Hello everybody! Jiri answered the September Quiz late, after I had already turned it in. But, I felt her (I assume it’s a “her”?) answer deserved a thorough going-over, because only one person got this quiz right! So, what I’ll do is this, I’ll post the case here for those of you who didn’t see it, then we’ll discuss how to solve it:
Name: “Bardeau”
Age: 81 years old
Male or Female: female
Weight: 154 pounds
Height: 5’1/2″
Date: August 27, 2025
Email Address:
Describe the complaint–
Sunday evening I started sneezing , experienced congestion and then a runny nose and was very tired.
Monday and Tuesday symptoms continued and I slept the entire day. I felt warm. Today I woke up not as tired. Same symptoms but not warm. I had a regular doctor’s appointment so i went. He said I probably had a cold and had fluid behind my ear. My lungs were clear. He said I should use a nose spray but the one he suggested was not recommended if you have glaucoma. He also suggested some allergy medicine which was out of stock which I would prefer not to take.
This evening I am coughing more from the phlegm.
Bridget suggested kali bic which i took and seemed to work for awhile
Etiology–
over-tired— doing too much
Sensation-
I have no pain
Appearance–
according to my husband —darker around the eyes— less color in my skin
Location–where on the body is your complaint located?
sinus, nose, throat
Modalities–
Better— sleep, drink, food, moral support , fresh air
Worse — trying to do more than I should. Lying down causes more coughing
Concomitants
runny eyes. Anxious
Discharges–
clear runny nose, clear but thicker phlegm.
Generals–
I am tired, hungry, thirsty, bored, uneasy
The mentals:
anxiety, wanting to do something – want attention
What have you been saying?
get irritated when my husband reads instead of doing something that needs to be done. Sometimes I am too pushy.
What are you doing?
tossing in bed, watch tv, lying down, walking around the house and outside. Sitting on the porch swing.
Describe your thirst and appetite–
like cold drinks, trying not to have too much sugary items. Eating a lot of fruit, have protein veggie smoothie. Regular food
Fever?
just one day felt warm
Sweating?
so far no sweating
Odors?
mouth feels like it has an odor.
What is most striking, peculiar or identifying about your condition?
my voice
Is there a diagnosis?
COVID?
Describe your energy–
(no answer)
What does your tongue look like?
(no answer)
If you have a cough, please tell what it sounds like–
i taste the phlegm and the coughing starts. I am coughing more and more.
If you haven’t already said if you’re hotter or colder than usual, say it now.
legs colder and feet, ache in my shoulders, neck
This question only applies to complaints of a more chronic nature: I need to know what you eat, drink and “take”.
n/a
Tell me what drugs you’re taking, prescription or over-the-counter:
88 milligrams of synthroid. Vit d plus k, b 12, brain regain. Biodent, magnesium, albaplex, zypan, vascular care complex, brinzolamide eye drops.
___________________________________
Hello Elaine and Shana,
Hi Jiri, nice to meet you, welcome to the Hpathy Quiz! Listen, I’ve already submitted the September Quiz answer, BUT, because of that, I will make your Quiz Answer something very special, I will make it my featured article of the month! Because I think there is information here that will benefit everybody! So, let’s get started!
Could it be Pulsatilla?
No. To make it simple, if a patient says she’s thirsty, we can immediately eliminate our well-known thirstless remedies like Gelsemium, Pulsatilla, Apis and Belladonna right off the bat; at least we should put them on the back-burner.
Pulsatilla is found in the following rubrics:
mind; restlessness, nervousness (3)
I couldn’t find a sub-rubric “nervousness” under “Restlessness”. I couldn’t even find a rubric, “Mind: nervousness”. However, even having said that, I couldn’t find any mention of nervousness in the case either. She never said she was nervous. I see this a lot in quiz answers; people make assumptions, and then when you go back to check, they aren’t there. We have to try to be more careful, more accurate.
mind; restlessness, nervousness; anxious, etc. (2)
Again, this isn’t a rubric. The rubric is, “Mind: restlessness, anxious”. And you were so close here! If you had just scrolled down. There’s a sub-rubric that describes her behavior perfectly and I’ll get to it in a minute, but, there was a remedy there in Bold, a keynote, which we’re desperately hoping to find in a case!
cough; constant (2)
We don’t know that. According to her, she’s “coughing more and more”, but what does that mean? I didn’t ask. And the reason I didn’t ask was because I believed I had all the information I needed already.
eye; tears (3)
The rubric is “Eyes: lachrymation”.
nose; runny or blocked nose (3)
I didn’t see “blocked nose” in the case, I saw runny nose; and the rubric for that is… “Nose: coryza”.
throat; mucus (2)
throat; mucus; larynx (2)
I don’t see a rubric “Throat: mucus, larynx”, but, if you’ve taken the rubric, “Throat: mucus”, that should be enough; but, I think the more salient issue here is that she must have post-nasal catarrh, because the doctor said her lungs were clear. And she did say her sinuses were part of the problem which is why Bridget told her to take Kali bic. The rubric is, “Nose: sinusitis, post-nasal catarrh”. What does catarrh mean? It’s a build-up of mucus in the throat, nose or sinuses. It’s also referred to as Post-nasal Drip.
throat; voice; hoarseness; with running nose (1)
She never said her voice was hoarse. She only said that the most striking thing about her was her voice. If I had felt I needed to know more about this in order to solve the case, I’d have said, “What’s striking about your voice?”
expectoration; thick (2)
We don’t really know if she’s expectorating. Some people can’t raise phlegm and are forced to swallow it. I think you should take “Generals: mucus, discharges, thick”.
chest; anxiety (2)
She said she had anxiety, but didn’t specify her chest. I think you covered this symptom when you picked “Mind: restlessness, anxious”.
cough; better open air (3)
cough; constant; worse lying down (3)
The rubric is “Coughing: lying agg.” We don’t know that it’s “constant”, we only know that it’s “more and more”, and if I felt that I needed clarification on that in order to solve the case, I’d have asked, “What do you mean by ‘more and more’?”
generalities; better open air (3)
…let me quote the general state of Pulsatilla as described by Cowperthwaite….
Yes, exactly, the GENERAL state, which would be great IF we didn’t have mentals! IF we didn’t have peculiars! But we do!
Am I still missing something here?
Yes. This is what I want people to understand and why I’m so glad you answered the quiz, because I get lists like this all the time, which means people have fallen under the spell of “the totality of symptoms” dogma: namely, that if we repertorize all the symptoms in a case, we will come up with the right remedy! Only sometimes is that true!
Looking at your list above, I can see that you think “totality of symptoms” means making a list of every symptom in the case and proceeding to solve as if they were all equal. In order for this approach to work, the assumption would have to be that every rubric in the Repertory had all the remedies in it that were supposed to be there, and that our Repertory was “complete”!
Would that that were true!!!!
In fact, the more rubrics you clutter up your case with, the more likely the remedy you need will be lost!
So, in place of making every symptom in your case of equal value, we should, instead, turn our attention to…..
The Hierarchy of Symptoms
- Etiology (listed as “Ailments From” in our Repertory)
- Diagnosis or “Chief Complaint” or “Here’s what’s wrong with me.”
- Sudden Onset? (This could mean we’re either down to: Aconite or Belladonna because these are our 2 main Sudden Onset remedies)
- “Characteristic Symptoms” as per Aphorism 153 of The Organon, which would include anything that’s striking, strange, rare or peculiar, plus the most recent symptom, keynotes of remedies, and delusions.
- Mentals
- Emotionals
- Physical Generals (Symptoms that tend to start with the word “I” or “I’m”: I’m thirsty, I’m nauseous, I’m sweating, I’m freezing, I want everybody out, etc.)
- Physical Particulars (also known as the “locals”, symptoms that tend to start with the word “My”. My nose is running, my nose is stopped up, my sinuses are congested, my eyes are running, etc.)
OK, now, implicit in the word “hierarchy” is the idea that everything is not equal, that some things take precedence over other things, that some things over-rule other things. Obviously, whatever is at the top matters most. And what is that? Etiology!
And what does etiology mean? The cause. It’s listed as “ailments from” in our Repertory. What’s our most famous etiology? Ailments From Blunt Trauma—what’s the remedy? Arnica! Does anybody take an Arnica case? Does anybody sit down with an injured person and say, “I have to take your case. Do you like ice cream? What about onions? What would you rather be, an insect or a mammal?”
Nobody does that! Arnica is given right away! Why? Because everybody knows that Arnica over-rules the Totality Of Symptoms! Everybody knows that!
But, here’s what you don’t know: this is true for everything on that list! Each entry on that list over-rules what’s underneath it! OK? It’s very important that you understand that!
Speaking of our case right now, that means I don’t have to care about the mucus in her throat, her runny eyes, her cough, her post-nasal catarrh … because all of that is down at the bottom!
According to the 4th item in our Hierarchy, what is the most striking thing about this case? It’s the sheer number of times she told us she was restless! OMG! Here is her case. I’m going to paste it here again but with hi-lighting this time! I’m going to hi-light every time she mentions words that mean “restless”, and what else? What else is striking? How many times did she mention that she wanted attention? I’m going to hi-light that too. What are the 3 big mentals here? Restlessness, anxiety and needing attention; let’s look at what’s hi-lighted below:
Describe the complaint–
Sunday evening I started sneezing , experienced congestion and then a runny nose and was very tired.
Monday and Tuesday symptoms continued and I slept the entire day. I felt warm. Today I woke up not as tired. Same symptoms but not warm. I had a regular doctor’s appointment so i went. He said I probably had a cold and had fluid behind my ear. My lungs were clear. He said I should use a nose spray but the one he suggested was not recommended if you have glaucoma. He also suggested some allergy medicine which was out of stock which I would prefer not to take.
This evening I am coughing more from the phlegm.
Bridget suggested Kali bic which i took and seemed to work for awhile .
Etiology–
over-tired— doing too much
Sensation-
I have no pain
Appearance–
according to my husband —darker around the eyes— less color in my skin
Location–where on the body is your complaint located?
sinus, nose, throat
Modalities–
Better— sleep, drink, food, moral support , fresh air
Worse — trying to do more than I should. Lying down causes more coughing
Concomitants
runny eyes. Anxious
Discharges–
clear runny nose, clear but thicker phlegm.
Generals–
I am tired, hungry, thirsty, bored, uneasy
The mentals:
anxiety, wanting to do something – want attention
What have you been saying?
get irritated when my husband reads instead of doing something that needs to be done. Sometimes I am too pushy.
What are you doing?
tossing in bed, watch tv, lying down, walking around the house and outside. Sitting on the porch swing.
Describe your thirst and appetite–
like cold drinks, trying not to have too much sugary items. Eating a lot of fruit, have protein veggie smoothie. Regular food
Fever?
just one day felt warm
Sweating?
so far no sweating
Odors?
mouth feels like it has an odor.
What is most striking, peculiar or identifying about your condition?
my voice
Is there a diagnosis?
COVID?
Describe your energy–
(no answer)
What does your tongue look like?
(no answer)
If you have a cough, please tell what it sounds like–
i taste the phlegm and the coughing starts. I am coughing more and more.
If you haven’t already said if you’re hotter or colder than usual, say it now.
legs colder and feet, ache in my shoulders, neck
This question only applies to complaints of a more chronic nature: I need to know what you eat, drink and “take”.
n/a
Tell me what drugs you’re taking, prescription or over-the-counter:
88 milligrams of synthroid. Vit d plus k, b 12, brain regain. Biodent, magnesium, albaplex, zypan, vascular care complex, brinzolamide eye drops.
_______
She told us she was “restless” at least 8 times! She was walking around aimlessly, pointlessly, inside, outside…. Tossing and turning in bed, wanting to do something, doing too much, bored, uneasy…..What else? How many times did she say she wanted attention? Twice? How many times did she say she was anxious? Three times?
If we go to the rubric I told you about in the beginning when I said “You were so close”, “Mind: Restlessness, anxious” and if you scroll down to “Mind: restlessness, anxious, driving from place to place”, that was it! That was exactly what she was doing! She was walking all over the house, all over the outside of the house, and there are only 2 remedies in that rubric and one is in Bold! Arsenicum!
Now, I’m betting that Arsenicum covers everything in the case, including wanting attention—Arsenicum is in Bold for that. You can take “Mind: sympathy, desires” or “Mind: company, desire for”.
What’s peculiar other than walking all over the house and the outside of the house and swinging on the porch swing? She’s critical! She doesn’t think her husband should be reading! Apparently, there are things he ought to be doing… “Mind: critical, censorious”—Arsenicum is a 3. “Mind: fault-finding”—Arsenicum is a 3. She says she’s “pushy”. I took, “Mind: nagging”. Arsenicum is a 2—there are no 3s, and it’s a small rubric.
Thirst, everyone knows that Arsenicum is thirsty. Do we have to know anything else? No! Nothing else matters! The thickness of mucus, the lachrymation, post-nasal drip, it doesn’t matter! Why? Because we have “characteristic symptoms”, and what does Hahnemann say in Aph. 153 of The Organon? “The most striking, strange, rare, peculiar (characteristic) symptoms in a case” must, above all, be matched to the remedy under consideration.
Now, let’s look at an example of how you can use the Hierarchy of Symptoms to solve a case. Let’s say you’ve got a case before you, but the etiology is too general (ailments from cold weather) so you go down to #2, the second item, “What’s wrong with you?” Virus. We use the Influenza rubric for that if it’s a flu-like illness, but there’s too many remedies there, so, we scroll down to #3: Sudden onset? Yes! It came on suddenly! Now we’re down to 2 remedies, Aconite and Belladonna! We go back to the Etiology rubric: “Generals: cold, temperature, weather, ailments from”—guess what? Aconite is there, Belladonna isn’t; the remedy is Aconite, we’re done! Yes, that’s it, we’re done!
Now someone’s gonna say, “What if there’s a cough? What if there’s sneezing and a sore throat? It doesn’t matter. These symptoms are over-ruled! We’re done!
Now, of course, there’s such a thing as human error. Maybe it wasn’t sudden onset at all, maybe the patient got confused, or, it came on suddenly only “in his opinion”. What does sudden onset mean? You went out on a cold day without your hat and your gloves. You came back an hour later, walked in the door and wham! You felt sick with a fever and had to lie down. That’s sudden onset.
OK, I could go on and on, but, I think I’ve introduced a new concept that might possibly serve you well in the future! We’ll see.
Elaine Lewis, DHom, CHom
Elaine takes online cases. Write to her at [email protected]
Visit her website: https://ElaineLewis.hpathy.com
