The first prescription

- BENERJEE.P,

The so called diseases known under the various names of rheumatism, asthma, eczema, fever and diarrhœa etc., are by no means independent diseases. They are only different manifestations of Psora or of Psora in combination with Sycosis or Syphilis or both. This has been sufficiently explained before, and when these so called diseases of different names appear in any individual, it is to be understood that it is Psora only which is showing itself in different shapes, either alone or in combination with the other miasms. It is also to be understood that this Psora and the other two miasms will ever be bursting out into different concrete disease manifestations in this way, until they are radically removed from the system, that is to say, until they are knocked out of the system by deep acting potentised drugs administered on the basis of the curative law of similarity. You might have observed how white-ants work out small hillocks on the soil, and how impossible it is to stop this process of their work, until the mother-ant at the furthest bottom, which is ever producing the smaller ants, is traced out and destroyed. The so called diseases are like the small hillocks and they are being produced by Psora which is like the parent-ant and is at the bottom. Just as you cannot stop the production of the hillocks merely by removing them day after day, similarly you cannot destroy the so called diseases merely by removing them. In order to destroy these so called diseases, you have to destroy Psora like the parent-ant. So long as this Psora is not destroyed, the so called diseases will appear continually one after another and no amount of treatment of these apparently independent diseases will cure the man.

 The flow of the life force in its natural process has no unnatural result. But when the normal flow of the life force receives an interference from any source, there is a disturbance and the normal processes and functions become abnormal at once; and then result abnormal growths and developments. Growths and developments there are, but, on account of the life process having been directed in an unnatural channel by an interference, they are no longer normal. Instead of normal growths and developments, there are now abnormal growths and developments. There is over-nourishment in some parts and under-nourishment in others, such as tumour, cancer, enlargement of the liver and spleen and so forth. It Psora, Sycosis and Syphilis that interfere with the normal flow of the life force and lead to abnormal results, and the only way of restoring the life process to its normal course is by administration of a deep acting drug according to the law of similarity. Let us discuss the method of administering drugs on this law.

 If from an examination of a given case, it appears that there are other miasms than Psora alone, as indicated by the totality of its symptoms, there is no other method of freeing the system from diseases than by eradicating those miasms. And this necessitates the administration of drugs in high potency selected on the law of similarity, and the process of selection is this. If (besides Psora, because Psora must there be in every case), one or both the miasms other than Psora are indicated in your patient's case, then it will not do if your prescription is based merely on the whole array of symptoms recorded by you. But, before you actually make your selection, you will have to make out the whole array of symptoms into different miasmatic groups, that is to say, if there are all the three miasms Psora, Sycosis and Syphilis in your case, the symptoms that indicate Psora should be placed in one group, the symptoms that indicate Sycosis should be placed in another, and those that indicate Syphilis should be placed in a third group. Then you will have to ascertain as to which of the several miasmatic groups of symptoms or in other words, which of the several miasms is causing the most troubles to your patient at the time of your prescription. If it appears that it is Syphilis which is causing the greatest hardship to your patient and the other two miasms Psora and Sycosis, which there are in the case as indicated by the symptoms, are in the background for the time being, that is to say, are not predominating for the time being, then you have to select a medicine on the totality of the group of Syphilitic symptoms only. That is to say, where Syphilis is predominating you will have to select an anti-Syphilitic remedy as indicated by the group of Syphilitic symptoms. It therefore comes to this, that in making your prescription you will have to deal your first stroke to the miasm that is predominant at the time. As a matter of fact, it will always be apparent to you that in every case, even if there be all the three miasms in it, only one of them is predominant at a time. It will never happen that all the three miasms are equally torturing your patient at the same time, while, on the contrary, the rule is that only one of the miasms is torturing him most, while the others are lying comparatively dormant. The one that is torturing the patient most, the one that is predominant must draw your attention first. It needs however be mentioned that the reason why only one of these miasms is predominant at a time, while the others are comparatively dormant, is the operation of the immediate exciting cause. A certain exciting cause has a greater power of exciting one of the miasms, while a certain other exciting cause has a similar power of exciting another. Thus if Syphilis is predominant now owing to a certain exciting cause, it may be that some other exciting cause, if that has a greater affinity for it, will make Psora or Sycosis predominant after some time. The miasms are made predominant one or the other, according as the exciting cause is capable of exciting their manifestations; and it is an inevitable law, that only one miasm is predominant at a time, while the others lie dormant. And you must select the medicine indicated by the symptoms of the miasm that is predominant and not by the totality of the symptoms of the whole case. It may so happen in a given case that the patient has apparently nothing beyond a few itching eruptions here and there on his person, but as soon as there are some rain and storm he begins to have frequent calls for profuse urine. This means that Psora was only predominant at first, but the sudden rain and storm which have a special power of exciting Sycotic manifestations, made Sycosis predominant, and an anti-Sycotic remedy Dulcamara would now be called for, though there was no indication for Dulcamara before the rain. Suppose again, here is a patient who was improving, but suddenly he gets an attack of influenza due to a change of season, and soon after, he developes tubercular symptoms. What do these indicate?-These indicate that there may be more miasms in the system than one but only one is predominant at a time, and the predominance of one or the other of these miasms is always in accordance with the exciting cause. A thorough study of the records of cases in your own diary will clearly show this. However, the law of prescription in a chronic case is that the medicine indicated by the totality of the symptoms of the miasm predominant will have to be selected and not the medicine indicated by the tolality of the symptoms of the whole case. In brief, the prescription must be miasmatic and not otherwise. This has been made still more clear by the records of cases that have been appended to the book.

 Now, when the selection has been made, your business will be to choose the potency. But there are no hard and fast rules for arriving at the potency, as this depends on various circumstances, and as such, it is always different in different cases. In some cases, the 30th. may be a sufficiently high potency to begin with, while in some others even 1,000th. or 10,000th. may be too low. The question of potency is an important one and it will be dealt with separately. We may, however, understand that the potency to begin with in a chronic case must be high. But why?-Though this has been explained to some extent previously, let us clear up the question once again. Chronic cases, having run on for long periods and having been bungled with all sorts of suppressive treatments, are ever made more and more complex. Not only this, but also, the miasms, which alone make diseases chronic by virtue of their nature and on account of their knotty combinations one with another, are masked and made apparently latent. Being aprarently latent, they have to be brought out and made to appear in their natural colour in order that they may be seen face to face and then dislodged from their combination and then cured. If cure is at all to be effected in such cases, the miasms or rather the suppressed manifestations of them, must be made to re-appear, and this re-appearing of suppressed conditions is not possible without the use of high potencies. Low potencies cannot effect this; they are not so deep-acting. Some people might of course argue that, Hahnemann cured all his most inveterate of chronic cases with the 30th. or 60th. potency, and as such, there is no sense in such high potencies as c.m. , and d.m. m. etc. of to-day. But we must remember that in Hahnemann's time, there was hardly so much and so varied disorder in man's economy as we have to-day. Sycosis was a miasm that was very rare in his time, while there is hardly any body to-day who is free from it. Thus, it is the complexities in disease that demand higher potencies to-day. Then again, he saw that the world at his time was not understanding the use of the 30th. potency even, and if he had talked of c.m.  or d.m. m. potencies, he would have made himself still more unintelligible. He was therefore going to higher potencies gradually and cautiously. If he had lived longer yet, he would certainly have used much higher potencies. That he was gradually having a tendency for higher and higher potencies, can be gleaned from his writings. Then again, the third thing is that in Hahnemann's time, there was not such a variety of Pathies as we have to-day. Even "Allopathy" of his time was not as insidious and mischievous as it is now. The more "Scientific"(?) it is becoming with all its novel injections etc., the more dangerous it is growing-the more dangerous in that it is suppressing diseases in a more insidious manner. To this Allopathic "advancement" (?) has again been added the patent medicines, which are multiplying every day. Thus only complexities greater and still greater have come upon man, and he cannot be freed from them except with the use of high potencies. It must be said that, if Hahnemann had such awful complexities of diseases in his time, he would certainly have used high and higher potencies. He has not prescribed any limit to potency while he has ever shown a tendency to go higher and higher up. The accusation, if any, against the modern use of high potency, has therefore no justification.

 I must not omit to say one thing just here,-namely that you must be especially cautious in making your first prescription. It is a weighty business, and there must be no mistake in it, because any mistake may not only fail to cure the patient but also do some grievous mischief to him. The common belief that Homœopathic medicines are harmless and that they do no injury even if they fail to do any benefit, is pure nonsense. If a medicine can do you some benefit when used, it may also do you some injury when abused. It is not an inert substance. It is a highly powerful something or it could never cure any disease at all, and as such, it may injure you if it is wrongly used. It is idle to suppose that its powers will sleep silently in the system when it is not required to cure the case.
 If, however, before the administration of the medicine so carefully selected by you for the chronic disease, the patient happens to have some acute manifestations, or if the chronic manifestations even happen to have an aggravation like an acute disease, then the medicine selected for the chronic disease should not be used at once. In such cases some superficially acting medicine as called for by the symptoms should first be used and the acute manifestations or the aggravated condition of the chronic disease, as the case may be, controlled. It is only when these acute manifestations or the aggravated condition of the chronic disease has passed away, that the miasmatic medicine selected for the chronic case should be used. A deep-acting miasmatic medicine in high potency, when used during the course of an acute disease or during the aggravation of a chronic disease will cause severe aggravation. This is a point that you must carefully remember.

 Another thing has to be considered here. The law of selection of medicine in Homœopathy is always the law of similarity. And it may be argued-"what is the necessity of selecting an 'anti-miasmatic' medicine in a chronic case on the basis of the miasm that is predominant at the time, if the selection of the medicine is made correctly according to the law of similarity? If the medicine is correctly selected according to the law of similars on the totality of the symptoms of the whole case, what is the harm if I do not know whether the medicine selected is anti-Psoric, anti-Sycotic, or anti-Syphilitic? Being based on the totality of the symptoms, the medicine is bound to cure the case".-To this however, I have only to say that, unless you take account of the miasm, you cannot select correctly on the totality of the symptoms. The knowledge of the miasm that you want to strike at, is essential for correct prescribing. Not only this, but also the knowledge of the miasm will help you to understand the action of your medicine with exactitude. Suppose for example, in a given case, you administer a medicine on the totality of the symptoms without knowing that it is an anti-Psoric. And when the psoric element in your patient is controlled, the sycotic element comes up prominently. Now, unless you know about the miasms, you will be unable to see that your medicine has acted correcly and to the benefit of the patient, and you will be unnerved at the sudden appearance of the sycotic symptoms. If however you have the knowledge of the miasms, and if you ever prescribe on the basis of these miasms one or the other, you will be in a position to observe the effect of the medicine used, with exactitude and follow up the subsequent developments of the case with certainty. There can be no fight with your enemy unless you know his nature.
 
 The next thing that should engage our attention after the prescription has been made and the potency fixed upon, is the question of regulation of dose. Whether to give only one single dose of the selected remedy and then wait until re-action sets in, or to give several doses in succession and stop when re-action is perceived to have begun. This is a matter that has to be decided by the sensitiveness of the patient's mind and physique. If the patient looks likely to have re-action from a single dose, there should be no repetition at all, as this may cause severe aggravation. But in cases where the patients are not sensitive enough, and as such there is likely to be delay in re-action, it is better to give a few repeated doses and then stop as soon as re-action is perceived to have commenced. In repeating doses like this, Hahnemann has advised in the sixth edition of his Organon that every succeeding dose should be of a slightly higher potency, and the method of increasing the potency in such cases has also been laid down there.

 But how to ascertain that one single dose of a selected remedy is sufficient to excite re-action in one given case, and that in another some repeated doses are necessary?-If the patient is extremely nervous, if he is frightened easily, if he is pleased and displeased easily, or if he has ever before given indication of re-action on a very few doses of medicine, it is to be understood that he is a sensitive patient, and in that case, one single dose is enough and it should never be repeated, or, if after the use of the first dose there is some change perceived on the next day, there should be no repetition, and you should wait until the action of the dose given is exhausted. If however, on the contrary, the patient appears to be not easily impressionable and if he is not very weak, and as such, is likely to stand the re-action even if it be a bit severe, repeated doses may be given for a few days and then stopped when re-action has commenced. If again the patient's sufferings are not severe, the dose may be repeated until re-action begins. But in all other cases in which the patient is very weak, the potency to be used should be comparatively low and the repetition of the dose should also be carefully avoided. In fact, the whole condition of the patient should be carefully studied up and the question of repetition of dose dispassionately considered. The main thing that should be borne in mind is, that your object is to obtain a response from the patient to the medicine used, and if you gauge that one single dose is enough for this purpose, you must wait for a reasonable time and you must not repeat the dose until you perceive the response. If however, you think that several doses will be necessary, you may repeat until you get the response. You must remember that to give a single dose in a case where repeated doses are really necessary and to wait and wait, and to give repeated doses in a case where a single dose is sufficient to excite re-action, are equally bad. Because in the first case you lose time unnecessarily, while in the second you subject your patient to a lot of avoidable sufferings of a severe aggravation. You cannot therefore be over-cautious in this matter, and the fact remains that you must not repeat the dose when there is re-action, and that you must repeat the dose, even if it be at the rate of one dose daily, when there is delay in re-action, because all these repeated doses when given before the setting in of the re-action, will act like one single dose.

 In acute cases, the action of a medicine is perceived in a few minutes (eg., in cholera etc.) or at the utmost in a few hours, but such is not the case in chronic cases. The first symptoms of the action of a medicine in a chronic case are hardly seen in less than 5 or 6 days, while in certain cases it may take even 3 or 4 weeks or more. In chronic cases, therefore, you have to wait patiently and observe the action of the medicine used, with care.
 It has already been stated before, that the first prescription in a chronic case is a highly weighty business and that there should be no mistake in it, and I repeat the same thing again, as it is very very important. A correct first prescription in a chronic case really means half the cure for your patient and an immeasurable simplification of your work. But if unfortunately, there is a mistake in the first prescription, that is to say, if a wrong medicine has been given, we must learn the process of detecting it as also of taking remedial measures. This leads us to the following questions:-(1) What should be the symptoms for indicating that the medicine used has been wrong? (2) How to remedy this? (3) How to understand that the medicine has been correct? (4) How to make sure that the potency also has been correct? (5) What should be the symptoms for indicating that the correct medicine has been used?
 Before I undertake to explain the above problems, I should begin by saying that, like acute cases the treatment of chronic cases cannot possibly be carried on by examining the patient at the will of his guardian. In chronic treatment, the physician must have the privilege of making his examination of the patient whenever he considers it necessary, because the guardian of the patient or even the patient himself cannot understand as to when an examination of him is necessary. The physician only knows what developments he expects after the use of his medicine and what developments and aggravations he will hail with delight as symptoms of a process of cure and what he will view with alarm and try to remedy. It is therefore, that the physician will examine his patient whenever he considers it necessary, and unless there are facilities for this, there can be no chronic treatment.

 Now, to the point. (1) and (2)-If after the medicine used, there is a development of such symptoms as the patient has never experienced before in the whole course of his sufferings, it is to be understood that the selection has not been correct. It is a fact that in chronic cases patients are in the habit of having this and that occasionally, say a headache, an attack of dysentery, or fever etc; and if some such thing appears there as has never appeared before and if the patient is troubled with that, the evident conclusion should be that the prescription has not been correct. In such a case however, some antidote has to be used if the suffering is severe. If however, the suffering of the patient is not so severe, it is better to wait and allow the action of the wrong medicine to pass off completely, before a fresh prescription for the chronic disease is attempted. But, if this freshly selected medicine happens to be an antidote to the wrongly used medicine, then it should be given at once without any waiting for the passing off of its bad effects, as waiting in such a case would only be waste of time and unnecessary suffering to the patient.

 I have explained the method of detecting the mistake, if any, in the first prescription as also of remedying it (i.e.  questions 1 and 2 above), and I shall elucidate the remaining three questions (3, 4, and 5) in the next chapter.