The Second Prescription - PartII
NATIONAL JOURNAL OF HOMOEOPATHY 1999 May / Jun VOL VIII NO 3.
Source: Condensed from
The Second Prescription: Kent's Minor Writings on Homoeopathy- Ed by KH Gypser,
Publisher: B Jain Publishers, New Delhi
(We had seen in the last issue what Dr Adolph Lippe said about the second prescription. As this is an important aspect in the art of prescribing we extract below what another master Homoeopath, Dr Kent has to say on the subject. In later issues we will cover other aspects to demystify the art of prescribing)
Dr Kent said the return symptom image unfolds the knowledge by which we know whether the first prescription was the specific or the palliative. The manner of change taking place in the totality of symptoms means everything.
First: If aggravations of symptoms follow
Second: If amelioration of symptoms follow.
Aggravation of existing symptoms may come on with general improvement, which means well; but if the aggravation of the symptoms is attended with the decline of the patient, the cure is doubtful and the case must be handled with extreme care, as it is seldom that such patients recover perfectly.
If amelioration follows the first prescription, it may apply to the general state or to the few symptoms. If the patient does not feel the elasticity of life returning, the improved symptoms are the facts on which to doubt the recovery. The knowledge that the disease is incurable is obtained only in this way. In such cases every remedy palliates but does not cure.
Dr Kent cautions not to repeat the remedy too soon. If the doctor repeats it too soon, he never gives the symptoms a chance to come back and call for a second prescription; but they come intermingled with drug symptoms so that a rational second prescription cannot be made.
If the first prescription was the similimum, there will be two situations.
- Dr Kent says that the original symptoms will return and when they return, they will ask for the same remedy. "If the same potency fails to act, a higher one will generally do so quite promptly, as did the lower one at first. I have observed in cases where a lower potency had been administered in frequently repeated doses, that some time must elapse before perfect action will follow the higher potency. Where the dose has not been repeated after its action was first observed, the new and higher potency will act promptly." Dr Kent cautions that when the picture comes back only with the absence of one or more symptoms and no new symptoms, the remedy should never be changed until a still higher potency has been tested. " No harm will come to a case from giving a single (higher) dose of a medicine that has exhausted its curative powers; it is negligence not to do just this thing."
- When it is clear that the present remedy, in higher potencies, has done all it is capable of doing, then the time is present for the next prescription. "What shall the next remedy be? The last appearing symptom shall be the guide to the next remedy. Long have I waited after exhausting the power of the remedy; while observing a few of the old symptoms returning, finally a new symptom appears. This latest symptom will appear in the anamnesis as best related to some medicine having it as a characteristic, which will most likely have all the rest of the symptoms. It is an error to think of a medicine when a symptom picture is changing; the physician must wait for the image of the disease picture to settle before making the next prescription."
- When the first prescription has acted improperly or without curative results, then it is necessary to consider the second prescription. Dr Kent warns: "the first prescription sometimes changes the symptoms, that are harmless and painless, into symptoms that are dangerous and painful. If 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. If its antidote is not known, the new symptoms must be prescribed for."
- If the disease is incurable, the action of the remedy was not expected to do more than to change the sufferings into peaceful symptoms, a second prescription is to be considered only when new sufferings demand a remedy. But suppose such a change of suffering comes after the first prescription and the disease is undoubtedly curable, then the first prescription was not the true specific and that the true image of the disease has not been seen. The second prescription is then to be considered; but avoid hastiness and wait till the full image of the disease has returned.
- Dr Kent warns that it will be a perilous practice to follow up rapidly all the changing symptoms in any sickness with remedies, which simply for the moment seem similar to the symptoms present. The observing physician should be able to decide by the symptoms and their directions whether the patient is getting better or worse. He also advises that "the complaints of a patient constitute no ground for a second prescription".
- There can be no fixed time for making the second prescription; it may be months. If the first dose was of a very high potency, then it is necessary to wait before the second prescription. "The finest curative action I ever observed begun sixty days after the administration of the single dose."
- The acute expressions of a chronic disease have a different management from the acute disease, eg a child suffers from bronchitis every change of weather and may grow worse and worse if treated with a remedy for the acute symptoms. The miasm, which predisposes the child to recurrent attacks, must be considered. A single paroxysm may not express the totality in this case, but several must be grouped to get the true image of the miasm. " In managing chronic sickness the remedy that conforms to an acute phase of the illness is worth knowing, as very often its chronic may be just the one that conforms to the symptoms. Calcarea is the natural chronic of Bell and Rhus-tox. Natrum-mur sustains the same relation to Apis and Ignatia; Silicea to Puls; Sulphur to Aconite. If Puls has been of great service in a given case and finally stops acting, and now the symptoms point to Silicea, then the latter can be given with confidence as its complementary relation has long been established."
- "The doctor notes improvement and the corresponding disappearance of the symptoms under the first prescription and then the case comes to a standstill, he is uneasy and with increasing fidgetiness he awaits the coming indications for the next dose of the medicine. Often he does not wait; and hence the reports of lingering sickness in our journals. The first prescription may have been correct, but the second prescription is dangerous to make in a hurry."
It is rarely the case that a new prescription becomes necessary when the case merely comes to a standstill. After the first prescription the symptoms commence to change in an orderly way; they change and interchange and new symptoms come up but finally the symptoms go back to their original state, but not marked enough to be of any importance, without any special suffering to the patient. In such a situation, Dr Kent advises "it is the duty of the physician then to wait, and wait a long time. But if after many months no outward symptoms have appeared and no external tendency of the disease, it is true that another dose of the same medicine will not do any harm and the same remedy is the only one that can be considered."