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Case Study

Follow Up Prescription in Homoeopathy
Dr S S Vithal
'Iod / Cinnb

In Homoeopathic practice the first prescription is easier than follow up prescription, which requires more skill and patience. Dr Hahnemann has clearly described this in Vth Ed of Organon, para 246 (with long footnote) 247, 248 and in VI th edition paras 246-248 (footnote Nos 132-134).

Later, Dr J T Kent, the highly respected teacher and prescriber, elaborated in his teachings in the chapter on prognosis after observing the action of remedy (Lecture XXXV of Philosophy) in 12 observations after giving homoeopathic prescription.
We are all well conversant with the basic principles of homoeopathy i e single remedy, minimum dose and law of Similars.

The moot question is how long one is to wait after first prescription of single dose?
Theoretical Considerations:

  1. Nature of remedy: Certain drugs are slow acting, some are of medium range and another group is fast acting. Drug likes Aurums, Calc-carb, Lyco, Thuja, Sil etc have action of very long range.
  2. Potency used: Higher the potency, longer we have to wait.
  3. Environmental factor: More congenital atmosphere and diet regimen, the longer period of action of 1st dose. More distributing factors or maintaining cause - shorter will be the action.
  4. Nature of the case in hand - More sensitive, irritable or neurotic patient - quicker the response, shorter the action of remedy. More sober and balanced personality- slower and longer will be action of the remedy. More fleshy and blunt patient - slower and shorter will be the action. Lesser the vitality of the case - slower, shorter and weaker will be the action.
  5. Type of the disease - More acute the case, the quicker and shorter is the action of the remedy. More chronic case - slower and longer will be the action eg In benign tumors, fibrosis, Keloids etc generally frequent repetition of low potencies of indicated remedy is required.

The general fundamental: so long as action of first prescription continues, whatever may be theoretical grounds only SL will be the best second prescription.

Practical Consideration
One must keep in mind all the above theoretical points, then prescribe single dose of correct similimum remedy especially in chronic and very chronic cases. It will be followed by onset of homoeopathic aggravation followed by amelioration of lesser and lesser intensity through a course of many months and years.
The Patient is the sole infallible guide in the selection of second prescription.

How to find out if the First Prescription is correct or not?
Herring's law is the sole criteria of ascertaining if the first prescription is correct or wrong. It is very beautifully and scientifically described by Dr Prafull Vijaykar in his chart of 7 layers of ascending and descending of disease.

Waiting Period of First Prescription
For acute cases - few minutes
For chronic cases - Maximum 24 to 48 hrs.
Whether it is acute or chronic disease, after giving the correct genetically constitutionally similimum (C G S) there must be a positive change in:
Desire to work
Stamina to perform must increase
Sleep better and refreshing
Urine, stool normalize
Improvement in appetite
Patient feels more energetic
We as homoeopaths must have holistic approach i.e TREAT THE MAN IN DISEASE and NOT THE DISEASE IN MAN.

Harmeet Singh M-15, student. Came on 30.1.99.

Chief Complaints - Dyspnoea and cough since 10-12 yrs < lying, midnight. With cough and cold has to sit whole night, unable to study.
PAST HISTORY - skin eruptions and itching in childhood, fever due to tonsillitis, chest infection of and on, warts on groin region (Penis) treated with homoeopathic medicines.

Family History: MGF- heart patient- bypass surgery done, TB, Diabetes, thin, lean, irritated person. MGM - TB
MU - 1 Ch. Coryza, Sinusitis, Schizophrenia mania, Ch Bronchitis.
Fa - Ch. Bronchitis, cough.
PGM - Tonsillitis, Arthritis, PGF - Ch GIT
PU - Ch allergic sinusitis, Mo- RA, Si- Obesity

Personal History
Desires - citrus fruits, spicy food though it <, fatty food.
Appetite - +++ http://www.njhonline.com/images/toparrow.gif. Thirst http://www.njhonline.com/images/toparrow.gif
Sleep: likes3 http://www.njhonline.com/images/toparrow.gif, sleeps on side, jerking during sleep, Dreams-successful businessman. +++, Perspiration - ++ . Urine, stool-N
Thermals: Hot but sensitive to cold, in acute hot, SPEED - fast.
Mind: Likes to be alone, cannot do mental work, likes qawalis, ghazals, melodious songs, creates new things, Anxiety++, doesn't like to sleep in summer, traveling desires, traveling sickness, doesn't like to be teased or scolded - angry but cannot say, forgetful - weak memory understands but fails to apply it. Desires to play all games especially fast games even in acute illness it >

4.3.99 - dullness, dizziness, sleepiness, tires. sleep http://www.njhonline.com/images/downarrow.gif restless. dyspnoea http://www.njhonline.com/images/downarrow.gif < of all the problems. Blood test reports - Hb 9.2, Tlc: 12500, P80, N10 E/o, ESR 120 mm.
Rx - Iod 200 - 1 dose.
18.6.99-Physically better, mentally tired, doesn't like to study; summer < Asthma - better, backache + appetite http://www.njhonline.com/images/downarrow.gif desire - cold, ice cream though it <. Rx Cinnabaris 200 - 1 dose.
23.3.2000. >> mentally, physically, appetite normal, active ++, eczema appeared on penis, which is better now. Now wants to study.

Summary - Automaticity of the Body
(Source - Physiology By Gitun)
The body is actually a social order of about 100 trillion cells organized into different functional structures, some of which are called organs. Each functional structure provides its share in the maintenance of homoeostatic conditions in the extra cellular fluid, which is called the Internal environment. So long as normal conditions are maintained, the cells of the body continue to live and function properly. Thus, each cell benefits from homeostasis, and in turn, each cell contributes its share toward the maintenance of homeostasis. This reciprocal interplay provides continuous Automaticity of the body until one or more functional systems lose their ability to contribute their share of function. When this happens, all cells of the body suffer. Extreme dysfunction leads to death whereas moderate dysfunction leads to sickness.