Clinical Cases

Revisiting: Lifting, Pushing and Hauling Leads to Confusion, Soreness and Crying!

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Revisiting: Lifting, Pushing and Hauling Leads to Confusion, Soreness and Crying!. Elaine gives the answer to last month’s quiz.

Did anyone happen to read last month’s Peabody Award-winning quiz?

To read last month’s full case quiz. Visit – Lifting, Pushing and Hauling Lead to Confusion, Soreness and Crying!



Rhus tox-9





Bellis p.

Don’t look now but it looks like we didn’t fool too many people. Over
half of you knew it was Rhus tox! OK, let’s get right to our letters:

Hi Elaine

I think you gave her Rhus Tox 30C

I used Synthesis and these rubrics to confirm my

General, injuries from over exertion

Generals, lifting, straining of muscles and tendons,
ailments from

Extremities, pain sore, bruised exertion after

Extremities pain sore motion ameliorates

Mind confusion

Mind weepng

Generals eating amel

Two things stick out as unusual – pain better for
motion which points to Rhus T and not Arnica

Mind weeping which points much more to Rhus than
to Arnica

Rhus tox is well known for its amelioration from
motion especially continued motion. Arnica is well known for

bravado and saying they are OK when clearly not.
Rhus is known for weeping and confused dullness as well as

being famous for pain in muscles and tendons from
over lifting /extertion.

Cheers from Kanmantoo


you are absolutely right! In fact, I’ve never seen so many points going for
Rhus tox in a single case, including, as you pointed out, the crying and the
dullness (in a fog); most people don’t know that about Rhus tox! Did you like
the Shirelles song?

Yup! By some strange co-incidence this is one of the first records
my dad ever brought home.

He was a care taker at a high school up the road from our house.
We didn’t have many records. Some time a
round 1970 he was clearing out one of the garbage bins in the drama room and happened across some “old” records. He brought them home and I listended to them until they wore out.

Will You Still Love Me Tomorrow was one of them.  I love the Shirelles!

Thanks for the memories Elaine–Deb

I’m only doing my job as a homeopath!


hi elaine,

i think RHUX TOX 30C will be the similimum in this very case… the main
symptom which has to be noted is the modality which says there is amelioration
after movement………..

also, rhux tox has a wonderful action on tendons……i want to know something…….the
potency selection has been done on what basis……why you gave 30c and not
200 or 1m……..

also i wanna know does potency selection make much difference practically
if remedy chosen is right……becoz i have heard that practically it does
not make much difference if remedy chosen is right…….

Dr. N. Gupta

a great question! It’s so important, I may write an article about it in the
future. In this case, it was probably due to the fact that Shirley had only
a 30C at home. But Dr. Gupta, if 30C worked so well, with no aggravation,
and nothing but amelioration right from the start, doesn’t it suggest that
maybe we’re too quick to go to the highest potency as a knee-jerk reaction
when we could be saving it in the event that it might be needed later in the
case? If you start with the 200, and it wears off, and you have no 1M, what
will you do, what will you go up to? It would be like playing your “Ace”
right off the bat, when you could have played a Jack or a Ten, and kept the
Ace for when it was truly needed.



Dear Elaine,


I think the remedy that you suggested to Shirley was Ignatia.

Revisiting: Lifting, Pushing and Hauling Leads to Confusion, Soreness and Crying! 1

It is there in the rubric “exertion, physical,amel.” as a 2 in the
Kent’s repertory. Of course, Rhus Tox is a 3

(Um….does that tell you anything?)

But, Ignatia is a 3 in the
rubric “Generalities, eating ameliorates” while Rhus Tox is only
a 1 in that rubric.

Who cares, Rajiv!

Has anybody heard of the “hierarchy of symptoms”? Let’s see a show of
hands. What’s at the top? The Etiology! And what’s my famous saying? I’m sure
alert-reader Anirudh Purswani knows what it is!

“Etiology over-rules symptomatology!”

That’s right!

What is the etiology here? There’s actually a rubric for it in the repertory and
here it is:

Muscles: lifting, straining muscles, tendons, ailments from

In every case, we are hoping to find an etiology or “ailments from”,
also known as the “never well since” (NWS), if at all possible.
So, this is our primary rubric here. If we can find a remedy in this rubric
that also has the other elements of the case–the crying, the dullness, the
confusion, the amelioration from movement, etc. that she talks about, we’ll
be home free!

Besides, it also covers
the mental fogginess and anxiety expressed by the patient with respect to
her ailment.

The problem is that Ignatia simply is not
listed in our primary rubric! Let’s look at the hierarchy of symptoms:

Etiology (meaning, “Ailments from” or
“Never well since…”)

What’s Wrong? (This is similar to etiology in many cases.
Is it an electric shock, a heart attack, an allergic reaction?
What happened? How will we know what chapter of the Repertory to look in if
we don’t know what’s wrong?)

Onset (did the complaint come on suddenly or
gradually? If you’ve got an ailment that came on suddenly, you could be down,
all of a sudden, to 2 remedies: Belladonna and Aconite! Now, wait a minute…
by “come on suddenly”, I don’t mean that somebody suddenly started
coughing after smoke was blown in his face!  Sudden onset means that you went out on a windy
day after being perfectly fine, but by the time you got home in the afternoon,
you had a fever! That’s sudden onset.)

Striking/Strange/Rare/Peculiar symptoms (Paragraph 153 of the Organon)



Physical Generals (The “I” symptoms–I’m hot, I
have a fever, I’m hungry, I’m nauseous, I’m restless, I want ice… These
“I” symptoms affect the WHOLE person, that’s why they take precedence
over the “Locals”. Along with the “I” symptoms, a modality
that covers the whole case is also a general. If a hot shower makes EVERYTHING go away, then “better hot bathing” is a general.)

Locals— also called the “Particulars”
— these are the “my” symptoms (My arm hurts, my shoulders are sore…)

Sensation— from Shirley, we elicited the sensation
as “soreness”.

Location— Sometimes, an exact location is a keynote
of a remedy; for example, pain under the right scapula is what remedy? Who
said “Chelidonium”? I think I heard Pat say it. Anyway, that’s right!

Modalities— for every complaint your patient gives
you, you have to ask for the modalities, which are factors that either ameliorate
or aggravate the complaint. For example, your patient says, “My shoulders
are sore,” you want to know, “What makes the soreness better or
worse?” Then you have to give them examples or they will tell you, “Aspirin”
and “Motrin”! So you say, “N’ n’ n’ n’ n’ n’ no! That’s not
what I mean! What about, hot applications? Cold applications? Bathing? Movement? Lying perfectly still? Stretching? Massage? etc.”

Time— the “time modality”: what
is your worst time of day or night? I once had a cough that came on every
night at 11:30 like clockwork! I could look at the clock and say, “The
coughing will begin in 5-4-3-2-1 and….there it is!”

Concomitants— these are extraneous, remote symptoms,
this is where your peculiar symptoms will undoubtedly come from. Shirley,
for example, has: Confusion, Dullness and Crying.

Discharges— Color, odor, consistency

Perspiration— how much, what color, when/under what
circumstances, where, is there an odor, what’s the consistency, is it oily
for example, does it ameliorate or aggravate?

So…..what happened here, Rajiv? You sailed right past the etiology
and decided that the eliminative rubric in the case was going to be…”Eating
ameliorates!” Well that’s great, that’s just great!

This is why we have a hierarchy, so you won’t just pick a symptom
out of a case at random and make that the eliminative rubric.

Again, of course, you can’t take this too literally either! You have to use
common sense. If a cancer patient is “Depressed” (a “mental”,
which we’ve been taught is very important in remedy selection), how seriously
are you going to take this? Depression is common in cancer patients,
common symptoms are not going to help us find remedies, and symptoms that
fall into rubrics that have hundreds of remedies in them aren’t going to be
too helpful either, even if they are etiological. Look, for example, at Ailments
From cold weather! There’s over 100 remedies in that rubric, including many
“hot” remedies like Sulphur, Pulsatilla and Medorrhinum! It’s just
not going to be very helpful. What if the concomitant in the case isn’t that
big a deal? “Well, I’m irritable, but not very irritable.” Well,
thanks a lot! What about, “I’m a little bit better after sleep”?
Forget about it!

You picked Ignatia which is one of our big emotional remedies. But,
we don’t have Ailments From emotions here, we have Ailments from lifting/pulling/hauling.

We need a remedy that has an affinity for muscles and tendons; and after we’ve
found that group of remedies, we can then ask, Of all these remedies, which
ones are confused and cry and are better from motion?

I look forward to your comments.

Are you sure, after all the rambling I’ve done?

Thanks for taking the time to explain in such
a great detail. Once again the important learning of etiology at the top of
the hierarchy in acutes got re-emphasised in my mind. I sure look forward to
your comments. It has always been a pleasure to learn from you. I have learned
so much from your various posts available on the net.

With warm regards,



Dr Elaine

My choice after repertorizing with Phatak is BRYONIA

Look what Kent has to say in his “Lectures”

“Bryonia is often indicated in injuries of joints where Arnica would
be a failure”

Thank you

Dr. Wequar Ali Khan

Bryonia? And to think, I made January “Dr. Wequar Ali Khan Month”

Now listen everybody, this is basic! Bryonia and Rhus tox are complete opposites and they can’t be confused! Bryonia is never, I repeat, never “better from motion”! OK? It is absolutely worse, WORSE, from motion! Sometimes they can’t move at all and are simply locked into position! Rhus tox, on the other hand, even though first movement may be painful, experiences less and less pain the more they move! If you ever get a case of muscle strain, and the person says, “The more I move, the better I feel, but the more I
sit or lie, the worse I get,” that’s Rhus tox! Rhus tox is typically
worse in the morning. It’s not because “sleep agg.”, it’s because
he’s been lying still all night, it’s the worst thing a Rhus tox can do is lie
still! However, Bryonia is actually better for lying still. So there you have
it. Two opposite remedies: Bryonia and Rhus tox.


Dear Elaine,

Here is my rep with Boenninghausen…

You simply must buy a modern repertory!

I am not very good yet,

so I am trying to learn.

Good for you! I don’t understand why more people aren’t here trying
to learn! We actually get letters to the editor saying, “Why don’t you
teach us homeopathy?” (Grrrrrrr!!!!)

BACK – Amelioration – motion

MIND – Weeping, tearful

MIND – Thinking – affected

part – amel.



From this, Pulsatilla seems to be the similimum

It is the Mind – Thinking affected which makes
the choice.

Have a wonderful week !

And thank you for the Quiz


Veronique, basically, we have a case here of over-lifting; so, our
primary rubric would be:

Muscles: lifting, straining, ailments from.

It doesn’t much matter that it’s the shoulder or the arm or the back…it’s
the idea of straining muscles. Even though Pulsatilla is in this rubric, there
are other remedies that are stronger for this.

Our next big consideration here is the modality: motion ameliorates.
We go to Generals: motion amel for that.

Next come our concomitants: crying and dullness of the mind. Even
though it’s true that Pulsatilla cries, other remedies cry too.

I’m not sure how much to make of the eating amel modality. She says
she feels better “overall” after eating; so, apparently eating helps
her feel better in general but doesn’t affect the complaint at all. I think
most people feel better in general after eating, so, I’m not bothering to
repertorize “eating amel.”

So, with the rubrics:

Ailments from lifting/straining

motion amel.

crying and

dullness of the mind

The remedy that comes out on top is Rhus tox.

Thank you Elaine 😉

Right! Rhus tox came on top when I added lifting
right after I sent my Email



Puls and Rhus Tox came side by side.

But, Veronique, which remedy is stronger for muscle strain? This is
the paramount issue! This is what happened–a person was lifting and pulling
and wound up with pain because of it. Is pulsatilla known for that? Not
as well as Rhus tox is; AND, if the concomitants and modalities go for the
remedy that is best known for the complaint? You have to go with that!

Mind: thinking affected came for Puls and not for Rhus tox.

Well, that is absolutely wrong, which is why having a good repertory
and materia medica make a big difference. Rhus tox very much has confusion.
Here is from Murphy’s Materia Medica:

“Anxious, sadness, helplessness and profoundly despondent. Extreme
restlessness with continued change of position . Delirium with fear of being
poisoned. (Hyoscyamus) Mind and senses become cloudy. Low mild delirium incoherent talk, answers correctly but slowly or hastily or reluctantly.”

Remember, she said her mind felt as if in a fog? That is very similar
to the above description.

I thought mind affected was more important than
the lifting because, she could still feel better when lifting her arm up to
reach the cupboard. (I know lifting seemed to be the cause….)

Yes, exactly, lifting is the cause; and, what do I always say? “Etiology
over-rules symptomatology”!

this feeling better lifting tricked me.

No, no, better “motion”, not better lifting.


So, who are our winners this time? Congratulations go to:

Anirudh Purswani, Azeez Kapasi, Myriam Dettori,  Mary Gahl, Lynn
Castellari, Erica Dixon, Deb, Dr. N. Gupta, and Palkesh.

Give yourselves a big hand!


See you in May!

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

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