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Case Study

Miasmatic Downloading
Dr Rama Hariharan

Coughs and colds are recurrent childhood problems in India and Homoeopathy is an efficient and popular therapeutic route adopted by many parents. I wish to share one such seemingly simple case where the prevailing miasm took hold of the child's body and mind. It took a few months of treatment to perceive a shift in the miasm and for the child to be able to respond to her environment easily.

A 4 yr-old girl was brought with a recurrent throat infection since 6 mths. She always had phlegm in her throat but did not expectorate. She had neither cold nor cough. She stammered especially at the beginning of each sentence or whenever she was excited and had to communicate. Since a few years, she also had frequent urination in the daytime and bedwetting at night without being aware (no fixed time).

Stools: Normal
Thirst: +++
Sweat: low despite the hot Chennai weather,
Sleep: sound but goes to sleep late.
Appetite: OK no fuss.
Aversion: curds ++ desires cold drinks. Needs the fan always.

Her parents say she is a very determined person, friendly and mixed well with other kids. Depending on her mood would share her toys. She enjoyed puzzles.
This deterioration in her throat problems and stammering started after her father met with a car accident 6 mths ago, though she never expressed her fear/anxiety. She seemed a happy child.
The parents complained that even with fever for a day she goes off food completely, only takes water. It takes her almost 10 days to regain normal appetite.

Observation Here was a child that did not even have the usual robustness of bouncing back to normalcy after an acute episode of fever, despite eating, sleeping and behaving normally. It was strange that the child had no special aversions/desires as also was unable to express herself easily (stammering, hardly any tantrums) despite being the only child in a moderately liberal upper middle class family with doting parents. The excess baggage of the immunisations in a child with a F/H of heart and chronic liver problems was too obvious as also the systemic downloading of "Disease" through excessive urination and excessive phlegm. The topmost layer of the Sycotic miasm had to be addressed first.

Past History: After 1st birthday she had one episode of sudden high fever (105-106). DPT, POLIO MMR 1&2, HEPATITIS 1,2,3, DPT boosters were all given. Mother's pregnancy and delivery were normal.

Family History: F-HT at 35yrs. PGM-Hypertension & stroke PGF-HT, MGF died at 51from Cirrhosis of the liver after 4 attacks of jaundice (teetotaller).
MU - Triglycerides-600.
M - Adenomyosis of uterus P/E NAD. Very hairy all over.

Plan - To select the appropriate remedy according to the situation arising, always keeping in mind the prevailing miasm. The discharges should not be immediately stopped.

Follow Up


Thuja 200 1p SL14p OD


Throat less phlegm, urination during day better, stammering same. SL 14p OD


No cold/cough despite erratic weather and cold drinks. Stammering now not all
the time and nil when singing /reciting rhymes. Bed wetting ++; Teeth
grinding++ at night. Thuja 200 1P OD


2 days ago, in heavy rains, went in an A/C car, with the blast of cold air on her face. Since then low grade fever, throat pain on swallowing, wet cough with occasional thick white expectoration, appetite and thirst normal. Desires cool air. P/E nose-both turbinates swollen, throat - OK Chest- faint rales in both lungs.
Influenzinum 1M 1p, Ars-iod 200 12p tds


No fever. Lots of greenish discharges from nose. Cough still wet sounding but no expectoration. Appetite, thirst low. Child cheerful. P/E Nose-wet with thick green liquid phlegm, throat-ok, chest-occ faint rales on both lungs. Puls 30 6p tds.SL7p od


Cough only occasionally but while sleeping some heavy phlegm sounds. P/E NAD Bacillinum 200 1p SL 7p od


Since 3 days nose block with lots of thick greenish phlegm whenever nose is blown. .Aphthae inside lower lip. Teeth grinding++. Salivation when very excited. Bedwetting+++ despite a check on the nightly liquid intake. Stammering rare. Child cheerful. P/E Inside of lower lip aphthae. Nose- both turbinate swollen. Puls 30 6p BDS; Thuja 200 1p


2 days ago ate icecream and had Pepsi. Yesterday thick, pale, green nasal discharge. At night, breathing sounds laboured. No teeth grinding but bed-wetting still present. Puls 30 6p BDS.


Since 1 week pain in urethra, urination during. Stools sometimes hard, sometimes smelly. Bed wetting still occ. Grinding teeth+ Stammering occ. Av. juicy fruits (new) Puls 200 3p bd. Thuja 200 1p Berb-vulg Q BDS 1 wk.


Sudden wet cough since last night , no expectoration. Fever low grade, no appetite Thirst low. Cough < lying down. Infl 1M 1p+ Puls 30 9p tds.


Sudden wet cough since last night , no expectoration. Fever low grade, no appetite Thirst low. Cough < lying down. Infl 1M 1p+ Puls 30 9p tds.


Telephoned to report that fever went to 1030 last night with chill prior to it. Lots of mucus from nose and throat. Infl 1M 1p Ocimum- sanct Q TDS and asked to test blood and urine


All clinical tests normal. No fever. Some phlegm in throat but no cough. Weakness++ appetite low thirst ok. Bed wetting now early morn. Stammering occ Sulph 200 1p SL 14 p Kali-phos 6x BD 1 wk


Went for open air drawing competition. Rash inside of thigh which turned to urticaria all over the body in a few hrs. Dry, itching+++ no fever. Thick green nasal discharge , deep cough Appetite low, Stammering nil. Bed-wetting needs to be taken once but no "accidents" Acid-carb 200 9p tds


Had mild fever for a day on 18/3. Took Some Biochemics and was fine. Today played for 3 hrs non-stop. Now fever with pain in cervical glands pain in throat < swallowing , voice hoarse, nasal discharge less ,cough wet but no expectoration, Legs Pain+++ restless thirst+++ P/E nad except for mild coating of tongue Streptococcinum 1M 1p Rhus-tox 200 9p tds


-Since yesterday fever with heat and pain in all joints >warmth, pressure. Sudden left ear pain at night. Throat pain++ >hot drink (new). No cough but some phlegm in throat, Restless esp lying down P/E nad
Rx Strept 1M 1p ; Rhus-tox 1M 6p tds


No jt pain, no fever. Clinically ok C blood tests=N. Bedwetting nil. Stammering occ.Teeth grinding occ. Ear pain fleetingly < coming into
room from outside Tub-bov 1M 1p SL 14 p


Dramatic improvement on all counts-Stammering nil, teeth grinding nil, no ear/ throat pain. NO BED-WETTING even gets up on her own to go to the toilet early in morn. Has grown taller and put on 1kg wt.!


Had ice cream in the rain That night throat pain > Bell 200 2p Today green nasal discharge wet cough < night but no expectoration Puls 200 6p tds; Tub-bov 1M 1p


Reported fine

What I Learnt From This Case
On the face of it this case looked an easy one. As I grappled with it, I learnt the universality of the Organon - The rules when to repeat, when not to, to recognise the chronic miasm, to observe, wait and interfere only minimally.

Her constitutional medicine Puls was obvious: Off food and water in any acute illness, tendency to respiratory problems with thick, bland greenish mucus easily discharging, involuntary urination, needs the fan always, affectionate and not demanding.

Thuja was the obvious "Sycotic miasm downloader" ---P/H vaccinations and the "loaded" F/H. After the urticaria, Ac-carb did help in bringing about a cure by Herring's law. After this the miasm shift started towards the TUBERCULAR and when Tub-bov was given, dramatic improvements started. The child became more expressive in craving and aversions for food, threw the occasional tantrum and behaved normally for her age. Enuresis and stammering were history ! It was also interesting that she continued to be Puls despite the miasmatic shift. By no means is this child cured and am sure I shall be seeing more of her in future for minor ailments, but the case is certainly on the lines to cure.

Editor: Here, a clearer Miasmatic understanding would have allowed the choice of Tub-b in the first place and this would have led to a more RAPID cure.
Fundamental Miasm: Tub2 with F/H: cirrrhosis c 4 attacks of Jaundice.P/H High fever 
Syc 2: Adenomyosis of uterus and hirtusism
Syphiticic 2 with paralysis and stroke
Dominant Miasm:: Tub2 - CC colds and fever.
Therefore veers towards a choice of Tub-b.
You will say - to comment after the event ie hindsight is easy! But the advantage is that such hindsight allows us to be able to act better in our next case.