October 2010|Vol 7|Issue 10

October 2010 | Volume 7 | Issue 10


The Art of First Prescription


Dr.Amina Meer
Homoeopathic Clinic ,
Super Bazzar. K,M.Margh,
Udupi 576101

         As Homoeopathy is both a Science as well as an Art, the success of our first Prescription depends upon effective case-taking and analysis. A Homoeopath has to remember that there is a vast difference in the method of case-taking and final diagnosis/and/or deciding the required remedy between allopathy and homeopathy. The principle of INDIVIDUALISATION should form the basis of art of prescription .

    When the patient comes with Pathological Diagnosis
    A male child, aged 4 years referred after laser surgery for Recurrent Juvenile Laryngeal Papillomatosis, to treat with homoeo medicines to prevent further recurrence.
    Apart from noting down the classical symptoms pertaining to the pathological condition and its development in a period of 2 years, I came to know that.

    This child belongs to the middle class family, the father works in a cashew factory. He is the third child of the parents, previous two girls and both are healthy. The child is of lean and thin built, weighing 12 kg., physically restless- keeps moving constantly in the clinic touching things. He is also short tempered and during the spell of anger beats his sisters and sometime to mother too. No particular desires in food- eats anything offered. Full term normal birth. During pregnancy as the father is an alcoholic, used to come late at night in drunken state and beat his wife everyday. The mother was always afraid as the night approaches recalling beating and torture. She used to feel palpitation, fear and was unable to sleep properly.

    Considering the insecurity feeling, fear, desire to protect her unborn child— the theme of carbonate (Homoeopathy And Minerals- Jan Scholten) but lean,thin and restless carbonate, my First Prescription was CALC-PHOS. And followed by TUBERCULINUM after few weeks.

    The physical manifestations and mental make- up
    A male child aged 2 years, brought with the complaints of frequent desire for stools for last 2 weeks, daily 10-15 times and on one day the mother said, he passed stools as many as 35 times. Stools are scanty with normal consistency; no pain with no change in appetite. The child insists that after every defecation he has to be washed with warm water only and make the area dry immediately; does not like use of tissues or does not want to wear pampers.
    While examining the child I gave a small stuffed penguin toy in his hand which he immediately turned it upside down and started checking the other end of the toy. When the mother asked what he is doing, he said,” mama, I am seeing whether this white crow has done the kakka and whether his bum is dirty, so that I can clean him.”

    I considered the symptoms of Fastidious; Hypochondriac; Chilly patient and frequent desire for stools and prescribed two doses of Nux-vomica in 1M potency for two consecutive night . In a weeks time the frequency reduced to 2-3 times a day.

    Abundant subjective symptoms
    When the patient comes with abundant subjective symptoms- with no head or tail of the case; when there are no life threatening symptoms- give Placebo for few days until you get the clear picture. Very often it has been found in patients of nervous constitution; with lot of anxieties give such case histories and in such cases few doses of Mimulus- Bach Flower Remedy often takes care most of anxieties and the patient comes back with residual one or two complete symptoms.

    When the patient comes with only one or two distressing signs/symptoms with no guiding modalities or when the patient is not in a state to explain due to intense suffering/pain –along with physician’s keen observation, the laboratory investigations can help to decide the first prescription. Exam.- Severe bouts of cough due to dust allergy with increased eosinophils- Drosera. Diminished appetite with increased Serum Bilirubin- Chelidonium.

    Physical examination
    A thorough physical examination after detail case-taking is essential guide to first prescription.
    A female patient complaining of pain in nipple while feeding the baby; pain-stitching,burning,severe etc. A very deep crack on the nipple guided the prescription of Castor-equi.

    Spot prescription
    n certain situations, the physician has to do “SPOT PRESCRIPTION” due to patient’s demand and at certain times due to paucity of time on the part of the physician for which a sound knowledge of Materia Medica and Repertory is of immense help.

    This experience is in the initial days of my practice when I was very much firm with my principles in practice that I will not prescribe to any patient without proper detail case history. A female patient came when I was about to close the clinic and requested , “ Doctor I have only problem of acidity, give me something, I will again come next week on time, you can give for temporary relief”.

    I refused and sent her back saying I cannot prescribe without case history. When I went outside to a nearby chemist to purchase few cosmetics, the same lady is describing to the chemist her complaint and he gave rantac and gelusil charging her almost about more than 110 rupees.

    I felt so ashamed and started thinking- when a chemist without much medical knowledge can prescribe for acidity and earns a good some of money; what for my knowledge of material medica is ? I had the golden opportunity to prove the efficacy of homoeo medicines for a person who is interested in taking homeo medicines and I lost that. I would have as well prescribed few doses of carbo-veg and robinia and would have called for further follow up and of course this patient never returned to me, possibly never thought of going to homeo medicines for any of her complaints.

    From that day I made a rule not to send back any patient willing to take homeo medicines for the first time.Utilise your knowledge of Materia Medica, Repertory, Organon and Therapeutics and do what is known as bedside prescription. Let the first comers understand the efficacy of this medical science which they have never tried before and will stick to it later on.

    In conditions when the patient is unable to visit your clinic due to old age or immobility, the case-history described by persons staying with him/her will help for first prescription. Certain complaints like cough/dyspnoea, the patient can be asked to cough/talk on telephone to judge and then conclude the nature and intensity of suffering.