The First Prescription
is more important in our practice as it determines effective
cure or recovery. It also determines what will be the subsequent
prescription after it has completed all its action. Hence, it
is important to know about the “The Art of the First Prescription”
and the first priority is to be given on the “First Prescription”.
The Art of the First Prescription lies in the searching of a
beneficial First Prescription and it becomes a beneficial one
only when the individualizing examination of a case of a disease
is done as Dr.Samuel Hahnemann has laid down as a general instruction
in Sec:83-Sec:104,in Organon Of Medicine.
Therefore, the Art of the Prescription, above all depends upon
the proper case taking to constitute a totality of the characteristic
symptoms and individualize the case. To take a proper case much
emphasis must be given on the mental general symptoms of the
patient regarding his desire, will, emotions intellect, memory,
The past history, family history and in case of females the
entire gynaecological and obstetrical symptoms are to be considered
as because, these symptoms helps to diagnose the underlying
miasms which is the basis of the individualisaton. For the selection
of a proper simillimum for the First Prescription the Age, Sex,
Susceptibility, Constitution and Temperament of the patient,
nature and intensity of the Disease, Seat of the disease, etc
are to be taken under consideration.
As, these factors not only helps to find out the Specific Homoeopathic
medicine but also to choose a correct potency which makes the
similimum much more effective. How these factors help to search
a similimum for the first prescription, some of the factors
are discussed below:
Age: It is observed that, some medicine are
found much more effective in childhood age e.g.-Calcarea carb,
Aethusa cynapium, Baryta carb, Cina, Mag carb, etc., whereas,
some medicines found effective in old age, e.g:Aloe socotrina,
Avena sativa, etc. Though these medicines are found effective
but other constitutional symptoms are to be taken under consideration.
Sex: Again, if we consider the sexual sphere
it is observed that usually in case of female medicine like
Pulsatilla, Sepia, Ignatia, Kreosote, etc. are beneficial, whereas
in case of male Nux vomica, Agnus castus, Caladium, etc is found
effective, if the medicine matches with the totality of the
Constitution: While selecting a remedy for
a given case a physician has to observe the constitution of
the patient. To make it easier Von Grauvogl had arranged the
morbid constitutions depending upon the excess or deficiency
of certain elements in the tissues and in the blood e.g.-Carbonitrogenoid
constitution: it corresponds to Dr.Hahnemann’s psoric
miasm and thus covers Sulphur, Psorinum, Graphites, etc. Hydrogenoid
constitution: it corresponds to Dr.Hahnemann’s sycotic
miasm which covers Thuja, Antim tart, etc. Thereby, similar
medicine can easily be found after understanding the correct
constitution of the patient.
Symptoms of the Mind: The ultimate symptoms
i.e. the result of the disease, functional symptoms, sensorial
symptoms and mind symptoms are all useful and should not be
overlooked. According to Dr. J. T.Kent, as he told in the homoeopathic
Philosophy, if the Will and Understanding is put into the order
the cure can be achieved. As because, the Mind is the key to
a Man. A man consists in what he thinks, what he loves. If these
two grand parts of a man i.e. the will and understanding is
separated that will produce insanity, disorder, or death.
All the homoeopathic medicine found to act upon the will and
understanding extensively, affecting the man’s ability
to think or to will which ultimately affects the tissues, function
and sensation. In “Aurum Met” it is found that affection
is most disturbed and the patient loses his love for his life
and wants to commit suicide.
Susceptibility: Dr. Samuel Hahnemann in his Organon of medicine
in sec: 31, stated that “The inimical forces partly psychical,
partly physical to which our terrestrial existence is exposed
which are termed morbidly noxious agents, do not possess the
power of morbidly deranging the health of man unconditionally,
but we are made ill by them only when our organism is sufficiently
disposed and susceptible to the attack or the morbific cause
that may be present ….”
Thus our Master Dr.Samuel Hahnemann had clearly stated along
with all the factors ,one of the most important factor “susceptibility”
must be taken under consideration, as because- “….the
morbific noxious agents possess a power of morbidly deranging
man’s health that is subordinate and conditional, after
very conditional.” Again our Master continued in sec:
33, “Whilst the medicinal agent has an absolute unconditional
power, greatly superior to former”. Hence while selecting
a medicine the physician has to take a note on susceptibility
clearly, not only to select the simillimum but also to determine
its potency as more the susceptibility the higher will be the
potency and the lesser the susceptibility the lower the potency.
Nature and Seat of the disease: It has been observed that in
the acute disease a short acting remedy is much more effective
where as in case of true natural chronic disease a deep acting
anti-miasmatic medicine gives a better result. Along with this,
the seat of the disease also indicates what potency is to be
selected and how often the similimum is to be repeated.
Miasm: After taking the note of all such factors
e.g. Age, Sex, Present complaints, Desire, Constitution, Temperament
etc, when a physician comes to a final selection of the similimum
he must again revise the family history and past history of
the patient, so that he can find out the predominant miasm acting
behind the suffering. As because, in clinical practice it has
been observed that the various anti-miasmatic medicine remove
all the hindrance in the process of the treatment of a true
natural chronic disease, specially when the recovery becomes
standstill and after such a treatment the good prognosis of
the patient becomes evident.
In the clinical practice, the physician has to take a note of
all the general, particular and common symptoms giving special
attention to the striking, singular, uncommon, peculiar, (characteristic)
symptoms and signs regarding all the essential factors, that
is, he takes details of the patients during his first visit.
Thus, finally he comes to a conclusion by selecting a specific
homoeopathic remedy which is specific to the given case.
This knowledge of remedy from Materia Medica if again be consulted
with the Repertory the selection of the remedy will be much
more satisfactory. As because, if the views of the physicians
skip the proper similimum the Repertory will act as the supportive
instrument for the selection of the First Prescription.
Causation of Disease: Dr Hahnemann during proving
of the homoeopathic remedies noticed that some drug shows symptoms
belonging to causation, e.g.-Aconite and Opium have symptoms
from the effect of fear .Colocynth and Nux vomica has symptoms
from effect of the anger.
Hence Dr. Hahnemann had classified the causation of the disease
into two types.
1) Acute cause which may be due to malefic emotional influences,
allergic influences, epidemic, endemic, etc.
2) Chronic cause which are due to misams-psora, syphilis, sycosis.
According to J.H.Clarke a similimum can be selected depending
upon the causation of the disease.
First Prescription of Some Special Cases
1)In patient with surgical sufferings or with gross pathological
changes, when visit to a Homoeopathic Physician, it is the duty
of a physician to investigate the case properly to select a
similimum which will be a short acting remedy and to be administered
in lower potency while giving much more importance to the proper
management and suitable advice. As in case of nephrolithiasis
while selecting a similimum like Berberis vulgeris, Sarsaparilla,
etc, investigation is to be suggested like U.S.G. and X-ray
of K.U.B. and along with this an advice is to be given to take
a plenty of water. If necessary he is also advised to visit
to a surgeon.
2) In pediatric patient though it seems to be tough to select
a similimum (as in children the physician has to depend on the
objective symptoms only) but for the Homoeopathic physician
it is not such, as because, we, homoeopathic physicians use
to take a detailed account of the child regarding his present
complaints, objective symptoms and symptoms of the mother that
had occurred during her pregnancy, i.e. while the baby was leading
his intra-uterine life. This history of the intra-uterine will
help us to find out a similimum and the result found good. A
child of three years suffering from insomnia was treated with
various well selected remedy without any effect. When treated
after taking the history of the intrauterine life it appears
beneficial. After getting the history of Herpes of a strange
black vesicle of the mother during pregnancy and other corresponding
symptoms like desire for raw vegetables, aversion to potato,
and aggravation from jerks etc, a similimum selected “Tarantula”
as a first prescription and found acting beneficially.
3) In a busy O.P.D. where a physician gets a very little time
to take the true internal essential essence of the patient and
he has to depend upon a very few symptoms which may be a characteristic
one, in such a case a quick repertorisation of the collective
symptoms are usually found beneficial in search of a similimum
for the first prescription. On the other hand if he gets a single
striking, uncommon, peculliar, characteristic symptom, it may
also help to select a similimum which is also found beneficial
in a number of cases.
The First Prescription should be such a prescription which should
act beneficial so that its effect can gain the confidence of
the patient .On the other hand it helps to select a subsequent
medicine or corresponding treatment in the next visit. Hence
the First Prescription should not be done blindly or depending
upon the hypothesis but should be done by using all the sound
senses after keen observation of the patient.