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OK! Everybody who wants to talk, line up! Who’s first?
This is a real “toughie”.
Hi Wayne, yes I know!
After reading the case and seeing the most likely remedies being ruled out, things got really difficult.
My rubrics are:
Vomiting, general; drinking,after
Nausea, general; headache, during
I wouldn’t pick that one. She has a virus, you could even use the stomach flu, or gastric flu rubric. They almost always come with headaches, it’s a common symptom. So what you want to do is look at the gastric flu rubric and ask yourself which of these remedies has the characteristic symptoms in the case? So that means you have to know what the characteristic symptoms are.
All kids whine, it doesn’t mean anything. If she weren’t complaining, just accepting? That would be more characteristic.
Ice, general; desires
Restlessness, mental; bed, in; tossing about in
With over 100 remedies, that rubric would not be my choice! Better is the rubric: “Mind: restlessness, nausea, from”. There are only 3 remedies in that rubric! Arsenicum, Cina and Phosphorus. Wouldn’t you rather be deciding among 3 remedies than 100?
Vomiting, general; water
That doesn’t mean anything either. She’s vomiting because she’s got a stomach flu. She’s vomiting water because that’s what’s in her stomach. If she had eaten something, she’d be vomiting that.
Forehead, headaches, pain, general
Again, doesn’t mean anything; it’s a common symptom of the flu or stomach virus–headache.
There are roughly 200 remedies in that rubric, meaning it’s not going to help us.
The only remedies desiring ice, which to me is a key to the case, as is vomiting it up after warming–
I wouldn’t assume that that’s why she’s vomiting (because it turned warm). She’s vomiting because she has a stomach virus.
Arsenicum, Veratrum, Phosphorus, Aconite, Pulsatilla
Arsenicum and Phosphorus have been tried unsuccessfully.
Not true! This is where a lot of people made their mistake! Arsenicum showed a marginal improvement. Listen to what Claire says:
“I gave her Ars-alb 30c, water dose this time, and she fell asleep comfortably until 11:30 am, which was good.”
See that? She uses the word “good”. What does that suggest?
Of the balance, I choose Veratrum Alb., which is for children and old people in the extremes of life. It also has copious vomiting with nausea, aggravated by drinking and the least motion.
Well, geez, that totally eliminates Veratrum alb. then, if least motion aggravates? This kid is tossing about! She’s restless!
It also has general coldness.
Nevertheless, reports are that it has violent vomiting with profuse diarrhea, other: pale blue skin and cold sweat, which is not the case here. The symptoms generally are more extreme to those with which we are confronted in this instance.
Finally it does have Vomiting: Excessive with nausea and great prostration; by drinking; by least motion; great weakness after.
I’m really looking forward to seeing what the answer is.
Veratrum is a reasonable guess once you assume that Arsenicum and Phosphorus have been tried and failed. But we’re given the hint here that maybe there’s more to Arsenicum than meets the eye, and then when she says, “Oh yeah, didn’t I tell you? She’s been tossing about with the nausea.” I said, “What????? Claire!!! You never said anything about tossing about!!!! This is why I make people fill out my questionnaire!” Now, given all that, what do you think the remedy is now?
I still can’t get it!
Thanks Elaine for explaining your thinking in solving the case.
Despite all the rubrics which you say are superfluous, my strong choice would have been Arsenicum,
Wayne, it IS Arsenicum! But there’s the little matter of potency, isn’t there? Claire gave Arsenicum 30C. Did you ever see the 30C fall on its face? I have! I’ve seen it do absolutely nothing! So when you’re sure the remedy is Arsenicum and Arsenicum 30C doesn’t work, what do you do then?
It was ineffective.
It wasn’t ineffective, it just wasn’t very effective.
I can’t see the importance of the patient being restless, as arsenicum has restlessness in its qualities.
That didn’t make any sense to me. You appear to be saying: Why is restlessness important if Arsenicum has restlessness and it was tried and didn’t work? It’s important because it confirms Arsenicum, meaning…what do you do now?
The patient was given Arsenicum 30c dry, and then in a liquid 30c – I can’t see that there should have been any difference.
The one in water is stronger.
Thanks for the tip on “Mind : Restlessness, nausea from”. It must be that the nausea is causing restlessness?
I assume; but, I’ve also seen people hold perfectly still in nausea, which would be what remedy? Anybody??? Bryonia!
Finally, I think you should put out your own repertory, discarding all the rubrics which don’t help much – it would be much smaller.
I suppose all rubrics are important given an appropriate context, but you have to ask, “Does this rubric matter in this particular case?” For instance, the headache–you know she has a virus. Headaches are common in viruses. What does Hahnemann say in aphorism 157? He says you have to find the strange, rare and peculiar symptom in the case because the common ones apply to just about everyone and will therefore not lead you to a remedy. I checked the “Headache, forehead” rubric, it’s huge! Over 250 remedies with 28 of them in bold!
Symptoms like “whining”. You simply have to remind yourself that the patient is a child and most likely whines all the time! When is “whining” a symptom? I had a quiz once where the patient said, “What’s most striking about this case is the amount of whining I’m doing!” Well, there ya go!
“Vomiting water”? Is the child really “vomiting water”, or is she just vomiting because she has a stomach virus?
“Worse in Autumn”. How can we say that without a second autumn to confirm it?
“Accelerated breathing”. Isn’t that fairly common when you’re sick? Do you know what would be peculiar? If her breathing were slow despite being nauseous. It’s just like the remedy Pyrogen has a paradoxical symptom of the pulse being out of synch with the fever. When the fever is high, the pulse is slow; when the fever is low the pulse is fast. If you saw something paradoxical like that in the case, you might have something to go on; but since it’s common, you have nothing. Plus, that rubric is huge with almost 200 remedies in it!
Just because the patient or mother of the patient “reports” something, doesn’t mean you automatically repertorize it. It doesn’t become part of the case just because it’s told to you. Patients usually report things that are important to doctors–out of habit–assuming we want to hear it too. They don’t know that these things probably don’t matter to us. The things that do matter, they probably won’t say, as this case amply demonstrates!
What is actually important or peculiar or characteristic in this case? It was the one thing Claire forgot to mention– the tossing about with nausea! That’s not common, there’s nothing about a stomach virus that says you have to be tossing about! So when she said it–finally–I was incredulous! “How could you have left that out?” If she had just said that in the first place, I would have known the remedy was Arsenicum right away! So as you’ve now probably guessed, the remedy is…
I appreciate your comments as everything you say helps my approach.
Who’s next? Step right up!
Still learning, but I am going to guess Iris for this month’s quiz.
(I probably would have proceeded just as she did with Arsenicum, but Iris has the killer frontal headache with nausea and vomiting, as well as profuse saliva-she mentioned frothy saliva.)
True, but Iris’ saliva is stringy.
So that’s my guess…
Well, Natalie, it is a fact that Iris has headaches with vomiting! In fact, I believe it was Kent who said that Iris has the All-American Sick Headache! (Which pretty much means a migraine.) But here’s why it’s not Iris. Claire’s daughter had a virus, a stomach virus. Kids seem to pick up these horrible things in droves! When Shana was in kindergarten, I was sick all the time! I caught everything she had! I don’t know what goes on in kindergarten and pre-school classrooms, but they should obviously be disinfected 10 times a day! Anyway, so this is what Claire’s daughter had–a stomach virus–for which a headache is par for the course.
It’s just like a rash goes with the measles. See, first you have to get the diagnosis right, because symptoms often fit many diseases. For example, a person can have an itchy rash because he has poison ivy, chicken pox or eczema. So, clearly, you have to first determine what the person has, and start from there.
The diagnosis for this case is not “headache with vomiting”, it’s “stomach virus” or “stomach flu”. Now, how do you look that up in the repertory? Well, if you have Murphy’s Repertory, 3rd ed., you can go to Clinical: influenza, stomach. If you have his 2nd edition, it would be Diseases: influenza, stomach. There are 36 remedies. You look at them and ask yourself, “Which one of these has the characteristic symptoms of the case?”
This means you have to determine what the characteristic symptoms are! They’re not the COMMON symptoms of the case, like headache! What’s uncommon here? Well, unfortunately, Claire didn’t tell me until AFTER she had given the remedy! She said, “Oh, didn’t I tell you? She was tossing about!” No, you didn’t tell me!!!! So what is that? Restlessness? Which of our stomach flu remedies has restlessness? Clearly, Arsenicum–our famous gastro-intestinal flu/ restless remedy!
I know, you’re going to say, “But she already gave Arsenicum!” She gave too low a potency! I have frequently found that in certain viral infections, 30C isn’t strong enough! I once gave Arsenicum 30X to myself for a stomach virus I had and got nowhere–nothing, a complete failure!!!! And it was a clear Arsenicum case, including the restlessness; but, all I had at the time were 30X’s! So this is another important lesson for everyone–get your acute remedies in higher potencies if all you have are 30C’s because even though they might work most of the time, this is what can happen!
Who’s next? Oh look! It’s our two room-mates, Miroslav and Jitka!
Dear Elaine and Shana,
we answer the October quiz:
It is quite an interesting case, even Phosphorus and Ipecac are already excluded .
I probably would give Eupatorium perfoliatum.
Symptoms on basis which I chose this remedy: big soreness of body –
Are you sure her body was sore? I didn’t see a single thing about soreness.
it would explain her whining and tossing around
Oh! You’re assuming her body was sore because she was whining and tossing about? Well, we’re not on solid ground if we’re presuming things.
…desire for ice, acidic (oranges)
How did you come up with “desires oranges”? Oh, because she ate an orange after she was well? But she also ate broccoli and noodles! Eating something after the complaint is over, by definition, isn’t part of the case!
and immediate vomiting, also alleged chills, headache …
In the absence of Eup-perf’s famous keynote–bone pains as if bones are broken–and in the absence of any reported muscle aches at all, I would find it hard to prescribe Eupatorium perf.
Mind, lamenting, bemoaning, wailing etc. (compare weeping)
Mind, restlessness, bed, tossing about in
Jitka, if you see restlessness in a case, the last remedy you should be thinking about is Bryonia! If there’s one thing we can be absolutely sure of, it’s that Bryonia is not restless and not tossing about, especially with nausea. “Stomach: nausea, motion agg.”–Bryonia (3)
Also, this rubric you’ve taken is wrong. It’s not “Mind: restlessness, bed, in”. It’s “Mind: restlessness, nausea, with”; the “restlessness with nausea” rubric contains just 5 remedies and it describes exactly what the situation was. The child wasn’t restless just for the sake of it, she was restless with nausea; so, that’s a more specific rubric; and with just 5 remedies in it, it really gives us something to work with.
Stomach, vomiting, morning
Stomach, vomiting, drinking, immediately after
Stomach, vomiting, drinking, smallest quantity
Stomach, vomiting, headache, during
Stomach, vomiting, waking, on
Stomach, vomiting, bile
Stomach, vomiting, bile, headache, with
Stomach, vomiting, water
Head, pain, morning, bed, in, first motion, on
Head, pain, morning, rising, on (agg.)
Head, pain, morning, waking, on
Head, pain, forehead, morning
Generalities, autumn, agg. In
Jitka, you’ve been too nit-picky, you’ve gathered too much information, most of it trivial. The first thing you have to do is ask yourself what does the child have? What is this a case of? Well, Claire has told us what it is, it’s a virus. And we can reasonably surmise it’s a stomach virus. To find this in the Repertory, we’d have to go to the “Influenza, stomach” rubric. Now, please don’t tell me you’re only using Kent’s Repertory because Kent doesn’t even have an Influenza rubric! Please buy Murphy’s Repertory, 3rd ed. (or 2nd ed. if you can find one) and look up Influenza in the “Clinical” chapter or the “Disease” chapter, depending on what edition you have. Go to the subrubric “stomach” or “gastric”. Now, since “stomach influenza” is an umbrella for all, or most, of what you’ve just listed (vomiting, headache, etc.), it makes them all irrelevant! So all you want to do is ask yourself, of all these stomach flu remedies (36), which one is chilly, thirsty and restless (tossing about)?
Thank you for your comprehensive answer to our misunderstood quiz . Thanks to your clarification of the case, we will try to answer correctly, even though we won´t be among the “winners” of some great song….:)
Hmm…a great song…. Shana, get to work on that!
So as we have a second chance, I’ll seek to make use of it. I think Elaine advised us well, how we should concentrate on the central problem. This case is a virus, moreover the mother mentioned about it throughout the case. And it does not matter that we do not have such options as in the US or another countries, nor that our lecturer taught us not to solve acute cases (we were advised to contact a doctor)
What??? Excuse me??? Say that again??? You were told to send your acute cases to a doctor???? For drugs???? No homeopathic remedies??? And this is what your lecturing homeopath told you to do???? OMG! Who is this guy? I want to know so I never accidently send someone to him! Acute prescribing is what homeopathy is famous for! Acute prescribing is why there are statues of Hahnemann all over the world! Maybe your teacher should read the ezine.
I feel that it will not be an unknown remedy, on the contrary something that we know well …In rubric stomach flu are several remedies, including BRY, also EUPATORIUM… however they were incorrect… I made out a list of symptoms: aggravation cold,
She had chills, I don’t know if that’s the same as “Cold temperatures agg.”
chilliness, gastric flu, desire for cold water and about a key symptom: restlessness (really, I did not know where to find it)
“Mind, restlessness, nausea, with”
so I settle for: no positions bring relief),
I can’t find that! That’s a sub-rubric, what’s the main rubric? I found “Generals: position, change of body, desire for, continually”
Too big a rubric; in fact, it’s a whole chapter!
Too big a rubric with 182 remedies!
You have to look at the reasons Rhus tox is restless. Generally it’s all about musculo-skeletal problems which, without movement, cause stiffness, compelling the patient to move. This is why Rhus tox has to keep moving. If you see a virus patient who needs Rhus tox, he will complain of muscle aches and stiffness which compel him to move. We don’t have any muscle aches here. The restlessness is coming from the mental plane.
Following your answer, where you stressed three key symptoms: chilly, thirsty and restless, I choose remedy Rhus- tox
Best regards, Jitka
Note: We both have Murphy’s repertory but it is translated into Czech. I looked for a rubric that you suggested: “Mind: restlessness, nausea, with” with – 5 remedies.
In my Murphy’s repertory, I found rubrics: Mind: restlessness; nausea, from: ars, cina, phos.
And you can see that Rhus tox isn’t there. Rhus tox is restless, yes; but the “Mind: restlessness” rubric is huge! So big, we can’t use it. This is why we need the more specific, MIND: restlessness, nausea, with (or nausea from). Also, under Food: ice, desires–Rhus tox isn’t there. What IS there is Arsenicum!!! Now, here is the mistake you made: All we know about Arsenicum not working is that Arsenicum 30C did not work! Isn’t potency just as much a factor as the remedy itself? Is the right remedy in the wrong potency going to work? No. When everything points to Arsenicum and you give it and it doesn’t work, what are you going to do? In point of fact, there are indications in this case that Arsenicum 30C did help somewhat; which should have prompted us to do what? Raise the potency to 200C! And that, my friends, was what cured the case–Arsenicum 200C.
D’oh! We messed up enough! In any case, thank you for a good lesson.
Shana, what great song did you pick for Miroslav and Jitka?
They got “Bad Luck”!
(“That’s what they got, that’s what they got”) by Harold Melvin and the Bluenotes
Are there anymore people lined up? Oh look, it’s Esther, aka “HomNZ”. Esther, what does it look like from your part of the world?
Arsenicum has been helpful in this case. On giving Arsenicum the intervals between the vomiting spells have gotten longer and sleep has resulted. I would not hesitate to apply a higher potency of Arsenicum as I am thinking the situation is sudden and violent and the 30c potency may just not be holding. Did she give Arsenicum 200C?
OMG! We’ve got a winner!!!! Yes! Case too violent for 30C, must try 200C! Perfect! You go, girl!!!!!
Oh Yeah!!!! Thanks Elaine, I was pretty sure I was on the right track. But it is sooo easy to think that if symptoms don’t go straight away it must be the wrong remedy.
I know, Esther, that’s what this quiz is all about, and also to hammer home the point that those of you who think that low potencies are for acutes and the high potencies are for chronics? You’ve got it completely backwards, and if this case doesn’t prove it, I don’t know what will. I see Maria is here!
Hi Elaine and Shana!
Well you killed my first choices, namely Ars and Phos 😛
I am between 2 remedies. Veratrum and Aconite.
They are both restless; under desires ice rubric, Acon is 1 and Veratrum a 3.
I will go for Aconite and if I am wrong I will try again.
So sorry, Maria, I tricked everyone this month! But only to make a point; because surely, this is something that has happened to all of us: we had the right remedy, but we gave it in too low a potency, and so nothing happened! When you look at a case and you are so sure that you have the right remedy and then nothing happens, the first thing you should think of is raising the potency and trying again. This, apparently, was a really bad virus, and 30C just didn’t cut it! I hope people learn from this case not to be content for too long with just their 30C emergency kit! What do you think the remedy is now?
Arsenicum!!!! She shows an almost complete picture of Arsenicum!
Great quiz Elaine and Shana! I think we should give attention to what you said: The simillinum HAS to match the potency also.
Of course it has happened to us too. For example a friend of mine suffered from vertigo with left sided headache, worse during sleep. He was talkative, sarcastic, mocking at others. He took Lachesis 30C at first and it worked!
Totally great image of Lachesis, by the way! Left-sided complaint, sleep aggravates, talkative, sarcastic? Perfect!
The next time it happened he had to raise the potency to 1M. Now when it happens, it goes away with 10M only! With lower potencies it seems that it is the wrong remedy, doesn’t work at all!
Thanks so much for pointing it out to all of us.
I keep telling people, if you’re trying to save money by just buying the 30C emergency kit and thinking you’ll be fine? Guess again! Thanks, that was a great example, Maria!
And now it’s time to congratulate Esther, our winner, who was not tricked by our tricky quiz! Esther, this is for you:
Elaine Lewis, D.Hom., C.Hom.
Elaine takes online cases! Write to her at [email protected]
Visit her website: elaineLewis.hpathy.com