A patient has thick sinusitis with stringy yellow mucus, worsened by beer, aggravated around 1 am, and wandering pains in small spots. Which remedy fits best?

• A. Kali carb
• B. Ledum
• C. Kali bich
• D. Lycopodium

Answer: (C)

The key idea here is matching the mucus character and pain pattern in sinusitis. Kali bichromicum is the classic remedy for thick, ropy, stringy yellow mucus that clings and thickens in the sinuses, with pains that move or wander from spot to spot. The description of thick sinusitis with stringy yellow discharge, plus wandering pains in small areas and a night-time aggravation around 1 am, fits that ropy-mucus picture and the shifting pains seen with Kali bichromicum. The beer aggravation adds a modality often associated with this remedy, supporting the match.

Ledum typically points to a different nasal picture, often with acrid or thinner discharge and a different pain pattern. Kali carb can also produce thick discharge but doesn’t align as well with the distinctive ropy, yellow mucus and wandering small-spot pains. Lycopodium’s sinus symptoms usually accompany digestive signs and have a different distribution and modalities.