Boger touches upon some of the finer points of the technique of prescribing. “A single dose,” he remarks, “is given and the effect awaited. In very acute affections the response will come in a few minutes or hours. If the disease is of a more prolonged nature, from the fourth to the twelfth day it will develop a crisis and show us our bearings. In chronic cases, periods of aggravations may come and go like waves even until the sixteenth week, while the patient himself shows a gradual improvement. When, however, each of these waves is followed by increasing weakness, the case is usually hopeless.” On the appearance of new symptoms he says, “Often a new symptoms complex is only a variation of the older image and requires a repetition of the former remedy in a different potency.
Having carefully made up our mind as to the indicated remedy, we should be slow to change, always thoroughly testing the chosen medicine in the same scale of potencies as well as in the repetition of the dose, before abandoning it for another… We all know that when the constitutional remedy is finally worked out, it will cure almost any disease that may attacked him, even though these later symptoms may seem the opposite of those previously removed, for it must be remembered that these later manifestations are also, in all likelihood, alternate effects of the drug already in use; it were therefore folly to change the prescription.
It is a trouble maker and mixes up our cases.” Elsewhere he makes the pertinent statement that, “when old groups of symptoms come back, the mental are the most important and the best guide for the selection of the remedy.”
Again, in commenting on a paper by Grace Stevens, Boger says: “The cases with the feeblest aggravations are the ones that get along best- those with a mere suggestion of an aggravation. A gentle reaction leads to a more permanent cure.”
Under the heading of “Pointers” in the same volume, Boger is quoted as saying, “You can avoid an aggravation from a high potency by giving it in three doses two hours apart.”
Case has this to say about new symptoms: “If an eruption is an old symptom reproduced by the homoeopathic remedy, it will usually be cured by that prescription unless the appearance was of a chronic nature, then it may need one or more repetitions of the same remedy, at long intervals, to effect a cure. If the eruption is an entirely new symptoms, it shows that the ailment was in the system and the vital force needed help to throw it to the surface. If so, the eruption will soon reach its height, then gradually disappear. But if, on the other hand, the eruption persists or continues to increase in severity, it should be regarded as a new symptom and as the important guide to a remedy required for the cure of patient.”
Kent gives, by far, the most comprehensive treatment of our subject in his Lectures on Homoeopathic Philosophy. His teachings are based on the works of the homoeopathic school, including his own. The greater part of what follows is, in effect, a resume of his lectures, those of Close, or paragraphs 252 to 263 of The Organon and Hahnemanns work on Chronic Diseases.
All of these eminent homoeopathists, as we have seen, emphasize the absolute necessity of learning to wait on the action of the remedy, and of being able to distinguish between a genuine homoeopathic aggravation and one due to the action of the medicine or to the natural course of the disease itself.
Thus Wells says, “Those periods of time during which we are anxiously waiting, are a necessary part of cure; and chiefly during this period the drug is not necessarily inactive because the results of its action are not yet externally visible.”
And Lippe: “The most serious mistake that we, as well as others, have made [is] in not carefully following Hahnemanns third precaution. Hastiness in not allowing each dose sufficient time to develop and exhaust its action.”
Boger exclaims: “The watchword is wait, wait, while the full picture develops; then prescribe and your success will be pronounced and permanent.”
Close says that the hardest thing we have to learn is to wait.
There are, in general, eleven different phases in the reactions of the patient after the remedy has been given. They are as follows:
1. A steadily progressing amelioration of all symptoms.
This by most informed prescribers is considered the ideal of remedial action. It is positive proof that the potency was not too high, but quiet high enough to cope with the ailment from which the patient is suffering. While it is most often met with in acute cases, it is frequently observed in affections uncomplicated by the effects of previous drugging or other ill- advised treatment; it rarely occurs in chronic cases where the potency was right.
2. A Sharp, short and vigorous aggravation, followed by relief of all symptoms and an increase in the patients strength.
This type of aggravation is much to be desired. It is a positive indication that the medicine and the potency were correctly chosen and the cure will be rapid and complete. An aggravation of this sort is most often seen in patients of strong vitality and good reactive power, and who have little or no gross tissue changes in the internal organs; but it is frequently observed when the potency used was higher than it need have been. A lower dilution would have produced the gentle reaction which, Boger says, leads to a more permanent cure.
3. A long continued aggravation but final and slowly progressing improvement.
This reaction occurs when the medicine was administered in a potency too high for the reactive power of the patient, whose vitality, however, was able finally to assert itself, and in time, genuine curative action begins. It is usually and indication that the case was on the borderline of incurability, and often one where extensive pathology is present.
4. A prolonged aggravation and final decline of the patients condition.
If the remedy was well chosen, this is a sign that it was too deep-acting or given in too high a potency, and that vital, curative reaction in the patient was not possible.
It is well, Kent says, in incurable or doubtful cases, to give nothing higher than the 30th or 200th and to watch the results with the greatest care.
5. Amelioration of the symptoms, followed in a longer or shorter period by an aggravation.
This type of reaction is unfavorable and for two reasons. Either the medicine was not truly homoeopathic to the case and therefore acted only as a palliative, or the disease is incurable. Only by a careful review of the symptoms can the physician decide which of these two reasons is the right one. He must consider the time element, the nature of the disease and the peculiarities of the remedy prescribed. Before changing to a new remedy, he must determine whether the increased severity of the symptoms was due to the unusual but normal action that characterizes some drugs, or to the failing energy of his patient.
He must bear in mind that some drugs have deferred aggravation. Phosphorus is one of them. Case found that a patient who has received this drug may experience an aggravation at the end of twelve days; Boger has observed the same phenomenon in four days; Roberts as early as forty-eight hours. Under these circumstances, it is unwise to repeat the remedy or to change it too hastily.
The severity of the aggravation and the nature of the symptoms involved also calls for the most careful scrutiny. If they are more or less trivial or belong to the so-called external parts of the body-the skin, limbs, etc. while the mental condition and the general tone of the patient are improved, by no means should the remedy be interfered with. As Hahnemann has pointed out, these symptoms will usually pass off in a few days and improvement will continue uninterruptedly. Moreover, as Boger has told us, “Disease of a more prolonged nature, from the fourth day, may develop a crisis and show us our bearings. In chronic diseases, periods of aggravation may come and go like waves, even until the sixteenth week”.
6. A brief period of relief followed by a return of the symptoms as they wee before the medicine was given.
This is a sign that the remedy was only partially homoeopathic to the case, that its action was in some way interfered with, that it was administered in too low a potency or that the case is incurable. It is often met with in violent, rapidly progressing acute diseases, where the power of the medicine is used up by the intensity of the disease process and frequent repetition is necessary to produce a curative reaction.
This reaction is also observed in sluggish, phlegmatic individuals who are slow to respond to the action of the best selected remedy. Kent advises the use of the very high potencies in such cases. Close on the other hand, entertains the theory that in some instances, the crude drug is actually more homoeopathic than the potencies where pathology has masked the finer indications. He cites several cases of heart affections in the later stages where Digitalis, which corresponded to the pathology and the few remaining symptomatic indications, restored the invalid to a fair degree of health, which was maintained for several years thereafter.
In any event, a re-study of the symptoms is called for. If the remedy given proves to be inappropriate, a new one should be considered; if it is found to be the similimum, it should be tried in a higher potency before changing it for a new one.
But this does not apply in all cases. A higher potency may do harm. According to kent, too short an amelioration from a well- chosen remedy suggests the presence of hidden or unrecognized pathology in some of the vital organs. If the case is patently hopeless and palliation is the only recourse, the treatment should consist in the use of lower potencies of the lighter acting remedies, which will be found chiefly among those derived from the vegetable kingdom.
Roberts says that, “sometimes a complementary remedy of less depth of action will actually assist the patient to a place where cure may be carried out later by the deep-acting similimum, or it will surely palliate the dangerous and distressing symptoms if no cure is possible.”
In reviewing the case after a remedy has suddenly ceased to function the physician should, by all means, endeavor to discover whether or not something in the patients habits, environment, his recent experiences, or the possibility that he has taken some drug which has interfered with proper remedy action.
7. A full time amelioration of the symptoms, yet no special increase of the strength or mental condition of the patient.
Roberts has found that “this condition is encountered in cases where there are structural changes. We meet these conditions where organs like the kidney or kidneys are involved and can function only in part. The remedy may keep the patient comfortable, however, and by careful repetitions at frequent intervals the patient may be kept comfortable for a considerable period of time, even though you will not be justified in expecting a cure.”
8. When the patient reacts unduly to every remedy given, no matter what the potency in which it is administered.
These are the over-sensitives, and usually they are among the most difficult to treat. They make the best provers.
Hahnemann has already spoken on this observation. He says that “Every aggravation of a disease that occurs during the use of a medicine.. in the form of new symptoms not hitherto proper to the disease.. is always the effect of the medicine, which is an unsuitably chosen positive remedy, or as a negative (palliative) remedy, either ill-selected or given for too long a time, and in too large doses.” These new symptoms may be easily identified if the prescriber knows his materia medica, for, as Hahnemann says, “they are not proper to the disease,” but are due to the “peculiar mode of action of the remedy,” whereas the true homoeopathic aggravation is an increase in intensity of the symptoms on which the remedy was prescribed.
If the new symptoms are more or less trivial, they will pass off in a few days; if severe, an antidote should be administered. Needless to say, if due to too frequent or too long continued dosing with a low potency, the medicine should be stopped at once.
But there is another class of new symptoms which indicate that the remedy is acting curatively. They may be purely physiological, as the hoarse cry of an infant with cerebral meningitis, the moaning and other indications that a comatose patient is returning to consciousness; or marked tingling and formication in a paralysed part, when the motor and sensory nerves are again beginning to function. That the remedy is working in the right direction is proved, in the first case, by the subsidence of the fever and reawakening of the mental faculties, and in the third, by a gradual restoration of the power of motion; and in all cases, by the fact that the patient is somewhat stronger.
A bilious diarrhoea occurs quite naturally if a distended gall bladder is emptied when the remedy has reduced the swelling in the cystic duct; a purulent discharge from the urethra may be expected when an old stricture sloughs out, or a leucorrhoea must follow from the release of pus from an abscess in a Fallopian tube, else the remedy has failed to act.
On the other hand, a leucorrhoea never before experienced by the patient may be a most favorable sign when it occurs under the action of a well-chosen remedy. The unexpected appearance of an eruption on the skin is an indication that it had been suppressed and the patient had forgotten to tell the physician about it, or it may be, as Case says, that “the ailment was in the system and the vital force needed help to throw it to the surface.” The allopath considers these manifestations as a new disease or an allergy and treats them accordingly, as does the average routinist of the New School.
Diarrhoea may be an indication that the case is progressing favorably even when the gastro-intestinal tract seems not to have been involved. For example, an infant girl suffering from gonorrhoeal ophthalmia had a copious alvine discharge half an hour after a dose of Sulphur 200th, followed almost immediately by improvement and eventual cure of the eye-condition. Possibly this new symptom may be explained on biological grounds, but it had no apparent relation to the original disease.
9. The reappearance of old symptoms.
This is an unmistakable sign that the symptoms are taking the right direction and that the patient is on the road to recovery. As Roberts expresses it, “It is a step in the right direction. Cure takes place from within outward, from above downward, from important organs to less important ones, and symptoms disappear in the reverse order of their appearance.”
10. Symptoms disappear in the wrong direction.
It is scarcely necessary to say that in this case the remedy has been wrongly selected and no time must be lost in antidoting it. As Kent points out, “To prescriber for gouty or rheumatic conditions without due regard for the other symptoms of the case is dangerous. To fit a remedy to one part or organ may jeopardize the future health or even the life of the patient.”
The majority of those who consult a homoeopathic physician have gone the rounds of the old school doctors or have endeavored to cure themselves with patent medicines or even homoeopathic remedies before seeking his advice. However much the physician may know of the materia medica, however proficient he may be in the art of prescribing the remedy and the manner of its repetition, if he wishes to make genuine homoeopathic cures, he should familiarize himself with every least detail of the instructions given in this paper and in the writings of the old masters of our School.