After Prescribing, What After Prescribing
NATIONAL JOURNAL OF HOMOEOPATHY 1995 Sep / Oct Vol IV No 5.
Kulay F M.
Cases.
` Calc / Nat-m.

It is well known that drugs have their own pace. Aconite and Belladonna are quick, act fast. Bryonia state develops slowly and Bryonia-action too is slow. There are deep-acting drugs which are reputed to be slow. Alumina being one of these frustratingly slow acting drugs, even in its curative process. It is therefore a study in itself to realize what and when to expect anything after prescribing a remedy.

Kent writes feelingly in his picture of Helleborus:- "The remedy acts slowly in these slow, stubborn, stupid cases of brain and spinal trouble. Sometimes there is no apparent change until the day after the remedy is administered, or even the next night, when there comes a sweat, a diarrhoea or a vomit - a reaction. They must not be interfered with; no remedy must be given. These are signs of reaction. If the child has the vitality to recover, he will now recover. If the vomiting is stopped by any remedy, the Helleborus will be antidoted. Leave the vomiting or the diarrhoea or the sweat alone, and it will pass away during the day. The child will become warm, and in a few days will return to consciousness - and then what will take place? Just imagine these benumbed fingers and hands and limbs, this benumbed skin everywhere. What would be the most natural thing to develop as evidence of the rousing up of this stupid child? It is necessary for you to know this. It is not really a part of the teaching of Homoeopathic Materia Medica, but you must know what to expect after giving this remedy. It is a clinical observation which you will see if you see Helleborus cases, and Zincum cases. Zincum is, if possible, even more profound in its dreadful state of stupefaction than Helleborus. Well, that childs fingers will commence to tingle. As he comes back to his normal nervous condition, the fingers commence to tingle, the nose and ears tingle, and the child begins to scream and toss back and forth and roll about the bed. The neighbors will come in and say. "I would send that doctor away unless he gives something to help that child", but as sure as you do it you will have a dead baby in twenty-four hours. That child is getting well, leave him alone. You will never be able to manage one of these cases if you do not take the father into a room by himself and tell him just how the case will proceed".

Kent reiterates the above observation in his picture of Zincum-metallicum. Kent thus helps one to envision the formication, the tingling that will be unleashed by the resumption of blood circulation all over in these sluggish, stupid, stupefied cases lying like dead logs. The patient may writhe in distress and frighten those around him, who will then become impatient and alarmed. But surely, as Kent teaches, this is the time for the prescriber to keep his nerves, not to succumb to the temptation to prescribe or repeat. He must recognize the state as one of a desirable reaction and as one that must not be interfered with. The prescription for the patient - more to allay the fears of those around - has to be PLACEBO!

Way back in 1963, I had a case of a woman of 35-36 years of age, with a total right-sided paralysis. She was discharged from a hospital, where she had only three evacuations in 45 days, all after enemas. Apparently, the paralytic condition had affected the colon too, and there was no bowel movement. On the basis of symptoms, which I do not recall now, I confidently settled upon Alumina and gave two doses in the 10m, one at night and the second on the following morning.

Not expecting the paralysis to yield in a short time, especially in view of the well-known slowness of Alumina, my worry was - What to expect? Theoretically the worry was really about how long to wait in the absence of a reaction or response, when to repeat or what to do next?

A week later, the husband reported that there was no change, except that she passed a normal stool on all days of the week. I had the reply on my anxious question. Since there was nothing else to go by, I decided to wait, not to interfere, as long as the stool report was the same. On reflection, I also suspected a within-outward action of the drug as well as, which is perhaps the same thing, an action on a more important organ first. Week after week, I received the same report, no change in paralytic limbs but stools normal, and at times I felt frustrated. This went on for about ten months, when signs of life were first seen in the limbs. Then, within a matter of few days - four or five, the paralysis was completely gone. For a couple of years thereafter, she was perfectly well. Then I lost track of the case.

Before describing another case of Alumina, I may be permitted a digression. The classification of remedies as, slow or fast, or even as acute and chronic, does not display a rigid index, but only nurtures an expectation. A single dose of Bryonia often relieves in minutes and Belladonna frequently needs to be repeated over twenty-four hours or more.

After prescribing several remedies over a period of about five months for a nagging left should pain with some ameliorations now and then, followed by definite relapses, my attention was drawn to Belladonna. Not that I had not thought of it before. I had written Belladonna off from the drug-repertory for the case right from the beginning; I was prejudiced, to say the least. I could then see, in a flash as if, features of Belladonna pain which had been peeping through the mass of symptoms - aching pain, worse least jar, sudden intense onslaught of pain and as sudden its departure, and so on. Prescription: Belladonna 1M - 1 dose at night.

The man reported the next morning that within eight to ten minutes of taking Belladonna 1M, he began to belch and sure enough, the pain almost disappeared in a few more seconds. Slept well after many nights. But felt a ghost of a pain - just an awareness of a very mild discomfort - in the affected site. I had given Belladonna 1M the previous night, less out of conviction, more in desperation. A second dose was given now out of the curiosity to know what follows its administration. Again, he had a few eructations within eight minutes and he felt fine as never before.

This set me thinking. I recalled, and reconfirmed, what Clarke had said in his Dictionary under Silica, "The symptoms of Sil differ from those of Puls in being more constant, more deep-seated, and longer lasting; for instance, the mucous secretions of Pulsatilla become easily purulent under the action of sil. Tests point out that Pulsatilla flourishes best on sandy soils (as Bell does on calcareous soils). "I wondered if Bell could, flourishing in calcareous soil, promote a case towards Calc-carb. In Kents repertory, Calcarea carries two and three marks, and none, under the rubrics.

1. Stomach, eructations
2. Abdomen, flatulence
3. Stomach, eructations amel

Lyco carries three marks under each of the above rubrics. Bell scores three, one, zero, respectively. So, both Bell and Calc have no mark in "Eructations amel".

Does the above convey a lesson? One does not know. Learning is not a matter of zeal alone (though zeal there must be). It must be backed by the potential to learn. That the two-zeal and potential - are often in inverse proportion is not a cause for concern; it confirms, as has been done time and again, the volatile nature of man. Only that which matches his (mans) volatility, and therefore unpredictability, can cure him to an extent, be it a drug, a smile or a smite. Cure in the absolute sense is not possible nor desirable, as long as man is discontented with his finitude, and propels himself towards the unachievable, and keeps implicating sorrow as joy, foolishness as intelligence, vindictiveness as bravery, and projecting on others his own failings (a miser seeing others as misers).

So, the lesson - Homoeopathy has discovered the behavior of substances in Nature, to match mans behavioral anomalies. In certain conditions, Pulsatilla and Bryonia become chilly. Though generally known as warm drug personalities, and Silica is warm, though a chilly drug essentially, yet likes cold drinks although chilly. Kali-iod is very warm but is worse from cold drinks, and so forth.

Belladonna showed, by its action in the left shoulder pain of five months, that it will help any case, when correctly chosen, irrespective of chronicity or otherwise. More importantly, it revealed the next prescription, Lycopodium, by jumping over its well known complementary, Calcarea-carb.

A remedy chosen correctly not only benefits but gives out certain signals which must be watched carefully and interpreted in accordance with the laws of cure. A turmoil that follows administration of Helleborus or Zincum needs to be analysed to ensure whether it is a desirable response. Alumina left behind an unmistakable clue, normal stool, and the drug was never repeated for ten months. There can be various signals. Consider the following case of Alumina.

"From 1942 or so onwards, I was subject to annual winter attacks (December - January - February) of Right Knee Rheumatism, making the leg immobile for a month or more, year after year. In July of 1958 or 1959, Dr. EGK Menon gave me two doses of Alumina (200 or 1M). He told me after I had taken them that the pain might return. It surely did in a weeks time, but in a very mild bearable form, lasted a few days and never returned (1994). However, it did something else in exchange. Small boils began to appear on the seat. A group would come and go and another crop would follow. This went on with varying severity for the next eleven years. It did cause discomfort but nothing compared with the annual agony of the knee-pains. The process continued till 1968 or so. There has been no recurrence of rheumatism (1994)".

The long period of skin -suffering had to match the depth of original ailment of the knee and had to be borne. It was not easy to suffer for so long, but given the choice between it and the annual knee episode it was acceptable.

In this case a mild knee pain appeared within a week of taking the drug, lasted only a few days and after a fortnight I had been completely rid of the rheumatism. What can be faster, especially in view of the snails speed of Alumina? But was the curative action of the drug over in a fortnight? No, it lasted a decade, cleansing the economy slowly but thoroughly. Yes, Alumina is slow, yet fast, and Belladonna acts on planes deeper than generally attributed to it.

The question, "after prescribing what" is answered by Homoeopathic Laws of Cure (Dr. Herings Law of the direction of cure). They are couched in a few words, but they say much more. Stated simply, they say that the curative process should move along fixed directions, such as from -

1. Above downward;
2. Within outward;
3. From more important organs to less important; and
4. In the reverse order of the appearance of symptoms.

Some authors may add - From the Centre to the Circumference or From the Mind to the Body and so forth.

Serious reflection shows that these various formulations express a single law of the process of cure. The various forms of its expression listed above is armed at simplifying the matter for a learners comprehension, for violation of the law is a sure indication of a wrong prescription. Cure must proceed above downward, within outwards and from more to less important organs. Look at the human body beginning with the brain, moving down to heart etc. ending in lower limbs, and consider the protection provided to internal organs (say, heart) as compared with those at the periphery (Knerr) (call them organs within and without or those occupying the centre and others lying on the circumference, etc). Disease with its disciplined behaviors manifests itself on least important organs first, eg. in the form of the eczema, ringworm, pain in knee and so on. Maltreatment suppresses these avenues of expressive and the angry disease force moves inward (suppression of rheumatism of the knee leading to cardiac rheumatism, or ill-treatment of tuberculous lungs end by attacking the brain in the form of insanity). Reflex on the above which is, undoubtedly, an oversimplification for the sake of brevity, and you will realize the asthma which came AFTER the suppression of, say ring worm, should go first, being the last to appear. Ringworm must THEN reappear, and must be treated not suppressed. This is conveyed by the phrase "reverse order". One can now realize that all the laws express a single truth that the process of cure must respect the discipline of Disease.

The discipline of Disease is to spend its force on non-royal organs. If these manifestations are suppressed, the Disease will be compelled to spend its force on deeper organs and royal organs, and to do so, it will move upward or inward as the need of its own discipline may require.

This is a law none can violate without inviting more serious suffering and even death. It is therefore necessary to realize that the law helps to evaluate AFTER a prescription is made if the curative process is moving along the desired direction. Administration of that remedy which not only ACTS but ACTS in accordance with the DIRECTION explained in the LAW, alone qualifies as a correct prescription. It is here that the concepts of First and Second Prescriptions assume importance and are assigned chapters in Homoeopathic books enunciating principles. A remedy may have disruptive action even though it is a Homoeopathic remedy, given by a Homoeopath. So, the question "After prescription what?" is vitally connected with the question "Before prescribing what?" The answer in theory may appear simple but its application in practice is by no means easy. The aim of the homoeopath is to discover the similimum, to consider the totality of symptoms given case and choose that remedy which has produced a SIMILAR pathogenesis in its proving.

But what is a "similar" remedy? What Totality? Homoeopaths often prescribe successfully on the basis of a single piece of information relating to history. For example Head-injury - Nat-sulph, Loss of sleep with anxiety - Cocculus. Equally good results are frequently obtained on the basis of Key-notes. For example Nausea with clean tongue - Ipecac; hunger with aversion to bathing - Sulph etc. Such prompt prescription cannot be condemned; but they cannot be recommended to a novice. Medical men with a deep study of Materia Medica and long experience alone can achieve such feats, sometimes on the basis of what is reported, ie., without even having seen the patient. An example - A case not seen actually is lying in a hospital with gangrene of left small toe sadly awaiting amputation of the foot. The Homoeopathic prescriber on learning of the patient having diabetes, diabetic gangrene, very old constipation, with numbness and emaciation of the left leg over the last two years, sends a dose or two of Plumbum 200 with confidence and is happy, though not surprised, about the good results that follow. These represent short-cuts born out of knowledge and insight; they do not amount really to a compromise with the concept of Similar or Totality.

When do we call two things as similar? If we think of similars as resembling, then we may say any two things are recognized as similar if the points of resemblance between them outweigh the points of difference.

Thus, we first learn what object is called a "table"; we learn, in other words, the essence, or the meaning and application of the word "table" to a certain class of objects. When we see next an essentially similar object, we ignore its colour, material of which it is made (wood, steel), and unhesitatingly identify it as "table". No two tables are alike in an absolute sense. It is hard to find any such pair in Nature.

We can, however, conceive two absolutely resembling things, if only to grasp the concept of similarity well. Two things, which have no points of difference are called "identical". If they were named A and B, then one of them could not be identified as A or B, when presented alone. Two Pulsatilla persons can be identified as A and B because they are similar in spite of differences; they could not be identified in the absence of all difference. Our Doctrine of Similars is not a doctrine of Identicals. A person having no similarity whatever with Pulsatilla symptoms has been in fact, so poisoned by Pulsatilla that the whole nature of Pulsatilla has been unexceptionably engrafted on him. He needs an antidote, not more Pulsatilla. He is not similar to, but identical with, Pulsatilla.

It is for this reason that Pulsatilla which receives only one mark for constipation in Kents Repertory may be perfectly Homoeopathic to a severely constipated case because the case and Pulsatilla are similar in their essence. When the book says, "Sluggish and constipated bowels contra-indicates Chamomilla", and again "mental calmness contraindicates Cham". (both from Boericke), it emphasizes what is essential to the nature of Chamomilla and in what degree. If not diarrhoea, at least normal stool, is expected, but whining, spitefulness, impatience etc are a must to Chamomillas nature. A calm Chamomilla is a contradiction-in-terms.

In the light of the above, we may understand a few more things about the concept of similars in Homoeopathy. A polycrest covers many and diverse conditions of commonly, and sometimes uncommonly, met human sufferings. Firstly, no case which benefits from Pulsatilla has all or even most of the symptoms recorded in its provings.

Different cases can be assumed as smaller symptom-groups under Pulsatilla, but all, share its essential nature, and benefit from it. Secondly, we cure many advanced and even "incurable" cases, but our system of proving is not pressed to the extent of producing such pathological or malignant states. Provers are instructed to stop taking the drug being proved as soon as its action is felt. We then glean from the records of many provers that which reflects the essential nature of the drug - action on intellectual, emotional and bodily planes. Prescribing with the help of the understanding of the essences of drugs, we gain clinical experience and report to the fraternity our clinical successes in serious diseases. Our repertories keep swelling with a host of details collected from clinical evidence.

Why are provings not pushed deep enough? Why should we stop the consumption of the drug-being proved once symptoms begin to appear? Here is what Kent says under Thuja:

"The taking of the drug to prove it, does not do so much harm, provided the one who is directing the proving realizes when the symptoms begin to rise, and then stops the drug. Now if we go on with the proving by repeating the doses after the symptoms come on, we force the drug into the economy when he is already poisoned, and by this means we get a confusion in the symptoms, the drug disease engrafted upon that individual for life".

If we have such a prover coming to us as a patient and if we did not know that he has over-proved Thuja, we would see an unmistakable image of Thuja and prescribe it with conviction. And by doing so, we would, poison him further with Thuja, unwittingly though. This is the distinction between similars and identicals which I have tried to clarify earlier.

Thus, it is no mean responsibility not to rejoice inwardly when we find an over-similar drug picture in a patient. For, it is possible that every little thing may be found to match with the drug in our mind, and that may be a red signal. On further enquiry, we are most likely to find that the patient has not only received the drug earlier, but has been continuing to receive it!

If all this appears far-fetched, I may reveal the genesis of my coming to consider the distinction between the two concepts. A friends wife was brought for treatment. She looked Calcarea totally. My friend knew a good bit of Homoeopathy. I therefore wondered why he failed to see the Calcarea image? He told me that he was very sure of Calc and kept giving it over the previous two years without effect and that he brought her to me because he was so puzzled. That must have been in 1969 or so. I recalled Kents Thuja passage, and I saw immediately that here was a case of drug poisoning. Persistent reflection led me to draw the distinction between Similars and Identicals, the latter needing an antidote if the graft is not permanent like that of Lachesis on Dr. Hering, (which was not for any fault of his).

So the ideal of prescribing is to pass the test of the Law of Cure, so to say, for that confirms the correctness or otherwise of your effort and, thus, the responsibility begins before prescribing. The first prescription may be the fifth or sixth drug chosen and administered. In the by now well known Astacus case, George Vithoulkas "caught" it after having administered several other and certainly well thought-out drugs.

CASE 1:

Master SMP, 11 years old, developed black painful warts on left side of face and forehead since 4 months. Slightly flabby tongue with white coating on sided on the back posterior of the tongue.

P-H-O-Malaria

Likes potatoes, milk. Aversion to fish.
A moderately warm boy, he was lean but active. Afraid of dark, poor in studies. At times got violent and even threw things away. Except for his fear of dark, occasional violent behaviour and definite love of potatoes, there was not much to go by.

Considering his being lean, and poor in studies, one dose of Calc-phos 1M was given on 14-7-1993. There was no change for a month. Giving weightage to the affinity for facial warts, a dose of Calc-carb 1M, was given on 18-8-1993.

On 11-9-1993, his mother reported that some warts has fallen off. By 22-9-1993, only one big wart remained, but none when he called on 13-10-1993.

Calcarea family is easy to miss in favour of the Natrum family, especially Natrum-mur. It would be better to keep in mind the following repertorial comparisons:

Calc-carb Calc-phos Natrum-mur

1. Consolation agg 1 2 3
2. Company, aversion to 1 2 3
3. Desire salt 1 2 3

I was forced to take note of the above comparison in a chronic case having numerous complaints of a middle aged fastidious man whose symptom picture unmistakably brought Nat-mur to ones mind. He came to me after having been treated long enough by a repeated Homoeopath. I argued to myself that he must have been given Nat-mur and I must, therefore, look for a drug that could have been missed. And Calc-phos did the trick.

CASE 2: Cure By Transference

A two and a half months old baby girl, quite chubby with a sweaty scalp, was brought on 2-6-1994 with a painless umbilical hernia of the size of a ping-pong ball. I thought of Calcarea-carb, but did not prescribe it. I had given Calcarea-carb 1M - 1 dose - to the mother on 11-5-1994. Since the mother was definitely improving, I decided, by the way of learning, to see if mothers milk transmits the Calcarea benefit to the baby.

When the mother called on 25-6-1994, the babys hernia-size was reduced by about 80 percent. In another three weeks, it was completely gone.

EDITOR: I gave this title to the case as it is the most singular aspect of this case. But it brings to my minds some questions:-

1. When did the mother receive her first dose of Calcarea? and why did the baby not start improving as soon as mother took Calcarea?
2. Whether all breast-fed babies require no medication the mothers remedy happens to be the same as the childs?

These questions were put to the author and his reply already received is included here.

The Author replies -

1. The baby had the hernia since birth. The mother come for treatment of her complaint and on feeling better she brought her baby for treatment within a week - too short a time to see amelioration.
2. The Author who is practising since 1969 says that if a baby is exclusively breast-fed, he does not require any treatment if the following two conditions are met.
   1. The mother is improving according to the Herings Law of cure, whatever her complaints.
   2. If there is a history of say Asthma and the baby develops it while mother is on Homoeopathic treatment, then too the baby does not require any treatment - it will pass off by itself, or rather through mothers medication.

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