Dr Devika M
The second prescription is not the one prescribed after the first one, but any remedy prescribed after the action of the remedy which is given in the first prescription is called as the second prescription. Even after selecting the first remedy carefully(similimum) the case may get spoiled due to wrong second prescription.
The return symptom image gives the knowledge by which we know whether the first prescription was specific or palliative. This article focuses on the views of Dr J T Kent on second prescription which is given in his lesser writings.
Keywords : Homeopathy, Miasms, Remedy.
Kent says, “What is more beautiful to look upon than the bud during its hourly changes to the rose in its bloom. This evolution has so often come to my mind when patiently awaiting the return of symptoms after the first prescription has exhausted its curative power”
The many things learned by the action of the first remedy determine the kind of demand made upon the physician for the second prescription.
There are many problems that must be solved, or failure may follow
- How long shall I watch and wait?
- Is the remedy still acting?
- Is the vital reaction still affected by the impulse of the remedy?
- How long shall the returning symptoms be watched before it is necessary to act?
- Is the diseases acute or chronic?
- Why second prescription is more difficult than first?
- Why so many patients are benefitted when first going to the physician and thereafter derive no benefit?
Many physicians fail because of not waiting, To know that this waiting is right is quite different from waiting without a fixed purpose. This knowledge cannot be found with unbelievers of homoeopathy.The manner of change taking place in the totality of symptoms after the first prescription signifies everything.
IF AGGRAVATION OF SYMPTOMS FOLLOW:-
a)If it is with general improvement of the patient, which means well
b)If it is attended with decline of the patient, the cure is doubtful.
IF AMELIORATION OF SYMPTOMS FOLLOW:-
If the patient does not feel the elasticity, of life returning, the improved symptoms are the facts upon which to doubt recovery. Here disease is incurable and every remedy may palliate his sufferings but, cure does not come.
After the curative impulse has entirely subsided the symptoms will appear one by one, falling into place to arrange an image of disease before the intelligent physician for the purpose of cure.
If the first prescription has been continuously given the returning image of the disease must be very unreliable. When the remedy has been fully exhausted only then we can trust the symptoms constituting the picture.
If the first prescription was the similimum, the symptoms will return – and when they return – asking for the same remedy.
This rule is almost free from exception if the remedy is antipsoric. If the remedy given only similar enough to the superficial symptoms, the image comes back altered, resembling another remedy, by which the case is sometimes spoiled, the master may fail to correct the wrong done.
Ignorant homoeopaths give a drug that is not indicated because the one that is indicated does not cure.They feel that, they have performed their duty, forgetting that ignorance was the culprit. Administration of low potency in frequently repeated doses sometimes must elapse, but after its action was first observed the new and higher potency will act promptly.
When the picture comes back unaltered except by the absence of few symptoms the remedy should never be changed until a still a higher potency has been fully tested.
1) PROPER TIME TO CHANGE
2) AVOID HASTE
3) WAIT AND OBSERVE
4) IMPROPER ACTION
5) REMEDIES SUITABLE TO FOLLOW
6) CAREFUL RECORDS
PROPER TIME TO CHANGE
The last appearing symptom shall be the guide to the next remedy.
After exhausting the power of the remedy, while observing a few of the old symptoms returning, finally a new symptoms appear. This latest symptom is best related to some medicine, having it as a characteristic which most likely have all the rest of the symptoms.
So long as old symptom reappear and disappear it is granted that no medicine is to be thought of.
The physician should not think of another medicine when the symptom image is changing, should wait for Permanency. The acute expressions of a chronic disease have a different management from the acute disease. A child suffers from bronchitis in every change of weather. It may grow worse if treated with the remedy for the acute symptoms.
The miasm that predisposes the child to recurrent attacks must be considered.
Patient had received Antimonium tart, Calcarea, Sulphur, Lyco, etc,child was not cured. The waiting on Sac –lac permitted the drug effects to pass off and the true image of the disease was expressed.
When Western ague is complicated with a miasm, a single paroxysm does not fully express the totality, but several must be grouped and the true image will be discovered. If the acute disease be complicated with a miasm the indicated remedy will wipe it out “cito, tuto, et jucunde”.(quickly, safely and pleasantly)
In very grave disease haste is a common error especially in 2nd prescription than first. Doctors think that “Something must be done”; this is an error. Eg: A little girl suffering from a severe attack of diphtheria, treated with Merc 3x, and Kali bich 3X in alternation. She was in a very bad state, nose, mouth, and larynx full of exudate. After a long study child received Lyco cm, one dry dose which cleared the exudate from nose and fauces, but didn’t touch the larynx.
He waited for long until the poor child was threatening dissolution when he saw a little tough yellow mucus in the mouth. Kali bich cm one dose, cleared the larynx in one day, and there was no further medication necessary. After the first prescription doctor watches the improvement and the corresponding disappearance of the symptoms. And when the case comes to a standstill, he is uneasy, and with increasing fidgetiness he awaits for the coming indication for the next dose of medicine.
This fidgetiness which comes from a lack of knowledge unfits the physician as an observer and judge of symptoms. The prescriptions of beginners often give proper results after 1st prescription, then ceased to respond to any remedy. Close investigation reveals that after first prescription patient improved and then the symptoms changed slightly without new symptoms. The “new photo” seemed to call for some other remedy, when of course the remedy changed the trouble began. Constant changing of remedies followed until all the antipsorics in the chronic diseases had been given on flitting symptom images, and the patient is yet sick.This is a grave mistake from the part of the physician.
WAIT AND OBSERVE
If the first prescription is not well chosen then it becomes necessary to make a second effort. After re-examination, new facts are brought out in relation to the image of the sickness, indicating that the first medicine had not been suitable. Perhaps several weeks have passed and the re- examination finds no change in the symptoms.
If the remedy is still the most similar to all the symptoms then wait and watch. And study the patient for a new light on his feelings to which he has become so accustomed he has not observed. Commonly the new study of the case will reveal the reason why the first prescription has not cured the patient.
If it still appears to be the most similar, the question arises, “How long shall I wait?”The length of time is not as important as being on the safe side and “wait” is the only safe thing to do. The finest curative action Dr Kent had observed was begun sixty days after the administration of the single dose.
The curative action may begin as late as a long acting drug can produce symptoms on healthy body.
It is the practice for some to go lower if a high potency has failed, this method has but few recorded successes but should not be ignored.
Giving of a dose of medicine in water and divided dose seemed to have favor over the single dry dose. The best reports are made from both methods, and both are in harmony with correct practice.
When the first prescription has acted improperly it becomes necessary to consider a 2ndprescription. First prescription changes the symptoms that are harmless and painless into symptoms that are dangerous and painful.
If a rheumatism of the knee goes to the heart under a remedy prescribed for the one symptom, the remedy has done harm.
It is an unfortunate prescription and must be antidoted. In incurable cases when a remedy has set up destructive symptom, an antidote must be considered. If the remedy changes the general symptom image, and the general state of the patient growing worse. Is it because, was the prescription covered only a part of the image or the disease is incurable???
Knowledge of disease may settle this question. If disease is incurable, the remedy given will change the sufferings into peaceful symptoms, and the second prescription should be considered only when new sufferings demand a remedy. But suppose such a change of sufferings comes after the first prescription and the disease is undoubtedly curable, then the first prescription was not the true specific.
Wait until the old image has fully returned is all there is to do. It is hazardous practice to follow up rapidly all the changing symptoms in any disease, with remedies that simply for the moment seem similar.
The observing physician will know by the symptoms and their directions, whether the patient is growing better or worse.
Greatest suffering may intervene in the change of symptoms during progress of permanent recovery, and if such symptoms are disturbed by a new prescription the patient may never be cured. The object of the first prescription is to arrange the vital current in a direction favorable to equilibrium. There can be no fixed time for making the second prescription.
It should have a friendly relation to the last one or preceding. No intelligent prescription should be done without knowing the last remedy. Concordances in Boenninghausen must not be ignored.The new remedy should sustain a complementary to the former.
REMEDIES SUITABLE TO FOLLOW
In managing a chronic sickness the remedy that confirms to an acute experience of the illness is worth knowing, as very often its chronic may be just the one that confirms to its symptoms.
- Calcarea is the natural chronic of Bell and Rhus.
- Natrum mur sustained the same relation to Apis and Ignatia.
- Silicea to Puls
- Sulph to Aconite
- Puls is complimentary to Silicea.
- But Causticum and phosphorus do not like to work after each other, nor Apis and Rhus
Should write out faithfully all the symptoms of the patient treated, and note carefully the remedy, and how given. It is necessary in patients likely to need a second prescription. Physician who has the notes of every illness of his patients has a wonderful hold of any community.
He can make indirect inquiry after all the old symptoms long ago removed. Experience soon leads the close prescriber to note all the peculiar symptoms and to omit the non-descript wandering indulged in by sick people.
Homoeopathy is nothing if not true and, if true the greatest accuracy of detail and method should be followed. It is fortunate that the physicians who repeat while the remedy is acting are such poor prescribers or their death-list would be enormous.
The whole future of the patient is depended upon the judgment that the physician arrives when patient comes for the second prescription, so It is very important that how physician interprets the action of the first remedy and current state of the patient.
Kent J T.Lesser writings clinical cases, new remedies, aphorisms and precepts. Second prescription,14th impression:2019,B Jain Publishers(P)LTD,Noida, U.P.India.(415-426).
Dr Devika M
PG Scholar, Department of Organon of Medicince with Homoeopathic Philosophy,
Government Homoeopathic Medical College & Hospital, Bengaluru.