Prescribing the correct treatment is the primary concern of a physician. They do it often with care after studying the case. Prescriptions could be based on the pathology, diagnosis, symptom totality, prakrti and so on depending on the concepts in the system. Usually, during the follow up of the case, the medicine is either repeated, reduced or enhanced depending up on the course of the disease. This is because the medicines are prescribed for the disease and the dosage is also determined on the cause and course of the disease. In such circumstance a standard treatment protocol of treatment is also possible to be pre determined ciriteria.
In Homeopathy, medicine is selected based on the principle of similimia. For this, physician resort to build up a portrait of the patient based on the totality of symptom. Then he arrives at a similimum and prescribes the remedy. This called the first prescription. During the follow up of the case, more important to the physician is to know what is really happening or happened to the patient after the fist prescription. This information shall help him to make the Second prescription.
Logic of second prescription in Homeopathy
In homeopathy, the medicine is prescribed to the patient suffering from the disease and the selection of the remedy is done through the concept of totality of symptom. The processes of treating a case in homeopathy are the case taking, case analysis, case synthesis, portrait formation, individualisation, selection of the medicine, first prescription, observing the action of the remedy and then the second prescription. Though these steps seem simple, it is complex and so higher level of acumen. The second prescription is that which follows a remedy which has acted. It need not be the one prescribed after the first one, but any remedy prescribed after the earlier one is called second prescription. In that case the preceding prescription forms the fist prescription and subsequent one forms the second prescription. Therefore, the medicine prescribed on the third visit shall be the second prescription to the one prescribed during the second visit and the medicine prescribed on 4th visit shall be second prescription to the one prescribed on third visit. Thus second prescription is a unique concept in homeopathic treatment.
Usually, every physician selects the similimum for the first prescription after carefully following the requirements of individualisation. Such remedy produces certain effects on the patient depending up on the nature of illness, sensitivity of the individual, correctness of the medicine and so on. Therefore, the second prescription is the one, after observing the action of the remedy given to patient. This could be a repetition of the same remedy, a complementary, antidote, a different remedy or even simple placebo depending on the response of the action of the first medicine. Taking a decision as to what is to be prescribed as second prescription is very important, rather more important in the treatment of the sick. The second prescription may save the patient or spoil the case if adequate care is not taken.
Remedy response and interpretation.
In aporisms 272 to 277 of Organon of Medicine, Dr Hahnemann laid down the guidelines for the second prescription. This remedy response on the patient can be observed and interpreted on these principles. In some cases the response may be favourable and in some other cases it may be unfavourable. Dr James Tylor Kent and Dr Constantine Hering, two stalwarts in Homeopathy further elaborated the norms to be observed, the possible changes after the first prescription and interpreted its effects.
Dr Kent codified 12 responses after an indicated remedy is given to a patient. These are:
1. Prolonged and final decline of the patient
2. Long aggravation, but final slow improvement
3. Aggravation is quick, short, and strong with rapid improvement of the patient
4. No aggravation with recovery of the patient
5. Amelioration comes first and aggravation afterwards
7. Full time amelioration of symptoms, yet no relief to the patient
8. Some patient prove every remedy they get
9. Action of medicine upon prover’s
10. New symptoms appearing after the administration of the remedy
11. When old symptoms are about to reappear
12. Symptom takes the wrong direction
Each of the responses has its own meaning and to be interpreted with reason. When the first remedy is capable enough to change the complaints, we have to wait for results. The change in the totality of symptoms signifies everything. If the original symptoms disappeared completely without any new symptom and the patient generally feel better signifies a complete cure. Aggravation of existing symptoms –may come-on with general improvement of the patient means recovery of the case; but if aggravation of the symptoms is attended with decline of the patient, the cure is doubtful. If amelioration comes first follows with aggravation of the symptoms signifies that the first prescription has only palliated the case temporarily. In such cases, it may apply to the general state or but to the few symptoms. If the patient does not feel well, the improved symptoms are partial relief to the distressing symptom, a good sign in incurable cases.
But if the first prescription is not correct, the patient will develop new symptoms that he never experienced. In that case the medicine will have to be changed and the second prescription is to be made afresh.
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 done some mischief by complicating the original picture with some drug symptom. This may happen in highly sensitive patients.
Every homeopath has to observe the response of a remedy and take decision as to what he should do next based on the teaching of Dr Kent.
Dr Constantine Hering had formulated the law of the direction of cure after a well selected remedy is given to the patient. He postulated that the favorable direction of cure in a diseases should be :
1. The complaints improve from above downwards.
2. The symptoms disappear from within outwards.
3. From a more important organ to a less important one.
4. In the reverse order of their coming.
Based on these concepts, homeopathic physician select an approach to make the second prescription.
Types of second prescription
The second prescriptions could be:
1. Repletion of the first remedy: This is done when there was an improvement of the diseases, but the symptoms start re appearing. However, caution is that repetition should not be hasty just because the progress is not fast enough. The golden rule is, wait and wait to see that the action of the fist medicine is exhausted and the patient really is slipping back to the old stage.
2. Change of potency: This is called when the response is no longer consistent, and the potency is no longer sufficient
3. Change the remedy: When new symptoms which have no relation to the earlier symptoms are appearing and there is no appreciable change in the old symptoms.
4. Inter-current remedy: When the fist prescription has give relief to the patient and the physician feels there is blockage of action, then prescribe an inter current remedy. This could be a nosode, could be an anti miasmatic, or a chronic remedy of the earlier one
5. Alternation of remedies:
6. Placebo is prescribed when the physician feels that the remedy is still acting he has to wait to complete its action. In Homeopathy it is very often done by the treating physician while observing the remedy action.