By Dana Ullman MPH, CCH

(Excerpted from Everybody’s Guide to Homeopathic Medicine, Stephen Cummings, MD, & Dana Ullman, MPH Tarcher/Putnam, 2004)

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A sore throat may be the sign of a viral or bacterial infection, but just as commonly it results from a postnasal drip or simply from dryness of the throat. Most sore throats, even when they result from infections, are self-limited symptoms that the body can heal on its own. Medical practitioners use laboratory tests to determine whether Streptococcus bacteria are involved. The most accurate test is still a throat culture, but you must wait up to two days for the results. In many offices, swab tests that give almost instant results are used instead. Usually, no attempt to identity other germs other than strep is made.

Noninfectious Sore Throats
Mucus trickling down the back of the nose and into the throat often causes enough irritation to produce pain. Postnasal drip can be a problem for those with acute colds or acute attacks of allergies like hay fever or reactions to cat fur. It can also trouble those who have chronic nasal congestion due to allergy. People with acute symptoms can be treated at home according to the guidelines in the articles on colds and allergies, but those with chronic or recurrent symptoms should be treated by a professional homeopath. Sore throats are also commonly the result of dryness caused by open-mouth breathing or artificially heated air.

Viral and Non-Strep Bacterial Infections of the Throat
A substantial number of infectious sore throats are precipitated by the same viruses that cause the common cold. Bacteria other than Streptococcus are also frequently involved in sore throats. Symptoms accompanying viral or non-strep bacterial throat infections are various. Pain may be minimal or intense; fever, swollen lymph nodes, and pus in the throat may or may not be present. Cold symptoms often occur.

Less commonly, other germs infect the throat with more severe symptoms. Both herpangina and true herpes viral throat infections may cause marked general symptoms and small blisters or sores on the throat tissues. Mononucleosis, another viral infection, may cause severe sore throats. We discuss mononucleosis in more detail later in this chapter. Gonorrhea, covered in the chapters on womenís and menís health concerns, can also infect the throat.

Most sore throats that result from infections caused by viruses or nonstrep bacteria are not very serious. They clear up on their own, though the patient with mononucleosis may be sick for quite a while. Other kinds of bacteria that infect the throat produce self-limited illnesses and rarely lead to serious complications.

Conventional medicine offers no treatment for viral infections associated with sore throatóantibiotics are useless and can be risky. At this time there are no simple tests to detect non-strep bacterial sore throats (with the exception of gonorrhea). Since such infections donít cause serious problems and since they clear up by themselves, antibiotic treatment is unnecessary.

Strep Throat
“Strep” refers to a particular type of bacteria, the group A beta-hemolytic Streptococcus. Although a person with a strep throat is often sicker and has a higher fever and more pain than one with a viral sore throat, the disease itself is not serious; the symptoms clear up within a few days. Cold symptoms and coughs are less likely to accompany a strep throat than a viral sore throat. Scarlet fever may occur, but this is simply strep throat accompanied by a rash, and the treatment of a person with scarlet fever is no different from that of simple strep throat.

The main reason for the concern about strep throats is that they canóonly rarelyólead to serious illnesses, including kidney inflammation and rheumatic fever. The person with a kidney disease resulting from a prior strep infection becomes quite ill, but usually recovers without any permanent ill effects. On the other hand, rheumatic fever can lead to permanent heart damage to one or more of the valves of the heart. Rheumatic fever has become quite rare, but it is still important to take it seriously.

Rheumatic fever can be prevented if all the strep germs are killed within the first ten to twelve days of the infection. Often, the bodyís own defenses have eradicated the strep within that time. Still, to be safe and to prevent spread of the infection to others, when the lab test is positive for strep infection, pediatric authorities recommend that children with strep throat receive penicillin or other appropriate antibiotic treatment. In order to prevent rheumatic fever, antibiotic treatment must be begun within the first week or so after the symptoms begin.

Antibiotics also relieve discomfort and shorten the course of the symptoms, especially when treatment is begun during the first day or two of the illness. However, this period has often passed by the time a strep infection is diagnosed. Also, various studies have shown that even the proper use of orally administered penicillin fails to eradicate strep bacteria in up to 30% of those treated.

Taking these complexities into account, you should start with homeopathic treatment. Homeopathy is often very effective in helping the person with strep heal the illness. And if you do decide to use antibiotics, thereís nothing wrong with continuing the homeopathic treatment concurrently.

Regarding the use of antibiotics, sometimes the decision is easy. Any child with a family history of rheumatic fever should definitely receive antibiotics. People of any age who have already had rheumatic fever must take antibiotics preventively from the onset of any significant sore throat, even before the type of infection is known.

If there is no history of rheumatic fever the choice can be a little more difficult. On balance, we feel itís reasonable to forego antibiotics even for children since rheumatic fever is so rare today. But since these rare cases generally do occur in kids, we wouldnít argue with a decision to opt for antibiotics. Adults in generally good health need not take antibiotics, but might consider doing so if they will be exposing others to the disease.

“Mono” is a viral infection of the whole system and is most common in ten-to-thirty-five year olds. Symptoms often include a very painful sore throat, red, swollen tonsils (sometimes spotted with white material), exhaustion, aches, and fever. The lymph nodes, especially in the neck, are always swollen. Mono is like the flu, but mono lasts longer than the flu, and the sore throat is worse. Mono may also be accompanied by cough, hepatitis (liver inflammation), swelling of the spleen, or symptoms affecting the nervous system. A blood test is required to confirm mono. Mono has no orthodox medical treatment, and it usually resolves itself in two to four weeks, though it may last up to three months. Homeopathic treatment may reduce the length of the illness.

The epiglottis is the flap of tissue that covers the entrance to the larynx; when one swallows, it prevents food from getting into the tube leading to the lungs. Rarely, the epiglottis becomes infected by bacteria, resulting in a serious medical emergency, since swelling of the epiglottis may totally block the windpipe. The symptomsósevere sore throat, sense of constriction, and marked feveróbegin suddenly. As the swelling worsens, swallowing becomes so difficult that drooling occurs. Struggling to breathe, the patient often sits leaning forward and open-mouthed. Epiglottitis occurs most often in children under six but older children and adults can also get it. It requires immediately emergency treatment in a hospital.

General Home Treatment
Sore throats caused or aggravated by dryness are often relieved simply by reducing room heat, running a humidifier, and remembering to take frequent sips of liquid. Gargling with warm saltwater, lemon juice and honey in warm water, or dilute apple cider vinegar temporarily relieves sore throat pain. Throat lozenges may help too. Sucking on a 100 mg or 500 mg tablet of vitamin C may be soothing, but be careful not to irritate the tongue or throat. If you are being treated with homeopathic medicine, however, do not take lozenges containing menthol or eucalyptus, since these substances may interfere with the action of the medicine.

Home treatment for mononucleosis is the same as for other sore throats or for flus. Vigorous activity must be avoided, since the spleen is vulnerable to rupture.

Casetaking Questions

Character of the symptoms:

  • How would you describe the throat pain (for example, raw, burning, or stinging)?
  • What other sensations are present? Does the throat feel swollen, or do you feel as though there is a splinter or a lump in the throat?
  • On which side, if any, is the pain worse? Did it start on one side and move to the other?
  • Are there patches of white material or pus on the tonsils or throat?
  • Does the pain extend to the ear?
  • Is the external throat sensitive to touch?Modalities:
  • How does swallowing warm or cold drinks affect the pain? How is the pain affected by empty swallowing or swallowing only saliva?
  • Is the pain affected by warm or cold weather or rooms?
  • Is the pain worse at a particular time of day?Associated symptoms:
  • How does the tongue lookóis it red with raised ìbumpsî or coated yellow? Is the tongue painful?
  • Is salivation increased? If drooling isnít obvious, check if the pillow is wet or if the mouth simply feels full of saliva.

Remedy Summary

  • Give the medicine: Every 6-8 hours for 2-3 days, stopping when there is definite improvement
    When to try another medicine: If there is no significant improvement after 24 hoursNote: All medicines below cover swollen lymph nodes in the neck and scarlet fever rash.

    Belladonna Essentials

  • During the first twenty-four hours when the pain has come on suddenly and is accompanied by fever and flushed skin
  • Redness of the throat or tonsils, often with swelling, but no pus is presentConfirmatory symptoms
  • “Strawberry’ appearance of the tongue as in scarlet fever
  • Throat pain worse from swallowing, especially liquids
  • Sensation of dryness in the throat

    Phytolacca Essentials

  • Sore throat with body aches and fever
  • Throat appears dark red or even purplish or bluish
  • Pain worse from warm drinksConfirmatory symptoms
  • Pain shooting up to the ears during swallowing.
  • Incessant desire to swallow
  • Chilliness
  • Pain at the base of the tongue when protruded

    Mercurius Essentials

  • Pus or white/yellow material in the throat
  • Excessive salivation, droolingConfirmatory symptoms
  • Sensitivity to both heat and cold
  • Throat pain worse at night
  • Thirsty
  • Swollen or puffy tongue, bad breath

    Lycopodium Essentials

  • Sore throat worse on the right side or beginning on the right and spreading to the left
  • Pain relieved by warm drinks and warm foodConfirmatory symptoms
  • Feels worse in general in the late afternoon, between 4 and 8 P.M.

    Lachesis Essentials

  • Pain worse on the left side or spreading from left to right
  • Pain worse from drinking liquidsConfirmatory symptoms
  • Sore throat worse in the morning, especially on waking
  • Throat sensitive to touch; clothing around the neck causes discomfort or choking sensation
  • Person feels worse in general from warmth

    Hepar sulph. Essentials

  • Pus has formed and the throat and tonsils are very swollen.
  • Irritable
  • ChillyConfirmatory symptoms
  • Sensation of a splinter or something stuck in the throat
  • Throat pain worse from cold and better from warm drinks and external warmth

    Arsenicum Essentials

  • Chilliness, thirst, and restlessness combined with fatigue accompany the sore throat
  • Throat pain relieved by warm drinksConfirmatory symptoms
  • Throat pain burning in character
  • Pain worse from swallowing in general, cold drinks, or exposure to the cold

    Rhus tox. Essentials

  • Throat pain better by warm drinks and warmth in general
  • RestlessnessConfirmatory symptoms
  • Symptoms begin after straining the voice or from cold, wet weather
  • Thirsty for sips of water
  • Dry mouth, dry sore throat
  • Aches and pains while lying still; worse when first starting to move but get better with continued motion

    Apis Essentials

  • Stinging sore throat pain
  • Marked swelling of the throat or tonsilsConfirmatory symptoms
  • Throat pain better from cold drinks and worse from warm drinks and external heat
  • Swollen parts of the throat appear as though filled with water
  • Absence of thirst

    Sulphur Essentials

  • Lingering sore throats
  • One or more of the following general symptoms: discomfort from warmth; general lethargy; and offensive breath, sweat, and dischargesConfirmatory symptoms
  • Burning throat pain with dryness of the mucous membranes better from drinking warm liquids
  • Sensation of a lump, splinter, or hair in the throat
  • When a person has a sore throat, Belladonna is the first medicine to think of. During the first twenty-four hours, if the pain has come on suddenly, particularly if it is accompanied by fever and flushed skin, Belladonna is the likely medicine. The throat is very red and may be quite swollen, but little or no pus is evident. The tongue may have a ìstrawberryî appearance as in scarlet fever. Swallowing, especially swallowing liquids, makes the throat pain worse, and the patient may have an aversion to drinking. There may also be a great sense of dryness in the throat.
  • Consider Aconite when sore throat accompanied by and high fever and thirst comes on suddenly (the Belladonna patient is not so thirsty and may be actually averse to liquids). The condition may have begun after exposure to cold or drafts. Aconite ís other characteristic mental symptoms may be present (see the materia medica section).Arsenicum should be considered when the general symptoms of the medicine are evident: chilliness even during fever, thirst, and restlessness combined with fatigue. Most typically, the throat pain is burning in character. Warm drinks relieve the pain, whereas swallowing, cold drinks, or exposure to the cold make it worse.
  • The Rhus tox. person has a painfully sore throat that is made better by warm drinks and warmth in general. The pain in the throat is usually worse in the morning. The pain often begins after straining the throat while speaking or singing or after exposure to cold, wet weather. Sometimes the pain is worst when first swallowing but gets better after repeated swallowing. The Rhus tox. patient is very restless but is less tired and more achy than the Arsenicum patient. He may be anxious, irritable, and weepy.
  • Lycopodium sore throats are typically worse on the right side or begin on the right side and spread to the left. The pain may be relieved by either warm or cold drinks, whereas being in cold air may make it worse. There may be pain extending up into the ears. In general, the illness doesnít begin particularly suddenly, and usually the patient isnít terribly sick. She typically wants fresh air. The symptoms in general, sometimes including the sore throat, may be worse in the late afternoon, between 4 and 8 P.M. in classic cases.
  • When the sore throat is severe and is accompanied by fever and weakness, Mercurius may be indicated. The throat is red and swollen, and pus or other white or yellow material may be seen on the tonsils or walls of the throat. The Mercurius patient can be generally sensitive to both heat and cold. Becoming cold aggravates the throat pain, but a warm bed may also make it worse. Liquids of any temperature arenít known to influence the symptoms particularly. The sore throat tends to be more painful at night. A classic Mercurius sore throat symptom is the tendency to salivate and drool. The pillow may be wet or more frequent swallowing may be noticeable. The tongue often looks or feels swollen or puffy, and at times the teeth make imprints on the tongue. The breath may smell bad. There may be cold symptoms such as thick, greenish or yellow mucus draining from the nose.
  • Hepar sulph. is similar to Mercurius in severity of infection. Pus has formed and the throat and tonsils are very swollen. Often the person says he feels something stuck in his throat like a splinter (Lachesis and Apis may also have this symptom, though less characteristically). The patient is irritable and easily angered. Chilliness is a predominant symptom, and both the general condition and the sore throat are definitely aggravated by exposure to cold. Warm drinks and warmth in general soothe the sore throat. The pain may extend to the ears.
  • Lachesis is particularly useful when the throat pain is worse on the left side or begins there and spreads to the right. Drinking, especially drinking warm liquids, makes the pain worse (sometimes cold drinks bring some relief). Swallowing can be difficult, with solid foods being harder to swallow than liquids. Typically the symptoms are made worse by warmth in general, and the pain is often worse in the morning, especially upon waking, and during the day. The throat is sensitive to touch, and clothing around the neck may cause pain or a choking sensation. A sensation of swelling in the throat is a strong symptom of Lachesis (as well as Hepar, Rhus tox., and Sulphur).
  • When the pain of a sore throat is stinging in character, Apis may be the medicine, particularly if the pain is made better by cold drinks or a cool environment and worse by warm drinks or warmth. The throat, tonsils, and tongue are swollen and characteristically appear as though they were filled with water. Absence of thirst is typical.
  • Phytolacca should be given when there is much aching in the body along with the fever and when the sore throat is worse with warm drinks. The appearance of the throat may be dark red or even purplish or bluish, and the glands are swollen. The pain may shoot up to the ears, particularly during swallowing. People who need Phytolacca tend to have an incessant desire to swallow, despite the fact that it is painful to do so. They are cold and like to be covered, but they still may feel chilly. Their body aches may cause them to be restless, but these pains are worse during motion. One rare but distinctive feature of people who need Phytolacca is an acute pain felt at the base of the tongue when protruded.Sulphur should be considered when a sore throat lingers or when the indicated medicine is not working, as long as some of the Sulphur general and particular symptoms match the personís own. There is much burning pain in the throat, with dryness of the mucous membranes, diminished appetite, and increased thirst. Despite the burning, the pain is better when the patient drinks warm liquids. The pain in the throat can also be stitching, pressing, or cutting. A sensation like a lump, splinter, or hair in the throat may be felt. The general symptoms of Sulphuróparticularly discomfort from warmth, general lethargy, and offensive breath, sweat, and dischargesóare important in determining when to use it.
  • Beyond Home Care
  • Get Medical Care Immediately:
    • if there is a severe sore throat and great difficulty swallowing, or if there is much drooling or difficulty breathing.
  • Get Medical Care Today:
    • if there is swelling of the region around the tonsils to the extent that it is bulging or pushing the uvula to one side;
    • if a sore throat is accompanied by a fever and a red rash that feels like sandpaper;
    • if a child has a significant sore throat, or a sore throat and fever, for more than a day or two. Adults can safely wait a few days longer;
    • if there is white or yellowish material on the tonsils or throat;
    • if a person who previously had rheumatic fever gets a sore throat.