Saturday, 12 September 2020

Second prescription- Why it is more difficult than first prescription?

Before we discuss about second prescription, we should know what is first prescription.

First Prescription- After studying a case, having given each symptom its proper evaluation,deciding the remedy on symptom similarity and having administered the simillimum, we expect some perceptible changes in the patient, term as " First Prescription".
But if our prescription is absolutely wrong, there will be no change in the patient's economy ( except idiosyncratic patient), such prescription cannot be termed as prescription. So it is the ' No Prescription'.
According to J.T. Kent- "In other words, the prescription must be considered as the simillimum. Unless the patient reacts to the administration of a remedy and it has produced an effect, it is not a true prescription, for it is quite evident that it is not the simillimum. It is really bungling."
Now what is Second Prescription- The symptom-image which returns, reveals the knowledge by which we know whether the first prescription was the specific or the palliative, i.e., we may know whether the remedy was deep enough to cure all the deranged vital force (or we can say altered state of life) or simply a superficially acting remedy, capable of only producing a temporary effect.
According to J.T. Kent- "The second prescription is that which follows a remedy which has acted."
                          "How will we decide that it is the time for second prescription?"

It is unfolded by the manner of change taking place in the totality of symptoms. Therefore there are different types of second prescription which are as follows-

  1. Repetition of the first prescription
  2. Antidote to the first prescription
  3. Change of remedy
  4. Complementary to the first prescription
  5. Cognate to the first prescription
  6. Inter-current remedy
  7. Change in the plan of treatment 

1- Repetition of the first prescription-

a) When the old symptoms reappears: - After prescribing the similimum, patient seems to be improved but after a period of time, the same old symptoms appear. In such conditions we should interpret it as-
i) The first prescription was the right one
ii) The case is well under control and curable
iii) The second prescription must be the repetition of former

b) When the case comes to a standstill: - But if the standstill condition comes after the symptoms being relieved or some original symptoms come back again and waiting fairly for a long time no further movement of symptoms, a repetition of previous prescription may help to complete the cure.

 Change in potency- 
As per Dr. Kent the same potency be not repeated on more than two occasions.
As per Hahnemann every repetition of same medicine will be the slightly changed potency from former.
As per H.A. Roberts a remedy without any good reasons should not be changed. But if necessary repeated with a whole range of potencies after securing full amount of good from each potency before passing on next.

2- Antidote to the first prescription-


a) Appearance of new symptoms: - But if these symptoms are not old ones or not the symptoms of the disease and they belong to symptoms of medicine given with patient is not feeling better( Kent's 10 observation), it indicates medicinal aggravation then

  • If symptoms are of light nature- We should wait till new symptoms pass off and after re-case taking similimum is to be given.
  • If symptoms are of serious nature and threaten then we should antidote without any delay and when previous condition returns a similimum should be given.
b) A prolonged aggravation and final decline of the patient ( Kent's 1st observation)-
If after deep acting similimum, the aggravation continues for a very long period and general condition of patient is continues to deteriorate, it indicates 
  • The case is incurable
  • The structural changes in tissues is established
  • The selected potency being the higher than the susceptibility
These above conditions demands antidote the first prescription immediately.

c) Symptoms take wrong direction for cure ( Kent's 12th observation)
If symptoms takes wrong path of cure and starts disappearing against the ''Hering's Law of Cure" indicates that first medicine was partially indicated and causing the serious damages of internal organs. In such cases, the second prescription must be an immediate antidote.

3- Change of remedy-

a) When a striking new group of symptoms appear leading to an entire change of base in the symptoms - It means that patient has never had these new group of symptoms indicates a new remedy and the second prescription should be a change of remedy .

b) When the symptoms have changed - 

  • If the patient has improved, there is no need to change of remedy and wait for some time.
  • If the patient has not improved, change the remedy.
4- Complementary to the first prescription-

If after continued improvement for several hours or days, the symptoms do not completely disappear, rather shows a tendency to persist, we are to think of a complementary medicine in our second prescription. Remedies which carry on or complete most successfully the action of other given remedies are called complementary medicines. 
As per E. A. Farrington- "The drugs which completes a cure which the other begins, but is unable to effect."

5- Cognate to the first prescription- ( The medicines which are closely related to each other are called cognates)

If during the course of treatment of a chronic disease, any acute disease or symptom supervenes, the second prescription should preferably be a cognate of the first prescription.

6- Inter-current remedy-

Sometime even after careful selection, the remedy is unable to produce any favorable effect on the patient. Under such circumstances a suitable anti-miasmatic remedy may help to remove the miasmatic obstacle to cure. 

7- Change in the plan of treatment

During the treatment of mixed miasmatic diseases, when the symptoms of another miasm has come up in prominence with disappearance of symptoms of previous miasm treated.

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