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Sudden cough - pls help me diagnose

I am trying to address a nagging cough that has been an on-off problem with a colleague.

a) Female, 36 yrs
b) For the last 2 years, she gets a sudden cough, dry, with throat/larynx itching that prompts her to cough. They are sudden, and short, but violent when it occurs. These bouts of coughs do not occur all the time, they come in spurts of around 1 month then go away, and come back after a few months. She mentions the cough can hit her any time of the day, but for sure, it also hits her when she is lying down to sleep (no specific time - sometimes before midnight, sometimes after).

c) Mind - She is a worrying sort of personality. Worries about all sorts of things and is somewhat insecure.

Based on this, I found Rumex Crispus to be the best match due to the following matches:

a) Mind - insecure, scared, depressed

b) Symptoms - sore larynx on cough, throat scraping, cough while lying down, cough intermittent, cough tickling in throat pit

c) Generalities - all times of day

Based on the above, I feel Rumex Crispus is the closest match.

I have started her in Rumex Crispus 30C 3 times a day. I administered it yesterday, but today she said it had no effect. I plan to continue it for another day. If there is no effect at all - i.e. no improvement or aggravation, I am wondering if I should next try 200C once a day for a day or two or another medicine?
  aske123 on 2008-06-30
This is just a forum. Assume posts are not from medical professionals.

Worse from the least cold air; so that all cough ceases by covering up all the body and head with the bedclothes. ...Boericke


If he steps into the open air a paroxysmal cough takes his breath away; or if he passes from the open air into a warm room the same paroxysmal cough comes on...Kent


Violent incessant dry cough; worse on inhaling the least cold air; covers the mouth to keep the cold air out, with relief.

'Violent, incessant cough, dry and fatiguing, with very little or no expectoration, aggravated by pressure, talking, and especially by inspiring cold air, and at night' (Dunham.) There is perhaps no remedy under which the sensibility of the mucous membranes of the larynx and trachea become more exalted than this one. The patient must cover up the head in bed in order to protect these membranes from contact with the air, which immediately excites cough.

Going from warm room into cool air and vice versa...Nash


A keynote of many Rx. c. cases is sensitiveness to cold air.

The cough and skin symptoms are < by uncovering or exposure to air. Guernsey thus describes the cough of Rx. c.: 'Cough caused by an incessant tickling in throat-pit, which tickling runs down to the bifurcation of the bronchial tubes; touching the throat brings on the cough; by covering up all the body and head with the bed-clothes there is no cough.' .......Clarke


We must try to understand the 'essence' of a remedy by reading various MMs.

Rumex patients are generally worse in cold air. In majority of the cases the dry cough gets ameliorated when they get warmed up by covering them fully.

They react on even slightest change of temperature to the extant that they get itching while undressing.

Unless this peculiar nature is there in the patient Rumex is not going to help.

Look for the totality of symptom even if it is a single symptom.

Cough is not a total symptom. Cough caused by tickling in the throat, which gets ameliorated by covering up fully , in persons sensitive to slight change of temperature is the way you have to remember Rumex.

Now take a look at the (b) you mentioned.

b) Symptoms - sore larynx on cough, throat scraping, cough while lying down, cough intermittent, cough tickling in throat pit.


Where are the modalities? Under what conditions this cough is getting aggravated/ameliorated?

I am not offering any remedy suggestions here but telling you a way on how to study remedies.

Hope this helps.

gavinimurthy last decade
You should wait for 2-3 days, and if there is no reaction , it is not the indicated remedy.

There is no need to try 200C if there is no change whatsoever with 30C.
sameervermani last decade
Hi Mr. Murthy,
thanks for obliging. Such inputs are critical for me.

I actually thought I had a very good match with Rumex Crispus and the lady in question.

There was a match in 'Mental' state. Boericke's MM (the one I own) states one key element of Mental state to be 'insecured, scared, depressed'

This is a 100% match with her personality.

In Boericke's MM, 'Generalities', it says that the cough can occur any time of the day

This is a 100% match with her sympton

In specific symptoms the MM says 'Symptoms - sore larynx on cough, throat scraping, cough while lying down, cough intermittent, cough tickling in throat pit '

This is a 100% match with her condition. There is no question lying down aggravates, and wheenever she coughs, she complians of a itchy and tickling throat. The cough is also intermittent. Finally, she complains of soreness in throat.

The keynote that you mentioned does not match, or is not prominent enough to notice (she coughs in warm air too):

'A keynote of many Rx. c. cases is sensitiveness to cold air.'

'The patient must cover up the head in bed in order to protect these membranes from contact with the air, which immediately excites cough. '
The above is not evident, and is not something that stands out in her case (which is not to say it is not possible, but just that she has not noticed)

So having said this, why should the focus be on the above two you mentioned and not all the other matches I found ?

I agree, the symptoms you point out are more 'peculiar' than the ones I matched. So if my diagnosis was wrong, which may well be, is it true that:

a) You must always try to find the peculiar symptom (stuff like itchy throat, intermittent cough are not peculiar)

b) If you find a remedy where many symptoms match, but not the 'keynote' (or essence), then it is not the right remedy. Instead, if you find a remedy with the 'essence' but not too many other symptoms match, then that is a better remedy ?

c) I don't know in this case, what can be termed as peculiar. I don't see anything peculiar in her condition, nor does she describe it. It is pretty much the 'sudden, intermittent cough, lasts for 1-2 minutes of heavy coughing, tickling and soreness of throat. There is no evident proof that either cold or warmth does her harm. Her cough can come anytime of the day. The only pattern is it ALWAYS comes at night, when she lies down, at least once. It can happen either before or after midnight (which is also a property of RxC)

There is no clear indication of what makes it better though. It goes as fast as it comes. It happens everyday.

aske123 last decade
The remedy must match the PQRS symptoms. Peculiar, queer, rare and strange symptoms.

You must read a few books first to understand these things in depth.

Start with Organon. It is available online. Take your own time but read slowly and thoroughly. Re read each postulate as many times as required till you understand it well.

gavinimurthy last decade
Ok, thanks!
I've actually read quite a few book till now and think I understand the core principles of homeopathy, but haven't really attempted to read the Organon cover to cover (have read sections other books refer to).

Anyway, enough said. Obviously, both you and Sameer don't think RxC is the right medicine here, which is contrary to my current understanding, since several symptoms did match. So I suspect I am missing something fundamental here, which the Organon will help me answer.
So I will be back in a few weeks!

(BTW, Mr. Murthy, thanks for the hpathy course link earlier - I took it. It was basic but good. I think I need to focus more on how to interpret the MM. Other aspects of homeopathy seem clear to me, or so I think)
aske123 last decade
You must repertorize keeping in mind her symptom of getting worse from lying down on bed.

But, as you can see from below, the list is long :)

Then you should ask, what is the mental state of the patient , has she had this mental state for a long time ?

Is there a lifestyle cause to this mental state ?

If yes, help her remove that cause.

If no, there is definitely something miasmatic at work here, and you should see what her miasmatic state is. And, depending upon her dominant miasmatic state , pick the most similar anti-miasmatic among the ones below.

cough; while lying down; bed; agg.; |*
*alumn., am-c., am-m., anac., ant-t., aral., arg-n., 2ars., bry., cact., calc., 2caps., cham., coc-c., coca., coff., 1con., 2crot-t., |*
*dros., euphr., ferr-ar., ferr-p., hep., 2hyos., ign., indg., iod., |*
*kali-c., kali-n., kali-s., kreos., lach., lachn., lact., lyc., mag-c., mag-m., mag-s., meph., mez., nat-c., nat-m., nit-ac., nux-v., 1phos., psor., 2|*@26@*rhus-t., sabad., samb., sang., 2sep., 2sil., squil., 2still., 1sulph., verb.

And, just as a pointer Rumex Crispus is not an anti-miasmatic medicine, and will not cure the root cause in case there is something miasmatic at work in the case you mention.

sameervermani last decade
Thanks Sameer. Question on your first statement:

'You must repertorize keeping in mind her symptom of getting worse from lying down on bed. '

Why would this be the first condition to repertorize? As I described, the cough is not only while lying down. It is also at other times (sitting up). If I start with this condition, haven't I already created a more limited subset?
aske123 last decade
Also, I think you are referring to the abchomeopathy repertory. It has two classed 'lying down' and 'while lying down'. The latter has 2rumx (2nd order) while the first one doesn't even list it. I guess the difference between the two is that the latter is 'coughing as you are in the process of lying down' and the former is 'coughing after you lie down'?
aske123 last decade
If I understand what you said correctly , she ALWAYS coughs while lying down whether or not cough is there on other times is a bit random.

Hence it becomes a modality of the cough that her cough is ALWAYS worse when lying down.

I just copied pasted from the abc repertory. The purpose was not to be very accurate in the remedies there, the purpose was just to show that these lists can be very long, and hence miasmatic daignosis becomes very very important in order to filter to the right medicine.
sameervermani last decade
ahhh... gotcha.
aske123 last decade
And, in a case where there are mental indications, these have to given precedence. The chief complaint will take a back seat (do not toally ignore it as it might offer some peculiar indications as well).

But try to find

a) any delusions the patient has
b) any never well since events in her past
c) odd mental/emotional traits
d) her general temperament
e) her food cravings/aversions
f)her physical generals (response to environements , temepratures)
g) modalities of her chief complaint

While looking at all these, try to give more weight to what is ALWAYS is true e.g. patient says 'I am ALWAYS worried about..' 'I am always worse from ...'
sameervermani last decade
Ok. But here is what I have observed - when you focus more on mental/emotional you often need to try 4-5 different medicines before you hit on the right one (this is corroborated by many threads I have read here), which goes to several weeks because you ask them to try, wait, watch and then try another if needed.

I am completely fine with that to solve chronic cases, but in many cases I want a 'quick' solution. Now I know that you are not a believer in 'this or that' remedies, but hear me out:

In a case where the condition is acute, say this crazy cough, and I really need to first temper this cough and then get into a deeper constitutional analysis that may take time to bear fruit, what do I do? I ask this because the person(s) in consideration say 'To hell with the remedies - if it doesn't work in 2 days, I am downing some cough syrup'.

I want to avoid such situations by giving something that can definetely address the cough, and buy me time and his/her faith to find the right similum.

I want to be realistic here - very experienced people seem to take a long time finding a similum, so I will take much longer, unless I get lucky.

Given that line of thought even if you don't agree, I want to know if this approach is at least possible, even if it means temporary cure.

IF it is possible, then can I just focus on the main symptoms and not the mental/emotional?
aske123 last decade
Hmm.. I tend to disagree that if you take mental and emotional symptoms into account, there are 4-5 different remedies. That might happen over the internet because you cant get the feel for a Sepia';s coldness or a Kali Carb';s stiffness over the internet, but in real life one can hit the right remedy in the first or at most the second attempt after meeting the person. Even the mannerisms of the person convey the remedy. The most striking and deepest indications of the CHRONIC disease are visible on the mental plane. Mental symptoms are worth their weight in gold.

But indeed, if you think it is easier for you to find the remedy that covers the chief complaint very well, it might be possible to palliate with this approach before you get into touching the constitution. I agree that this approach although superficial might help in avoiding situations like ''To hell with the remedies - if it doesn't work in 2 days, I am downing some cough syrup''.

However, IF this is a chronic miasmatic problem sooner or later this remedy will stop giving benefit or if you repeat too much it might result in suppression. You will not be able to cure it.

When we know, finally, only the similimum based on person's emotional/mental manifestations of the disease will cure, so I guess it is worth the effort.
sameervermani last decade
Why not try Hep Sulf 1M 2-3 doses(once daily)
znaeem51 last decade
I managed to address this case with two doses of Spongia Tosta 200c. The cough was actually a result of respiratory infection. (Kudos to Morisson's Desktop Reference of Keynotes and Murphy's Repertory - they are both gems for beginners such as me)
aske123 last decade

In fact Spongia helps many types of dry coughs for which no definite cause can be ascertained.

gavinimurthy last decade
Thanks. Actually, based on my attempt at repertorization, with focus on keynotes, Drosera was a better match, but since I did not have it, I went with the next one. It's been a week now where the cough has not re-occurred, so lets see..
aske123 last decade

Interestingly both Drosera and Spongia are strong tubercular remedies.
sameervermani last decade
Sudden cough for no reason. Anytime, day or night. Worse while lying down. Proping up head with pillows does not help. While lying, if I touch my throat, it causes me to cough and get choked. Will be sitting, driving, standing, walking, shopping, doing nothing and I get a twitch in my throat instantly for no reason and start coughing. Very dry cough. Sometimes last a minute or two. Sometimes last for 10 to 15 minutes and is so violent that I throw up. Uncontrollable. It's like a tickling in my throat or an irritation. Throat is very raw feeling and sore afterwards.Have had all kinds of tests. Lung xrayed. Muscle in throat cut. Muscle in throat with balloon to expand it. Lungs are said to be clear. Cold or hot weather do not make a difference. No mucas is observed when coughing. Cough so violently at times that I wet my pants. All kinds of blood tests preformed with no results. Has been going on for over 3 years. Anyone know anything I can do to help this? Promethazine-codeine syrup has been prescribed and it seems to help a little but I cannot take during the day. This is not a once or twice a week cough. It is daily. Please help!
bitzygirl 8 years ago

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