To read full case quiz. Visit – Case # 3 of case solving contest: ‘Everyone Is Looking at My Acne’ 
This is a Thuja case (the client did extremely well on Thuja; not only did it clear up her acne, it improved her relationship with her boyfriend and her coworkers; it helped give her the strength to quit her job at the health food store and go into the music promotion business; you can see the Medorrhinum characteristics from a previous layer, a previous time in her life, and in fact she did need Medorrhinum at one point when the Thuja had done all it could. She mentioned that many of the customers in the health food store remarked to her how well she looked when she started the Thuja.
List of characteristic symptoms:
on cheeks and jawline
amenorrhea NWS going off birth control pill
delusion pregnant, delusion something moving inside her
dyslexia: leaves out letters or words when writing
sensual: exotic dancer, shows cleavage
loves wild dancing
pushes life to the limits
feels everyone looking at her acne
wants to hide
disgusted with body
feels diseased, something wrong (r/t amenorrhea)
PMHx genital warts (frozen off)
fears loss of control
easy weeping when helpless
feels people talking about her behind her back
hair falling out
dislikes damp weather
weepiness before menses
irritability before menses
constant burning vaginal discharge
Evaluate and Prioritize the Characteristic Symptoms
The first thing that jumps out is all the sycotic characteristics. Another theme that stands out is the wildness and sensuality, although this is mostly in the past and may represent a past layer that needs a different remedy. I need to keep this in mind.
Another theme (part of the sycotic miasm but so marked in her that I want to be sure to cover it) is the hiding/self-conscious/self-disgust theme in how she feels about her body.
I am not going to include the amenorrhea because it is normal in women going off the pill, and my experience is that it comes back with a good hormone-balancing remedy. However, I do want to find a good hormone-balancing remedy for her, so I want to take a couple of her symptoms of hormone imbalance  like weepiness and irritability before menses. I will also use her chief complaint of cystic acne before menses.
I could repertorize the “likes tea” and “hair falling out” but I think I will save them for a confirmatory or later remedy differential. Instead, I will use several distinctive mental symptoms: dyslexia, fear of losing control, and sensation something moving in abdomen. These don’t really fit into another theme so I will just list them so as not to forget them.
I did not list her past history of depression and anxiety, because there are no specific features to narrow down these huge rubrics. I can keep them in mind when comparing remedies at the end.
sycotic: cystic acne, wants to hide, disgust with body, genital warts, vaginitis, candida, averse damp weather, burning vaginal discharge, postnasal drip
wild/extremes: exotic dancing, drug use and promiscuity, pushing life to limits
hormone imbalance: acne, weepiness, irritability
hiding/feels unattractive: disgust with body, feels people are looking at her
fear of losing control
sensation something moving in abdomen.
Thuja: delusion something alive in the abdomen, disgust about her appearance, acne etc.
Medorrhinum: sex and drugs, wild dancing, sensual/provocative, tattooed and wearing black
Search for rubrics (from Synthesis)
Face, eruptions, acne
or Face, eruptions, pimples [combine]
Female, leucorrhea, burning discharge
Female, condylomata [genital warts]
Mind, vivaciousness (these two rubrics were not used; not accurate enough)
Mind, dancing, desire for (not used; different reasons for desiring dancing)
so no rubrics for this difficult-to-repertorize theme; keep in mind
for the remedy differential at the end
Premenstrual: Mind, weeps, menses before [combined with]
Mind, irritable, menses, before
Hiding: Mind, hide, desires to
Dyslexia: Mind, mistakes, writing [this was used because broader and it includes the following two more specific subrubrics]
Mind, mistakes, writing, omitting letters
Fear of losing control: Mind, fear, control, of losing
Alive/moving in abdomen: Mind, delusions, animals, of, abdomen, in
Abdomen, movements, as of fetus
Mind, delusion, pregnant [these are small and can be combined]
Remedies from Repertorization of the above rubrics
Sulphur, Pulsatilla, Thuja, Calc carb, Ars, Lachesis, Ammonium carb, Sepia.
The patient is sycotic as noted above.
Family miasm: no information given
Choose three, pick one
Lachesis matches in some ways: can be high energy, wild and vivacious, with hormonal, acne and sex issues. Lachesis can be suspicious (which might cover her belief that people are talking behind her back) but we would not expect Lachesis to have such a negative body image. If she stated that her PMS symptoms immediately got better as soon as her period starts, we might take Lachesis more seriously. But it doesn’t match the wide range of symptoms that Thuja does.
Thuja is not only is it the top sycotic remedy, but it best embodies the desire to hide and the disgust for the body. As a sycotic remedy, it will cover well all her specific sycotic conditions; as a hormone-balancing remedy, it will cover her PMS and (eventually, although maybe not right away) her amenorrhea. In addition, it covers her delusion of something alive in the abdomen; her desire for tea; her hair falling out; her fear of losing control; and her past history of anxiety and depression. Almost every aspect of this case is covered by Thuja. This is a real case and I chose it because this woman was such a remarkable living example of Thuja.
Medorrhinum must also be considered for her. It does not show up in the repertorization because it does not repertorize well (not enough symptoms in the repertory). However, it matches her past better than her present: her wild, drug-using, promiscuous, exotic-dancer days. It shows up now only in her dress (black, showing cleavage, tattoos, etc.) I expect that she will definitely need Medorrhinum at some point.