Clinical Cases

A Case of Anxiety

Written by Petr Zacharias

Homeopath Petr Zacharias’s case of anxiety required differentiating Stramonium and Aconite and relief from drinking cold water became the critical clue

A Case of Anxiety

Petr Zacharias

Reprinted courtesy Petr Zacharias from: Case Quizzes And Clinical Hints For Devoted Students Of Classical Homeopathy by Petr Zacharias  © Petr Zacharias, 2017


A young man 17 years old, is suffering from strong anxiety in his chest that prevents him from breathing. He has to concentrate a great deal to breathe properly. Together with this problem he has a strong stitching pain in his chest (3). These problems started last spring after mononucleosis. At the same time, before the problems had started, his father had an accident. After the phone call about this accident he was very frightened (3). Soon after mononucleosis and this accident he developed strong stitching pains in his chest together with an anxiety.

The anxiety is much aggravated in the evening and he is not able to fall asleep in a dark room. He must turn lights on to be able to sleep normally. He saw the black silhouette in the room once, but it has never happened again. He says he feels very bad during twilight, not only psychologically but concerning his energy. He feels drained during twilight. His state is much worse when alone, as he imagines what can happen in case of an anxiety attack. He has a strong thirst for very cold drinks and needs about 4 liters of water daily.

He has a very strong fear of a crowd and therefore he stays at home and does not go outside with friends. He does not like sweets except ice- cream.


Follow-up after four weeks

The breathing problems are gone completely and the pain in chest is still there from time to time (not so often as before the remedy) but it is still present. Sleeplessness diminished completely as well as the feelings of anxiety that he has not had at all. He says: I feel no anxiety in a crowd and therefore I can go outside with people. My energy is much better (no tiredness).


When I was listening to his story, I realized the big influence of his father´s accident upon his general health as he has experienced a significant drop in his health since then. The main physical complaint was stitching pain in the chest that was accompanied by strong feelings of anxiety. What was very remarkable was his aggravation in a dark room. He was not able to fall asleep at all in a dark room and this information together with fear of dogs led me to think of Stramonium. This remedy was confirmed even more when he said spontaneously that he saw black silhouettes which is a keynote of Stramonium. But,  something was not right with Stramonium and that was the extreme aggravation during twilight which this boy mentioned very strongly. He feels totally drained during twilight and I began to doubt about Stramonium when I found out that this remedy is not listed in this rubric at all. The rubric is: GENERALS – EVENING – twilight, agg.  At this moment I came back to etiology, because I knew that Stramonium has an ailments from fright but I needed to find out what exactly he felt at the moment of his father´s accident. I asked him for what he felt and he answered: “It was a big shock”. After hearing this, I realized ailments from shock, aggravation in the dark, agravation in twilight and strong feelings of anxiety to be the keynotes of Aconite.

Vithoulkas wrote in his Materia medica Viva about strong agravation in a dark room and especially inability to fall asleep in a dark room. I looked at the corresponding rubric: SLEEP – SLEEPLESSNESS – room, in – dark and there are only 7 remedies and beside of Stramonium which is listed in the third degree, there is also Aconite in second degree.

I said to myself: It looks good on one hand but there is a history of seeing black silhouettes which is not covered by Aconite and although it was only once, it is quite specific. At this moment I knew that to be absolutely sure with Aconite I needed to find other keynotes and confirmatory symptoms to confirm it further. I opened the repertory to see how these two remedies stand in the rubric CHEST – PAIN – Stitching which is a main physical complaint. There are 225 remedies but while Aconite is listed in 3rd degree, Stramonium is not there at all. I read materia medica of both remedies and found in Aconite a keynote of it in materia medica while in Stramonium there is no single reference to this symptom.

This was nice but it was a general rubric and although we can be more sure since it covers the main physical complaint, it is a big rubric and I wanted to find out something more specific. I remembered one very peculiar keynote of Aconite that is described in many materia medicas which is the amelioration of the anxiety by drinking of cold water which

I have seen many times in my practice. I asked the guy: You said that you have a big thirst for cold drinks. What about need of drink during your anxiety states? He replied: That is the time I drink the most. I feel better regarding my anxiety when I am drinking cold water. This was a very strong confirmation of Aconite.


About the author

Petr Zacharias

Petr Zacharias is the founder and main teacher at the Prague College of Classical Homeopathy. He studied with George Vithoulkas at the IACH and has conducted seminars with Dr. A. U. Ramakrishnan, Dr. S. K. Banerjea, Dr. Jorgos Kavouras and Erik van Woensel.


  • A 4-week follow-up of the case may be a little short to confirm that it is definitively settled. An underlying stratum may very well be revealed and the need for an anti-psoric after Aconit is not uncommon.

    I will be happy to get feedback on this case and its consequences in the coming months.

    Otherwise congratulations on the differential diagnosis Aconit versus Stramonium.

    • Hello, yes, 4 weeks is not enough but unfortunatelly I have not have any other feedback from him. Anyhow I have plenty of cases where Aconite solved a chronic problem for good. One of them is a case one of my former student who suffered from suicidal depression that developed after very long period of strong panic attacks. Aconite was confirmed and I gave it in 1M potency and after it suicidal depression disappeared as well as anxiety states and metrorrhagia and there has not been any sign of relapse for 8 years now. You can see Aconite in MM Viva from Prof. Vithoulkas where he describes its chronic picture. I know there are lot of “rules” that advice to do something in routine way like “Aconite is for acute states only” or “Aconite is short acting remedy” or “When you see a chronic case where Aconite is indicated, you must look for a Sulpur which is chronic Aconite, etc”. My teacher G. Vithoulkas and my practice have shown me that many of such “rules” go against the very essence of homeopathy which is an INDIVIDUALIZATION. That means that the only thing that determines what remedy should be given are SYMPTOMS PICTURE (§7 of Organon). When Aconite covers a case completely, than it will be a very deep acting remedy. If it covers a layer that has developed after a specific event like shock, cold dry wind or fright, than it will take this layer away and then another remedy will be needed once the organism will produce a clear symptom´s pattern. Warm regards, Petr

      • Hi,
        I have no doubt that Aconit is a very great remedy and that you have made excellent use of it. However, in your answer and in particular in what you write about the relationship between remedies (e.g. Sulphur following Aconit) there may be an underestimation, in the homeopathic cure, of the role of the specifically anti-miasmatic remedies that are part of Hahnemam’s legacy to the homeopathic doctrine. Hahnemann had observed that some healings did not last and gave rise to recurrences, whereas they had been obtained by individualizing as much as possible the choice of remedy among those available. This has given to Hahnemann the opportunity to develop his reflections and experiments both on chronic diseases, which he classified as Miasma, and on the remedies capable of eradicating them and on their specific modes of preparation (liquid or olfactory LM doses of the last Organon). I do not think that miasmatic prescribing in the Hahnemanian sense of selecting the “genius epidemicus” individualized to both the chronic disease in question and the patient’s expression , is a luxury that can easily be dispensed with today.
        Best regards.

Leave a Comment

Donate to Keep the World's No.1 Homeopathy Resource Alive!