Principles of Prescribing

PRINCIPLES OF PRESCRIBING 

Introduction

The general concept in Homeopathy towards treatment of the sick is Treat the patient not the disease.  On a superficial sense, this may be preposterous, but in a deeper sense it conveys its holistic concepts towards the patient.  A patient with hypertension, diabetes mellitus and COPD may express multitude of symptoms common to each of these diseases. Based on the clinical findings and diagnostic evidences, he is considered as a patient of hypertension, diabetes and COPD. Such a concept necessitates different prescriptions to balance the patho- physiological changes in the patient’s health.  Whether the patient is lean or obese, irritable or gentle does not matter in selection of remedies. Even the patient is not personally present  for consultation,  the medicines can be prescribed  merely based on the diagnostic evidences. Most of these prescriptions shall give relief to the suffering.

Treat the patient not the disease concept of homeopathy explains that the patient suffering from one or many diseases is an individual whose health has got deranged due to multitude of factors. This external factor (meturic and telluric) influence the susceptibility of the individual and deranges the weaker parts of the human economy. This brings changes in the patho- physiological frame of the individual and  thus the wellness person become  the sick. In short, homeopathy believes that the hypertension, diabetes and COPD are the result of the derangement of the human economy (life force). The susceptibility of the individual depends on his genomic states (constitution), lifestyle, living conditions, habits, past history, family history and so on. This explains rationally, why certain people falls sick on similar situations and certain people escape from the diseases inspite of reasonable exposure to  similar situations. This also explains why the expressions of the same disease differ in different people (individuality).

Symptoms are the language of the disease — the body’s attempt to warn about the  internal derangement of the person. Without symptoms, a person could not have illness. The symptom may be trivial or significant.  This may be at physical, mental or at spiritual level. As experienced physician  shall be able to identify  the internal derangement through the signs and symptoms, even if it is trivial or insignificant to the patient.

In homeopathy, medicine is prescribed after a detailed case taking, giving importance both to mental and physical attributes as well as any particular symptoms. Both subjective and objective symptoms have got its importance. The symptoms that represent the patient as a whole are of more value, especially such as are expressed in the patient's own words.

The core concept of Homeopathy is principle of Similia Similibus Curantur, which demonstrates that a remedy selected for the treatment of a natural disease shall be the one that is capable of producing a range of similar symptoms in a healthy person. Therefore, the precondition to call a substance a homeopathic remedy is its ability to produce set symptoms on  healthy human volunteers during the course of its clinical trial (Human Pathogenic Trial/ drug proving). Basically, this principle demonstrates that disease can be cured by a medicinal substance that is tested on the principles of Homeopathic pharmacodynamics.

In homeopathy, the prescriptions are made by tailoring of remedies to the patient’s personality type, causation of the illness and totality of symptoms.  This method differs from prescriptions in other medical systems, wherein prescriptions are mainly based on the name of the diseases or main causative factors. The physicians of the biomedicine would prescribe  the same  medication  or treatment regimen  to all patients  with the same disease, where as a homeopathic  practitioner would ask detailed questions  about each patient's  symptoms and the  modalities,  or factors, that make them  better  or worse, his likings and dislikes and so on. Here the main focus is to  individualise the person from other patients with similar diseases. In view of this difference, the homeopath might prescribe different remedies for different patients with the same illness. 

Evaluation of Symptoms  

The word symptom connotes any change that the patient experiences during the illness, including changes in emotional patterns, sleep, eating habits, temperature variations and so on.  According to the importance for selecting a similimum, symptoms are evaluated for their value.  The following are the different approaches of evaluation of symptoms:

Peculiar symptoms: These are symptoms unique to the individual that do not occur in most persons with the same disease. Homeopaths make  note of  peculiar  symptoms  because  they oft help to determine the remedy.

Mental and emotional symptoms: These are important general symptoms that inform about the patient's total experience of the disorder.

Other general symptoms: These are physical symptoms felt throughout the patient's body such as tiredness, changes in appetite, or restlessness.

Particular symptoms: Particular symptoms are localized in the body; they include such symptoms as nausea, skin rashes, headache, etc

During homeopathic case-taking, the practitioner  will evaluate  the intensity  of the  patient's symptoms, assess their depth, duration, note any peculiar symptoms, evaluate the modalities of each symptoms and make a list of key  symptoms  to guide the selection of the  proper  medicine.

Selection and administration of a remedy

The choice of a specific remedy is guided by the patient's total symptom profile rather than  by  the illness. Homeopathic remedies are prescribed according to the law of similars. There are several types of prescriptions according to the different types of clinical presentation   of the case.

The following are the major  prescription approaches followed  by homeopaths.

1.    Acute Prescription

The acute disease in homeopathy is a clinical condition with a sudden onset, sudden progress and a sudden decline. Acute disease is mainly self-limiting in nature. It is characterized by the symptoms having a rapid onset. These symptoms are fairly intense and resolve in a short period of time. The common acute diseases are colds, flu, bronchitis, childhood illnesses, tonsillitis, appendicitis, ear aches, most headaches, sudden diarrhoea, most infectious disease.  In many cases there may not be many peculiar symptoms other than the disease symptoms to select a similimum or there may not be much time for a detailed case taking. In such cases, while taking the case, one has to give importance to the observation, objective signs or symptoms and any keynotes besides the major symptoms. Try to find the causation which would definitely help you in the prescription.

Acute homeopathic prescribing needs immediate attention and faster action. The remedies given in acute prescribing are intended to stimulate the body's internal ability to heal itself. Usually the therapeutic books helps in finding remedies  for acute prescriptions.

2  Aetiological Prescription

Homoeopathy gives great importance to causation. Aetiology or causation or ailments from has formed a very important factor in the selection of homeopathic remedy. The cause of a disorder is very important in determining the most similar remedy in any emergency, acute, or a chronic case. The causes could be mechanical, exciting, maintaining. The only precondition for the basis of such prescription is the direct and unambiguous co relation with the causation. In some cases, the causation could either be a coincidence or a over emphasis by the patient. Hence there is a need to give credibility to the causation before it is given importance on selection of the remedy. Causation is one of the elements of symptoms, which when strong and genuine, is of much benefit in the remedial diagnosis.

  In the Homeopathic Repertories, there are specific rubrics for specific causations. Usually the rubrics ailments from shall be helpful to select remedies for specific causation.

3.  Keynote Prescription

There are some great stalwarts who prescribe based on one or two keynotes for the cases with great success.  This become possible only when the experienced physician could identify those few key notes that represent the patient as a whole and  is in a position to  select the similar remedy with  the same characteristics. Depending on the calibre and efficiency of the physician the prescription could be scientific, artistic, or intuitive.

The physician’s hard work backed up by the knowledge of Materia medica is essential factors for any success on key note prescription.

Materia medica such as Allens Key notes the striking symptoms of each remedies in bold letters. In some other Materia medicas, this may be in italic letters.

4.        Constitutional Prescription

This prescription is based on the patient’s constitutional makeup which includes the patient’s physical, mental, temperamental, and emotional aspects. Constitutional homeopathic prescribing, also called classical prescribing. When accurately implemented, homeopathic constitutional care can elicit a profound healing response. Unlike  acute  homeopathic prescribing, constitutional  prescribing  refers  to the selection  and  administration  of  homeopathic preparations over a period of time for treatment related to inherent  disorders,   those caused by an inherited predisposition to a disease. 

Constitutional prescribing is holistic in that it is intended to treat the patient on the emotional and spiritual levels of his or her being as well as the physical symptoms. 

Constitutional prescribing is also aimed at eventual cure of the patient, not just suppression or relief of immediate symptoms. Homeopathy can be extremely effective in treating chronic and long-term health problems through this approach. It is seen that constitutional medicines not only cure the disease, but also strengthen the body’s immune system and thus prevent future occurrences of the disease. After taking the case in detail, case analysis are done  to identify the prescribing symptoms and then these symptoms are subjected to Reportorial analysis to find  a group of similiar remedies. Thereafter the physician uses his wisdom to select the similimum. This need much expertise of a homeopath and also time consuming.

5.        Intercurrent Prescription

Intercurrent prescriptions are the remedies given during the course of homoeopathic treatment for some chronic diseases for the purpose of removing any acute diseases & accelerating the mode of cure or removing any hindrances called miasmatic blocks. In the introduction of “The Theory of Chronic diseases” first edition, 1828 Dr. Hahnemann presented the method of using acute & chronic incurrent remedies. It is used when a well indicated remedy fails to  give desired result. It is  usually prescribed where the indicated remedy works well for a while and then begins to taper off. It can be in the form of a nosode, a complementary, or constitutional / Polycrest remedy.

Acute Intercurrent are those remedies given during an acute crisis in the management of a chronic case. This acute crisis may be due to any cause (like getting wet, severe trauma, injuries, acute miasms, some epidemics, any exciting factor, etc), but it is different from the clinical picture of the chronic natural disease.

Chronic intercurrents are those medicines which are usually given as anti-miasmatic remedies in the midst of the chronic treatment for miasmatic blocks, suppressions and obstacles to the cure.

The common Intercurrent remedies are mentioned under the relationship  of remedies in  Materia medica or in certain repertories.

6.   Miasmatic Prescription

 

Miasms are, in brief, the tendencies and predisposition to certain diseases either inherited or acquired. Miasm as an invisible, inimical, dynamic principle which permeates into the system of a living creature, creating a groove or stigma in the constitution which can only be eradicated by a suitable anti-miasmatic remedy. These Miasms could be dormant or active If effective anti-miasmatic treatment is not given then the miasm will persist throughout the life of the person and will be transmitted to the next generation. Depending on the expression in a particular individual, the respective Miasm could be diagnosed and treated with an appropriate anti-Miasmatic remedy so as to achieve cure or open up the concealed diseases picture that may give new clues for selection of remedy.

7.  Nosological prescription
 

This method of prescription helps the physician mostly when there are acute infections with only common symptoms.  Nosological prescriptions are made when there is no or very less symptoms to individualising case.  In such conditions certain remedies that were found effective in such conditions are routinely prescribed to take care of the acute symptoms. Also in case of epidemics, where most of the patients have the same set of symptoms, remedies that had given relief to the earlier patients are prescribed for that disease

This sort of prescriptions is done rarely by experienced homeopaths.

8. Organopathic Prescription
 

Oraganopathic prescriptions are made based on the Paracelsus principle that the given drugs affect given organs (parts) by self elective preference. Many doctors like J H Clark, R T Coopers, Boger, and Burnett, have given in their experiences  on the importance of selection of Organopathic remedies and their usefulness when other guiding symptoms, causations and Miasms were rare or not available.

Such references are available on Chelidonium, Cardus, Chionanthus, Leptendra, Myrica, Kalmegh, for liver disorders;  Sabal Ser, Ferr Pic  for Prostate affection;  Adonis V, Cactus, Crategus,  Strophanthus for heart disorders.  From their experience, these experts have identified the special affinity of these medicines on special organs and used at random for affections.  These are usually prescribed as rejuvenators of the organ.

9.  Pathological Prescription
 

Pathological prescription is given based on the similarity to the disease process or pathological changes. Generally low potencies in repeated doses are effective for severe pathological conditions like cancer.  Dr C M Boger’s  Boenninghausen's Characteristics MM and Repertory  gives several information for selecting remedies based on Pathological generals

10.  Synthetic Prescriptions
 

Many mineral remedies exist naturally as salts. Nat. Mur is a synthetic form of Sodium and Chloride; Nat Mur is already available as a fully proven remedy. But in some cases wherein the symptoms of two mineral remedies appear some physicians prefer to give a synthetic prescription. For example, when a case looks like Cal Carb and Phos, one might give Calcarea Phosphorica, which is a synthetic form of those two.

11.  Tautopathic Prescriptions
 

Some remedies are made from drugs or chemicals, which are known as tautopathic remedies Example: cortisone, Penicillin, etc., If a person has never been well since taking the drug or he is addicted and is trying to get off the drug, that specific drug in Homoeopathic form (tautopathic) can be prescribed.

12.  Palliative Prescriptions
 

In terminally ill patients the aim of the physician would be to ensure painlessness, less discomfort and relief to the suffering of the patient. In this regard Homeopathy is effective without side effects.

In some cases, palliation is a necessary tool of prescribing, not just in terminal illness but in any situation where there is extreme pain or urgency. As human beings, our inclination is to alleviate suffering where possible; however, this may be resorted to incurable cases, otherwise the precious symptoms that form the totality may get suppressed and the case may become an incurable one.

Conclusion

In Homeopathy, the most appropriate treatment protocol is based on the simila principle; however, this may not happen in all the cases. This is because in certain cases there may not be adequate symptom to select the similimum, or in certain cases  already  other mode of treatment might have been applied and the true picture  might be masked. There may also be instances the case may be at an incurable stage, which may warrant only palliation. Therefore, planning the course of treatment may not always be on a fixed protocol. Experienced physicians switch from one method to another based on the case, availability of the symptoms and also based on his experience.  The basic objective is to find out a closest similmum to the patients totality of symptom perceived by the physician, through his skill, knowledge and observations. Sometimes the physician may get a clue about the similmum with one or two symptoms, wherein he may resort to key not prescription, in another case he may have to take full case history to get the totality. Even in such cases  if the physician is not able to arrive a similimum, he may evaluate the miasmatic back ground, past history etc to get  more accurate prescription. This is the artistic aspects of case study peculiar in homeopathy. 

 References

Best of Burnet, Compiled by H.L. Chitkara,   First Edition, 1992, B Jain Publishes, New Delhi

http://www.homeorizon.com/homeopathic-articles/homeopathic-philosophy/200-years-of-organon-of-medicine

http://www.homoeopathyclinic.com/articles/homoeo/prescribing/prescribing_11.htm9.

  • PUBLISHED DATE : Dec 17, 2015
  • PUBLISHED BY : Zahid
  • CREATED / VALIDATED BY : Dr. Eswara Das
  • LAST UPDATED ON : Dec 17, 2015

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