Abstract: Sac.Lac. is simply Placebo and Placebo is the second-best remedy in Homoeopathy. In day-to-day practice, certain situations arise which lead us to prescribe placebo. Beginning from the case when the patient is taking some medicines, In the middle of the treatment process, placebo is needed, also at the end of the treatment when homoeopathic aggravation occurs during improvement of the case, in all that time the physician requires placebo. Certain disease conditions like Artificial Chronic Disease, Pseudo Chronic Disease, Mental diseases of emotional origin, Indisposition, Hypochondriac patients demand placebo. In randomized controlled trials with homeopathic medicines the value of placebo is unquestionable.
Keywords: Placebo, Medicine, Second best remedy, vehicle, indisposition, artificial chronic disease, psychotherapy, homoeopathic aggravation, drug proving, supplement.
Introduction: Saccharum Lactis= Sugar of Milk, Chemical Formula- C12 H22 O11
- It is a non-medicated solid vehicle, used for dispensing medicine.
- It is used as ‘Placebo’.
- For preparation of potentized medicine in decimal potency.
Sac. Lac. Is the best crystalline, substance, scentless, gritty to touch, faintly sweet.
The word ‘Placebo’ originated from the Latin word ‘Placere’ which means ‘to please’. The second-best remedy without which no good homoeopath could long practice medicine. Its technical name is Saccharum Lactis officinalis abbreviated sac.lac.
PLACEBO is a term used for a pharmacologically and pharmacodynamically inactive substance administered to a patient during the course of therapy when no active drug treatment is indicated.
Indications of Placebo in Homoeopathy
1. Indisposition and Artificial Chronic Disease
Not every case encountered in medical practice calls for a medicine. A homoeopathic similimum may not be required in cases of indisposition (aph. 150) and those ill health due to exposure to avoidable noxious influences, who are in habit of indulging in injurious liquors or ailments, are addicted to dissipation, who undergo prolonged abstinence from things necessary for support of life, who reside in unhealthy localities, who are deprived of exercise or open air and who ruin their health by overexertion of body and mind (aph.77). The treatment in such cases may only require the searching out and correcting of the diet, regimen and mode of living of the individual.
Having discovered such a case, the question arises of management of this case. It might seem very simple, merely to tell the patient bluntly that he does not require medicine, but only to mend his life and correct his habits. This view does not take into account the peculiarities of human nature.
The average patient who goes to the doctor expects to get medicine. He often resents the assertion that his trouble is due to his own ignorance. To direct the attention to his errors of living and order him to correct them is to apparently put the burden of cure upon him and this is not what he wants. The patient expects the doctor to bear the burden.
Placebo in such cases comes to the rescue of a homoeopathic physician. Some patients come to the physician at every change of wind, at every attack of snuffles the baby has, at every little headache or every little pain. If the physician proceeds to change the remedy or prescribe for each one of these little spells of indisposition, one will, in the course of a little while, have such a state of disorder in the individual that one will wonder what is the matter with that patient.
So one can give them placebo, and let the indisposition pass off of itself.
2. The Indicated Remedy Must Be Given Time to Act.
The remedy in Materia Medica is indicated remedy, which when administered must be given time to act and its action must not be interfered with by other drugs or influences until it has accomplished its utility. Also too many doses of the best remedy may spoil the case. This is also true of cases where the medicine has to be given at a particular phase of disease, as in case of intermittent fevers. Hence administer the second best remedy- placebo.
3. Let the Case Clear itself- to Form a Faithful Picture of Disease.
When a disease is of a chronic character, and the patient has been taking medicine up to the time he is seen, physician may with advantage leave him some days quite without medicine, or in the meantime administer something of an unmediated nature in order to be able to grasp in their purity the permanent uncontaminated symptoms of the old affection and to form a faithful picture of a disease. At times patients may say “I took some medicine, and most of my symptoms subsided.” They lead to another image from which the physician can gather nothing; a scattering has taken place. Or the symptoms may cover page upon page, and yet no remedy may be clear. No individualization is possible. Administer placebo, let the portrait clear.
“Besides this, patients themselves differ so much in their dispositions, that some, especially the so called hypochondriacs and other persons of great sensitiveness and impatient of suffering, portray their symptoms in too vivid colors and, in order to induce the physician to give them relief, describe their ailments in exaggerated expressions.”(Aph 96)
4. Homoeopathic Drug Proving-
Placebo is also a very vital member of ‘controlled, double blind therapeutic and proving trials.’ Influences and bias on the part of the prover and the investigator can significantly modify the drug responses, interfering with the interpretation of therapeutic efficacy of a drug. In order to avoid such complications, dummy preparation or substitute drug i.e. Placebo is employed, which should be of the same color and texture as that of the test substance and should be administered in the same way as that of the experiment group.
5. A Supplement to Indicated Remedy-
Another use of placebo is as a supplement to the indicated remedy. Dr. Hahnemann advocated the use of sugar of milk following the giving of a remedy in order to allow the latter to unfold its activity in its entirety.
Sometimes quite definite aggravations follow the good homoeopathic prescription when too low a potency is employed, and physicians may think that the case has become worse.
6. Psychotherapy
The use of placebo is one form and a very powerful form of therapeutic suggestion- psychotherapy. There is evidence that mood or emotional state of a person affects markedly the manifestation of disease, action of drug and the process of cure. The process of homoeopathic interview combined with the expectations of patients seeking homoeopathic cure may enhance the placebo response itself. Thus, homoeopaths interested in distinguishing the action of homoeopathic remedy from that of placebo response must reasonably begin each case with placebo-“second best prescription” or may be the first.
7. Homoeopathic Aggravation.
In cases of Homoeopathic aggravation(Aph 280), Dr. Hahnemann advices- ‘In order to be convinced of this, the patient is left without medicine for eight, ten or fifteen days, meanwhile giving him only some powders of sugar of milk.’(Aph 281)
8. If you are not Sure Give Placebo.
When a physician is called to a new case, a decision is to be made for medication. To avoid a mistake in the first prescription which might prejudice the case by confusing it, so a quick and satisfactory cure would be impossible. When a physician is unable to decide what remedy is indicated and time is required to study the case, administer the remedy at once if you are sure of it, but not otherwise. If you are not sure, give a placebo.
All this emphasises the fact that homoeopathic drugs dare not be lightly used, precaution in regard to medicine is to be taken off by judicious resort to a placebo.
The placebo effect refers to the phenomenon where a patient experiences an improvement in symptoms after receiving an inactive substance or intervention, simply due to their belief in its therapeutic effects. It highlights the complex relationship between the mind and body and underscores the importance of psychological factors in the healing process.
The placebo effect is well-documented and has been observed across various medical conditions. It plays a significant role in clinical trials and can lead to improvements in subjective measures such as pain, mood, and overall well-being.
The common trend of a human being, whenever he or she feels ill, is to have a strong impulse to take some medicine for the illness. But sometimes it happens that there remains no need to administer to the particular patient, and the respective physician does not like to administer any medicine to him; then the physician prescribes some non medicated substance which is called placebo for the sake of patients. In the meantime, until the second medication is given, one can soothe the patient’s mind and desire for medicine with something inconspicuous such as a few teaspoons a day, of sugar of milk. Placebo is an agent employed in medical practice with the primary aim of gratifying the patient. It is the psychological state of the individual at the time of its administration that determines the effects produced by the placebo.
Homoeopathy and Placebo:
Many people still believe that Homoeopathy is a placebo. For them it must come as a surprise that Hahnemann, unlike most of his contemporaries, was already familiar with a phenomenon which we call today the placebo effect. First, he differentiated clearly between the homoeopathic drugs administered in line with law of similars that is “similia similibus curentur” and such pharmaceutical substances he considered quite rightly as medicine (for example “milk sugar”). Second, as far as we know, he was the first physician who systematically used a single blinded approach in therapy. In aphorism 91, Hahnemann states, when the disease is of chronic character and patient has been taking medicine up to the time he is seen, the physician can leave him some days quite without medicine or meantime can administer something of an non medicinal nature and defer to a subsequent period. In case of hypochondriacs, when pure fabrication of symptoms comes, Dr. Hahnemann advises the physician to “give them nothing at all, or something quite nonmedicinal” in footnote to aphorism 96.
Aphorism 281, states that when the improvement begins, in order to be convinced of this, the patient is left without any medicine for eight, ten, fifteen days, meanwhile giving him only some powders of sugar of milk. In the period between 1833 and 1835 more than half (54%) of Dr. Hahnemann’s prescriptions was placebo.
As observed in his case journals, the main reason for giving placebo by Dr Hahnemann was to please the impatient patient who was used to frequent medications in allopathic medicine, not only every day but sometimes also hourly. In the homoeopathic treatment of serious chronic pathology, if the remedy is correct, usually a strong initial aggravation takes place. Such an aggravation may last from a few hours to a few weeks and even then, we may have a syndrome shift and not the therapeutic results expected, here one can take help of sac.lac. To continue with patients’ desire to take medicine.
Utility of Placebo:
- To determine a medication’s part in the actual effect of a medication on the improvement in symptoms of a disease that has been tested with psychological effect of participating in a clinical trial and with the psychological effect of taking any kind of medication.
- When improvement begins: It is necessary to stop the medicine prescribed. Here indicated medicine may be substituted by placebo till another dose of the same medicine or other medicine is required.
- Reduced anxiety: Taking the placebo and expecting to feel better may be soothing and reduce the levels of stress chemicals and body produces, such as adrenaline.
- A change in behaviour: The placebo may increase a person’s motivation that plays an important role to take better care of themselves. Improved diet, regular exercise or rest may be responsible for the easing of their symptoms.
- During homoeopathic aggravation: symptoms are worse, but the patient says that mentally he feels better, so the wait and watch method is necessary in that situation. At this stage any sort of medication will spoil the case, placebo may be prescribed instead.
During homoeopathic aggravation by LM potency: At the end of treatment few symptoms of the drug remain; these symptoms disappear within a few days, meanwhile the patient may be given only powder of sugar of milk.
- The antipsoric medicine is repeated in long intervals and to fill up gaps, sugar of milk may be given every day at the usual time and usual manner.
Results of studies of placebos showed improvement in 56% of patients experiencing cancer related fatigue, 70% of women experiencing menopausal hot flushes, and 75% to 80% of the patients with depression.
People who find placebo prescribing acceptable seem to do so primarily because they believe placebos can be effective and they prioritise such patient benefit over other concerns.
Placebo Effect and the Brain: Functional imaging upon placebo analgesia shows activation of some areas in the brain. High placebo responses link with dopamine activity. Since the body brain response that controls the placebo effect is neurological, they work best for conditions controlled by the neurological system, such as pain, irritable bowel syndrome, depression, Parkinson’s disease.
Physiological Effect of Placebo: A groundbreaking study in the late 70’s showed for the first time that a placebo could trigger the release of Endorphins (the body’s natural painkillers), just as certain active drugs do. In the study, Jon Levine, gave placebos instead of pain medication, to 40 dental patients who had just had their wisdom teeth removed. Not surprisingly, because the patients thought they were getting medicine that would indeed relieve their pain, most reported relief. But then the researchers gave the patients an antidote to morphine, which chemically blocks the receptor sites for both Endorphins and Morphine in the brain.
When the researchers administered it, the patient’s pain returned. This proved that by taking the placebos, the patients have been creating their own endorphins- their own natural pain relievers.
It was a milestone in placebo research, because it meant that the relief the study subjects experienced wasn’t all in their minds; it was in their minds and their bodies- in their state of being. In a study, participants are given a placebo but are told it is a stimulant. When the participants take that pill, their blood pressure and pulse rate are increased, and their reaction speeds are improved.
However, when the same people are given the same placebo and told it will help to relax and sleep, they experience relaxation instead. If a person experiences a treatment to do something, it’s definitely possible that the body’s own chemistry will cause effects similar to what a medication might have caused.
Conclusion:
Dr. Hahnemann states, our mission is to cure the patient not to hurt them. It is very much better to give a placebo than an unwanted or wrong medicine.
-Bruce H. Lipton states that, if the brain expects that a treatment will work. It sends healing chemicals into the bloodstream, which facilitates that. That’s why the “placebo effect” is so powerful for every type of healing and the opposite is equally true and equally powerful: when the brain expects that the therapy will not work, it is called the “nocebo effect”. The placebo response is about being healed by thought alone. In the current scenario, the placebo is mandatory not only in homoeopathy but in all types of medical systems, in situations where a real medicine is not needed.
References:
- Dr. Sumit Goel, M.D. (Hom)-Art and Science of Homoeopathic Pharmacy
- Dr. Partha Pratim Mandal Dr. Biman Mandal- A Textbook of Homoeopathic Pharmacy
- Close S. Indisposition and the second-best remedy. The Genius of Homoeopathy,
- Kanjilal JN. Placebo, Writings of Homoeopathy, 1st Ed.
