Clinical Cases

Case of A Tough Guy Gone Soft

man coughing

Homeopath Erika Simonian presents a case of recurrent cough in a man of 40.

A hefty 40s-something guy walked into my office a few summers ago. He eased himself into a chair and began by telling me how he’d seen two homeopaths in his life; the first one went to jail twice and the second one barely listened to him and told him to get a few remedies before dismissing him. He loved the jailbird, and the bad listener had completely turned him off to homeopathy for a decade, so I immediately gave the guy credit for seeking out homeopathy again.

I have thirteen single spaced pages from this man’s intake alone – loquacious! I won’t subject you to it, but his manner and language was colorful, and, as in any case, best depicted his state; I’ve interspersed some verbatim paragraphs throughout my 3 page edit of his case.

Patient:  I used to be a workout freak – I ate really healthy, natural – and about 4 years ago, something just burned out in me and I’m on a pure beer and chocolate diet. Got a cold, working in crappy place where afraid to take off time, and coughing non-stop. I hit zero in January and went to a doctor who asked how long had I been been out of work. Zero I said. He couldn’t believe I didn’t have pneumonia or bronchitis. Every six months like clockwork, in December, I’m not able to do anything. Not as bad this year, but I always get something this time of year. Always 3-4 weeks, June 12th or 14th when I first got it, start off, regular cold, bad sore throat, eventually turns into cough, lingers (fist at chest). Pretty good during the day, a little worse if I move at all, even a walk around the corner, then at night, really bad.  Even coming here, 2 blocks to subway, I was starting to cough.

At night, I feel it. (fist) There’s a tickling in my throat, as if tickling is back deeper and cough only goes here (throat) and when I lay down, it feels as if it’s getting deeper. Almost as if liquid is going down to my lungs. When it gets real bad, keep coughing and coughing, and sometimes spit up phlegm.

I asked him about the phlegm. Clear, only at night. 6-8pm, in that range.

He went on to describe GI issues, he’d get heartburn, even when “healthy” in his working out days. It has intensified since his diet moved to chocolate, beer and pizza. He’d also had instances of meat getting stuck in his throat, once received the Heimlich  Maneuver, and once went to the ER where they dilated and biopsied his esophagus, at which point he was diagnosed with esoniphilic esophagitis. He also suffered from chronic back pain.

How this is affecting your life? When it happens, can’t go anywhere or do anything. On the subway, coughing like crazy. I can’t work out, I’m unemployed right now so work isn’t an issue or obviously it would be.

When I was healthy, weighed 185, pretty much all muscle. After my ex left me back in 99, I didn’t take care of myself. Got up to 200 lbs. I’d be very happy with 200 now (he is considerably heavier.) First time I ever saw a stomach on myself. Eating habits were, Chinese food, crap, drinking hard alcohol. Slowly over time, my willpower waned, I moved back to NY from Boston. A lot more stress in my life when I came back to NY. There’s no such thing as paying attention to what I’m eating. No such thing as 2-3 oreos, a whole sleeve. A lot of pizza, a lot of eating out. Got to point where wasn’t working out at all.

He went on to describe that moving to NY was a mistake, he lived with his parents, cared for his brother who has a mitochondrial disorder, got fired from his job as an accountant, for which he believed he was a scapegoat and this made him incredibly angry, in his words. I (makes fists) NEED TO DO something physical. I lifted for a long time, every weekend, played softball, soccer or flag football until 40 years old. I now study martial arts, which is without question the highlight of my week.  Not good at biting my tongue, not – just a lot of anger and I ram down. Always on edge (fists) as much as it’s horrible to be unemployed, my now wife is much happier that I’m unemployed. “You were always ready”, she says, “at the slightest thing. What’s wrong with you!?!”   Turned into vicious cycle. I don’t even want to work out, then didn’t have physical outlet. Instead I’ll ram this sleeve of Oreos down my throat, angry eating.

Ram down?

Physically feel like I have to stop myself otherwise it just has to come out! That’s the great thing about how lucky the grand master of dojo is. If you’re not doing it right, he’ll scream in your face. Outlet! Angry energy, couldn’t let it out, it would just turn back in. After my ex left me, such a bad point of depression. Started getting this agitated depression, couldn’t stay in my apt. closing in on me. 3am walks, job I had at the time, leave at 4am so I could walk to work. All this energy and breathing issues. I’d be laying in bed at night and feel like I couldn’t breathe. When I’m really stressed out, I can’t lay down, my breathing is starting to catch, my throat is closing up, have to get up and walk, go outside or something. During this period, only way I could relax, focusing on my breath. My breath is only coming own here instead of to here. (Middle of chest). In some ways that was the beginning of everything.

When she first left, it was just…. I do not cry. I cried 16 days in a row. I remember day 17, I’m not crying. I would walk to work. The darkness at night, it got so much worse. I needed the day and it was the winter. I’d walk to work and I’d walk home from work. At time, office had a big window, sitting there and try to do my work. At 3pm, started getting dark. Feel it in me, oh no the darkness is coming. I remember being when Blair Witch Project was out. Suddenly got afraid of sleeping in my apt. is that Blair witch? I know no such thing as witches. Close my door, had to close my bedroom door. Convinced I’ll wake up, somebody will be around the door. Logic, if it’s a human being, I’ll get up and kick their ass. If a ghost, well, then…

Door is locked. I unlock the door, open it, with feeling of, will I see something there that scares me? Then if I go into the kitchen, light is all the way around the corner, walk through the dark kitchen don’t like to do, flip on light in bathroom so some light. Door to backyard and window, have to look out both because expect to see something in there that’s gonna make me jump. Have to look around that corner before go in the bathroom. If in bathroom, standing up, have to turn and look over my shoulder to see if someone’s back there. Home a lot during day, not working, never get spooked during day. Never ever, except if in the bathroom taking a shower, have to close and lock the door. When get out, open the door, always that initial, something could be right there.


Death, not being able to breathe. Not being able to move. Confined places. Probably about it.


Dying process and again the BREATHING and the fear. So much fear around breathing. Then what happens, I go and choke on that thing, my greatest fear would be realized.


Sometimes get deep. Feels as if tickles here (throat pit) and then cough here (neck). When turns into involuntary cough – can’t stop it until phlegm comes up. Feels so completely unproductive.

Involuntary cough – how long does it last?

Measured in seconds probably, uncontrollable, again, can’t breath because so busy coughing. Then ends with one big one, sometimes stuff comes out, sometimes doesn’t. Whole body wracks with it. (spasmodic, paroxysmal).


Horrible burning – solar plexus – like where valve is at bottom of esophagus. If really bad, feel it up here (throat). No ulcers in esophagus. Said scarring there from acid.

Foods you crave?

Pizza. Chocolate. Chocolate definitely, go stir crazy sometimes. If I put that in me, affect me, almost on a cellular level. Now all I think of is with my mouth, taste buds, that would be good! Boy I could go for some chocolate, thought gets bigger and bigger and bigger. Cookies – chips ahoy, Oreos, any Pepperidge Farm stuff. Sometimes candy bar, but not big candy bar person. Sometime sugar. Chocolate ice cream. Summer thing. Big culprit without question is chocolate.

I don’t know if I mentioned, one thing – developing pain between shoulder blades in upper back. Sometimes I wake up, literally hurts to breathe. Like a knife in my back, when I move it’s like the knife is moving. If not that bad, turn neck. Or hang there for a while, literally feel two of the vertebrae separate. From one side of the spine to the other side. Traveling along the rib.

Part of it is the approach I had for myself, trying to get back to being healthy. There are no excuses. You don’t TRY to do something, you do it. I don’t want to have to have patience for those who don’t.  You either do it or you don’t do it.


Etiology – shock/grief?

work ethic/fighter, no excuses, anger.


closing in

fear of ghosts


paroxysmal cough, < lying, as if liquid going down throat. 

< night ago (cough and depression)

++ chocolate

Knife- like pain in the back, thoracic spine

Analysis/Core of the case:

I felt lucky that this man had expressed himself to me in such an open and uncompensated state. There was a clear etiology for when he essentially broke down; he lost his ‘willpower’ when his wife took him by surprise and left him. He cried for days on end, stopped working out and stopped eating a healthy diet.  And now he had sought out homeopathy due to these bi-annual coughing ailments that were difficult to shake and deeply affecting his ability to work. (I edited this part out, but he had been fired because a union head had complained to upper management about his non-compliance with their way of doing things, so he was currently unemployed. He was now writing fiction – “about losers and guys who weren’t born lucky and have to work hard for what they’ve got.”) He also had longtime esophageal trouble that dated back to when he was ‘healthy’.

I repertorized his symptoms, taking the breathing troubles and particulars of the cough (paroxysmal, worse lying and at night, and sensation of liquid dripping down his throat). I normally don’t think ‘desires chocolate’ is much of a rubric since 90% of people I see mention it as soon as I ask about food desires, but in this guy’s case, he brought it up before I ever asked and repeatedly spoke of it as part of the downfall. So I used that rubric as well as the esophageal burning and gagging, the knife-like pain in his dorsal region, and his fear of ghosts and robbers (‘robbers’ was as close as I could get to fear of people behind doors at night in his apt.) Finally, I added ‘fear of narrow places’ for his claustrophobia, and put on the side ‘ailments from grief and shock’. I didn’t necessarily use it because it wasn’t clearly the etiology of the main reason he was coming – these coughs – but I did think it factored into his overall decompensation.

Lastly, I added a too-large rubric (260 remedies), but one I felt applied mentally/emotionally as well as physically: aggravation at night.

Lycopodium, Kali-carb and Arsenicum were obvious leading remedies to consider and came up high in the repertorization. And I think Kali-carb might have really helped him. But down the line, represented in only the cough rubrics, and aggravation at night, was Ferrum Metallicum. This excited me, as it covered what I thought was the gestalt of his angry and aggressive attitude toward himself and others  – ‘You don’t try to do something, You do it’ , and his envy of the Grand Master who had an outlet for his anger – the mat. I confirmed a few things against the other remedies I was considering – yes, Ferrum had the burning esophagus/throat and choking on food. It did not list a desire for chocolate though which bothered me a little, but sweets, yes. He had talked about ramming Oreos down his throat, so sugar used as a form of self destruction was interesting. His oreo description had literally and clearly combined his anger/aggression (big in Ferrum)  with desire for sugar.

Lastly, Zandvoort’s repertory listed under Ferrum the rubric “Fear, trains and closed places.’ And it was one of maybe 50 Bold-listed remedies in the aggravation at night rubric. I felt my heart start to pump with excitement.

I decided to give him Ferrum Metallicum 200c, a dry split dose, and see him in 5 weeks, and asked him to check in with me at about 2 weeks or so to let me know how his cough was (mainly because I had Kali-carb in my back pocket, should his cough remain untouched by Ferrum). And I did hear from him once. He expressed having felt better enough that I had him repeat Ferrum at that point.

Follow Up 1

I’m feeling a lot better than last time I saw you, although the cough came back that one time when I emailed you. Other than that, cough once in a blue moon, last week a little bit more. Starting to get symptoms of hayfever. Itchy and burning eyes, A LOT.

My back pain, I actually went to chiro, curvature in upper back.

Digestive issues seem to have – getting a little bit better, has to do with me eating a lot better. Focusing a lot on fruits and vegetables, staying away from crappy sugar. If I do it for a couple of days, better, but if I go back to crappy chocolate, heaviness and tightness (in throat) that I was feeling before. I think that heaviness fed into my anxiety in nighttime, laying down, heaviness, with the breathing, worse and stuff, then all the stuff of afraid of monsters. I think everything overall is kind of getting better in all those different areas. Still have heartburn but not that bad.

I think overall I definitely feel much more focused and motivated. My writing is so much better, so much better, it’s unbelievable. Got me so motivated, feel like I’m thinking clearer. One thing I find, I’m getting tired quicker at night. Still toss and turn, not terrible insomnia I used to have. Now I’m actually getting tired at 11:30.

More motivated going to the gym and getting to the dojo. If I don’t get there, I’ll say I at least have to go to gym. 20th of July – came back from wedding, lost 8 lbs in that time.  In a month.  That’s all I can think of.

This all started about a week after, the end of July or a little bit before that.

I think part of it is physical. There’s almost a haze that’s gone. Even to the point, the heat isn’t bothering me as much. yesterday I didn’t even turn on the a/c. before I feel a little warmth, turn on the a/c. part of it is I think just mental, I want to go, I want to keep going, instead of there’s something good on TV or gotta take a nap. Don’t know exactly how to describe the physical from the mental – seemed on both levels.

Hayfever – over the last five or six years, started to come back a little bit. Never to the extreme as it was before. In the old days, couldn’t open my eyes you know? Now eyes bother me a little, drops in it, gone. Sneeze three times and gone.

Esophageal – Drink the ginger ale and it goes away. Not the unbearable level that it had been in the past.

Chocolate? Cookies?. Beer?

Definitely cut back. I can’t even tell you, went to Mets game, had three beers, maybe that’s all I’ve had in the last month. Promised myself I wouldn’t have any beer until I got down to 200. Craving for beer? Not at all.

Getting up in the night, having to check over shoulder?

Definitely not as bad, that door I open, afraid of someone being there. I don’t have that feeling at all anymore. I don’t have that feeling that I’m peeking and something’s going to be peeking back. Finally able to have the shower curtain all the way closed without the feeling that something’s there. I almost feel like part of it is I’ve consciously said to myself to stop being stupid.


Hard to tell, don’t have that kind of stress not at work. When I’m focused and motivated, don’t lose my patience. Do whatever you want, I’m here (HG tunnel) I’m tunnel vision, all this stuff over here, can’t get in, it’s like walls.


Just saying to my wife this am, when I’m in this mode, it’s a good mode. When I’m writing a lot or motivated, tend to dream a lot or remember them a lot more. Unfortunately, the dreams seem to be happy dreams. Fun dreams, I can’t remember the details. Impressions are good.

Describe more the feeling you have?

Refreshed, in a good mood. About the motivated, more to it than just a dream. I had a few weird things where – woken without the alarm clock. Had a couple of incidents where I slept REALLY LATE which I never do. Sleep of the dead until 10am! happened maybe twice. Those are the only 2x in the last year I’ve done that. Never happens to me.

Feeling from dream?

Happiness, I get the feeling that it was some kind of really good party. Kind of that glow you have afterward. There’s a lot of people I know in the dreams that I know from real life. Know them from different eras, college and high school. Never anything bad, always fun, something fun is happening.

No tickling in throat. That’s how I differentiate it from other stuff. New, something I want to talk to you about as opposed to stuff going on in last week.


Haven’t really tested that. I think one night got really hot when sleeping. a/c, did kind of wake up with I’m not claustrophobic, but if I don’t turn it on, I will be. CAN be related to the heat. If it’s really hot, wake up and feel like I can’t breathe.

Gagging, fear of not breathing?

Not been an issue with eating or sleeping, hasn’t bothered me. taken to being able to, a couple of times, sleeping on my back. Back pain is gone, shortly after I saw you. Four nephews at wedding, constantly throwing them around. Laying on my back was one position that didn’t hurt it. but issue was breathing. Prop myself up with 4 pillows, just have to take the pain, sleep with it and turn over.  A year ago, lay down on my back, turn into a mental thing. Anticipation of breath catching made my breath catch. Now I do have to sleep with pillows propped up, but still an improvement from the past.

Angry eating?

I haven’t felt the anger that much because of my focus and everything, eating’s been good. Have to see when that’s tested because I spent the wedding itself with my family, then spent a couple of days with my family last weekend. Temptation is there, cookies and chips everywhere, also I don’t like them and they drive me crazy, and it’s just (feeds face with cookies).

Obsession with death?

One night thinking about it, think a movie triggered it. Watching people, of course, I can’t believe I forgot this!!! Two days before wedding, my wife’s grandmother passed, we visited her the day before, she was 94, knew she’d be going. When we went to visit her, real tough time. so worried about the breathing thing when you’re dying. Want my death to be like that (snaps) like a truck running me over. All I could do is watch her and completely focused on the breathing. She looked dead. Although it didn’t stay with me in SUCH an emotional way as I would’ve thought. It stayed with me intellectually, but didn’t go there, didn’t suddenly become her. (HG forward, tunnel from eyes). Which I used to do and probably will do again. I do remember thinking at some point, maybe it won’t be that horrible to die.  I remember saying to my wife, do you ever think about how you’re dying? Sometimes. Doesn’t that drive you crazy? No. what?! You’re not going to exist! Laughs. Thoughts are still there, not as much, not as terrifying, not as emotional.

Writing – how has it changed?

I’m free-er. The history of my process – I want to write something so wonderful, then I overwrite in a sense. As I got better and learned more and more, learning techniques, pick better verbs, get rid of adjectives and adverbs. Became pretty good at tech side of it but always something missing to me. So obsessed with rules and everything, everything was flat, flatness – but this time, everything was flowing.  People I’m showing it to, so much better. I’m just so psyched about it. the two things came together at the perfect time. I’m so excited.

Anything else you think is important?

There was a time when I felt very centered and nothing could touch that. I was too possessive of it, the white knuckle years I called them, made me more selfish too. Whatever happened, got into psychology, my field. That’s where all the fear started coming in, nothing protecting it. now I’m a little more in whack, in balance. When I see the fears, talking about the death, more intellectual, not expecting someone to come out at me.

——-I thought he sounded great. Of course, the itchy watery eyes did make me consider Arsenicum for a moment, and of course, his following of rules is classic Kali, but I wasn’t gonna mess with this overall improvement! We waited on another dose, and I told him to call me if he needed between now and his next follow up in 5 more weeks. 

Follow Up 2

Sweating like crazy on that subway!

Start with good or bad?

I’ll start with good! No heartburn whatsoever. Maybe chocolate, not eating as much. gone a week without it. believe, me, that’s miraculous.

Something very very weird. Don’t know if it has anything to do with this or something else. About three weeks ago, a friend of mine from SF came in, went out drinking, drank too much. Hung over. Since then, haven’t had one beer that doesn’t taste disgusting to me. like back when 18 – bitter. Like body saying what was unhealthy body, don’t like that anymore.

Went to a party, didn’t drink.  Still very motivated. So psyched about my writing  last time, gotten even better. God! How did that go through me?! Come out of me.

Bad thing – an injury that I got, don’t know if you can help or not. Not getting to dojo a lot. 2 weeks ago, grandmaster mad at me, demonstrated on me. hand to my neck – for next two days had a sore throat. Feel it right here (adam’s apple) talking doesn’t bother it. just when I swallow. Even with water, it hurt. For a while, if I drank anything, I cough. Like a little water caught in there. At first it would hurt, even if touched it there.

What is pain like? It’s like an ache, doesn’t feel like anything sharp (hg) but an ache. When it was hurting, like this, felt like when you press a bruise.

It’s so unlike him, I don’t get it. should’ve known that’s your neck. The guy is like IRON. Seriously. This is what his forearm is like (hits chair.) I hit him, when he blocks me, it hurts me.

That’s pretty much it.

Any dreams?

For the most part, I think my dreams have been very upbeat. Some I enjoyed so much, think through the day, I hope I have that dream tonight.

Motivation for exercise?

Miss sometimes, my aunt died. Anytime I’m missing, not from lack of motivation, just crap going on.

Hayfever – two incidents that pass in 10 minutes. weird. Gone.

Getting up in night, nervousness? Oh that’s pretty much gone.

Gagging sensation – no problems.


Well, this is weird. One day when I had the real bad indigestion, in Boston with in-laws, got up in middle of night with it – just whole torso was full and said to Kim, I need alka seltzer. She ran out to get it for me. We’re in their basement, pacing back and forth, now is this really a heart attack? When stuff like that happens, start obsessing on death. Not sweating at all, definitely not a heart attack. But this will be what it is like when I die. pain, fear.  Afterward, my reaction was more like, I could deal with that. That’s not so bad. Then it will be gone, nothing to worry about. A more logical approach to just this runaway emotion.


Just free-er. Trusting my instincts more, I think. More playful. When I’m at my best. Ideas come into my head, wow, I can’t believe I thought of that. A story I wrote about Abe Lincoln – We get stuck if we don’t’ work hard, considered lazy and failures. Damn, that’s clever! How the hell did that come out of me? it’s playful! I’m open to more things, you know?

Injury – 2 weeks ago.


I had him repeat Ferr 200c for the injury and asked him to be in touch in three days. His throat felt much relieved after that! And I was especially delighted that he described his idol, the Grand Master of the Dojo, as ‘IRON’, the substance I’d given him! That’s when homeopathy is extra-fun!

About the author

Erika Simonian

Erika Simonian, CCH, is a co-founder of New York Homeopathy (, a private practice with offices in Manhattan and Brooklyn. Erika studied for four years at the School of Homeopathy, New York, and upon graduating in 2006, traveled to India for post-graduate study and clinical work with Rajan Sankaran’s Bombay School. She received her US board certification in 2008 and has built a practice working with children and adults of all ages.

1 Comment

  • Great case! And a great affirmation not to change remedies too hastily. Thank you.

    Interesting that in TBR2 : Modalities {1687 1694}; From Situation & Circumstance; Talking, from {2195}; amel. {2196} (1) ferr.

    One question: what is a dry split dose? (I thought a split dose referred to watery doses?)

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