THE PRINCIPLES OF PRESCRIBING
Homoeopathic prescribing is scientific prescribing and is based on the Science of Symptomatology, which includes or is based upon the Law of Similars. Unless one comprehends the Science of Symptomatology homoeopathic prescribing is very difficult and unsatisfactory, and even with the broadest comprehension of true Symptomatology it is often no easy task, as none of the sciences are in their art. The farther we get from the teaching of the Organon of the healing art as taught by Hahnemann the more uncertain and the more unsatisfactory becomes the art of healing the sick. Homoeopathic Symptomatology is not a mere array of the signs of sickness as expressed by the patient. Nor is it the aggregate of the subjective and objective expressions of disease. The mere symptom cover is not a true homoeopathician. Yet today the tendency with homoeopathic physicians is to cover symptoms, as nosological prescribing is with our allopathic fraters. There is more to a sick condition than the mere name, as there is more to a homoeopathc symptom than the simple sensation. The homoeopath must be a broad-minded man as well as philosophical. He is to consider the “totality of symptoms.” This “totality of symptoms” is misconceived by a certain part of the profession. It has not to do with the aggregate of symptoms so much as with the completeness or entirety of symptoms. Totality means whole, entire, full, complete, not divided, and its synonyms are “whole, entire, complete” Wholeness implies freedom from deficiency, not deflective or imperfect, integral. The “totality of symptoms” means, then, the completed symptoms, the symptom in its entirety, with all its integral parts.
At times many symptoms of a patient should not be considered in a given prescription because they are lacking in completeness and are misleading, or lead to guessing. This is what Hahnemann refers to in the last clause of Section 153, of the Organon when he says the undefined symptoms demand but little attention in prescribing. Every symptom to be complete or total must have four integral parts: (1) the Locality; (2) the Sensation; (3) the Concomitant; (4) the Modality, or the conditions of aggravation or amelioration. The Science of Symptomatology is the consideration of complete symptoms with their relations to conditions and circumstances, to causes, family history, the history of the patient, environment, and every feature that can affect the sick condition of the patient. The “Taking of the Case” is the most difficult part of the prescriber’s work, but when that is thoroughly done the selection of the remedy is less difficult and its certainty of action is more pronounced.
But even after the remedy has been given, the greatest judgment must be exercised to allow its uninterrupted action, for the interrupted action of a curative remedy will give very much trouble and sometimes will spoil the case. The only rule governing the repetition of a remedy is that given by Hahnemann, that is, to let it alone after a good response has been noticeable so long as it acts. But right here it is often most difficult to know with certainty whether the new symptom picture is the result of the curative action of the right remedy or the disorganizing action of the wrong remedy. Experience and patient waiting must largely be the guide. Many physicians fail in this part of their labors and give up in despair instead of facing the ordeal by determined efforts to overcome the deficiency and to master the Philosophy of Homoeopathics.
The greater the mastery of the Science of Symptomatology and the Philosophy of Homoeopathics the easier becomes the art of prescribing successfully. It does not require a great amount of knowledge to palliate sickness, especially by the censurable routine of our old school friends, but good judgment, comprehension of the Law of Cure, and hard work are necessary to the cure of disease, particularly that of the chronic form.
If we should stop here the task of prescribing would remain too difficult except for the master mind. We have an invaluable aid to prescribing in the Peculiarities of a given case that make the task much easier in the majority of instances when we have properly studied the Materia Medica in the true “totality of symptoms” or the completeness of symptoms, as well as their relation to diseased conditions. We must know what to expect in a given sick condition before we can know what is peculiar to that condition. There is no greater help in this field of study than the comparison and differentiation of the pathogenesis of the remedies with the diagnostic signs of disease. You must know your remedies by their peculiarities as you know your friends by their idiosyncrasies, and the familiarity must be so marked that the mention of the peculiarity by the recitation of complaints by the patients at once calls up the remedy. This is accomplished by the mental law of association. There is no need to endeavor to commit to memory the Materia Medica, it would be as foolish and impracticable as to endeavor to commit the dictionary in all its parts, but by forming the mental picture of the peculiarities of remedies vividly on the mind, they become, by the law of association, the keynotes around which the other symptom notes assemble to make the harmony of the case.
The peculiarity is not merely the odd symptom. It may be a very common one, but peculiar by its relations and modalities. In Paragraph 152, of the Organon, Hahnemann says: “In this search for a homoeopathic specific remedy, that is to say, in this comparison of the collective symptoms of the natural disease with the list of symptoms of known medicines, in order to find among these an artificial morbific agent corresponding by similarity to the disease to be cured, the more striking, singular, uncommon, and peculiar (characteristic) signs and symptoms of the case of disease are chiefly and almost solely to be kept in view; for it is more particularly these that very similar ones i the list of symptoms of the selected medicine must correspond to, in order to constitute it the most suitable for effecting the cure.”
We see from this paragraph that a true keynote symptom or symptomatic peculiarity has four characteristics. It must be
- Striking; that is surprising, forcible, impressive, very noticeable, a prominent feature.
- Singular; that is, out of the ordinary course, unusual, exceptional.
- Uncommon; that is, not common, infrequent in such a case, rare, hence remarkable.
- Peculiar; that is, belonging solely or especially to an individual; of private, personal, or characteristic possession; not possessed in common; not usually present in the diseased condition; belonging to the patient as distinct from other patients with the same sickness; the individuality of the patient or case.
There is much confusion regarding the keynote. Some physicians conceive it to be a mere oddity or a prominent action of the remedy. It is this, but much more. The keynote is a peculiarity as well as an uncommon symptom, but the setting, the association, makes it the guide in the selection to the homoeopathic remedy. Remember, I say, makes it the guide in the selection of the homoeopathic remedy, and not the sole basis of the selection. What is a peculiarity or keynote in one case may be a very common or unworthy symptom in another case. The keynote peculiarity does not merely refer to the pathogenetic symptom of the remedy, but must correspond equally to the totality of the symptom list in the patient. It must not only be present in the symptom picture of the case, but it must be strikingly, forcibly present and show its peculiarity by its setting and relative association in the symptom complex. This peculiarity may be such from its location, from its sensation, from its concomitants from the modalities, or from its association alone.
The keynote is not the only note in a given piece of music the keynote would not make harmony if sounded alone; it requires other notes to make a tune. While it is the principal note of the piece of music, other notes may be more essential to musical harmony, yet these other notes revolve around and about the keynote. Those who prescribe on one symptom because it is known to be a peculiar one to the remedy, err and fail simply from the fact that they forget that the remedy must be suited to the peculiarities of the patient and not the patient to the peculiarities of the remedy. The patient must be examined to ascertain the individual peculiarities and then the remedy adjusted to the symptom picture as a whole.
The warfare by some eminent and highly respected physicians against the keynote because of its abuse is simply a logomachy, a war of words. The very best prescribers use the keynote in a legitimate way. Even those who fight the name use the principle in every possible way. It is not wisdom to oppose a principle because of its abuse by those who do not understand the Science of Symptomatology nor the Philosophy of Homoeopathics. These warriors, for the purity of practice, stultify themselves by the practical use of the principle they denounce. It would be wiser and more conducive to the furtherance of the good cause of pure Homoeopathy to denounce the abuse and error of conception of the principle and exemplify the correct use in reports of cases from actual practice.
The whole foundation of Homoeopathy is the Law of Similars, and no prescription is homoeopathic, no matter what potency may be used, unless the principle of Simility is at its foundation. It in not prescribing, on the name of a disease, the diagnosis, though that may be a prominent feature for consideration. It is further est removed from routine prescribing, yet in edidemics when the characteristics of the epidemic have been ascertained by careful investigation, it may border on the routine because the one remedy will largely cover the cases of the epidemic. There is such a thing as family prescribing, for members of a given family with apparently different diseases may, from the peculiarity of the family as present in the given case, require the same remedy. There is also a large foundation of truth in the employment of the organ or locality remedies, remedies having peculiar and marked affinity for certain organs and locations of the body. But in all these care must be exercised not to overlook the “totality of symptoms,” the peculiarities of the individual patient. The curative remedy must correspond in its pathogenesis to the symptom picture of the patient, not in part, but in whole. This correspondence must be, not only in the list of symptoms, but in the degree of relative importance and prominence of the symptoms. A prominent symptom of the patient must be covered by a corresponding eminently prominent symptom in the remedy. A symptom of low degree in the patient should not be covered by a symptom very prominent in the remedy, because it may magnify that symptom and change the relative value of the patient’s diseased symptoms. The equation of symptoms is a factor in homoeopathis prescribing.
Finally, of the two classes of symptoms, the subjective and objective, the former is of the greater importance. The subjective or mental symptoms are those of the patient’s own consciousness, those not knowable to the physician except as the patient reveals them. The objective are those symptoms observed by the physician and are, hence, more material and of less value from this reason. The objective symptoms refer more to the diagnosis and pathology of the disease. The diagnostic symptoms are of little value in the selection of the homoeopathic remedy because they are common the disease and not peculiar to the individual patient as are the subjective or mental symptoms. The objective symptoms have more or less value in prescribing and may be of great value in the absence of the mental symptoms, but usually not of great value, whereas the subjective symptoms are always of the highest value.
It is no easy task to be a successful and scientific homoeopathic prescriber, but it pays to seek the highest ideal.
By Dr. W.A. Yingling, Emporia, Kan.