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SECOND PRESCRIPTION
Dr.
S. K. Vashisht, B.sc., D.H.M.S.
Today’ topic, ‘Second prescription’ must
have been heard by all, known by many, read by most,
understood by some, understood and followed by few of
us.
Second prescription is unique to
homoeopath as it is a chance to review his case and his
first prescription for the case. It is a specialty of
its kind taught, read and followed by only by a
homoeopath.
Many a time, after the first prescription
a patient does not even bother to report back to the
physician. When he comes back to the physician, he may
report:
1. He is better;
2. He has some relief;
3. He is relieved of a few complaints;
4. He is cured;
5. That there is no change in his
condition;
6. Aggravation of his problem;
7. New set of symptoms;
8. Appearance of old symptoms (which have
reappeared);
9. He was better for initial few hours or
days but after that his condition is again back to
square one.
All the observations and reporting could
be rechecked by the physician with his knowledge and
art of observing the action of the remedy. If a
homoeopathic physician is not an accurate observer, his
observation will be indefinite and if his observation is
indefinite, his prescription will be indefinite.
Dr. Kent defines Second Prescription as
the prescription after the first one that has
acted. The second prescription presupposes that:
1. The first one has been the correct
one;
2. It has acted;
3. It has been left alone to act full
time;
4. Doctor records and maintains the
record in true sense
When patient reports back to a homoeopath
he has many options for second prescription. These are:
1. Repeat the same remedy;
2. Change the potency;
3. Change the remedy;
(I) Prescribe an alternating remedy;
(ii) Prescribe an intercurrent remedy;
(iii) Prescribe a remedy on miasmatic
basis;
4. Prescribe placebo.
Repetition of same remedy
It is indicated when the symptoms of that
disappeared have reappeared, or in other words, there is
relapse of the complaints. Here repetition should be
made in the same potency and the same dosage as the
first prescription.
It is important to note that repetition
not indicated for mere cessation of progress or
reappearance of old symptoms (according to Herring’s law
of direction of cure). If these symptoms persist and do
not disappear of their own, then one must think of
repetition. Similarly one should never indulge in
repetition because the rate of progress is not
gratifying. Such repetitions can prove quite harmful and
damaging by precipitating severe aggravation or by
mixing up the case with drug symptoms.
Change in the potency
Change in the potency of the remedy is a
very delicate and a controversial issue. It should be
considered when the response to the first prescription
is not satisfactory either because of inadequate relief
or because the remedy has exhausted its action and is
incapable of achieving further relief. In such
situations, before going to next potency, it is good to
examine if the multiple stimulation of the same potency
could stimulate the vital force.
Change in the remedy
It is indicated if symptom picture
indicates a definite change and no longer corresponds to
the original picture on which the first prescription was
based. In such cases it is better to give a thought to
relationship of remedies. Remedies bearing inimical
relation should be avoided. These tend to spoil the
case. Remedies having antidotal relationship might
neutralise the effects of first prescription, therefore
should be avoided although they may appear also in the
list of remedies that of follow well. Generally, one
should try to select the next remedy according to the
indications from the list of remedies given in the list
of follow well. For example, follow well cycles such as
Calc.-Lyco.-Sulph.-Calc. should be kept in mind.
A case which has ceased to progress
further needs a change. Here also relationship should be
carefully considered. At times, the selection may be
determined by miasmatic history, which might indicate
some nosode. At times remedy like Sulphur or Psorinum
that may be indicated as an intercurrent remedy
which restores the sensitivity.
A sever aggravation might require an
antidotal remedy. Use of antidote remedies arises in
unfortunate situations where first prescriptions have
proved bad ones leading to a response contrary to the
law of direction cure.
Alternation of remedies
It should be considered in acute cases
with symptoms alternating between two different groups
like Bryonia & Rhus tox.
In chronic cases, however, a single
remedy capable of covering both the states will have to
be selected for effecting a cure. Routine alternation of
remedies has no justification and such practice displays
utter lack of comprehension of the basic principles of
homoeopathy.
Intercurrent remedy
Sometimes it is noticed that the action
of a well indicated remedy gets blocked and there is no
progress. In such circumstances one should make a study
and analysis of symptom-picture and the circumstances
from a miasmatic point which may indicate the miasm
responsible for the block. A prescription based
on miasmatic aspect is helpful. For example, in some
cases toublesome symptoms like burning of soles might be
relieved by a dose of Sulp.30, though it may not answer
the total picture. A dose of Tuberculinum might prove
helpful in a patient with family history of TB.
Nosodes
Nosodes were introduced in homoeopathy
practice on isopathic consideration. Later many were
proved and incorporated in homoeopathic materia medica.
Today, we can employ many nosodes as homoepathic
remedies like Syphillinum. Isopathic use of nosodes is
generally confined to high potencies repeated
infrequently.
In some instances, a definite history
might point to a contact with some chemical which has
produced a severe allergic reaction. A similar remedy
when prescribed fails to give relief. In such
circumstances, the same chemical or drug administered in
high potency is known to have cured.
Variolinum, morbilinum, influenza have
solely been employed on the indication that the ill
health dated from an attack of measles/influenza.
Miasmatic remedy
In an obscure case a history of
vaccination may suggest remedy like Thuja which either
may cure or clear the case and furnish good indication
for the constitutional remedy. At times, a chronic
patients improves after the first prescription but later
some symptoms appear which are not properly covered by
the remedy prescribed. The total symptom picture does
not indicate any single remedy. An analysis of these
symptoms indicate that they belong to a different
miasmatic origin as compared to the original symptom
picture. Example, appearance of syphilitic or sycotic
after initial psoric dominated symptom-picture. The
symptoms group in question is cleared much better
response follows the administration of that remedy now.
Placebo
Our most safest tool which I mostly use
in my cases. It has many advantages. Placebo is an
agent employed in our practice with the aim of pleasing
the patient. Placebo is inert pharmacologically. It is
available in many forms such as sugar of milk, globules,
tablets, etc.. Use of placebo helps homoeopath in many
ways. Some them are given below.
1. In ascertaining the nature of the
disease;
2. In understanding the nature of the
patient;
3. Gives time to the doctor to review his
findings;
4. Gives time to observe the action of
the remedy prescribed;
5. For pleasing the patient and his
attendants by giving placebo as special dose, reserve
dose, etc.
Placebo is a tool which can be utilised
according to the situation. It helps one to come out of
the doubts and keeps one cool.
Even the modern medicine has now started
to recognise the value of placebo in clinical therapy as
well as investigations. Hanhnemann advised that the
treatment of chronic cases should commence with
administration of placebo. A greater awareness and usage
would enable a homoeopath undo many wrongs he could
commit. It is a very powerful aid with maximum
advantages with which a homoeopath could evaluate his
first prescription. Thus, it is the best second
prescription.
Practical problem comes when a patient
changes doctor. If the second doctor finds that the
patient is partially cured and feels better he should
advise the patient to go back to first doctor or request
for the case-record. The first doctor should hand over
the case-record (may not sound possible but is also not
impossible). If the second doctor is not aware of the
first prescription, he may not be able to judge the
effect of first prescription properly and may hurry with
his prescription without giving enough time for the
first prescription to act completely. This may be
dangerous and should be avoided as it leads to
intermingling of the disease symptoms with the drug
symptoms. It is then difficult to make a correct second
prescription.
A question to be answered by the
profession that the above mentioned options are for
those homoeopaths who take there cases in all
seriousness and make there first prescription in
accordance to the ORGANON. The question is what if he
does not prescribe a single remedy, a single dose but
1. Gives single remedy in multiple doses;
2. Single remedy in ascending potencies;
3. Gives two remedies alternatively,
gives multiple remedies in multiple doses;
4. Combines homoeopathic medicines with
allopathic medicines;
5. Gives specialties or patents.
Friends, keeping this treasure of
knowledge of second prescription to a second level is
one of the causes for confusion in a homoeopath. How
many students, during their clinical studies are given
or showed and taught about second prescription. This is
one of the main reason why our students lack confidence
to practice. It’s like a car driving school where after
a month’s training a person with a license in hand feels
he could drive but it’s invariably seen that he gets a
jerk on the first gear itself. So most of our students
invariably jump their track and fall in the lap of an
allopathic.
I take this opportunity to appeal our
teaching fraternity in Homoeopathic colleges to take
this subject more seriously especially during the
bedside clinical study. This would definitely brighten
and strengthen the in coming generation of homoeopaths
in the 21st century. |
