The question of a second prescription comes only when the first prescription has been administered; it has been given sufficient time to act and allowed to exhaust its action. So, before making a second prescription thorough understanding of the first prescription and inspection of all remaining symptoms becomes mandatory.
“The second prescription technically speaking is the prescription after the first one that has acted” —says Kent
Dr. H.A.Roberts says, “After administering the similimum, the patient shows the desired reaction, there may and probably will come a time when the physician is called upon to meet a symptom picture once more. This is the time he must consider the second prescription”.
The second prescription may be of the following types:
- Repetition of the first remedy
- The antidote of the first remedy
- Change of then first remedy
- Complimentary to the first remedy
- Change in the total plan of the treatment
1. Repetition of the First Remedy
Under 2 circumstances the same remedy can be given as a second prescription:
i. The reappearance of the same old symptoms
ii. When the case comes to a standstill.
i. The reappearance of the old symptoms
When any suitable homeopathic remedy is administered, the symptoms disappear and the patient seems to be improved. But after a period of a few days to a few months, the same old symptoms reappear. The duration of the time taken for the reappearance of the symptoms varies from the individual and the nature of the medicine prescribed. In such conditions the physician has to interpret that the first prescription was the right one, the case is well under control and curable. Hence in the Second prescription, the same remedy can be prescribed once again.
“In a such case when symptoms return, when the patient has the same general and particulars as formerly, it means that the first prescription was a good one, that the case is curable and the second prescription must be the repetition of the former.” says Kent
ii. When the case comes to a standstill
In certain cases after the first prescription, the symptoms start changing in an orderly manner with the production of new symptoms. But this picture again changes with the reappearance of old symptoms, the patient may not complain of any physical problems, yet he is not considering himself completely improved. The patient may say, “I have no symptoms, yet I am not improving, I seemed to have come to a standstill position”. This he says regarding himself and not his symptoms. The best way to handle such cases is to wait and watch for a considerable time without giving any medicine.
If after such long waiting no outward symptoms have appeared, no external manifestations of disease appear and then the same remedy can be administered as the second prescription. A new remedy is not advisable as no indications are available for such action. According to the 6th edition, the homeopathic physician can repeat the same medicine, if the case demands it. But every repetition of the same remedy will be the “slightly changed potency from the former”.
Dr. H.A.Roberts has the view, “A remedy should not be changed without very good reasons. It is possible that the remedy may be repeated at the necessary intervals though a whole range of potencies, securing the full amount of good from each potency before passing on to the next”.
2. Antidote to the First Remedy
The appearance of new symptoms after the first prescription indicates that the remedy is not perfectly homeopathic to the case; the remedy has to be antidoted. The new symptoms have to be examined carefully. If the new symptoms are symptoms of the remedy prescribed then it has to be understood that the patient is proving the remedy prescribed. In the second possibility, the new symptoms may not be the symptoms of the remedy prescribed.
In such conditions, before coming to any conclusion, the physician has to cross-examine the relatives of the patient whether the patient had these symptoms anytime in his life. If the patient never had such symptoms before physician concludes that he had made some mistake in the selection of the first prescription. Hence the disease is changing the direction, and he immediately antidotes his first prescription.
Dr. H.A.Roberts says, “After having given antidote remedy and a little time for the patient to rest, we should study the case again from the beginning. The second remedy should correspond more particularly to the new symptoms than the old, but both present symptoms and the former symptoms must be considered. If we do our work carefully, this second prescription will cause the new symptoms to disappear and it will probably remove the old symptoms as well”
3. Change of the First remedy
After the first prescription, when strikingly new symptoms develop with an entire change of the original symptoms, a change of the remedy has to be thought of. These symptoms the patient never had in his life before and the symptom picture is strongly demanding a new remedy. In some instances, the symptoms may have been changed after the first prescription, but the patient is not improved totally despite waiting for a long period. This sometimes leaves the physician in a confused state.
Hence both H.A.Roberts and Kent say, “When you are in doubt wait”. It is a golden rule that never changes the remedy unless the same remedy is tested and given in one or more doses of various potencies and without any effect. When the previous remedy has failed to do any good to the patient in all potencies, a change of the remedy can be thought of.
4. Complementary to the First Remedy
A complementary remedy is used after the first remedy has acted sufficiently and it helps to complete the cure. In some cases, a complementary remedy to the first prescription is needed, because the previous remedy has done only the half work. Kent gives an example of a complement remedy. Example: a little four or five years old child, large-headed bright, blue-eyed boy is subjected to cold and every cold settles in the head with flushed face and throbbing carotids.
Based on these symptoms, we prescribe “Belladonna.” Which relieves him as a palliative. But the child continues to have headaches because psora is in the background. On examination, we find that when the child does not have a headache, his constitution is different. He has flabby muscles, glands are enlarged, and he takes cold on every change of weather and craves eggs. Now the constitutional remedy “Calcarea” will cure him.
Kent says, “Do not give Calcarea during the paroxysms, but after the wire edge has been rubbed off by Belladonna, give him that constitutional remedy that is complementary to Belladonna which is Calcarea”. Dr. H.A.Roberts gives an example: Pulsatilla may be as effective in acute manifestations, while constitutional condition calls for Silicea. It is so with many remedies.
Those remedies that are closely related to each other are called cognates. Once the first remedy completes its action, some cognates may be called for as the second prescription. But administering cognates is not a compulsory task. Selection of the remedy in homeopathy is always based on the current totality of the patient at the time of consultation.
For example, a medicine always leads to one of its cognates, and we find that the cognates are closely related to each other, like Sepia and Nux vomica. A bilious fever in Sepia constitution is likely to call for Nux; as soon as that bilious fever or intermittent fever subsides the symptoms of Sepia come out immediately. This shows its complimentary relation to Nux. A Sepia patient with acute inflammatory attack demands Nux or its cognate. The whole materia medica abounds with these complementary and cognate relationships-Kent comments.
6. Change of Plan of Treatment
In chronic diseases, after a thorough study, the physician diagnoses predominant miasm and gives the first prescription. The first prescription may remove all the symptoms of that miasm. Then suddenly another condition may arise that shows the symptoms of another miasm which was subdued all these days by the previous miasmatic condition. In such conditions, the second prescription has to be changed based on the current totality and the miasm that is responsible for it. We cannot expect to cure any mixed miasmatic condition by a single dose of one single remedy.
But to cure such conditions, we need various remedies to be administered in succession i.e. one after another. The miasms have to be removed one after another just like the “peeling of layers of an onion”. During the treatment of the mixed miasmatic conditions, when one miasm is predominant, the other will be quiet, so the physician has to change his plan of treatment according to the symptoms that guide the miasm at the time of each sitting with the patient.
- What is Deflected Current in Homeopathy? – H.A. Roberts
- What is Causa Occasionalis in Homeopathy?
- What is Prima Causa Morbi (Homeopathy)?
Let’s have another part where second protection is needed
7. Intercurrent Remedy
Intercurrent remedies can be used as the second prescription in some conditions. In some chronic cases after a period, some patient’s condition refuses to progress. This condition can be termed as a blockage. This blockage could be because of miasm, a bad family history, or a history of vaccination, etc. To remove this blockage an intercurrent remedy can be used as a second prescription. Selection of this intercurrent remedy can be done based on the identification of the blockage, the nature of the disease, constitution, diathesis or the hereditary disorders in the family, etc.
Example: A patient with a family history of tuberculosis can be given Tuberculinum as an intercurrent remedy to remove the blockage of the miasm. Some cases do not improve because of the blockage produced by vaccination and its bad effects, such cases may improve with the usage of Thuja (Burnett’s “vaccinosis”), Malandrinum, etc. Histories of some patients reveal that his complaints have dated back from an attack of smallpox, measles, and influenza. Here intelligent use of nosodes like Variolinium, Morbilinum, Influenzinum, etc often removes the block and helps in the progress of the case.
After all, homeopathic practice is an art. A thorough understanding of the disease and the individual suffering from the disease is very necessary at every step of consultation. Always study your cases. “You meditate and you hesitate”. “No prescription can be made for any patient except after a careful and prolonged study of the case”-says Kent. H.A.Roberts also has a similar view “No prescription, either first or second can be made without careful, thorough study of the case and sequence of symptoms. It is only then that we can administer another remedy intelligently and with confidence”.