October 2010|Vol 7|Issue 10

October 2010 | Volume 7 | Issue 10

 

Article
 
Art of First Prescription
 








Dr. Saurav Roy,B.H.M.S.
Dr. Aditi Samanta, B.H.M.S.
The authors of this article are Residential Medical Officers. M.M.Homoeopathic Medical College and Hospital, Katihar, Bihar. They can be contacted at:dr,souravroy09@gmail.com




         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, etc.

    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 disease picture.

    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.

    Conclusion
    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.