Rational use of Ashwagandha in Ayurveda (Traditional Indian Medicine) for health and healing.

ETHNOPHARMACOLOGICAL RELEVANCE: Withania somnifera (L.) Dunal (Physalis somnifera L.) is a fairly known perennial shrub of Solanaceae family, and is used in Ayurveda- Traditional Indian Medicine (TIM), since ancient times. It is well known as Ashwagandha in Sanskrit language in Ayurvedic classics. Its Mula (root) is recommended for health and healing, and the number of single and compound formulation is prescribed rationally. It is believed that the species name-somnifera is coined based on popular use to "induce sleep" in Ayurveda. AIM OF THE STUDY: The present study was aimed to bring out the experience-based traditional uses of Ashwagandha for health and healing with an emphasis on the pharmacological and biochemical scientific evidences to corroborate them. The scientific evidences have been explored from the national and international publications. MATERIALS AND METHOD: A comprehensive literary search of Ayurvedic classics was carried out systematically regarding Ashwagandha for its rationality behind the traditional uses. To excavate the subject matter, the original Ayurvedic scriptures and several standard Ayurvedic texts of different period was studied insightfully for meaningful contribution. It is to be noted that the primary source of knowledge was considered in writing this manuscript without any biased attitude. The available literature on Ashwagandha was also searched to ascertain the basis of scientific Latin name and correct identity. The Ayurvedic Pharmacopoeia and other relevant scientific works were also taken into consideration to make the subject matter more clearly to the scientific world. For the scientific evidence of the uses, the international and national Journals and other published material were also searched to make it inquisitiveness to the scholars interested in Ayurvedic medicinal plants. RESULTS: The present paper throws ancient luminosity behind the therapeutic uses of one of the promising plant drug i.e., Ashwagandha of ancient India even to the present time. The scientific evidences corroborate the rationality ascribed in available Ayurvedic classics of various period of India has been gained. CONCLUSION: The study explores that the first reference of Ashwagandha with its significant nomenclature, useful part, properties, action, and eloquent uses has its footprint in the original texts of Ayurveda. In later works enhanced knowledge with traditional uses continued even today. Several single and compound formulations have been found to maintain the health and to alleviate the disorders rationally. It is worthy to note here that the scientific evidences corroborate the uses practiced in Ayurveda.

Analysis of historical changes in traditional Chinese medicine based on an Indonesian collection of Chinese materia medica from c. 1870.

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Chinese Medicine is subject to changes over time: product names, botanical ingredients, processing methods and uses have varied throughout the course of history. Historic collections of Chinese materia medica (CMM) are of great value for research on the evolvement, development and variability of Chinese herbal medicine over time. These changes may have a significant influence on the safety and efficiency of nowadays' clinical practice. Here we investigate a historic collection of Chinese medicinal products purchased in Indonesia in c. 1870, containing about 395 specimens. AIM OF THE STUDY: This study compares the specimens contained in late 19th century collection of CMM with contemporary marketed materials by investigating changes in vernacular names, botanical identity and processing methods which are important aspects for safety and clinical practice today. MATERIALS AND METHODS: The contents and associated documentation of the CMM collection of Dr. C.H.A. Westhoff (University Museum Utrecht) were revised by means of morphological identification and study of the associated historic documentation. We compared this Westhoff collection with contemporary CMM, information from literature and various quality standards, including the official Chinese pharmacopoeia. RESULTS: The Westhoff collection represents a unique, well preserved collection of Chinese materia medica, with original uniform bottles, Chinese labels and a partly intact handwritten catalogue. Among the 395 specimens (bottles) of CMM surveyed, there are 387 contain a single component drug, while eight contain multiple components drugs. A total of 293 of the 395 specimens are mentioned in the modern Chinese pharmacopoeia. Ca. 25% of the specimens had been processed, such as stir-fried with or without adjuvants. Our analysis of local Chinese names, botanical content and processing methods indicate that this collection originates from southern part of China, possibly including in the region of Taiwan and was meant as a showcase for pharmaceutical education and/or as curiosity object. CONCLUSION: Differences in vernacular names, plant parts and processing methods between the Westhoff collection and the current Chinese pharmacopoeia illustrate the regional variety of CMM and changes in CMM in the course of time. This work contributes to the understanding of the evolvement of CMM from a historic perspective.

Safety assessment of homeopathic medicines: The Adonis vernalis paradox and the 'analysis trap' of using different pharmacopeias.

Regulatory agencies have to ensure the end-user safety of botanically derived homeopathic medicines prepared with diluted starting materials derived even from toxic plants. In the case of plant-derived homeopathic products, assessment must consider the particular characteristics of an extract and its component molecules, even if diluted. The identification and quantification of these molecules have a crucial role in risk assessment, as it allows complete toxicological evaluation in a regulatory perspective. Different results can be achieved using different approaches and references supported by the same regulatory framework, as different methods of preparation used, assays and test analysis performed in compliance with different referent pharmacopoeias. All these facts can introduce a bias in the safety assessment and the paradoxical outcome for homeopathic Adonis vernalis underlines the need for caution. The case also demonstrates the relevance of considering the analytical method for assessment of all herbal medicinal products or herbal supplements, with the purpose of finding the total amount of toxicants as a good approach.

Empirical investigation of preparations produced according to the European Pharmacopoeia monograph 1038.

According to the European Pharmacopoeia monograph 1038 (Praeparationes homoeopathicae), homeopathic preparations are produced by successive dilution and succussion steps. Dilution levels beyond Avogadro's limit, however, render specific effects implausible according to standard scientific knowledge. Accordingly, we were interested in a critical empirical investigation of preparations produced according to this monograph. Within a precursor study we developed a bioassay based on a fingerprint metabolomic analysis of Lepidium sativum seeds germinated in vitro in either homeopathic preparations or controls in a blinded and randomized assignment. Results of the precursor study were not consistent with the hypothesis that the effects of a Stannum metallicum 30x preparation are identical to placebo. In the present study we investigated the reproducibility of these effects after scrutinizing and optimizing experimental procedures. Ten independent experiments were performed in a blinded and randomized assignment in two independent laboratories. Additionally, 10 systematic negative water control experiments were performed in both laboratories to critically assess the stability of the experimental set-up. The effects of the Stannum metallicum 30x treatment were reproduced. The systematic negative control experiments did not yield false-positive results, indicating a stable experimental set-up. We thus repeatedly observed biological effects conflicting with the assumption that Stannum metallicum 30x is identical to placebo. We therefore wish to discuss whether these findings are to be considered a scientific anomaly or whether they might stimulate further investigations to clarify whether application of the European Pharmacopoeia monograph 1038 may result in pharmaceutical preparations with specific effects.

Current Status of Herbal Drug Standards in the Indian Pharmacopoeia.

The benefits of herbal drugs were well understood way back. They have been used for the promotion of health and medical purposes - in disease conditions. It is a conventional belief that herbal drugs have no side effects, are cheaper and locally available. Among Indian systems of medicines, herbs/herbal formulations are used to a larger extent. The quality control of the marketed herbs/herbal formulations is important for acquiring optimum therapeutic benefit as well as for expanding global outreach. Therefore, herbal drug standards are important. Reference standards, the Indian Pharmacopoeia Reference Substances especially the botanical reference substances and the phytochemical reference substances are required for comparison of quality of herbal drugs. The Indian Pharmacopoeia Commission has initiated the process of providing Indian Pharmacopoeia Reference Substances to the stakeholders. Therefore, this article provides an overview of the history and the status of herbal drug standards in the current and forthcoming issues of Indian Pharmacopoeia. In Indian Pharmacopeia, efforts have been made for the harmonization of standards with international counterparts wherever possible. Copyright © 2017 John Wiley & Sons, Ltd.

Therapeutic use of the rebound effect of modern drugs: "New homeopathic medicines".

The homeopathic treatment is based on the principle of therapeutic similitude, employing medicines that cause certain disorders to treat similar manifestations, stimulating a reaction of the organism against its own ailments. The occurrence of this secondary reaction of the organism, opposite in nature to the primary action of the medicines, is evidenced in the study of the rebound (paradoxical) effect of several classes of modern drugs. In this work, in addition to substantiate the principle of similitude before the experimental and clinical pharmacology, we suggest a proposal to employ hundreds of conventional drugs according to homeopathic method, applying the therapeutic similitude between the adverse events of medicines and the clinical manifestations of patients. Describing existing lines of research and a specific method for the therapeutic use of the rebound effect of modern drugs (http://www.newhomeopathicmedicines.com), we hope to minimize prejudices related to the homeopathy and contribute to a broadening of the healing art.

Enhancement of adaptive biological effects by nanotechnology preparation methods in homeopathic medicines.

Multiple studies have demonstrated that traditional homeopathic manufacturing reagents and processes can generate remedy source and silica nanoparticles (NPs). Homeopathically-made NPs would initiate adaptive changes in an organism as a complex adaptive system (CAS) or network. Adaptive changes would emerge from several different endogenous amplification processes that respond to exogenous danger or threat signals that manufactured nanomaterials convey, including (1) stochastic resonance (SR) in sensory neural systems and (2) time-dependent sensitization (TDS)/oscillation. SR is nonlinear coherent amplification of a weak signal by the superposition of a larger magnitude white noise containing within it the same frequencies of the weak signal. TDS is progressive response magnitude amplification and oscillatory reversal in response direction to a given low dose at physiological limits with the passage of time. Hormesis is an overarching adaptive phenomenon that reflects the observed nonlinear adaptive dose-response relationship. Remedies would act as enhanced micro- and nanoscale forms of their source material via direct local ligand-receptor interactions at very low potencies and/or by triggering systemic adaptive network dynamical effects via their NP-based electromagnetic, optical, and quantum mechanical properties at higher potencies. Manufacturing parameters including dilution modify sizes, shapes, and surface charges of nanoparticles, thereby causing differences in physico-chemical properties and biological effects. Based on surface area, size, shape, and charge, nanoparticles adsorb a complex pattern of serum proteins, forming a protein corona on contact that constitutes a unique biological identity. The protein corona may capture individualized dysfunctional biological mediator information of the organism onto the surfaces of the salient, i.e., resonant, remedy nanostructures. SR would amplify this weak signal from the salient remedy NPs with protein corona adsorbed, leading to sensitized nonlinear dynamical modulation of gene expression and associated changes in biological signaling pathways. When the system reaches its physiological limits during a homeopathic aggravation or the natural disease state, the amplified remedy signal triggers a nonlinear reversal in dynamical direction back towards health.

Development and validation of an ICP-OES method for quantitation of elemental impurities in tablets according to coming US pharmacopeia chapters.

May 1, 2014 the United States Pharmacopeia (USP) will implement two new chapters stating limit concentrations of elemental impurities in pharmaceuticals applying inductively coupled plasma methods. In the present work an inductively coupled plasma optical emission spectrometry (ICP-OES) method for quantitation of As, Cd, Cu, Cr, Fe, Hg, Ir, Mn, Mo, Ni, Os, Pb, Pd, Pt, Rh, Ru, V and Zn in tablets according to the new USP chapters was developed. Sample preparation was performed by microwave-assisted acid digestion using a mixture of 65% HNO3 and 37% HCl (3:1, v/v). Limits of detection and quantitation were at least a factor of ten below the USP limit concentrations showing that the ICP-OES technique is well suited for quantitation of elemental impurities. Excluding Os, spike recoveries in the range of 85.3-103.8% were obtained with relative standard deviations (%RSD) ranging from 1.3 to 3.2%. Due to memory effects the spike recovery and %RSD of Os were 161.5% and 13.7%, respectively, thus the method will need further development with respect to elimination of the memory effect of Os. The method was proven to be specific but with potential spectral interference for Ir, Os, Pb, Pt and Rh necessitating visual examination of the spectra. Hg memory effect was handled by using lower spike levels combined with rinsing with 0.1M HCl. The tablets had a content of Fe and Pt of 182.8 ± 18.1 and 2.8 ± 0.2 µg/g, respectively and did therefore not exceed the limit concentration defined by USP. It is suggested that the developed method is applicable to pharmaceutical products with a composition and maximal amount of daily intake (g drug product/day) similar to the tablets used in this work.

Bioprospecting: evolutionary implications from a post-olmec pharmacopoeia and the relevance of widespread taxa.

ETHNOPHARMACOLOGICAL RELEVANCE: "Nothing in biology makes sense except in the light of evolution" The historical legacy and relevance of ethnopharmacology in drug discovery is undisputed. Here we connect the parameters influencing the selection of plant derived medicines by human culture with the concept of evolution. AIM OF THE STUDY: In the present contribution we compare global data with local data and try to answer the questions, to what extent are the taxonomic clades included in indigenous pharmacopoeias associated with certain ailment groups, and to what extent can ecology and phylogeny, which we consider a proxy for chemical relatedness and convergence, account for the observed bias? MATERIALS AND METHODS: We use an approximated chi-square test (χ(2)) to check for associations between 12 ethnomedical use-categories and 15 taxonomical clades. With cluster analyses we test for correlations between phylogeny and use-categories. We compare the 67 drug-productive families identified by Zhu et al. with the medicinal flora of the Popoluca and the APG database and compare our results with the phylogenetic target classes evidenced by Zhu et al. Furthermore, we compare the medicinal flora of the Popoluca with the world's weeds (cf. Holm et al.) and discuss our results in relation to anthropological rationales for plant selection. RESULTS: The null-hypothesis "species from the 15 taxonomic clades are selected proportionally to their share in the treatment of the twelve organ- and symptom-defined use-categories" is rejected. The cluster dendrogram for the clades shows that the use patterns are to a certain extent associated with Angiosperm phylogeny. With the occurrence of 53 families the 67 drug-productive families are overrepresented in the regional flora of the Popoluca. The importance of these families in terms of their share is even more pronounced with the medicinal flora holding around 70% of all individual Popoluca informant responses. CONCLUSIONS: The overall phylogenetic use pattern is influenced by both the inherent pharmacological properties, which depend on phylogeny, biogeography, ecology and ultimately allelopathy, and on culture-specific perception of organoleptic properties. The comparison of the 67 drug-productive Viridiplantae families with the ethnopharmacopoeia of the Popoluca and the APG database, shows that "traditional" pharmacopoeias and plant-derived drugs are obtained from widespread and species-rich taxa. This is not a function of family size alone. We put forward the theory that as a function of evolution, widespread taxa contain a broader range of accumulated ecological information and response encoded in their genes relative to locally occurring taxa. This information is expressed through the synthesis of allelochemicals with a wide ecological radius, showing broad-spectrum biota-specific interactions, including the targeting of proteins of mammals and primates.

A relic of medieval folklore: Corpus Christi Octave herbal wreaths in Poland and their relationship with the local pharmacopoeia.

ETHNOPHARMACOLOGICAL RELEVANCE: Herbal wreaths are blessed all over Poland on the eighth day of the Corpus Christi Octave (usually in June). They used to contain many species of aromatic and medicinal plants, both collected from the wild and cultivated. The aim of this study was to document the present composition of wreaths using photographs (etic perspective) and questionnaires (emic perspective) and compare it with the local pharmacopoeia, the composition of Assumption Day bouquets (blessed in August) and historical data on the composition of the wreaths. MATERIALS AND METHODS: The study was carried out in SE Poland (near Krosno). Photographs of 245 wreaths were taken and 133 questionnaires concerning the blessed plants and their medical use were obtained. RESULTS: On average a photographed wreath contained over five species of plants and an average informant listed six species. The frequency of species in photos and questionnaires was similar. Several medicinal plants which used to be the key elements of the wreaths (e.g. Sedum acre, Asarum europaeum, Matricaria recutita, Thymus pulegioides, Alchemilla spp.) are now less frequently seen, mainly due to vegetation transformations. Nowadays only about a quarter of species in the wreaths are medicinal plants, the remaining are mainly ornamental flowers. Only a part of the local pharmacopoeia is represented in the blessed wreaths and bouquets. The wreaths were often used in fumigation practices (whole wreaths or single species taken out) for a whole continuum of purposes: from purely ritual to medicinal. Nowadays they serve a mainly apotropaic function, but help to preserve traditional ethnomedicinal knowledge. CONCLUSION: The blessing of herbal wreaths in Poland seems to be the last relic of a more widespread custom found in medieval times throughout northern and central Europe originally associated with summer solstice.

The science of high dilutions in historical context.

This paper begins from a discussion of the terms currently applied to the preparations used in homeopathic practice and relates them to the names given to them by Hahnemann, the founder of homeopathy. The latter were directly related to the notion of matter Hahnemann held, this is discussed as it evolved from the earliest sources to the sixth and final edition of the Organon of Medicine, through all the editions of this work as well as many other hitherto rarely explored sources. This review shows that Hahnemann moved conceptually within the field of concepts of late 18th- early 19th century science. This is only natural, and, a legitimate object for studies of the history of science and medicine.

Study of the risk of heavy metal transfer to homoeopathic mother tinctures.

To assess the risk of heavy metal contamination of homoeopathic mother tinctures, 9 plant species and 1 fungus used in the manufacture of homoeopathic medicaments were investigated. Mother tinctures were prepared according to the manufacturing procedures described in the European Pharmacopoeia. The original herbal drug and the material processed during production were analysed for their cadmium (Cd), lead (Pb) and mercury (Hg) content. The plant components were harvested from 2 sites contaminated by different heavy metal exposure pathways and compared with reference material from Deutsche Homöopathie-Union (DHU). It was confirmed that in all cases a significant depletion of all heavy metals studied occurred during manufacture of the mother tincture, regardless of the starting material used. In all cases, most of the heavy metal content was retained in the press cake; low levels only were detected in the mother tincture. None of the mother tinctures of plant origin exceeded the required limits, not even those of plant starting materials originating from highly contaminated sites. Substantial heavy metal concentrations could only be detected in the mother tincture of the fungus Amanita muscaria, calculated from the dry weight of the starting material. According to the results obtained, a risk-based approach to heavy metal assessment is suggested where permanent control is focused on the heavy metals accumulating in organisms such as fungi.

[To the study of conventual health in the beginning of 19th century: the pharmacies]. / Para o estudo da saúde conventual no início do século XIX: as boticas.

The institution "Junta do Exame do Estado Actual e Melhoramento Temporal das Ordens Regulares" (Examination Council for the Actual State and Temporal Improvement of the Religious Orders) was created in November of 1789. Among other things, each Religious House should inform that institution about its heritage either the movables and the landed estates. The inventorying included all the goods belonging to wards and drugstores. In this paper, we aim to study those places using records obtained from a variety of Religious Houses with no regional or Religious Order preferences. We will try to give answers to questions related to that spaces such as 'Which objects could be found inside the Houses?'; 'Were they properly equipped?'; and 'Were there big differences between them in what concerns Religious Orders and Houses locations?'.

No fear of ghosts in Lycopodium: a contribution to the discussion on repertory reliability.

BACKGROUND: Repertory mistakes in modern homeopathy have been pointed out since the early years after the publication of the sixth edition of Kent's repertory. A structural error of many current repertories is the use of Kent's repertory as a basic information source. 'Fear of ghosts' is widely considered to be a symptom of Lycopodium clavatum by the homeopathic community. OBJECTIVES: To demonstrate that the source of 'fear of ghosts' in Lycopodium clavatum was an inaccurate translation, that has been spread by secondary sources and to review Hahnemann's conception and efforts towards a reliable repertory. RESULTS: The symptom 'fear of ghosts' does not exist in the primary source, being the product of a misunderstanding of the English translation of Hahnemann's original record, 'fear of frightful imaginary images'. Hahnemann's efforts to compile a reliable and complete dictionary of Materia Medica were also briefly presented, as well as Rückert's repertory, which, in addition to collating and classifying symptoms in alphabetical rubrics and sub-rubrics, displayed them completely, as registered in primary sources. CONCLUSION: The misunderstanding about 'fear of ghosts' in Lycopodium clavatum exemplifies how distant current homeopathic information is from its primary sources and from Hahnemann's ideal of a symptom-lexicon. In spite of its technical limitations, Rückert's repertory, which was strongly recommended by Hahnemann, can be considered as a template for new repertories based on primary sources.

Phytotherapy in medieval Serbian medicine according to the pharmacological manuscripts of the Chilandar Medical Codex (15-16th centuries).

The Chilandar Medical Codex is the most significant and best preserved medieval Serbian manuscript and collects together documents on European medical science from the 12th to 15th centuries. It represents the best-known and most complete example of a large collection of medical manuscripts from the Salerno-Montpellier school, written in the vernacular - something which does not exist among the majority of European nations. This paper presents the section of the Codex that deals with phytotherapy, which is contained within the pharmacological manuscripts. An analysis of their contents shows that out of a total of 167 recorded substances, 135 are of plant origin (81%), 13 animal origin (7.7%) and 19 inorganic (11.3%). The recorded plant species are categorised into 63 families, of which the most frequent are: Apiaceae (8.1%), Lamiaceae (8.1%), Asteraceae (5.9%), Rosaceae (5.9%) and Fabaceae (4.4%). All possible plant parts were used in treatments: the whole plant (6%), underground parts (13.7% - root, rhizome, bulb) and aerial parts (80.3% - stem, leaf, flower, buds, fruit, seeds). Of the plants quoted, the following are mentioned most frequently: Vitis sp. (120), Rosa canina (55), Olea europaea (45), Pistacia lentiscus (25), Saccharum officinarum (23), Artemisia absinthium (16) and Foeniculum vulgare (15). The contents of the pharmacological manuscripts of the Chilandar Medical Codex point to the sound contemporary knowledge of the diversity of plant species, their origins, habitat types, the levels of their healing powers, and when and how to gather them and prepare them, as well as the recommended dose for the treatment of specific illnesses. As these manuscripts contain not only common, lay terms for the plants, but also scientific, botanical ones, we can consider them the precursor to Serbian botany. Based on its contents and the way in which they are presented, it can be viewed not only as the first Serbian pharmacopeia, but first Slavic pharmacopeia, too, because similar manuscripts written in the vernacular did not exist during that period among the other Slavic nations, or even most European nations.

Viral safety in homoeopathic medicinal products.

To guarantee the safety of medicinal products as regards infectious agents, numerous national guidelines and recommendations have in recent years been included in the pharmacopoeia general monographs and have influenced the content of the substance monographs. Although the stipulations of the European Pharmacopoeia set out objectives, there is still a certain scope in how the requirements are implemented. This is reflected in the very different responses in Europe to the problems of safety from infection. Different traditions in the use of homoeopathic and anthroposophic therapy and varying levels of expertise among the regulatory authorities within the European Union have resulted in varying standard of assessment. The aim of this publication is to present a standard form of assessment for medicinal products in these therapeutic systems. Demonstrated hereunder is an approach that can be adopted to ensure that the high safety standard required is met for homoeopathic and anthroposophic medicinal products.

The quality of selected South African and international homoeopathic mother tinctures.

The high potential variability of chemical composition of the plant material involved in the manufacture of homoeopathic mother tinctures (a common source of homoeopathic medicines), renders both their quality control and assurance a significant challenge (Pande and Pathak, 2006). The absence of significant regulations regarding the quality of Complementary and Alternative Medicines (CAM) in South Africa contributes to this challenge (Gqaleni et al, 2007). In order to assess any quality differences between local and international manufacturers, the following homoeopathic mother tinctures, Artemisia absinthium, Rosmarinus officinalis e foliis recentibus, Salvia officinalis and Sambucus nigra, were chosen on the basis that they can be grown both locally in South Africa and internationally and are prepared according to the German Homoeopathic Pharmacopoeia (GHP), method 3a. Colour analysis was followed by thin layer chromatographic (TLC) analysis on each selected sample and relevant reference sample using both aluminum-backed TLC plates and glass-backed HPTLC plates. Photographs were taken of the resultant chromatograms, active components were identified, comparisons to the reference chromatograms were made and the overall quality of each homoeopathic mother tincture deduced. The quality of all nine of the selected samples manufactured internationally complied with the minimum quality standards set by the GHP. Five out of the six local samples complied with the minimum standards of the GHP._Notwithstanding the minimum GHP standards, the superior number of high quality international samples implies that their quality exceeded that of the locally manufactured tinctures. Greater regulation regarding the quality of these types of products has therefore been identified.

200 years Organon of Medicine - A comparative review of its six editions (1810-1842).

In 2010 the 200th anniversary of the Organon is celebrated by the homeopathic community. Samuel Hahnemann's Organon of Rational Therapeutics, published in 1810, however, marks neither the beginning of homeopathy nor the endpoint of its development. On the one hand, its contents are based on terms and concepts developed and published by Hahnemann during the preceding two decades. On the other hand, the five revised editions of the Organon that followed in the next three decades contain major changes of theory and conceptions. Hahnemann's basic idea, running through all the stages of the foundation, elaboration, and defence of his doctrine, may be detected by a comparative review of his works from a historical and philosophical perspective.

The concept of health - in the history of medicine and in the writings of Hahnemann.

The number of notions of health is not infinite. In the history of medicine we can only find a number of different conceptions or paradigmatic ideas of health, in a variety of references and combinations. Health was seen as: 1. harmonious balance between principles or entities, 2. result of a struggle against opposing forces, 3. continuous dialectical process, 4. hierarchy of components or functions, 5. potential to perform and to develop, 6. transcendence towards higher levels of being, 7. result of conscious autonomous action, 8. optimal causal functioning, or 9. public task and responsibility. Hahnemann's view of health, as reflected in his writings, utilized virtually all of these elements. They reappear for instance as: 1. harmonious tuning of the life force, 2. defeat of pathogenetic influences, 3. admittance of aggravations, 4. autocracy of the spirit-like life principle, 5. reference to a higher goal of human existence, 6. perfecting character of medical service, 7. concern about dietetics and life style, 8. utilization of causality and natural science, and 9. appealing to governmental provisions and medical police. These paradigms have been repeatedly recombined and applied. The theory of medicine is the attempt to analyze, adjust, and develop concepts that meet the demand of contemporary medical practice. Medical theory lies between the fields of observable facts and metaphysical convictions. Distinguishing the levels of practice, theory, and metaphysics could allow the open discussion of theoretical issues, such as the concept of health or disease, without raising purely theoretical objections to well-established practice.