsenic powders seemed to do more harm than good. Hahnemann began to ignore his training and to prescribe a regimen that at the time was quite revolutionary: fresh air, personal hygiene, exercise, and a nourishing diet. Since there was little chance of earning a living by simply recommending this regimen, he supplemented his income by using his fluency in eight languages: he undertook to translate medical texts. While working on one of these translations, he encountered an explanation of why quinine supposedly cured malaria -- the substance fortifies the stomach.

Intrigued, Hahnemann took some quinine himself to see if it really had this effect. It did not, but soon he felt feverish: his pulse quickened, his extremities became cold, his head throbbed. As these symptoms were exactly like those of malaria, he reasoned that quinine cured malaria because fever cures fever. In other words, "like cures like." Homeopathy, from the Greek homoios' (like) and pathos, (suffering), was born.

Hahnemann went further, and began systematically testing the effects of a large variety of natural substances on healthy people. Such "provings" led him to conclude that belladonna, for example, could be used to treat sore throats because it caused throat constriction in healthy subjects. But belladonna is a classic poison. Was homeopathy therefore dangerous? Not at all. Hahnemann had another idea. He theorized that the smaller the dose of a given substance, the more effective that substance would be in stimulating the body's "vital force" to ward off disease. So reduced the prescribed doses by repeatedly diluting the original extracts.

The dilutions were extreme. Hahnemann was not bothered by the fact that at high dilutions, none of the original substance remained. He claimed that the power of the curative solution did not come from the presence of an active ingredient but from the fact that the original substance had, in some way, imprinted itself on the solution. In other words, the water in the diluting solution somehow "remembered" the material that had been dissolved in it several dilutions back. This imprinting process had to be carried out very carefully; a simple dilution of the solution was not enough. The vial had to be struck against a special leather pillow a fixed number of times in order to be "dynamized."

Mainstream physicians did not take kindly to these peculiar rites. In fact, the American Medical Association was formed in 1846 largely as a reaction to homeopathy; one of its founding goals was to rid the profession of homeopaths. At times, the association's strictures became ridiculous. One Connecticut doctor lost his membership for consulting a homeopath -- who happened to be his wife.

Nevertheless, homeopathy did not disappear and its advocates gleefully point to studies in peer-reviewed scientific journals that appear to show benefit. But wait a minute. A careful review of these studies yields unimpressive results. In the treatment of a few minor conditions, homeopathy has been reported as slightly more effective than a placebo, but this has no practical implication; it merely attracts academic interest. How can there be any positive results at all when there is no active ingredient? Publication bias is one explanation. "Positive studies" are more likely than than negative studies to be reported. If enough studies are carried out, sooner or later some will have to show positive results based on the law of averages. Reporting these while maintaining silence on negative findings can create the illusion of effectiveness.

Several large reviews of homeopathic research have been published, some done by proponents and some by critics. All agree that homeopathy has not been proven clearly effective for any clinical condition. A detailed analysis of homeopathic research will be posted to HomeoWatch within the next few months.