Dr. Srivatsan: …we have a very interesting
subject for discussion as you are all aware of the topic
it is “Dispensing homoeopathic medicine whether it
needs quality assurance”. There might be a lot of
ideas moving into your system and has to say what exactly
this is, what the kind of quality to give and what the discussions
has to be done on this topic. . So we will start with the
discussion. Now the most important question which arises
over here is “Whether homoeopathic medicines are dispensed
according to homoeopathic principles?” |
Dr. Ramdass: In period of time, there are
two things whether it is based on Hahnemann’s concept
of dispensing the medicines or the subsequent unison taken place
that has taken as over many methods of dispensing the medicine
which is standard that is question number one. And if you purely
go by Hahnemann’s concept of dispensing he used to prepare
the medicine and put only one pill of the drug under the tongue
of the patient. That was the concept. I don’t think that
is being followed that is to say if is purely Hahnemannian method
of dispensing the medicine. I think few people still do that
but I’m not sure whether it is widely practiced. It is
questionable and whether it is equally efficient that is again
questionable. Over a period of time I think the thing again
come for discussion.
Dr. Srivatsan: Thank you doctor. Now certain
points we have got out of this question whether the homoeopathic
medicines are dispensed according to the principles. Now the
point is Dr Ramdass is clear. He was telling that single dose
and it has to be packed in sugar of milk. This is what explained
to us during our studies. And I would like to throw some details
about how the homoeopathic medicines have been dispensed all
over the world. How many ways and methods it is been dispensed.
Here we are talking only how it is been dispensed. Now let me
just read out some of modes in which we have been giving these
homoeopathic medicines, we are packing these homoeopathic medicines
to the patients.
As you all are aware that many doctors they give it as dilution
itself, they will ask them to take in drop dose mixed in water
or directly. So it is the dilution which we call it as liquid
form and many of them still put the sugar of milk, then put
the pills on it or the globules and then they pack it. So those
packets have been given. Some of them put it in the glass vials
or plastic vials and some of them put it in the diskets or tablets.
Some triturate the medicine and then give. Some of them put
it in the distilled water, then liniments, ointments, oils and
few of them seen in Kerela where they administered homoeopathic
medicines through olfactory that is inhalation I would like
to ask Dr Ramdass to kindly enlighten the audience as to how
this homoeopathic medicines have been dispensed in liquid forum
and what method have been used and what is the efficacy of it?
Dr. Ramdass: This has originated right from
Hahnemann’s time. If you go back to history where he initially
started with dispensing of medicine in watery doses where he
mentioned about the plussing methods. Of course I’m sure
that you all are aware about the advantages of plussing method.
Each of us has an experience especially in those cases where
the susceptibility requires an elevation, a stimulation or where
the patient is highly sensitive like in idiosyncracy cases,
where you expect there is an aggravation, the plussing system
of method is more helpful. This is one of the commonest thing
that is been used. And the other concept that has come across
is the dilution system. Dilution is not the same as the plussing
system. In plussing system what we normally do, we prepare the
solution. Let us say 4 spoonful of water; out of that take 2
teasspoonful add 8 to that and sake it thoroughly. So that it
is a succession which gives rise to a higher potency. That is
a plussing method whereas in dilution you take 2 teaspoonful,
add to another 2. Take 2 from that and add another 2, where
there is no question of succession. See again the concept of
succession and the trituration, are the 2 process which increase
the potency. This is not exactly what the increase in potency,
this is just a dilution where the sensitivity of individual
is taken care off. These are the 2 major concepts in which the
liquid dispensing is carried out.
Dr. Srivastan: Dr B T Rudresh I would like
to ask you about dispensing homoeopathic medicines on globules
or diskets or tablets. What is your view on this?
 Dr.
B.T. Rudresh: I think that is the most appropriate
approach of dispensing medicines through globules or diskets
or through our lactose or any other sugarcane powder. I
think that is the most appropriate way of giving it. Because
the first thing is, if I say plussing method and I give
it in alcohol or in the dilution method, in liquid form
we need more medicine. We need to keep on moving. Suppose
if I see 100 patients a day for everybody you should have
one more, two more or three more and they should go on doing
it. I think instead of that, according to me whatever the
mode you take universal application is fine. Bit for me
it looks like to give it in globules, or give it in diskets
or give it in lactose powder mixed together is more prevail
in the society as we have seen atleast. With all other homoeopaths
wherever we have seen atleast they have given their powders
along with the globules or diskets. |
Homoeopathy means it is been I think projected as globules
in a vial. I mean that’s what we have seen even as symbolic
way, even as told to us also from the time of students. But
then it changed I think some people started giving it in diskets.
For example I dispense my medicines with diskets, easy to dispense,
easy to take, easy to tell, take one tablet at a time, three
times a day. And all the people who now atleast even in urban
area or rural areas they are more used to take tablets, they
are more used to that. So if we tell take three times a day
for three days I think that would suffice more, take one pill
a day.
But unfortunate thing is what public aspires? Or what public
feels is that there is no uniformity as far as dispensing homoeopathic
medicines is concerned. Everybody feels because somebody dispenses
it in lactose powder, somebody gives it in vials. I still feel
dispensing homoeopathic medicines either in globules or in diskets,
according to me it is more viable.
Dr. Srivastan: So out of your experience soaking
it on the diskets the efficacy is not lost?
Dr. B.T. Rudresh: No. According to me it
is not lost. Even when you are transferring it into the diskets,
which I do regularly, I think i have seen. That has worked wonders.
Dr. Srivastan: Thank you Dr. Rudresh. Dr Manjunath
Kumar, at government sector how do you feel dispensing in the
liquid form or dispensing on the globules or diskets?
Dr. H.D. Manjunath Kumar: To speak from the
government sector actually the easiest method we should follow,
a comfort zone is more important because plenty of patients
we are receiving in a day, we have to dispense in a fast manner
so that we require globules and the best method to be dispensed.
We get best results also. No where we have gone wrong in dispensing
with globules but still I’m having the opinion that it
requires, if the case requires. If the patient is more sensitive
you have seen there are different methods where people used
to dispense homoeopathic medicines. So most of it what we can
understand is doctor comfort zone and how easily the patient
will be able to accept it.
Dr.B.T.Rudresh: Certainly yes. See, the urban
sector have total faith in homoeopathy so that they have come
to you. He will take whatever you give and however you give,
whatever form you give, it makes no difference as far as the
urban sector is concerned. But for him also he will be more
happy if he can carry it in his pocket and take it in afternoon
after his lunch or in night while traveling. So on that basis
he would be more happy to have it, either medicine dispensed
in globules in a vial. I have seen most of the patients on the
way carrying the homoeopathic medicines and show to me on the
roadside from his pocket. So carrying becomes more easy as far
as the urban sector is concerned. Thats why they want it in
globules or disket form. But they don’t mind taking the
medicine in whatever form we give. Because they know that doctor
is the best man to decide. We will take whatever he gives. But
when it comes to the rural sector their thought is different
that always doctor giving same white globules for all condition.
So I think at the psychological levels for his comfort zone
I would rather prefer to give it tablet form which is more used
to rural sector to make him aware that I’m taking some
medicine. It is only making him to understand and of course
it is not as compromising with homoeopathic principles of dispensing.
If you can able to dispense it through the diskets to the rural
side he will be more happy. He will be much more happy if you
can give it in bottle, the mother tinctures; in 2, 3 bottles,
in 2, 3 different colours. But he will be more happier by giving
just diskets and I’m very comfortable with them but one
thing which we must say diskets are more comfortable both in
urban and rural sector. Urban sector will take whatever you
give; we are giving in more comfortable form in chewing, in
carrying or whatever it is: so that we are giving it in diskets.
In rural side they expect the size, shape, quantity, everything
matters to him. It really makes sense to him as far as his apprehension
and his comprehension is concerned. So if we want to catchup
both, I feel the diskets will be more ideal.
Dr.Ramdass: I don’t think there is any
problem in either of these there because that one the concept
is that we are trying to transfer the medicinal energy into
another inert substance. So inert substances as you say is purely
a vehicle, it’s a carrier .So anything for example if
you have to charge the sugar of milk with alcohol; sugar of
milk is likely to dissolve so I don’t know whether how
far it is practical to transfer that. Where as if you charge
it in the globules and with the globules if you mix it with
sugar of milk that’s a different method. I think that
is what Dhankare is talking about, that is how it was dispensed.
I don’t know whether that is been done in the hospital
.See one more thing is there are certain challenges that we
encounter , if for example if it is a newborn baby ,now how
do you introduce the medicine. I normally ask them, to mix it
with the mother’s milk, so this is a practical way of
applying medication. And there are some people who are alcoholic,
who doesn’t want to give up alcohol but his wife wants
him to give up alcohol. Now there are medicines that we give
whether it is acid sulph or whatever in potency if you want
to give that, so we ask them to mix it with alcohol and give
him a peg. I think these are the various methods, so that based
on the craving. That is the objective of the treatment.
Dr. B.T.Rudhresh: Now probably at the end of
this discussion, what we would like from the opinion is whether
there should be a
1. Universal methods of dispensing to the patients.
2. Should there be guidelines behind all these.
3. Universally accepted norms of dispensing , right now do we
have any code of conduct, how to prescribe, how not to prescribe
,what to do all patients feels each one of you give same white
pills, we don’t know what you have given. Same thing,
for cold also you give the same for cough also you give the
same and you give some white pills we take it that’s fine;
but we don’t know for what you give. Of course as far
as my answer goes you don’t need to know because I have
given medicine .But the other point is, now the other question
comes is whether as a scientific system of medicine are we maintaining
some scientific steps to tell people, look we dispense medicines
uniformly, universally acceptable norms within the framework
of prescribed norms of homoeopathy.
Dr. H.D.Manjunath Kumar: What I have to add
here is I was working about 20 years in rural area; in more
the method and more different ways of dispensing you have the
better I feel. Because this gives a psychological effect on
the patients also. Because I was in a rural area where we were
dispensing through only globules and after 10 years I started
getting the blame that we are prescribing only one single medicine.
For each and every disease we are dispensing a single medicine
that was a blame I started getting, then we had to shift on
to sugar of milk and other dilution method and all which worked
out better. So you have more the method the ultimate aim is
to send this dynamic medicine through the root of the tongue
to the patient, that’s all. You can any method according
to it.
 Dr.Veerabramhasary:
… even I have been practicing in rural areas. There
also this problem I have been facing, but I educate the
patient. The patient comes to me and asks what this sir
you have given white pills is, so many diseases I have,
and do you think it will work. Then I will educate the patient,
these are Homoeopathy medicines, we charge it and give.
They will tell, sir if we go to Bangalore they will give
so many medicines. They will give syrup, biochemic and they
will give so many tablets. But I educate them in rural area,
see this is homoeopathy, this is the form of homoeopathy.
Globules is the homoeopathy and I also educate it takes
time according to the diseases. In urban also so many people
will question us whether this white pills will definitely
cure us. So initially we have to educate the patients regarding
how we dispense the medicines, this is my opinion. |
Dr.Srivatsan: Exactly correct Dr.Brahmachary.
So now we have come to one understanding that homoeopathic medicines
are been dispensed based on the requirement of the patients.
As Dr.Ramdass said if the patient is idiosyncratic he requires
the dilution method that is the liquid form and otherwise on
a comfort zone both doctor and the patient easy to handle the
homoeopathic medicines at keeping the quality assurance over
there. Dispensing on globules, on tablets and on diskets, so
these are all certain methods where we are following and this
also depends upon the needs and psychology of the patient.
Have you understood about this aspect, now I would like to have
a discussion on how these globules or liquids or the diskets
can go into the hands of the consumers that is the patients.
So whether you are putting it in the bottle is it good, is it
a glass bottle is good or a plastic container is good or packing
it in a paper is good or putting it in a paper cover is good
or taking a plastic sachet so which are these methods where
we can try to a bring a better quality dispensing point over
here. So I would like to ask Dr.Ramdass of this aspect.
 Dr.
Ramdass: Purity is the criteria basically, now
for example if you think of plastic vials which are now
abundantly used, I think there are standards of plastic
also “Biograde”. So there is one criteria I
think we need to keep, see the point any object that can
pollute the medicine can reduce the effect of the medication
that you are introducing .So hence those substances that
can reduce the effect must be avoided. So these are the
standard silica glasses, silica is the fundamental thing
of the glass. So this can retain the purity of the medicines
without spoiling it is the most ideal thing. If that can
be done that is number one. (Dr.Srivatsan) Sir what about
this amber colored bottles also? Ya see when we expose it
to sun’s rays that is the criteria. Some people say
that the UV rays are filtered through this, so the purity
of the medicines is maintained if it is kept in an amber
glass. Whereas this doesn’t have that kind of provision
.Hence the best thing is avoid it from the sun’s rays
why do u want to expose it to sun’s rays if you are
using it in a white. That is why usually the tea could check
that we use to get which are the best earlier we use to
get, even now it is available |
But keep it in a cool and dry place not a damp moist place
that is one advantage. And as per as dispensing the medicines
in a paper is concerned it has to be print free that is the
number one and number 2 preferably if it is a butter paper that
is the most ideal, or atleast a plain biodegradable paper would
be the most ideal. What about these plastic containers sir?
And nowadays many of the doctors are been dispensing through
it. See one thing that you have to know if you are dispensing
in this don’t charge the medicine in this, ideally speaking
only because again the alcohol can stimulate some reaction with
the plastic which may get contaminated. Where as if you charge
the medicines, dry the globules and then put it in these and
dispense it that is a different thing. Purity can be maintained
in that way for practical purposes. So this is an observation
that has been made. Because plastic has its own medicinal property.
So if one goes into the material medica of plastic, I don’t
know do you have any idea sir .I don’t have any idea one
may do the proving of plastic.
Dr.Srivatsan: Even today that a scientist they
do conduct all kinds of tests in the glass containers only.
So the glass is most ideal than the plastic containers. I would
like to say a little about these blister packs. See the blister
pack is something where you have holes in it where u put the
globules or the diskets in it and then it is the foil which
covers it and under the heat u press it. Now I would like to
ask Dr.Ramdass whether the purity gets disturbed once the heat
is used.
Dr. Ramdass: Personally I have not used any
blister packing and I’m not used to that and I’m
still probably little conservative. But initially when the blister
this packing concept came, I thought we are trying to psychological
role again with the patients. That this appears more like an
allopathic and the patients are comfortable. That was my initial
impression.But however that may not be purely altered. So it
has its advantages and disadvantages.Advantages are that if
you prepare this blister packing of so many medications , it
is easier to dispense and easy to carry so that way the patient
can pop out the blister area and take out the tablet and pop
it into his mouth. So that way it is convenient but the disadvantages
is how many medicines, how many thousands of medicines we are
going to prepare in blister packing and then dispensing. Whether
that is practical I’m not sure. But as per as the heating
element is concerned, whether that will have a impact on the
medication is something, we are talking of anything, see we
are telling that don’t expose the medicines to the perfume
bottle, don’t expose the medicines to heat, so whether
that has impact on the people who have used it much can be..
But if that is the element that is going to block it, you must
as much as possible avoid it, that’s from the purely scientific
point of view, I’m coating it across. But practically
it may appear pretty good.
One of my experiences is which I had much earlier when I started
my practice, there are practitioners, I don’t want to
name anybody who is packing, they use to buy these empty capsules(Gelatin
capsules), and fill the medicines with five size globules or
even powder and then ask the patient to take it. It’s
I think purely cheating. I don’t think it is necessary
because our medicines are best absorbed sublingually when we
say it doesn’t have to really go into the stomach, see
allopathic drugs have certain character only where they have
to dissolve in the stomach and the capsules are given, injections
are given, because the drug can get mixed up with the blood
faster. So there are different theme, but not for homoeopathy.
 |
Dr. B.T. Rudhresh: See the main demarcating
point is ours are dynamised system and dynamic medicines were
dispensed. They are dispensing inert substance, so it makes
no difference whether they dispense it through X, Y, Z whatever
it is. We say don’t keep it near the perfumes, we say
don’t keep it near the high level vaporizing conditions;
we say lot of things, why because they are dynamic in nature.
The dynamicity and the quality of the medicines can be disturbed,
so when we are dispensing, we must be aware that we are dispensing
the dynamic medicines and we are not dispensing the inert substances.
These two basic things and go to fountain it. Dispense it as
far as possible, what Hahnemann has told, with slight modifications
to the present day.
Dr.Srivatsan: Thank you Dr.Rudresh. So we have
to come to a kind of conclusion with the today’s discussion,
that the homoeopathic medicines are being dispensed in different
modes and the best method of dispensing, and the best method
to carry these homoeopathic medicines to the patients is the
glass vials. That is what the Dr.Ramdass and Dr.Rudresh also
said, but depending on the needs of the patient, depending on
the psychology of the patient and depending with that whether
they are urban or rural.So I thank the panelists for having
such a wonderful discussion on this aspect and thank all the
audience also.
