A 44-Year-Old Female With Recurrent Upper Respiratory Infections

A Homeopathic Medicine Case Report

The following case is formatted according to CARE guidelines (1)


In 1828, after twelve years of practice, Samuel Hahnemann, MD, found that certain diseases were easily cured with the most indicated homeopathic medicine, according to the Law of Similars, while other diseases tended to recur. He believed the underlying cause in these latter cases was the result of a “derangement of the vital force” that predated and was more fundamental than the current illness. Hahnemann believed that these “latent miasms” began as an initial infectious disease that was suppressed and continued to manifest itself in various forms, becoming hereditary. He believed that these miasms took hold of the body mentally, emotionally and physically so that the vital force could not repair itself, manifesting in a wide variety of symptoms and chronic diseases. Hahnemann stressed the importance of using the Law of Similars in each and every case. However, he also discovered that in some cases, the influence of these miasms could be completely removed by using the corresponding nosode prepared from either pathological tissue or from the appropriate drug or vaccine that created the initial illness.(2)

These nosodes are some of the most important medicines of our homeopathic pharmacopeia today, 200 years after Hahnemann’s time. While any homeopathic medicine based on the Law of Similars will resolve acute or chronic symptoms, there is something truly remarkable about the ability of nosodes made from infectious agents to remove inherited weaknesses resulting from these very same disease organisms that may have affected relatives in the distant past; the resulting “genetic predispositions” have often plagued patients and/or their family members for years. The following is one such case. (See Timeline below.)

Patient Information

A 44-year-old mother of three children came to see me on the advice of a friend. “I have been sick my whole life” was her chief complaint. As a child she had recurrent “strep throat,” a “bad case” of mononucleosis at age fourteen, constant colds and coughs (“I catch everything from my kids”), and recurrent bronchitis. “I’ve been sick every month for the past year,” she said. “I’m constantly on antibiotics and I think it’s making me worse.” She complained of severe fatigue, a persistent dry cough, bouts of vertigo for the past year, and poor sleep. She lamented, “My ears hurt; they are always filled with fluid; my back went out a few months ago and I was on steroids for awhile. I have a cough now, as usual, and I don’t want to go on antibiotics again—they only work temporarily anyway. I’m pushing myself to function for the kids, but I’m so worn out by the end of the day.”

Physical Exam

Temperature 99.5, BP 120/70, pulse 85, fluid in the ears bilaterally, wheezing on auscultation throughout, moderate rales right lower lobe (RLL).

Diagnostic Assessment

Right lower lobe pneumonia. Patient refused “yet another” chest X-ray ordered by her family doctor and she strongly expressed her preference to try homeopathy first before using antibiotics “yet again.”

Timeline of patient medical history, diagnoses and treatment received

June 6, 2015 Patient ℅ recurrent upper respiratory infections (URI’s) since childhood, chronic cough, aches and pains, multiple courses of antibiotics. Physical exam (PE) revealed rales right lower lobe (RLL). Dx: right lower lobe pneumonia. Rx: Phosphorus 200c, one dry dose
June 26, 2015 Cough cleared within a week of the Phosphorus, PE reveals chest clear on auscultation, but patient’s fatigue is unchanged and she feels as if she will “get sick again soon.” Rx: Tuberculinum 30c, one dry dose
August 12, 2015 Patient stated “I’ve been healthier than usual for the past seven weeks, and my energy is better.” Plan: Wait
September 4, 2015 Patient stated “I’ve been well; my energy is definitely better; a few weeks ago I felt something coming on, but it didn’t manifest. This is very unusual for me.” Plan: Wait
August 5, 2016 Phone follow-up one year later: “I’ve been so healthy since that last remedy, I can’t believe it! I actually got through the entire winter without a sniffle. It’s a miracle.” “Just a few days ago though my ear started bothering me. I’m worried I’m getting an ear infection.” Plan: Belladonna 30c, 2 dry doses with instructions to come in if there is no resolution.
August 12, 2016 I received a text from patient one week later stating that the Belladonna did not work, so she took a dose of Tuberculinum 200c that I had given her last year to have on hand. She said that within 24 hours she felt much better. “It worked like a miracle!” Plan: Wait
November 3, 2016 Brief phone follow-up: Patient still doing well since Tuberculinum 200c in August.

Homeopathic Assessment

Due to the suppressive effect of years of allopathic drug treatment, there were few characteristic symptoms to prescribe upon in this case. General physical symptoms of fatigue, recurrent coughs, and aches and pains plagued this patient for years. Mentally and emotionally the patient appeared fairly balanced; she had no particular fears, worries or anxieties though she was appropriately frustrated by her chronic illness. When I asked how she would live her life differently if she were healthier, she told me she would love to travel more. Otherwise she was content with her family life and besides her illnesses, had no other major complaints. I repertorized what I felt were the most significant symptoms in her case, though admittedly these were few.


MIND; Travel, desire to
CHEST; Inflammation; lungs, pneumonia; right
COUGH; persistent
GENERALITIES; Food and drinks; cold; drinks; desires

[See repertorization graph below.]

Homeopathic Intervention

Phosphorous 200c, one dry dose. While Phosphorus fit her case more closely than the other remedies, I had the nagging suspicion that it wasn’t quite right. I was therefore not surprised when, upon her return three weeks later, her local symptoms were resolved but her underlying fatigue and weakened immune state remained.

Three week Follow-Up

Patient returned to me with resolution of her cough, which occurred within a week of taking the Phosphorus. On examination, her chest was completely clear on auscultation, but she complained of severe fatigue and the feeling as if she “would get sick again soon.”

Homeopathic Assessment

Did I need to wait longer (usually four to six weeks) to allow the medicine to have its full effect? Or was the dose of Phosphorous “used up” to resolve the acute symptoms and therefore needed to be repeated or given in a higher dose to resolve her constitutional state? My clinical impression, based on the nagging suspicion that Phosphorus was not the simillimum in this case, was that it helped resolve the local symptoms but did not act deeply enough to cure the her underlying pathology. I was concerned that she felt as if she was getting sick again and that her deep-seated fatigue was unchanged. Even though only three weeks had passed, I decided to reanalyze her case, but I could find no other constitutionally appropriate medicine for her. Something was “missing”—that piece became completely clear to me once I delved deeper into her family history.

Upon further questioning, she remembered that her father was diagnosed with tuberculosis when he was in the military. It suddenly became crystal clear to me why this otherwise healthy woman could not rid herself of recurrent URI’s since childhood. Chances were that she had inherited a miasmic “taint” from her father, who was treated for his tuberculosis with pharmaceutical drugs that palliated his condition but did not eradicate it. The condition continued to manifest in his daughter, not as tuberculosis, but as a weakness in her upper respiratory track which resulted in long-standing recurrent URIs. No amount of a healthy diet, exercise or lifestyle could “throw off” the effects of this miasmic “taint,” as Hahnemann so clearly described in the Chronic Diseases, written 200 years ago.(2) It is important to note that, unlike her siblings who were relatively healthy, my patient was constitutionally susceptible to the dynamic energy of the initial pathogen/infection in her father.(3) My patient’s passion for travel (a keynote of Tuberculinum) and the fact that I had given her Phosphorus, a “tubercular” remedy, cinched my prescription.

Plan: Tuberculinum 30c, one dry dose. Send her home with Tuberculinum 200c to have on hand.

August 12, 2015 (Two months later)

“I’ve been healthier than usual for the past seven weeks, and my energy is better.

”I asked, “On a scale of 1-10, 10 being the worst and 1 being asymptomatic, where were you before the remedy and where are you now?”

“Let’s see, before I was an 11, now I’m maybe a 7,” she responded.

Plan: Some improvement. Wait.

September 4, 2015

“I’ve been well, my energy is definitely better, and a few weeks ago I felt something coming on, but it didn’t manifest. This is very unusual for me.”

Assessment: Excellent and classical response to the simillimum; a slow but steady improvement in her immunity and energy.

Plan: Wait

August 5, 2016 (One year later: phone follow-up)

“I’ve been so healthy since that last remedy, I can’t believe it! I actually got through the entire winter without a sniffle. It’s a miracle. Just a few days ago though my ear started bothering me; I’m worried I’m getting an ear infection.”

I asked the patient to come in so I could check her ear, but she said she had too many family commitments, and asked if I could prescribe something she could get at the local health food store.

Based on the suddenness of the pain in her right ear, which started “sometime in the afternoon” (3 P.M. aggravation) while picking up her kids from school, I instructed her to take a few doses of Belladonna 30c and advised her to come in if she wasn’t better soon.

Plan: Belladonna 30c, bid for a few days.

I received a text from her a week later stating that the Belladonna did not help her; so she decided on her own to take a dose of the medicine I had sent her home with last year (Tuberculinum 200c). She said that within 24 hours she felt much better. “It worked like a miracle!”

Homeopathic Assessment

Tuberculinum is not listed under Ear: inflammation; media in the Complete Repertory 2016. However, I have learned through 25 years of practice that the constitutional medicine—the simillimum—will often work acutely even though it may not be listed in the rubrics describing the acute symptoms.

As of this writing, almost two and a half years later, patient has continued to do well.


In 1828, after twelve years of homeopathic practice, Hahnemann discovered that certain diseases were easily cured with simple homeopathic medicines while others tended to recur. In his book on The Chronic Diseases, Hahnemann wrote:

“To find out then the reason why all the medicines known to Homeopathy failed to bring a real cure in the (above-mentioned) diseases, and to gain an insight more nearly correct and, if possible, quite correct, into the true nature of the thousands of chronic diseases which still remain uncured, despite the incontestable truth of the Homeopathic Law of Cure, this very serious task has occupied me since the years 1816 and 1817, night and day; and behold! the Giver of all good things permitted me within this space of time to gradually solve this sublime problem through unremitting thought, indefatigable inquiry, faithful observation and the most accurate experiments made for the welfare of humanity.”

Samuel Hahnemann believed that the chronicity and relapsing nature of many diseases (that were not cured with the most indicated homeopathic medicines) could be traced to an initial infectious disease whose external manifestations— “the itch” (psora), fig-wart disease (sycosis), and the chancre (syphilis) —were suppressed (mainly by allopathic treatment), not cured. This often resulted in a myriad of symptoms that continued to manifest in various illnesses, and this miasm or “taint” became hereditary. He explained that even the most healthy lifestyle was not enough to remove this predisposition and its resultant innumerable symptoms responsible for most of the chronic diseases, as clearly shown in this patient’s case above.

Again, Hahnemann:

“But that the original malady sought for must be also of a miasmatic, chronic nature clearly appeared to me from this circumstance, that after it has once advanced and developed to a certain degree it can never be removed by the strength of any robust constitution, it can never be overcome by the most wholesome diet and order of life, nor will it die out of itself. But it is ever-more aggravated, from year to year, through a transition into other and more serious symptoms, even till the end of man’s life, like every other chronic, miasmatic sickness; e.g., the venereal bubo which has not been healed from within by mercury, its specific remedy, but has passed over into venereal disease. This latter, also never passes away of itself, but, even with the most correct mode of life and with the most robust bodily constitution, increases every year and unfolds evermore into new and worse symptoms, and this, also, to the end of man’s life.”

The job of the physician was to:

“…first find out as far as possible the whole extent of all the accidents and symptoms belonging, to the unknown primitive malady before he can hope to discover one or more medicines which may homeopathically cover the whole of the original disease by means of its peculiar symptoms. By this method he may then be able victoriously to heal and wipe out the malady in its whole extent, consequently also its separate members; that is, all the fragments of a disease appearing in so many various forms.”

Hahnemann’s initial three miasms—psora, sycosis, and syphilis—have been greatly expanded upon by the doctors Vijayakars from India. Please see “Predictive Homeopathy Course Review, Part 1”, AJHM, Winter 2015 edition for a review of these miasms.

In his timeless book, The Science of Homeopathy, George Vithoulkas believed Tuberculinum was a fourth miasm, considered a combination of Psora and Syphilis by some, since tuberculosis was one of the earliest diseases known to mankind. The doctors Banerjea from India expand on the Tubercular miasm in “Report from Calcutta,” AJHM, June 2017 e-edition, briefly reviewed by Karl Robinson, MD.

It is important to emphasize that it is the individual susceptibility that determines whether a particular miasm will have a detrimental effect on the organism. For example, not everyone who acquires the disease gonorrhea—and is treated with antibiotics, for example—will necessarily end up with deeper symptoms that are reflective of the Sycotic miasm. However, this “taint” can be passed on to future generations but only those individuals who are susceptible to this miasm may become affected by it.

Therefore, in every case the homeopathic remedy based on the totality of symptoms must be prescribed as Hahnemann explains in aphorism 81 of the Organon.(4)

From clinical experience, we homeopaths know that when the most well-indicated homeopathic medicine is not working sufficiently, we must consider that an underlying miasm may be preventing a deeper cure. Of course, in every case, other obstacles to cure must be considered such as prior vaccinations, allopathic drugs, poor nutrition, etc., as Hahnemann clearly describes in the Organon.

Ultimately it may require several visits and homeopathic prescriptions, each given for the totality of symptoms presenting at that moment, before the underlying predisposition or miasm becomes clear. As homeopaths, we often describe this to patients as “peeling away the layers of the onion,” which most of our patients instinctively understand.

This case of a 44-year-old woman with recurrent URI’s since childhood, despite a healthy lifestyle, that resolved with a single dose of a homeopathic medicine clearly demonstrates the profound effect that miasms have on individuals, which Hahnemann so brilliantly described two centuries ago. The fact that homeopathy can resolve these types of “genetic predispositions” is testimony to its powerful epigenetic influences that demand further research and discussion.

Patient Perspective

“Most of my life I have been sick. Not sick as in disease management, sick as in low immunity and getting whatever ‘bug’ or virus happened to be going around. When I was a younger child, I had strep throat more times than I can begin to count. My mom, who was a pediatric nurse at the time, started doing throat cultures on me even when I was not sick, and I always tested positive for strep. When I would become symptomatic with a sore throat and a fever, the doctor would simply give me yet another shot (yes, they had good ole’ fashioned shots back then!). No one seemed concerned with why I seemed to constantly have strep throat.

Fast forward to my teen years.I outgrew the strep throat years but began getting sick every month right before I would start my period. This just became a fact of life for me, and doctors would simply tell me it was normal for some women because immune systems are at their lowest at that time in a woman’s cycle. For some reason, this rationale seemed okay with me until my 30’s after I had my second child. It dawned on me that I could not function running my own business, caring for 2 babies, managing a household, and literally be sick in bed with a virus monthly for at least 9 months of the year. This was my first ‘ah-ha’ moment that perhaps western medicine was not working so well for me.

During my journey into a more holistic approach to my health and desire to find the underlying cause of why I kept getting sick so I could stop it, I eventually met Dr. Saltzman. I first went for an appointment during my winter ‘cough season.’ Literally every winter since I was a teenager, I would at some point get a bad cough. Sometimes it came in late fall, sometimes not until February, but regardless of when it started, it did not go away until spring. I considered a good year to be when my cough started after December. It was exhausting and left my immune system more compromised during the winter months.

Dr. Saltzman took such a thorough history on me, and my family, that she was eventually able to narrow down the possible cause of my cough to my father’s tuberculosis exposure. She gave me a remedy (which I should probably have written down, but sadly did not) on the first office visit which made my cough worse for a few days (thankfully she knew to give me a heads-up about this). Three days later, I took another dose of the same remedy, and the cough cleared up over the next few days. However, I was still feeling very fatigued, and on the second visit Dr. Saltzman gave me a new remedy. Now, more than two years later, I remain cough free—even through the winter months! I no longer get sick with my monthly cycle, and I no longer spend most of the colder months sounding like I might cough up a lung! Do I still get an occasional virus? Of course, but I recover in a reasonable amount of time, and it is the exception, not the rule for me to be sick. I am so thankful to Dr. Saltzman for taking the time to get to the root issue of this lingering problem for me.”

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nymc-Logo-250Susanne Saltzman, MD
Editor, American Journal of Homeopathic Medicine

Article published in the Winter 2017 edition of the American Journal of Homeopathic Medicine.

Learn more about the American Journal of Homeopathy


  1. Gagnier JJ. et al., The CARE guidelines: consensus-based clinical case reporting guideline development, BMJ Case reports 2013; doi: 10.1136/bcr-2013-201554
  2. Samuel Hahnemann, Chronic Diseases, translated by Louis H. Tafel, second German edition (see pg 123)
  3. Lessons from the Organon by Joel Shepperd, MD, AJHM, Winter 2017
  4. The Organon, Samuel Hahnemann, sixth edition