Case Quizes Clinical Cases

Revisiting: Claire’s Daughter Gets a Virus–Suddenly

Did you try to come up with a remedy for last month’s acute Quiz?

To read last month’s full case quiz. Visit – Claire’s Daughter Gets a Virus–Suddenly






Nux vomica

OK, who wants to be first this time?

Hello Elaine & Shana,

Hello Wayne from Australia!

Seems like this girl had an emotional upset and she needed consolation or she was fearful.
Most probable remedies would be Phosphorus, Nat Mur or Ignatia.
A sudden headache has Ignatia, as does headache with nausea, only very weakly.
Phosphorus runs through the rest and could probably be given with effect.
It is not Belladonna, no dilation of the pupils.  A slight fever is strongly Phosphorus, with Ipecac less so.
Ignatia is worse for consolation, although the headache is sudden.
All slightly confusing.  I will go for Phosphorus.

Well, Wayne, the key to this case was the word “sudden”.  I’m thinking this could be the first signs of a stomach flu or gastro-intestinal virus of some sort.  We have two main remedies for “sudden onset”–Aconite and Belladonna.  Thinking it might be Belladonna, Claire looked to see if there were dilated pupils or glassy eyes or cold extremities.  Finding nothing of the sort, she went to our other sudden onset remedy, Aconite, which was confirmed by the child’s fearfulness, and she was right.  

The point of this quiz was to show how “onset” can be the deciding factor in a case, it’s right near the top of our “hierarchy of symptoms”, something I wrote about in a previous article:

Here’s an excerpt from that article:

This is the value in having a hierarchy of symptoms because…knowing that you will most likely NOT be able to match every symptom in the case with the same remedy, you will at least know to match what’s at the top of the hierarchy and be successful.

We’re more concerned that the remedy match what’s at the top–usually the mental and emotional symptoms–than what’s at the very bottom, which are usually the local physical symptoms.

In this context, the remedy that matches the Generals would be of more value, more likely to cure, than the remedy that matches only the Particulars. The Generals are the symptoms that start with the word, “I” or “I’m”: “I want air!” “I want to go home!” “I’m thirsty!” “I want to be left alone,” and so on.  The local symptoms start with “MY”: “My nose is stopped up!” “My eye itches.”

Even higher than the mental/emotionals in the hierarchy is the Etiology (the cause) …!

Now, since I brought it up, here is the standard hierarchy:

  1. Etiology (“Ailments From” or “Never Well Since” a certain trauma, event or illnesss)
  2. Diagnosis (the name of the condition: Measles? PMS? Arthritis? Gallstones?) Some of you are going to say, “Isn’t that allopathy?” If I don’t know what you have, if I don’t know the name of your illness, I won’t know which chapter of the Repertory to look in!

You can have a rash, for example, but what’s it from? Is it an allergy? Is it the measles? Is it poison ivy? … Knowing the answer to this will tell me what the primary rubric is; so, having a diagnosis is basic.  Now, keep in mind, you don’t always need a doctor to acquire this information, sometimes what’s wrong with a person is quite obvious; but, you do have to ask your patient, and if he says, “I don’t know, I don’t know what’s wrong with me,” ask him, “When did it start?  What were you doing that day or around that time?  Re-trace your steps, give me the run-down.”

  1. Onset (sudden or gradual?)

A sudden onset might trump everything in the case and lead to an immediate consideration of Aconite or Belladonna and maybe even Baptisia in septic states.

  1. Delusions and Strange/Rare and Peculiar symptoms
  2. Mentals (symptoms like confusion, forgetfulness, poor concentration, stupor.)
  3. Emotionals (fear, crying, yelling, whining, making demands, throwing things, etc.)
  4. Physical Generals (“I’m thirsty”, “I’m cold”, “I want to sleep”, “I’m nauseous”, “I want ice”, “I want the lights out”, etc.)
  5. Local symptoms (“My leg hurts”, “My eye itches”, “My throat is sore”, “My nose is stopped up.”)



OK, so who else is here today?

Hi Elaine!

Oh look! It’s Maryam from Pakistan!

Hope you are good.

You were looking gorgeous in the snap with your brother.

Really? I was? Thanks! Now have your eyes examined!

My vote for this month’s quiz is Aconite.

You’re right!!!!

She got a sudden headache, and she is scared.


And I have noticed one more thing that pupils are not dilated, hands and feet are not cold which differentiate it from belladonna.

Right again!


Maryam from Pakistan.


Thanks again, Maryam! Do we have another caller on the line? Speak up, caller. You’re on the air at!

Hi Elaine,

Hi Anurag!

For this month’s quiz, my answer is Gelsemium!

The sudden onset of Headache marked with nausea and fear indicates this remedy.

Thanks to confirm!



Anurag, Gelsemium isn’t in the “sudden onset” rubric. In Murphy’s 3rd ed., you’d go to the Clinical chapter, and then go alphabetically to “Diseases, general, Complaints and Symptoms, sudden manifestations” and the 2 remedies in bold are: Aconite and Belladonna. Gelsemium’s not there. Meanwhile, as this is a 7 year old child, and children aren’t prone to getting headaches the way adults are, I would look at this more as the beginning of a virus similar to the flu; and therefore, I wouldn’t bother with the headache chapter, as headache is a common virus symptom; if you think of this only as a headache, it can be misleading–even though the correct remedy was listed under “Headaches, sudden”, just not in the highest degree. Our two main remedies for sudden onset of a virus are Aconite and Belladonna; so, Claire checked for Belladonna confirmatories and found nothing, so, she gave the other sudden onset remedy and it worked!

Yes! I agree with you. I was not sure about Gelsemium either.

I believe Gelsemium is known for slow onset.  Look at “Generals: pain, appear gradually, the pains”–only two remedies in bold: Gelsemium and Conium, Ignatia is in italics.  All the rest plain type.

I wanted to write Belladonna instead.  If Belladonna symptoms not there, Aconite is a good choice for sudden onset of symptoms (I dropped it when Claire mentions “Hands and feet not cold”).

You dropped the ball.  You’ll get it back next time!


Who do we have next?  Oh look!  It’s Miroslav and Jitka!

Hello Elaine and Shana, we hope that we are not too late with our responses to the September quiz.

No, not late at all!

We have read carefully your article “Acute vs chronic remedies, the hierarchy of symptoms and the kitchen sink”.

Catchy little title, isn’t it?  You should have no problem with this quiz at all.

Now you can see whether it was useful for one of us..:)

OK, let’s see!

Miroslav says: Nux vomica


After a short repertorization I picked Nux-v. :

There was actually no need to repertorize this case.

Rubrics :

Mind, being held, amel.

No, no, no, no, no. All children want to be held, it’s common, and we don’t repertorize common symptoms.  She’s 7 years old, so it means nothing.  If she was indifferent to being comforted and held while sick, that would be very striking and we would surely want the remedy to cover that.

Headaches, agitated, emotional, after

No, look, here’s the problem. Kids get upset all the time, at least 10 times a day, it doesn’t mean anything unless it’s extreme.  Also, 7-year-olds don’t get headaches like adults do.  If a child reports having a headache, you have to wonder or consider the possibility that she’s coming down with a virus and maybe even the flu.  Claire did say that “Matilda” felt “warm”. And then when she said it’s now taking on another symptom–nausea–all the more reason to suspect a virus!  So what we really have here, then, is a sudden onset of a virus, possibly a stomach flu.

Headache, vomiting with headache

No, no, no, I knew someone would get tripped up by that!  This is not a case of headache with vomiting.  In fact, vomiting isn’t part of the case at all!  The vomiting didn’t occur until after the remedy was given, and you do know that the right remedy typically leads to discharges, right?  In fact, here’s another quiz where the same thing happened, headache followed by vomiting after the right remedy was given:

It would be very useful for you to look at it.  So, the vomiting is caused by the remedy (or the case resolving) it signals the end of the case, and after that, everything is over and all is well! If vomiting had been part of the case, it would have just led to more vomiting, not a cure!  Can you see that?  Unless it is just a case of bad food or water, in which instance vomiting once MIGHT conceivably end the case.

Headaches, stomach headache

Stomach, vomiting improves – (MM Phatak)

Mind, confusion, mental confusion

No, none of this matters, and I don’t even think mental confusion was part of the case.  You told me you read my article on the hierarchy of symptoms but you made the same mistake as the example given at the end where a sun headache seems to be Sulphur, looking only at the symptoms at the bottom of the hierarchy–the local symptoms; but, if one starts at the top of the hierarchy, the remedy is clearly Belladonna.

In the case of “Matilda”, you started at the bottom of the hierarchy and repertorized the local symptoms, ignoring “sudden onset” and the two essential remedies that cover it–Belladonna and Aconite!  And since “onset” is at or near the top, the remedy has to be one of those two!

Look, it’s like this, if the 2 of us are playing cards, and I’ve got a Queen, and all you’ve got is a 3, a 5 and a 9, all your cards are irrelevant, my Queen wins!  Do you see that?  Does everybody see that?  All those low cards mean nothing!  

So Claire tried to confirm Belladonna by checking for dilated pupils, glassy eyes and cold extremities and none were there; so, with Belladonna eliminated, there was only Aconite left standing.  So Aconite wins.  All those other “symptoms” in the case were like “low cards”! Unless you’ve got a King or an Ace, Aconite wins! 

Here’s the thing, people.  It is hardly ever that you have an illness where the proposed remedy covers everything–the locals, the generals, the mentals, the peculiars, the onset, the etiology….etc.  So, knowing that your remedy’s not going to cover everything, what MUST it cover?  The TOP of the hierarchy!  Why look for other remedies when your case has “sudden onset” and you know there are only 2 sudden onset remedies?  Why repertorize when you know it’s either Aconite or Belladonna?  All you have to do is confirm or eliminate Belladonna!

Some people make the mistake of making “sudden onset” just one more in a sea of many rubrics chosen for the case, such as: 1. headache, 2. sudden onset, 3. nausea, and then repertorize and the #1 remedy wins!  No, the hierarchy of symptoms nullifies that approach.  What this approach tells you is that if you’ve got the mentals of Arsenicum, for example, in a case, but there are a myriad of physical symptoms in the case as well, which could be almost anything, you are going to give Arsenicum!  Why?  Because being a “mental”, it trumps all the physical particulars below it!

This is the value of Jonathan Breslow’s book Homeopathic Medicine In The Home.  Breslow is the only person, to my knowledge, who has written a book on how to take an acute case! Everyone would do well to have it!

Jitka says: Phosphorus

Oops, sorry, it’s not Phosphorus.

Mind, sensitive; children– PHOSP

No, we actually know nothing about “Matilda’s” sensitivity to make this judgement.

Mind, agitated, excited children in– 2phosp

No, no, no, you’re assuming information not in evidence.  In fact, she was sitting rather quietly in her mother’s lap.

Mind; emotions; becomes ill after strong emotions– 2phosp

There was no evidence of “strong” emotions.  Kids are emotional anyway.  Imagine if they got sick every time they became moderately emotional, they’d all be sick constantly!

Mind; fear; groundless– 2 phosp

No, she didn’t have groundless fear, she was afraid because she didn’t feel well.

Mind: fear in children, night– PHOSP

This isn’t a case of fear at night in a child, it’s fear when sick; or, in repertory language, “anxiety about health”.  People are too often choosing rubrics without giving careful thought.

Mind, being held; desires– PHOSP

It’s common in children, so, we don’t pay any attention to it.

Headache, agitation, emotions, after– PHOSP

You know, the whole “emotional” so-called etiology in the case was too vague to draw any conclusions from so I just ignored it.

Headaches, nausea, during– 2phosp

Well, again, go back and read my remarks to Miroslav.  I can see that this was a very important quiz because people need to learn about the hierarchy of symptoms AND being much more careful in choosing symptoms.

Elaine, I actually thought it was Aconite but I thought that would be too easy.


Best regards, Jitka


We have time for one last contestant.  Go ahead, caller, you’re on the air at!

Hi Elaine and Shana, my vote for this month’s quiz is Aconitum.  Mostly for the sudden onset and the scared look.  I couldn’t come up with something better, maybe I missed something as usual.  I’ll try again if I am wrong.

No, Maria, you are not wrong!  I repeat, not wrong!

Wow, it’s been a while since I voted correctly 😛

Actually, this is exactly how I saw it: sudden onset, scared.  Aconite.

Did we learn about the hierarchy of symptoms today?  That was the importance of the quiz.

And now it’s time to give a shout-out to our winners!  Congratulations go to……

Dr. Salma Afroz


Maryam from Pakistan

Dr. Saroj from Mumbai


Bye-bye, see you again next time on the Hpathy Quiz!!!!

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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