Difficulties in Prescribing



“The signs of aggravation, however slight they may be, are the opposite of the preceding, and consist in an embarrassed, helpless state of mind, while the department, attitude, and actions of patients appeal to our sympathy.” (Org., p. 174.)

Dr. “C” writes: “What value must I put on the generals Heat and Cold?”

These generals must be used with care. Be careful, for example, to distinguish between stuffiness and warmth. Also the patient must be very markedly affected by heat or cold. And this susceptibility is far more important when it is a change of condition, due to illness, than when it is the patient’s normal state.

He asks: “Are these generals sufficient to cut out cold or hot drugs, whatever the mentals may be?”

Here the question of Grading of Symptoms comes in. If mental symptoms are well marked, they are of prime importance in prescribing.

He adds: “I have often been disappointed by my second prescription. At end of four or five weeks after a single dose, when patient is going back (after having had a good result) when the repetition of the drug produces no benefit, after waiting a fortnight, how am I to find the new drug or potency?”

Hahnemann meets this question. He says: “The homoeopathic physician ought to examine the symptoms every time he prescribes; otherwise he cannot know whether the same remedy is indicated a second time, or whether a medicine is at all appropriate.” (Chr. Dis., p. 160).

On the other hand, the very fact that a remedy has so helped the patient is a valuable symptom; and it may be unwise to abandon it before trying the effect of a higher potency.

Dr. “D” writes: “My greatest difficulty is in the second and subsequent prescriptions. The generals remain the same; the chief guide therefore is unchanged; and there are only particulars to guide one… on which your method places little value.”

In the first place the method is Hahnemann’s, not mine.

If patient is improved give sac. lac., and give this again and again, so long as improvement continues. Even the particulars, unless dependent on a mechanical cause, should disappear. If patient goes back and symptoms remain the same, repeat same remedy and same potency. If it ceases to hold so long, and symptoms return, give same remedy in higher potency. And again, and again placebo, so long as improvement continues, probably for a longer time. If symptoms change, and yet the patient feels better, still give placebo. These may be a return of old symptoms, on the road to cure. Patient may be doing his return journey, especially if they reappear and die away, in the reverse order of their appearing years ago. If the symptoms change, and are not a return of old symptoms, and the patient is not improving, reconsider the case and get the new drug that now fits the altered condition. At the same time do not be too slavish in basing your prescription on ill -marked generals. Marked particulars with modalities, or peculiar symptoms, may be really all there is of the case; and far more important than a host of generals that one has manufactured, and which are not sufficiently marked to exclude remedies from consideration.

Dr. “C” asks further: “Is a knowledge of the drugs that follow well the most important thing?”

The lists of drugs that follow well contain mere suggestions, and are helpful where there are few symptoms to guide you,

He then quotes the case of a child that did well under Calcarea carb. (200 to c.m. potencies) for a year. He improved very much under treatment, but the parents complained that he was only well while taking the medicine.

Hahnemann says where there is no manifest exciting or maintaining cause, one must always have regard to the possibility of the existence of “some miasm.” Probably, to complete the cure, the child needed Tuberculin, or one of the other nosodes.

Dr. “E” raises an important point… “Why did not the well- indicated remedy help this case?”

His excellent results, as you will see, answer his question.

“1923. February 20.-Mrs. O., aged 28; two children. Constipation, getting worse; no desire for stool. Purgatives lose their effect; takes raw fruit, Upset with menses, which last twenty days, with seven days clear. They are copious, bright-red, with clots. Sickness and vomiting for first three days of menses; keeps her in bed generally. No trouble when children born. Patient is tall; thin; fair hair; waxy complexion. (<) cold; warm room; (>) open air. Feels will lose her reason during thunderstorm. (<) on rising; (>) noon. Desire for salt; aversion to meat, to all fats, which upset. (<) pastry. Music her delight; highly strung. (<) dark; alone. No T.B. history. Phosphorus 1m, one dose.

“March 1.-No change. Phosphorus 10m, one dose.

“April 11.-No better. Tuberculinum bov. 1m one dose.

“May 28 – Much better every way till May 18. Eating better. Stronger; more cheerful. Less nervous; no sickness with this M.P. Has had a daily stool till May 18; since then going back in this respect. Says `wonderful wee pills’. Tub, bov. 1m, one dose”.

“Why did not Phos help this case?”

Hahnemann recognizes the stop-spot of treatment by symptoms only. He says: “These alone (with due regard to the possible existence of some miasm) must constitute the medium through which the disease demands and points out its curative agent”.

Sometimes patients declare there is no T.B. history; and later tell us, after inquiry, that statement was not correct.

Allen says: Think of Tuberculinum when the best selected remedy fails to relieve, or permanently improve.” Dr. “E” finds another difficulty “where there are only particulars relating to complaint – no mentals or generals. Patient appears to be in perfect health.”

Here one must be alive to the possibility of some tumour causing pressure symptoms.

On the other hand, there are often cases which present merely particulars, and these, forming the totality of the case, must guide to the prescription. The following is a case in point:-

February, 1913: J.W., a minister, aged 52. Headache for thirty years, every few weeks. These bowl him over for two days. Wakes with slight pain, which increases during the day till he vomits, which relieves. Buries his head in the pillow. He seems to be poisoned with them. Lies like a log, quite dazed, wakes up to vomit, then dozes again. Pain, nail-like; in patches. Better for pressure; lying on sore side; dark; eyes closed; keeping still. Worse for light; noise; sitting up. Gets bilious attacks at changes of the weather. Is faintish on first lying down at night. Vertigo looking up, There were no mental symptoms; no worry or depression.

The drug that worked through best was Sanguinaria….It had his nail pain; pain right temple in the a.m.

Better dark room; pressure; after vomiting; worse light; noise. Vertigo looking up. He got Sang 200, three doses.

June he reported: “Very bad the first few days, and scarcely a headache since. Nothing to even stop me from reading. No vertigo no faintness. Not feeling the changes of the weather. No medicine.

September: One bad headache the beginning of July. Sanguinaria 200, three doses.

February, 1914: Only slightest traces of headache till this week. Sanguinaria 200, three doses.

May, 1914: Perfectly well. No headache. Some years later I heard that patient was still well.

Dr. “F” feels more and more the importance of getting all the modalities of the physical stage before entering on mental symptoms. Recently good result in case of duodenal ulcer from Chelidonium given because of relief lying on left side, with legs flexed. A cholecystitis (probably) has had relief (great) from Calcarea, given because of relief lying on back. Drugs selected according to mental symptoms had failed.”

In this regard one must remember that “a number of strong particulars must not be neglected on account of one, or even more, weak generals.” Strong particulars with modalities are very important in the working out of any case. One must also remember that not all drugs are equally well represented in the repertory.

Many very important drugs appear, perhaps only once, but in highest type, in some small rubric. They have come into too recent use, or are not sufficiently proved, to find a place in the work. In such cases one has to go to the materia medica to realize whether the drug truly fits the case.

Again he asks: “How can one get mental symptoms without asking leading questions?”

Dr. Gibson Miller says: “These symptoms are naturally the most difficult to elicit, for people, as a rule, shrink from revealing their inmost thoughts and motives, their hatreds and yearnings, their evil tendencies, and their delusions,, and it requires the greatest tact and a full knowledge of human nature, before we can hope to win the confidence of our patient and to understand his deepest thoughts”.

Here, also, the friends of the patient may help us much, specially in regard to important changes of disposition; besides that, we are helped by our own observation. The mental symptoms we generally leave to the last, till the patient is familiar with our methods, and we have had time to gain his confidence.

John Weir
Sir John Weir (1879 – 1971), FFHom 1943. John Weir was the first modern homeopath by Royal appointment, from 1918 onwards. John Weir was Consultant Physician at the London Homeopathic Hospital in 1910, and he was appointed the Compton Burnett Professor of Materia Medica in 1911. He was President of the Faculty of Homeopathy in 1923.
Weir received his medical education first at Glasgow University MB ChB 1907, and then on a sabbatical year in Chicago under the tutelage of Dr James Tyler Kent of Hering Medical College during 1908-9. Weir reputedly first learned of homeopathy through his contact with Dr Robert Gibson Miller.
John Weir wrote- Some of the Outstanding Homeopathic Remedies for Acute Conditions with Margaret Tyler, Homeopathy and its Importance in Treatment of Chronic Disease, The Trend of Modern Medicine, The Science and Art of Homeopathy, Brit Homeo Jnl, The Present Day Attitude of the Medical Profession Towards Homeopathy, Brit Homeo Jnl XVI, 1926, p.212ff, Homeopathy: a System of Therapeutics, The Hahnemann Convalescent Home, Bournemouth, Brit Homeo Jnl 20, 1931, 200-201, Homeopathy an Explanation of its Principles, British Homeopathy During the Last 100 Years, Brit Homeo Jnl 23, 1932: etc