Repertory and materia medica: sore throat

Sore throat sorts cleanly in the materia medica by laterality, the character of the pain, the swallowing modality, and the associated systemic picture. A handful of remedies cover the great majority of acute cases.

Red flags

A few presentations need prompt assessment rather than acute prescribing alone: stridor or difficulty breathing; inability to swallow saliva; a muffled "hot potato" voice with severe unilateral swelling, the classical picture of peritonsillar abscess; spreading facial or neck swelling; high fever with a spreading rash. A sore throat that persists beyond a week, recurs repeatedly, or comes with a persistent neck lump, unexplained weight loss, or hoarseness lasting more than three weeks belongs in the same category.

Principal remedies

Belladonna is the remedy of sudden, fiery onset — bright red, dry, hot, the pain right-sided and throbbing, the patient flushed and febrile, often with the characteristic dilated pupils and radiant heat of the face.

Lachesis begins on the left and is worse from swallowing liquids and from empty swallowing — solids, paradoxically, are better tolerated. The patient wakes worse, cannot bear a collar or anything pressing on the throat, and is often loquacious and worse from sleep.

Lycopodium is the right-to-left mirror of Lachesis: onset on the right, crossing to the left, relieved by warm drinks, with the keynote afternoon aggravation between 4 and 8 pm.

Mercurius solubilis covers the raw, ulcerated throat with profuse stringy saliva, an offensive metallic taste, and a marked night aggravation. Sweating is profuse but brings no relief — the distinguishing point against the simpler febrile picture of Belladonna.

Hepar sulphuris is the remedy when the predominant sensation is a splinter or fish-bone in the throat, in a patient who cannot bear cold air or touch; even a draught from an open window aggravates.

Phytolacca presents with a dark-red, almost dusky throat and the keynote of pain shooting up to the ear on swallowing, accompanied by aching in the muscles and limbs. Unlike Lycopodium, warm drinks aggravate.

Differentiation keys

Laterality is the first sorting question. Right-sided onset points to Belladonna or Lycopodium; left-sided onset to Lachesis. The right-to-left progression of Lycopodium versus the fixed left-sidedness of Lachesis is the most-taught clinical distinction in this group.

Swallowing modality is the second. Lachesis is worse from liquids and from empty swallowing — the counter-intuitive keynote that solids are easier than liquids is the remedy's calling card. Lycopodium is better from warm drinks; Phytolacca is worse from them. Mercurius is indifferent to temperature but worse at night.

Sensation refines the choice further. The splinter or fish-bone sensation is specific to Hepar. Pain shooting to the ear on swallowing is Phytolacca. The hot, throbbing, dry, bright-red character belongs to Belladonna. The raw, ulcerated, salivating throat with offensive breath is Mercurius.

For a wider differential, the throat chapter is fully repertorised in Boericke and Kent; you can also search the free repertory by rubric and modality.

References

Boericke, W. (1927) Pocket Manual of Homoeopathic Materia Medica with Repertory, ninth edition, Philadelphia: Boericke & Tafel.

Kent, J. T. (1905) Lectures on Homoeopathic Materia Medica, Philadelphia: Boericke & Tafel.

Clarke, J. H. (1900) A Dictionary of Practical Materia Medica, three volumes, London: Homoeopathic Publishing Company.