Homeopathy Papers

Tidbits 34–Homeopathy: Case-Solving

Written by Elaine Lewis

Navigating the maze of confusion

Confusion Abounds!

Kent once famously said, “Why do we lose the case from the 2nd prescription on?”  Some students are taught never to treat diseases or physical complaints.  “Send them to the doctor!” they’re told.  “I never treat acutes,” many a homeopath has told me.  Some think all you need is to give the constitutional remedy no matter what’s wrong; some think aggravations are good and should be sought after, some think you treat acutes with low potencies and chronics with high potencies…it seems there is an “opinion” or “school of thought” for every homeopath in existence.  Why do we have this confusion?  Because Hahnemann is not studied.  His book, The Organon of Medicine, is considered boring, old-fashioned and difficult to read.  However, as I have said many times, the Kunzli translation is not to be feared at all!  

If I can read it, anyone can!

This article is dedicated to helping you navigate the maze that is the homeopathic case.

Methods of Prescribing

There’s no one method of prescribing that we should be adhering to dogmatically.  Constitutional prescribing is the norm, but makes no sense if the patient is suffering from an injury or the flu! 

If the etiology is clear, the totality of symptoms doesn’t matter!  If a person is hit on the arm or hit in the head, aren’t we going to give Arnica, regardless of the difference in the symptoms?  Why?  Because the etiology is the same in both; hence, they both get Arnica!  The stronger the etiology, the less we care about the totality of symptoms.

On the other hand, if the symptoms are unmistakable, what does the etiology matter?  An unmistakable Spongia cough (like a saw going through a pine board)?  A Phosphorus thirst for ice cold drinks?  The round swelling of Apis?  As Robin Murphy always says, “If you see a keynote of a remedy, give the remedy!”

You have to be flexible.  

If you see keynotes of a remedy, if you see a remedy picture, give the remedy.  

Learn to see what’s striking and compelling about a case and adjust your approach accordingly.  

Keep the Case Moving!

Chronic diseases have periodic acute flare-ups.  Treat them!  Don’t say, “We can’t interfere with the constitutional remedy; so, we can’t treat that.”  

If you don’t seal up the “energy leaks”, like pain and itching, your patient will relapse, your gains will be marginal if at all.  This is what’s wrong with Kentian prescribing–the so called “one-dose-high-and-wait” prescribing.  You give one high dose of the constitutional remedy and then you’re not permitted to do anything for the next month, which includes treating something that might have inconveniently popped up along the way.  It could be a sore throat, menstrual cramps, headaches, an injury…  How much do you think the patient appreciates hearing, “You can’t take a remedy for that!”  He’ll say, “But when I take Mag-phos, it always goes away!”  “No, no!” comes the answer.  “You can’t do that!  Take an Advil!  Stop taking remedies!”  

It doesn’t feel right to the patient, and it doesn’t sit well with a lot of homeopaths either!  They know this can’t be right!  What good is our profession if we can’t treat a cough or a sore throat because we just gave a constitutional remedy?  Are we really moving the case forward if we’re encumbering the patient with an illness?  Is the constitutional remedy more important than the sore throat the patient has?  Think about it.  The throat pain is keeping him up at night, making him miss school, sapping his strength; he can’t swallow, so he can’t eat; his vitality is collapsing but do we care?  No.  Why?  Because of dogma!

All suffering in a case must be removed!!!!! 

Learn to be flexible and see the big picture. “Energy leaks”, like sore throat, have to be sealed or the constitutional remedy is just a meaningless phrase.

Change Your Prescribing Method So You Can Respond to Acutes

If high potencies given once are supposed to last a month or longer, but can potentially be antidoted by one thing and another, then you can’t prescribe that way!  If prescribing that way means no emergency can be attended to, no unexpected acute can be treated, no emotional upset can be vanquished, then you can only treat the “perfect patient”!  (Good luck finding that person!)  But this problem is so easy to correct!  All you have to do is put your patient on daily constitutional prescribing!  A 6C three times a day, a 9C twice a day or 12C given once daily, then any acute can be prescribed for because you simply stop your daily dose, give a 30 or 200C of Arnica, for example, and when the emergency is over, go back to your constitutional daily treatment, and you’ll have lost nothing!  You’re invincible this way, and the case keeps moving forward!

You Don’t Need High Potencies for Constitutional Prescribing

I know that’s what everyone thinks, that anything “mental” requires high potencies.  Do you know what requires high potencies?  Sudden, severe or extreme presentations, whether mental or physical, that’s what you need high potencies for.  But most constitutional cases or chronic cases, are not severe and not sudden.  You will get faster action from the remedy if you do what Hahnemann said: put the remedy in water (one or 2 pellets in half a bottle of spring water), succuss your bottle 5 times before each dose, and you will see that within a few days your patient is sleeping better, eating better and feeling more “centered” and calm.

Patients like taking remedies every day, it makes them feel like they’re doing something, they’re more inclined to attribute their improvement to homeopathy rather than some bizarre excuse they come up with for why they’re doing better.

Sure these low potencies will wear off!  And you’ll have to raise the potency when that happens.  The patient will say, “I don’t think the remedy is working anymore, my complaint is coming back.”  So, if you were on a 6C three times a day, go up to 9C twice a day or a 12C once a day. See my “FAQ” article on my website for directions on how to raise the potency of your remedy bottle:


Or simply buy the next potency.  You may eventually wind up at 200C for all I know, but you get there based on feedback from the patient.  He, his body, tells you, “this potency isn’t strong enough,” and you respond and accomodate his needs rather than impose a protocol on him as the allopaths do!

Again, the value here is that you never have to say No to your patient.  “I can’t give you a remedy for that, see your doctor.”

Don’t See Your Doctor! (Unless You Need A Diagnosis or You’re in an Emergency)

We do not want our patients started on drugs when they could be on a remedy!  Most drugs are addictive, supressive, toxic and make people sick!  This is not a responsible treatment plan!  In writing this, I’m reminded of a story our editor, Alan Schmukler, told me when I interviewed him as the “Homeopath In The Hot Seat” for our August issue of 2006.  It shows you what all too often happens when you forego homeopathy in favor of “responsible” mainstream medical care.  Alan writes:

My friend’s mother, at 94, was cheerful, lively and living independently.  A month ago she developed a small boil on her ankle.  It was red, hot and throbbing.  I said “Give her Belladonna and she’ll be better by tomorrow.”  “She’ll only take what the doctor gives her,” he told me.  A few days later her leg was inflamed half way up the calf.  She was admitted to the hospital where they gave her I.V. antibiotics and pain medication.  The antibiotics didn’t work, so a few days later they tried another one.  Still in the hospital a week later, her right arm became inflamed and exquisitely painful because the I.V. had infiltrated.  The painful arm had been keeping her awake at night, so she was exhausted.  The pain meds made her constipated and she didn’t have a bowel movement for three days.  This normally cheerful woman was now totally depressed and feeling hopeless.  Her son brought her some vitamins, which she had used for years.  The nurse promptly took them away.  It’s now been almost a month and she’s still in the hospital, wracked with pain and is soon to be transferred to a nursing home.  This all started with a little boil.

In fact, it is very likely that whatever is wrong with your patient is actually being caused by some hospital treatment or his or her prescription drugs!  This should be right at the top of your list when a patient comes to see you, find out what drugs he’s on!  Then go to www.drugs.com and look up the side-effects.  You may find your patient’s whole case right there!  And then the idea is, he’s gotta get off of that drug!  But not cold-turkey!  That means not all at once, because drugs are supressive, like a pressure-cooker, you have to EASE OFF of them, slowly, and you may have to make a remedy out of the drug to help them with the withdrawal syndrome.  See my article on “How To Make Your Own Remedy”:


The other big cause of your patient’s complaints is usually their food!  You have to ask them what they’re eating, and I guarantee you that they are most likely over-dosing on carbs and processed food!  This kind of eating can lead to symptoms that mimic almost any disease including mental illness (prescription drugs can do this as well).

Maybe you’re not that well-versed in how to counsel people on changing their diet to restore health but I’ve done all that work for you!  All my articles on eating errors and healing with nutrition are right here, just ask your patient to read them:

Food Fight!

Obstacles to Cure

Two of them I’ve just mentioned–drugs, and “food”– but there may be others.  Think of toxins in the environment, things like air fresheners, beauty-aids, toxic cleaning products, sun screen, computer radiation, cell phone radiation, polyester clothing and other materials that don’t breathe, electric blankets, cold/damp houses, mold, alcohol and tobacco, recreational drugs.  Hahnemann told us, “You have to remove the obstacles to cure.”

Basic Rules

I don’t know how many cases are lost due to simple lack of familiarity with basic rules that are all written in the Organon, but, here they are:

  1. If your patient is strikingly better after a remedy, STOP DOSING!  Continued dosing could result in provings, aggravations and accidental antidotes and undo all the good work you’ve done.  Resume dosing if the patient starts to relapse.
  1. If your patient has aggravated on a remedy, STOP DOSING!  See Diane Fuller’s and my article “The Aggravation Zapper”.
  1. Start your chronic cases off with the lowest potencies and go up as needed.  (This is all in The Organon, folks).
  1. All remedies should be in a water bottle with 2 to 10 succussions before each dose, the number depending on how sensitive the patient is.  The first dose can be taken dry but if dosing is to continue, put roughly 2 pellets into half a bottle of water so you can succuss before each dose.  This raises the potency so the patient doesn’t develop a tolerance to the remedy.
  1. If your patient has a strikingly bad aggravation or proving, you can’t just let that sit there, it is not good for your patient.  What to do about it?  Diane Fuller and I have written an article called “The Aggravation Zapper”, please familiarize yourself with it:


  1. We always rejoice when we see a “return of old symptoms” after a remedy, but, what if it’s severe or doesn’t go away?  Treat it!  Take the case of it!

What Do You Mean By ‘Take The Case Of It’?

I’m glad you asked!  There are 5 essential questions, basic bits of information, you have to gather from your patient, otherwise you will be like the proverbial deer in the headlights when your patient starts reeling off his numerous horrifying complaints.  The info you need is as follows:

  1. Etiology
  2. Sensation
  3. Location
  4. Modalities
  5. Concomitants

If you can just memorize this list, say it over and over again to yourself or write it down and stick it in your wallet, you stand a good chance of being able to actually solve someone’s case!  Remember, if the etiology (the cause of the complaint) is strong, the totality of symptoms matters less.  Let’s say the symptoms were caused by a fright, you give Aconite.  If the symptoms were caused by an acute grief or loss, the remedy is most likely Ignatia.  When the etiology is unspectacular, you’ll be looking at the symptoms.  

Let’s say your patient has asthma and no one can remember what the cause was, move on; find out what the sensation of the attack is. He might say, “The sensation is nausea, suffocation.”  Location would seem obvious–the lungs.  Modalities, which means, what makes your complaint better or worse?  He might say, “Warm rooms make the attack worse, fresh air makes it better–I have to open the windows during an attack.”  All this information should have you thinking of Ipecac.  Concomitant means what accompanies your complaint?  He might say, “Vomiting.”  Now you know for sure that the remedy is, in fact, Ipecac.

So you see how far these 5 essential case-taking questions can take you, and don’t forget the “time modality” (the time the complaint typically comes on, a.k.a. the “aggravation time”), a lot of us aren’t aware that the “aggravation time” falls under “modalities”.  

This will take you a long way towards solving cases.

What If My Patient Has A Million Complaints?

He probably does!  Well, first of all, you have to get your cards in order!  Do you know what I mean by that?  You’re dealt a hand of cards (symptoms) and they may not make any sense when viewed altogether, or you may feel overwhelmed and confused by them, too much information, until you put them in order!

How you do this depends on where you find the significance in the hand you’re dealt.  Maybe you noticed that most of your cards are spades, or maybe you saw that you have 4 aces, so you put all the “like” cards together (“this symptom is due to his insomnia, this symptom is the result of being punished through childhood by a strict parent…”) and you determine what looks compelling to you.  You might say, “My patient has a million symptoms, but, they’re all from the same cause–the flu!!!!  He needs a flu remedy that’s famous for all these symptoms–diarrhea, anxiety, chilliness, restlessness, thirst, prostration, burning pains, sore throat, runny nose, headache…” (What remedy is that?  I’ll wait while you think about it. … Theme music from “Jeopardy” playing… And the answer is….?  Arsenicum!)

Or you might say, “My patient has a million things wrong, but, some start in childhood, some are from the car accident in 2007, and the rest are side-effects from his anti-depressant which I just looked up on drugs.com!”  OK, so at least now you’ve got your “cards in order”.  You’re not just looking at a million symptoms out of context anymore, they all have a context now, they’ve all been categorized, put into order!  Then you can determine which category has to be dealt with first–chances are it’s the most recent one; whatever is most recent tends to be most active and most limiting.    

You might decide, “The anti-depressant is causing the worst things in the case, it’s making him sleep all day, he’s dizzy and drowsy but he can’t sleep at night; plus, he’s imagining things, his moods are becoming unstable; he needs to get off this anti-depressant right away.” 

When you’ve achieved that feat (and remember that no drug can be stopped “cold turkey”), you can decide what is next in line in terms of symptoms that are most limiting.  Again, I can’t state strongly enough that a diet of mostly processed food, take-out, sweets and carbs, etc. can result in depression, headaches, tiredness, constipation, anxiety attacks, panic disorder, insomnia, etc.; so, you always have to find out what they eat and what they drink.  

It’s always a good idea to ask your patient, “What is bothering you the most?”  If they say “I get 3 to 4 headaches a week!” that should immediately make you think of the food they’re eating and the drugs they’re taking.  And keep in mind, if they’re doing something “embarrassing”, like over-dosing on sleeping pills or opiates like Tylenol 3, drinking too much alcohol, smoking too much pot, etc., they may not tell you!  They may even be doing something they think is “normal” and so won’t tell you about it, like drinking 12 cups of coffee a day or eating 12 candy bars a day!  Maybe they’ll tell you they eat “well”—boy, have I heard that before!  What I’m saying is, you might really have to really dig to find these things out!  Ask, “When did your headaches start, how long ago?  What was happening in your life at the time, is there an event that makes you think, ‘That’s why I have this!'”  If there’s no event, no trauma, no loss, no illness, surgery or injury you can pin the headaches on, you have to think about life-style; you have to think about processed food, junk food, drugs and alcohol, exercise (are they under-exercising; or, over-exercising and under-nutrifying?)  Are they drinking enough water, or maybe too much water because they heard you need 8 glasses of water a day?  Are they living in a toxic building?  Does their chimney need cleaning?  Is there a stressful person in their lives?  Are they being stretched thin by family members’ needs?

If the patient has a disease, you’ll be wanting to know what the characteristics of it are.  Explain to him that everyone has a disease differently.  What’s it like for him?  In that context, you’ll be wanting a disease remedy that matches the way he’s experiencing it, which brings us to our next topic:


Working with “differentials”:  A differential is list of remedies commonly known to treat a disease.  They’re called “differentials” because you’re supposed to differentiate among them.  For example, what do you think the differential for “injury” is?


Rhus tox







Bellis perennis


Right?  So if a person is injured, instead of thinking that it could be any one of 3,000 remedies, or that you have to take a 2 hour constitutional case, think of it as probably being one of 10 or 15 remedies, and all you have to do is ascertain which injury remedy matches the case most closely.  Blunt trauma?  Arnica.  Black eye?  Ledum.  Head injury/concussion?  Nat-sulph.  Breast injury?  Bellis perennis.


In summation…..

Is there more to be said about solving cases?  Of course!  But we need to learn the basics and then build from there!  Here are the common mistakes I see being made all the time:

  1. repeating the remedy during an aggravation.
  2. giving the remedy again after the patient is strikingly better, thinking it will make him “even more better”.  In reality, it’s more likely that it will cause an antidote, wiping away all the improvement!
  3. not dosing in water.
  4. not succussing before each dose (Hahnemann says the vital force does not tolerate such unchanged, repeated doses of the exact same potency).
  5. giving low potencies in acutes (often ineffective) and high potencies in chronics (often leading to aggravations).
  6. sending people to allopathic doctors for complaints homeopathy can easily and safely cure.
  7. giving the constitutional remedy for everything when an acute remedy is needed.
  8. letting people suffer for the sake of adhering to dogma rather than using your common sense!
  9. giving a remedy over and over again mindlessly without waiting an appropriate interval for it to act.  The more suddenly or recently a complaint came on, the faster you expect to see results.  Someone told me recently her son had a cough and she was giving a remedy every hour for the past 24 hours!  Needless to say, I told her to stop.  See my article “Dosing in Acute Cases”: 

    Dosing In Acute Cases: How Often to Take the Remedy and in What Potency?

Well, that about does it for me!  It’s time for my snack.

Here’s a book you need to buy to supplement this article: Homeopathic Medicine In The Home by Breslow.

I’ll see you again next time!  Happy case-solving!

Elaine Lewis, D.Hom., C.Hom.

Elaine takes online cases! Write to her at [email protected]

Visit her website: https://ElaineLewis.hpathy.com

About the author

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:
https://elainelewis.hpathy.com/ and TheSilhouettes.org


  • An eminently practical, down to earth, easy to understand explanation of some important basics. I once sent a patient to a famous homeopath who put her on a constitutional remedy and then told her to “tough it out” when she got acutes ranging from flu to dental problems. She was also given antibiotics for infections that could have been addressed by homeopathy. All this to avoid antidoting the constitutional.

  • Great Alan, Words of wisdom indeed. This is how I approach a case. Treat her/him for immediate issue on top of mind. Increase comfort level. Instill confidence and then treat for constitutional issues God Bless You

  • Hi Elaine
    The information is very useful. I have a query though.I had a case of Merc cyn.but in a haste I accidentally overdosed.now the patient went into aggravations. I got panicked and I antidotes it with low potency.
    Now all the old symptoms are back.I don’t know what to do which potency to use.
    Thank you

  • So you’re saying the original symptoms you prescribed Merc-cyn. for are back? Did you originally prescribe Merc-cyn. in high potency and repeated too often? At any point during the high potency prescribing, was the case ever cured or strikingly better? After antidoting, did the case seem to be cured, and then later all the symptoms came back? Because if that’s what happened, I would make a water bottle out of the low potency you antidoted with, let’s say it was a 6C because I don’t know, and I would give the 6C three times a day with 5 succussions before each dose. Stop dosing if he gets strikingly better, stop dosing if he gets worse, raise the potency to 9C if the 6C starts to wear off.

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