The second prescription

- BENERJEE.P,

The second prescription 

 Let us now consider when the medicine prescribed at the first instance (first prescription) will have to be changed and the second prescription made.
 If, after the amelioration obtained from the use of the first prescription, the original symptoms return, that is to say, if the original picture of the patient on which the first prescription was made, is presented again in the same form or in a milder form, it is to be understood that the potency used has not been high enough for effecting a total cure, and as such the disease force was only partially controlled and is showing itself up again. In such a case the same medicine will have to be repeated in a higher potency, so that the disease force may be completely controlled and eradicated and the life-force restored to its normal condition. But, if instead of the original picture, a new picture consisting of some new symptoms is presented, it is to be understood that the first prescription was not altogether correct. At times, it is the symptoms of the first medicine that appear, or in other words, the patient appears to be proving the remedy. In such cases, the first prescription has not only to be taken to have failed to cure the patient but has also to be taken to have done some positive mischief, by complicating the original picture with some drug symptoms. In such a case, one single group will have to be made of the whole array of symptoms now available, that is to say, the original picture of the patient plus the drug symptoms brought on by the erroneous selection will have to be considered as presenting one picture, and a fresh selection made correctly on that. If this second prescription is correctly made, it is sure that it will be quite a different medicine, that it will be by no means the medicine that was prescribed at the first instance.

 In the above case, one thing should, however, be studied with care-namely, the condition of the "internal" of the patient-the condition of the patient's mind. If in spite of the appearance of some new symptoms the patient seems to be more at ease in the interior, then there should be no interference with a second medicine so long as this internal imporvement of the patient lasts, merely on account of a few new symptoms having made their appearance. It may be that with some more waiting, the original symptoms will return and call for a higher potency of the same medicine, or it may be that this internal feeling of ease will gradually disappear and there will remain then the additional new symptoms only that had cropped up. In this last case there is no other alternative than to make a second prescription. Let me however, explain why I have advised waiting in case of new symptoms attended with an internal improvement of the patient. The fact is that these symptoms which the patient describes as "new", may not be really new. Perhaps they appeared in the course of the patient's disease or perhaps in his childhood, and it is possible that the patient did not either notice them or has forgotten them altogether. For this reason, whenever there is the slightest feeling of internal ease, it is all very wise to wait. In chronic treatment, waiting is a great thing. The slightest doubt or indecision should make you wait and watch. Now, in the present case, what are we to wait for?-For a return of the symptoms on which the first prescription was made. If they do not return at all, and if the patient is also ceasing to feel the internal ease and improvement, there is no other help than to resort to a second prescription.

 Besides the above case for a second prescription, there are other cases yet in which a second prescription becomes necessary. Suppose, for example, you have a colic patient. He gets the fit every 10 or 12 days, and suppose, while treating him as a chronic patient, you have given him some such thing as belladonna, Colocynth or Magnesia Phos., as indicated by the totality of his symptoms. You then find that your medicine has acted well enough, but the fit returns after some days. You then change the potency, but yet it returns as before. On close scrutiny of such a case, you will find that it is because the medicine you have used is not sufficiently deep-acting that the fit is returning every time; and if you now use a deep-acting anti-Psoric, anti-Sycotic or anti-Syphilitic complementary as may be indicated by the miasmatic picture of the patient's case, you will be surprised to see that the patient is cured. If you had given him belladonna, perhaps Calcarea Carb will be necessary; if Colocynth, then perhaps Kali Carb; and if Magnesia Phos., perhaps Ars. Album. I have only given a few examples, but the main fact is that some deep-acting complementary remedy is necessary in cases where superficially acting remedies only have been used and where they have failed to effect a complete cure. You might of course argue in the above case-"Why, the prescription of belladonna, Colocynth or Magnesia that was made at first was not correct, and that a deep-acting remedy like Calcarea Carb, Kali Carb or Ars. Album should have been prescribed at once.-But no, and this should never be done. Because, a deep-acting remedy straight, where a more superficial remedy is called for by the symptoms in hand, is apt to cause a severe aggravation and endanger the patient's life. It is advisable to reduce the strength of the disease force by superficial and short-lived remedies when they are called for by the symptoms, and even to make a gradual trial of higher potencies of them. It is not quite impossible that some cases may even be completely cured by only such a gradual change of potency of the first selected superficial drug. It is however true, that even if a case is completely cured by such remedies, yet some deep-acting complementary will have to be used, or the possibility of a relapse in the future will not be totally gone. However, this is one other of the cases in which a second prescription is necessary.

 A third class of cases for second prescription are those in which one, two or even three remedies are called for in a cycle after the action of the first remedy used is exhausted. As for example, Sulphur is at times required after Sepia, then Sepia and then Sulphur, and so on several times. Then again, for example, Nux, Sulphur and Calcarea, or Nux, Sulphur, Calcarea and Lyco. It must however be noted here, that this cyclic use of complementary remedies is never arbitrary, but is ever compulsory, as it is the symptoms that call for these remedies one after another. I may quote a case. A lady at Halishahar required a cyclic use of three such complementary remedies for two long years, before she could be cured completely. How marvellous it is for one medicine to act and exhaust itself and make the ground ready for nothing else but for a complementary of its, and again for this complementary also to act and exhaust itself and prepare the ground for a complementary of its in its turn, and so on. This alone ought to set one thinking that Homœopathy is based on some immutable law of Nature and is the only curative therapeutic yet discovered.

 However, besides the above three there is a fourth class of cases in which a second prescription is necessary. These are the cases in which there is a combination of several miasms. Let me take a concrete example. Here is a patient who has all the three miasms, Psora, Sycosis and Syphilis in him. While recording his case and making the first prescription, you find that the Sycotic element is predominant, and you therefore give him an anti-Sycotic on the totality of the Sycotic symptoms. As soon as the Sycotic element is controlled by the anti-Sycotic remedy, perhaps Psora becomes predominant. Then you have to select an anti-Psoric on the totality of the Psoric symptoms existing now. Suppose, the Psoric element is controlled by the anti-Psoric, and the Syphilitic element becomes uppermost at once, and you have then to select an anti-Syphilitic, and so on, until the case is cured. It may happen that after the Syphilitic element is controlled, Sycosis and Psora, and even Syphilis also come up again one after another, and thus several times, and each time a remedy according to the predominance of the miasm has to be selected and used.

 Thus, we see that the necessity of a second prescription arises in various cases, and only some of these cases have been described above.