Case Quizes Clinical Cases

Revisiting: Tennis Trauma

tennis trauma image

It’s called “over-use injury”; but no matter, homeopathy saves the day–again! Did you guess which remedy? Scroll down for the answer.

To read last month’s full case quiz. Visit – Tennis Trauma



Ferrum met.


Rhus tox








 How did we do this time?  Does anybody want to be the first to step up to the microphone?

 Hi Elaine ,

Hi Neil!

Not at all confident about this month’s answer.  Going for Ferrum…

Ferrum metallicum?

…as think it’s sciatica even though Doctor says otherwise, because nerves don’t show on MRI.  Found Ferrum listed under sciatica, under worse sitting, worse standing and better stretching.  Couldn’t find it under better cold applications though, which seems an important modality and seems to rule out Rhus tox and Ruta for complaints from over use.

Yes, “better cold” absolutely rules out Rhus tox and Ruta.  In fact, “better cold” is so characteristic, I basically put two symptoms together: Neuralgia and Better Cold, and came up with Spigelia! 

A long time ago, I heard a lecture by Vasilis Ghegas on Trigeminal Neuralgia.  He said, “It’s very simple; if it’s on the left side, it’s Spigelia.  If it’s on the right side, it’s Mag-phos.  If it’s better cold, it’s Spigelia.  If it’s better warm, it’s Mag-phos.” 

So with that information, I went right for Spigelia.  This is my only Spigelia case ever!

Well it sounds simple when you put it like that.  Must admit, only think of Spigelia in headaches so good to learn something.

That’s the thing with homeopathy, you’re often having to extrapolate something you know from a previous case and applying it to another one BECAUSE our Repertory is incomplete, and in fact, being “complete” may be impossible, as we can never know all there is to know about a remedy!  So, if you know that Spigelia’s keynote in facial neuralgia is “left side” and “better cold”, and you see a “sciatica” case that is left-side and better cold, you’re within your rights to apply what you know about Spigelia to the new case.

My question is, can one modality carry more weight than others?

Yes, definitely!  One modality might be a strange/rare/peculiar while another modality might be common and unremarkable or it may be inconclusive; like, for example, “worse sitting”; but the patient was OK to sit on the bed!  So that modality is therefore confusing and inconclusive so you can’t use it.  What he was, if I remember correctly, was “worse walking”–another reason it can’t be Rhus tox.  So I did find this symptom:  “Hips: pain, hips, gluteal region, walking”–there were only 2 remedies.  One was Spigelia!  So, that rubric was a real gift to me, really confirmed what I was thinking!

Does Spigelia also have the modalities I mentioned?

Spigelia is a 1 under worse standing, not listed under worse stretching…however, that is also misleading because the patient wasn’t stretching his leg per se, the physical therapist was “pulling” his leg by the foot, which may simply mean he was taking pressure off of whatever nerve was being impinged, which makes sense, doesn’t it?  And you know, if a symptom “makes sense”, it’s not a “symptom”, and we can’t use it.  So, we had 2 useful modalities in this case, “worse walking” and “better cold applications”.  And by the way, I just checked the Repertory (Murphy’s), and Spigelia is a 3 under “Generals: walking agg”!  Wow.  I didn’t expect to see that!




Is anyone else here today?  Oh look, up in the sky!  It’s a bird, it’s a plane…. oh wait, it’s Sarah.

Hi Elaine,

Hi Sarah!

I hope you and Shana are well.

We’re plodding along…haphazzardly, mostly, but, forward, in a manner of speaking….

My condolences for the loss of your friend Debby Bruck.  Its always so much harder to lose someone that helped so much in this world.

I know; shocking!

I hope others come forward to carry her torch and bring homeopathy back and stronger than it ever was before.

That’s my hope too!

This quiz makes me nervous, the whole physical injury thing, it seems too easy.

But that’s just it, Sarah, it’s not really an injury as we know it, like if I fell and hit my head (Arnica).  This is “over-use syndrome”; I guess they used to call it “repetitive stress disorder”.  Not sure.  But, it’s not in the Repertory anyway!

So four major remedies for post injury, other than Ledum which is a really specific case (puncture wounds) not applicable here.  Hypericum is for nerve damage and/or nerve rich areas, so not that one either.  Rhus Tox we would have seen more stiffness and more of an amelioration from motion, we didn’t so not Rhus T.  That leaves Ruta and Arnica.  Now I am not sure which one.  Arnica is worse for heat, Ruta is not.  Ruta is much worse for jar.  But I guess being that this is an injury of the growth plate, kind of where the periosteum and joints are, Ruta seems to be a better fit.  Ruta is my first choice and Arnica is my second.

Oh, wait a minute, I just thought of something.  Calcarea Phos has problems that are the result of “Ill effects of over-growth”, which is kind of what happened to Marvin, at least partly, he grew a ton in a short while without enough nutritional support to make his growth structurally sound.  Of course there was that other major factor of over doing it with the athletics.  I’ll keep Calc Phos as a third choice.

Ok. Good idea with the calc-phos. But actually, Sarah, this was not an easy case, I will have to admit.  Maybe not such a great quiz case cuz frankly, I can’t see anyone getting it right; but what I like about the case was the way the patient responded so quickly and unambiguously to the remedy after being in pain for a month with no end in sight, and no allopathic treatment under consideration (not that that should surprise any of us…) so, I liked the fact that the case was so strikingly cured; but, I sincerely doubt that anyone is going to get the right answer.  It’s Spigelia, and this is my first Spigelia case; so, not a common remedy by any means.  And how did I come up with it?  Basically, it was simple: nerve pain (“neuralgia”), better cold applications; and also, left-sided complaints.  So, that’s pretty much it!

Wow I really oversimplified the case.  Marvin had a really impressive response to the remedy.  I always thought Spigelia had a really severe pain,

Yes, it does.

It is really cool to see it working on just everyday neuralgia.

I just think we don’t have much information on that, on how bad it was.  Here’s what his mother said:

“Wonder Woman” told me to get in touch with you.  My son, “Marvin Gardens”, is suffering from pain in his left upper thigh.  The pain starts around his left glute area and travels down to his knee.  It is more intense when he puts weight on that leg; so, walking is bad.  We refrained from all physical activities from past one month.  I have seen Neurospine Surgeon initally, as they were suspecting that it might be associated with spine.  But lumbar spine MRI findings were normal . … The pain keeps getting less and more intense but nothing else comes with it.

What we’re hearing from this statement is that there are times when the pain IS “intense”, apparently.

Thank you for the quiz Elaine, I didn’t win, but I am going to win some knowledge instead.

Left-sided nerve pain + better cold applications = Spigelia.

Time to dig into Materia Medica for Spigelia.

Thank you Elaine for all your hard work.  Wishing you health, wealth and happiness.

Thanks, I could use all of those things!  Is anybody else here today?


Hi Elaine and Shana,

Hi Salma!

Hope you are doing well by the grace of Almighty.

Doing well, thanks!

In this quiz i only get this one rubric:

“legs, sciatica, pain, injury after”:  Arnica, Hypericum, Ruta.

I can see why you picked that rubric but I think it’s too small.  For example, let’s think of a very common nerve pain remedy–like Mag-phos.  It’s not there!  What about Colocynthis?  That’s not there either!  And I think the reason why is because this is an etiology rubric: “ailments from injury”; so, naturally, we come up with “injury remedies”, right?  But, are we sure this is an “injury”, per se?  It’s “over-use” syndrome, aka, “repetitive stress disorder”, not quite the same as an injury as we know it, like a fall.

Arnica is not appropriate in this case.  Between Hypericum and Ruta I will vote for Hypericum as it covers inflammation due to wounds.  Though I could not find the appropriate rubric like sciatica ameliorated on stretching the leg.

But think about it.  He didn’t really stretch his leg.  The therapist “pulled his leg”, and that may have removed pressure from the nerve that was being squeezed, hence the pain goes away for the moment.  Where do we find that in the Repertory?  We can’t.

Or sciatica pain relieved by cold application.

See, that’s the symptom!  That and “worse walking”.  In fact, here is our case:

Generals: neuralgic pain

Generals: cold, wet applications amel.

Generals: sides of body, left side

Generals: walking agg.

And the winner is……..Spigelia!  See repertorization below:


Revisiting: Tennis Trauma 1

I think I see Wayne charging this way.

Hi Elaine,

This case is confusing because it looks so like sciatica.

It is sciatica!  The doctors are not comporting themselves well here at all!  First they said it was Sciatica, then they looked at an MRI that doesn’t show the nervous system and said it wasn’t.  They were completely clueless about this case, had no treatment plan.  To me this was a case of neuralgia, left side, better cold, worse walking.

If the problem is with the bones I would prescribe Symphytum.

The unusual part of the case is that it is better with cold and this indicates 3 remedies, Bryonia, Bufo, and Iris Versicolour.

Iris versicolor has symptoms which go from the left hip to the back of the knee, and seem more appropriate so for the case of sciatica I would prescribe Iris Versicolor.

The information you supplied with the case was very interesting.

Thank you.  It was actually Spigelia.  Nerve pain (neuralgia), better cold, worse walking, left-sided.  Very simple.

Thanks for voting!

Oh, look!  It’s the gang from Slovakia!


Hello Elaine and Shana,

Hi Jitka!

as every month, even now we send our responses to your very interesting quiz.

Thank you!

Miroslav votes: Ledum

Here’s what he says (I will translate):  In this case, it probably doesn´t matter, whether it is a sciatic pain or other reason.  In this case, I was most attracted by two symptoms: movement aggravates and cold application ameliorates.

You’re right about the modalities, but we still have to know what’s wrong with the patient!  People are forgetting all about “Repertory Round-Up, Part 4”!  Please read again:

or you won’t be able to solve your cases.  What is number-2 on the “Hierarchy of Symptoms”?  Diagnosis!  We have to know what’s wrong!  I have to be able to say, “I’ve got a neuralgia case here that’s better cold and worse motion.”  Let’s say it’s a sprained ankle with the same modalities: “I’ve got a sprained ankle here that’s better cold and worse motion.”  They’re two different remedies, even though the modalities are the same!  This is why we have to know what’s wrong. 

The second symptom excluded all “warm” remedies which I took into account whether a sciatic pain or another cause of pain.  The only remedy came out of it: Ledum.

I was surprised, as there is no cold swelling and moreover, the symptoms of Ledum move from the bottom up which is not in this case.  Well, on the other hand, Herscu says about this remedy (Ledum) that it’s a combination of Hypericum and Arnica.


Jitka votes: Arnica

I felt  completely confused while reading  your quiz.  There were a few hypothetical diagnosis and and several  significant symptoms.  I struggled to match symptoms of left sided remedies with cold applications, which ameliorate, plus a desire to be fanned…

Whoa!  Slow down!  “Desires to be fanned, although a very interesting symptom, is the way he ALWAYS is and, therefore, is not a part of the acute case; so, we just ignore that!

…plus, an aggravation when walking, and so on.  Whenever I thought I had found the right remedy there appeared something in a remedy  picture that didn’t fit to Marvin’s case.  So I decided to vote for Arnica, which is used frequently for muscles and limbs over-use and overstraining.

OK, but wait.  If we can agree that this is “nerve pain”, and we go to the rubric for that — “Generals: neuralgia”– Arnica is only a 1 in that rubric and there are 8 remedies in BOLD.  Remember how you once said, “Elaine, I will always remember now: first find the ‘City’, then find the ‘Streets’!”  But you and Miroslav have gone for the streets and ignored the city; and remember, in almost every city, there is a “Main Street”, a “Broadway”, not to mention “Oak Lane”, “Pine Street”, “The Parkway”, and maybe even “River Drive”!  We have an East and West River Drive here in Philadelphia.  So the first thing, if someone’s trying to get to “East River Drive”, is to find out what city he’s in!  Right?  Because if every city has a “River Drive”, then saying to someone, “How can I get to East River Drive from here?” isn’t going to get you very far unless you first say that you’re in Philadelphia!  So, in that context, we have to first say that this is a case of Neuralgia (“the City”) that is left-sided, better cold applications and worse for walking (“the Streets”).  When stated in this way, the remedy is…….Spigelia!

Thank you for your review. I didn’t think that my answer would be right, it was just an emergency solution.  I just want to say that I didn’t forget about your “city-first-then-streets” strategy, but the “city” I picked was “Legs, sciatica”, and there was no subrubric for cold applications amel.  Just cold agg.

Yes, I see that.  This is why the “better cold” modality is so important, because it’s a “strange/rare/peculiar”!  We don’t expect sciatica to get better from cold!

I found a rubric “cold application amel.” in the “extremities” chapter.

I can’t find it.  But you can always go to “Generals, cold applications, amel.”  27 remedies.

“Extremities, limbs; pain; better cold applications”. In this rubric there are seven remedies

Oh!  Well, that is very under-populated if there are 27 remedies in Generals that are better cold!  Also, “pain in limbs”, is not quite accurate.  “Marvin” actually has hip pain (“left glute”, as his mother says); the pain only extends to his leg when he walks.  So, I went to the “Hips” chapter in Murphy’s Repertory, scrolled down to “pain”, scrolled down again to “gluteal”; so, “Hips, pain, gluteal” and under “gluteal” was “walking”.  Marvin’s mother made a big point of saying the pain was much worse on walking.  So, there were only two remedies in that rubric–Spigelia and Tabaccum, and Tabaccum isn’t in the “neuralgia” rubric at all, while Spigelia is there as a 3; so, the remedy clearly is Spigelia.

I tried to assign symptoms as “left sided remedy”, “walking aggr.”, “walking crookedly“…

That’s not a symptom either.  It means he’s limping because of pain.  If a symptom “makes sense”, then it’s not a symptom.  You can’t use it.  We’d all be limping if we had hip pain.

…and Guaiacum was the most similar of all, but I was not persuaded fully about it.  That’s why I deleted all my findings and I took into account only the etiology when Marvin over-used his muscles and tendons; so, I choose Arnica as an emergency remedy.

Right, but our etiology is very shaky here.  Better to go for what’s peculiar and characteristic in the case.  You know, to tell you the truth, Miroslav came closest with his vote for Ledum, because the subrubrics under “Legs: sciatica” include “Sciatica, walking agg.”–13 remedies with Ledum as a 2 (there are no 3’s) and Ledum is famous for being better for cold applications, so, in that sense, Miroslav did well with his choice.  The problem here is that once again, the Repertory has shown itself to be defective!  So, you chose “Legs, sciatica” as the “City” while I chose “Generals, neuralgia” and it turned out that the winning remedy was there.  It should have been under Sciatica too.  I think you came very close.

Well, we didn’t have any winners this time, though I didn’t really expect any as Spigelia is a very small remedy; but, now maybe you’ll think of it in left-sided Sciatica, better cold; and Trigeminal Neuralgia, left side, better cold.

See you again next time!


Elaine Lewis, D.Hom., C.Hom.

Elaine takes online cases! Write to her at [email protected]

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About the author

Elaine Lewis

Elaine Lewis

Elaine Lewis, D.Hom., C.Hom.
Elaine is a passionate homeopath, helping people offline as well as online. Contact her at [email protected]
Elaine is a graduate of Robin Murphy's Hahnemann Academy of North America and author of many articles on homeopathy including her monthly feature in the Hpathy ezine, "The Quiz". Visit her website at: and

About the author

Shana Lewis

Shana Lewis

Shana spices up the Hpathy Quiz with her timely announcements and reviews on the latest in pop culture. Her vast knowledge of music before her time has inspired the nickname: "Shanapedia"!

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