|Single or Multiple
Medicine Prescribing - A Debate
at the Royal London
Homoeopathic Hospital on 7 July 1992.
The debate was chaired by Dr Peter Fisher.
'This House believes that the single
remedy is the
medicine of experience'
Proposing the motion
Dr David Curtin:
Ladies and Gentlemen: I would like to begin by
just a very brief review of the basis of homoeopathy. On what do we base a homoeopathic
prescription? We look at the totality of the symptoms of the patient, paying particular
attention to symptoms which individualise the patient and then we look for a remedy to
match the symptoms of the patient, one which has a similar symptom picture and we look for
such a remedy in the materia medica. The information about each remedy in the materia
medica is based on provings, in many cases verified by clinical experience and in a few
cases based on clinical experience alone. We look for one that is the most similar to the
symptoms of the patient and that is the simillimum. This remedy is homoeopathic for that
particular case and it is the similarity to the totality of the symptoms of the patient
that makes the medicine homoeopathic.
We also have the repertory, a tool which opens up
the materia medica for us and guides us towards certain remedies. Computers now speed up
this process considerably so that the professional homoeopath has the possibility of
prescribing quite quickly with a high degree of precision. So what of the action of
remedies? I would like to look first at the single remedy. What actually happens when a
remedy is given? If we give the simillimum, the whole patient may be cured and all the
symptoms removed thereby. This is what I hope for in every prescription I give. Sometimes,
however, the prescription I give is not the simillimum. It may have no effect on the
patient, in which case I look for a different remedy. It may be a partial similar, in
which case there may be a partial cure, i.e. some of the symptoms of the patient are
removed, others may remain.
There is an additional factor where the partial
similar is given and that is an appearance of new symptoms which are symptoms of the
remedy. This constitutes a proving. So in fact by giving a remedy that is not the
simillimum for the case we may produce a proving in the patient and produce some new
symptoms. So what then is the next step? To observe the effect of the remedy: if we have
given a single remedy, the action of this remedy can be clearly observed and appropriate
action taken when necessary; perhaps to repeat the remedy when the symptoms return, if
they return; perhaps to give a higher potency if this is called for. But by giving a
single remedy we can see quite clearly exactly what that remedy has done. The prescriber
thereby learns about this remedy and gets precise feedback about the accuracy of his
choice of remedy. This improves the quality of his work and the precision of his future
But what happens if two remedies are given at the
same time? We have a more complex situation. One of these remedies might act and the other
might not. If one of these remedies is the simillimum it might cure. But which of the two
is it that has cured? When a repetition is called for, as might be if the symptoms return,
it will be necessary to repeat that combination exactly as before and the prescriber will
still not know which of the remedies has done the curative work. Both of these remedies
may act. If one is the simillimum it might act curatively, but the second might act
antagonistically, thereby interfering with the curative action of the simillimum or the
patient may prove the other remedy. So we have a much more complex and potentially
confusing situation. The overall result is likely to be not as good as if the simillimum
was given alone. There can be considerable confusion of the case, particularly if more
than two remedies are given together. I have seen this kind of confusion many times.
Both of these remedies may be partial similars but
neither the simillimum, in which case there may be an improvement of some symptoms but
also the appearance of new symptoms of both remedies. Which is which? What remedy is doing
what? How are you going to find out? Neither remedy may act. Two or three remedies in
combination can be just as wrong as one. The only way to truly know what combination of
symptoms call for a combination of remedies is to prove those remedies in combination.
Otherwise the prescriber can only be guessing as to what the indications are for such a
combination. Why should a prescriber want to prescribe more than one remedy at a time
anyway? There may be many reasons, but as time is short I will look at just one or two.
One may be that the prescriber is not sure which
remedy to prescribe. Giving more than one may seem to double or triple the possibility of
getting it right. It may work like this in some cases, but in others it will not. Even if
this strategy does work, the prescriber will never know which of the remedies cured the
patient and therefore misses an opportunity to learn how to differentiate similar remedies
in practice. Some prescribers give more than two remedies at a time. I have seen
prescriptions of twenty different remedies prescribed every day. Can this really produce
good results? If so, why stop at twenty remedies, why not give 500? If you gave 500 you
could be sure of including the simillimum as one of those remedies. Certainly results of a
sort are obtained by multiple prescriptions, but I have yet to see such prescriptions
produce a result anywhere near as good as the simillimum. I often wonder if these
poly-prescribers have ever seen how good the result of a simillimum given alone in a
single dose can really be.
Another practitioner faced with the dilemma of
which of two or three different remedies to choose, but who prescribes only one remedy at
a time and only prescribes the second and so on if this does not act, will discover which
of the remedies was curative and by re-examining the case can discover why that was the
curative remedy. This is the practitioner who will continually refine his skills and
prescribe with greater precision and accuracy as he grows in experience. It may take more
time in his early days of practice, but in my experience it is this single remedy
prescriber who most rapidly cures his patients.
I have often tried to think of a place for
combination prescribing. I've thought of the ABC or the Aconite, Belladonna, Chamomilla
first aid and simple acute prescribing for people who are completely new to homoeopathy.
But I actually think that even this is an insult to most people's intelligence. There
cannot be many people who could not easily be taught how to distinguish between these
three remedies. No, it is the single medicine prescriber carefully matching each
prescription to the totality of his patients symptoms and conscientiously observing the
results of each prescription who will learn the most and the fastest. It is he who will
become the master of this great art and science of healing called homoeopathy. The single
remedy is the remedy of experience. Thank you very much.