Thesis submitted to the university of Calicut in partial fulfillment of the rules and regulations for the degree M.D (Horn) Repertory. Government Homoeopathic Medical College.Calicut, 2000

Introduction
A prescription is the written statement of the suggestion of a remedy. As far as homoeopathic system of medicine is concerned, a prescription should aim at the patient and his individual reaction to the disease. But there are practical difficulties in obtaining a totality of symptoms. The immediate cause of the present illness if determinable or its exciting factor will be a great aid in the administration of the remedy. This Hahnneman teaches in aphorism 5 and in footnote of aphorism 206.
The physician in curing derives assistance from the knowledge of facts concerning the most probable cause in the history of a case of chronic disease aided by such knowledge he is enabled to discover the primary cause of the later, dependant mostly on the chronic miasm.(aphorism 5)

In the footnote of aphorism 206, it is said, these causes are much too insignificant to develop a chronic disease in a healthy body, to keep it up for year and to aggravate it year by year as it is the case with all chronic disease from developed psora. Causes of a much more important character than these remembered noxious influences must lie at the root of the initiation and progress of a serious, obstinate disease of long standing, the assigned causes could only rouse in to activity. The latent chronic miasm.

Every patient is having a primary cause and exiting cause is the secondary cause. Exciting cause is the secondary cause.
Exciting cause are different for same fundamental causes and symptoms are precipitated by exciting cause. The symptoms start from the excitation by the exciting cause of corresponding miasm. We can diagnose the fundamental cause by the nature of response of the individual to the exciting cause. Eg: A patient with no complaint in dry weather & asthmatic in humid weather  sycotic miasm is excited.

There are different types of exciting factors for different miasmatic diseases. Each miasm will be excited by corresponding exciting factors. So treating exciting cause means treating fundamental cause.

Aim of the study
The aim of the study is to evaluate the efficasy of etiological prescription in homeopathic treatment. Even if the etiological prescription is effective, a scientific study in the matter based on statistical data has not been undertaken so far. This is an attempt to do a scientific study based on statistical data.

l(a) Etiology has been defined as a study or theory of the causation of any disease: the sum total of the knowledge regarding causes. Etiology does not concern itself with synthesis of causative factors in the pathogenesis of a disease to enable an observer to form a comprehensive picture of the development of the disease in all its stages.

l(b). The knowledge of etiology depends necessarily on the understanding of the various physical and biological phenomena that man has observed in nature.

l(c) Hahnemann was always at great pains to emphasize the importance of the causative factors in the environment - both physical and emotional - which could be held responsible for the development of illnesses. He advises the physician to remove the cause first whenever it is feasible. But at the same time he cautioned the physician against the dangers of armchair theorizing and speculating on the ultimate cause or mechanism of disease. He cautions the true homoeopathic physician to remove all obstacles to cure before proceeding with the administration of the similar remedy.
In a case, the causative factors form the core of the image of the patient in his illness. Their
identification or the incorporation in the image is therefore imperative if the prescription is to prove homoeopathic and hence curative,

(2) The Physician should first try to elicit the evident cause and course of the sickness, to which he will add all the things, which now seems to interfere with the sufferer's comfort,

(3) It is self evident truth that the cause of the disease or the symptoms representing the cause, are most important as indications for treatment.

(4) Almost all diseases have relations of some kind to the various accidents and conditions of ordinary life. Their symptoms are made worse or better by heat or cold, rest or motion, by night or by day, or other circumstances or conditions. Many remedies are related to the effects of certain conditions. This is not just the same thing as aggravation, though allied to it and sometimes identical with it. For instance Arnica removes morbid conditions (apart of course from surgical injuries such as broken bones) caused by falls; Ruta relieves the effects of bruised bones. It is not correct in either case to describe these as aggravations.
Although causations and aggravations are not the same, they are closely allied. Rhus tox is related to the effects of damp weather, and appears in the list of remedies having this causation, but it also having this causation, but it also has its symptoms, when not caused by damp, aggravated in a supreme degree by conditions of damp. Therefore the prescriber who uses this list of causes as a rough list of aggravations also will not go far wrong and may find no little help from it in some of his cases.
(5) The diseases are not 'just happened .Their origin may be from an event or series of events,extending over many years. Sometimes the cause is an inherited constitutional fault, or it may be a progressive accumulation of toxic material in the organisms created by defective elimination* Other causative factors are bad hygiene, over indulgence in bad habits, over-eating or malnutrition.
Ailments often appear as a result of a severe mental or physical shock such as grief, prolonged anxiety, or great disappointment.

 It will be seen, therefore, that the fundamental cause of disease spring from two main sources.
1. Inherited - the type of constitution.
2.Acquired - direct contamination, physical or emotional shocks, hygiene or dietetic lapses.

Inherited Causes: They are being dealt with at length later as they are most important in our treatment of chronic ailments.
Acquired Causes: Direct contamination covers the epidemic diseases. Endemic is the term applied to disease which exists in particular localities or amongst certain races. For example cholera is an endemic disease of certain parts of Asia. Epidemic is the term applied to a disease which affects a large number of people in a particular locality at one time.
This type of disease is therefore infectious from person to person.

Many epidemic diseases occur at certain regular seasons. For example typhoid fever begins to show itself in August, increases during autumn months and gradually decreases during the spring. Measles produces two epidemics one in midsummer and one in December.
Physical and emotional shocks which may be the root cause of a patient's disorder will be revealed when the patient is questioned by the practitioner; from this questioning any hygienic or dietetic lapses should also become evident.

It should be noted that all curable diseases created by these causes could be removed, or greatly modified, by correct homoeopathic treatment. In simple or acute cases, the correct remedy produces almost an instantaneous effect. A demonstration of this rapid action will be seen when arnica is given for shock and bruising in an accident.

In chronic cases one may have to wait for weeks or even months, but improvement will follow providing the disease has not ultimate itself in gross pathological changes.

(6) The external causes or occasional causes embrace everything which, where there is such an internal disposition to disease may produce disease. To this belongs
- After effects of acute diseases.
- Medicinal diseases and poisoning.
- Contusions, sprains, burns and the like.
- Exposure to cold.
- Infectious diseases.
These are anamnestic and are of special importance.

7(a). As regards acute diseases, the exciting cause being injurious influences to which they were particularly exposed. Excess of food or an insufficient supply of it, severe physical impressions, chills, overheating, dissipation, strains etc... or physical irritations, mental emotions, and the like are exciting causes of such acute febrile affections; in reality, however, they are only a transient explosion of latent psora, which spontaneously return to their dormant state if the acute diseases were not of too violent a character and were soon quelled.

7(b), The causes, (either a cold caught many years ago, or a former fright, a sprain, a vexation) are much too insignificant to develop a chronic disease in a healthy body, to keep it up for years, and to aggravate it year by year, as it is the case with all chronic diseases from developed psora. Causes of a much more important character than these remembered noxious influences must lie at the root of initiation and progress of a serious, obstinate disease of long standing; the assigned causes could only rouse into activity the latent chronic miasm.

8(a). The chronic rniasms are the fundamental causes of the acute miasms; if there are chronic miasms there would be acute miasms also. It is the very nature of a chronic miasm to predispose man to acute diseases and the acute diseases are as fuel added to an unquenchable fire. Acute diseases then exist from specific causes co-operating with susceptibility. If there is no chronic miasm there would be no susceptibility.
Indisposition from external causes mimic the miasms, ie, their group of symptoms is an imitations of a miasmatic manifestation, but the removal of the external cause is likely to restore the patient to health. The active cause is within and the apparent cause is without.

(9). Pathological explanations and speculations are too far removed from our entirely practical method to have any great value in a therapy and cure. Diseases are logically divided into internal and external. The former arise from the natural disposition,which is sometimes highly susceptible (idiosyncrasy).

The latter can excite disease principally by means of external impressions, when there is already a natural predisposition thereto.
The modified natural tendency to disease depends, according to Habnemann, upon the uneradicated miasms of psora, syphilis, and sycosis. When it does not originate in these it is mostly composed of remnants and sequel of the acute affections which so largely go to make up drug diseases and poisonings, but we do not see both factors combine to undermine the health, thus presenting a proportionately deeper rooted disease just that much harder to combat. In such cases anti psoric remedies very much excel all others in efficiency. (The scrofulous diathesis - psora - is constantly being extended by the practice of vaccination, our view of the matter receives confirmation from the fact that in very many cases of such diseases which are essentially acute in character it is only by the administration of our so called anti psoric remedies that rapid and durable cures can be effected.)

Whether or not we believe the psoric theory, the fact remains that the best selected remedy is often ineffectual unless preceded by the proper anti-psoric, anti- sycotic or anti-syphilitic as the case may be, but because of their almost identical symptom list it is generally chosen with difficulty by differentiating and searching out the few true characteristics.

Drug diseases and poisonings do not differ in their health destroying power. The drug taken should be ascertained and properly antidoted. Simple poisons are easily detected by their effects, but a drug disease is generally a compound result which fails to show a clear andaccurate picture, hence a knowledge of the contents of former prescriptions taken is a necessity and lightens the labour.

Practice has extracted and rendered the anamnestic symptoms easy of access, thus greatly restricting the list from which the selection is to be made so that attention to but a few characteristics quickly determines an accurate choice. This is especially true of sprains, bruises, burns etc. Colds are more complicated because of the diverse manner in which they are contracted and the different parts which they affect point to different remedies: for instance, it makes a great difference whether they are contracted while sweating, by exposure of a part, being drenched all over or partly etc. Various remedies must be considered, according to whether the symptoms localize themselves internally (stomach, chest, abdomen etc...) or externally (head, feet, back etc...). Such remedies are to be too readily thrown aside unless certainly found dissimilar in other respects. So much depends upon the knowledge of the cause (Anamnesis) of disease, that without it the choice of homoeopathic remedy cannot be made with safety.

Homoeopathic prophylactics are tested and sure. The very remedies, which cure the fully developed disease, will protect exposed persons. This is very important for the reason that incipient diseases are generally very lacking in the characteristics, which determine the choice.

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