Why Failures In Homoeopathic Prescribing

Rastogi R S


Homoeopathy is based upon the laws of nature. “Similia Similibus Curantur” is a law of nature, as unerring and immutable as the law of Gravity. As a fruit detached from the tree must fall to the ground, so recovery must follow when a patient is treated according to the homoeopathic laws provided recovery is possible. The homoeopathic laws cannot make a man immortal as immortality is against the laws of nature. So also, where the disease has advanced so far as to lead to the destruction of organs and tissues, it would be futile to expect a cure. The limitations of homoeopathy must be understood, and the laws applied rationally if success is to be aspired for.

All sickness express itself through signs and symptoms and this is the only channel through which it reveals itself. A diseased condition would be deemed incurable when there are no prescriptive symptoms or when the Vital Energy fails to respond to the indicated remedy. When the physician fails to find out the symptoms or the patient conceals the symptoms, or when there are no prescriptive symptoms as often happens in malignant growths or too far advanced organic diseases, they are unknown to the prescriber and the chances of recovery are very feeble indeed.

The expression “prescriptive symptom” means a symptom having value for the purposes of prescribing. To be of prescriptive value symptoms should have certain characteristics and modalities. For example, a pain in the chest conveys little meaning to the homoeopath and will not enable him to pick out the curative remedy for his patient from a list of remedies having chest pain as a symptom, but when the patient qualifies his statement by adding that it is a sort of stitching pain aggravated at each breath and ameliorated by lying on the painful side, it has very decisive significance for the prescriber pointing to Bryonia as the indicated remedy.

In malignant growths and too far advanced organic diseases, there is a great paucity of prescriptive symptoms, as the patients entire attention is focussed on the tumour or an intense pain and all the past and present symptoms with prescriptive characteristics and modalities sink into the background and are often forgotten, and in proportion as this happens, he is to be considered incurable. To illustrate:

A boy aged 15 years whose mother had died of uterine cancer, came in for the treatment of a tumour of the size of a large pea on the right side of his lower lip. He was in excellent health otherwise and had nothing else whatever to complain of. The problem was what to prescribe on! One thing struck me as the patient entered my clinic; the lower half of his body was well built and strong while the upper half was comparatively thinner so much so that if you saw both the halves separately you could not believe they belong to the same person! He clothed himself moderately. This guided me to the selection of Lycopodium which in the 200th & 1000th potencies cleared up the growth in a little less than two months.

Fortunately the sphere of incurable diseased conditions is very small under Homoeopathic system of treatment as it puts the patient in maximum harmony with the laws of Nature.

Some other limitations of Homoeopathy should be clearly understood if unnecessary disappointment is to be avoided. Hahnemann has clearly said that a physicians duty is to understand and remove the Cause of the disease, and this may at times be entirely external or mechanical, requiring purely external means of treatment. Thus in cases of external injuries, e.g. when there is profuse bleeding due to some artery being cut or when a bone has been fractured, or a foreign body has got into the eye, ear or nose, or in cases of poisoning, it would be far from wise to attempt to treat the case homoeopathically alone without the application of mechanical or surgical methods.

If any dynamic effects are anticipated e.g. tetanus after injuries, etc. (Ledum, Hypericum) or if any dynamic effects do actually ensue as in chronic effects of poisoning or blood poisoning from wounds, etc., internal homoeopathic medication must be resorted to. When there is a foreign body, say a bullet, encysted in a lung or lodged up in a Vital place, or if there is an abscess in an internal organ with no external outlet, it would be unwise to suppurate out the abscess or the foreign body, and the matter must be left to surgical discretion.

Again, in the class of diseases where malnutrition results from lack of proper foods in stead of lack of powers of assimilation, Homoeo-therapy cannot be expected to take the place of a correction of dietetic deficiencies and errors. In short, all obstacles to recovery must be removed before we proceed to apply the indicated remedy. The internal and dynamic causes are to be treated by internal and dynamic means while purely external causes have to be dealt with by external means.

It may be pointed out, however, that Homoeopathy has considerably narrowed the sphere of Surgery, and patients no longer need to run to the surgeon in a routine way for the operation of tonsils, tumours, abscesses and carbuncles, etc. Fortunately, conditions hitherto considered by the orthodox medicine to be surgical are now amenable to homoeotherapy. One marvellous feature of Homoeo-therapy is the process of aborting abscess and carbuncles and promoting a reabsorption of pus even when the same has been clearly demonstrated by fluctuation.

With this background of a realisation of the limitations of Homoeopathy, we now proceed to consider some other common faults in Homoeopathic prescribing which spell failure.

How often we have received the admonition treat the patient and not the disease. And just how frequently we forget this basic concept and court failures. There was a very bad case of Dysentery, a girl of about 11 years, and the tenesmus was so severe that the girl would double up on account of pain and would go into convulsions and faint. The usual features of mucous, blood and great frequency of stools were, of course, present.

She had been treated with Nux Vom and Merc Cor., but then the patient called me and also requested that a certain physician be called in consultation as in his view the condition of the girl was very serious. Now this physician made a very through physical examination and after a percussion of the abdomen exclaimed Great flatulence! This is the cause of the convulsions and fainting”. Basing the prescription on this finding, he suggested Carbo Veg 30 three hourly. But as the patients father entrusted the case to my care, I had to depend upon my own judgment, and was able to bring her round with Colocynth 30.

Another case may be in point as an illustration. A young man of about 30 years was a dyspeptic, suffering from indigestion, flatulence, heartburn and occasional pain in the region of the appendix. He had been drugged with Penicillin, all kinds of allopathic mixture, and Bismuth and Soda Bicarb powders till he came to the condition; in acute attack, when whatever nourishment he took and even water was vomited out as soon as it reached the stomach. He had great thirst, taking water in small sips, and was mentally and physically very restless. He had not passed any stools for the last few days in spite of enemas.

They asked me to take up the case, and I started with Nux Vom 200 and later gave Bismuth 200, with a little relief to the patient. After two days they got impatient and felt like calling another physician in consultation to expedite recovery and very entreatingly asked for my consent. So this physician came on the scene and after an examination of the patient exclaimed – “Reversed peristalsis! Just give three doses of Asafoetida 30, four hourly and you will see the different!” A relation of the patient who happened to be an allopathic physician asked me if I agreed. It would have been a tough job to say that I did not agree; so I left it to them to decide what course they wanted to adopt.

They decided to try the other physicians treatment, administered Asafoetida 30, three doses four hourly. At about midnight, the allopath relation came and reported that while there was no relief in the vomiting, a diarrhoea had been added on and the patient was feeling very much weak, worse generally, with marked anxiety and restlessness. He also disclosed that China 30 had been given since the evening to arrest the diarrhoea but without any favourable results. On his offering apologies for the bungling, Ars 30 was given in two hourly doses, three times, which not only tided over the night, but enabled the patient to go on to recovery with Placebos spread on a period of about two weeks.

Now, if failure in prescribing is to be avoided, we must avoid the temptation to treat diseases and pathological states. Every time it is the patient who is to be treated.

The image of the patients sickness is reflected in the “totality of symptoms” upon which alone Hahnemann has advised us to base prescriptions. By this, some of us and most laymen seem to understand that homoeopathic prescribing is merely symptom matching in its ordinary sense, and so they administer remedies in which they just happen to see some of the symptoms of the patient regardless of their quality or proportion, interweaving them with their own theories of certain symptoms being caused by certain factors. Such prescribing is just hitting in the dark and may score a solitary cure here and there but it will never make a good prescriber.

The law “Similia similibus Curantur” demands that there should be a real and genuine similarity between the symptoms of the patient and the symptoms of the remedy as regards the nature, intensity, volume and velocity of the symptoms, so that the “totality” is not a mere numerical totality but a qualitative totality which is tantamount to an image with the correct emphasis on the proportion in which the symptoms are blended to form the image or the picture of the sickness as a whole. We are then to determine from our knowledge of the materia medica which remedy gives the image most similar to our patients sickness.

And just as you cannot give an identifiable description of a friend by merely saying he has got two hands, two feet, a nose, and two eyes, so you can never describe or understand a diseased state by describing the common symptoms of the disease or by its pathological state. Our main reliance must always be placed upon the symptoms which signify the patient. Hahnemann has given a clear directive that we should be particularly and almost exclusively attentive to those Symptoms that are peculiar to or characteristic of the patient, and not to those that are common to the disease.

As an illustration, dyspnoea, wheezing, inability to lie down, difficulty in raising expectoration are some of the common symptoms of asthma and can hardly lead you to prescribe a remedy, but if the dyspnoea is aggravated in damp weather, the patient gets a weak gone feeling in the chest and must hold the chest when coughing, how clearly we are helped in the selection of Natrum Sulph as a remedy. Or if our asthma patient feels marked relief by lying down, it is a strange and rare and peculiar symptom and at once decides choice in favour of Psorinum.

Having seen the value of peculiar and characteristic symptoms, we must take note of another important aspect of the matter. To be of prescriptive value, even a peculiar and characteristic symptom must be equally well marked both in the patient and in the remedy. For example, if a patient sometimes feels slight heat in the soles of feet at night, this symptom may not justify the selection of Sulphur which has got this symptom in a very strong degree, having made the provers declare that their feet burnt as if on fire.

Yet another important thing to remember is regarding the velocity of symptoms, i.e. the pace at which symptoms develop in a case of sickness and in the proving of the drug which appears related to the case. Thus, how much so ever, Aconite or Belladonna may appear to be indicated in a case of Typhoid, they are not likely to be helpful in the case as their velocity is not at all similar to Typhoid velocity. In serious conditions we cannot afford to indulge in the “trial and error” method and so a knowledge of these stages and states is essential if we want to be saved from failures and disappointments.

Thus in a case of Puerperal Septicaemia, the earlier we can control the case the better it is. Instead of hunting around among Aconite, Bryonia, Belladonna, Opium etc. which have got little or no resemblance to Septic states, study closely for Sulphur, Lycopodium, Ferrum, Pulsatilla and Pyrogenium. In a severe case of Pneumonia involving the hepatisation of a considerable portion of the lung, suppose your patient starts sinking at about 2 or 3 A.M. with the characteristic Arsenic symptoms, you may be able to tide over the crisis with the help of Arsenicum.

But do not wait too long upon it as it is not related to the stage of hepatisation and will not be able to clear up the lungs of the products of hepatisation. As soon as the patient has rallied round sufficiently from the state of sinking and collapse, he must receive a suitable remedy like Sulphur or Phosphorus if he is to be saved from fatal termination.

How we neglect considerations of velocity, stages and states will perhaps be illustrated better by an illustration. A lady of about 40 years of age got fever and abdominal pain. Considering it to be malarial, the allopathic physician gave her Quinine by mouth and injection. When this failed, he gave her Sulpha drugs despite which the fever and pain persisted and a hard mass appeared to be localising near and attached to the uterus. A course of Penicillin injections also was given by which the range of fever came down a little, but the hard mass continued to increase in size. About a month rolled by and the lady had by now grown very weak and anaemic, and the verdict of her physicians was that operation was the only thing left which she was too weak to undergo.

Her husband could see that her chances of surviving after the operation were very remote and called in a homoeopath who diagnosed an inflammation and started giving her Belladonna 30 three times a day. A two days trial found her weaker and more restless with aches and pains in the body, particularly back, with a slow pulse. Pyrogenium 200 was prescribed and two doses were given every 4 hours. She became more restful and felt considerably better. On the third day she started passing lot of pus per rectum whereupon her allopathic physician frightened them very much, warning them to be prepared for the fatal end.

I, however, asked them to boil a small handful of neem* *Azadiract Indica, a tree whose leaves possess germicidal and healing properties When used externally as a lotion. It is used as a medicine internally also. leaves in a little water and to give her low pressure enemas once a day to wash out the pus. Internally she was given placebos for four days, and finally a dose of Silica 200 to finish off the cure. It is now four years and the lady continues in excellent health.

The important point to consider in the case is that we are to treat the patient and not an inflammation, and that even if for a moment we concentrate our attention on the “inflammation” aspect of the case, we must try to visualise what remedy has in its genius inflammation of the nature and type which our patient has, coming on with the pace and speed with which it came on the case under consideration. Belladonna – inflammations have quite a fast and violent speed and are attended with a high fever, and do not take such a long time in their resolution.

We have already noticed that all symptoms are not alike but they have different values for the purposes of prescribing. A detailed exposition of the comparative prescriptive values of symptoms would be beyond the scope of the present paper. I would, however, outline a brief classification to assist in such valuation. As we have observed, symptoms most peculiar to the patient should be the first to be considered and these are valuable in proportion as they are related to the whole individual rather than to its parts. The following gradation would perhaps express their relative importance best.


i.e. symptoms relating to the patient as distinguished from his parts:-

(1) Symptoms relating to desires and aversions, loves and hatreds. To illustrate: some people lose the love of their very life and want of commit suicide; some persons begin to hate their near and dear ones; their own children; some crave hot food and drinks, others desire ice-cream and cold, refreshing things. Some develop aversion to meat, others to milk or bread.

(ii) Now in importance are those relating to the mind and intellectual faculties. One patient is obstinate, head strong, quarrelsome and irritable, the other mild, gentle, yielding, inclined to feel hurt and weep over trifles. Likewise remedies too have different types of temperaments.

(iii) Thirdly come to the symptoms relating to the memory.

II. next in gradation or almost equally important are another class of symptoms including their modifying conditions, relating again to the whole individual.

(c) One group of this class are the symptoms showing the patients reaction to heat, cold, rest, motion, storm, weather, day, night and time.

(b) Second group of these is the symptoms showing the nature of the patients blood, discharges from bowels, bladder, uterus, ears, nose, ulcers, wounds, etc. Nature of the discharges means their colour, consistency, odor, acridity and blandness. The discharge show the imprint of the disease on the vital economy as much as other symptoms referred to above.

III. Lastly come the symptoms relating to the parts, with their modalities. Here also there may be strange, rare and peculiar symptoms which may be considered as guiding as those of the first two classes. In fact many cases seem to be composed only of particulars, and the generals, if any are of a vague and unimportant nature. In such cases peculiar and characteristic particulars become very important, and the selection of the remedy must be based upon them. In this connection, another point demands notice. The modalities relating to the parts may be contradictory to the modalities relating to the whole individual, and the remedy selected should be able to reconcile both.

Any remedy correctly worked out should reflect the image of the patient, and should fit him, his parts, his symptoms, and modalities. I would again emphasize that it is the rank of the symptoms which should weigh in the selection of the remedy rather than their numerical preponderance. In a case with ten peculiar and characteristic symptoms, if one remedy covers seven but of a very low rank while another remedy covers five which are of a high grade corresponding to the rank of symptoms as experienced by the patient, the second remedy is more likely to be the curative one. Also, if generals of a high rank are present, we should not worry if the particulars are not found in the remedy.

The master prescriber, Dr. Kent, has strongly emphasised this point. An illustration may be helpful. A boy aged about 12 years got malarial fever and was cured (?) of it in about a week. After remaining well for about 3 or 4 days, he started getting attacks of abdominal pain daily, accompanied by ineffectual urging to stools, commencing daily about midday and subsiding by about 10 P.M. when he would go to sleep and wake up all right next morning. All this had been going for six days when I was called, and during this period the boy had passed no stools, not even flatus.

He had also been getting vomiting at times, the vomited matter being very bad-testing and foul smelling, greenish and sometimes blackish fluids. The pain would make the boy very restless obliging him to assume all sorts of positions in bed and driving him from bed to chair and chair to bed. His allopathic doctor had asked him to go to a surgeon for abdominal operation for obstruction of the bowels.

A single dose of Ars. 200 settled the matter. The next day there was hardly any pain but there was a very offensive smelling vomit containing four hard round balls appearing to be faecal matter. He then started passing winds and the next day passed a stool. Without any further medicine he progressed on to full recovery. If attention were to be focussed only on the obstruction of the bowel what would be the position of Arsenicum? Yet, the generals strongly demanded Arsenicum, and it did not disappoint!

And when with all possible care you have selected the remedy and administered it in a suitable potency, there are the chronic miasms Psora, Syphilis & Sycosis to obstruct the action of the remedy or to terminate it in an unexpectedly short time. I remember the case of a child of about four years of age who used to get convulsions during the least fever off and on. In one of these attacks I tried the best indicated remedies and failed to stop the convulsions. Two doses of Sulphur 30 at half-hourly intervals marvellously ended the whole trouble, and a dose was given on the next two consecutive mornings. It is now four years, and even though the boy has had fever sometimes, the convulsions have never been witnessed ever since then.

After weighing all these considerations, would anybody still assert that homoeopathy is mere symptoms covering? The artistic matching of the genius of the sickness with the genius of the remedy is an art which is the acquisition of a lucky few, coming after hard labour and mature experience alone. And yet this is only the first hurdle to be crossed in the attainment of the goal of clinical success.

The selection of the suitable potency, the repetition of the dose only when the effect of the earlier dose is exhausted and not earlier, knowledge and application of the prognostic conclusions from the action of the remedy, patiently watching the effects of the remedy, watching the old symptoms, reappearing and disappearing according to the laws of cure, retaining the power of sound judgment in trying reactions, resisting the temptation to repeat or change remedies too quickly – these are some of the other hurdles where many of our less fortunate, less experienced and less steady comrades falter.

Hard work and persistent endeavour alone can enable each and every one of us to attain the goal. In the hours of trials and tribulations, let us not despair and start blaming homoeopathy, but in all humility ask ourselves – “Have I done my part flawlessly?” Kent says: “And if you hear that somebody has tried this and tried that without success, remember that somebody has demonstrated his own failure. Homoeopathy is capable of demonstrating itself in all intelligent hands.” If we shall adopt the aphorism “Glory is all Homoeopathys, the faults are entirely our own” and approach our failures with the genuine outlook of a student, the success we aspire for will surely be ours.

Homoeopathy never betrayed a heart that loved her and followed her faithfully.

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