Antidoting the first Prescription: When and Why did you do it?

Abstract: The sick individual should be the aim of the physician; his whole concern should be centred upon the sick to determine whether he is improving or declining with the treatment or unknowingly he is making proving of the medicine. The whole future of the patient depends upon the conclusions that the physician derives from his observations during case taking, case processing and follow up assessment which further directs the action i.e. first and the subsequent second prescription. Based upon the action of the first prescription, the next second prescription can be a placebo, repetition of the same medicine, change of medicine, anti-miasmatic remedy or an antidote. This case based editorial will help us to understand what we infer when a patient narrates his chief complaints and the history of frequent consuming of prophylactic medicine Ars Alb 30 without any medical supervision and approach towards selecting an antidote.

Introduction

Hahnemann in his guidelines on case taking mentioned that “the individualizing examination of a case of disease, for which I shall only give in this place general directions, of which the practitioner will bear in mind only what is applicable for each individual case, demands of the physician nothing but freedom from prejudice and sound senses, attention in observing and fidelity in tracing the picture of the disease.” [1] As per the above aphorism, one of the demands on the part of a physician is his powers of observation. Physician observes the evolution of symptoms, further he does analysis of symptoms for the purpose of selecting the similimum. After the administration of the similimum some action should result.  What are we to expect after the remedy has been administered? It is upon the development and interpretation of the action of the remedy, or the reaction of the vital energy to the remedy, that successful prescribing very largely depends. [2] After administration of a remedy to a sick individual the probable outcome can be either amelioration or aggravation. If there is amelioration that means the prescription was similimum and there is registration of medicine. If the patient is taking the wrong direction i.e. the prognosis has become bad after the first prescription, then the physician should antidote the medicine instantly. Therefore, after remedial prescription the second important part is follow up (outcome assessment), and its interpretation decides the further course of action. But what will happen when the healthy individual without any medical supervision consumes Homoeopathic medicine as a prophylactic?  Definitely his state of health will be altered into a state of disease. Therefore, prognosis after observing the action of the remedy demands perceiving what changes have taken place after administration of medicine by a Homoeopathic physician [3] or after self- medication. At this instance the knowledge of remedy relationship [4] will help the physician to undertake study of the remedies that are complementary, follows well, followed well by, similar to each other and antidote. 

• Caselet:

The case taking was done through telemedicine during Covid-19 outbreak. This case demonstrates the importance of homoeopathic clinical investigation, if rightly conducted, evaluated and acted upon, yields results to live up the mission of physician. 

• Opening of Interview

Mr. YZ, a 40-year-old businessman with a known case of (K/C/O) chronic allergic rhinitis, was under homoeopathic management with Calc Carb 200 a weekly single dose at bedtime. He provided oral implicit consent for telephonic consultation.

• Body of the Interview

The patient’s complaints were (a) sudden fear of contracting COVID-19 as one new case has been identified in his vicinity, (b) anxiety for his 6-month-old son, (c) worried about what will happen to his family if they contract the disease, (d)

anxiety felt in and around the chest and (e) 2–3 episodes of loose motions in small quantities with generalised weakness and exhausted feeling.

• Interview Plan (IP)

Based on the patient’s narrative, the physician formulated the IP and enquired specifically about consumption of Ars alb 30 as a prophylactic medicine. The patient confirmed it. 

The physician had asked this specific question as the panic generated by COVID-19 had led to free distribution and over-the-counter availability of Ars alb, often leading to unnecessary repetition without any medical supervision.

• Logical framework

The physician needed to conduct an anamnesis of the case information available through telecommunication. Further, integration of the chief complaints, COVID-19 and pre- or post-Ars alb consumption questionnaire will reflect the

physician’s skills.

• Case Analysis

Quick assessment for patient evaluation can be formulated using problem definition (PD) in terms of identifying the cause, evolution and expression of disease; this helps to form the totality of symptoms (TOS), [Table 1].

Table 1: Patient evaluation by identifying cause, its evolution and symptomatic expression.

Table 2: Repertorization sheet 

Remedies covering the TOS

After repertorization, Ars alb (14/5), Calc carb (11/4), Phos (10/4), Carc (8/3) and Arg nit (8/4) were the closely coming up remedies. Ars covered the totality and there was a recent history of Ars alb 30 consumption as a prophylactic. Therefore, this was interpreted as to be a proving of Ars alb, as ‘all medicinal substances have the power of causing disease when given to persons in health.’ 

Action: Antidote.

Antidote selection:

Table 3: Remedy relationship of Ars Alb.

Remedy relationship of Ars alb (Table 3) and repertorization sheet (Table 2) were studied. It was observed that the remedies that antidote Ars alb and the ones that are there in the repertorial sheet i.e. closely coming remedies are Nux v (7/3), Tab (6/4) and Camphora (6/3) were considered. 

Ars 14/5, Calc, 11/4, Phos, 10/4, Carc 9/3, Arg-n 8/4, Kali-ar 8/3, Nit-ac 8/3, Sulph 7/4, Apis 7/3, Gels 7/3, Kali-c 7/3, Merc 7/3, Nux-v 7/5, Phos- ac 7/3, Cupr 6/4, Hep 6/4, Plat 6/4, Puls 6/4, Tab 6/4, Acon 6/3, Arn 6/3, Camph 6/3, Chin 6/3, Kali- p 6/3.

Table 4: Differentiation between Nux Vom and Camphor

Differentiation was done by understanding the Ars alb remedy relationship [7] with Nux v, Tab and Camphora as well as the patient’s constitutional remedy (Calc), [Table 4]. Nux v, Tab and Camphora are antidotes that cover the TOS. However, on studying the Materia Medica, we can select the antidote using the principles of arriving at a Similimum. Ars alb is followed well by Nux v, it also follows Calc and Nux v. Moreover, it is similar to Calc and Nux v and is antidoted by Camphora and Nux v. Fear, phobias and disease impending, is the qualified characteristic mental symptom that predominantly affected the patient and led to other expressions, is covered by Nux v as 2 marks and Tab having 1 mark gradation [Table 4]. Further study of Ars alb being Anti-psoric and its duration of action being 36 days [8], the therapeutic plan was to antidote the medicine with Nux Vom.

Therapeutic Management: Nux v 200C single dose.

Follow-up consult (remedy response evaluation) on telephone:

• The patient felt somewhat better within an hour of the dose. 
• On day 2: Anxiety >+++, Sense of well-being (SWB) is present, stools are normal, there is no weakness. Patient was fully restored to health.

Action: Rx: SL 2 pills qds x 7 days

Advice: To report, if needed.

Learning

Significance of history taking through the telephone (telephomoeopathy), formulation of problem definition (PD), problem resolution (PR), interview plan (IP), [9] study of proving, remedy relationship and remedy response evaluation.

References:

1. Hahnemann, S., 2005. Organon of medicine. B. Jain publishers
2. Roberts, H.A., 2002. The Principles and Art of Cure by Homoeopathy: A Modern Textbook. B. Jain Publishers
3. Kent, J.T., 2003. Lectures on homoeopathic philosophy. B. Jain publishers.
4. Knerr, C.B., 2003. Drug relationship. B. Jain Publishers
5. Jawahar S, Zomeo Software, Mumbai: Mind Technologies: 2018 
6. Tiwary HS, Treuherz F. Treasure Works of John Henry Clarke. 1st ed. Noida: B Jain Publishers; 2019. 
7. Boericke W. Pocket Manual of Homoeopathic Materia Medica. India: Motilal Banarsidas Publishers; 1993. 
8. Lutze, F.H., 1890. Duration of Action of Antidotes of the Principal Remedies. The Homoeopathic Physician, 10(10), p.439.
9. Kapse AR. ICR Operational Manual. Mumbai: Dr M L Dhawale Memorial Trust; 2015.