A 4-year-old girl has had an acute cough for two days. It is a dry, barking cough (3). She coughs with the same intensity throughout the whole day and night. She has paroxysms of coughing every few minutes (2). She has had salivation in sleep (2/3) and grinding of teeth in sleep (3) for the last two days which she normally does not have. She does not want to drink (2) and is less thirsty compared to when she is not ill. She is very weepy (3), especially between the cough paroxysms and more especially when she feels she is about to cough again (3). Sometimes she also groans between the individual coughs (2). She also has very frequent eructations when coughing (3). She has a fever 37.6°C which started around 3 p.m. Her feet are cold (3) and the rest of the body is warm (1/2), but not very hot.
Note: the numbers behind the symptoms represent their intensity
Selection of symptoms:
Fortunately, this case provides us with some very peculiar symptoms, which are always important in finding the remedy if they are available. So-called strange, rare and peculiar symptoms, already described by Hahnemann, are symptoms which cannot be explained by the pathology itself and which are not common in a given diagnosis. In other words, these are symptoms which we do not find in the majority of people with the same diagnosis. Such symptoms represent the unique way that the organism is dealing with the imbalance or how it reacts to a negative stimulus and thus, they are very important from the homeopathic point of view. This is one of the main differences between homeopathy and conventional western medicine. Whereas in western medicine, remedies are selected on the basis of diagnoses, in homeopathy, we select our remedies on the basis of an individual response of a given organism to a certain situation (stimulus).
In this case, there are a few symptoms, which do not commonly occur with a cough. They are listed below as peculiar. We also have some other symptoms which can be used because of their high intensity.
- grinding of teeth in sleep (3)
- salivation in sleep (2/3)
- eructations during a cough (3)
- groaning and weeping before spells of coughing (3)
- fever starting around 3 p.m.
- dry, barking cough (3)
- weeping (3)
- lack of thirst (2)
- cold feet (3) with warm body and head (1/2)
Note: As fevers usually rise in the late afternoon or early evening, I consider the beginning of the fever at 3 p.m. peculiar.
Relevant rubrics from the Synthesis repertory:
TEETH – GRINDING – sleep agg.; during
MOUTH – SALIVATION – sleep – during – agg.
STOMACH – ERUCTATIONS – cough – during – agg.
MIND – WEEPING – cough – before
GENERALS – AFTERNOON – 15 h
COUGH – BARKING
MIND – WEEPING
STOMACH – THIRSTLESS
HEAD – HEAT – coldness – Feet; with coldness of
Note: I did not use the rubric “FEVER – AFTERNOON – 15 h” because it is incomplete and important remedies like Belladonna or Chininum Sulphuricum are obviously missing there. Instead, I used a bigger rubric from generals which expresses a general aggravation of the organism at this particular hour. This technique can sometimes be used when we are not able to find an exact modality for a symptom, but the modality is important in the case, or when the relevant rubric is unreliable (too small, or contains additions that are not confirmed well). In such instances, we can sometimes use rubrics from the chapter “GENERALS” where we can often find the modalities we need. Of course, it is quite easy to remember the remedies which have a general aggravation at 3 p.m. as there are not too many, but I give this just as an example of a repertorising technique which can be applied in general in some situations.
Differential diagnosis of the most relevant remedies:
Lycopodium is an interesting option because it has a combination of salivation in sleep, grinding of teeth in sleep, and eructations. Apart from the eructations, none of the above-mentioned symptoms is a keynote of this remedy. The grinding of teeth and increased salivation can be found in the materia medicas from Hering7, H.C. Clarke5 and T.F. Allen, but as they are not keynotes, we cannot consider them prominent. Lycopodium is an important remedy for a cough, bronchitis and even pneumonia (especially right sided) and it has been reported to be effective in tuberculosis. It is especially useful in respiratory troubles in emaciated children, particularly boys, as J.T. Kent states.4 It covers a dry type of a cough very well. It is interesting to read in J.T.Kent’s materia medica:4 “The extremities are cold while head and face are hot, with much coughing and troubles in the chest.” However, what is more typical for Lycopodium is to have one foot hot and the other cold and this remedy is also known for having hot feet and uncovering them at night. Typical time of aggravation of Lycopodium starts at 4 p.m. and not at 3 p.m.
Mercurius solubilis has salivation in sleep as a keynote but it cannot be confirmed otherwise.
Apis mellifica has lack of thirst as a keynote. It has general aggravation at 3 p.m. and especially fevers and chills get worse or start at this hour. Apis covers grinding of teeth, but not so prominently in sleep. The remedy cannot be confirmed otherwise.
Stramonium has a deep barking cough as a keynote. It covers grinding of teeth in sleep and coldness of extremities with heat of face, although not as keynotes. Stramonium can be thirstless during fever and it can be sometimes confused with Belladonna in cases of high fever with hot head and cold extremities. There are no other strong indications for this remedy.
Pulsatilla covers lack of thirst and excessive weeping. These are keynotes of this remedy. It can have aggravation between 2-4 p.m. It cannot be confirmed otherwise.
Hepar sulphur is the first remedy from this differential diagnosis which covers weeping before coughing. It is the most important remedy to think of when we see a child crying from fear of pain before (or during) cough. Of course, this phenomenon originates from the extreme oversensitivity to pain of this remedy. At the same time, it belongs to the main remedies for dry barking painful cough. However, there are not any other confirmations for this remedy.
Sanguinaria covers a cough connected with eructations or of a gastric origin. Kent writes that every cough ends with eructations.4 Cough ameliorated by passing flatus or eructations (which is not present in our case) is one of the main keynotes of this remedy. It is the only remedy in the second degree in the rubric FEVER – AFTERNOON – 15 h (the rest of the remedies are only in the first degree). In Hering’s and T.F. Allen’s materia medica, we can find confirmation for fevers between 2-3 p.m. However, I was not able to confirm it in other books and it is definitely not a keynote. Sanguinaria has hot feet as a keynote, which represents a contraindication in our case. There are not any other confirmations for this remedy.
Belladonna has a barking cough, lack of thirst, aggravation at 3 p.m. and congestion (heat) in the head with cold extremities as keynotes. It covers grinding of teeth in sleep. As Belladonna cough tends to be very painful and there is often strong pain in the chest, it is typical for children who have a cough and need this remedy that they cry from fear of pain before each spell of a cough. This is well described in J.T. Kent’s materia medica. Belladonna does not cover the salivation in sleep particularly, but it can be found in the rubric MOUTH – SALIVATION – profuse in the third degree and increased salivation can be confirmed in several materia medicas, for example, in the materia medica from C. Hering7 or H.C Clarke. Belladonna belongs to the main remedies for barking cough, together with Stramonium, Drosera, Spongia and Hepar sulphur.
Choice of the remedy:
As we can see, the picture of the remedy is not crystal clear and there is no remedy which would cover all peculiarities and characteristic symptoms in the case. Then we have to simply opt for a remedy which has the most indications, a remedy which covers the highest number of keynotes and possibly an essence and which is not contraindicated. Looking at the case from this perspective, the remedy which covers the most keynotes is Belladonna. It does not cover salivation in sleep, but none of the remedies, which have this symptom as a keynote can be confirmed. We can actually confirm profuse salivation in Belladonna (although not as a keynote) in different materia medicas. It is interesting to look in the rubric COUGH – ACCOMPANIED BY – Teeth – grinding of. There is only one remedy and that is Belladonna. It is listed in italics. In Hering’s Guiding Symptoms of Our Materia Medica, we can find: “Violent cough during sleep, with grinding of teeth.” This is a good confirmation of the previous indications we discussed above. The remedy is not contraindicated.
Prescription: Belladonna 200C single dose
Outcome of the treatment:
The girl got a dose of the remedy in the evening. She became very tired afterwards and fell asleep. The next morning, she had higher fever than the previous day. Her fever rose to 38.4°C, but her cough was already better. She did not cry before coughing anymore. The fever completely subsided the same day in the afternoon, her energy became significantly better, she stopped being weepy and the cough changed into a less violent loose productive cough. The grinding of teeth subsided too, as well as the salivation in sleep did. She became more thirsty. The third day, the cough kept improving further, together with her overall energy and psychological level. The fever did not return anymore. The fourth day, all acute symptoms were completely gone apart from a very infrequent and mild residual coughing, which is normal when the organism expels rest of the mucus from the air passages. There was no relapse of this episode and the girl was treated further with constitutional treatment.
There was an initial aggravation in the form of tiredness, followed by improvement of the main complaint and the psychological level. This information itself means that the remedy was correct. Temporary rise of a fever in an acute state is a good sign when it is accompanied by improvement of the main pathology or psychological level. When the organism is stimulated by the remedy to a more vital response, it is natural that it sometimes raises the fever in order to fight the microorganisms more effectively. In cases where the fever is already very high before giving the remedy, we do not usually observe marked or even any elevation of the fever, because this might be dangerous for the organism and our intelligent “vital force” somehow knows that it has to solve the situation in another way (by aggravating other symptoms). In some cases with low fevers, the problem may be that the organism is too weak to raise the fever more and to produce a more intense and effective reaction. In these cases, elevation of the fever after the remedy is quite common. In our case, the organism was weak in a sense that instead of raising a higher fever, it did not prevent development of some emotional symptoms and grinding of teeth, which is a sign of irritation of the nervous system. The disappearance of the keynotes on which I prescribed Belladonna confirms the correctness of the remedy. Change of the cough from dry to productive is a good direction and it may take a few days until the body gets rid of the residues of the microorganisms, toxins, and mucus in the air passages. As long as there is a general improvement, this local symptomatology is nothing to worry about.
In cases like this where although we may have good characteristic symptoms, we are sometimes not able to find a remedy which would cover all the important symptoms of the case. We can see keynotes of different remedies in such cases, but the question is, which one has to be given first. This is mainly valid in chronic cases, but in acute situations, we also sometimes need more than one remedy to finish the treatment.
There is an interesting phenomenon in homeopathy that even though the chosen remedy (provided it is a similimum) may not cover all symptoms of the case, it can also cure those symptoms which it does not cover, as long as it covers most of the characteristic elements of the case. The reason for this is that with homeopathic remedies will stimulate the organism to function more effectively as a whole. We basically raise its vitality and subsequently, the organism by itself can eliminate all the symptoms it does not need anymore. There is also a possibility that those cured symptoms which are not recorded in a particular remedy may really be covered by this remedy, but we do not know it yet because our information in materia medica will never be 100% complete. In this way, new symptoms from clinical observation that are repeatedly confirmed to be cured by a particular remedy by several independent homeopaths are added to the materia medica and the repertory.
A 6-year-old girl has an acute cough. The cough is dry and barking at night, and productive during daytime.(2) She usually coughs once at a time.(1) She coughs up very thick (3) tenacious transparent (2) mucus. The cough is worse from lying down (2) and better when she goes out to cool fresh air (3). It is also much better from any kind of drinks (3). There is no fever. She also has a bit of coryza (1) without any modalities or peculiarities. There are no other symptoms. Psychologically, she feels fine; she has no peculiarities as far as thirst or food preferences are concerned.
Selection of symptoms:
- cough better in cool air (3)
- coughs once at a time (1)
- cough better from drinking (3)
- thick tenacious expectoration (3)
- transparent expectoration (2)
- dry barking cough at night, loose by day (2)
Relevant rubrics from the Synthesis repertory:2
COUGH – AIR; IN OPEN – amel. (a)
COUGH – COLD – air – amel. (a)
COUGH – PAROXYSMAL – consisting of – one cough
COUGH – DRINKING – amel.
EXPECTORATION – THICK (b)
EXPECTORATION – TOUGH (b)
EXPECTORATION – TRANSPARENT
COUGH – DRY – night – loose by day
EXPECTORATION – DAYTIME only
COUGH – BARKING
Note: letters “a” and “b” label rubrics which were combined because they express a very similar thing and at the same time, the remedies listed in them differ. Using this technique, we can decrease a possibility of omitting some remedy which may be present only in one of these rubrics and prevent the computer from putting a double value to remedies that would otherwise be listed twice.
Differential diagnosis of the most relevant remedies:
Pulsatilla has general amelioration in the open air as a keynote. The cough of Pulsatilla is better in the open air and worse in a warm room. Dry cough at night and loose cough during daytime is a keynote of Pulsatilla too. This remedy is known for thick mucus discharges.
Coccus cacti covers a cough that is worse from anything warm (warm room, warm air, warm bath, warm drinks and food) and better from anything cold (cold drinks, cold open air, etc…). A cough better from drinking and a cough better in the open air are keynotes of this remedy. Another keynote of this remedy is thick viscid mucus in the throat. This remedy has a paroxysmal spasmodic type of a cough and it is useful in whooping cough, for example. It also covers a barking type of a cough, as can be confirmed in Hering‘s7 or T.F. Allen‘s materia medica3.
Spongia has a barking cough as a keynote. Cough ameliorated from drinking (and eating) is also a keynote of Spongia, especially from warm drinks and food. Cold drinks aggravate the cough of Spongia. A “Spongia type” of a cough is very dry and harsh and in the materia medica, it is often described as sounding “like a saw”. This, together with dyspnea (another keynote of Spongia) predestines it to be indicated in many cases of laryngitis or croup. However, there is usually no or very little expectoration in a Spongia cough, so this is a contraindication in our case to some extent.
Hepar sulphur belongs to the main remedies for a barking cough and has thick expectoration. It covers the symptom dry cough in the evening and loose cough in the morning. However, this remedy is generally strongly aggravated from cold air including local respiratory symptoms.
Kali sulphuricum is generally better in the open air and it is a keynote of this remedy. Its local symptoms of cough ameliorate in the open air too. It has thick catarrhal expectoration as a keynote. However, its expectoration is typically yellow and the remedy cannot be confirmed otherwise.
Argentum metallicum has transparent gelatinous expectoration and a cough which is better in the open air. It can be confirmed in Kent’s materia medica.4 However, none of these symptoms are keynotes of Argentum metallicum and the remedy cannot be confirmed otherwise.
Kali bichromicum and Senega are important remedies for respiratory troubles with thick viscid tenacious mucus. Both these remedies have a cough worse from cold air and, therefore, they are contraindicated.
Choice of the remedy:
Although the case may look like a case of Pulsatilla at a glance, we should not get confused by a superficial evaluation. There is one important modality which is not covered by Pulsatilla – the strong amelioration of the cough from drinking. As we have a very few useful symptoms in the case and this is a very strong and intense modality, the remedy should cover it. The extreme thickness and viscid nature of the mucus can be covered by Pulsatilla, but it is not a keynote of this remedy. There is only one remedy which has both these symptoms as keynotes and which also covers the amelioration of the cough in the cool open air. The remedy is called Coccus cacti.
This remedy is an important remedy for respiratory troubles and affections of mucus membranes. Although the respiratory complaints needing this remedy may develop after getting cold, once they develop, they are worse from anything warm (in a warm room, from warm covering, etc.) and better from anything cold including cold fresh air. The cough of this remedy is better from drinking, especially (but not necessarily) from cold drinks. Another peculiarity and a strong feature of this remedy are thick tenacious stringy discharges (similar to Kali bichromicum) which sometimes create long continuous strings hanging deep down into the trachea; they make the patient nauseous and sometimes even induce vomiting. Patients needing this remedy often get nauseous from anything solid that comes into contact with larynx or mouth – the mucus, the food, or foreign bodies like a spoon or even a toothbrush. This last characteristic of the remedy is not present in our case but it does not exclude the remedy.
It follows from the above-mentioned facts that Coccus cacti seems to be the best choice for this case. As the intensity of the disease is not extremely strong, I opted for a single dose of a 30C potency.
Prescription: Coccus cacti 30C single dose
Outcome of the treatment:
The parents of the child were not able to get the 30C potency of this remedy (this remedy is not indicated very often) and they managed to get a 9C potency only. Therefore, I suggested giving it repeatedly every two hours. They only gave two doses before the child went to sleep. However, they did not need any more doses because the child fell asleep calmly and had no barking cough at night. She slept well the whole night and coughed only very little. The previous nights, the cough woke her up frequently. The next morning, she coughed up a lot of mucus (much more than before the remedy), the cough was considerably milder than the previous day and her coryza got much stronger. The cough disappeared the same day and the coryza went away in the next two days.
This case shows how careful we have to be with evaluation of our cases and little details. If the child was given Pulsatilla, the remedy would most probably act very superficially or not at all. If we miss an important element in the case (if the remedy does not cover it), the remedy is not going to have a deep effect. What we seek for is a remedy which covers the most important (most characteristic) symptoms of the case as keynotes and if possible, which has an essence6 (a characteristic that runs through the general symptomatology of the remedy) that matches with at least some aspects of the case.
 HAHNEMANN, S. Organon of Medicine, Sixth edition. New Delhi: B. Jain Publishers, 2008. ISBN 978-81-319-0223-3, §153, page 158
 SCHROYENS, F. The Essential Synthesis 9.2E. London: Homeopathic Book Publishers, 2007. ISBN: 978-0-9557151-0-5
 ALLEN, T.F. The Encyclopedia of Pure Materia Medica. [online] https://hpathy.com/e-books/encyclopedia-of-pure-materia-medica-by-tf-allen/
 KENT, J.T. Lectures on homoeopathic materia medica. New Delhi: B. Jain Publishers, 2011. ISBN 978-81-319-0259-2
 CLARKE. J.H. A Dictionary of Practical Materia Medica, Vol. III. New Delhi: B. Jain Publishers, 2012. ISBN 978-81-319-0261-5
 VITHOULKAS, G. The Science of Homeopathy. Athens, Greece: International Academy of Classical Homeopathy, Center of Homeopathic Medicine, S.A., 2009. ISBN: 978-960-87429-3-2
 HERING, C. Guiding Symptoms of Our Materia Medica. Sulphur [online]. https://hpathy.com/e-books/guiding-symptoms-of-our-materia-medica/
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