Individualized homeopathic treatment and fluoxetine for moderate to severe depression in peri- and postmenopausal women (HOMDEP-MENOP study): A randomized, double-dummy, double-blind, placebo-controlled trial

Positive Research

Authors

Emma del Carmen Macías-Cortés, Lidia Llanes-González, Leopoldo Aguilar-Faisal, Juan Asbun-Bojalil

Journal

PLoS ONE, 2015: doi:10.1371/journal.pone.0118440

Abstract

Background:
Perimenopausal period refers to the interval when women’s menstrual cycles become irregular and is characterized by an increased risk of depression. Use of homeopathy to treat depression is widespread but there is a lack of clinical trials about its efficacy in depression in peri- and postmenopausal women. The aim of this study was to assess efficacy and safety of individualized homeopathic treatment versus placebo and fluoxetine versus placebo in peri- and postmenopausal women with moderate to severe depression.

Methods/Design:
A randomized, placebo-controlled, double-blind, double-dummy, superiority, three-arm trial with a 6 week follow-up study was conducted. The study was performed in a public research hospital in Mexico City in the outpatient service of homeopathy. One hundred thirty-three peri- and postmenopausal women diagnosed with major depression according to DSM-IV (moderate to severe intensity) were included. The outcomes were: change in the mean total score among groups on the 17-item Hamilton Rating Scale for Depression, Beck Depression Inventory and Greene Scale, after 6 weeks of treatment, response and remission rates, and safety. Efficacy data were analyzed in the intention-to-treat population (ANOVA with Bonferroni post-hoc test).

Results:
After a 6-week treatment, homeopathic group was more effective than placebo by 5 points in Hamilton Scale. Response rate was 54.5% and remission rate, 15.9%. There was a significant difference among groups in response rate definition only, but not in remission rate. Fluoxetine-placebo difference was 3.2 points. No differences were observed among groups in the Beck Depression Inventory. Homeopathic group was superior to placebo in Greene Climacteric Scale (8.6 points). Fluoxetine was not different from placebo in Greene Climacteric Scale.

Conclusion:
Homeopathy and fluoxetine are effective and safe antidepressants for climacteric women. Homeopathy and fluoxetine were significantly different from placebo in response definition only. Homeopathy, but not fluoxetine, improves menopausal symptoms scored by Greene Climacteric Scale.

Trial Registration:
ClinicalTrials.gov NCT01635218.

External URL

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118440

Aconitum Napellus

Aconitum caule simplici; Aconitum vulgare
English: Large blue wolfsbane, Monkshood, Aconite, Helmet flower, Friar's cap.
French: Aconit napel, Napel, Aconit.
German: Napel Sturmhut, Eisenhut, Blauer Sturmhut
Italian: Napello
Spanish: Napelo
Dutch: Monnikskap
Danish: Dreumunke
Swedish: Stormbat
Russian: Borets
Natural order: Ranunculaceae
Family: Jussieu [vegetable substance] - Polyandria trigynia, L.
Mode of preparation: The juice of the fresh herb is prepared and mixed with equal parts of alcohol, yielding the mother tincture.

THE ESSENTIAL HOMEOPATHIC FEATURES

In the beginning years of my practice I used Aconite only for acute inflammatory conditions, like everybody else in the homeopathic world, because of the wrong assumption that Aconite was indicated only in acute, febrile conditions. It was only later that I discovered that it was also very useful for what could be called chronic conditions, especially chronic phobic or anxiety states. Since that time we have been using it at the Center of Homeopathic Medicine in Athens quite frequently for such chronic conditions with very good results.

Actually Hahnemann had made a similar observation when he wrote: "Although aconite, on account of the short duration of its action, might seem to be useful only in acute diseases, yet it is an indispensable accessory remedy in even the most obstinate chronic affections, when the system requires a diminution of the so-called tension of the blood-vessels."

The Reactions of Aconite

There are remedies for which the causative factor is of paramount importance in determining their indication; Aconitum is one of them.

The central theme that runs through Aconitum is an excessive excitability in the nervous and vascular systems. These systems can easily be upset by different stimuli. Modern civilization is rife with innumerable stresses — disappointments, grief from loneliness, loss of a lover, child or parent, fears, frights, failure in work or on examinations, financial insecurities, financial ruin, stresses from the weather, chemical and medical stimuli, enviromental pollution, etc. — which, if sufficiently severe, can shock an individual. An Aconitum case will not develop from all of these stresses, only from some specific ones. Aconite, for instance, is well known for producing inflammatory conditions from sudden exposure to cold, dry winds, but it has become increasingly apparent that there is another stimulus, namely sudden fright, that can also produce an Aconite state.

It is, of course, not necessary to have a history of a sudden fright to prescribe Aconite, but, if such a causation exists in the case under study, then this remedy must be seriously considered. The rest of the symptomatology will, of course, affect the final decision.

During Kent's time Aconite individuals were typically vigorous and plethoric, and he vividly describes them as such. Today's typical Aconitum cases have changed to a great extent. Of course, some of them still fit his description. They are usually sympathetic, vital, and extroverted people, yet, despite the apparent robustness of their appearance, they are exquisitely sensitive to a mental shock.

Aconite individuals will not develop their symptomatology when the shock is caused by financial ruin, an exam failure, a grievous love affair, etc. They have a specific vulnerability to sudden stresses that can create a simultaneous overexcitement of both the circulatory and nervous systems. In simpler terms we can say that an Aconite state may develop if the organism is subjected to the shock of "fright" or of "freezing." "Frightful" shocks obviously affect or stimulate the nervous sytem first and, secondarily, the vascular system, while in "freezing" it is the vascular system that is primarily affected, through vessel contraction, and the nervous system that is secondarily affected or excited.

What is important in both cases is that the systems can easily be overexcited. This actually means that the person who develops a constitutional Aconitum state under such specific stresses must have certain inherent predispositions for weakness of the nervous and vascular systems imprinted in his DNA. Not everyone who undergoes similar types of shocks will develop the same symptomatology, and, therefore, not everyone will need the same remedy.

The Reactions of Aconite

It must be understood that when we speak of an Aconite constitution being exposed to "sudden cold winds,'' we are referring to a sensation of being "extremely chilled;" he feels as if he has come very near death and reacts violently. Conversely, if an Aconitum constitution faces the possibility of dying, the experience is a "chilling death experience" for him. It is interesting here to note and understand the underlying mechanism that evokes an Aconitum state, the sudden mobilization of the vascular system — sudden intense constriction or dilatation — as a result of a strong stimulus.

The weakness of Aconitum lies in the easy mobilization of these systems, their predisposition to tumultuous upheaval. Such vascular systems, as Kent observed, are often encountered in plethoric or vigorous individuals; however, as I previously intimated, today's Aconitum patient is far less likely to possess such vigor. His robustness has been compromised by the hazards of modern civilization: poor diet, environmental pollution, constant use of chemical drugs, etc. As the plethoric Aconitum becomes more and more rare, we see fewer of the Aconitum febrile conditions of old, and instead are increasingly confronted with the mental and emotional disturbances characteristic of the newer Aconitum constitution.

Furthermore, we may, in general, say that whenever there is sudden exposure to cold and, at the same time, an immediate, violent inflammatory reaction in any system or organ, we should think of Aconitum. The poison is deadly, the effect immediate and the result violent — such are the characteristics of Aconitum.

The Fear of Imminent Death

The Aconitum picture seems to especially develop after violent events events in which the patient experiences a fear of imminent death; such as, when someone is threatened with a pistol during a robbery.

Automobile accidents and earthquakes are other types of stresses that can especially provoke an Aconitum state. The 1982 earthquake in Athens provided ample example of this observation. There were many Aconitum cases seen after this earthquake whose fears reached panic proportions; these fears were accompanied by trembling, restlessness and exhaustion from the constant anticipation of another earthquake. Aconitum 30C provided quite a bit of relief for these individuals.

Other situations or types of stresses that can induce an Aconitum stare are: entrapment in an elevator, riding on a train through a dark tunnel and suddenly experiencing an electrical blackout (The mere anticipation of such events may be sufficient stimulus.) Informing a patient prior to major surgery that it may end fatally for him, seeing one's child in a precarious position and sensing that death is near. This last causation is illustrated by the following case report.

"A little girl was accidentally wounded by a pistol. Her mother suffered mental shock, paleness and faintness, especially on attempting to sit up; great concern for the result. Relieved after a dose of Aconite." - J.C. Morgan, M.D.

The important element in all of these situations is the sudden fear that death may come to the individual or to his beloved ones at any moment. Aconitum contains this element strongly in its causation. In febrile states this very same idea overwhelms an Aconitum case. The fever is so severe, so sudden that the patient is convinced that he is not going to survive, that he will die soon.

In the acute state, as mentioned, the fear is that "they will suddenly die at any moment." In chronic states the fear is that death is nearing; it is a fear that death will occur within the next few months (up to a year or so). Only seldom will Aconite predict death at a precise moment; such as, "I am going to die when the clock strikes eight." They are absolutely sure that because of their condition they are not going to live very long. They make preparations for death, such as writing their will, etc. If one does not know that this element belongs to Aconitum pathology, one might think that the patient is just being prudent in making such preparations, but in such cases the driving force is the fear of dying, a fear which is not justified by the pathology of the case. This conviction of imminent death has nothing to do with reality and must be taken as a symptom.

The Mental-Emotional Structure

Let us now review Aconitum as it is seen in the patient of today. Because Aconite cases of today so seldom present with the traditional physical inflammatory reactions of old, it is critically important to understand the remedy's inner mental-emotional structure that its current indications might be better recognized.

The shocks in an Aconitum case penetrate the entire body and mind and send the whole organism into a shudder, into extreme trembling with tremendous restlessness, unrelieved by any change of position, and an agonizing fear of death. Phobias, especially of death, that persist for years can result. It produces a fear that death will come on suddenly, when least expected; this phobic state is not constant, but rather one that comes in fits. The fear is most accurately expressed as a "fear of impending death." We witness this kind of picture today in patients suffering from phobic neuroses. From time to time, with or without small provocations, acute states erupt with the above characteristics.

In the provings Aconitum has produced a sudden tumultuous stimulation of the vascular and nervous systems, bringing about fear, heat, flushing, strong palpitations or arrhythmias and eventually coldness - blueness, small pulse and death. Vertigo and, often, one-sided numbness of the face or body can result. The numbness can be severe or can resemble a tingling state; it may affect the whole body. Aconitum patients will suffer from episodic spells of any or all of the above symptoms; that is, the pathology takes the form of separate crises which last from but a few moments to a few hours.

The attacks are not regular, nor are they constant; they come in fits, in sudden acute crises and can come at any time and as a consequence of any stimulus. The most important point is that in almost all cases we see a tremendous fear of death, which sometimes reaches panic proportions, in addition to the feeling that death is imminent. A Physician attending an Aconitum patient in a crisis may hear the patient saying that he has "come too late," that he will "die soon," this being another expression of the presentiment of death. The books say,

“Predicts the time of death”, and while it is not always expressed in exactly these words, the patient's comments will have the same implication. A similar fear of death during pregnancy or during labor can be seen and is a keynote for this remedy. In chronic conditions the patient will not make such specific predictions; he just has a general presentiment that death will come soon and suddenly. For instance, a woman may fear that she will die before she can bring up her children. This is an almost clairvoyant perception; in fact this remedy often has clairvoyant experiences and in particular clairvoyant dreams.

The Complaining, Reproaching and Wailing

Aconite patients have a disposition to weep; they moan, and complain bitterly, with fears, despair, and loud whining. Here are a few examples: He has a feeling as if something is kicking in his heart and an overwhelming fear arises. In this state he does not want to do anything, and, if forced to do it, he will have the tendency to break the things he is handling. Any kind of outside pressure gives him the impression that he is going to have a brain stroke or heart attack.

In the past she loved her family, children, husband, etc., but now she avoids them because they irritate her and she cannot tolerate any contradiction from them. Anything that the husband does is wrong. She does not know why she is behaving like this, but she cannot avoid it. She tries to suppress her anger, but she feels such rage inside that she wants to kill somebody. Although she loves her husband, she wants to kill him.

The Plethora

Here it should be noted that Aconitum patients have a desire to be the first in whatever they are doing; it is difficult to suppress this inclination. If they do try to suppress it, a boastful attitude usually results. A similar result - appearence of another deeper disturbance - applies when discharges are suppressed. The suppression of anger can also have adverse consequences. Also, if any of their desires are not appeased immediately, they fall to pieces. Great impatience is characteristic of the remedy; time seems to pass too slowly while waiting.

The Anxiety Attacks

Picturing an Aconitum individual with the intense fears, pounding tachycardias, arrhythmias, or other intense symptoms, one might expect to see a plethoric and intensely communicative patient in the consulting room, but this is not the case. When he is not in a crisis situation, he will be calm and quiet. He will appear fairly normal. Even his descriptions of the crises will not be very intense. However when the crisis comes, the violent intensity, panic, and fear surface to an unbelievable degree.

These sudden attacks of anxiety are of such an intensity and so overwhelming that they normally cannot be controlled at all. They are like a storm coming on, a storm which overcomes the psyche and produces a terrible state of panic-stricken fear. But despite their anxiety these patients will still try to control their fears, and if their efforts are successful a kind of internal trembling and shaking occurs sometimes, invisible to others. In this situation, even during the crisis, it is not necessary to see the patient restlessly running around or tossing about - it may be enough to perceive the sense of agony and despair exuding from such patients to prescribe this remedy.

Chronic Aconitum conditions are typified by intense exacerbations interspersed with completely normal intervals. It is as if Aconitum cannot go on having attacks all the time because the attacks are too strong, too terrifying for the patient to survive a constant onslaught.

The anxiety state of Aconitum can be reflected in many symptoms/syndromes. Here are some examples:

Flickering before vision makes him anxious on the street, he thinks he constantly jostles the passers by.

He needs to press his heart and at the same time breathe deeply because he is afraid his heart will explode.

Inconsolable anxiety, sad wailing; peevish and impatient.

Anxiety is transiently ameliorated by drinking cold water; followed by apathy; with cold sweat.

Anxiety as though a great misfortune would happen to him. Increased anxiety, followed by total apathy.

Anxiety which does not allow him to remain in one place, he must constantly walk about.

Anxiety and peevishness,with fine stitches in the side of the chest, then palpitation at the pit of the stomach, and pressive headache. Inconsolable anxiety and piteous howlings, with complaints and reproaches about unimportant matters.

Pitiful anxious complaints, with fears, despair, loud wailing, weeping, and bitter reproaches.

He cannot banish anxious apprehensive thoughts, even in gay company

Suddenly, as he is walking or sitting, a sudden feeling of faintness and intense weakness overtakes him that may last for one or two days.

The Sadness and Indifference

Aconitum can show a completely different picture which is far less known than the anxiety and restlessness. Many homeopaths would never think of Aconitum when they see a person who is very sad or apathetic and indifferent to everything.

In this particular state of mind he whines and howls piteously and weeps without cause. Music is unbearable to him because it makes him sadder. He desires to be left alone, shuns other people, does not want to talk and if someone asks a question he answers only with a yes or no. It is as if he has lost all affection for anybody and he becomes indifferent to his relations, friends and persons he normally loves. He sits buried in thought. He may even think about committing suicide by jumping from a high place or from a train.

This state of mind appears sometimes after a long period with very severe anxiety attacks. It seems to be a kind of reaction, as if he could not endure his panic anxiety any longer and therefore found an escape in a state of emotional indifference or a suicidal mood.

Here it is important to note the polarity that appears quite often in Aconitum cases. Most patients have fear of death and agonising restlessness, but a few will manifest the opposite extreme and actually desire death. Sometimes the two states alternate. A similar opposition can be seen in fevers. In such instances rather than the usual restlessness and fear that accompany high temperatures, we witness indifference, exhaustion and sleepiness or a stupid, groggy feeling.

All of the above symptoms do not necessarily have to be seen in one individual for him to be given Aconitum. Some people will have fear of death, vertigo, fear of fainting, and tachycardia; others may have trembling, arrhythmia, perspiration, unilateral numbness (e.g. numbness of half of the face,) etc.

Another group of patients may experience a type of extreme psychogenic dyspnea, similar to that of Lobelia but more intense, which causes them to inspire deeply, loudly and with great anxiety. We may also see flushes of heat involving parts of the body, especially the head. There are also allergic eruptions surfacing after flushes of heat. The time of aggravation in general is during the night, especially from midnight to 4 A.M. There is generally an aggravation from sudden changes of temperature. Once the chronic state of Aconitum has become established, the acute exacerbations or crises can be precipitated from either sudden dry cold, dry heat, overheating, or warm rooms.

The Sympathetic Element

These patients are very sympathetic. They need company and are usually extroverted, but they do not like consolation. They express their feelings easily. The sympathetic element leads to a state of anxiety about others. They are very concerned about their relatives and friends, and they react exaggeratedly when something happens to someone about whom they care. They erupt emotionally when they hear news of something bad happening to a friend. The reaction is out of proportion to the significance of the event. Because of that element, Aconitum patients do not like to hear bad news. One should not be misled into prescribing Aconitum simply because a patient has such a symptom. The whole picture must be seen to justify the prescription of this remedy — the intense crises with panic, fear of death, tachycardia, perspiration, etc. Prescribing solely on a symptom such as "anxiety about others" is an example of "one-dimensional" prescribing which is not only misleading but erroneous. Even if only one symptom exists upon which to prescribe, it must be viewed in a three-dimensional context if there is to be any hope for success in keynote prescribing. To glean an impression of what is meant by three-dimensional prescribing let us consider the differential diagnosis of one symptom — anxiety about others — and the corresponding remedies:

The Aconitum sympathy is reactive. It consists of an emotional eruption or explosion; such as, " Oh, my God! What shall we do!" Such reaction arises especially when the patient is suddenly faced with a severe health problem or, even worse, an accident concerning one of his relatives. Aconitum is especially afraid of accidents and consequently over-reacts when hearing of one. The anxiety about others is very intense and disproportionate to the reality of the situation. Stoicism is not Aconitum's long suit; his reactions are immediate and exaggerated.

Sulphur will not show such anxiety. He will worry only in special situations. Sulphur is anxious about his children. It is very seldom that he worries about anybody else, being in essence quite self-centered. If his child is late coming home, he starts to worry. He will be unable to sleep, will walk up and down imagining that the child has had an accident or some other mishap. When his son or daughter drives into the driveway, all of his concerns evaporate and he goes back to sleep.

Phosphorus will have a completely different kind of anxiety. He shows great affection and concern for everybody, even recent acquaintances. He becomes especially concerned and attentive if he hears of their having a health problem. His involvement is genuine, his sympathy for them great. Phosphorus does not display the imaginative worry that Sulphur does; he suffers only when he actually encounters a situation in which another person is suffering, and then he empathizes intensely.

A Phosphorus mother has to get up in the night to see whether her little baby is breathing, or is alive. A Phosphorus patient who is confined to the hospital will not be able to tolerate the pain of his roommate; he will persistently ask the nurse to do something to alleviate his pain. The same is true in Causticum, because of the extreme sympathy towards the pain of others that the two remedies have.

Arsenicum is also anxious about others. In this case it is an inner anxiety. The objects of his anxiety are those who are close to him— father, mother, brother, etc. These people provide him with a sense of security; thus, he himself feels threatened when they are not well. It is a self-motivated anxiety for others; he wants them to be well so that they can help him.

Baryta carbonica has a sweet concern about the people who are looking after her. She is very concerned that something may happen to them though she feels completely inadequate in doing anything about the situation. Baryta carbonica will display a lot of silent sympathetic concern which others can feel, but underneath there is a terror that something may happen to the individuals that take care of them or protect them. This is a genuine concern but one arising from a feeling of insecurity, inferiority and helplessness. They fear that they will be left completely unprotected, unable to fend for themselves if something happens to their protector. They resist even thinking of such a possibility.

Cocculus has a passive anxiety about others — a type of anxiety that makes him stay in the hospital the whole night, attending one of his relatives and not sleeping for an instant. His anxiety that this relative may die is so great that he does not allow himself to relax. Cocculus does not think; instead he acts almost instinctively when one of those he loves is in danger. He seems not to feel the tiredness while in the grip of his anxiety for others and their welfare. His anxiety, though, is limited to those he loves.

Causticum has a more general anxiety or rather compassion about others, that is so great that he suffers when he hears or he even reads that others are suffering, or are under a kind of suppression by authorities or injustice. It is enough for him to read in a newspaper or to see in television that people, even in a foreign country, are starving and he is affected so deeply that he has to weep and he gets extremely excited.

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Aloe Vera

Aloe vera, Barbadensis vel Socotrina, Aloe Soccotrina N.O. Liliaceae Family: Jussieu [vegetable substance] - Hexandria monogynia, L. Mode of preparation: A tincture is made from the fiery red gum of the plant by trituration.

THE ESSENTIAL FEATURES
This is a remedy that primarily affects the digestive system and more especially the end of the large intestines. Its tendency is to produce an engouement of the veins causing fullness throughout the body, but more especially in the liver region, an abdominal, rectal and intestinal fullness. The main pathology in which you will find Aloe to be indicated is spastic or ulcerative colitis.

I have found, however, that the great characteristic of this remedy is a preoccupation that the patient has with his pathology, that is to say with the whole cycle - eating to excreting. Aloe is easily disturbed by the intake of food, its digestion and its expulsion.

If you should have such a case, and treat it for a long time before recognising it, you will find that the patient takes on a hypochondriacal attitude towards his "stool" and the disturbances that accompany it. The patient may complain constantly about being unable to have a normal stool, and though there may be several stools a day he remains unsatified.

Actually Aloe can produce a state where the intestines work intensely, as if inflamed for a few days, where the patient may have several stools a day, and then for a certain period of time there may be total inactivity. Stool is not diarrhoic, but soft, unformed and can come several times in the morning, for several days, and this in a crescendo, e.g. three times the first day, four times the second, five times the fourth etc. This can then be followed by an obstinate constipation for two or three weeks, during which there may be no stool, or very little, passed with great difficulty.

Together with this or a similar situation the patient may feel an uncertainty concerning the rectum. He may often pass some flatus, and accompanying this, or instead of it, a little bit of a soft stool. The patient knows this and tries to control it, but there is excessive flatus in the abdomen and a lot of rumbling and gushing; much gas is evacuated with stool, but he gets little relief and you will tend to prescribe Podo. or Lyc. with little or no effect.

This syndrome seems to annoy the patient tremendously. He may become angry against his disease and almost constantly preoccupied with his stool. Why can't I have a normal stool? Where is this condition going? Am I going to have a normal stool or not? Today I did not have any stool, and so on and so forth. He is so preocccupied with it that he will give you the impression that he is very anxious about his health. If you ask him directly whether he is afraid of having cancer he will deny it but he will accept that this whole situation annoys him tremendously and makes him somewhat anxious.

There seems to be a disturbing feeling originating from the rectum; this may be due to a number of causes, namely: an intense itching deep in the rectum, a sense of fullness as from the presence of stools that cannot come out, deep pain from hemorrhoids, the fact of having mucus in the stool, or some involuntary discharge of stool or mucus. Whatever the cause, the result is always the same: tremendous annoyance that leads the patient to despair, and sometimes leads him to put his finger right into his rectum to relieve the itching or whatever other feeling may be there.

Your final observation will be that "his stool and his rectum" preoccupy his mind so much that he cannot think of anything else; this at least is the impression that he will give you.

A grand keynote of Aloe that can always guide you to this remedy is the lack of control he has over the sphincters of the anus in both acute and chronic conditions. Kent describes this beautifully for the acute state: "Dysenteric and diarrhoic troubles. In the attack of diarrhea there is gushing of thin, yellow, offensive excoriating faeces, which burn like fire, and the anus is sore. He holds the stool with difficulty, does not dare take his mind off the sphincter because as soon as he does so the stool will escape. He cannot let the least quantity of flatus escape, because with it there will be a rush of faeces. With the Aloe diarrhea the abdomen is distended with gas, causing a feeling of fullness and tightness, and he must go often to stool.

Little ones soon after they begin to walk, will drop all over the carpet, involuntarily, little yellow drops of mucus and faeces,..There is a lack of control of the sphincter. This state is not always confined to diarrhea because sometimes children will go around dropping involuntarily little hard, round, marble-like pieces of stool. They do not even know the stool has passed... "

I had a case of chronic spastic colitis with a lot of rumbling and flatus and distension, with little pain in the abdomen and an amelioration in the evening and I prescribed Lycopodium in different potencies with very little effect, then I gave Gambogia and Podophyllum and waited but no effect. I took the case again and again until I learned, out of a direct question, that sometimes the patient would have a little involuntary stool thinking that it was flatus; she confessed further that at least three times during the last few years she had had an involuntary stool during sleep that passed out unnoticed, a complete evacuation. She was too shy to tell me all that from the very beginning, and did not think that it was that important as it happened infrequently. Aloe brought about a relief not only of the spastic colitis but of her mental state as well.

Looking upon the case in this way we notice the great annoyance which the patient suffers from the stool and rectum. The patient becomes irritable and hateful, dissatisfied, discontented and his conduct repels others. The Aloe case may become cross and peevish, without any reason, but especially in cloudy weather. Dissatisfied and angry about himself. In the text it says loathing of life during pain, irritability during pain. All this seems to be connected with the functioning of the digestive cycle.

Sometimes the patient may become particularly angry if somebody expresses a different opinion; he then has to restrain himself not to hit the other person, not to be violent. All this turmoil upsets him enormously however, and he starts having pains in the abdomen, and more distention and more flatulence and more irritability. He knows that by becoming so angry inside he will have to suffer.

Aloe appears to be a rather calm and stoic individual in spite of such inner irritations. To others he looks calm and serene and takes up a rather philosophical attitude. He looks content. Aloe individuals appear to be phlegmatic and indolent. Underneath there is actually a state of indifference. Indeed I have often found a state of resignation from life, an attitude such as: "I know there is no hope. I will die soon, but it does not matter really". A loathing of life is apparent, where it seems as though he were not interested in continuing to live, though the pathology does not at all justify such an attitude. In the books we read: "Tranquility, serenity, reconciled to fate." Further on we read: "predicts the time of death", but this symptom, if you should find it, is only expressed in this way in the acute states.

There is a strong fear on seeing blood which may cause Aloe to faint, also fears of doctors, of hospitals, of being alone and of high places.

Aloe people seem to be rather closed up and do not establish deep relationships.

The Aloe organism is one that goes up and down easily, and has alternating states. For instance he can be excited easily, the face becoming flushed, heated up, the mind racing with thoughts crowding each other, and then a change can take place leading him to a state of lassitude and indifference. The mind can be very active for a certain time, followed by periods of exhaustion and indolence with an aversion to mental work. Mental exertion makes him feel worse.

This kind of functioning of the mind, for instance discontent in the morning followed by contentedness in the evening, is similar to the one we see in rectum: a lot of successive stools and then a period of constipation. In remedies we must try to see patterns rather than symptoms; be aware, however, and make sure you see the real ones and not imaginary ones. Once you understand the pattern you can recognise it with greater ease in a case than a keynote which can often be misleading.

A usual time of aggravation for Aloe is undoubtedly the time after eating. Immediately after eating his mood changes, he wants to be by himself, wants to remain silent, immersed in his own thoughts. Many times he becomes anxious or indifferent. He may have fainting spells, vertigo or headache. A similar condition will appear in case of abnormal or inefficient stool.

What is important for you to remember is that his mood changes once the process of digestion starts and will not stop until it is finished.

Of course this is an exaggeration, but the underlying idea, the pattern, is correct.

It is an organism that labours under the effort of processing food and expelling the waste. It is aggravated with irritability before stool, or if the stool is insufficient, but we do not see the real amelioration after stool characteristic of Natr-s., or Calc-carb. On the contrary we see a general weakness, a faintness after stool, and in severe acute cases Aloe may fall into unconsciousness during stool.

The time of amelioration of this remedy is in the evening, the anxiety, the irritability, the discontent, the sadness are all better in the evening.

Generalities
Suitable for obese people with sedentary habits, of a lymphatic or hypochondriacal temperament. Phlegmatic, indolent.

We must stress also the portal congestion, the portal stasis and the propensity of this remedy to manifest haemorrhoids which protrude like "a bunch of grapes".

Weakness with perspiration; entering a warm room; after vomiting; from sour food. Fainting after diarrhea, also after stool. Desire for cold air. Sensation of congestion and fullness all over the surface of the body. There is orgasm of blood with anxiety and restlessness. Sensation of a plug internally.

Aggravations: There is a general aggravation from heat; after eating; from oysters; in warm season; in a warm room; in the morning at 5 or 6 a.m. Aggravation of colitis symptoms with beans and peas.

Amelioration in cool open air, with cold applications, passing flatus, after tea. Needs stimulants

Aloe has a reputation for clearing a case after a lot of medication. I have not been able to understand this reputation or to justify it.

Vertigo – Head
There is a peculiar vertigo as if elevated higher than he actually is, as if he is sitting in a very high chair, which is felt mostly after meals.
Vertigo while reading; after fright; from stooping; rising from a seat; after congestion; from sun; from suppression of menses; from concussion.
A child during teething turns suddenly red and falls unconscious.
Head congestion due to venous stasis. He has to sit up. The head feels hot and he wants something cool on it.
Burning headache as of brain agitated by boiling water.
Hyperemia of the head during stool. Pain in the head before stool. Headache from insufficient stool.
Dull headache across the forehead with heaviness in eyes and nausea.
Headaches are aggravated by heat and ameliorated from cold applications.
Headaches before and after menses, ceases during menses.
Sensation as if air is passing through the head. Sensation as if the head is enlarged.
Pain in the temples extending to eyes.

A great peculiarity of this remedy is the alternation of symptoms of the head with different other symptoms.

Head symptoms alternating with abdominal or uterine symptoms or with backpain, lumbago. Headache alternating with hemorrhoids. Dandruff.

Eye
Congestion of eyes. Lacrimation.
Closes the eyes partially from pain in the forehead.
Twitching of eyelids during day time, more of the left. Pain deep in the orbits.
Flickering before the eyes. Colours before the eyes; yellow rings moving in front of the eyes.
Dim vision while writing. Scotoma.

Ear
There is a peculiar sensitivity towards sounds, mostly musical, which can make her tremble. She hates it (in hysteria).
On pressing the teeth together a sensation of numbness behind the ears.
Tearing pain in left and then in right ear.
Noises and pain in ear while chewing. Cracking noise while moving the jaw.

Nose
Coldness of the tip of nose.
Redness of nose in the cold open air while the rest of the face is not red. Bleeding after waking.
Dryness of the nose.
Burning pain during coryza.

Face
Heat of the face during excitement and during headache.
Lips dry and cracked. Dry and scaly, continuously licks them with the tongue.
Lips red, cracked and bleeding.

Mouth
Yellow white discoloration of tongue.
Sensation of coldness of the left side of the tongue.
Sore spots inside cheeks. Difficult to protrude the tongue, causes pain. Yellow ulcers in the mouth and tongue.
Taste like ink or iron in the mouth. Metallic taste.
Tongue and mouth dry.
Accumulation of saliva in the mouth.
Sensation as if the palate was swollen.

Throat
Thick lumps of jelly like mucus in the throat which come out easily early after rising.
Rough, as if burnt.
Pain in the throat as if soft palate and uvula were swollen.

Stomach
In the stomach in general we observe an immediate association between the appetite and eating and the functions of digestion. There is definitely an inbalance which appears in different ways like :
Increased appetite in the evening, also in the morning after stool.
While having diarrhea the appetite is increased.
After eating there is pulsation and sexual irritation.
Hungry after stool. Empty feeling in stomach after stool. Indigestion.
The stomach is disordered from beer and from wrong diet.
Desires juicy things, fruits, especially apples; salty things. Aversion to meat or desire for meat.
Thirsty during eating. Thirsty after supper.
Bitter eructations and pains after drinking water. Pains after breakfast.
Eructations ameliorate a feeling of heaviness in the stomach.
Sour things disagree with him, cause indigestion and a general feeling of weakness.
Pain in the pit of stomach from a mis-step.
Hematemesis.
The stomach pains are worse from jar and motion and usually extend upwards towards the chest and throat.
Vomiting of thick mucus on going to stool, or after drinking water.
Distension of epigastrium and both hypochondria.
Fullness in epigastrium with great desire for stimulants.

Abdomen

In the abdomen we see a lot of characteristic symptoms as this is the area of special action of this remedy. The fullness, the distension, the dragging down sensations prevail.

There is fullness due to portal stasis, irritation of the mucous membranes of the intestines with a lot of mucous discharge and weakness of the muscular structure especially of the sphincters of the anus.

The abdomen feels full and bloated with gurglings before stool. There is heaviness in lower abdomen with dragging down sensation. Prolapse of rectum.

Distress and a kind of anxiety felt in the abdomen before stool.

The pains in abdomen tend to extend to different directions. It is one of very few remedies that have this tendency.

Pain in the hypochondria extends to the chest. Pain extends from the inguinal region down to the legs and knee.

Pressing pain from the sides extends to the navel.

Pain from the umbilucus or the lower abdomen extends downwards, to the anus. The peculiar thing is that this pain will appear immediately after the stool or in the effort to have an unsatisfactory stool. The pain is better lying on abdomen or bending forwards.

Dull pain, uneasiness, tension in the liver region, worse when standing, has to bend forwards.

Discharge of flatus relieves pain in the abdomen. Sensation of pulsation during night in bed.

Constant rumbling in abdomen, with a feeling as if they must have a stool, but no evacuation following (in cases of severe gastroenteritis).

Rectum
Sense of insecurity in the rectum, he is not sure whether stool or flatus will pass.
Stool escapes with the flatus or even during urination. It seems that the least pressure on the sphincters will make them give in. Before stool, much rumbling in the bowels, accompanied by the escape of large volume of wind.
Involuntary stool during sleep, after eating, during urination, on walking. The stool is formed and can also be hard.
Stool passes unnoticed in little children.
Has to rush to the toilet otherwise feels that he will loose stool
Sensation of paralysis in the rectum.
Sensation of a plug between the pubis and the coccyx with urging to stool.
Bowel motion every time he moves around.
Anus feels weak, mucus oozes out, soils the underpants and irritates the patient tremendously.
Hemorrhoids that protrude like a bunch of grapes.
Diarrhea: after eating unripe fruits, oysters; from been overheated; before menses; from vexation
Diarrhea early in the morning about 5 or 6 am, driving him out of bed.
The diarrhea is better when lying on his abdomen and worse when standing and worse walking
Diarrhea alternates with constipation.
Constipation of old people. Constant desire without effect. Can pass a stool only when urinating.

Intolerant itching in rectum, ameliorated by cold bathing, has to stick in his finger to ameliorate the distress.
Stool burning excoriates rectum
Pain in the rectum extends to abdomen.
Burning pain in the rectum after flatus. The burning is ameliorated by cold bathing.
Cutting pain after stool.
Pulsation in rectum while sitting.
Sudden urging for stool on passing flatus; after eating; on rising; while standing; all symptoms pointing out again the basic weakness of the rectum.
- Stool: cream colored,
- Stool: first hard and then soft
- Stool: hot, burning excoriating the rectum
- Stool: lumpy and liquid
- Stool: sputtering
- Stool: watery, bloody, yellowish-greenish.

Urinary Organs
Involuntary urination in the aged, bearing down sensation and enlargement of the prostate gland. Dribbling with enlarged prostate.
On passing urine feels that stool will escape.
Frequent urging with burning during urination.
Urination retarded, must wait for urine to start.
Sediment bran-like, granular.
Urine copious, offensive, putrid.

Male – genitalia

In the male we see either impotency with coldness of the scrotum and indifference, no desire at all, or easy excitement especially after the urethra has been stimulated with urination or involuntary emissions.

Penis shrunk, atrophied, testicles cold. Impotency. There is neither desire nor erections. They can be easily disappointed from their own performance in sex, they feel they cannot satisfy the partner, which makes them lose their desire and potency. In general the libido is not strong. Erections in children.

Involuntary emissions during sleep at night, in the morning and during siesta, followed by sexual excitement and erections.

Sexual irritability, erections without desire after eating. Sexual excitement after urinating.
Seminal emissions from slight fright, from noises.
Affections of the prostate gland.

Female – genitalia
The desire for sex is less than normal and the pleasure is local.
Fullness and heaviness felt in the uterus, feeling of congestion worse when standing.
Labour-like pains extending to the rectum or to thighs.
Menses early and profuse. Menses can easily be suppressed if she takes a cold bath, even washing herself locally the menses may stop.
Leucorrhea of bloody mucus preceded by abdominal colic.
Cold feet during menses.

Chest
Hoarseness of voice on waking in the morning.
Tightness of chest, congestion. Bronchitis.
Cough which is better on lying on abdomen and worse standing.
Cough worse in the act of rising from a sitting position.
Winter cough with tickling.
Respiration difficult, impeded because of stitches on the left side of the chest.
Pain in chest from rising after stooping. Pain on the sides of chest on bending forwards.
Pain in the heart extending to back. Pain on deep inspiration.

Back
Pain in lumbar region alternating with headaches or hemorrhoids.
Pain in back on beginning of menses.
Pain from lumbar region extending to rectum.
Pain in sacral region worse sitting and better moving about.

Extremities
Coldness and numbness of the extremities are very prominent symptoms in this remedy.
Cold hands alternating with cold feet. Cold hands with hot feet. Warm feet with coldness of the rest of the body.
Pains of the extremities of all kinds. Pains as if bruised, dislocated.
Drawing pains in the joints.
Soles painful walking on a hard surface.
Feet burning during fever, uncovers them.

Sleep
Sleep is easily disturbed by joyful news, from coldness of hands or feet, after midnight until 5 a.m.
Wakes early at 5 or 6 a.m. with urging to stool.
Sleeplessness from itching of the anus
Dreams amorous; of stool, excrements, that he is soiling himself; of becoming insane. Dreams of monsters.

Fever
Heat in spots.
Succession of stages, heat and then sweat and then heat again.

Skin
Eruptions mostly in winter.
Spots that once scratched become painful and sensitive. Heat of the surface of the body.

CLINICAL
Affection of anus. Constipation alternating with diarrhea. Gastroenteritis. Cholera. Dysentery. Hemorrhoids. Proctitis. Prolapsus uteri, anus. Affections of prostate. Lumbago. Pain in sacrum.

CAUSATION
Sedentary habits.

RELATIONSHIPS
It is related to: Aescullus, Podoph., Sepia It is complementary to: Sulphur Remedies that follow well: Kali bichromicum, Sepia, Sulphur and Sulphurosum acidum

ANTIDOTES
It is antidoted by: Sulphur, Mustard, Camphor, Lycopodium and Nux vomica.

DOSAGE
From 3x to the CM.

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Anacarduium

Anacarduium orientale
Semecarpus anacardium
English: Marking-nut tree, Malacca bean
French: Anacarde, Anacardien, Anacarde a feuilles longues, Feve de Malac
German: Elephantenlaus, Malakka-nuss, Elephantem Laeusebaum, Anakardiem baum
Italian: Anacardos
Spanish: Anacard
Dutch: Anacardienboom, Hartjes
Bengal: Belaluhi
Natural order: Terebinthinaceae.
Family Jussieu [vegetable substance] - Pentandria digynia, L.
The name is derived from two Greek words, “ana” - without, and “cardium” - a heart, because the pulp of the fruit, instead of having the seed enclosed, has the nut growing out at the end of it. There was a discrepancy as to whether Anacardium was the nut of the Semecarpus anacardium, or the Marking-nut Tree, or the seed of the Avicenna tomentosa, or Malacca bean, but as Hahnemann described the nut, it leaves no doubt that he was talking about the Semecarpus anacardium.

THE ESSENTIAL FEATURES
The concept of inner conflict or of mental schism is central to Anacardium. There is a rather specific dimension to the conflict; that is, it focuses on the desire of the individual to prove himself to others of importance to him and to the world. The conflict arises because, despite this determined will to prove himself, the person suffers from a profound inferiority complex.

The Inner Conflict
Anacardium is reluctant to admit his feelings of inadequacy, and he attempts to subjugate his lack of confidence with his will to succeed. The stress provoked by this effort creates an extremely painful conflict, a conflict resulting in great suffering for the affected individual. For example, a man is treated somewhat badly by his superior at work. He suffers hurt feelings as a consequence and begins to feel ill at ease while on the job. As the conflict with the superior continues, it eventually assumes the character of an internal conflict in which the employee feels torn between quitting his job and remaining in order to prove his worth. While his rational mind dictates that he leave, another part implores him, "No. You must not leave. You will stay, suffer if need be, and prove that your superior is wrong. You are really capable, really good. You can prove yourself!" Such a conflict can persist for a very long time with dire consequences for the health of the individual.

Another characteristic example: a husband is at times prone to criticize his wife; he treats her a bit badly or unjustly. This maltreatment is magnified enormously within an Anacardium individual. She readily adopts deep feelings of inferiority, but at the same time she decides to prove herself. She embarks upon a program of self-improvement. She begins attending seminars, studying, etc. However, to the Anacardium patient, her husband will continue to seem to constantly belittle her. Subsequently she is disheartened and an inner conflict arises. She tells herself, "I must leave him. I must separate from him and get a divorce. I'm going mad; this situation is intolerable." But at the same time she cannot leave; she continues to want to prove herself, to eradicate her sense of inadequacy. She continues in this conflicted state without any peace of mind until she finally has a nervous breakdown, goes into a depressed state, and eventually wants to commit suicide by shooting herself or jumping from a high place.

The Feeling of Inferiority/The Lack of Self-Confidence
Together with the feeling of inferiority, there is a great lack of self-confidence. This is expressed in different ways. A student knows that he has studied his subject well and that he knows it, yet the thought comes that he will fail in his examinations. The anxiety that develops is so great that he actually fails his examinations. His mind is blocked and there is almost a hysterical reaction with flushes of heat, an upset stomach, heaviness in the whole head, etc. He knows that he is worthy, and, after speaking with his teachers or parents, for a moment he is further persuaded that he is worthy, but after a while the thoughts return and torment him. A feeling of cowardice develops.

In another example one may see a doctor, a microbiologist, who has a responsible post in a hospital and in whom everybody places a lot of trust, yet every morning on going to the hospital he has the thought that he is not capable of this position, that he will make a mistake and that he will be ridiculed by his colleagues. He goes to the hospital expecting that at any moment he will make a mistake, and, when in this state, his mental clarity sometimes does suffer lapses, causing him to make mistakes, thus confirming and strengthening his belief. Eventually his life becomes unbearable; he withdraws from others, broods, becomes morose and depressed. The interesting thing is that he may say that he logically knows that he is capable and that he knows his subject well, but thoughts centering on his lack of self-confidence persist and overwhelm him.

The student of homeopathy has to understand that in the above case the pathology is so deep and painful for the individual that everything else is of minor importance. It is the intensity of this symptom and this symptom alone that will lead us to prescribe Anacardium, ignoring all other symptoms. In such cases one may see no aggression or cruelty; the organism is occupied solely with this pathology on a very deep level.

The lack of self-confidence can be expressed in different ways in different stages of the pathology of Anacardium when this is not the main symptom. These patients will not say, "I have a lack of self-confidence," but will provide statements which are indicative of an underlying insecurity or inferiority complex. Some such expressions might be:

Very timid; she felt that everyone was looking at her when she walked in the street.
"I cannot express myself."
She feels secure in her own home, but when alone in her room, she fears that someone will enter and kill her. She fears cars in the street.
He does not want to communicate with new acquaintances, having an inimical attitude towards everyone.
As stated previously, Anacardium is the most prominent remedy for lack of self-confidence, the other major remedy being Baryta carbonica. Here it is important to comment that the symptom which is depicted with the highest degree in the Repertory does not always have to be depicted to such a degree in the individual. In both of these remedies an inferiority complex will be apparent; on comparison, however, they are completely different. Baryta carbonica will manifest an inferiority complex from the very beginning of life, childhood, to the end of life. Baryta carbonica does not want to become a grown-up with responsibilities; she feels that it is too much for her and wants to remain protected, like a child. She feels that she cannot undertake and accomplish anything. Baryta carbonica very frequently corresponds to those elderly people who simultaneously lose their mental powers and their self-confidence. Baryta carbonica is also very soft, timid, and very irresolute. Anacardium also has great irresolution, but these people are not soft; they are hard people. There is a hardness inside them which prevents their yielding to their suffering, prevents their giving in to the urge to escape a conflict-ridden situation. They will tell of tremendous suffering; e.g., that their husband hits them or curses at them, etc., but they will endure it with the intention of proving themselves. Their inferiority complex prevents them from seeking a better situation, from establishing a new relationship, new job, etc.. Anacardium persons want to prove themselves. One can see a somewhat similar dynamic when observing Anacardium persons arguing. They are prone to foolishly prolong a losing argument despite their obviously weak, uninformed position. This kernel of hardness expands with time to affect the entire organism. These people become increasingly hard in order to cope with their life circumstances. To others they appear strong, uncompromising, unyielding and hard. Eventually the hardness can reach the point of cruelty.

The Misanthropic Tendency
When in this weak state in which they completely lack confidence, they have no feelings of love or warmth. They feel isolated and unprotected and may need somebody to be with them all the time for support, yet at the same time they have an aversion to being with people, especially strangers: aversion to company. Anacardium individuals can become real misanthropes, with a fear of associating with others. Eventually they will reach a stage of paranoia where they suspect everybody and feel that they are being followed, pursued by others who want to do them harm.

The Hardness and Cruelty
Anacardium is also one of the first remedies to consider for cruelty. These people can be extremely cruel to both people and animals. They are capable of torturing animals and can be indifferent to the torture of humans; they may even enjoy seeing others suffer violence. It is as if they are devoid of all ethical feelings of morality. Of course, there is a spectrum of degrees of hardness in Anacardium that ranges all the way up to people who are capable of inflicting torture; not all Anacardium patients manifest cruelty, but the element of hardness is quite common.

Most of these people possess a deep feeling of inferiority and inadequacy that they are unable to escape. Such a sense of inferiority may be appeased by the feeling of power that can be bestowed upon one by an authority; for this reason, one might expect that many of the cruel and sadistic interrogators working for repressive political regimes may be sick people needing Anacardium as their constitutional remedy. Working in such a capacity, their urge to subjugate others and to torture can be fully satisfied. They are deprived people without morals, but with malice, who suddenly find an outlet to express their maliciousness. It is a perverted state. It is intriguing that during the interview these people do not appear capable of cruelty; they seem soft and nice. One might even be inclined to confuse them with Staphysagria during the first interview. However, when they are given authority by another, the cruelty can emerge. Again, the violence of Anacardium dwells in the interior of these people; externally they appear quite placid. Sometimes the hardness gives way to a complete lack of self-confidence, and a person who was considered strong, hard or even cruel completely loses these characteristics and becomes a "little nothing," with no confidence at all and a desire for encouragement and approval at all times.

The Double Will
There are stages in the development of the Anacardium image. All of the symptomatology of this remedy is not apparent from the outset. For instance, the familiar personified double wills of Anacardium - an angel sitting on his right shoulder telling the patient to do one thing and a demon on the other telling him to do exactly the opposite - arise only in the late stages of pathology, especially with the begining of schizophrenia. It is an hallucination. This familiar theme, expressed in the above manner, which appears in the texts will not be encountered in the vast majority of Anacardium patients. The conflict will instead more often manifest itself in different ways and to varying degrees with such expressions as:

"I hate my sister and I love her at the same time." "I am two persons; one criticizes people and the other justifies them." "There is a conflict inside me between the love I have and the feelings of hate that were left inside me after a certain period in my life." She fears that she might hurt herself or others, something that she does not want. "I have become wild. I cannot tolerate anything. I swear badly over trite things, or say very bitter things that hurt others quite deeply." In a quarrel she had with her brother she wanted to harm him. She grasped a knife to throw at him, but at the same time she grabbed the knife she was thinking, " I will harm him and I will undergo the consequences. I shall hurt him and punish myself afterwards." "I feel as if my mind is separated from my body." Disposition to laugh at serious things while he may remain serious when he should laugh. He laughed during his father's funeral; he makes jokes when everybody else may be in tears from a scene in the street or cinema.
All these examples portray, to varying degress, the same idea, the idea of a schism or a strong internal conflict.

Anxiety about the Future
In the first stages of the development of pathology, the suffering provokes an anxiety about the future. They experience a constant sense of insecurity. They anticipate that small problems are going to expand into major ones. This anxiety, suffering and fatigue generated by perpetual inner conflict lead to an eventual compromise of mental vitality. They start suspecting that everything will go wrong and become suspicious of everything around them.

Memory
Memory loss is another characteristic of Anacardium. Initially the effect on memory is forgetfulness. They will be unable to recall what they have read. The mind is rendered empty from the effort made in trying to prove themselves. It resembles a form of mental paralysis.

There is one specific arena of life which is especially prone to evoke the Anacardium picture - school, especially around the time of examinations. A student, who has perhaps suffered the indignity of having been criticized by his teacher, will be determined to prove himself by excelling at his examinations. In the midst of his studying he will be overcome by a sudden profound loss of confidence. He will then feel unable to take the examination. His mind has become a blank; he is unable to remember what he has studied. There are other remedies that can similarly correspond to pre-examination difficulties and which, by way of contrast, we will briefly describe. Again, that which distinguishes Anacardium is the urge to be first - to prove oneself - in the face of perceived criticism; e.g., "My teachers do not acknowledge my abilities."

Gelsemium will present an entirely different picture. Those requiring Gelsemium will experience intense fear at the thought of appearing for an examination; a feeling of paralysis and trembling often accompanies this anticipatory fear. Unlike Anacardium, they encounter no difficulty while studying; they have the stamina to study, and they do not suffer a similar memory loss. With Gelsemium the focal point of their difficulty is imagining themselves before the examiner, especially for an oral examination; that image paralyzes them with fear. They will say, "No, I cannot do it. It is better that I do not go. I give up." Gelsemium will want to give up; they are softer, far less determined than Anacardium. The fear in Gelsemium is an expression of cowardliness.

The case of a man, a student of economics in England, illustrates the Gelsemium dilemma. He was the son of a very rich man. When initially seen, he was almost at the point of quitting school. He was quite lazy and was unable to pass his examinations because he could not muster the initiative to study. He spent his time living a carefree life, drivng expensive cars, entertaining girlfriends, etc. He felt that he could not concentrate, that his mind wandered. He wanted to succeed in school, wanted to study, but he was just too lazy. One dose of Sulphur greatly affected him. He was subsequently able to study and passed one examination after another... until he arrived at the final stage of his school program. The school was quite difficult, very demanding. The professor of his final course had already failed him three times. He became afraid of this teacher. He phoned his parents, telling them, "I have studied the subject completely. I know it very well, but I am not going to take the examination. I cannot. " The parents phoned me asking what they could do. This was quite a different situation from before; there was no longer the laziness of Sulphur, but a lack of courage to appear in front of the teacher. A repetition of Sulphur, here, would do more harm than good. This was a Gelsemium situation. [The practicioner has to be aware of such subtle differences if he wishes to prescribe correctly.] I recommended that he take a dose of Gelsemium 1M the day before the examination. He did so, appeared for the examination and did very well.

Picric acid will also be frequently indicated for pre-examination difficulties. The causation in Picric acid is overexertion and fatigue of the mind. These are people who have studied very diligently for a long time and who, as a consequence, have overexerted themselves. They do not experience the conflict of Anacardium nor the cowardliness of Gelsemium, but rather predominantly suffer from a tiredness of the mind. They may say, "I am so tired. I feel as if I have been thinking for ages." The feeling of mental fatigue is unrelenting and will induce them to want to quit and forego the exam. In this state even five minutes of studying will be exhausting.

One must exercise caution in discriminating between these remedies for they may all complain that they are exhausted. Therefore, one must look at the case deeply in order to ascertain the underlying reality. In the Anacardium case there will most probably be an underlying conflict, a strong desire to succeed, and a subsequent sudden loss of memory. Later, as the case advances into the next stage of development, peevishness, irritability, and violence may appear. The pathology develops progressively; it originates predominantly as anxiety and insecurity; later the aspects of the inferiority complex, of cruelty and the double will become more prominent.

In the second stage of development the memory deteriorates even further. Their memory loss may become so extensive that they begin to fear the loss of their sanity. This is not a fear of insanity as such, but rather, because of their profound decline in memory, a fear that their health is going to take an ominous turn for the worse, that something very bad is going to happen. They suddenly realize that they are unable to remember anything, even from one minute to the next. Some will describe it as if "someone or something is holding my brain," not allowing it to work. The mind becomes feeble; he feels as if he is in a dream and does not have a direct perception of reality. The mind feels sluggish and dull. It is a state bordering on imbecility.

It is important again to emphasize that loss of memory is a very important characteristic of Anacardium, and, as stated, this memory loss is precipitated by the suffering produced by the anxieties and insecurities. A businessman whose business has been doing quite well suddenly begins to encounter one problem after another. He becomes anxious and subsequently notes that he can no longer remember anything. He has to make lists of things to remember. This symptom evolution can occur within a span of six months to a year in a person only thirty years of age. There is forgetfulness in the morning, especially on waking.

The Irritability and Violence
The irritability of Anacardium arises as these people begin to lose control of themselves. The constant suffering generated by their inner conflict, their struggle with their sense of inferiority, gradually erodes their control, allowing irritability and violence to surface. They may break all the things around them in a quarrel if they cannot harm the person involved. The irritability and the feeling of inferiority are connected; for instance, these people are liable to misinterpret someone else's behavior as an intended slight against them and react to it with irritation. Someone enters a room with flowers, for example, and the Anacardium woman is likely to respond, "Oh, you're bringing flowers for your daughter." In fact, the flowers may be for her, but her first reaction is to assume that the gesture is intended as an offense. Her feelings of inferiority do not allow her to accept that someone is willing to care for her, or be nice to her, or show her love and affection.

At this stage in the pathological development of Anacardium these people have no belief in love; they believe in brutal force. Anacardium patients who are quite introverted and capable of introspection will describe themselves in the following manner, "I have lost my control. I really want to do harm. I don't care about anything any more." They will report these symptoms as if they are not natural, integral aspects of themselves, but as something apart. The more assertive Anacardium patients are unable to take the least offense without rapidly flying into a temper. One of the initial expressions of their irritability is a great tendency to swear. This tendency may take place in a person who never before even thought of swearing. For instance, it may happen that after a shock a headache develops, and with it there arises this peculiar tendency.

Anacardium is one of the main remedies for those who have an irresistible desire to curse (Nitric acid, Hyoscyamus, Nux vomica). Subsequently, if the disturbance is left to develop, an increasing aggressive urge may appear, evoking more hostile actions; teenagers, for instance, may become juvenile delinquents, committing mischievous, malicious acts such as slashing tires, hitting people with chains, etc. They may join marauding gangs of hooligans. Some Anacardium patients may say that they experience violent thoughts only (e.g., shooting or stabbing people), without ever reaching the point of actually commiting violence.

Initially the natural feelings of tenderness, love, and sympathy diminish, leaving behind a dullness, blankness and hardness of emotions and thoughts. This torpor of the emotions occurs as a consequence of the suffering previously described, and this emotional void allows for the emergence of cruelty. After constant shocks, disappointments and hardships, they become insensitive, their emotions stilled, and they find that their stagnant emotions can only be, in a sense, revived by performing cruel actions. Their cruelty can almost be a source of joyfulness for them. The lack of emotional liveliness, the hardness represents significant pathology. It can be likened to a hard tumor - a tumor of the emotional body.

Some may see a similarity between the emotional inertia of Anacardium and that of Sepia. Sepia, however, will never enjoy doing harm. They will say, "I have no emotions, and I don't care." Sometimes they may become so irritable that they hit their children, but as soon as they do so they will suffer remorse and feel emotionally exhausted. This state is quite different from that of Anacardium. Another similarity is that in Anacardium, once the emotions have become blunted and hardened, there is a lowering of sexual interest which can develop into an aversion to sex.

Cruel Anacardium people who harbor malicious feelings toward the world can eventually develop paranoia. They will begin to believe that everyone is their enemy, that they are pursued by enemies. They are afraid of everybody, even those who may approach to hug them, and become suspicious of everything. As they progress further, they may enter a delusional state in which they feel as if they are living in a dream. Reality and dreams intermingle as their confusion increases. It is at this point that they will say, "I have an angel on the right who says to do the correct thing and a demon on the left who says to do the wrong thing. Someone is telling me to do one thing, and someone else is telling me to do the opposite." This delusion is characteristic of a patient who is approaching the final stage of Anacardium. As we have noted, not all Anacardium patients will express such a division in this way nor in the way it is expressed in the texts, but there is a similar idea underlying their symptomatology. The irresolution, the hesitation, and the lack of confidence are manifestations of that theme. The constant second guessing about a course of action, the questioning of one's capabilities, etc. creates a split that progressively enlarges until a schizophrenic condition may develop. Finally there is the appearance of fixed ideas involving the belief that they are double, that they have a demonic half. They see devils and angels, etc., the main idea being that of a schism.

The Religious Aspect
On examining the lives of most Anacardium patients one would not be inclined to identify them as religious people. On the contrary, they are people who believe in human power. As the pathology progresses, however, there is a tendency to develop a religious turn of mind. This attitude, though, is not one that is motivated by a true religious spirit. These are people who have engaged in much cruelty, who did not care about others; they have lived a life of hardness and eventually reach a point where they ask themselves, "Have I done right or wrong?" They become afraid of God and of angels; they fear the consequences of their past actions and become preoccupied with their salvation. Thus, we can see how these people, who had previously exhibited cruelty, hardness and violence as part of their sickness, now take on a religious bent. It is pathology, not spiritual maturity.

There may be some tendency to confuse Anacardium with Lycopodium. There are several distinguishing points. Lycopodium will not want to assume responsibility; they will try to shun it. Even their family can become a burden, and they will contemplate deserting them. Anacardium, on the other hand, will attempt to undertake responsibilities to an extreme degree in an effort to prove themselves. These two attitudes are wholly dissimilar. Lycopodium persons are not cruel; they are cowardly. They have anxiety about their health and anxiety about seeing blood. Anacardium could well enjoy seeing blood. Blood and violence stimulate them; their stilled emotions are aroused by violence. Otherwise, in the later stages, they are incapable of the more usual forms of emotional arousal. They have experienced a lot of suffering, and, as a consequence, their emotions have become blunted. This scenario is unlike Lycopodium. Lycopodium people are selfish; they like to enjoy themselves. They are often among those who, when attending seminars, conferences, and the like, will show no restraint. They will be eager to establish a licentious relationship with any woman to whom they are attracted. Their pleasure is a priority. This is an aspect of Lycopodium that serves to illustrate the significant differences between the two remedies.

An important point to emphasize in the recognition of Anacardium patients is that in any given patient there is usually a preponderance of one of the following pathological states - either the inferiority complex, the cruelty or the double will. Patients should exhibit evidence of at least one of these qualities to justify the prescription of Anacardium on the basis of psychological symptoms alone.

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Apis Mellifica

Apium virus. Honey-bee poison.
N.O.Insecta
Tinctures are made of the whole bee or of dilutions of the poison with alcohol.

THE ESSENTIAL FEATURES

Apis is a large remedy that has been but partially understood and little used, mainly because of a lack of appreciation of the inner nature of the remedy. Kent probably felt similarly when he said in his lecture on Apis: "We must be able to see in the general beginning of provings the disease which they resemble, for we do not always see the remedy in the advanced state. We see the disease in a state of progress and must be able to see it in the beginning. As was the disease in the beginning so was the remedy in the beginning. Things that have similar beginnings may have similar endings."

It is the subtle changes in the behavior of people in the beginning of illness that most of the time foretell and determine patho/ogica/ changes in the end. To be able to code these subtle changes is the main objective of this materia medica.

To understand the inner pathology and the idiosyncracies of this most interesting remedy we have to look upon the effect that the bee sting has on the human organism and its side-effects: a sudden edematous swelling which is hot, burning and stinging, and which forces the person to shriek because of its suddeness and intensity. Few people stung by the bee will not give a shout of pain. Sometimes the effect can reach the proportions of a severe generalized allergic reaction in a very short time and can be so serious as to endanger the life of the person who is sensitive to its poison. There is an obvious aggravation from heat and touch. We know all too well how bees do not like to be touched or interfered with, and how they cannot stand the heat well.

The entire pathology of this remedy is built primarily around these external manifestations, as well as some other characteristics of the bee yet to be discussed. If we keep this picture in mind and try to understand its analogous action upon the rest of the human body, then we will be able to recognize the action of the remedy from its beginnings right through to its different advanced pathological states.

The edema of Apis, characterised by burning and stinging, will naturally be aggravated by heat and touch. You cannot aproach the bee, and the Apis person definitely does not like to be touched. The Apis patient does not want to be touched in painful areas, whether physical or psychological. Additionally, the heat of a room, or the radiant heat of a fire, or a warm bath with its hot vapors not only can aggravate pre-existing pathology, but can also provoke it. The aggravation from touch is quite a strong feature of this remedy. For instance, in cases involving an inflammation in the abdominal area, touching the abdomen is likely to provoke stiffening and tightening of the abdominal muscles.

Whether acting upon the skin or the mucous or serous membranes, Apis' tendency is to create edema, effusions, retention of water within the tissues. Water appears to be entrapped in certain parts and cannot be eliminated via natural avenues. This pronounced tendency may lead to general anasarca. "The face is greatly swollen at times, the eyelids look like water bags, the uvula hangs down like a water bag (emphasis mine), the abdominal walls are of great thickness and pit upon pressure, and the mucous membranes in any part look as if they would discharge water if they were punctured," writes Kent.

This being said, it is understandable that this remedy should have no desire to drink water. It is one of the most thirstless remedies of the materia medica because there is retention of water in the tissues; any more water would simply aggravate the situation. However, in cases involving dehydration resulting from the pathology, such as cholera infantum, typhus, diarrhea, ulcerative colitis, even abscesses, etc., we may see the opposite - insatiable thirst. When there is retention of water in the organism, there is a notable thirstlessness, but where we find loss of fluids due to the pathology, we may see excessive thirst.

The edema or the effusions of this remedy are not minor, accidental events, but the main pathognomonic manifestation of its pathology. As mentioned, this remedy has a great preference for collecting and retaining water in certain areas. Acting upon cellular tissues like the eyes, face, throat, uvula, ovaries, etc., it causes edema. Acting upon the membranes covering the heart, the brain, or the lungs, it causes effusion. Kent writes: "The outer part of man is his skin and mucous membranes. When we are dealing with man from centre to circumference, we think of the innermost as the brain and heart and internal organs that are vital, while their coatings and coverings are external. Apis affects the things that are external, it affects the envelopes, the coverings (emphasis mine). You notice how frequently it affects the skin and the tissues near the skin, and it also affects the envelopes, the coverings of organs; for example the pericardium. It establishes serous inflammations with effusion thus we see that the coverings are especially affected by Apis, viz., the skin, the mucous membranes and the coverings of organs."

Such observations are all too important when studying a remedy, but again we should not adhere to such ideas in a superficial way. For example, in a singular action upon the kidneys, Apis forbids the passage of water, causing a generalised anasarca. Can we say that this is something external?

The edemata or swellings usually manifest themselves with great rapidity and intensity. In such cases we see a very rapid effect upon the lower extremities. As an example, you may have a case of severe enterocolitis which is not doing well. On visiting the patient the morning after your first visit you are told that he has passed very little urine. You note the patient's swollen lower legs, which can be twice their usual size, and then you watch in amazement as the swelling moves upward toward the thighs by the hour. This will most probably be a case of Apis.

An analogy may be drawn between the retention of water in these patients and the way strong emotions are retained, creating an "excitable" state. Apis individuals possess intense emotions which are not easily expressed. They are people of passion and intensity, especially in the sexual sphere, but they feel awkward if they express these feelings. For this reason, they keep their emotions hidden, and the pressure of these pent-up emotions can create an extreme sexual fervor which cannot find deep release, thereby resulting in nymphomania in some cases.

It is interesting to note the inclination of the bee to find "nectar" and to impulsively "attach" itself to that sweetness, while at the same time reacting aggressively in case of interference with its activities. It attacks with a blind passion both the nectar and the intruder who tries to approach or touch it. Here there is a very interesting similarity with the personality of Apis - they cannot detach themselves from the "honey" once they have found it.

This is not a question of immorality, but rather of passion. A woman will start an extramarital affair with the idea of stopping it as soon as possible, but she becomes caught and cannot give it up. It is too appealing to her sexually even though she continues to respect her husband and does not want to break up her marriage. She actually can enjoy both her husband and her lover. This story may seem quite common, especially in Mediterranean countries, but it is the result of pathology in Apis individuals.

These people become so involved in sexual play and enjoy it to such an extent that they will become lewd. One must understand that they reach such states because of an inability to express their emotions and erotic needs in a natural and comfortable manner.

Another striking similarity with the honey bee is that the bee is constantly busy, constantly working; it labors in pursuit of the "nectar" as if it were a great pleasure to do so. It is significant perhaps that we prescribe this remedy mainly for two mental conditions: one is a form of "busy insanity", in which the patient is constantly busy doing things, and the other is an erotic insanity! Such analogies may not seem "scientific," but they help to understand and to remember the essential features of the remedy.

Erotic insanity and sexual mania, especially in women, both form part of the mental pathology of this remedy. Manic-depressive states consisting of eroticism during the manic state and complete apathy during the depressive state could need this remedy. Ailments from sexual excesses is an Apis characteristic. The husband of an Apis patient might be heard to say, "The woman is terrible in bed." By this he means that she is very active and lewd, that there is an almost violent frenzy in her sexual behavior; she needs constant stimulation and never seems to be satisfied. It is a state similar to Cantharis ; indeed, Apis will actually antidote the effect of Cantharis upon the genitourinary organs. These two remedies antidote each other if the seat of trouble is the genitourinary area.

The above description should not give the student the mistaken impression that all Apis women are "nymphomaniacs," but only that they usually have an increased sexual appetite which can sometimes reach such extremes.

In this remedy we may see nymphomania or sexual mania in women coexisting with, alternating with, or stimulated by cystitis. Another interesting characteristic of Apis in women is the easy development of cysts in the ovaries, or enlargement of the ovary, especially on the right side. The cyst can be enormous and can develop in a considerably short time. When you have a case of an ovarian cyst in a sexually frustrated woman which has developed in a short time, is enormous in size, and is soft, as if full of serum, then most probably you have a case of Apis.

You should remember here that the development of the cysts is proportionate to the frustration of the woman's sexual demands. I have seen enormous cysts of this kind disappear in a very short time under a high potency of Apis in women who had been subject to "relationship" stress involving sexual frustration for a long time.

In Apis we see also a strong tendency to jealousy, which is to be expected in such sexually driven women. Ailments originating from jealousy may be seen.

It is interesting to observe that a person suffering emotionally because of some frustration connected with love may often have a weakened heart; such a person could develop a heart complication, pericarditis for instance, as a result of a common cold which has progressed to bronchitis. It seems that once the organism's resistance is lowered, the organ that has been chronically compromised is more liable to break down. Although this theory may seem a gross simplification of the complicated and highly sophisticated biological processes which take place in the human organism, you will nevertheless often perceive such a connection in your cases if you look deeply into the real, dynamic causation of each case. Such perception requires that we evaluate each case on a level far deeper than that of gross pathology.

Just as the heart may be impaired by romantic frustration in Apis, the reproductive organs and the kidneys may suffer as a result of sexual frustration.

The fact that Apis is a jealous remedy could lead to confusion with Lachesis, especially in light of other general characteristics common to both remedies - an aggravation from heat and touch, and an amelioration from cold. Yet the jealousy of Apis is different from that of Lachesis. The jealousy of Lachesis is much more insane and unfounded than that of Apis. Lachesis is tormented due to its suspicion; Apis does not suffer so. The Apis jealousy usually arises for the following reasons: these are sexually passionate people whose intense sexual behavior can approximate, if not parallel, that of the sexually maniacal, yet they are clumsy in expressing their feelings and emotions. This combination of clumsiness and sexual ardor leaves them feeling constantly insecure about their partner. Apis women, for instance, are constantly apprehensive that they may lose their husband to another woman, that he will have sexual experiences with other women of an intensity similar to that which they share within the marriage. They have great difficulty in discussing such concerns however.

They will observe certain signs in their partner, flirtatious behavior for instance, and they will not say anything; however, the poison of jealousy will begin to consume them. Eventually, after many such "signs," their suspicious nature, which had previously remained dormant, will explode in a fit of jealousy. In their rage they will say things which hurt the other person deeply, and regret it later. They sense their own awkwardness, their lack of smoothness and admire how others can express themselves so easily, smoothly and calmly, even in matters like jealousy. After several such explosions, their sexual desire becomes suppressed, and the pathological process which eventuates in an ovarian tumor or cyst begins. It is as if the sexual energy, unable to gain expression, acts destructively.

At this stage they try to laugh and to look happy, even though they feel unhappy and miserable. In our texts it says, "Simulates hilarity while he feels wretched." This is a great keynote for this remedy. They do not want to show their misery, and, even more, they try to give the opposite impression - they pretend to be happy. In our texts we read, "exaggerated joy." It is a peculiar state bordering on hysteria or mental imbalance. Also, "laughing at misfortunes," another characteristic mentioned in the literature, has to be understood as an unbalanced expression of the emotions. They probably feel so awkward at being touched by misfortune that they burst out laughing instead of crying. There is definitely an hysterical element in Apis which makes these patients laugh over serious matters, sometimes with a silly or stupid expression on their face. They do understand that this behavior makes them look ridiculous, but they cannot help themselves.

It is not that they do not complain; indeed, they will often express dissatisfaction and find fault with everything and everybody. But at other times they will try to conceal their misery by maintaining a joyful fagade, especially if they are amorously interested in somebody.

One has to see the clumsiness and awkwardness of Apis to believe it. Regardless of how careful they may try to be, they will knock over two or three glasses when reaching across the table for the salt While walking on a perfectly level street, they will somehow manage to suddenly trip and fall to the ground. If you ask them what happened, why they fell so suddenly and easily, they will not answer; they themselves do not know. They feel awkward; they are awkward. They will knock over both the bedside table and chair before reaching their bed at night, even though that same table and chair have been in that location for a very long time.

They seem to walk in a manner suggesting that they are rushing to get something quickly, without consideration of the surrounding topography.

This clumsiness is the exact opposite of the famous ability of the bee to orientate itself and locate objects spatially. Many Apis patients seem to have lost this faculty, especially when they are in a hurry. They give the impression of being internally busy or preoccupied; it is as if they are absentminded and an awareness of the location of external objects does not register in their minds. Kent goes so far as to say that this disturbance in coordination is the result of a faulty nervous system.

When they try to express their own emotions, they exhibit a similar clumsiness. They are "bumpy" with their expressions, finding it difficult to discuss their emotions in a smooth way. A natural and easy manner of self-expression is denied them, even though they harbor strong emotions. They prefer to contain their emotions, and if they do express them, they do so "jerkily."

Apis individuals are closed, not because it is their nature to be so, but because they do not know how to express themselves. It is this state that makes them often feel irritable, discouraged and weepy. They feel like crying all the time. Kent writes, "The symptoms themselves are great sadness, constant tearfulness without any cause, weeping night and day; cannot sleep from tantalizing thoughts and worrying about everything...; extreme irritability, borrowing troubles about everything. Absolutely joyless. No ability to apply things that would make her happy or joyful.." They try to hide their misery, but at night they will stay awake with depressing thoughts. Eventually, they arrive at a point where they are ready to cry with the least provocation. They may also react aggressively and quarrel for even insignificant reasons.

The state described above can arise after suffering a love disappointment, a grief, or as a result of some other cause for unhappiness. A woman hearing, for instance, that she cannot have a child because her ovaries are full of cysts might go straight into such a state.

These persons try to be kind, to behave in an obliging, even cordial manner. It is only when they are irritated that they will rage, their tongue becoming like the sting of the bee. Then they will suddenly explode and say things that can really hurt another person. They may lose control and want to break things, to strike objects around them or themselves - "knocking his head on the walls or against things."

Apis, however, is the only remedy in the materia medica that suffers so much after the rage has passed. After such an explosive release of uncontrolled emotion, they feel ill for quite sometime. Women erupt in red patches around their face or external throat and may suffer headaches, etc.; men might develop a fear of having a heart attack or a brain stroke. The rage seems to induce a surge of blood to the head, hence the subconscious fear.

Another fear of Apis that I have seen once, but very strongly, is a fear of birds; in her case it was so severe that she said, "I would prefer to have a snake near me than a bird."

This remedy, like Natrum muriaticum, has ailments from grief, also ailments from the over-excitement of emotions, such as rage or fury, fright, jealousy; bad news and mental stress are other causations. It is a remedy that is very much affected by the state of the emotions. For example, a characteristic symptom of Apis is: "After severe mental shock paralysed on the whole right side." There is also a possibility that one side of the body will display twitching or intense motor activity while the other side remains motionless, as if paralyzed.

Apis is considered complementary to Natrum muriaticums, and the two remedies will complement each other in either sequence. While Natrum muriaticum may remove many of the results of grief in a patient, certain bodily symptoms may develop which point to Apis and which will be deeply and lastingly cured by this remedy. The two remedies also share similarities, among them: awkwardness, hysteria, a closed personality, and an impassioned self-abandonment in sexual relations; however, Natrum muriaticum is always more romantic and refined, whereas Apis is more coarse and more earthy sexually. Apis is very passionate and deals with others roughly, especially on the emotional and sexual levels. Natrum muriaticum, on the other hand, is a much more refined and sensitive individual, one who cares very much about hurting others and strives not to do so. Both are not overtly sexual in the beginning of a relationship, but once they have established a rapport with their partner, they can behave quite lewdly. Apis women, in particular, do not have the ability to make contact easily with members of the opposite sex and can, therefore, suppress themselves for a long time, but once they have established a relationship, they let themselves go.

From the description of Apis provided so far, the reader will have understood that Apis is an explosive remedy in many respects. We see the same explosiveness, the same suddenness, the same rapidity in the development of the diseases for which it is indicated. There may be a sudden, explosive effusion on the meninges, for instance, and the sudden pressure can make the child shriek with pain. Apis is well known for that symptom, which used to be referred to as a brain cry, a symptom which has been known to appear mostly in inflammation of the meninges or in conditions characterized by increased cerebrospinal fluid pressure on the brain. The pain in Apis comes suddenly and so piercingly that it forces the person to shriek. The shriek or the cry seems to come from the deepest recesses of the organism, causing a chill in the listener. Shrieking in children during sleep, during dentition or after vaccination for polio are symptoms of Apis. Apis is indicated in cases of hydrocephalus manifesting this same kind of shrieking.

In heart conditions such as pericarditis we see the same intensity and the same suddenness, the same intense effusion.

"In those intensely violent and rapid cases of diphtheria in which the whole throat fills right up with edematous swelling, the uvula hanging down like a transparent sac filled with water, and the patient is in imminent danger of death by suffocation from actual closure of throat and larynx, there is no remedy like Apis," writes Nash. But Kent gives another hint - "Apis cures diphtheria, especially when there is a high grade of inflammation and the membrane is scanty or comes slowly or insidiously ... the parts are edematous and the soft palate is puffed like a water bag, and the uvula hangs down with a semi-transparent appearance like a bag of water. All around the throat and mouth there is an edematous condition looking as if it would flow water if pricked." Such vivid descriptions should remain fixed in the memory of the student because it is the impression of a condition that will give the clue to the correct remedy.

We will also observe intense excitement reaching states of delirium in a very short time in cases of congestion or inflammation in the brain; e.g., meningitis or meningoencephalitis; excitement in hydrocephalus. The delirium becomes most prominent at night during sleep and is at its worst after midnight; loquacious delirium; "sexual delirium." There is all this activity at night, but the next morning she is depressed, apathetic, and totally uncommunicative. The midnight aggravation is a characteristic of the remedy.

In similar conditions we observe hallucinations: that he has died or is dying, that someone is in bed with him, that people are beside him, that she is pregnant, that the tongue is made of wood.

And then we see, especially during low types of fevers, a tiredness, weakness, and total apathy that can reach complete unconsciousness. They are not aware of anything going on around them. They seem not to perceive what is being said to them. When pricked with a pin, no sign of feeling is given; when water is put into his mouth, no attempt at swallowing is made. There is no evidence of seeing, hearing or feeling.

There is an interesting keynote in the mental sphere which we see in certain cases: a sense that life is ebbing away with a resignation to dying. They feel they will be dying soon, with the next breath or in a few minutes, and they appear not to resist, as if they do not have the energy to resist. This sensation most probably results from difficult respiration; they seem to have to draw breath to garner enough strength to even pronounce a word. It is not a fear of dying, but rather a presentiment, a foretaste of death - a feeling they are now "going," and they are resigned to this fact. It will sometimes look as if they desire to die, as if their defences have suddenly been completely relinquished.

In chronic mental conditions we see delirium during the menses or delirium with menstrual difficulties. In such cases it is likely that the female hormones are unbalanced due to frustration, again, of the sexual demands.

Allergic conditions that come suddenly, unexpectedly, and with violence and which cover the entire body are seen in Apis. Even anaphylactic shock is possible. In this respect the French dentist, Jean Meuris, writes: "The treatment of anaphylactic shock: the worst kind of shock is the kind that occurs suddenly. The patient suffocates (edema of the glottis), while red spots appear on the throat and face which burn and sting and are worse by warmth. That is the picture of Apis, a remedy which we have always been able to rely on. Placing a few globules of Apis 15 (or 200 Korsakov) on the patient's tongue brings the shock to an immediate halt, and the symptoms usually disappear in the time that it takes for the globules to dissolve."

Apis will also meet cases of allergic conjuctivitis in which the eyes become red and inflamed within a few hours, and the eyelids, as well as the tissues around the eyes, become so edematous that they almost cover the whole eye. The swelling can be such as to obstruct vision.

Apis will be indicated in cases in which the kidneys suddenly fail and from one day to the next an enormous edema develops in the lower limbs. One can almost see the increase in the swelling from one hour to the next. This picture may be seen in severe complications of serious acute diseases or in chronic conditions, such as ulcerative colitis in the advanced stages.

Generalities

What is outstanding in the general features of this remedy is the aggravation from heat of any kind, for instance in a warm room, more so if there is warm air blowing at him or heat from an open fire and even worse in a hot bath, or in a sauna. Typical Apis patients will never enter a sauna, not even a moderately warm bath, as it will make them suffocate and feel dizzy - they may develop headaches, congestion in head, red rash of the skin etc. "In brain troubles", writes Kent, " if you put an Apis patient with congestion of the brain in a warm bath he will go into convulsions ... If a baby needs Apis in congestion of the brain the fits become worse by bathing in hot water."

The patient wants the windows open to cool the room even if he has chills. It is one of the characteristics of this remedy that they feel that they cannot breathe, that they will suffocate in a warm room. He will uncover himself even when suffering from chills as heat makes him feel uncomfortable. Cold bathing ameliorates allergic conditions of the skin. Here we may point to the sophisticated system of uentilation operated by bees to survive in the heat of the summer.

Another general symptom is the aggravation from touch. Apis is extremely sensitive to touch, similarly to Lachesis, and indeed Lachesis will often be given first in such cases. This aggravation is apparent not only in the skin conditions where we may have allergic exanthemata, nodular swellings, erysipelas etc, but also in cases of inflammation of the intestines, enteritis, cholera infantum, ulcerative colitis or common diarrhea where the patient cannot stand any touching on the abdomen. In ovarian cysts where there is inflammation or in uterine problems we see the same sensitivity. Even the hair is sensitive to touch.

The complaints of Apis appear with violence and rapidity and can become quite serious in a short time.

The right side is primarily affected; ailments start on the right side spreading from there to the left. But one should never be discouraged from prescribing Apis for a cyst on the left side, once the other characteristics of the remedy are there. In the beginning of my practice, I missed several such cases because I thought I should adhere with absolute faith to the books. Later on I prescribed Apis with success for cysts or enlarged ovary on the left side.

Lying down aggravates many of the complaints of Apis while there is an amelioration from sitting. General prostration, lassitude with trembling.

Apis can be an important remedy for the bad effects and consequences of acute eruptions and exanthema that have been suppressed or never properly developed. Thereby many different ailments and diseases may occur; restlessness, delirium, convulsions, meningitis, hydrocephalus, inflammation of the throat, dyspnoea, asthmatic respiration, diarrhea, nephritis, edema with scant urine, cysts of all kinds etc.

Special attention should be paid to the ability of Apis to develop all kinds of cysts, which are usually enormous in size and develop with extreme rapidity. Apis should also be thought of in cystic tumors.

Head/Vertigo

In the head, as may be expected, we have a lot of congestions, fullness, confusion felt as vertigo. Headache with vertigo. Head confused and dizzy with constant pressive pain above and around the eyes. Confused vertigo, very violent at times, worse when sitting, extreme when lying with eyes closed. The whole brain feels tired, as if asleep and crawling.

Congestion of head much worse in a warm room and better in open air. Most of the head ailments are worse from warm room, warm bathing etc. and better in open air and from cold applications. Congestion of head before menses, the congestion grows in inverse proportion to the flow of menses. Head feels as if too full, as if there is too much blood in it. Great rush of blood to the head. Head feels too large, swollen, causing her to look into the glass involuntarily.

Head feels big and confused, bewildered. The headaches are mostly of a pressive character, as if pressure is exercised from within. Sometimes this becomes much stronger and then we have bursting headaches. Many kinds of headaches, the dull, pressive pain and the throbbing in the head for instance, are ameliorated by pressure with the hands. A known time aggravation for the headaches is 10 a.m. lasting until the evening or around 6 P.M.

Headache worse reading, increased in a warm room. Forgetful during headache.

Bores head into pillows, rolling the head from side to side or the head is drawn back rigidly in serious forms of brain affections. During diarrhea, while the weakness increases the headache diminishes.

Eye

Conjunctivitis, trachoma and in general most of the severe inflammations of the eye and its deeper tissues will be covered by this remedy. Enormous swellings around the eyes in allergic conditions or conjunctivitis or kidney problems will call this remedy to mind initially. The eyelids could be red and edematous and enormously swollen. The swellings are always impressive and sometimes can entirely close the eyes. Burning and stinging pains. Sensitive to bright light. Kent gives a vivid description. - "Inflammations that are erysipelatous in character, that leave thickening of the mucous membrane and lids and white spots over the eyes, opacities. Inflammation with opacities very extensive or in patches. When the inflammatory condition is active it is attended with edema of the lids, such as you would expect to see after a bee sting. The swelling of the mucous membranes of the lids is so enormous that they roll out, looking like pieces of raw beef. The fluid will run out on cheeks in great abundance."

On close examination of the eyes and immediate surrounding, you will seldom fail to recognise a case of Apis, whatever the pathology from which they are suffering may be. Most of the time there will be the characteristic swelling around the eyes and more prominently the affection of the right eye.

The inflammations will be relieved by cold applications, and aggravated by radiating heat and bright light. Inflammations with severe shooting pains.

Keratitis with pains shooting through eyes, with swollen lids and conjuctiva. Keratitis with hot burning lachrymation gushing out on opening the eyes. Severe inflammations with dreadful shooting pains. t gives you the impression that it is ;yes. Either the whole face may be eruptions or lupus) or around the soft palate is puffed like a water bag, and the uvula hangs down with a semi-transparent appearence like a bag of water. All around the throat and mouth there is an edematous condition looking as if it will flow water if pricked."

Sometimes during a severe cold with sore throat, a pharyngitis, the uvula will be so inflamed and elongated that on empty swallowing it will be caught by the contraction of the esophagus and pulled down. In such cases the uvula is very long, hanging from a thin stem and at the end there is a kind of an edematus swelling while the whole pharynx is inflamed and painfully burning.

In such severe inflammations there is an aggravation from warmth, especially warm air blowing from a radiator and at the same time there is some relief from drinking something cold. The relief is not tremendous - because the inflammation is usually severe - but it is definitely there.

Aversion to warm drinks. Mouth, throat and pharynx bright red, glossy as if varnished. Tenacious mucus in throat, very troublesome. Constricting feeling in throat with the sensation, as if a foreign body was lodged in it, worse from tight clothes. Splinter-like pain on swallowing or stinging pain. Tonsils are so swollen they impede swallowing. Deep ulcers. Dryness without thirst; burning in the throat extending to stomach. Vascular goitre, cysts of the thyroid gland especially in combination with ovarian diseases.

Stomach

Thirstless when there is retention of water in the body, thirsty when there is loss of fluids. Thirstless in ascites, in kidney insufficiency, in cerebrospinal meningitis, in hydrothorax etc. Violent thirst, would like to drink all the time (during typhus, or in severe diarrhea).

When thirsty would like some vinegar in the water otherwise the water seems tasteless. Gastritis or duodenal ulcer with burning heat in the stomach rising up to esophagus. Pain in epigastrium, cannot bear to be touched, even the bed sheet is intolerable. Desire for salads, especially celery and sometimes a strong desire for fat of meat. Desires to drink milk which ameliorates the pains and the burning.

Appetite and sleep totally lost in manic depressive states, especially during the state of mania (for four weeks). Eructations taste like food, increased after drinking water. Desire to vomit. Vomiting of everything he has eaten and mucus. Vomiting of bile after the stomach has been emptied. Vomiting and retching with great anxiety. Distress felt in stomach region. Extreme pain and tenderness in region of stomach with vomiting. Nausea followed by yellow and bitter vomiting. 2 a word of caution here concerning the expression "especially when" which I often use myself: this is not the only condition under which the remedy is indicated, but it is the most unique, the most characteristic for that remedy.

Abdomen

The abdominal walls are very tender and sore, they feel almost bruised not only in all kinds of inflammations of the intestines, or the peritoneum but also in ascites, very tensed or tight and sensitive to even light pressure or touch.

Soreness of the bowels when sneezing or pressing upon them. Burning and stinging pains are characteristic of this remedy. The abdomen feels full, bloated and is evidently enlarged. Ascites; peritonitis. Abdomen full, swollen and tender, with swollen feet and scanty secretion of urine is a typical picture for this remedy.

Violent burning pain under the short ribs, worse on left side. Violent pains in the abdomen aggravated in a horizontal position and relieved when sitting up. Violent pains across the lower abdomen with bitter vomiting and diarrhea.

In severe acute diarrhea an uneasy feeling like restlessness or distress is felt deep in the abdomen; it gives them great anxiety, they cannot tell whether this restlessness is purely psychological or whether the intestines are really moving. I have seen a similar symptom in Calcarea carbonica. Internal trembling with anxiety. Restlessness of intestines; pain in abdomen with a feverish trembling feeling.

Rectum

This remedy has diarrheas with vomiting making it a good remedy for cholera infantum or for severe cases of gastroenteritis. Sensation of an electric shock in the rectum followed by urging to stool. Sensation of rawness in the anus with diarrhea. The stool is acrid excoriating the anus. Watery diarrhea. Stool yellowish, greenish, watery. Diarrhea before menses. During climacteric women have chronic diarrhea with passage of blood and mucus. Painless diarrhea which ameliorates chest complaints. Every day six to eight diarrheic stool which smell like carrion (a decomposing animal). Diarrheic stool in children that is mixed with mucus and blood making it look like "tomato sauce". Anus protrudes and seems to remain open, "stools occur with every motion of the body as if the anus were constantly open" (in ascites). Colourless water oozes from rectum. Loose stool in the morning. Many affections like inflammation of ovaries, meningitis, prostatic affections etc are often accompanied not by diarrhea but by: difficult stool; constipation; hard stool, retention of stool, prolonged periods of constipation alternating with diarrheas.

Chronic constipation. Constipation or hard, regular stools, during menses.

Urinary organs

Apis has a profound effect upon the genito-urinary organs. Its main action is the retention or suppression of urine. The urine is scanty, coming in drops. Much straining but only a few drops are passed. Must press a long time before urine starts (prostatitis); dribbling a little hot urine. Urine scanty in heart diseases. The whole urinary tract is irritated; burning, smarting, soreness, constriction of urethra; agony in voiding urine; uneasy feeling in cords. Urine suppressed. Kent writes: -"Infants go a long time without passing urine, screeching and carrying the hand to the head, crying out in sleep, kicking off the covers. Very often a dose of Apis will be found useful". Frequent urination in cases of cystitis. Constant urge to pass water but only a little urine is voided every time (in inflammation of the ovaries.) The urination is sometimes profuse (prolapse of uterus). Excessive proteinuria, "half of the bulk of the urine is albumin." With proteinuria the urine is scanty and fetid.

Proteinuria during pregnancy. Frequent but scanty emission of milky urine (hydrocephalus, meningitis). Urine dark, like coffee; urine of a greenish hue (pleurisy). Urine contains uriniferous tubes and epithelium (in acute or chronic nephritis). Nephritis that develops as a sequel of acute disease. Involuntary urination in old people. Stinging stitching pains in kidneys extending to ureters.

Tenderness and soreness in region of kidneys worse on pressure or when stooping.

Male – genitalia

The sexual desire is increased with frequent and long-lasting erections. Sexual passion increased to the level of mania. There is violent sexual excitement without any cause, when studying, when driving, when sitting alone in the room.

Swelling of testicles, fullness felt mostly on right testicle. Dropsy of scrotum and prepuce. Hydrocele. Erysipelatous inflammation and swelling of scrotum, of penis.

Affections of prostate gland, hypertrophy of prostate with agonising pains during urination. Walks up and down the room with the pains. Condylomata of penis, burning.

Female – genitalia

The female organs seem to be affected by an excess hormonal functioning, so the desire for sexual intercourse is tremendously increased. The ovaries become engorged, hardened, particularly the right one. Great heaviness in the ovarian area, cases of cysts or tumors in that region or a feeling of drawing downwards in the area of the ovary with burning pain that extends down the thigh. Worse stooping. Cystic tumors that appear first on the right ovary and then on the left.

Patients dislike touching this area, and will avoid doing so. Pains in ovaries from continence or after coitus. Tightness in ovarian region, worse on raising the arms.

The uterus swells up. There is hypertrophy of uterus, a sensation of fullness, weight with downward pressing and stinging pains in uterus. Cysts, tumors, indurations, enlargement of ovaries more on the right side. Prolapse of uterus with tenderness in the area. Menses suppressed at puberty. Menses too scanty, lasting but one or two days. During menses great sleepiness with dullness of mind and cold feet. Leucorrhea profuse; acrid; green. Habitual abortion during the early months 2-4th. Apis should be prescribed with caution for pregnant woman with acute complaints such as fever or the common cold, and the low potencies should not be repeated too often or for several days. However, Apis can, and should, be given during the abortion process if the symptoms agree. Sharp stinging pains in the ovarian region during abortion. Metrorrhagia with profuse flow of blood with heaviness in abdomen, faintness, great uneasiness and restlessness. The Apis woman is likely to encounter many problems in bearing children, because due to these constitutional complaints she will either have great difficulty in conceiving, or may lose the child (abort) in the early months of pregnancy.

Chest

Respiration - Apis has difficulties with respiration in general but these difficulties vary in the diverse pathological conditions.

For instance the breathing will be difficult when we have dropsy or ascites: here we see shortness of breath, oppressed breathing which is worse in a heated room, worse lying, worse at night in bed, must sit up, cannot bend forward or backwards as the respiration becomes laboured, lying flat in bed is impossible, has fear of suffocation and will stay sitting up for days. Here the difficulty in breathing is part of the whole picture of dropsy, or hydrothorax, as if the lungs were pressurised and have no room to function, but the lungs per se do not show pathology.

The difficulty in respiration is only part of a much greater picture that looks grave but not because of lung disease.

The case is much more dramatic when Apis is indicated in real severe cases of laryngitis with edema or in asthmatic cases. During the crisis they lose their color, face becomes dark, blue, the lips become blue, the situation looks desperate, they cannot breathe at all, they are unable to speak, can speak only in a whisper, they have to loosen the collar around the throat, it appears as if the larynx is constricted and cannot stand even the slightest pressure, around the throat, they have to force the air in and out. They need to have somebody constantly fanning them otherwise they feel they will die. Much like Carbo vegetabilis they need to go and stand at the open window (if they can walk), they need fresh cool air which seems to ameliorate the situation a little.

Heat of the room is entirely intolerable, the temperature has to be quite low and the windows open. They cannot lie down with the head low, they always sleep with the head high or sitting up but if the crisis comes during sleep, which happens especially after midnight, they will have to sit up in bed in order to be able to draw a breath. There is restlessness and agony.

There is another pathological situation which can be called a nervous or functional dyspnea. You can see it in meningitis, or in acute high fever diseases that are not necessarily focussed on the lungs. When the fever is high even in the stage of chills, the breathing is very difficult, feeble, interrupted panting, they feel that they are going to die soon, that they cannot survive because they cannot breathe, but the physician cannot find any underlying pathology to explain the situation, only the high fever. A woman has an inflammation of the ovaries with fever and the respiration is affected in the way we described.

This is exactly what we call "strange, rare and peculiar" in the remedies. What we call the "keynotes".

Apis cannot stand the external heat or the rising of the inner temperature of the body, as in fever; he cannot breathe in the heat.

Is it then a coincidence that bees have to ventilate themselves constantly even in quite moderate temperatures? How is it that the tongue of Lachesis when protruded fay the patient acts exactly like the tongue of the snake? How coincidental are these phenomena or how much do they point to another hidden reality ?

Many times we have been asked to explain the action of the remedies, to understand the why's and wherefore's, the underlying causes, the correspondences, and when we see these phenomena and point them out as a matter of interest and research we are accused of being "meta-physicians," even by so-called homeopathic-physicians, as if the logical mind could perceive and explain everything, and pretend in the name of science to be able to understand the totality where we only know a small part of a whole. Actually we still know very little on matters of health and disease, because for many decades we have been following the wrong path in investigation and research. Today tremendous amounts of money are spent on a heart transplanted in an old man, but with the same money homeopathy could have saved thousands of heart patients from arriving at a stage where they need a transplant. But in these matters I would like to refer the reader to my book "A New Model for Health and Disease."

Cough

Whooping cough, croupy cough, dry with gagging. Cough that starts at night and continues until the early hours of the morning, worse at midnight. Violent cough with dyspnea and blue face. Farrington writes :"In pleuritis with exudation Apis is one of the best remedies we have to bring about absorption of the fluid. Apis and Sulphurwill cure the majority of these cases." Expectoration of profuse, frothy mucus. Expectoration sweetish. Sensation of soreness of the chest as if bruised. Stitches in chest, sticking pain in right side of chest. Shooting pains from front to back. Erysipelas on the mammae.

Heart

The heart has its share of symptoms in this remedy as well. There is effusion into the pericardium. Hydropericardium. The pulse is accelerated. The heart is audible, with every contraction of the heart the whole body shakes.

Cardiac distress, great anguish, restlessness, feels as if each breath will be the last. Palpitation of heart from scanty secretion of urine.

Insufficiency of mitral valves. Organic heart disease. When the case is gone to exhaustion the pulse is feeble, imperceptible, indistinct.

Back

Stiffness of the back and neck. Stiches on right side of neck worse moving the head towards this direction. Swelling in the back of the neck in gouty patients.

Pulsating pain in cervical region extending to left shoulder. Burning pressing pain in coccygeal region worse from any attempt to sit down.

Back feels bruised. Bearing down in small of back as if menses would come on.

Coldness, chilliness of back but does not want warmth locally. Great weakness of whole back.

Extremities

There is definitely a tendency to paralysis in the extremities not only with affections of the spinal cord, after apoplexy or thrombosis, but also with diseases like arthritis, rheumatism, and especially with strong emotions or mental shock. "Whole nervous system under a paralysing influence in scarlatina." "After excessive grief the whole right side paralysed". The extremities become heavy, stiff, powerless.

One side paralysed the other twitching, or convulsing. Partial paralysis of right side with numbness. Left arm almost paralysed due to severe cervical syndrome with burning pains from cervical region extending to the arm worse in the morning on waking. Upper extremities perfectly powerless, cannot take hold of anything, has to be fed (in spinal disease). Edema of feet and legs in a man affected with chronic rheumatism and partial paralysis. Sticking pains in right forearm with a paralysed feeling. Rheumatic pains in shoulder joints extending to back of neck. Electric-like pains go through the extremities. Lower extremities swell, become edematous mostly from disfunction of the kidneys or heart. Edema of hands. Drawing pain in arms extending to ends of fingers. Sensation of numbness in fingers especially tips, about root of nails. Swelling of ankles. Sensation in feet and toes as if too large, heavy, swollen and stiff; especially in the evening or at night when taking off the shoes. The swelling makes the leg look transparent, waxy. Panaritium with burning, stinging and throbbing.

Sleep

It is very interesting to look at the dreams of Apis and compare them both with the symptomatology and with the action of bees: dreams of travelling long distances; dreams of flying far in the air; dreams that he made journeys in great leaps through the air; plagues himself in dreams all night, with a flying apparatus, tries to arrange the wings which, however, will not work. (!)

The suppressed anger is also of interest: dreams of many people who are quarrelling; one of them, who becomes nearly beside himself, he leads from the room by the arm, whereby he is calmed. Dreams with vexatious care about about various kinds of business. Dreams of a tormenting, active kind, full of care and toil (remember the "busy insanity"). And finally the aggravation from heat which terrifies her: dreams of a great, hot stove; was obliged to walk over a hot floor. Great desire to sleep amounting to the most extreme sleepiness. Great inclination to sleep but inability to do so from great nervous restlessness. Sleepiness during menses. Very sleepy early in the evening.

Fever

Fever or chills are more prominent in the aftemoon from 3 p.m. to 4 or 5p.m. Even during chill the patient feels worse if the room is overheated especially by radiated heat and better uncovered.

Excitement during fever. Motion brings on shiverings; shiverings followed by heat.

During fever or when the fever drops patient goes to deep sleep. Dry skin with high fever. Thirstless during fever; thirsty during chills. During the time fever is high it is usually accompanied by a strong headache. Heat of one part with coldness of the other. Sweat is absent or breaks out only in spells, but soon dries off again.

Skin

Skin dry, hot, better bathing in cold water, cold applications. Has a transparent waxy appearance. Erysipelas, carbuncles, ulcers, bites from insects, edematous swellings, all with stinging, burning pains. The patient will not let you touch these areas, she will scream, so sensitive and raw does it feel. Urticaria and nettle rash, with edematous swelling of the skin, burning, stinging, intolerable itching at night, which is ameliorated by cold water. Urticaria caused by warmth, physical exertion, fever, perspiration or allergy; can occur with many diseases. Body covered with large, elevated, white areas.

CLINICAL

Inflammation, enlargement and cysts of the ovaries. Abortion in early months. Proteinuria during pregnancy. Kidney diseases, dropsy, hematuria, anasarca. Hydrocele. Retention or suppression of urine. Angina, laryngitis, pleuritis with exudation, diphtheria. All kinds of ophthalmia, (severe conjunctivitis, trachoma, allergic conditions etc.) Hay fever. Asthma. Anaphylactic shock. Hydrothorax. Headaches, congestion of head. Heart diseases, pericarditis. Hydrocephalus, meningitis, meningo-encephalitis. Dysentry, gastro-enteritis, cholera infantum. Allergic conditions, urticaria, lupus erythematodus. Delay in the appearence of skin eruption resulting in internal troubles. Suppressed eruptions.

RELATIONSHIP

Complementary: Natrium muriaticum. The "chronic," Apis.; also Baryta carbonica, if lymphatics are involved. Inimical: Rhus.

Compare: Apium w'rus (auto-toxaemia, with pus products); Zincum; Cantharis; Vespa; Lachesis.

DOSAGE

From the lowest to the highest.

CASES

"A lad aged about twelve years has been afflicted for several months with ascites and hydrothorax. He has been treated for some three months by allopathic physicians first for dysentery, followed by ascites, and afterwards for several months by a homeopathic physician. No permanent benefit resulted from either mode of medication, and the symptoms finally became so urgent that I was called in consultation, and tapping was at once resorted to in order to save the patient from imminent danger.

Appropriate homeopathic remedies were again prescribed, but without arresting the onward course of the malady. The patient commenced to ill up again with great rapidity. The secretion of the urine was nearly suspended, the skin was dry and hot, pulse rapid and weak, respiration short and difficult, great tenderness of the abdomen, dryness of the mouth and throat, thirst, excessive restlessness and anxiety, short irritating cough and an almost entire inability to sleep.

At this stage of the case, a strolling Indian woman -one of the few survivors of the Narragansett tribe, suggested to the family the use of a honey bee every night and morning. She enclosed the bees in a covered tin pail, and placed them in a heated oven until they were killed, and then after powdering them, administered one in syrup every night and morning. After the lapse of about 24 hours the skin became less hot and softer, the respiration less difficult and more free, the pulse slower and more developed, and there was a decided increase in the quantity of urine. From this time the symptoms continued steadily to improve, the dropsical effusion diminished day by day, until at the expiration of a few weeks the patient was entirely cured. " Dr.E.E MARCY and others : Elements of a new materia medica p.4422.

Observation: no comments

2. A number of years ago I was called in Watkins Glen N.Y. in consultation in a very bad case of diphtheria. One had already died in the family and four laid dead in the place that day. Over forty cases had died in the place and there was an exodus going on for fear. Her attending physician, a noble, white haired old man, and withal a good and able man, said when I looked up to him and remarked I was rather young to counsel him; "Doctor, I am on my knees to anybody, for every case has died that has been attacked". The patient was two rooms away from us, but I could hear her difficult breathing even then. Apis was comparatively a new remedy then for that disease, but as I looked in to her throat I saw Apis in a moment, and a few questions confirmed it. I told the doctor what I thought and asked him if he had tried it. He said "No, he had not thought of it, but it was a powerful blood poison; try it." It cured the case, and not one case that took this remedy from the beginning and persistently, died. It was the remedy for the genus epidemicus." Dr. Nash. Both the above cases are quoted in Tyler's "Homeopathic drug pictures" under Apis.

Observation: The case is interesting because it stresses the effect of Apis in diphtheria, but it does not give us enough information, or new information, on Apis. The comment that "no one died that took this remedy from the beginning and persistantly" has to be taken with caution and not to be tried in this spirit. The catch words here are "from the beginning and persistently" implying that they have seen some deaths but attributed them to the fact they were not taking the remedy from the beginnng. And what does the doctor mean by "the beginning"?

3. This is a most instructive case that every student should read.

B.H. aged nine years, very scrofulous by inheritance from both parents. (Patient had a fair skin and was always pale; blue eyes; red hair.)

Had lost in his sixth year the use of his legs, but, after a tedious course of treatment, had regained their use, so that he could walk with considerable ease. We found the child with a high fever, sore throat and scarlet rash. Aconite was indicated and was given. He was very ill but did passably well until the fourth day, when the eruption commenced to disappear, and at the same time, alarming changes took place. The fever became continuous; the countenance bore an expression of stupor, increased by the drooping of the lower jaw; the nose looked pinched; the teeth were covered with dirty, sticky, slimy discharge of foul matter from the secretion. It seemed as if the vital forces had completely surrendered themselves to the poison, which evidently penetrated the whole system. At first Cupr-met. was given with the view of bringing out the disappearing eruption. The patient growing worse Apis 2 was prescribed without producing any change; the symptoms remained the same; the tongue became sore, cracked and bleeding; the discharge from the nose became very irritating; the bowels became hard and were tender to touch; diarrhea set in. Remedies were changed as seemed best, the patient apparently sinking, edema of the feet and limbs then set in with painful and scanty emissions of urine. At that time Arsenic 30 was given, but without producing any effect, when we concluded to give Apis 30 until the patient got better or died. This was strictly followed out during the six weeks of sickness following. He was on the verge of death for weeks. General dropsy developed itself; suffocation threatened one day to end his life, from effusion in the thorax; hydrocephalus had all but declared itself on the next; the glands of his neck swelled; his ears discharged ; his face was bloated so he could not see ; at last the abdominal dropsy became so threatening that 1 proposed tapping as a last resort to save his life, the parents objecting. At this time we changed to the second attenuation of Apis; the change was followed by excellent effects upon the kidneys. Within forty eight hours enormous quantities of urine were passed, relieving the patient very much. Under the action of Apis, for it alone was given, alternating weekly the lower triturations with the higher dilutions of the drug the one symptom after the other disappeared. Occasional aggravations showed themselves but on the whole the little fellow gained ground inch by inch. All during the succeeding summer, he was more or less of an invalid, but by the first of Oct., his father brought him to the office having walked the entire distance from his home, and looking fresher and healthier than he had for many years. The cure was permanent; and he seemed ever after in perfect health. Dr.C.J.Hampel and H.R.Arndt.

Observation: there are several points of great interest in this case.

a. The expression "Aconite was indicated" is rather unfortunate, as Aconite was not indicated at that moment. The prescription helped in a negative way to speed up the evolution of the disease.

b. The correct prescription was not apparent from the beginning due to the fact that there were not enough symptoms or the case was not taken in a complete manner.

c. After Aconite, instead of looking for the totality, Cuprum was given on etiological reasons, for they thought that the Aconite suppressed the eruption.

d. One of the main points of interest is that as the case evolved it pointed clearly now to Apis, but the remedy was tried in very low potency.

e. As various other wrong remedies were tried, instead of becoming confused the case tended more and more to point to the picture of Apis. That was the reason why the doctors decided correctly not only to retry Apis but to stick to it. - Once you have a clear picture the remedy must act.

f. Here we have a peculiar observation: While the doctors do not report any significant change with the higher potency yet they stick to it for several weeks. I think that in this point the report is not true. They must have observed certain slight changes in the general state of the patient that gave them hope. A change of remedy at this stage would have meant death for the child.

g. Now comes the most interesting observation: While the low potency showed no result at all in the beginning, and in spite of the fact that it was definitely indicated, after the repetition it showed an apparent effect. The question is: was it the effect of the lower potency that brought the change, or was it time for the high potency to show its effect? I believe in the first supposition. The organism having been sensitised and strengthened by the high potency, it reacts now to the stimulation of the lower.

Can we infer from this that the organism sometimes is "saturated" with a repetition of a high potency and stops reacting to it, while an even higher or lower potency may further stimulate it? The case shows that the answer here is in the affirmative. The lower potency is preferable in this case due to the heavy pathology. It is also most interesting to note the fact that in order to start a reaction we need a certain vibrational frequency which is provided here by the 30th potency. Perhaps the range which could have provided an initial reaction was between 12c and 200c. Higher than 200 would have been inactive.

h. Another interesting point is that after an acute has been treated with a remedy that seems to be the constitutional remedy of the patient the whole organism is rejuvenated and finds itself in a better state than before the acute.

i. This case due to its severity shows clearly what happens if we lose courage and, under the pressure of the gravity of the case, start prescribing one remedy after the other instead of sitting back, watching and studying the case well before going ahead and prescribing.

This case exemplifies also the thorough knowledge and expertise that is required in our science and tells of the many difficulties and the different angles that we have to deal with in treating patients with homeopathy.

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Arnica Montana

ARNICA MONTANA:Doronicum plantaginis folio alternum,
Doronicum oppositifolium,
Doronicum Austriacum quartum
Ptarmica montana

English: Mountain arnica, Leopard's bane, German Leopard's bane, Mountain tobacco.
French: Amique des montagnes, Arnique, Arnica, Tabac des Vosges, Betoine des Montagnes.
German: Amika, Wohi-verleih, Woverley, Fallkraut, Luzianskraut.
Italian: Arnica
Dutch: Amika, Val-kruid, Groot Luciaen-kruid
Swedish: Fibler
Spanish: Arnica, Tobaco de Montana
Natural order: Corymbiferae, Compositae, Senecionidae.
Family: Jussieu [vegetable substance] Syngenesia polygamia superflua. L.

Mode of preparation: We use the roots, flowers and leaves. Before using the flowers we should clean them of the eggs [musca arnicae] of a peculiar parasitic insect which infests this plant, called Arnica, a species of Staphylinus. We prepare the powder of the root by making three attenuations by trituration or dissolve it in twenty parts of alcohol to make the tincture. Arnica is a perennial plant; we gather the fresh plant when it flowers in July and August and use it to make a tincture. For the fresh plant, we express the juice of the whole plant and then mix it with equal parts of alcohol to make the tincture. We must be careful not to expose the root of this plant too long in air because it loses a portion of its strength, but powdered root may be kept for long periods in well stopped bottles.

THE ESSENTIAL FEATURES

The main theme of Arnica symptomatology revolves around a deep traumatic experience upon the physical or emotional or mental body. A traumatic experience of the human organism resulting from injuries, falls, blows, concussions, fright, fear, financial loss, etc.

The experience leaves the person with a tremendous fear of coming into physical contact with anything which is hard or penetrating. The whole of the symptomatology develops around this basic fear: Do not touch me, do not come too close to me, physically or emotionally and most of all do not penetrate me, physically or metaphorically. The traumatic experience in Arnica is such that the person is left with a feeling of having been wounded deeply, and of the affected parts being so sensitive after the wounding that the idea of somebody touching them is unbearable.

They can become and act almost paranoically in this respect. From this experience a defensive attitude develops that is then quite understandable.

The symptomatology develops in different stages or degrees. We see in the first stages of pathology an aggressive reaction, where the tendency of the individual is to "attack" in order subconsciously to prevent a "too close contact". The patient is easily irritated, aggressive, quarrelsome. He will appear to be fighting with everybody and everything, very opinionated, obstinate and sometimes irrascible and irrational.

The irritability and anger lead to cursing, after which the Arnica patient becomes really furious. He is contradictory, nothing pleases him; he wants certain things and later on pushes them away. In this stage Arnica may also become capricious, not knowing what he wants, unable to tolerate anything which is disagreable and shouts unreasonably. We shall have difficulty in differentiating this case from Nux-v., Angust. or from Cina.

Arnica does not accept anybody's authority (Caust.) and thinks that he knows better than anybody else (Sulph. or Ars.). He boasts and brags frequently (Plat). He is dicatorial, (Lyc) domineering, dogmatic, despotic and talks with an air of being superior or in command. Similar to Platina.

The above is a provocative, aggressive attitude that we see in these first stages of Arnica's defensive state. Yet later on in its pathology we will see a completely different picture, a state of passiveness, extreme touchiness (Angustura) and sensitivity. In this passive stage we see that the patient becomes morose, taciturn, wants to be left alone, does not want to talk to anybody. He becomes irritated if he has to give an answer, he seems to want to avoid human contact (much like Natr-mur). If somebody tries to console or pacify him, he will react aggressively. It seems that there is an analogy between the sensitivity of his psyche which cannot withstand the closeness of a contact and the pain felt by his physical body on being touched. Even the idea that somebody may come too close to him is painful. Arnica does not wish to talk to, or to be approached by others on account of this mental, emotional or physical soreness. He may take a walk in the open air and live with his phantasies, and once back from such a walk, he will want to continue to live with the emotions he had on the walk, without talking to anybody: he wishes only to be silent.

Arnica cases are people who may appear to be social, but are so only on a superficial level. They are "loners", doubtless due to their fear that others may hurt their feelings on coming into close contact with them. They may be compared to wounded animals that want to hide and stay away from any contact. They develop an aversion to sympathy or compassion.

An important point that has to be understood in their symptomatology is that they feel "bruised" all-over and therefore even the thought that something or somebody can touch or even worse penetrate their "bruised" bodies is absolutely unbearable. That is why Arnica is the main remedy when women have an insane fear of being raped. This fear is so great that they think about it all the time, the thought that they may be raped brings on a shudder, they cannot even bear to hear the mere word "rape". The problem is that they cannot tolerate to have anything penetrating their body.

Women can reach such an extreme state that the logistics of using tampons during menses, the act of insertion into the vagina, take on the proportions of a whole operation. They will sit in a particular position and try for "hours" to insert a tampon so that they may not be hurt. It is mostly the abhorrance of the idea of penetration that causes the problem rather than actual pain. During the sexual act the Arnica woman may be so fearful during the time of insertion that the man may be put off by the overexaggerated reactions. So strong is the fear of penetration that women can abstain completely from sexual intercourse, not from lack of interest but from fear of penetration. The idea of something foreign entering their body is intolerable.

There seems to be a tightness of the vaginal muscles; the walls of the vagina feel extremely sensitive and actually painful to the slightest touch. It may appear also, after many years of abstinance from any sexual contact, that the walls of the vagina are "sticking together". The woman has the impression that the vaginal walls are so tight that they have stuck together.

These examples are indicative of the peculiar sensitivities of Arnica. In view of these facts it is now easy to understand the different symptoms as they appear in the repertory such as: "Fear of others approaching him, lest he be touched. Has fear, apprehension, dread of being struck by those coming towards him, etc". The idea of causation because of a "blunt" shock runs through the remedy and affects the mental condition as well. The symptomatology of Arnica will develop after a mental shock such as fright, anger, fury, loss of fortune, overexertion etc. It is my opinion that, in the near future, we will see proof of the existence of areas in the human brain concerned with the "instinctual mental defences" of humans. These would open and close automatically once fear or shock are over. In our contemporary society however, once these areas are triggered by a fright (mental shock), they remain in a state of permanent "excitability", that is to say, open. The person thus suffers chronically as though there were a repetition of the frightful experience every day. Why this should happen is not a question that we are in a position to answer today in detail. I have given some suggestions on this point in my book "A New Model of Health". The fact remains that, in today's world, people suffer far more frequently and easily from mental symptomatology than was the case in the past. As the mental pathology travels deeper, we get severe anxiety states that originate from such shocks or overexertions. There is fear and anxiety that could be called hypochondriacal. In the Arnica anxiety states it seems that fear goes quickly into the subconscious mind and emerges every night during sleep in the form of a crisis, often several times a night. The symptomatology is similar to that of Aconite, Argentum nitricum or Lachesis and you will have to make a differential diagnosis. There is a tremendous fear of imminent death during the night, on waking up from sleep, which is triggered by a feeling that something is wrong with the heart. These states appear especially after an accident. There is a kind of cardiac distress, an anguish that originates from the heart region, a feeling that the heart will give in suddenly and he will die instantly. The idea of dying instantly is characteristic of Arnica.

Kent describes the state beautifully: "Horrors in the night. He frequently rouses up in the night, grasps at the heart, has the appearence of great horror, fears that some dreadful thing will happen. A sudden fear of death comes on at this time, he grasps at the heart, and thinks he is going to die suddenly. He is full of dreadful anguish, but finally comes to himself, lies down and goes off in to a sleep of terror, jumps up again with the fear of sudden death and says: "Send for the doctor at once". The fear of death is very much exaggerated if he is alone.

From such an experience his whole organism is affected, there is a horror that overtakes the patient and there are congestions that affect mostly the upper part of the spine.

He becomes forgetful, absent minded, cannot concentrate, loses all interest in his work, reads something and forgets immediately what he has just read, does not remember if he has just turned off the gas and goes back to check it etc.. Oversensitive, cannot bear pain. Restless because of pain and soreness.

Then we have a mental picture of Arnica which is characteristic during high fever, in serious diseases like typhus, malaria, scarlet fever, when the eruption does not appear, or in brain damage from extravasation of blood due to a concussion, or in subarachnoid haemorrhages, in apoplexy etc.

In such instances there is a profound prostration followed by delirium and finally stupor, unconsciousness and coma. Stupor with involuntary discharges of stool and urine.

During such states the Arnica case may see delusions, imaginations, or hallucinations. He may imagine the following: high walls and buildings falling upon him; that he is about to be arrested; that he visits a churchyard; that he is holding a council; that he is seeing a mutilated corpse, black images and phantoms. He dwells upon seeing these images and phantoms; he sees black forms of spectres, ghosts and spirits when dreaming; has fantastic visions.

Arnica will have constant muttering in brain damage (Lach.) and delirium like delirium tremens. Arnica cases may also have delusions that they are well while in a severe precarious condition, close to death. They may look at the doctor and say "I do not need you, I am well", refusing to take the medicine.

Eventually the Arnica case may go into a semi-comatose state, from which, though he can be aroused and answers correctly if he is asked a question, as soon as he finishes the sentence or even before finishing it, he falls back into a stupor. This is a grand characteristic of Arnica and the remedy will definitely be indicated if the pathology is similar to the ones described above. If he becomes unconscious he will lie there as if he were dead.

In the aftermath of a brain haemorrhage, and after the severe symptoms have subsided, we may observe an indifference, an apathy. Has dullness, sluggishness, difficulty of thinking and comprehending, torpor after dreams. He is in a state where he does not take notice of his surroundings, in a dreamy state. Talks loudly in his sleep. Makes loud speeches in his sleep.

Arnica will prove to be a very helpful remedy for alcoholism as it contains the peculiarities of it in its symptomatology. It is important for the student of Homeopathy to understand that the symptomatology that is described above for the different stages of pathology occurs predominantly, though not exclusively, in the particular stage described here. Similar or identical symptomatology occurring in the acute conditions can appear in the chronic conditions as well, and vice-versa. What the student is required to perceive is the remedy's underlying trend and its characteristics

Children

Arnica children are capricious, sensitive to pain, with a tendency to shriek every time their mother touches their hands or legs. They shout in their sleep with a weeping, tearful mood, especially after eating, or after coughing. In their fevers they look like Belladona with hot heads and cold bodies. Child cries before whooping cough attack. Angry and irritable from coughing. Shrieking, screaming, shouting aggravate their cough.

Generalities

As we said in the beginning this remedy will be indicated primarily when there is an injury that has resulted from a blow upon the organism with a blunt instrument. If the result of such a blow is a bruised, sore feeling all over the body then the remedy is Arnica. But if the same kind of feeling has resulted from another cause like the overexertion of an organ, or a strain, or an acute disease, Arnica could still be prescribed with success.

If the injury has resulted in lysis of the continuation of the tissues and blood flows freely Arnica is not indicated any more.

You have to have the significant characteristic where a part or the whole body is bruised, as if it had been beaten badly and is black all over.

Arnica produces a restless state due to the soreness, to the bruised feeling, that is much like Rhus-tox.

Kent again describes the restlessness with his characteristic vivacity: "If you watch an Arnica patient in order to get the external manifestations of his state, you will see him turning and moving. You will at once ask yourself why he is restless and if you compare remedies in your mind, you will say, He is like Rhus-tox, he stays in a place for a little while and then he moves. No matter if he is only semi-conscious, you will see him make a little turn, part way over, and then a little further over, and so on, until he is over on the other side.. Then he commences again, and will shift a little and a little, and so he turns from side to side. The question is why does he move so, why is he restless? It is an important matter to solve.

We notice the awful anxiety of the Arsenicum patient that keeps him moving all the time. We notice the painful uneasiness felt all over the body with the Rhus-tox patient so he cannot keep still.

The Arnica patient is so sore that he can lie on one part only a little while, and then he must get off that part or to the other side. So if we ask him,"why do you move so?" he will tell us that the bed feels hard. That is one way of telling that the body is sore The soreness increases the longer he lies, and becomes so great that he is forced to move. With Rhus- tox the uneasiness passes off after moving, and with Arnica the soreness passes off if he gets to a new place."

We may find the symptom of lameness, soreness, of feeling bruised and the feeling that the bed is hard, full of bumps, in any chronic disease requiring Arnica but especially in rheumatic or arthritic conditions.

Aggravation of pains in the evening and night in bed, from movement and from noise. Aggravation from lying on a hard bed. Damp cold aggravates Amelioration when lying with head in a low position.

Clonic convulsions from commotion of the brain; Clonic convulsions after drugs; Clonic convulsions from head injuries. Trembling alternating with convulsive movements of limbs. Traumatic clonic convulsions that have tetanic rigidity. Twitchings as from electricity. Epilepsy after injuries to the head.

If you see a case after pregnancy where the recovery is slow with a lot of symptomatology, especially if the labour was very strenuous for the woman, then Arnica will probably take the consequences and bring a speedy recovery. Neonatorum asphyxia.

General weakness resulting from injuries. After every stool he must lie down. Asphyxia after injuries. Ailments from using the catheter.

Trembling on exertion. Fainting from shock in injury; from pain in heart; after perspiration. Faintness, fainting in angina pectoris; during fever.

Tendency to hemorrhages. The blood vessels seem to be relaxed and extravasation of blood is easy. Internally there is easy bleeding of the mucous membranes. Parts that are inflamed bleed. Hemorrhage is watery mixed with clots.

Body is cold while the head is hot. Has sore, bruised pain in spots. Sensation of deadness in the bruised part (injuries). Feels numbness externally in the bruised part. Numbness of parts, suffering in bruised parts. Pulse is faster than the heartbeat. Perspiration stains the linen red.

Vertigo

Vertigo from injuries to the head. Vertigo while reading too long. As if high objects leaned forward and would fall on him. Objects seem to turn in a circle while walking. Giddiness on getting up after sleep, on moving the head or in walking. Vertigo on closing the eyes. Vertigo in old age.

Head

Arnica is full of headaches, especially if dating from a blow on the head or after a fall or an injury that caused concussion. It must be appreciated that the constitutional types of Arnica will develop such headaches very easily, as this remedy is exceptionally sensitive to the effects of blows or falls where a concussion results in chronic symptoms, whereas in other constitutional remedies we do not see such sensitivity. The headaches of Arnica are characterised by angiokinetic disturbances where we observe heat or coldness in different parts or spots of the head. Whenever a headache is accompanied by such concomitants as coldness or heat in spots or parts think of Arnica. Also if you see contrasts in body temperature like: "burning headache while the body is cold". Headache which feels as if a knife was cutting, darting and stabbing the head followed by a sensation of coldness.

Aggravation of headache in forehead, above eyes, from the heat of a stove. Head feels cold and chilly after breakfast. Head is cold and chilly internally.

Vertex of head is icy cold. Feels coldness and chillness on his forehead, as if a cold finger were touching him in certain small spots. Heat in head during cough. Has stitching headache in forehead, during chill. Heat in head while lying down. Head is hot face is red while body is cold. Heat in spots on vertex. Headache during nerspiration. In all these examples we observe the angiokinetic nature of the headaches.

Another characteristic of headaches is their extreme sensitiveness to any kind of touch or motion and the feeling that there is a nail going through the head. "Brain feels sensitive from brushing of the hair. Pain as if a nail was driven into the brain, feels as if a nail was imbedded in the temples. Sore, bruised headache, sensitive to pressure and sneezing. Headache worse coughing. Contraction of the brow brings on headache in forehead, above the eyes."

The Arnica headaches that come mostly in the morning after waking and last up to 10 a m sometimes in the afternoon from 3 to 8 P.M. are stunning, stupefying.

Many of the headaches of Arnica are located above the root of the nose or in the frontal eminence. Headache alternating with prolapse of the anus. Arnica is one of the remedies we have to think of in cerebral haemorrhages. Peculiar symptoms of the head are: Bores head in pillow during sleep. Jerking of the head during sleep. Great desire to scratch anything especially the head. Must bend head backwards while walking. Pain as if head were distended from within outwards. Stitches in left frontal eminence with a sensation as if extravasation of blood had taken place. Sensation of contraction and constriction! on head and forehead. Crackling sensation on side of head. Sensation as of a lump or a tumor on the head.

Eye

In the eye we have a real picture of what is taking place in the mucus membranes of this remedy under pressure. We see the sensitivity of the vascular system and its tendency to break down and let the blood ooze out. So we see: Ecchymosis of the eye from coughing. Ecchymosis of the lids with swelling. Retinal hemorrhage. Bleeding eyelids. Redness in eye after injuries. Acute inflammation after injuries. Another characteristic is an aggravation of the eye condition from heat. So we see: heat brings on iritis. Warmth brings on stitching pain in eye. Warmth aggravated eye pain. Walking in open air ameliorates pain in eyes.

Exerting the eyes causes problems. Sore, bruised, tender pain in eye after doing close work. Eyes feel tired after sightseeing, seeing movies, etc. Chronic pain in the eye from a blow. Has staring gaze on waking. Right eye protrudes and looks bigger than the left. Cataract from contusion; after operation. Eyes are painful at night in bed. Tearing pain Ir> eye is aggravated when person is in bed. Has diplopia on looking downward. Diplopia from hemorrhage of retina; from injuries; from paralysis of muscles. Has flickering vision while reading; while writing. Sees black spots.

Ear

In the ears we have results of injuries to the head with many times an impairment upon the hearing. Hearing is diminished or lost from concussions; the right ear is more affected. Pain in ears from injuries to the head. Has acute hearing during chill. Has noises in the ear caused by rush of blood to the head. His own voice seems distant to him. Redness about the ear. Pressing pain which begins in the left ear and then goes over to the right ear. Suppurative inflammation with bleeding.

Cartilages of ears are sore, as if bruised.

Nose

In the nose we have mainly symptoms indicating again the tendency of the remedy for easy bleeding and ecchymosis. Epistaxis from a blow, with every fit of coughing, during typhoid fever, from washing face. Epistaxis from blowing the nose in the morning, from exertion, from straining at stool. Blood is dark. A great characteristic here is that the tip of nose is cold. Though the environment is warm the nose feels cold to the touch. The nose is cold on one side while the other side is hot. Formication, tingling in the nose. Violent sneezing from overiifting.

Paroxysmal pain in root of nose. Burning, smarting pain in margins.

Face

Again here we notice the circulatory disturbances of the remedy: Face and hands are cold on one side while the other side is hot. The nose is cold on one side. Sensation of burning heat on lips. Face is red while body is cold. Heat flushes in the face in the evening. Red discoloration of face while shivering. Red swelling of the face. Black and blue spots on face. Tingling of cheeks and lips. Picks his lips.

Eruptions under nose. Pimples on upper lip. Pimples inside nose. Pustules inside nose. Herpes with spasmodic cough. Erratic erysipelas on face. Pain in face is aggravated while lying on affected side, from noise, from yawning, from a jar.

Has trembling of lower lip. Paralysis of right side of face.

Mouth

In the mouth we have a great offensiveness with a characteristic taste like that of rotten eggs especially in the morning. This taste is very characteristic of Arnica and we shall see it in eructations as well. Anyhow the smell is offensive, putrid, especially in intermittent fever. Bitter taste in mouth during apyrexia. Mouth has a sickening odor.

Arnica could be indicated after dental work only if the person has really received a shock through it and is in great pain or distress. It is not to be given routinely after any Hental work. Still we will require certain conditions like: Toothache after filling has been ut in Toothache that feels as if teeth are sprained. Toothache that feels as though oots of the teeth were scraped by a knife. We can however keep in mind the peculiar svmptom of having toothache after a concussion. This is a great keynote. Another keynote is toothache while eating dinner which is ameliorated after the dinner. Stooping ameliorates toothache. Other kinds of toothaches are: Pressing toothache as if blood were forced into them. Toothache feels as if roots were scraped with a knife. Stitching, stinging toothache in upper right. Pain in teeth with swelling of the cheeks and tingling in the gums. Pain in gums while chewing. Profuse bleeding of gums after extraction of teeth. Gums are sore after extraction of teeth. Sense of pulsation in gums. A crawling sensation in gums.

Tongue is brown in the center with white and moist sides. Tongue dry, very dark, almost black. Stitching pain in root of tongue. Salivation during sleep

Throat

Some peculiar symptoms of the throat are: Sensation of food lodging in throat. Gurgling in esophagus when drinking. Bitter mucus in throat. Pain in throat during menses. Has stinging pain when not swallowing. Swelling of soft palate.

Stomach

The great keynote in the stomach is: Eructations in early morning that smell like spoiled eggs. Eructations bitter after anger. Eructations of mucus. Retching at night. Empty eructations during nausea. Pain in stomach extending over abdomen. Has pressing pain, as from a weight, in stomach - extending to neck.

Other peculiarities are: Stomach tension in the morning, in bed. Sensation of ball rolling in stomach. Disordered stomach from mental exertion. Indigestion after mental exertion. Stomach pain from strain. Stomach pain before cough attack.

Pain in stomach extends transversely. Pressing pain in stomach, as from a weight, extending to neck. Feeling of a lump in the back part of stomach. Gurgling when drinking. Aversion to brandy and whisky in habitual drinkers. Aversion to broth, to meat, to milk. Aversion to meat in soup. Loathing of food with a feeling as if stomach is full. Desires vinegar. Constant desire to drink but does not know what as all drinks seem to her offensive. Vomiting from movements of fetus. Vomiting of dark clotted blood; of milk.

Abdomen

We can say in general that in every pathological condition or activity (pregnancy) that is centered in the abdomen we shall see this peculiar tenderness, soreness, bruised feeling, a great sensitivity with aversion to being touched. There is pain with every cough, with every step or jar.

The movements of the fetus are felt intensely and keep the woman awake the whole night. Movements of the fetus cause nausea and vomiting.

A keynote of Arnica in the abdomen is a feeling of sore, bruised, tenderness in the inguinal region that forces the patient to walk in a bent position. It has the same sore bruised tenderness in the abdomen during stool. Dull pain in inguinal region on coughing. In inflammatory conditions of the abdomen, liver, intenstines, appendix etc there is a lot of tympanitic distension with frequent urging for stool with prostration, uneasiness and great sensitivity. Distension of abdomen after supper. Anxiety felt in the hypochondria. Twitching and jerking in hypogastrium.

Abdomen has crusts; scales; vesicles.

Rectum

Offensiveness is a great characteristic of Arnica: Offensive flatus that smells like spoiled eggs. Stool extremely offensive. Has diarrhea after injuries, after emotional upheavals. Diarrhea the whole night. Involuntary stool at night during sleep. Obstinate constipation where the rectum feels loaded with stool but feces are expelled with great difficulty. Pressure in rectum while standing. Stool fermented, like brown yeast, undigested, bloody, with mucus. Black watery stools with black vomit.

Urinary organs

Arnica is one of the main remedies for retention of urine after exertion, after injuries like concussion of the brain or a violent accident. Suppression of urine from concussion of spinal column. Inflammation of bladder after injuries.

Some of the labor after-effects could be: Dribbling of urine [by drops] after labor. Involuntary urination after labor. Has dribbling of urine, night and day after labor.

Involuntary urination while running. Retention of urine in chill; during colic. Chilliness after urination. Ineffectual urging to urinate during chill. Itching sensation in anterior part of urethra. Brown sediment in urine. Urine is black like ink.

Male – genitalia

Arnica in the first stages seem to overexcite the sexual passion in men and to make the rson qUiCkly aroused sexually while at the same time taking away the power to hold erection for some time. The overexcitation can bring on an easy and premature ejaculation, so much so that an orgasm can take place even in the stage of carressing and kissing. For the same reason we find daytime seminal emissions and also nightly seminal emissions which come too easily. Eventually we may find impotency. Sexual erections in morning after waking. Erections without erotic thoughts

It has been observed to increase the sexual passion in an old man with continuous erections. Aching pain in testes. Inflammation and swelling of testes from contusion. Hard swelling of penis. Bluish red swelling of penis. Hydrocele caused by a bruise. Painful swelling of the spermatic cord, with shooting in the testes, extending to the abdomen. Has eruptions on scrotum that look like blotches.

Erysipelatous inflammation of scrotum. Pimples on penis, prepuce. Blotches on scrotum. Hematocele

Female – genitalia

As we have described already Arnica patients have tremendous sensitivity and tenderness in their sexual organs; they do not want to be touched there, they feel extremely painful and therefore prefer to avoid coition. The idea that the penis will enter their body is unbearable. Tremendous fear of rape for this reason. The soreness and tenderness in ovaries is so great that it is aggravated by walking.

Arnica is frequently indicated in all stages of pregnancy, during labor if the pains though severe are ineffectual. During pregnancy if the mother experiences pain or vomiting from the movements of the fetus, or if the fetus lies in an abnormal position, for instance crosswise, in asphyxia in a newborn infant where the baby comes out bluish red and you may feel that it will not survive, especially after a laborious labor. After labor where there is slow recovery from pregnancy and its consequences, if she has pains after instrumental delivery, if there is great haemorrhage after parturition. During the time of nursing if she has after-pains when nursing child or if there is pain in uterus while nursing the child. Alternation of uterine with mind symptoms. Threatened abortion from injuries, falls, shocks. Metrorrhagia after coition; after concussions. Walks bent over in prolapse of uterus. Shocks from copious menses. Foamy menses. Hot menses.

Chest

Shooting stitching pains on both sides of chest that prevents breathing is a great keynote for Arnica. Stitching pain when walking, aggravated by sneezing.

Pressure ameliorates this pain but also pressing aggravates a kind of sore, bruised pain in chest.

He has to hold the chest with both hands during cough to prevent pain, much like Bryonia. Has bruised, sore pain in chest upon respiration. Pain, as from a sprain, is aggravated by deep breathing. Inflammation in mammae from bruises. Induration of right mammae. Inflammation of nipples. Costal cartilages feels sore and bruised.

Arnica is one of the main remedies for a heart enfract as well as for angina pectoris or other cardiac problems. The peculiarities of this remedy in this respect are expressed through the following symptoms: Angina pectoris with pain extending to the elbow of left arm. Has stitching pain in heart with fainting. Has sore, bruised pain in region of heart. Heart strain from violent exertion. Palpitation during anger. Icy coldness of heart during chill. Constriction, tension tightness of chest after eating. Touch aggravates constriction, tension, tightness in chest. Grasping sensation in heart. Cardiac dropsy with distressing dyspnea.

Red perspiration. Offensive perspiration. Tickling cough in the morning after rising. Cough at night during sleep without been awakened. Cough begins one hour after going to sleep.

Respiration

Asphyxia in newborn infant where they can come out bluish-red and you may feel they are not going to survive, especially after a laborious labor.

Children who are coughing after they had been weeping and sobbing because of some ungratified caprice or because they were refused something they wanted. Children cry in whooping cough as they feel that an attack is coming.

It is interesting that in Arnica like in Cuprum there is a definite effect of the mind or emotions upon the respiratory system where we see : Cough from mental exertion or from grief or from lamenting. Coughing causes blood shot eyes or epistaxis.

Dry morning cough which is loose in the evening. Dry, tickling cough coming from low down in trachea. Noise aggravates cough. Spasmodic cough with facial herpes.

Whooping cough in the evening until midnight. Hoarseness worse from exertion, or from exposure to cold and wet. Asthmatic respiration from fatty degeneration of the heart. Difficult respiration after anger; cough with heart affections; irregular respiration while standing. Expectoration glairy. Blackish expectoration with lumps in center. Bloody expectoration at night. Hemorrhage that's coagulated and dark. Hemorrhage after exertion. Hemorrhage is frothy and foaming in character.

Inflammation of lungs approaching paralysis

Back

There is a sore bruised pain all over back, patient is weak and tired, wants to lie down yet bed feels too hard. There is a weakness of the muscles of the neck and the head tends to fall backwards. It is of course indicated in injuries of the spine. Has sensation of sore bruised pain during shivering. Important modalities are: Stitching, shooting back pain on breathing; when inspiring; on walking.

Pain in the lumbar region while lying. Pain in the lumbar region extending upwards made worse on stooping. Stitching, shooting pain extending to knees.

Has back pain on retaining urine. Back pain in cervical region when sneezing. Back pain in sacral region extending to groin during menses; extending down legs to great toe. Involuntary jerking pain when pressing on dorsal vertebrae. Back spasms while nursing

Extremities

Again we must stress here that in Arnica we may find the hands or the legs cold while the head and the face are hot. There is coldness of hands with internal heat of the whole body. Pain in extremities before chill. Thigh is cold in the morning.

The extremities feel sore and bruised especially when in contact with the bed.

Pains of the joints, especially wrists and ankles after injuries. Feels pain as if the wrist is dislocated. Tearing, sticking pain in wrist. Cracking in wrist. It feels as if wrist is dislocated when in motion. Has pain in ankle when in motion. Pain in joints of toes. Foot feels heavy after walking.

Drawing pain is felt in the hip while sitting with the thigh extended. Lower limbs feel as if they are sprained. Tearing pain in hand is ameliorated by letting arm hang down.

Arnica affects the peripheral nervous system causing a lot of peculiar symptoms such as: Sensation of paralysis in joints. Paralysis of shoulder while walking.

Sudden twitching of extremities. Twitching of the inner side of the thigh near genitals. Twitching of second finger. Shaking of extremities after faintness. Has shuddering of the shoulder and thigh shivering. Convulsive motions alternating with trembling of the body. Painful jerking of the ulnar side of the hand. Painful jerking of the shoulder. Weakness in upper limbs when taking hold of something.

Weakness in the foot while walking in open air.

Perspiration of inner side of upper limbs. Painful and symmetrical eruptions are the characteristics of Arnica on the extremities together with the ecchymosis:

Varices on lower limbs during pregnancy. Varicose tumors of the leg. Has blue spots on thigh. Has blue marks on thigh; yellow marks on thigh. Carbuncles on the thigh. Painful eruptions. Painful eczema on fingers. Painful eruption on the knee; Erysipelatous inflammation of foot.

Sleep

We see much of the excitation of arnica in their sleep. Sleeplessness for two or three hours until midnight, during climacteric period. Has sleeplessness because bed feels too hard. Has sleeplessness from painful motion of fetus; from mental and physical overfatigue. Wakes in the morning from the heat. Wakes during night with head hot and is afraid to go back to sleep because is scared that he will have a brain stroke. Wakes with soreness.

In Arnica we see a lot of vivid anxious dreams or nightmares: of being buried alive; of suffocation; of funerals; of graves; of mutilated bodies; of black dogs; of black animals; black cats; of black forms; of lightning. Has repeating dreams. Dreams seem true on waking.

Sleepiness in cholera infantum. In brain stroke we observe a very restless sleep with much drowsiness. He answers a question and during answering is falling back to sleep. His head is hot and the face flushed. Bores head into pillow

Talking in his sleep. Involuntary stool or urine in sleep.

Fever

Has continued, petechial fever, typhus, typhoid, with foul breath. Violent congestion of the head, with body cold. Fever is accompanied by chill from uncovering. Chilliness on slightest movement of the bed-clothes; from putting hands out of bed. Chilliness on the side on which he is lying. Chilly with heat and redness of one cheek. Feels burning heat in one spot which is cold to the touch. Vomiting during fever. Fever in affected parts. Fever comes in paroxysms, is changing. Fever occurring at night, 4 A.M. without chill. Before the fever there is a dragging sensation in all the bones. Sour perspiration at night. Musty odor. Stains the linen red.

Skin

Ecchymosis, black and blue spots is of course the great characteristic, but also crops of small boils can be considered a keynote. Symmetrical skin eruptions. Acne indurata that are symmetric in distribution. Green spots on skin. Blackish spots. Shiny, hot and hard swelling of the parts that are affected. Ulcers with bruised pain. Dirty ulcers. Ulcers have mottled areola. Skin is mottled during chill

Small pimples. Purpura miliaris.

CLINICAL

Skin
Abscess. Bed sores. Boils. Bruises. Carbuncles. Ecchymosis. Excoriations. Sore nipples.
Stings. Wounds.

Muscular system
Back pains. Paralysis. Lumbago. Rheumatism. Sprain. Exhaustion.

Nervous system
Apoplexy.
Brain haemorrhage.
Chorea.
Headache.
Meningitis.
Paralysis.

Gastrointestinal system
Fetid breath. Diabetes. Disorders of taste. Thirst. Hematemesis.

Respiratory system
Bronchitis. Chest affections. Pleurodynia. Nose affections. Whooping cough.

Circulatory system
Pyemia. Heart affections.

Urogenital system
Dysentery. Impotence. Labor. Miscarriage. Hematuria.

General
Purpura. Splenalgia. Traumatic fever. Tumors. Sore nipples.

CAUSATION

Mechanical injuries. Traumatic experiences on all levels physical, emotional or mental, fright, fear, financial loss, etc.

RELATIONSHIPS

It is complementary to: Aconitum napellus, Ipecacuanha, Veratrum album, Hypericum and Rhus toxicodendron.

It is followed well by: Aconitum napellus, Apis mellifica, Arsenicum album, Baryta muriatica, Berberis vulgaris, Belladonna, Bryonia, Cactus grandiflorus, Calcarea carbonica, China officinalis, Chamomilla, Calendula, Conium, Curare, Hepar, Ipecacuanha, Nux, Phosphorus,Ledum, Pulsatilla, Psorinum, Rhus toxicodendron, Ruta, Sulphur and Veratrum album.

It follows well: Aconite, Apis mellifica, Ipecacuanha and Veratrum album.

ANTIDOTES

It antidotes Ammonium carbonicum, China, Cicuta, Ferrum, Ignatia, Ipecacuanha and Senega.

It is antidoted by: Camphor, Ipecacuanha, Coffee, Aconite, Arsenicum, China, Ignatia.

Alcoholic stimulants, wine and coffee are inimical to it.

DOSAGE

Arnica should be given in the highest potencies especially in conditions arising from traumatic experiences.

CASES

1. In a case of whooping-cough, in a boy five years old, with light complexion, sandy hair, and sanguinous temperament. The paroxysms were attended with a great deal of "whooping" and bleeding of the nose; the eyes were blood-shot. A single dose of three pellets of Arnica montana, was given in the evening, and he never whooped afterwards. He coughed occasionally for a few days, but in the course of a week, he was entirely well. There was but the one dose given.

2. Effects of a blow, Concussio Cerebri. - A. C, a boy three years old, of lymphatic-sanguine temperament. The child had been healthy at birth and remained so till a year ago, when he was found paralytic on one side, without any known cause or previous illness, as reported. Under the use of blisters and leeches he had recovered in three months and seemed well up to the present time, except that the affected limb seemed smaller and colder than the other.

A fortnight ago he received a violent blow on the nose and soon after was seized with headache, fever and sickness, which have continued since. His present symptoms are, -

He complains constantly of pain in the head, great heat in the head. In the morning coldness and shivering, followed about 2 P.M. by heat and dryness of the skin all over the body, not succeeded by perspiration.

The heat continues during the greater part of the night, attended with great thirst, sleeplessness, restlessness and sickness and towards morning he falls into a heavy sleep with sonorous breathing.

No appetite - foul tongue and breath. Does not pass urine during the day, but at night passes a considerable quantity of strong smelling, high colored urine. Nothing remarkable was observed in the state of the pupil.

The first symptom, "pain in the head," is too indefinite to lay any stress on; the next, heat in the head, is of more importance and is one of the characteristic symptoms of Arnica.

The shivering in the morning and forenoon, followed by heat without perspiration, the heat with thirst and restlessnes and sleeplessness, and the heavy sleep with loud breathing, are quite homeopathic to the action of Arnica. Also the foul tongue and breath, and likewise in a marked manner the dysuria.

The Arnica being then perfectly homeopathic, both in respect to the etiological condition and the existing affection, was accordingly administered in the 6th dilution [billionth], to be taken night and morning. The result was, that in a few days the child was perfectly relieved from all the above symptoms.

Cases 1 - 2: The Journal of Homeopathic Clinics, Edited by C. Hering, M.D. and H. N. Martin, M.D., Philadelphia, 1869.

3. ... A stout, strong young man was helped into the room almost bent double with severe pain. He worked for the Union Transfer Company, handling trunks and a trunk had fallen off the delivery truck, the corner of it striking him in the left lower ribs. His face was drawn with pain and he could not help groaning. I put a dose of Arnica 2C. on his tongue, gave him three or four to take home with instructions to put one in 1/4 glass water and take a teaspoonful every 15 minutes for four doses. This group was to be repeated in two hours and again in four hours if necessary. I charged him to come back anyway on next clinic date, three days later. At that time he burst into the room demanding to know the name of that stuff. I told him it was Arnica. Then he told me excitedly that by the time he was half way home, he could straighten up and breathe much easier and by night the pain was about gone; none since. He had taken two groups of doses but no more.

4. A neurasthenic young lady consulted me for fatigue of the vocal organs in the upper register. There was a suspicion on my part of hysterical paralysis of the vocal cords. Repeated examination did not confirm this view and my treatment was in vain for ten days. I then had her sing the scales and vocal exercises to me. I immediately perceived that on account of deficient voice culture, she was compelled to strain her voice in singing the upper register. On consulting her teacher my opinion was corroborated. 1 gave her Arnica a dose every day for three days and requested her also to take a similar dose after each lesson.

In the five months which have elapsed there has been no new attack of fatigue of the voice...

5. Male, aged 17. First, second and third toes of left foot crushed. Amputation performed. Three unhealthy ulcers remained. Great pain at night, preventing sleep. No improvement in three months from Bichloride of Mercury, Creolin, Balsam of Peru, Ichthyol, Calendula and Aluminum acetate externally; Hepar sulph., Nux vom., Silica and Calendula internally, and Morphine hypodermically, prescribed by attending surgeon and his assistants. Re-amputation was considered by the surgeon, a man of great ability in his field. When called in the case I prescribed Arnica 30th, internally and a dilute Arnica dressing, externally, on the following characteristic indications: Great soreness with fear of being struck by those approaching the bed. He improved at once, slept the first night after receiving the remedy and was completely cured in nineteen days.

6. Mr. H. Right nostril bleeds on washing face, and sometimes when straining at stool. Arnica m.m. [Fincke] one dose, cured at once...

7. A man living twenty-five miles in the country was taken suddenly with unconsciousness. He does not remember getting out of bed, or eating breakfast. Left the table and went out to a wagon. He leaned his head upon a trunk-rack for a moment, then suddenly straightened himself up and fell backward in a perfectly rigid state, striking his head upon the hard ground. He came to his senses about noon and was brought home. I saw him in the evening. He complained of terrible pain throughout the back of the head, and all through the brain, of a bruised character. I gave him Arnica cm, one dose, and nothing else. The next morning the pain was all gone from the back of the head. He was ever so much better, only had slight pain in the frontal region. Next day entirely well. I have no reason for reporting the case further than for the potency used. One dose did the work. I want to put it on record for the benefit of the weak and not let it die an ignominious death in the dark.

8. An officer, some 30 years old, came to see me February, 1892. He had been ill since October, 1891, when his right inguinal gland had swollen suddenly and began to suppurate. In his garrison the military surgeon had made an incision, but the gland did not stop suppurating and though the skin closed again, there was a fistula left and after every long walk, more pus came out and the irritation of the gland was shown by pains all through the right leg. The officer could do no service and was practically an invalid. Having had homeopathic treatment in his boyhood, he came to see me on the 11th of February. I gave Arnica 30, because I heard that the initial irritation of the gland had started after a very long military march. After nine days the gland could be palpated and the cicatrix, which was deep in the flesh, could softly be massaged. This was done up till the 27th of the same month and then I dismissed the patient with some Arnica in his pocket, to take in case of need. When I saw him ten months later on his Christmas leave, he told me that from the 5th of March he had done service all the time.

9. A student of twenty-one had been struck full in the left eye with a tennis ball. He came to me an hour after the accident. I found ecchymosis extending to the peri-orbital region, which was tumid and painful. One drop of 2% cocaine made it possible to examine the eye, which was photophobic and lachrymating abundantly. The upper and lower lids were swollen and painful. The lower palpebral conjunctiva had been torn and there was widespread ecchymosis. There was much circumcomeal injection and the superficial layer of the cornea had been torn. The corneal wound involved the whole of the pupillary area, forming flakes which could easily be detached. The patient felt smarting pain and a very unpleasant sensation of scratching under the eyelids. The anterior chamber was normal, tension good, pupil reacting well; examination of the fundus showed nothing in particular. Sight normal. Treatment: Bathing with sterilized water and a few drops of Calendula [mother tincture]; then a damp, aseptic, occlusive bandage with a few drops of mother tincture of Arnica; and to be taken internally, Arnica 10M [Skinner], one dose. Twenty-four hours later the cornea was glossy and the epithelium had already healed. The patient had slept perfectly well, and after four days of occlusive, sterilized, daily bandages soaked in a little Arnica, all the symptoms disappeared and the patient was completely cured...

10. Some years ago a doctor wrote for help. He had had distressing breathlessness after running 80 yards [a month previously]. Heart had continued weak, with slight pain, and pulse slow. Awoke in the night with oppression of chest, anxiety and fear. Can't run up stairs without breathlessness. Legs heavy - head fuzzy. Heart-sounds normal; weak: no heart disease. "Heart's weakness suggests early death, yet calm and not anxious."

Arnica was sent, and he wrote, "Arnica had the desired effect. All symptoms went within 48 hours. I'm all right now."

11. We are often perplexed by those paralytic conditions that come into our offices from time to time. In January 1926 one of our real estate men, who had been apparently always in good health, came into my office dragging his left foot. I noticed too that his left arm swung rather helplessly, the left eyelid was closed, and he had it suspended by a little strip of adhesive plaster. His tongue seemed to be pretty thick, he was unable to articulate distinctly, the muscles of the pharynx functioned backward so that when he attempted to swallow the food it would regurgitate through the nose; that was especially true with drink. Solid foods he could not swallow. He was a man sixty-five years of age and my first thought when he came in was, "Well he belongs to that overworked class that naturally drifts into these paralytic conditions."

In talking with him a little while, I really forgot the significant feature of the trouble, as we often do. I prescribed for him Causticum, but as days and weeks went by, results were negative. He thought he was doing fairly well, but I did not think so. The latter part of February, his sister, an old friend, came into my office and asked me if this man had ever told me about his accident. "No." Then she told me herself, and she repeated later on, that on the Christmas previous, his son-in-law, who had become demented, was taken into his home, as he was unable to support his family. They had two little girls. On of the little girls did something that displeased him on Christmas day and he took the child by the shoulders, lifted her up and bounced her down on the floor as hard as he could. This old grandfather objected to such procedure. The son-in-law is a very robust man, and he struck Mr. Wolfe on the right mastoid, knocked him down and the old man lay unconscious for an hour and a half, and after he was able to get up, these things came on.

I was very glad to know that. In the latter part of March, I think it was, when I got the secret of the matter, I gave that man a dose of Arnica 10M. In about ten days he reported feeling a little better. I let him rest, I think something like thirty days, on that one dose of medicine. Then I repeated my remedy when I saw that the symptoms were about at a standstill and he bobbed up again and began to improve quite rapidly so that I dismissed him practically cured in April. He was so that he could eat solid food, he could drink without regurgitating through the nose, he could keep his left eye open and instead of dragging his left foot he walked very well.

Last summer, after a year's absence he came into my office walking like a soldier. "Good morning, Dr. Dienst, I came in to let you see how I could walk," and he has walked that way ever since, for I saw him the other day on the street, feeling fine, attending to his work and with his left eyelid, his left foot and his tongue all normal...

12. Mrs. S., 48, corpulent, of healthy appearance, states that in the last six years she has suffered twice from uterine hemorrhage. During the last three months she has had small hemorrhages for a day after every intercourse with her husband. But now it happens not only after such acts, but also from slight pressure at evacuation; she is not costive and her kidneys function normally. The hemorrhage is of bright red color and sometimes slightly coagulated; it is accompanied by pain in knees and hands. Examination with speculum shows nothing abnormal in vagina nor on cervix.

The remedy selection is based on the cause occasioned by sexual intercourse and pressure at stool and we know that both involve slight traumatism or force. It is clear that in this case every slight effort produces the hemorrhage. Consequently we thought of Arnica montana and it was given in the 6x potency, eight globules three times daily. On the second consultation the patient states that she has been free from the hemorrhage for six days. Gave placebo.

Here we see confirmed all we have heard and experience in our practice that the bad effects of force almost always fall under the action of this grand remedy and that its internal use generally shows its great therapeutic value in traumatism, even of the minimal sort.

13. Mrs. R. Y. complained of spitting blood, and during the consultation there was proof of it, thick and slightly foamy, red. It was easily ejected without cough. There was slight pain in chest, but much agitation and fear showed in her face. She was not nauseated, nor faint. Arnica 6x. every ten minutes was prescribed and complete rest ordered. Soon the cure was complete.

14. Mrs. J., 48, nurse. Diagnosis: Prepatellar bursitis on both knees for half a year. Tincture of iodine, aluminum oxide had been used without result. Aspiration had helped only temporarily. Prescription: Arnica 30 every evening, seven globules to be sucked. Night knee-pack with dry arnica flowers.

Course: After four weeks complete cure. Patient reports that her fear complex and cardiac weakness, which she had not mentioned previously, were very much improved, and her superintendent has remarked upon it too. It is to be regretted that she did not have the courage to report the homeopathic cure to her chief physician.

15. Mrs. S., aged 58 years, on March 6, 1913, had an operation for complete procidentia with ulcerated cervix, considered possibly malignant. Complete hysterectomy and appendectomy were done. Her recovery at the hospital was uneventful and she returned to her home after three weeks. It was following this that she became a patient of mine. Mental confusion began after being at home about one week. Desire to sleep nearly all the time; heavy unnatural sleep. Became indifferent to her surroundings, especially as to her personal appearance [naturally very neat.] Dazed at times; unable to remember what she had been doing at home. Physically, appeared stronger each day, which she laid to the relief from the mechanical condition that had existed previous to operation. Became childish, irritable, feelings easily hurt and especially so with her husband. When asked how she was, always said, "I feel fine!" Talked incoherently; began things and did not finish them. One day turned on the gas in her cooking range and then went away without lighting it. At another time went out on the street in night dress and kimono to a nearby store, returning a bag of coke, telling the storekeeper it would not bum. Dreamed of fire at night and wakened with a start. Head hot, especially occiput and feet cold. General aggravation in morning; in afternoon remembered some of her strange actions of the morning.

April 24, 1913 - Became violent, rave, screamed, cried, threw herself violently on and off the bed. Talked incessantly; saw weird lights; devils, strange people, her dead children and numerous other things. Rubbed her hands and feet back and forth until they hurt, but could not stop herself.

Was so much upset that a consultation of doctors was held, during the same afternoon and she was able then to give a fairly clear account of things, seeming to remember how she had acted in the morning. Usual afternoon amelioraton. During this time, I had prescribed Sulphur, Sepia and Natrum mur., with little, if any, result, the consulting doctor was an allopath and advised no medicine; simply rest, outdoor air, and happy occupation for her mind. So I was still left to prescribe any remedy I thought indicated. That evening, in thinking the case over again, it occurred to me strongly that the entire condition appeared to be the result of the operation and so I gave her Arnica 30th, three powders.

April 25 - In the morning, showed a slight indication of excitement, but was easily quieted.

From that time she steadily improved and has had no return of any such mental condition since...

Margaret Tyler in her book Homeopathic drug pictures mentions some representative cases of arnica:

(1) She was taken ill one night with stitching pains in the chest that made breathing a proposition. Her husband tried to help her with various remedies probably Aconite, certainly Bryonia, but in vain. Then in a "Domestic Homeopathy" he discovered "batrd pleurisy" with its remedy arnica; and he gave her a feww globules. They were scarcely swallowed when, with a long sigh, and "that is the first breath I have been able to draw tonight!" she was fast asleep in a moment.

(2) He was a doctor who wrote that for more than a month he had had distressing difficulty in breathing, since running eighty yards. He would wake at night with "oppression in chest anxiety and fear.""Heart weakness suggests early death.".he said, yet he was "calm and not anxious.." "legs heavy; head fuzzy; could not run upstairs. Heart sounds weak, but no disease." Arnica was suggested and he wrote back: "Arnica had the desired effect! All symptoms went within forty-eight hours I am all right now."

(3) A doctor, overfatigued mentally and physically lost all interest in work. His usual self-confidence disappeared, so that he began to doubt his prescriptions and wonder whether he had prescribed too much of this, or even the wrong medicine. He was never sure whether he shut the door or turned off the lights; had to go back and see. He was naturally keenly alert, and this change of mentality worried him. Arnica 1.000 put him right in a few days, restoring perfectly his memory and self-confidence.

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Arsenicum Album

Acidum arseniosum
English: White arsenic, Arseniuous acid, Arsenic Trioxide
French: Arsenic, Oxyde blanc d'arsenic, Acide arsenieux
German: Arsenik, Arsenige Saure

Mode of preparation: 5 centigrams are put into a vial with 4 grams of distilled water; the arsenic is dissolved by heating it, and water is added as it evaporates. Then 4 grams of alcohol are added to this and mixed well. One drop is then added from this preparation to one thousand drops of a mixture that is equal parts water and alcohol. Ten drops from this solution are added to a bottle containing ninety drops of alcohol. This is the second attenuation, and all the succeeding attenuations are made in this way. A second method used by Hahnemann was to triturate one grain of white arsenic with 100 grains of sugar of milk, making three triturations in succession, so that afterwards he would be able to make the remaining attenuations the liquid way.

THE ESSENTIAL FEATURES
Arsenicum is a classic remedy; its general characteristics are well-known to all homeopathic practitioners. Originally proven by Hahnemann himself, Arsenicum has since been exhaustively described in every materia medica. The classic description in Kent's materia medica covers all the essentials in both the acute and chronic states: Anxiety, Restlessness, Aggravation by cold, Worse after midnight, Thirsty for sips, Periodicity, Alternations of symptoms, Ulcerations, Burning pains, etc. A mere cataloguing of symptoms can be misleading in actual prescribing, however, unless the image is rounded out by an understanding of the essential dynamic process and stages of development of the remedy, particularly in comparison with other similar remedies.

The essential process underlying the Arsenicum pathology is a deep-seated insecurity. From this insecurity spring most of the key manifestations known in Arsenicum. The insecurity is not a lack of confidence on a social or professional level, but rather a more fundamental sense of vulnerability and defenselessness in matters relating to disease and death. From even the earliest stages the Arsenicum personality is dominated by this insecurity.

Arising from the insecurity is the Arsenicum dependency on other people. Of course, Arsenicum is a prominent remedy listed under the rubric "Desires company." In reality, the Arsenicum person has more than a mere desire for company; it is an actual need for someone to be present near him. Arsenicum surrounds himself with people because of his insecurity concerning his health and his unaccountable fear of being left alone to face possible health hazards. The need for company is not necessarily a need for interaction with people, such as in Phosphorus. Arsenicum needs people nearby more for reassurance and support in case something happens to him.

For this reason the Arsenicum patient becomes very possessive - possessive of objects, of money, and especially of people who are near, such as a wife or husband. The Arsenicum person does not readily employ a give and take dynamic in his relationships. He is much more selfish; he tends to be a "taker." In a relationship he will give support to another person, but primarily with the expectation of receiving support in return. It is in this sense that Arsenicum is a selfish remedy.

The possessive quality of Arsenicum extends to physical possessions as well as people. He is reluctant to give money or material objects away; he is even stingy with his discharges! (The discharges in Arsenicum are scanty; they are not "generous," not profuse. Should the discharges become really profuse and thick, great relief is afforded his constitutional symptoms.) He may appear to be generous on occasion with his money or possessions, but he gives with the expectation of receiving in return, and he will be upset if the anticipated returns do not materialize. The same possessiveness leads to a compulsive collecting nature. If there is anything that he believes might be of some value, even some insignificant little item, he will carefully store it somewhere where he will be able to find it easily later. He does not want to throw anything away, does not want to waste anything; miserliness and avarice are the results of this attitude. Yet Arsenicum does not have the fear of poverty that might be expected. On the contrary, he feels secure that he has enough in case of need due to his avaricious nature.

As the disturbance on this level progresses the miserliness becomes more pronounced. As mentioned, the patient hoards everything that may have any conceivable future value. He cannot bear to part with anything he has collected: boxes, useless odds and ends of repair materials, scraps of paper, as well as truly valuable objects are carefully stored away ( Mercurius ). Of course, the patient himself will never offer this symptom, rather he wonders at the wastefulness of others around him. Furthermore, if any of his possessions become damaged, he is greatly alarmed. For example, if the roof of his house leaks and causes even some trivial damage to his furniture, it is a major catastrophy to him. He may even become ill from his reaction to this event, as if something of himself were ruined.

Although capable of enjoying life very much, his enjoyment is quite restricted, restricted by the extent and specificity of his desires. It is as if he clings to life and its pleasures with a sticky tenacity. His greed frequently is satisfied only by the best of everything. Arsenicum often gauges the value of things (people, pursuits, pastimes, etc.) according to their usefulness to him, the extent to which they satisfy his needs and desires. And, having determined what it is he needs, he will then pursue his goal with rigid determination. For example, in the interest of attaining better health he will attend to his diet in a very meticulous, almost hypochondriacal way, severely curtailing the range of allowable foods. Or an Arsenicum woman may choose a mate because he is clean and has a good, secure job, her choice being based more on the feeling of security he evokes than love. Security and comfort is of primary concern.

The Arsenicum patient perceives events in the world from a purely personal standpoint. His philosophy is: look after yourself first, everything else comes second. If something happens to someone else, the Arsenicum person will think first of what it means to himself. For example, if an auto-accident occurs, the Arsenicum patient will not rush instinctively to help. He may not think at all of the other person, but only of the implications to himself. Sometimes he will not go near the scene for fear of facing bloody situations that will stimulate his anxieties and fears for his own well-being. In contrast, the Phosphorus patient's heart will automatically go out to the victim; he readily puts himself in the place of the other person. The selfishness of Arsenicum is completely different from that seen in Sulphur, Medorrhinum, or Platina, for there is no egoism per se; rather, the Arsenicum patient is totally preoccupied with his own fears, needs and insecurities.

Next we consider the well-known Arsenicum trait of fastidiousness. Here it is important first to reiterate that in homeopathy we do not prescribe on the basis of beneficial traits, but only on pathological qualities. Thus, if someone is neat and orderly as a manifestation of an orderly approach to life, this would not be considered a limitation, or a symptom. The same could be said about a perfectionistic quality of an intensity akin to normal orderliness. On the other hand, we see people who are compulsively fastidious, obsessed by the need for order and cleanliness to the point of expending inordinate energy, constantly cleaning and straightening. An Arsenicum housewife will be seen following after the guests who are entering her house, immediately repolishing the already meticulous floor so that even the slightest stepmarks will not be visible. An Arsenicum visitor will get up and straighten a picture which is hanging on the wall slightly askew. This same individual may not be able to restrain himself from repositioning a tablecloth in a restaurant which is not hanging symetrically. He will spend quite a bit of time symmetrically arranging his shoelaces; otherwise he will be bothered by their asymmetry. This excessiveness characterizes the Arsenicum fastidiousness.

This passion for neatness will also be reflected in Arsenicum's personal appearance. Even if he has owned a suit for many years, so neat and clean does it seem on him that one is left with the impression that it was recently purchased. He attends to his clothing with great care and precision; on arriving home, for example, he will carefully and neatly fold his clothes and put them away so that on the following morning he will be sure to find them in an immaculate condition. He enjoys rendering such care and spends an inordinate amount of time at it. The wardrobe of the Arsenicum is something beautiful to look upon: everything is aligned with unbelievable precision. Such uncompromising attention to detail results in the well recognized immaculate, perfect appearance of Arsenicum. Perfectionism is another characteristic. He cannot overlook an error or inadequacy in his work, no matter how insignificant; he is compelled to continue working until he is satisfied with the results. It is this inner drive for perfectionism that leads him to be very critical, very censorious of others. He readily criticizes anything done by anyone else, and his keen perception readily brings any existing imperfection to light. He is exhaustively fault-finding: the stove is burning too high, the light in the room is too low, his shoes are not in the right place, etc.

Arsenicum patients are greatly aggravated both psychologically and physically by the disorderliness of a messy room. Children with acute high fevers, for instance, will ask that their bed be straightened, covers hung properly and that the room be in order before they can feel restful, this despite the fact that they have a 40 degree (centigrade) fever and feel exhausted. This desire for neatness perhaps represents an obsessive attempt to temper the anxious insecurity felt inside by creating order and cleanliness in the external enviroment.

This passion for order and cleanliness can be so great that in more mentally disturbed cases serious obsessive behavior concerning dirt and microbes can result. These people will wash not only their hands, but also their clothes many times over. Some slight contact with another person may precipitate an intense feeling of uncleanliness. Their concern about being contaminated may cause them to avoid physical contact with others. These individuals may suffer a similar sense of uncleanliness as a consequence of contracting some physical disease, especially a skin rash. If a doctor tells them, for instance, that they are suffering from a fungal infection, they will immediately feel dirty inside [their body] and begin a paroxysm of frequent bathing. No amount of washing, however, will eradicate the feeling. They are very easily disgusted, not so much when eating at a friend's home, as in the case of Sulphur, but more by seeing or coming into contact with dirt.

The fastidiousness of Arsenicum can be compared to that of other remedies. While the Arsenicum fastidiousness arises as a consequence of anxiety and insecurity, the fastidiousness of Nux vomica arises more from an excessive compulsion for work, from overly conscientious attention to details, and from an exaggerated sense of the need for efficiency. The Natrum muriaticum fastidiousness is similar to that of Nux vomica, but it is more specifically concerned with the scheduling of time.

In studying remedies it is crucially important to have an appreciation of the stages of development of the pathology. Otherwise, if we see a patient at a given stage, we may miss the remedy simply because we are looking for symptoms that are characteristically found at a different stage. Also, an understanding of the stages of a remedy enables us to more readily discern the essence of the remedy and to differentiate it from other similar remedies.

In the early stages of Arsenicum we see a relative preponderance of physical level symptoms with less emphasis on the mental disturbances. Particular physical complaints - burning pains, restlessness, chilliness, aggravation from cold, frequent colds, periodicity, thirst for frequent sips of water, and aggravations occurring after midnight, especially from one to two AM (and one to two PM) - may be the primary symptoms with which to work. Upon inquiry, one will probably discover at least some of the following characteristics: fastidiousness, miserliness, a certain degree of insecurity, discontentment, restlessness coupled with weakness, censoriousness, and irritability. The irritability is seen primarily in the morning upon waking, morning being a difficult time for Arsenicum. In more advanced stages the anxiety is also frequently aggravated in the morning. At this stage, particularly if the complaints are more functional and not involving much physical pathology, it may be difficult to separate Arsenicum from Nux vomica. One must then search carefully for the psychological tendencies. Arsenicum will tend to be more insecure, needing the support of other people, whereas Nux vomica will be more self-reliant and impulsive.

In the second stage, as the illness penetrates deeper, the anxiety of Arsenicum becomes more pronounced and an anxious restlessness ensues. The anxiety tends to be most pronounced after midnight and in the morning on waking. The Arsenicum person may awaken in a panic during the hours of 12 to 2 AM. He may say that he is anxious even while asleep. Arsenicum will also at this stage display a prominent fear of being alone. There will be a constant need for company, particularly at night. The fears of Arsenicum are tremendously heightened while alone. His senses become more acute, especially his hearing (though less than that encountered in Coffea and Nux vomica). A fear of robbers is most characteristic of Arsenicum (also Natrum muriaticum). The anxiety of Arsenicum causes great internal anguish, and it is out of this anguish that the familiar restlessness of Arsenicum arises. The restlessness is not just a physical process; it is primarily a mental restlessness, an attempt to allay the deep-seated anxiety. The restlessness compels the Arsenicum individual to pace to and fro, to move from chair to chair, from bed to bed, but the motion and the changes in position do not ameliorate his symptoms nor his anxiety; on the contrary, his moving about totally exhausts him. The greater the suffering, the more the anguish; the more the restlessness, the more the exhaustion. Similarly the anxiety, which can easily reach the level of anguish will drive the patient from person to person, constantly seeking reassurance and support. Earlier in the course of the pathological development of Arsenicum the restlessness can appear periodically, rising and falling over periods of weeks.

The restlessness of Arsenicum invites comparison with other restless remedies. In Arsenicum the restlessness occurs in conjunction with anxiety and desperation. The desperation forces him to move from place to place with the hope that he will find some relief. Again, the restlessness tires the patient and leads to exhaustion. There may be periodicity to the restlessness: the patient will move about for a while and then be able to rest until the urge to move again asserts itself. The restlessness is, of course, most intense during the night, especially after midnight.

While the restlessness of Arsenicum is generally due to anxiety, a purely physical restlessness also occurs. This type of restlessness may often create confusion with Rhus toxicodendron. Both remedies can have a craving for milk, and both can have a desire for water in small quantities frequently. Both are aggravated by cold. Generally, Rhus toxicodendron is restless because the pain and stiffness are ameliorated by movement; turning, stretching, bending and moving about offer relief. In Arsenicum no relief is afforded by restless movement; the restlessness, provoked by the suffering, actually aggravates by bringing about exhaustion. Rhus toxicodendron patients repeatedly move from place to place because they hope to find a more comfortable position; one of the most typical examples of this tendency is to stretch and move the legs in bed at night - they do not know where to put their legs.

Sulphur and Medorrhinum may have a similar restlessness of the legs and, likewise, a difficulty in knowing where to put their feet, but they do this because they are trying to find a cool place for their overly warm feet (and burning soles).

Another remedy that must be differentiated from Arsenicum is Tarentula hispanica. The restlessness of Tarentula arises from a great hurriedness that pervades all aspects of life. They want everyone to hurry; they become irritable if they see someone moving slowly. Naturally, in a very advanced stage where the patient is out of control, one can have a very difficult time diagnosing the remedy. Tarentula, Stramonium, Nux vomica, Arsenicum, Hyoscyamus - all, as they shout, break things, and run about the room, can appear similar. Were one to attempt to distinguish Tarentula from these other remedies on the basis of an amelioration from music, one would have to be very circumspect. Tarentula's restlessness can be aggravated by music (as can Natrum carbonicum); the restlessness can increase in concert with the rhythm of the music.

Causticum is a remedy which can have much restlessness. This restlessness is a result of the stiffness and is worse during sleep. There is especially a restlessness of the lower extremities which is worse in the mornings. Another remedy with geat restlessness of the lower extremities is Zincum metallicum; as the Zincum patient sits in a chair, his legs will jump continuously.

The anxiety prominent at this stage of pathology focuses predominantly upon the patient's concern for his health. The idea of deterioration, of the ephemeral, of being deceased, or death is unbearable to him. Normally he pushes such ideas away from his mind, but if circumstances force them upon his consciousness, he then becomes most anxiously fearful of death and disease. He becomes absorbed by this concern and can talk about it endlessly, completely engrossed about even the most insignificant symptom. Arsenicum's fear is not so much of the consequences of a degenerating condition of health, but the fear of the ultimate state of insecurity - death. He develops an intense fear of death which can at times reach tremendous dimensions of panic. These "anxiety attacks" occur most frequently between 12 and 3 AM, but can appear any time as well. In the Repertory Arsenicum appears in the rubric "fear of death when vomiting." This symptom is but a reflection of a far more encompassing tendency - every symptom, no matter how insignificant, can provoke fear of death and then panic.

In the midst of his panic, the patient will thrash about in despair, weeping and imagining that he must die, that there is no hope. With this syndrome he will quite likely be rushed to the nearest hospital's emergency room. He arrives restless and trembling with fear. He restlessly turns his head to and fro; he writhes and constantly moves his limbs and shivers as from cold. His breath quivers. All of these symptoms are the expressions of an anguished fear of death (Compare Psorinum, Kali arsenicosum ). Eventually these panic episodes can occur without even the smallest provocating symptom.

The Arsenicum patient feels more secure if he has the attention of a physician, and, being a hypochondriac, he seeks the opinion of many doctors. He becomes dependent on the physician, telephoning frequently, demanding reassurance and advice for even the most insignificant symptoms. The homeopath is bound to feel the weight with which the Arsenicum patient clings to him. No patients in our materia medica are as clinging and demanding of relief from their anxiety as are Arsenicum, Kali arsenicosum, Calcarea carbonica and Nitric acid.

Arsenicum will exaggerate many of his symptoms in his imagination, blowing them out of all proportion. Even in the face of such apparently commonplace complaints as headaches, lumbago, fevers, etc., the thought readily enters his mind, "I have cancer and I am going to die!" Again, his fear will bring him promptly to a physician. Even if all the tests are negative, he will not be consoled; his anguished fear and restlessness will continue to lead him to more and more doctors. He fears cancer because it is the disease most readily identified as fatal in today's society. It is not really the possibility of cancer, but the prospect of death that causes him such anguish. The fear is not that he will contract cancer in the future, rather he fears that he has cancer at that moment (compare Agaricus ). In point of fact, malignancy is an actual element of Arsenicum, and, analogously, Arsenicum's fear is malignant, similar to a cancer eating at the mind of the patient.

A recognition of the peculiar characteristics of the Arsenicum anxiety about health is imperative as there are other remedies which also display anxiety about health of an at least equal if not greater intensity. The Repertory lists these thoroughly and in relative strengths, but it is unable to describe the particular distinguishing qualities which are so important in separating one remedy from another. If one only knows the fact that a particular remedy has "anxiety about health" without knowing how to differentiate it from the others, one will find great difficulty in selecting the precise remedy that fits the patient. This cannot be done by a simple process of repertorization; it requires a minutely detailed knowledge of materia medica.

Other remedies possessing a strong anxiety about health are Phosphorus, Kali arsenicosum, Nitric acid, Lycopodium, Calcarea carbonica, Kali carbonicum, and others. Calcarea carbonica has a strong anxiety about health which is primarily focussed on the possibility of insanity, cancer, and/or of contracting an infectious disease. Calcarea carbonica fears the condition or disease itself as opposed to the possibility of death. Calcarea is most apt to despair over having an incurable disease and of being unable to recover; death is a prospect which he can accept with relative equanimity.

Kali carbonicum has anxiety that he will get a disease in the future whereas Arsenicum fears he has cancer now. Kali arsenicosum has a particular anxiety about heart disease; he does not fear death as much as Arsenicum does. The Kali arsenicosum patient will say, "If I must die, it is O.K." If one begins to talk about his heart, however, he will begin to express anxiety.

Phosphorus feels anxiety about his health, but primarily when the subject is raised to him. Many Phosphorus fears revolve around health -his own or that of his relatives, but the Phosphorus anxieties are not as obsessive. The Phosphorus patient is suggestible. He hears of someone who has died from a bleeding ulcer, and then he imagines himself to have the same condition. He does not withhold his anxiety; he will engage the nearest person and animatedly express his concern. He will immediately go to the doctor who reassures him that he does not have an ulcer. The anxiety then disappears as quickly as it came; he leaves the doctor's office very relieved, saying to himself, "How silly I am!" With the next and slightest provocation, however, the anxiety will return. By contrast, Arsenicum album, Kali arsenicosum and Nitric acid are not so easily pacified. Their anxieties are inconsolable.

The Nitric acid patient, unlike Phosphorus, always has anxiety about his health - an anxiety about any possible ailment, not only cancer, infectious disease, insanity, or heart disease. He may read in a magazine about someone with multiple sclerosis, and he says to himself, "Oh, that explains it! That must be what I have." Then, instead of expressing his anxiety, he carries it around inside. Eventually, he may very secretively make an appointment with a doctor, but the doctor's assurances fall on deaf ears. He is convinced of what he has and cannot be consoled. Later, he may read another article, and the process begins again. The Nitric acid anxiety about health is not so much the fear of death that we see in Arsenicum; it is more a fear of all the consequences of a long-term degeneration, with the expense, dependency on others, immobility, etc.

Lycopodium has a marked anxiety about health. The Lycopodium anxiety can be about any type of illness, like Nitric acid, but it is an anxiety that springs from a basic cowardice. It is not a fear of death, but a fear of the pain and torture of illness. He has a fear that he will not be able to cope with a serious illness, that he will fall apart and reveal a lack of courage to others.

The above distinctions should serve to illustrate that the simple rubric "anxiety about health" is actually full of a wide variety of shades and subtleties which are crucial to the precise choice of a correct remedy. This assertion, indeed, is true of every rubric in the Repertory.

As previously mentioned, The Arsenicum patient is dependent upon his possessions and the people in his life. Kent says: "He dreads solitude and wants company because in company he can talk and put off the fear." Thus, at this, the second stage, because of the increasing anxiety, the Arsenicum fear of being alone becomes especially pronounced. Yet the Arsenicum person is discerning about those he wishes to have with him; he wants efficient, reliable people and people who care about him nearby. Interestingly, this need to be with other people may generate the impression that he cares for them, but essentially this impression is a false one. His own need, the appeasement of his anxiety, is preeminent in his mind. An Arsenicum woman, for instance, may go with her husband to his shop, not to help him with his work, but merely to avoid being left home alone. For it is when alone that the crippling fear becomes overwhelming.

Arsenicum is listed in the rubric "anxiety for others," but actually, as one would expect from the foregoing description, this anxiety is caused by the fear of losing someone close to him, someone upon whom he is dependent. Consequently, he will show little concern over someone who is a stranger to him.

Other remedies are prominent for anxiety about others. One of them, Phosphorus, is so sympathetic and suggestible that he can lose all sense of himself in his concern over someone else, whether a close friend or a stranger. If an Arsenicum person were to meet someone new to the area, he would welcome the company and the opportunity for some conversation. However, if the person were to mention some personal difficulty, such as an inability to find a hotel, the Arsenicum individual would limit his response to a courteous expression of consolation and, perhaps, a few suggestions; his inner, perhaps subconscious, attitude would basically be, "Well, you have your problems, but what about the problems I have?" The Phosphorus patient, on the other hand, would become excited and say, "You haven't a hotel? Oh, my goodness! We must do something about that! Here, we'll go right now to the directory and try calling a few."

Sulphur also has anxiety about others. In this instance, it is an active imagination which leads to the anxiety. A Sulphur father, for example, might lose sleep worrying about his daughter coming home two hours late from a date. It is not the Arsenicum anxiety over losing his daughter or the Phosphorus sympathetic anxiety. The Sulphur individual will lie awake inventing endless possibilities about what might have happened. He will allow his imagination to exaggerate the significance of the situation beyond all realistic dimensions.

To review the stages of the Arsenicum pathology: the first stage emphasizes the physical symptoms, the fastidiousness, and the miserliness; in the second stage there is increasing emphasis on the insecurities, dependency, anxiety about health, anxiety over losing others, the fear of being alone, and the fear of death; gradually the fear of death becomes an obsessive, anguishing fear - the cental issue of the person's life. Then the third stage supervenes.

In the third stage, the constant fear and anxiety finally exhaust the patient; he eventually surrenders to his exhaustion and subsequently falls prey to a state of despair. Arsenicum appears in bold print in the rubric "despairs of recovery." There are two reasons for this despair: the first is the realization that certain symptoms he suffers may be permanent. Even if these symptoms are relatively minor, he may still experience profound despair. Secondly, he may come to despair as a consequence of the toll exacted by the weight of the constant anxiety and fearfulness that have pervaded his life. His chronic mental suffering can cause him to begin to loathe his life and to despair of ever being able to comfortably enjoy life.

It is to this stage that Arsenicum cases of anorexia nervosa belong. These cases have a withered, wrinkled, old appearance; they are prostrated, feel cold all over, and suffer from an inability to eat or to retain any amount of food. They think that food is not good for them, that no type of food is healthy enough. There is much delusionary thinking in these cases. Delusions may alternate with a state of sleepy, partial confusion. They speak seldom and abruptly, giving foolish answers and making irrelevant associations. They seem confused and have the feeling that they are going insane.

In the final stage the Arsenicum loathing of life becomes absolute; the sadness is tremendous, and suicidal depression may supervene. This depression must be taken seriously for Arsenicum is one of the truly suicidal remedies. During this stage he avoids meeting friends because he imagines that he has offended them in the past. He lies in bed, occupied with thoughts that aggravate his depression and torment his mind night and day. He feels he is incurable, and thoughts of death constantly occupy his mind. The Arsenicum patient may develop despair and a suicidal disposition quite suddenly after a severe fright or shock or even during asthmatic attacks. A sudden fear may can come that he may be forced to commit suicide Also, a depression that is similar to that of Natrum sulphuricum may result from a blow to the head.

More rarely, a manic, paranoid state may develop in the last stage, with suspicion being the dominant characteristic. He suspects that people are plotting to kill him. He stares with a wild suspicious look. The patient may suffer from a fear that he will kill people upon whom he depends. In this stage he may avoid talking to people and may become obstinate and withdrawn. Finally, he may enter a state of complete tranquility, yet in this state he is completely out of touch with reality and refuses to talk to anyone.

The stages that have been described clearly illustrate the steady progression of pathology into increasingly deep layers of the organism. The pathology initiates on the physical level, progresses to a state of anxiety and insecurity, then to fear of death, and finally to despair, loss of interest in life, suicidal disposition, and a paranoid, delusionary state. In the final stages one may encounter great difficulty in accurately prescribing Arsenicum without the knowledge of its stages of development. Many of the usual symptoms of Arsenicum may be missing - restlessness, fastidiousness, desire for company, fear of death, anxiety, thirst, etc. It may be difficult to separate Arsenicum from other remedies at this stage, but if the case is taken carefully, the full dynamic process of the disease will become clear.

Acutely, Arsenicum corresponds to fevers, sometimes very high, of all types, but mostly septic fevers. During fever Arsenicum can display several interesting symptoms. Delusions may arise: he sees thieves in the room and hides under the bed; he imagines that the house is full of thieves or that the bed is full of worms. He may pick at the bedclothes. He may moan and lament loudly, screaming with pain. In manic states or in fevers with delirium, the Arsenicum patient may demonstrate a strong desire to be held.

It is interesting to note here that patients who never experience fever (apyrexia, even in severe acute ailments), frequently require Arsenicum for their chronic or acute conditions.

In Arsenicum, acute diseases have the same anxiety, restlessness, and even despair which characterize the chronic state. The restlessness and anxiety can be tremendous, compelling the patient to get up and move about. He moves from chair to chair and then drops exhaustedly into the bed, only to rise yet once again until he finally lies, completely prostrated, in bed. He is exhausted, thirsty for sips of water, and chilly -yet with a hot face.

I recall the case of an Indian woman suffering from a ureteral colic. Even in that tropical climate the patient was under four blankets. The nurse was fanning her face and supplying little sips of water for which the patient pleaded moaningly. She was restless, moaned in anguish, and rocked her head restlessly. Arsenicum 200C pacified the patient within three to four minutes. In such severe acute conditions, the restlessness exhausts the patient, and he will often fall into a stuporous, "cadaverous" state, only to become restless again upon recouping a little strength.

Arsenicum may be contrasted with the early stages of Belladona. Both remedies manifest high fever and a hot face with cold extremities. However, even though the Belladona's extremities are cold to the touch, the patient himself feels either warm or of normal temperature sensitivity.

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Bryonia

Vitis nigra; Bryonia nigram; Chironiam vitam; Bryonia dioica; Bryonia vera; Vitis alba.

English White bryony; Black-berried white bryony; White hops.
French Bryone; Bryone blanche; Coulevre.
German Weisse Zaunrube; Stichwurz.
Polish Pryestepbiaty.
Dutch Welde wyngaar; Witte Bry.
Portuguese...Norca branca.
Italian Brionia, Vita bianca.
Spanish Neuza alba.
Swedish Hundrosva.
Natural order: Cucurbitaceae - Monoecia, Monodelphia. Family: Jussieu [vegetable substance] Dioecia gynandria, L. Preparation: tincture of root procured before flowering.

Remember that the pathology which every remedy represents and cures in the human organism can be conceived as an 'idea' rather than as a heap of disconnected symptoms. The important remedies of our materia medica have been proven extensively and their symptomatology is sufficiently comprehensive for the contemplative student to extract from it the prevailing 'idea'.
THE ESSENTIAL FEATURES
In Bryonia we have a patient who is emotionally, bodily and mentally dried up. He wants to be left alone, undisturbed, while at the same time constantly needing great quantities of water to balance his dryness. If this is looked at symbolically, we see that the water element, symbolising the emotions, is lacking or restricted. It will be apparent to you when you look upon a typical constitu¬tional Bryonia type that there is an element of dehydration at all levels. The sensation of dryness of the mucous membranes is most frequently reported, but the dryness of Bryonia extends to the emotional and mental levels as well. The mind is dry; in other words, the mind lacks nimbleness and agility, it is unimaginative.

Stiffness of the Mind
Constitutional Bryonia patients suffer from a stiffness of the mind; they tend to be very business-like and matter-of-fact. Their pers¬pective is quite limited or earthy. Consequently, they often focus their energies upon the attainment of earthly things and material security, especially money. Underlying their rather gruff, business¬like manner, however, a sense of financial insecurity dwells, and the primary expression of this insecurity in Bryonia patients is a fear of poverty. They are afraid of being poor one day, irrespective of the degree of their bank balance or business success.

Bryonia is a remedy which is indicated quite frequently today. The need for Bryonia is quite possibly a result of the pressures arising from the prevailing socio-economic system. The pressures to perform effectively in the business world and to achieve financial success in the face of fierce competition can have a profound influence upon one's psychological functioning. As a consequence, many suscep¬tible individuals will develop the mental, emotional, and physical pathological indications for Bryonia.

The Bryonia individual, most often a male, will be one who primarily wishes to be alone. This desire to be alone is attribut¬able to a great amount of internal irritability and anger. Underlying the irritability is a considerable sense of insecurity expressed with an irrational fear of poverty and also fear about the future and, most specifically, about the future as it relates to his financial situation.

These people are very business-like. Business concerns even occupy their subconscious mind; as a consequence, they often will talk about business while in a delirium. As one might expect, these people will be very careful with their money and are reluctant to part with it, though they are not stingy to the extent of Arsenicum or Mercury.

It is unlikely that a Bryonia case would buy expensive goods for himself which he feels to be unnecessary. He may however spend money for a good cause. The Bryonia attitude is a materialistic one. Bryonia patients are earth-bound; i.e., earthy in their perspectives and attitudes. They will pursue with determination whatever they decide would be beneficial for them. Bryonia patients with any inter¬est in spiritual matters are definitely the exception. Emotional Dryness and Desire for Solitude The emotional dryness manifests in the patients' irritability and peevishness, major characteristics of Bryonia. They are very serious people, lacking in imagination. They are neither playful nor joyful; seldom will they attempt a joke.

Typically these people lack refinement and sensitivity, but they do retain a specific sensitivity to annoyance. They do not welcome interference in their lives; they simply want to find their own niche, their place in life, and to be left alone. They are averse to being bothered by others because of the internal irritability which they are reluctant to show. The problem with any kind of interference is that there must be some reaction on their part; this is tremendously difficult and aggravates them. Their attitude is, "Leave me alone."

This is the nature of Bryonia, and we must perceive its inner structure along the same lines. The agility goes and a rigidity settles in. This individual is drying up, and in order to keep in balance he must have supplies of water, of emotions and of money, all of which must come from the outside. He is afraid that in his old age nobody will love him, nobody will care about him and he has to have money to pay people. Emotionally he cannot give love but he needs to feel loved in order to feel secure, in spite of the fact that when he is loved he does not appreciate it. He can be busy and excited, buying and selling on the stock market, for which he can have a great passion, but he is unable to fall passionately in love with a woman.

He cannot feel or express passion, although he can perform sexually. For a Bryonia individual, it is enough that his wife should love him and be available, but he is incapable of romance or appreciation of her tenderness. He is usually angry and irritable and inconsiderate towards others, and after sexual intercourse he retreats into himself and is better if no-one bothers him anymore.

In a description of this type it is not possible to describe all the variations of the remedy and all the different moods. The student of homeopathy is required to understand the main ideas that run through each remedy.
Dryness of the Physical Body and Thirst
This same attitude will be apparent when the patient has to move a painful joint. Moving the joint creates a dry and cracking sensation, and he hates to have to do it. This dryness is apparent at different levels of the physical body. The mucous membranes, serous mem¬branes or skin can dry up to a tremendous extent. Further examples of such dryness include : dryness of the conjunctiva of the eyes, so that the eyes cannot be moved without distress; dryness of the synovial membranes, so the joints cannot be moved without pain; dryness of the lining of the intestines so the stool will not move and a most distressing constipation sets in.

Bryonia is, of course, an extremely thirsty remedy. The thirst is for large quantities of cool or tepid water. In Bryonia there is a preference for warm drinks that actually make the patient feel better, often tepid tap water is quite sufficient. These characteristics help to distinguish Bryonia from such remedies as Phosphorus, Natrum muriaticum, and Sulphur which all desire great quantities of cold water frequently. Lycopodium, on the other hand desires and is ameliorated by warm drinks but the quantity of water they require is much less; Lac caninum, Arsenicum and Chelidonium also crave warm drinks.

As mentioned, Bryonia manifests great dryness of the mucous membranes in many conditions. One must be careful when analy¬sing a case however, because some Bryonia patients can experience great dryness of the mouth without thirst. There are other remedies which have dryness and a simultaneous aversion to water. One of these remedies, Nux moschata, possesses such great dryness that the tongue feels stuck to the palate, yet there is an aversion to water. If these patients even attempt to drink some water to help wash down some food, they will have to spit out the water; they cannot drink it; there is a complete absence of thirst. Natrum muriaticum often exhibits this symptom too.

So far we have given a description of the symptoms of the remedy. However, you should bear in mind the importance of the patho¬logical picture that presents itself when you combine all the symptoms, for this is where the peculiarity and uniqueness of this personality lie. On prescribing this remedy you should not lose sight of the dryness, of the aggravation from moving these dry parts, nor of the "do not bother me" attitude, and the persistent but slow development of the pathology. And beyond that, you should make an effort to understand the subtleties of the pathology of the personality.

As you perceive the idea behind a remedy, you find yourself prescribing it with more certainty and greater confidence than ever. If, however, you prescribe the remedy on symptoms alone, the margin for error remains very great. In order for one to be able to see these images and ideas correctly, it is necessary to have seen a lot of cases, and most of all to have prescribed the remedy correctly in several constitutional types.
When I started talking about these ideas more than 25 years ago my students got excited and became very receptive. As a side-effect of this excitement, several 'eager homeopaths' came on the scene, trying to copy these ideas, as a result creating confusion in the minds of those who were listening. Do not be tempted to fabricate ideas about the remedies before you have seen enough cases and gained some real insight into the remedies, and before being able to confirm your observations.

The Acute State
Bryonia is a remedy that will show persistence and determination, and will not vacillate. The complaints start slowly and develop steadily in a crescendo over a much longer period of time than most other remedies. Acute conditions take several days to reach their full-blown manifestation, whereas in other remedies - e.g. Aconite or Belladonna - we see a much more immediate and explosive reaction of the organism. Bryonia presents a slow but steady development of complaints, which persists until a very serious level is reached.

We can better understand the chronic state of Bryonia by examining Bryonia's acute state. Typically during severe Bryonia acute states, usually involving fever and bronchitis, patients realize that they need to muster all of their recuperative powers. Their suffering and irritability are tremendous. They want to be left alone in order to collect all their energy to ensure that they will be able to weather the illness. Even in their normal chronic condition Bryonia individuals don't easily seek help for mental or emotional problems; they would rather attempt to work their problems out by themselves. In this acute state they are dry and dehydrated. The mouth is very dry and there is a constant need to drink. Consequently, during a fever, the patients tend to become irritated when someone enters the room to talk to them, console them, or to offer help. They feel that quiet is the best thing for them. It is very distressing for them to have to react to anything, or even to have to move.

During a fever, the simple question, "Do you want a cup of tea?" is liable to make the Bryonia patient feel worse. He feels that the simple act of answering such a question will cause an aggravation by expending the recuperative powers. The usual observation made in a Bryonia case is that the person attending the patient will say that the patient is very ill and does not want any interference. On being offered a cup of tea, even though the patient is thirsty, he is aggravated by the fact that someone has disturbed him. But when the tea arrives, he will drink it with great relish. He is very thirsty and is often ameliorated by warm drinks.

However, the whole process of being asked and of having to respond remains very aggravating. In such a case it is best to leave the tea and go out of the room immediately. If you are sensitive enough you will perceive the aggravation, even without words. Kent writes: ‘Do not cross a Bryonia patient for it makes him worse.’ The patient himself feels that it is unfair to treat others, who are interested in him, in this way, but he cannot help it.

Aggravation From Movement
Exhaustion and sluggishness play a role in this unwillingness to interact with others when ill, but far more responsible is an irritability and a basic aversion to motion. Any motion - that of physically moving, even breathing or moving the eyes, or the effort of feeling or talking, even of thinking - aggravates Bryonia patients; they do not want to move. They are aggravated from movement; and here we have the greatest characteristic and key-note of Bryonia. Such is the aggravation from motion that you may not be able to make a physical examination, as the patient faints as soon as he tries to raise himself in bed.

I recall a case of Bryonia that I saw in South Africa. When I entered the patient's room, he was lying facing the wall. He coughed and lay perfectly still with his back towards me. During the entire visit I conversed through an interpreter, and the patient never once turned around to look at me; it was too painful for him to move. He offered very little information. The person who was interpreting and who had been caring for him said that he had had no appetite for two to three days, that he had been in a great deal of pain while coughing and would lie in one position only, never moving. He did not want anything; he only drank water from time to time. He was given Bryonia, and the next day he was much better and recovered without needing any other remedy.
The aggravation from movement of Bryonia makes it a good remedy for arthritic conditions. Severe arthritic inflammations that are aggravated by the slightest movement will often be benefited by Bryonia. An important observation, however, is that sometimes, when the joint pain is extremely intense, the pain can be so severe that, despite being aggravated by motion, the patient feels compelled to get up and walk about. The suffering is so great that he has to move. This paradoxical restlessness can at times create confusion with Arsenicum and Rhus toxicodendron.

A further important key-note of Bryonia is an amelioration from pressure. Many forms of pain and discomfort are ameliorated by holding and pressing upon the affected part. Lying on the painful side (e.g., in headaches, chest pain, etc.) frequently provides respite from the pain. An important observation in cases of acute appen¬dicitis corresponding to Bryonia is that there will seldom be tenderness to direct pressure. When the examiner's hand is sud¬denly removed from the abdomen, however, severe pain occurs. This presentation is classic for Bryonia: with pressure there is an amelioration of the pain, but the sudden release of pressure (sudden motion) provokes pain. Bryonia is one of the specific remedies for acute appendicitis; it will cure a very large percentage of cases which present with marked rebound tenderness and a lack of significant tenderness to direct pressure.

Bryonia is full of anxiety and despondency. He is not easily pleased with others, and often does not know himself what he really wants. There is an internal restlessness that forces him to move about, in spite of being aggravated by motion. There is anxiety and fear, including fear of death and fear that he will not recover from his illness. But his mind which is logical and practical does not allow the fears to overwhelm him. He may allow his temper, his anger, or his irritability to reach violent expressions, but he will not allow the fears to cloud his mind completely.

Kent writes:
'The mental state of Bryonia is usually relieved from cool air, he wants the windows open. Anxiety, confusion of mind, fear, etc., are ameliorated from being cool. Sometimes the delirium, and the congestive fullness of the head affecting the mind, will increase if the room becomes very warm, or from the heat of the stove, from becoming heated, or from warm covers. In children this will be noticed, whereas if the window be thrown up to relieve the stuffiness of the room the child will sleep quietly. Such remedies as Bryonia, Apis, Pulsatilla, and many others, come in here. If you go into a room and find the child raging with delirium, turning and tossing, and the mother is trying to keep the room warm because she is chilly, and say, "Why, how stuffy it is in here!", and you open the window and then notice that the child goes off to sleep, do not overlook that; because that relief was caused by something. There should be nothing that can possibly occur to a patient, but that you should solve the meaning of before you leave the room. Settle in your mind as to what it was that caused it.

"Fear of death ". Full of fear, anxiety, despair of recovery, great despondency. Both mental and bodily quietness is required, that is he wants to keep still. Often he wants the room dark. It has complaints from getting excited. Bryonia patients are nearly always worse from visitors. "Morose". Do not cross a Bryonia patient for it makes him worse. "Bad effects from mortific¬ation." "Ailments arising from chagrin"; these are headaches usually. Violent, congesting headaches that come on a few hours after altercation or controversy, or little misunder¬standings with somebody that he cannot talk back to, will be covered by Staph., but Bryonia also has that.

Staph, is suited to irritable, violent, nervous, excitable people, who get into violent altercation or dispute. If a headache comes on, such a patient may need Bryonia. If in a chronic state a patient says, "Doctor, if I ever have a dispute with a man over anything I come down with nervous excitement, sleeplessness, headaches;" you do not have to work long upon that case, because more than likely Staph, will be suitable.'

The Bryonia Child
Bryonia children, during acute illnesses, will often ask for things that they cannot have. In the midst of their fever and moaning they will call out their demands, which typically will be for several impossible things. Should their parents hand them one of the items, they will immediately throw it away like the Chamomilla child does. The especially characteristic trait, though, is that they ask for things that are difficult for the parents to find. There is a feeling of dissatis¬faction, of discontent inside them; they don't actually know what they want. "He wants something and he knows not what" is a very important symptom for Bryonia. It is a symptom that calls for Bryonia only when the rest of the symptoms agree. You go to a child who is being carried in the arms of the nurse and wants one toy after another; you get the toy he wants and he does not want it and will throw it back at you. When that case is looked into thoroughly it may be covered by Kreosotum; another is never satisfied with anything and rejects everything he asks for; you look into that case and it may be covered by Chamomilla.

A characteristic that one may at times encounter is a tendency for nose-bleeds in children during the night while they are in bed, between 3-4 a.m. Children seem weary, easily fall down from dizzi¬ness. In brain infections children perform a strange chewing motion as if they were chewing the cud. This usually occurs during sleep. The mouth may distort during sleep when there is brain involvement.

Delirium
Bryonia's well-known time of aggravation is the morning on waking and at 9 p.m.; there is a general aggravation at this time.

This is how Kent describes it:

'In rheumatic complaints, in pneumonia, and in typhoid conditions, when he is aroused from this stage of stupefaction he is confused, sees images, thinks he is away from home and wants to be taken home. Sometimes he will lie and say nothing but he "wants to go home." The delirium is of a low type: it is not the flashing wild excitement of Bell, or Stram.; it is the very opposite; he talks and wanders and does not say much unless he is disturbed. You disturb him and he says, "Go away and let me go home" and if you let him alone he will relapse into a perfectly quiet state and seldom speak. Irrational talk or prattle of his business aggravated after 3 p.m. Usually you will find the delirium commencing about 9 p.m. and keeping up all night like the fever. The acute mental symptoms appear on rising in the morning, but as the febrile state advances and takes possession the symptoms take on a 9 p.m. aggravation; those that have chill will have it at 9 p.m.; in those who have a fever the fever will come at 9 p.m. If mental symptoms are uppermost they increase and spread over the night... Bryonia will begin at 9 p.m. and run through the night.'
When delirious, Bryonia patients will, in addition to talking of business, often express the wish to go home, even if they are already in their home. The origin of this delirious request is the feeling of security they enjoy when they are in their own place. This trait is very strong.

Bryonia is one of our major polychrests and a remedy that covers a vast amount of pathology. The above description has not exhausted the symptomatology and the conditions in which this remedy could be prescribed, and therefore we give below some characteristic mental conditions for the conscientious student wanting to know more about the mind of Bryonia.

Mental Conditions
Anger and Irritability: ailments after anger, vexation, fright, scorn or acute disappointment and mortification with anxi¬ety. Complaints from hurry; from perceived violence. Anger, irascibility, and irritability; in the evening. Irritability in the morning on waking, during chill, after eating, during headache, during heat, during menses, and during perspiration. Irritability in liver troubles and from cough during whooping cough. Quarrelsome and inclined to scold those around him. Envious of others and feels himself unfortunate. Becomes violently angry from contradiction. After having been angry he is chilly, but has a red face with heat in the head.

Ill Humour: morose during whooping cough. Ill humour with needless anxiety and everything seems to put him in a bad mood. Mocking and sarcastic. Bad tempered and weeping mood. Wearisome, weeping, tearful mood, in day time and at night, before coughing, during the heat, during the perspiration; he feels nervous all day. Taciturn and disinclined to conversation. Answers hastily, does not ask for anything and wishes to be alone. He is averse to any company, particularly the presence of strangers and does not wish to be disturbed. Aversion to being touched.

Dissatisfaction: generally discontented and dissatisfied with himself. Complaining and despondent.

Anxieties and Apprehensions: extreme anxiety for the future, especially in the evening, in bed at night, before midnight; ameliorated in the open air. Anxiety about his health and thinking about his complaints aggravates his symptoms. Baseless anxiety; feels anxious in the house. The state of apprehension is felt in the whole body forcing him to do something constantly. He is always busy and thinks about his work or his business all the time. Hurried, impatient and industrious. Conscientious about trifles. Avarice with a desire to have material objects and make plenty of money. Fear of poverty.

Restlessness: restlessness, nervousness, at night, with anxiety, during headache, during perspiration. Restlessness, causing him to toss and turn in bed and eventually drives him out of bed. Caprice: Capricious mood; has a desire for many things which when offered are refused; desire for change; obstinate. Lacks confidence and becomes hesitant. Timidity.

Stupefaction and Dullness: disinclined to think, with exhausted mental power. Indolence and aversion to work; irresolution. Stupefaction and confused hasty speech. Feels confused in the morning, on rising and in the afternoon, ameliorated in the open air. Persistent thoughts when walking. Confusion during the heat, as after being intoxicated; when lying, while riding, from motion, after sleeping, while walking, ameliorated by yawning. Confusion after drinking; ameliorated with eructations. The mind becomes so weak that his ideas seem to disappear, as if he would faint; he becomes hot in the face and feels worse standing. Inclination to sit. Momentary absence of mind with giddiness and forgetfulness. Dullness and sluggishness, while lying down and during chill. The imagination is sluggish with an inability to make any plans for the future. Ameliorated in the evening with clearness of mind and abundant ideas.

Depression: sadness and depression during heat and perspiration with much sighing. Wants to be quiet during chill and during heat. Becomes oversensitive during the chill. Sensitive to noise.
Despair of being cured and fear of death. He has many fears and is easily frightened, the fear rising up from the stomach; fear of being alone, of poverty, of death, of impending disease, of evil, of insanity, of narrow places, of being poisoned, when riding in a vehicle, of suffering, of starving, of thunderstorms. Mental symptoms before and during thunderstorms. Bryonia has ailments from mortification and from chagrin and these are usually headaches.

Psychosis and Delusions: Irrationality and psychosis with a desire to travel. Mental insecurity. Raging and raving during delirium, which occurs at daybreak, in the morning or in the evening, at night. On closing the eyes, he beco¬mes loquacious and busy. He has a presentiment of death and many delusions: as if the bed were sinking, the bed is too hard, imagines he is doing business, sees dead persons, sees faces on closing eyes, illusions of fantasy; thinks is away from home, is in a strange land, is being injured, being beaten; sees people on closing eyes, thought he was pursued by soldiers, sees spectres, ghosts, spirits, friends appear as strangers. Desires to leave home and talks about home. During the delirium he attempts to escape through the window. Impetuous during perspiration with moaning, groaning, during sleep. Symptoms are aggravated by heat. Starting on falling asleep in the evening, also in bed while lying awake; startled from sleep. Muttering and shrieking during sleep and becomes excitable with exaltation of fancies; very anxious and fearful during a fever. Talks about business matters when he is delirious and thinks he is somewhere else and wants to go home. Waves his hands around and gesticulates with the delirium. Unconsciousness in the morning, after delirium, during fever, on rising in the morning and on rising up. Suspicion.

With the information provided above, one can cure any condition that manifests the typical Bryonia picture, be it bronchitis, pneu¬monia, intercostal neuralgia, constipation, diarrhoea, etc. But the symptomatology must be present; dryness, aggravation from motion, irritability, the desire to be left alone, thirst etc.
Generalities
Kent writes:

'This medicine is suitable in a great many diseases, diseases of a typhoid nature, diseases that take on a symptomatic typhoid, diseases that start out as remittents and run into a continued fever, as in pneumonia, pleurisy, inflammation of the liver, of glands, of the bowels, etc. It may be a gastro-enteritis or peri¬tonitis, or inflammation of the bowels, with the sensitiveness, the aggravation from motion and the desire to keep perfectly still. Inflammation of joints, whether of rheumatic character or not, whether from cold, exposure or injury, Bryonia is often indicated in injuries of joints where Arnica would be a failure.
There is an extreme state of irritability in Bryonia; every word which compels him to answer a question or to think will aggravate him. The effort to talk will be attended with horror. At the beginning of complaints you go to the bedside of a patient who has been grumbling a few days; something is evidently coming on; the family meet you at the door and say, "The patient is almost unconscious;" you look at him, the face is puffed and purplish, he seems to be dazed, there appears to be a sort of venous stasis all over the body, but especially about the face; his countenance is almost that of an imbecile, yet he is perfectly capable of talking, although he has an aversion to it and appears to outsiders to ignore everything that is said.

This sometimes comes on apparently in a short time; the patient awakens in the morning with a dull, congestive headache and a stupid feeling in the head; dullness of mind so that he cannot work, and this feeling gradually increases; such a state is sometimes the forerunner of a serious illness. We find, when a pneumonia or inflammation of the liver, or some slow insidious inflammation is coming on somewhere in the body, but not yet located, that this state will begin in the morning. This is peculiar about the aggravation of Bryonia - its troubles commence many times early in the morning. On waking, with the first move, he realises that things are not all right, there is a state of stupidity bordering on unconsciousness. Those who have been grumbling for a week or ten days wake up in the morning feeling miser¬able, some time that night or the next day they have to send for the doctor. If this is watched for a few days, a continued fever is observed. Or at night a chill will come on, with much pain in the chest, rusty expectoration, short dry cough and other symptoms that will be spoken of under Bryonia later, showing that the trouble is going towards the chest; or the condition may gradually increase as a congestive, dull headache. This will be seen when congestion of the brain is coming on...

'...There is a feature worthy of consideration because it sometimes makes a case appear inconsistent. It is due to his anxiety that pervades the whole body. In Bryonia as in Arsenic there comes an anxious and uneasy feeling which compels him to move, but he is worse from motion, yet so uneasy and anxious that he must move. There are pains so violent that he cannot keep still, and yet when he moves he screeches from the pain. So it is really not an inconsistency but simply due to the great violence of the pain. Even though he knows that the motion is going to make him worse, he cannot keep still, for the pain is so violent. Early in the case he was able to keep still, and found that he was better from keeping still, and that the mental state was better from keeping still, and that the anxious restlessness increased the more he moved, until finally a reaction comes and he is obliged to move.

You would think, looking at the case superficially, that patient is better from motion as in Rhus-t., but in Rhus you find that the patient moves and in moving he gets feeble, and when he sits down the pains begin to come on again. There is the distinction between the two, and yet they look alike if not examined into carefully. It is common for Bryonia to be ameliorated from cool air, and from cool applications. Now, if he moves, he gets warmed up, the pains are worse, but there are rheumatic complaints of Bryonia which are better from heat, and under these circumstances he is better from continued motion. It is another form of relief, and another of the modalities. I sometimes wonder whether Bryonia has a greater element of relief from heat, or greater element of relief from cold. Most of the head complaints that are of a congestive character are better from cool applications, from cold air, etc. Yet there are some of the Bryonia head complaints that are relieved by hot applications, and these seem to have no accompanying cerebral congestion. So that Bryonia has opposite modalities, but in all its opposite states there is still a grand nature running all through, sufficient to detect it.

In a damp climate Bryonia is one of the most frequently indicated remedies, but in the clear climates, where the thermometer runs low, Aconite will be indicated more than Bryonia. These atmospheric changes should be thoroughly considered in relation to our Materia Medica. The patient is worse from a warm room, worse from too much clothing, worse from the warmth of the bed, wants the windows open, wants to breathe fresh, cool air. He suffers more than ordinary persons from a stuffy room. Persons who are subject to Bryonia conditions suffer in church, at the opera, in close warm rooms, like Lycopodium. Girls who faint every time they go to church are relieved by Ignatia.'

Bryonia has a marked action on all the serous membranes and the viscera they contain, causing inflammation and exudation. It disorders circulation, alters the blood and gives rise to fevers of the typhoid, bilious, rheumatic and remittent types. The acute symptomatology of Bryonia has a tendency to develop gradually over a course of two to three days, similar to Gelsemium.

Characteristic stitching and tearing pain with aversion to the least movement. The patient avoids even moving the eyes, and raising the head from the pillow causes faintness, nausea and vomiting. This stitching pain is found everywhere, but especi¬ally in the chest. Has strong effect on nerves and muscles, where it causes inflammation and soreness. Muscles become hard, after neuralgia.

The typical Bryonia patient is of dark complexion and hair, plethoric or choleric constitution, has a bilious tendency with firm fleshy fibre and a tendency to great irritability and bad temper. Easily angered (with biliousness, headache, and dyspepsia). Ailments after: anger, catalepsy from anger, chagrin, fright, suppressed eruptions and discharges; alcohol, over-indulgence in rich food and red meat, wounds; black or brown abscesses with acrid pus, suppressed abscesses. Ulcers of the skin with fistulae. Aluminium poisoning. Influenza. Measles after repelled exanthema. Lack of reaction in exanthema.

A remedy which closely resembles Bryonia and which is often effective when a case appears to call for Bryonia but fails to respond to it is Stellaria media. It is a remedy for rheumatism, stiffness of the joints, synovitis, general irritability; the neck muscles are 'stiff and sore'; 'the eyes feel protruded'. There is an aggravation from movement in this remedy as well.

There is typically an aggravation from heat. Complaints from drinking cold drinks in hot weather, from taking cold or getting hot in summer; complaints when the warm weather sets in after cold days. Irritability of mind and tissues runs through this remedy and chilliness predominates. Headache or neuralgia in (left) side of the head and face, aggravated by moving and ameliorated by hard pressure and cold applications.

There is a peculiarity of Bryonia that one may encounter in elderly patients. Arteriosclerotic patients will tend to make a lateral chewing motion with their jaws; it is somewhat like a cow chewing its cud. This chewing motion can also be seen in febrile children when there is brain involvement.

Dryness of the mucous membranes; scanty discharges. Dry, burning heat, as if blood were burning in the veins or one part cold with heat of another. Flushes as if warm water were poured over one and a sensation of heat in the evening in bed. Profuse sour or oily sweat night and morning. Dryness of the mouth and stomach; extreme thirst, worse from drinking beer. Desire for food which cannot be had or refuses things when offered. There are no particularly strong desires and aversions in Bryonia's food preferences with the exception of a strong desire for oysters and for meat. There is also a desire for warm drinks which ameliorate the stomach symptomatology. Bryonia is gluttonous in its eating and suffers many digestive complaints. Food lies like a stone; ameliorated by bringing up wind. Eructat-ions of tasteless gas is characteristic. Symptoms worse after a meal. The tongue is foul and everything tastes bitter. Sour stomach. Digestion usually worse in the summer. Teste regards the digestive canal, and more particularly the stomach, as the principal seat of the action of Bryonia. Diarrhoea in the morning as soon as he moves, but more commonly constipation with large, dry, burnt looking stools. Stools that smell of old cheese. Bryonia is one of the main remedies for constipation when the stool is large, hard, and dry; there seems to be no mucous lining to the intestines to facilitate the passage of the stool. There is also a deficiency of peristaltic activity in the bowels. Inflammation and tenderness of the liver and kidneys. Urine is dark red but without deposit. Haemorrhages are frequent; nosebleed especially in the night around 3-4 am is characteristic. Nosebleed from the suppres¬sion of menses. Bryonia has been found to be curative in chlorosis. Mastitis with hardness and tenderness of the breasts. Pain in the left ovary ameliorated by lying on the painful side. Stupid, drowsy condition during fever, where the patient has the delusion that he is somewhere else and "wants to go home". Headaches which are bursting, splitting and go backwards and are worse for any movement or from coughing. Headaches from over-indulgence in alcohol and food. Convulsions from suppressed eruptions, after perspiration and after haemorrhages where the aura begins with jerking in the nape of the neck. The respiratory organs and heart are profoundly affected. A characteristic of Bryonia is a frequent desire to take a long breath; must expand the lungs. The Bryonia cough can be quite painful; patients will be seen to hold their chests when coughing in order to minimise the painful motion of the chest wall. Dropsical swellings into synovial and serous membranes, painful to touch, which increase as the day goes on and disappear during the night. Hot swelling of the affected parts. Swelling of glands, like nodes. Joints red, swollen and stiff with stitching pain from the slightest motion. Children dislike to be carried or raised. Pains are bursting, stitching or heavy and go backwards and appear gradually. Pain tends to move to the part lain on and after the pain has subsided the patient trembles. On coughing he holds his sides, the chest and the head. Burning pain of parts grasped with the hand and burning and tearing pains externally and internally. Pressing pain as from load or pressing pain outward, from within. Painful joints, worse motion and touch. Often indicated in an injury of the joint when Arnica fails. Stitching in affected parts upon pressure. Jerking, especially in places of the forehead, with sensitivity of the teeth. Bruised or suppurating pain in whole body when taken hold of, especially in the pit of the stomach, worse in the morning. Pain worse on the right side; pain from motion and worse during rest. Drawing pain and tension in almost all the limbs, especially in sinewy expansions. Physical weakness from the slightest exertion, with general sweat. Worse in the morning, on rising; in the morning while walking so that he drags himself about. Weakness felt in the knees and legs on ascending stairs. Unsteadiness of all parts of the body when walking. Faintness on rising from the bed, with cold sweat and rumbling in the abdomen. Disappearance of symptoms after a short rest in bed, except the weakness and depressed mood. Rapid cooling after heated walk causes weakness and sore bruised pain. Symptoms are usually right sided, worse in the morning around 9 a.m. and in the evening at 9 p.m. Aggravation from annoyance, from warmth, in cool days after the summer; from cold wind; change of weather, cold to warm aggravates, becoming hot in a room or in the open air, drinking while hot; warm, wet applications. Aggravation after sitting up, rising from a seat and on beginning to walk, better for continued walking; worse ascending, physical exertion, running, stepping or jar; lying on the side, the painless side, worse from touch. Worse before, at the beginning of and during sleep. Worse from vegetables, acids, early morning. Aggravation from suppressed coryza or suppressed eruptions or discharges.

Amelioration from pressure; made better by lying on the affected part, lying on the back, in a warm bed with heat to the inflamed part, bandaging the affected part, for cool; for open air, for quiet; cloudy, damp days; drawing knees up; descending, sitting up, cold food and drink after eating, from perspiration, from diarrhoea, in the evening from 6-9 p.m.

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Calcarea Phosphorica

Calcium Phosphate. Phosphate of Lime. Tricalcic Phosphate. Ca32P04.
A mixture of the basic and several complex calcium phosphates - produced by adding dilute phosphoric acid to lime water.
Trituration.

THE ESSENTIAL FEATURES
Calcarea phosphorica is a deep-acting remedy with a wide range of symptomatology. Unfortunately, it is often confused with several of our polychrests, the most frequent of these being Calcarea carbonica, Chamomilla, Phosphoricum acidum, Phosphorus and Tuberculinum. A more thorough understanding of this remedy will enable the practitioner to better distinguish it from the others mentioned above.

There are three primary causative factors for the development of a Calcarea phosphorica case:

a) bad nutrition
b) bad news
c) bad weather

a) Deficient or poor nutrition is required to produce the classic Calcarea phosphorica picture, especially on the physical level. This picture encompasses the basic structural and developmental pathology described in earlier texts, whose symptoms include : rachitis; emaciation; bone diseases; the non-union of fractured bones; anaemic states; slow or difficult convalescence after acute diseases. Specifically in babies: the non-union of sutures, open fontanelles, late learning to walk, late learning to talk, late dentition and troubles incident to this period.

Fifty or one hundred years ago, case descriptions of Calcarea phosphorica children treated by earlier homeopaths were abundant in our literature. Nowadays, in Western countries, the remedy is not indicated as often because nutrition has greatly improved. In developing countries, however, the classic picture can still be frequently encountered.

b) Similar to the effect of malnutrition, unexpectedly hearing bad news causes an imbalance in the organism and makes the individual sick. Apart from the predisposition that a child inherits from its parents, there are other causes that trigger a Calcarea phosphorica state. These include psychological stresses experienced in everyday life, e.g. grief, anxieties, insecurity, anger, contradiction, insults, etc., with the most devastating effect being wrought by the sudden hearing of bad news. This is one of the great key-notes of the remedy. This kind of shock cannot be tolerated by the organism so predisposed and brings about a deep imbalance and disease.

For example, a Calcarea phosphorica individual receives a telephone call informing him of a car accident involving a close relative. He becomes overwhelmed and cannot cope. His organism reacts to the information by getting excited, by having palpitations and fainting spells. He perspires profusely, especially around the neck and head and wants to fan this area all the time. What began as a temporary imbalance then turns into a chronic condition. He is afraid of hearing anything bad and becomes distraught from any kind of unpleasant news. Even the mere idea that he may encounter something unpleasant is unbearable.

The pathological consequences of such a shock can affect the mental, emotional, or physical level, or all simultaneously. An individual that was previously patient and balanced now becomes fearful, fretful, afraid of the dark, and afraid to be alone. These people become oversensitive; they cannot stand to see others suffer, a feeling that assumes pathological proportions.

Irritability and anger develop. This remedy rages and swears almost as much as Nux vomica. The provings describe symptoms such as: 'Grows very violent if his opinion is differed from, or if contradicted, so that he is vexed afterwards not to have been able to control himself.' Or: 'Violent, irritable, and snappish; it affects him most to hear that someone has done wrong; indignation rises in him, and he would like to avoid conversation.' There is a tendency to become very critical of oneself and others, which may induce these violent and irritable states. Coffee has an aggravating influence. Not only may it cause nausea, heartburn, confusion of the head, and headache, but it may also produce or increase intense ill-humour and irritability.

The possible consequences of hearing bad news in a Calcarea phosphorica individual are described in the provings in this fashion: 'Unpleasant news make him beside himself; he cannot think of any serious thing, cannot collect his thoughts, and gets into a general sweat about it.' Phatak also says that numbness and a crawling sensation can come on after bad news. This indication probably has its basis in the following proving report: 'Very much out of humour, does not want to talk a word, prefers not to be asked and to be left alone, after disagreeable news. — Very restless sleep, tosses about much. — In the morning after waking, the extremities are 'asleep', especially hands and feet (the day after disagreeable news).' The vexation that comes from bad news may also produce depression, a feeling as if lame, an inability to work or even to walk, and diarrhoea.

It is interesting to note that Calcarea phosphorica is seldom indicated for romantic disappointments. In these situations people usually have some sort of warning, either spoken or implied, of the impending separation. This opportunity for preparation mitigates the suddenness of the shock that otherwise might have provoked a Calcarea phosphorica condition.

Calcarea phosphorica is often indicated for ailments caused by grief, especially when the grief is profound and is precipitated suddenly. A sudden insult that is left unanswered can bring about a state of Calcarea phosphorica. In this case one may mistake the patient for Staphysagria.

c) Changes of weather, especially to cold and to wet, often cause severe symptoms. Calcarea phosphorica develops rheumatic pains that are worse in the winter (due to the cold weather), disappear in the spring and return in the autumn. Another modality of rheumatism observed in Calcarea phosphorica is that special times for aggravation are in the autumn and when the snow is melting, i.e. in the spring. This is a valuable and well-confirmed symptom.

Getting wet in the rain often brings on rheumatic pains in the shoulders, chest and extremities; the pain moves about all over the limbs and rump. A kind of dull pain from damp, rainy, cold weather has been observed in the lower limbs, as well as a feeling as if lame and beaten in the buttocks and other parts.

Discontent and Restlessness
A psychological theme central to Calcarea phosphorica is that of discontent. These people never seem to be satisfied with themselves. Their inner discontent renders them aggressive and extremely peevish, causes them to complain and more specifically, to moan and groan.

This characteristic is most readily witnessed in children. They may suffer discontent for a number of reasons (bone pains, teething difficulties, etc.) and moan and whine constantly and for extended periods of time. Parents typically complain that the moaning grates on their nerves. Mothers of Calcarea phosphorica children typically describe their child as a 'moaning child', thus summarising the whole situation in one word and providing the practitioner with the true essence of the case. Calcarea phosphorica should be the first remedy considered for children who moan in their sleep; in adults, the main remedy is Aurum.

I recall the case of a four-year-old boy. He had fallen and sustained a head injury. For no ascertainable reason, he moaned, groaned, and shrieked for seventy-two hours straight. His father carried him about and took him for walks around the block, but with little effect. Chamomilla did nothing for this child, while Calcarea phosphorica immediately put him into a restful sleep from which he awoke with no residual problems.

We can compare Calcarea phosphorica's dissatisfaction to that of Tuberculinum. Both experience discontent and the resulting desire to travel. Tub.'s dissatisfaction, however, is active and pertains to his locale. These people are unhappy with their surroundings and consequently develop an urge to travel, hoping to alter their environment and situation. They search for another set of conditions or circumstance that will excite them and provide them with strong mental stimulation.

In comparison, Calcarea phosphorica has an indefinable inner and passive discontent. At its core, is a discontent with themselves more than with others, although they may exhibit great irritability, anger, and censorious behaviour toward others. As Calcarea phosphorica is a realist and not one to engage in flights of fancy, his inner discontent constantly brings him back to reality and to his organism that works at a slow pace, to his inability to think, to his feelings of dullness and to his lack of joy. This even further intensifies his suffering, as Calcarea phosphorica's symptoms are definitely aggravated by thinking about them.

It is not surprising, then, that the desire to travel while listed in our repertories along with Tuberculinum, has an entirely different meaning. Calcarea phosphorica does not have the desire to travel per se, nor the excitement of seeing new places that Tub. has. Calcarea phosphorica just wants to be 'off somewhere', to change the place where the person is at the moment 'just for the sake of changing it'. The act of travelling, the altering of impressions, focus and goals distracts him from his inner discontent and restlessness, and thereby ameliorates him. For example, if he leaves his home, not for any major reason, but even just in order to visit a friend in another town, he feels better while travelling. Once he's arrived, however, his discontent returns and he wants to go home again. Calcarea phosphorica and Ignatia share a feeling of being better while travelling.

At this point, I feel it necessary to insert a warning. It is unfortunate and confusing that several authors, based on my description of essences, describe in their teachings or writings the personality traits of their clients, instead of their psychopathology. Only the mental/emotional pathology, not the personality need be taken into consideration when prescribing a remedy. That which has changed in the mental/emotional sphere after the appearance of the disease is of interest to the homeopath. If, for instance, in our case, there is a curious person who likes to meet people from other countries and is asked the question whether he likes to travel, he may answer yes—but this is not pathology!
Although Calcarea phosphorica and Tuberculinum children have superficial similarities, especially the strong desire for smoked meats, bacon and sausage and the desire to travel, it is important to discriminate between the way they express their dissatisfaction. This is done by noting whether the expression of dissatisfaction is active or passive. The Calcarea phosphorica child, when hurt or displeased, withdraws and begins to complain and moan from morning until night. Nothing satisfies the child; it seems to be unaware of what it wants. The Tub. child, on the other hand, is more prone to act out its dissatisfaction by taking action - by becoming malicious or by trying to hurt others. Were a mother to say, "My child is very nasty," one would not consider Calcarea phosphorica.

Indignation is another key-note of this remedy. When insulted, Calcarea phosphorica does not stay in order to fight back, but rather leaves with a sense of indignation. It is interesting that they can even become indignant at unpleasant dreams. This is another point where they resemble Staphysagria. Staph., however, is sweet and mild and accepting, while Calcarea phosphorica is vehement, angry, censorious and displeased with others and themselves. Though the symptom is the same, the context is different.

Sluggishness
Without knowing what exactly is wrong or why, Calcarea phosphorica patients realise that something is awry with their system. They may be functioning at their optimum when they suddenly find themselves becoming tired more easily. They feel sluggish. They start to lose interest in pursuing their daily activities, whether it be work or play. Their minds are duller, less vital. In order to mobilise their minds, they need stimulation, either mental, i.e., a good conversation, or physical, such as a good strong coffee. They are unable to explain the reason for their vague discontent. They only perceive that they are no longer easily excited nor enthusiastic about life, and that they are tired and do not comprehend things as readily as before.

The sluggishness on the mental level can be termed a 'mental flabbiness', and parallels the physical flabbiness that characterises this remedy — similar to what was written in my description of Calcarea carbonica. In Calcarea phosphorica people, the ability to reflect is very compromised. (This is exactly the opposite of Chamomilla, where the ability to reflect is quite active.) Mental tasks require far more time to complete than they did previously. Mental exertion becomes very difficult and may even provoke a headache. Indeed, Calcarea phosphorica is one of the major remedies for headaches in school children (compare Natrum carbonicum). Calcarea carbonica is the major remedy for headaches from physical rather than mental exertion.

The increasing deficiency in the area of the intellect assumes various forms, among them are the following: the memory begins to lack precision (a prover reported that he was unable 'to remember common symptoms of common remedies'), or is lost so that one does not remember at all what one has done, or what one should do. The operations of the intellect begin to lack the accustomed acuity. Ordinary intellectual operations are performed only with difficulty. Words get confused (a prover found himself writing throat for tonsils, red for swollen etc.) or are written twice. It becomes increasingly difficult to distinguish among things and notions under consideration. Mental 'stamina' begins to suffer; the individual is unable to sustain prolonged mental efforts.

Exertion-Exhaustion
As a result of their mind being sluggish, Calcarea phosphorica people dislike mental exertion. In fact, these people dislike performing work of any kind; if they do not work at all, however, they feel they have been neglectful and suffer even more discontent. If they are successful in stimulating themselves to work or are roused by somebody else, they feel better for having made the mental effort. They briefly experience a sense of satisfaction for having done some useful labour. The sluggishness, however, eventually reasserts itself and the discontent and nagging sense that something is wrong return, and progressively worsen. If these people direct their attention to their symptoms —to the difficulty they have concentrating, to their loss of memory, etc.—they feel much worse and their dissatisfaction increases. Similar to Oxalic acid, and as mentioned earlier, Calcarea phosphorica patients are worse from thinking about their symptoms and complaints.

At a more advanced stage, their inability to comprehend can progress to the point where they begin to do silly things. They make silly jokes or say silly things that are inappropriate to the situation. Their comments might be understood were they presented as jokes, but they are often made in all seriousness and with little awareness of the impression created by them.

Calcarea phosphorica's emotions suffer from sluggishness as well. Their emotions move with difficulty; they are indifferent. The emotional indifference, while somewhat similar to that of Phosphoric acid, is not nearly as profound.

Sighing
Sighing is a well-known key-note of Calcarea phosphorica. One might mistake a Calcarea phosphorica case for Ignatia because both remedies sigh frequently. Calcarea phosphorica's sighing, however, is primarily of a physical origin as opposed to Ign.'s psychological etiology and seems to be a consequence of physical pathology rather than psychology. Calcarea phosphorica cases have a weakness of the respiratory apparatus such that there is a need to take a deep breath. The deep involuntary inspiration that ensues sounds like sighing.

The sighing does not commence after an experience of grief, though such an episode may aggravate it, and usually appears for no apparent reason and much earlier in the case than Calcarea phosphorica's emotional symptoms. A psychological shock, like grief, may produce other symptoms, such as those previously mentioned under the heading 'Bad News' 'in the Essential Features'. This is different from Ign.'s sighing, which results directly from an incident of grief, and can be traced back to that experience.

Sympathetic and Fearful
Calcarea phosphorica individuals are typically sensitive people. Before they reach the state of inner discontent, they are quite open and outgoing. Though they are shyer than Phosphorus, the phosphoric element contributes to their sociability. Their feelings can be rather easily hurt, and when this happens they tend to develop an aversion to company; they become sulky and angry.

Both the qualities of desire for, and aversion to, company are observed, but at different stages of the pathology. The sympathetic moment can take a pathological form, but it is seen at an earlier stage of pathology than the inner discontent that is so striking in the more progressed stages.

Calcarea phosphorica is also very sympathetic toward other people's suffering and many times can become considerably anxious about others (again displaying their phosphoric nature). These ailments, together with some fears like the fear of thunderstorms, of the dark, of dogs, of cats, of being alone that are all key-notes of both Phosphorus and Calcarea carbonica, are encountered frequently in the Calcarea phosphorica child.

In the sexual sphere, we have a polarity. On the one hand, Calcarea phosphorica's general weakness may make them less prone to seek out sex. On the other hand, some Calcarea phosphorica individuals, especially women, possess a very strong sexual drive, some to the point that they suffer from the intensity of the drive. This 'nymphomania' is most intense before menses. Also, having an orgasm sometimes gives Calcarea phosphorica extra energy, resulting in a feeling of general well being, a good appetite, and a desire for work after coitus.

The Calcarea Phosphorica Child
The general makeup of the Calcarea phosphorica child has frequently been described in homeopathic literature, especially cases where the cause is malnutrition. A good example of such a case is a child who is pale, thin, scrawny, very underweight, mentally and physically underdeveloped, slow at learning to walk (or has lost the ability), hardly able to talk, has tottery legs, a head that is inclined to wobble, a belly that is flabby and prominent or flabby and sunken, is subject to bronchitis and tonsillitis, has a very unstable nervous system, and is very restless. Remedies that should be compared are Baryta carbonica, Borax, Calcarea carbonica, Magnesia carbonica, Medorrhinum, Natrum muriaticum and Phosphoricum acidum.

Problems with the formation of bones and/or an inclination to bone diseases and bone pains, often indicate Calcarea phosphorica,. The remedy should be considered when the head bones are slow in forming or do not keep pace with the growth of the child, when the fontanelles don't close early enough, or even reopen. Clarke differentiates: 'Calcarea carbonica has an open anterior fontanelle; Calcarea phosphorica has both open, especially the posterior.' The skull is often thin and soft, gives way under the pressure of a finger or seems to crackle like paper. There are pains in the skull bones, especially in the region of the sutures.

Another indication of the remedy is the so-called 'growing pains' (due to delayed closure of the epiphyses) in fast growing children, which appear especially at night. These children grow very quickly, but the assimilation of nutrients to support such rapid growth is deficient; thus we see skeletal and dental problems. A number of pathologies that have been cured or favourably influenced by this remedy are: lateral curvatures of the spine (scoliosis); hydrocephalus, acute or chronic; rickets, frequently with diarrhoea (cholera infantum), in emaciated children; caries, easy decay of the teeth, especially of the first teeth; late or slow dentition, in connection with a host of teething complaints which include cough, diarrhoea and spasms, especially without fever. Symptoms associated with spina bifida are reported to be favourably influenced by Calcarea phosphorica. Enlarged tonsils and adenoid growths are often seen and have also responded well.

An important symptom, though not to the same degree as in Calcarea carbonica, is a profuse night sweat around the head.

Great sensitivity is also exhibited to cold and to jarring. Hering describes: 'A child of fifteen months, with a big head and open fontanelles... violent screaming, grasping with hands in great agony towards his mother; cold sweat, most in face, whole body cold. '

Concerning the mental makeup, some important traits have been described before. The discontent, with the typical moaning (especially during sleep) and the restlessness, is the core of the mental and emotional pathology. Patients tend to be peevish, fretful, and ill-humoured. Boericke describes them as follows: 'Anaemic children who are peevish, flabby, have cold extremities and feeble digestion. ' Babies turn over all the time, cry a lot, are restless, constantly kick and move their extremities. Trying to console them by picking them up does not work; on the contrary, it makes them feel worse and may cause a suffocative attack with a cyanotic face and extreme restlessness. This aggravation from lifting the child from its bed is just the opposite of Borax, where downward motion brings on symptoms.

Anxieties and fears are also frequent. They are often related to bodily symptoms (i.e. abdominal pains, chest and respiration symptoms, teething problems). Calcarea phosphorica children tend to be timid and shy; they tend to start or to develop convulsions from fright or other external influences.

On the intellectual level, the growth process of these children is also frequently disturbed. Their memory is poor, and mental exertion is often dreaded; prolonged mental efforts are difficult to sustain and often bring on symptoms (like the headaches in school children mentioned earlier, or a kind of dull sluggishness with the desire to be alone). Mental retardation with bodily hyperactivity is an indication that has been confirmed more than once by many homeopaths including Stiegele, who saw favourable results even in more advanced stages of this syndrome (after cerebral polio).

The food desires are very unusual and strong. 'Craving for fat bacon', or, as Margaret Tyler puts it, for 'ham rind', is a symptom that has been well-verified in children; however an aversion to ham has also been observed. Smoked meat is frequently the favourite food. We also see desire for sausages, for potatoes and farinaceous foods, and for indigestible things, which refers to things that the little patient cannot digest, such as fat bacon in cases of cholera infantum, or to slate pencils, clay or such things. An aversion to ham, however, has also been observed. Children's appetites frequently increase, and the child wants to eat (or nurse) all the time; this often occurs in emaciated children, who despite this do not 'put on flesh'. We also see nursing children who refuse their mother's milk; this, however, is due to the milk being spoiled and tasting salty, not to any problem with the child.

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Calendula Officinalis

Calendula officinalis.
The Marigold.
N.O. Compositae.
Tincture of leaves and flowers.

THE ESSENTIAL FEATURES
Calendula is to lacerated wounds what Arnica is to bruises. Both are considered specifics for injuries (as are Ledum, Bellis perennis and some others). When the skin or an organ is not torn and the external trauma only produces an extravasation of blood, then Arnica will be indicated. However, when there is laceration of the skin or of an organ and inflammation sets in, the correct choice is Calendula; yet this is not always the case, as the injuries have to have additional Calendula characteristics if the remedy is to be effective.

An important characteristic of Calendula is that once there is an injury, inflammation or ulceration, the pain experienced may be very violent, often out of all proportion to the extent of the injury. Also the effect on the general condition of the patient is quite distressing; general weakness which, again, may be much more debilitating than could be expected given the severity of the wound or the ulcer.

Exhaustion may also come from profuse loss of blood from the injured part, or from inflammation with exhausting suppuration and threatening sepsis; but weakness and pain will also be excessive even if the wound is not so severe. During these states of intense pain and weakness, the patient may feel nauseous, as well as suffer other consequences from physical trauma. Chill is a marked feature, and many symptoms occur during chill, as the proving showed; fever and headache may also follow the injury.

Calendula is indicated in cases of injuries of the muscles and tendons (where usually Bryonia and Rhus toxicodendron are given) and where there is intense inflammation and the symptoms look like Bry., but Bry. does not help. The pain will be worse on moving the part and relieved by lying perfectly still. The injured part is sensitive to touch and the wound is painful even after being dressed. However, in Calendula we may also see an amelioration from walking about, and also an aggravation from wet weather (like Rhus-t) with pain coming in paroxysms as in Lachesis.

The constitutional state of Calendula shows an individual with lowered defences, who catches colds frequently, gets tired easily - mentally, emotionally and physically - feels extremely nervous, irritable, fretful, is easily frightened, is very sensitive to noises, and starts from them. The patient gives you the impression of being a weak and frightened individual. Every difficult situation and every stress brings about a state of panic. A fear that something bad is going to happen (as in Causticum or Phosphorus) prevails, a 'feeling as if some overwhelming calamity was hovering over me as to be almost unbearable', as one prover put it, and this fear makes the patient very restless.

These people are very touchy individuals who react with irritability and fretfulness if they are criticised or insulted. A morose and fretful mood may be coupled with anxiety and apprehension, especially during a chill, but also with a sleepy, dream-like state. The mental pain of anguish and despair is so acute that it may become totally intolerable, such that the individual may eventually reach a state of indifference and may even seem callous. (It is interesting to note here that Calendula has been used successfully in cases where the skin of the hands and / or the soles of the feet were thickened, hard, and calloused).

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In an involuntary proving on a baby, Calendula caused screaming, twitching of the hands and face, with colicky pains (seemingly from flatulence). There were even convulsions with fixed eyes, a dark round mouth and vomiting of milk with slime. This was accompanied by extreme nervousness, and the sensitivity to noise mentioned above. Another symptom was a decidedly yellow tint of the skin and also of the stools ('the colour of marigold'). Clarke, who relates this involuntary proving, reports that cases of jaundice have been successfully treated with Calendula. Great irritability that is, like many symptoms in this remedy, aggravated during a chill may be a key-note in these cases.

In injuries, Calendula (in external application, but also per os) promotes healthy granulation tissue and rapid healing, with favourable cicatrization and without disfiguring scars. This tendency to produce granulation has led to its use in cases of excessive 'proud flesh', cicatricial keloids and true keloids. This is especially true when cicatricial tissue is found on the tympanum and impedes the hearing.

Cooper has shown that Calendula is one of the best remedies in loss of hearing, deafness from 'proud flesh' or cicatricial tissue on the tympanum, even if there is no actual injury to this part, but only a concussion of the head or some such causation. He also used it with success in cases where there was a history of suppressed skin eruptions. His main modalities were deafness worse in damp weather and from drinking.

Generalities
Calendula is well-known as a vulnerary, i.e. to be applied externally, especially for lacerated wounds with loss of tissue, in suppurating wounds and ulcers, in fractures, especially if compound and if repair is slow, and for consequences of a blow, shock or fall. Jahr, who was in Paris in the bloody year of 1849, used the remedy for several victims who had fragmented bones from gunshot wounds; limbs that would otherwise have been amputated were saved by means of Calendula.

This remedy is useful for inflammations due to mechanical trauma (ophthalmia, etc.), neuritis as a result of lacerated wounds and also after surgical operations, or after rupture of the perineum in childbirth. Clarke remarks that 'the application of a sponge saturated with a hot solution of Calendula after delivery gives the greatest comfort to the patient.'

It can be used when wounds from dental operations (extraction of teeth, etc.) do not heal readily and continue to haemorrhage. Its remarkable power to prevent suppuration, sepsis and gangrene has often been confirmed. Boericke praises its 'remarkable power to produce local exudation' and says that it 'helps to make acrid discharge healthy and free.' Bloody and serous infiltration of cellular tissues in open wounds and ulcers (sugillations, suffusions) is also considered as an important indication. It acts very promptly in some cases of carbuncles, subduing pain and fever. It has cured bad or excessive cicatrization, keloids, superfluous 'proud flesh', weakness and other consequences from badly healed injuries or ulcers.

Other indications on which Calendula was given with good results include : paralysis after apoplexy; rheumatism which is worse from motion; chronic vomiting; disturbed menses, especially suppressed menses and ailments from it; and more. 'Applied externally and as a fomentation, particularly the flowers are said to...relieve headaches and toothache' (Hahnemann's Dispensary Dictionary). A general feature is a strong tendency to catch colds, especially in damp weather, and a tendency towards catarrhal conditions. Calendula is most commonly applied externally as a solution, but it has also been used orally (in tincture or potency), either without external application or in order to support its external application. Head Lacerated scalp wounds. Compound skull fractures. Dullness in the head, as if he had a hangover. Heaviness of the head in the morning, as after prolonged illness. Dull, pressing sensation, especially in the occiput. Frontal headache after eating, with a sensation of heat in the forehead. Flushes of heat in the forehead, in the evenings.

Eyes
Traumatic ophthalmia with suppuration (e.g. from foreign body in eye); conjunctivitis, iritis, keratitis. Lacerated or incised wounds of the eyes. After operations on the eyes or lids where undue inflammation and suppuration is to be avoided. Wounds of the lids and brows which have not been correctly treated and where suppuration has taken place. Franz's proving elicited this symptom: 'White of eyes inflamed, with pressive headaches now in forehead, now in temple when lying, but not when sitting or standing.' Discharge from the lachrymal sac. Dryness and biting of the margins of the lids, as though from smoke. Yellowish vision.

Ears
Loss of hearing or deafness, with cicatricial tissue on the tympanum. There may be a history of otorrhoea and suppressed eczema. In one case, a thickening of the epidermis of the back of the hands had remained after suppression of an eczema, and this was the deciding factor for Calendula. Hearing may be better when there is noise around, also when riding on a train or a bus. Distant sounds are heard better. Worse in damp, heavy air; from drinking. Worse when having a cold or when tired. Bathing can trigger the appearance of deafness. Difficulty in distinguishing speech when two or more people speak together; an inability to distinguish where the sound is coming from.

Nose and Face
Coryza in one nostril; with much green discharge. Severe sneezing. 'Black and blue' eyes, from extravasation of the blood after injury. Face puffy and swollen, particularly under the eyes. After taking a tablespoon of the tincture, Price experienced the following: 'Immediately, sensation as if lips were swollen; from the lips it spread to sides of nose, and increased rapidly in intensity. After one hour, lids were much swollen and pupils dilated.

Mouth and Throat
After extraction of teeth, or dental operations resulting in laceration of gums. Burns on the lips, the tongue, scalding of buccal mucous membranes; tongue dry, red and cracked. Submaxillary glands swollen and painful to the touch, as if ulcerated, at the same time axillary glands painful to the touch. Or: submaxillary glands painful, but also without being touched there is a tensive pain which becomes a pressure in the throat, especially on swallowing. Or: drawing tensive pain in the glands behind the left ramus of the lower jaw, when moving the head. Bitter-slimy taste in the throat before eating, but food tastes normal. A case of violent toothache, diagnosed as acute pericoronitis, was treated successfully by a single dose of Calendula C 200 (per os). The symptoms exhibited were: severe pain in the muscles and bone of left lower jaw; worse at night; pain radiating to the left ear; tired, weak and nauseous; general aggravation from heat. The reason for prescribing Calendula was due to the advice from a workshop the practitioner had attended that the remedy was to be considered for any septic condition when another remedy was not indicated. (Gregory Pais, Simillimum, Winter 1991, p.82).

Stomach
Heartburn with horripilation (hair standing up) is a peculiar symptom. Sinking sensation; attacks of nausea or nauseous feeling. Nausea felt in the chest. Chronic vomiting: after catching a cold; with cardialgia, hectic fever and emaciation; with pain in the uterine region; preceded by diarrhoea. Epigastric distension.

Abdomen
Dull, coarse stitches in the middle of the right side of the abdomen upon motion, ceasing during rest. On walking, a boring and digging pain in the umbilical region. Enteritis caused by a foreign body. Constant soreness of the abdomen and tenderness in the left iliac region, with frequent, almost entirely mucous stools.

Rectum
Stool preceded by pinching and anxiety in the hypogastrium, with a chill. Diarrhoea: with flatulence; excoriating anus; with vomiting. Constipation: with flatulence, strains, but passes no stool; from retroversion of the uterus.

Urinary Organs
Injury to the bladder after an operation. Tearing in the urethra during a chill. Clarke mentions that difficulty in passing water, such as is commonly encountered in old men, was entirely removed for some days after the person had chewed a leaf of Calendula for some minutes. Frequent urination with pale, clear urine, which is very hot and burns, or dark, offensive urine.

Genitalia – Male
Mechanical excoriation of the mucous surface of the prepuce, after coitus; cured >n two days by a lotion of Calendula 200, a few globules dissolved in water (Journal of Homoeopathic Clinics, vol. 4, p. 116).

Genitalia – Female
Swelling and induration of the uterus; with stretching and dragging in the groin; sense of fullness and weight in the pelvis; rnenorrhagia; constipation from occasional retroversion; pain on sudden movement. Prolapsus. Ulceration of os uteri; with offensive leucorrhoea. Condylomata at os externum. Calendula has even been used in uterine and breast cancer. It helps when there is a rupture of the cervix uteri and perineum during childbirth, or for a lacerated womb after a Caesarean section. Inflammation of the genitals, with a lacerated hymen, from coitus or other causes. Excoriated and cracked nipples. Nodosities in the breast. Menses suppressed; with cough. Profuse, offensive watery discharge from the vagina, with great exhaustion, after instrumental delivery. Inflammation of the vulva resulting from cutting or tearing the parts.

Chest
Drawing pressure in the left side of the chest and on the sternum, with stitches in the right side.

Cough with hoarseness, green expectoration; with distension of the inguinal ring. Pressure and oppression on the left side of the chest, during the evening in bed. i

Neck and Back
Pressing-tearing pain between the scapulae. Rheumatic drawing pain in the right side of the neck, increased when bending the neck to the right and when lifting the right arm, extending to the shoulder. Pressive pain with sensation as if ulcerated and bruised under angle of the right scapula.

Extremities
Drawing-pressive tension in the hands and ankle joints, during rest. Pain as if beaten at the outer side of the knees when sitting. Burning tearing pain on top of the calf, when sitting. Drawing, cramp-like pain at the inner margin of the sole of the foot, when sitting. Tired, weary feeling in the lower extremities; hands and feet cold. Ulcus cruris varicosum. Deep, ragged ulcers with frequent intense pain, profuse suppuration, and a discharge with an offensive stench (compare Calc-s.). Erysipelas and gangrene after crushing the foot.

Sleep
Feels as if he would fall from a height, when falling asleep. Restless sleep, finds rest in no position, frequent waking, frequent urge to urinate, drinks much.

Fever
The chill and fever symptoms from Franz's proving are remarkable, strong and numerous. Chilly all morning, with great sensitivity to the open air. Almost all the symptoms make their appearance during a chill. Anxious, morose, apprehensive mood during chill. Chill in the hands and the feet all morning, without thirst; with drawing-pressive pains throughout the whole body; the ribs ache as if compressed and beaten, after having sat for some time. Shivering and goose-flesh, though the skin is warm to the touch. Shivering on the back, with pressure on the last true rib of the left side and movements in the pit of the stomach and abdomen which make him feel as if he would faint. Heat in the afternoon, intermingled with shivering, and frequent thirst, but drinking always causes shivering and a shaking chill. Great heat in the evening in bed, begins to perspire, the feet, in particular, burn intensely and sweat. Great heat all morning, with profuse sweat, a nauseous feeling in the chest, and the shoulders are very hot. Sensation of heat in the afternoon in the hands (which are otherwise cold) and the whole head, intermingled with shivering, thirstlessness, almost an aversion to drinking.

Skin Dermic thickening, callous, especially on the backs of the hands or the soles of the feet. A yellow tint to the skin; jaundice. Old, neglected wounds which become offensive. Keloids. Ailments from bad or excessive cicatrization. Some cases show that Calendula can exert a favourable influence upon cutaneous cancers (malignant epithelioma, etc.). Traumatic erysipelas.

CLINICAL
Abscess. Balanitis. Breast, suppurating; nodosities in. Bubo. Burns. Carbuncle. Chilblains. Deafness. Eyes, inflamed. Fever. Fistula. Glandular swellings. Jaundice. Labour. Nails, pulp of, inflamed. Nipples, sore. Suppuration. Tetanus. Ulcers. Uterus, inflammation of: cancer of; offensive discharge from. Varicosis. Whitlow. Wounds.

RELATIONS
Calendula contains a lot of nitrogen and phosphoric acid. Antidoted by: Arn. Incompatible: Camph. Complementary: Hep. Compatible: Arn., Ars., Bry., Nit-ac, Phos., Rhus-t. Follows well: Ars. Is followed well by: Arn., Hep. Compare: Arn., Ars., Bry., Calc-s., Carb-an., Carb-v., Ham., Hep., Hyper., Led., Nit-ac, Phos., Rhus-t, Ruta, Sal-ac, Sul-ac, Symph. Notes:

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Conium Maculatum

Poison Hemlock.
N.O. Umbelliferae.
Tincture of fresh plant in flower.

THE ESSENTIAL FEATURES
The idea of paralysis in Conium is not so much the one we know from Socrates' death by the 'noggin of hemlock'; real paralysis comes only as an end result, and this may take a very long time, twenty years, thirty years, or more. Conium suffers with a gradually progressing weakness and paresis, and gradual is the key word here.

The idea is much more that of sclerosis, of becoming hard, especially the glands, which become swollen and indurated. A gradually progressing weakness with the formation of indurations during the decline, is the picture of Conium pathology.

Mental Paralysis and Induration
This process develops on all three levels. On the mental level, we observe a gradual decline of the intellectual capacities.
The patient becomes more and more dull; he has more and more difficulty in comprehension.

Thinking is slowed down, memory becomes weak, and the patient becomes forgetful. His five senses lose their acuity, and his reserves slowly ebb away. A frequent and characteristic symptom is an inability to sustain mental effort over any length of time.

All these symptoms can also be found in other remedies; but the characteristic here is the snail's pace of the progress. It happens so gradually that the patient is not aware of the process himself. After some years he may go back in his memory and say, 'What is happening to me?' But it takes him years to see the declining process. Nor is this decline observed by the people around him, especially those who are in contact with him every day. The process develops too slowly and undramatically.

Even when he finally feels that something serious and deeply disturbing is going on, he will often say nothing to anybody, because no one else seems to have noticed anything. Finally a kind of stupefaction takes over, and now he feels that this state is definitely leading him into a serious condition of degeneration, of imbecility and premature senility.

Conium produces as it were areas of sclerosis, of callus in the brain. It seems to be a remedy that is very set in its thinking, to the extent that it becomes superstitious. Conium is the main remedy in superstition or 'superstitious thoughts'. It is like an induration in a certain area of the brain.

The patients tend to have compulsive thoughts and to execute compulsive actions, but only in a separate arena of their mental lives. The remainder of the brain is working beautifully, and they are otherwise normal people, performing their tasks, holding their jobs, and fulfilling all their social functions, but in this separate mental arena they have some fixed ideas which they cannot get rid of.

Those superstitious obsessions may be more or less harmless in themselves. They might think, 'If I don't touch the corner when I go around it, something bad is going to happen to me'. Or, 'I mustn't step on the cracks between the slabs of the pavement, and if I do, I will suffer some misfortune'. These ideas may make life intolerable for the people around them.

I remember a case in which the wife related that her husband would not take off his trousers to go to bed until everything was absolutely quiet outside. If he could hear a car, he was unable to take off his trousers. So he waited until he couldn't hear the car any more, and then he started pulling off his trousers.

But soon the noise of another car came, and he couldn't continue taking off his trousers: he had to wait for absolute quiet. This man was a manager in a bank, he had a responsible position, and he was normal in every other way, but he could not be talked out of this obsession.

Of course, there was more to it that. He admitted that his memory had begun to fail, and that his concentration was not the same as it had been. He could not read as much as he used to, because he was slower to comprehend. All of these functions came back after the remedy, Conium 10M in a single dose, and the compulsive action has disappeared.

Conium's fixed ideas often (but not always) centre around needing absolute quiet, as in the case above, and problems with strangers. This is especially true regarding toilets. They often cannot urinate or pass stool if there are people near the bathroom. And they can get terrible constipation because of that, especially when they are travelling, because there are nearly always people around. It is beautiful to see how such behaviour is taken away by the correct remedy.

Emotional Paralysis and Induration
On the emotional level, we again witness this gradual paralysis with induration. The emotions are gradually weakened and paralyzed until it is impossible to bring them to the surface, to 'move' them. The final state is a condition of complete indifference and apathy, when they find no interest in anything. And when they have gone so far, they are no more able to show emotion when it is needed or appropriate to the surroundings.

If they get a present, they cannot be happy, and they are also unable to cry when they would like to; their feelings may still be there but they are petrified and indurated, they cannot be moved. Then they become gloomy and unhappy; they do not want company and they feel unable to communicate with anybody.

But this indifference doesn't develop quickly, and again it takes a long time until the pathology has gone this far. Before that state of indifference, there is a stage where patients are worried because they feel that something is happening with their mental condition. They are worried about their health, they wonder what is happening in their mind, how all this will end. They become anxious, and in this state they do not want to be alone. In Conium the aversion to company is not a very strong feature.

How can we speak of induration presented on the emotional level? It manifests as a kind of insensitivity. Conium people are not sweet persons, they are hard, 'down to earth', materialistic and practical people. As the doctor you will see that they are demanding. They will be loyal to you as long as they feel you can help them and as you are not hurting them. But if there is a stage where, in their opinion, you are not helping them enough, they will immediately let you know, demanding their 'rights'.

Conium people are materialists in a different fashion to Platina. They don't have the extreme egotism and haughtiness of Platina, they don't think that they are 'big'. Rather, Conium's attachment is to the material world around him, his property, his habits, his family.

Conium says: 'This is mine. This table is mine. This is my house'. Once any of this is taken away from him, there is a definite morbid, pathological reaction, and this is often accompanied by an induration on the physical level, a tumour which is usually malignant.

These symptoms after a 'material loss' can occur very suddenly, even immediately, at quite another speed compared to the slow and gradual paralysis of the remedy. If, for instance, the patient's house burns down and many valuable things are lost, he can develop symptoms very quickly, especially hard tumours, even cancer, and in such a case Conium will often be indicated.

Suppression of Sexuality
The biggest material loss for Conium is the deprivation of regular sexual activity. The moment they lose regular sex with their partner, problems start. The body may function well as long as there is a regular release on the sexual level, a release of the hormones at regular intervals with a specific partner.

This is what they need to feel in balance, otherwise the balance is lost. Therefore you will often see Conium indicated in women who have lost or separated from their partner and do not have a new love affair.

Female Conium patients depend on the regular sexual activity they are used to, and if the husband dies, the woman does not easily start a new affair. Because of this failure to release the hormones, problems will arise, which can go from vertigo, which is usually the first to appear, to trembling and weakness.

It can go as far as developing severe problems, even cancer, and especially cancer of the breast or of the uterus. Cancer of cervix uteri is also often seen. The idea is that a hard tumour develops, mostly of the glands, but it can be anywhere.

Conium is the main remedy for the gland that is affected greatly by sexual activity in man: the prostate. If a suppression of sexual urge in a Conium man is present, the first gland that is affected is the prostate, it can swell and even cause prostate cancer. Moreover, Conium is an important remedy in indurated and malignant swelling of the testes.

Also we may see hypochondria in unmarried men with very strict principles of sexual morality: 'Hypochondriacal complaints, especially in unmarried people who are strictly abstinent in sexual matters'.

Here the comparison with Platina is again very interesting. Conium people have a strong sexual urge, as do Platina, but the difference is that Conium are not oversexed, they are more on the practical side. They don't think of sex day and night, like Platina, rather they look upon sex as something they just need from time to time to release their hormones; they are people without illusions, matter of fact in their approach to sex.

You have to understand the mentality: they feel that the good things which we can enjoy in life are given to us, it is our right to enjoy them. They do not tend to have bad feelings, feelings of guilt or doubt, neither do they tend to hypersexual behaviour. We can say, they know exactly what they want: sex and the release of orgasm is what they need to keep their organism functioning, that is the idea, and they take it as a fact or, as it were, their right.

But if this outlet stops suddenly, once this 'right' is taken away from them, then there is a kind of dizziness, which they constantly complain about, they say that their head is never clear. They start trembling, shaking all over and a feeling of paralytic weakness eventually takes them over. The dizziness can become really severe, and Meniere's Syndrome may develop. Things seem to be turning around them.

The worst situation is when they lie in bed and want to turn to the other side; this movement aggravates them terribly. (This should be differentiated from the similar symptom in Silicea, where the vertigo in bed only arises from turning to the left.)

On sudden motion, for example on turning the head to look behind them, everything seems to turn around them. They complain about the head problem, it is nearly indescribable for them: they do not say vertigo, instead they use words like a buzzing inside the head, a noise, a dizziness, or similar terms.

In a recent case from Argentina (quoted in Klassische Homoopathie 5/93), a 57-year-old man got 'vertigo, worse when turning around in bed, with a feeling as though the brain had gone to sleep'. This came on after his wife had (in his words), 'condemned him to celibacy'.

In other cases, patients start to tremble and feel as if paralyzed all over; even mentally paralyzed, unable to perform any duties, with problems in concentrating; unable to stand mental effort for any length of time.

Conium are also fixed on their sexual patterns, not at all flexible. They are not oversexed, and they do not tend to promiscuity or extramarital relationships. On the contrary, when they make a decision to keep with one partner, they will stay together until the partner dies.

Typical symptoms will be: complaints of swollen glands, the head is not clear and there are headaches, even very severe headaches, or headaches together with vertigo. The patient starts trembling and feels weak. With this picture you might prescribe Gelsemium, Cocculus or Carbo vegetabilis. But once you have the information about the loss of a partner and the abrupt end to sexual activity, then there is only one remedy that will help and this is Conium.

Of course, such a history also happens to other people who do not need a remedy, but where other organisms can manage this interruption and can balance themselves, it will be Conium who, almost invariably, will develop pathological symptoms.

Further Mental Symptoms
Some proving symptoms to show how the Conium pathology affects the intellect:
'Dullness; difficulty in understanding what he is reading, with confusion of the head'.
'Dullness, like stupefaction; difficulty in understanding what he is reading'.
'Want of memory'.
'Forgetfulness and weakness in head'.
'Unable to correctly express oneself by talking, with difficulty of recollecting things'.
'Inability to sustain any mental effort'.

There are often states of difficulty in concentration and absence of mind, even insensibility and confusion, especially after awaking from a midday nap.

There are many emotional symptoms where anxiety, gloomy thoughts, fears and peevishness dominate. They correspond to the state where the patient begins to feel his decline (see above), but they can also appear in other situations.

For instance: 'Deeply absorbed in thought, he meditates anxiously about present and future, searching for solitude'. 'Hysterical anxiety'. 'Ill humour and gloom'. 'Constant ill humour and peevishness'. 'Peevish mood; does not know what to do; time passes too slowly'.

From a proving by Robinson: 'She feels peevish, vexed, and easily put out about trifles'. Where these symptoms dominate there may be a rather contradictory attitude toward human company, as is manifested in this proving symptom: 'Shuns people and their approach, and at the same time dread to be alone'.

In the context of the menses, there are also states of sensitivity, tearfulness and restlessness. 'Before the menses, aching in all limbs, with tearful mood, restlessness and anxious worry about trifles'. Or: 'She is easily moved by trifles, moved to tears'.

In the Chronic Diseases, we even find a veritable weeping fit which later transforms into vertigo and weakness: 'Paroxysm: alone at home, she feels an inclination to weep; after yielding to it, the weeping changes to a loud sobbing; afterwards flickering before the eyes and indistinct vision, so that she had to hold on to something when walking; afterwards weariness in all limbs and a dull headache'.

A number of mental symptoms corresponds with the stage of indifference, apathy, emotional paralysis and petrefaction: 'Very ill-humoured, every afternoon, from 3 pm to 6 pm, as though a great guilt weighed upon him, with paralysed feeling in all the limbs, indifference, and taking no interest in anything'. 'Morose mood; everything about him makes an unpleasant impression upon him'. 'Disinclination for work'. 'No pleasant feelings whatsoever'.

Conium has successfully been used in depressive states, and it is easy to see that the depressive element prevails in the remedy. There is on record a cured case of a woman who fell into a 'very unhappy mood' every 14 days. She had no desire to dress, to eat anything, to talk or to see her children.

The periodic recurrence of this unhappy state may be a hint that Conium could also be indicated in cyclic manic-depressive states. And though the depressive symptoms preponderate, we still see proving symptoms like this: 'He is averse to being near people, and to the talk of those passing him; is inclined to seize hold of and abuse them'.

A cured case, fragments of which are very often quoted in literature, shows that Conium can be useful when there is an alternation of marked manic and depressive stages:

'A 16-year-old boy... became mentally ill... It was peculiar that he was alternately in a depressed mood for 10 days and then again in an excited mood for 10 days. He is silent for 10 days, sad and worried, picks his fingers, lies in bed most of the time, does not like to answer questions, with more frequent urination during the night. Confused feeling in head, often sits as if he were in a dream. Eats and drinks but has a stool only every third day; weak memory. Timid, cannot be persuaded to any work. Sleep very restless. Then very excited for 10 days, vehement, domineering, quarrelsome, tends to scold. Likes to wear his best clothes, makes useless purchases and then cares very little for them, wastes or ruins them; does not want to work, prefers to play; picks quarrels, does not tolerate contradiction. Continuously picks his nose which bleeds easily'.

Conditions of Weakness
As mentioned above, the Conium weakness increases very gradually, year after year, finally amounting to complete paralysis, and this process may take many years. Conium is an important remedy in chronic recreational drug users; not for the acute consequences of high doses of cocaine, for instance, but for people who are more careful with drugs.

They take small doses of drugs, they enjoy them little by little for many years, and very gradually they keep going into a state of loss of power on all levels, mental, emotional, and physical, so slowly that it is hard to perceive. After many years, the mind is totally paralysed, they cannot think any more, imagination is exhausted, all energy is lost. In chronic drug users who do not take large or strong doses of narcotics, Conium will be indicated if there is such a gradual loss of power.

I include alcohol as a recreational drug here; Conium is in any case sensitive to alcohol and is easily affected by it. Hahnemann writes: 'The least quantity of spirituous drink intoxicates him'. Headaches are aggravated from alcohol, and the characteristic process of weakening and decline may be sped up by alcohol. But we have to know that underneath there is a predisposition; alcohol and drugs may catalyze and intensify the process, but they are not the deepest reason for the pathology.

On the physical plane, the weakness of Conium especially manifests in the urinary and genital systems. In spite of the intensity of the sexual desire, the sexual powers are weak, and there is often impotence. Men tend to have ejaculatio praecox, and women may also get orgasms without even touching their partner. To quote Hahnemann's own delicate phrase: Emission even while frolicking with a woman'.

I once treated a female patient who used to flirt with priests. She liked to make them excited, and she would have a complete orgasm while she was flirting with them, without ever touching them. This symptom made me think of Conium. You may wonder why I call this a state of weakness. But in fact this is how I understand it: the sexual organs are weakened, almost paralyzed, and they are unable to hold back the release of the orgasm. A little stimulation, then orgasm happens, and that is it.

A keynote for Conium is interrupted urination. People in a Conium state will be urinating and the urination suddenly stops, in the middle of the flow. They wait a moment, and it starts again, stops again and so on, three, four or five times, before the urinary tract is empty. 'The discharge of urine suddenly stops during urination and only continues after a while'.

Such a symptom may point to a weakness of the bladder in expelling the urine, but sometimes also to a stenosis of the urethra or to the swelling of the prostate. If the urethra is narrowed because of an enlargement of the prostate gland, Conium may be indicated as well. If the urethral stricture is caused by inflammation and cicatrization, you should also think of Thuja and Medorrhinum when other symptoms agree.

An interesting modality: complaints of the extremities which respond to Conium are relieved by letting the affected limb hang down. This modality is indeed a strange, rare, and peculiar symptom that should call Conium to mind. As Kent puts it: 'Conium differs from a great many medicines. It is common for pains and aches to be relieved by putting the foot up on a chair; by putting them up in bed. But the patient with rheumatism, with ulceration and the other strange sufferings of the legs, will lie down and permits his legs to hang over the bed up as far as the knee'.

An ulcer on the foot that is painful even when lying in bed, is ameliorated by hanging the legs down from the knee. We may comprehend this peculiar symptom by knowing the pathology of the remedy, especially from the case of Socrates, who observed that its actions started by paralyzing first the lower extremities. It is therefore possible that Conium restricts the blood flow in the lower extremities, causing problems thereafter.

The Conium Vertigo
Vertigo is one of the most prominent features of the remedy. It may occur on rising from bed or from a seat, or on walking, on going downstairs, when lying, etc. But the most characteristic modality is vertigo on turning in bed. Also on moving the eyes or the head, especially in sideways motion. In this kind of vertigo Conium is the main remedy together with Belladonna, especially when the vertigo occurs when turning around in bed. Clarke mentions a case of lumbago with the symptom 'cannot turn over in bed without being dizzy' that was cured with Conium.

You may also compare Cocculus, because the Conium vertigo frequently has to do with an accommodation weakness of the eyes, as in Cocculus.

Nash reports a case where a patient seemed to have all the symptoms of locomotor ataxia. The striking symptom was that he could not, when walking, turn the head or the eyes the least bit sideways without staggering or falling. When he went out with his wife, he always walked in front of her or behind her, but never by her side! This strange behaviour made Nash think of Conium.

Some more proving symptoms and cured symptoms relating to the Conium vertigo:
Vertigo, in the morning, on rising from bed.
Very dizzy while walking.
Vertigo, like turning in a circle, on rising from his seat.
Vertigo, worse when lying down, as though the bed were turning in a circle.
Vertigo on becoming erect after stooping, as if the head would burst.
Vertigo on looking around, as though the patient were to fall sideways.
'On raising my eyes from the object upon which they had been fixed to a more distant one the vision was confused, and a feeling of giddiness suddenly came over me. So long as my eyes were fixed on a given object the giddiness disappeared... 'Another prover even staggered when walking, but as soon as he closed his eyes, '... I could now walk straight and steady, and, what was more, without any feeling of giddiness'.

Generalities
Glandular induration as a result of contusion. Conium has acted very well even in mammary cancer which developed after a blow against the breast, in cancer of the lip after long-time pressure by a tobacco pipe, etc.

Lassitude and weakness, even amounting to fainting. A striking symptom is a tremulous weakness after every stool that ceases in the open air. 'Sudden relaxation (a kind of paralytic weakness) while walking' has also been cured by Conium. But usually the weakness will develop very slowly and deeply, as discussed above. 'So weak that she has to lie down; sick and weary in the morning in bed, with ill-humour, sleepiness and pains in the stomach'.

The paralytic states of Conium usually begin below and proceed upwards (as in Socrates' death); this direction of development may also manifest in other Conium symptoms.
They are affected by cold and exertion.
Conium patients tend to have complaints from over-lifting.

They are particularly sensitive to complaints from walking in the open air where exertion and cold may combine: 'Great liability to catch a cold, even in a room, after a walk in the open air, during which he had perspired'. 'Walking in the open air makes her weary, and the air affects her'. Extreme exhaustion, sudden relaxation, ill humour and other complaints appear after walking in the open air.

Warmth will usually ameliorate, particularly warmth of the sun. 'Chilly with trembling in all limbs, and therefore she has to remain constantly in the warmth of the sun'. Bright light, however, will often disturb the patient very much, and excessive photophobia is a striking symptom of Conium.

Two strange symptoms that can be understood as keynotes:
Perspiration as soon as one closes the eyes. This symptom permitted Lippe to cure a 80-year-old man who suffered from hemiplegia.
'The clothes lie upon chest and shoulders like a load'. Conium may be indicated in mononucleosis infectiosa, especially in the glandular form (if the symptoms agree, of course). Other remedies frequently indicated in this disease are Iodium and Mercurius.

Head

'Violent headache with vertigo, from which she suffered for three or four days; she was sad and silent, just sitting there the whole time'. Sick headaches with vertigo and an inability to urinate. There are also headaches with unsatisfactory and too small stools.
Constant sensation of confusion and stupefaction in the head. 'Constant dullness of the forehead, in the region of the eyebrows and the root of the nose'. Alcohol aggravates, even when mixed with water and drunk in very small quantities. 'Even watered wine rises to his head'.
Great sensitivity of the brain, especially to jar. 'On shaking the head, headache from the forehead to the occiput, as if something were loose in there'. 'On every step a snapping in the vertex, without pain'. 'Forcing and griping in the forehead, seemingly coming from the stomach, with much sensitiveness of the brain; the brain is shaken even by a noise or by talking'. There are also headaches from over-study.
Sensations of heaviness in the head, especially in the occiput, arising when sitting bent forward and ceasing when raising the head.
Strange sensations: 'Numbness, with sensation of coldness, of one side of the head'. Sensation in the right half of the brain as of a large foreign body. Hot spots on top or back of head, worse from excitement or overwork.
Often there are severe headaches from within outward. 'Headache, as if the brain were too full and the skull would burst, in the morning, on waking'.
Sticking pain in top of head and forehead, from within outward. Very severe occipital pains on every heartbeat, 'as though the occiput were pierced with a knife'. Throbbing headache, felt in the forehead.
On the other hand, there is also a sensation of 'giddy constriction of the brain' or a headache 'as if externally contracted' above the os frontale, or else a headache 'like a compression from both temples, after every meal'.
Drawing in the head, as soon as one goes out in the cold air; relieved on closing the eyes. With this, there is a sensation of 'great weakness in the head and the whole body'.
Tearing pains in occiput and back of neck, but also in the orbits, with constant nausea, urging to lie down.
Headaches with blindness or disturbances of vision, also with a sensation as if something like a fringe was falling over eyes.
Falling hair.

Eyes

The most important symptom is a weakness of the eye muscles, and particularly of the accommodation of the eyes, sometimes amounting to paralysis. The remedy may be indicated in presbyopia, as Hahnemann already presumed in the Materia Medica Pura. 'Far-sightedness; could distinctly see rather distant objects'.
'Affected with a weakness and dazzling of my eyes, together with a giddiness and debility of my whole body, especially the muscles of my arms and legs, so that when I attempted to walk I was apt to stagger like a person who had drunk too much liquor'.
Double vision occasionally occurs, as well as squinting, etc. Conium affects all the muscles in the region of the eyes, producing difficulties with every kind of motion of the eyes, on looking around or behind, turning the head, etc. 'Eyes feel as if pulled outward from nose'. And: 'He could hardly raise the eyelids, which seemed pressed down by a heavy weight'.
Weakness of vision may be cured with Conium, but also many other disturbances of vision. For instance: Sees before his eyes dark spots and coloured stripes, or clouds and bright spots, or else bows, sometimes playing in all rainbow colours; red vision.
'Fiery zigzags, moving through each other before the sight, on closing the eyes at night'.
Excessive photophobia, frequently without any signs of inflammation in the eye. Dazzling of the eyes from light of day, even in the room. Photophobia may be coupled with lid spasms. From a classic case: I frequently saw the most excessive photophobia with spasm of the lids. After hard efforts to separate the lids it finally succeeded, and a flood of hot tears spurted out, but cornea as well as sclerotica proved free of any inflammatory process'.
Disturbances of vision that are caused by injury, as for instance: ophthalmia after injury by a wood-chip, with dimness of cornea; dimness of the lens (cataract) after a blow against the eye, etc.
Much and constant dilatation of the pupils.
Burning in the eyes, and especially of the inner surface of the eyelids. Pressure in eyes, worse when reading.
A biting pain in the inner canthi as if something caustic had come in, with lachrymation. Itching beneath the eyes, rubbing does not ameliorate but leads to a burning biting pain.
Repeated manifestation of styes, especially if styes became indurated A strange symptom from Bonninghausen: cold feeling in eyes when walking in the open air.

Ears

In Meniere's disease it is the first remedy to be thought of.
Much accumulation of earwax, even obstruction of the external meatus, with partial deafness. Conium may act curatively, especially when this complaint is coupled with pain in the liver region.
Something comes before the ears on blowing the nose and they feel stopped.
Or else: painful sensitivity of hearing, noise startles him.
Noises in the ears: ringing, buzzing, humming, throbbing. Tinnitus.
Tearing and stinging pains in and around the ears.
Or else: drawing stinging pain, from within outward, in the ear.
Swelling and induration of the parotid gland, with painful tension of the skin.

Nose

Tendency to bore or pick in the nose, which bleeds easily.
Epistaxis when sneezing.
Excessively acute sense of smell.
Burning at the nostrils.
Stitching and sore pain in the nasal septum, also on tip of nose.
Too frequent sneezing, or obstruction of nose, which may become chronic. 'Obstructed nose for years' (Hahnemann).
Discharge of pus from the nose, mingled with blood.
Before the menses, pain inside in root of nose, aggravated by blowing nose and pressure.

Face

Eruptions in face, itching; pustular or vesicular; gnawing ulcers in face. Blisters at the upper lip, at the margin of the red portion, painful. Indurated tumours on cheeks and especially on lips, also as a consequence of pressure or contusion (tobacco pipe). Malignant tumours of the lips. Hardening and enlargement of the submandibular glands. Tearing stinging face-ache, directly before the ear; or a drawing pain from the jaw to the ear, or else painful tension near the ear. Facial pains that mostly occur at night.

Mouth

Drawing toothache, extending through the temples, aggravated by eating cold things, but not by cold drinking.
Drawing, jerking or gnawing toothache, with a sensation as if the teeth were loose, especially on mastication.
Tongue swollen, stiff, and painful, with difficult speech and articulation. Paralysis of the tongue.
Saliva tasting sour, or bitter taste in mouth.

Throat

Bitter taste in throat.
Constant inclination to swallow, especially when walking in the wind. Strange rising in the throat, with a sense of stuffing as if something were lodged there. This may be a hysterical symptom (globus hystericu): 'Pressure from pit of stomach upwards into oesophagus, as though a round body were ascending'. Or else: 'Fullness in pit of throat, with fruitless efforts to belch'.

Respiration, Chest and Cough

Irritation to cough in the larynx, especially in this form: dry spot in the larynx, where there is a crawling, and almost constant irritation to dry cough. There may also be itching, tingling or scraping in throat, provoking dry cough.
Conium cured a 13-year-old boy who had a 'clapping noise' in the larynx with the act of expiration. The noise was distinctly audible and was usually preceded by marked spasmodic twitching of the right facial muscles.
Difficult inspiration, also with air hunger; with a sensation as if the chest couldn't expand enough, or else with a feeling of constriction of the chest; especially in the morning on waking and in the evening in bed.
Cough that occurs almost exclusively when first lying down, immediately after assuming a lying position; has to sit up and cough it out, afterwards he has rest.
Cough which is triggered by lying down and deep breathing; especially in the evening and at night.
Loose cough, but nothing can be expectorated; has to swallow the mucus which is detached by the cough. Conium is often indicated in obstinate dry cough remaining after influenza or a cold.
Cough which is followed by vomiturition. 'Night cough continued without any intermission until gagging and vomiting occurred'.
A sharp thrust directly through the chest, from the sternum to the spine.
Stitching pains in the sternum and in the whole thorax are frequent with Conium.
'Violent stitches in side, as if a knife were plunged into it, causing loud moaning'.
Or else: violent stitches in the right side of the chest about the nipple, on every inspiration while walking, relieved by hard pressure with the hand. Dry cough, excited by the slightest exposure to cold air, even by putting arms out of bed {Hepar).

Heart

Palpitation of the heart after stool, with intermission of heart beats. Violent palpitation: after drinking , when rising from bed.

Stomach

With many Conium complaints, there is loss of appetite. But Conium has marked desires: for salt and salty food; for sour food; for coffee. Milk does not agree. Bread tastes bad and 'does not go down'.
Empty eructations are frequent. They can start in the morning and continue all day. Usually they are odourless and tasteless, but there is also 'putrid eructation'.
Much nausea after every meal, with inclination to vomit and often enough with real vomiting. Conium may be indicated in vomiting in pregnancy.
Violent spasmodic pains in the stomach, especially if coupled with a tendency to constipation. From a cured case: 'Feeling as though the stomach contracted, as though a heavy weight were pressing upon it; she thinks she cannot tighten her clothes, and believes the stomach cramp would never stop, it only remits sometimes but increases again, making her sufferings intolerable'.
Contracting stomach pains, together with feeling of coldness in stomach and back; sensation of soreness and rawness in stomach.
In excessive stomach pains, e.g. in the context of a perforating ulcer or even cancer, Conium has been given with good results; the pains and the general state of the patients were markedly ameliorated. In one case the pains were gnawing and appeared mostly two or three hours after a meal and during the night, in another case they had a burning and cramping character and extended as far as the back and the shoulders. But the most remarkable modality was, 'pains relieved most in the knee-elbow position'.

Abdomen

Distension of abdomen, the belly is often hard and tense, with flatulence. 'Hardness and severe bloating of abdomen, in the evening after eating, the umbilicus protrudes which makes her sleep restless'. Swelling of the mesenteric lymph nodes.
Rapid bloating of the belly especially after drinking milk. Cutting in the abdomen precedes the discharge of flatus.
A strange concomitant symptom: 'Distension of abdomen, like flatulent colic, in the evening, with coldness of one foot' (compare Lycopodium). Stitching pains in the liver region, sometimes with intervals, or painful tearing there. Swelling of liver with pressive pain and accumulation of ear-wax, causing partial deafness.
Painful tension about the hypochondria, as from a constricting band.
Pressive-tensive pain in the left hypochondrium, extending to the left side of the hypogastrium. Oppressive contraction of the hypogastrium. Contractive pain in lower abdomen, like after-pains. Pinching pains in the abdomen, as if diarrhoea would come on. Spasmodic or bearing-down pains, like menstrual colic or labour pains. Sore feeling in belly when walking on stone pavement. Trembling of the whole abdomen.

Rectum and Stool

Conium has some very characteristic and unusual symptoms in this region. The symptom 'Discharge of cold flatus' seems to be unique in the materia medica. Clarke reports that in a case of severe diarrhoea where the stools felt cold Conium was successfully given.
However, there is also the opposite sensation that is much more 'normal'.
'During stool, burning in the rectum' and 'Heat in lower portion of rectum' (but not in the anus!).
Conium has been useful in constipation with ineffectual urging or with unsatisfactory stools. Sometimes violent stomach cramps in combination with the constipation. Hard stools, only every other day. 'Constant urging without any stool. Frequent unsuccessful urging'. Several stools every day, but in very small quantities.
The remedy may also be indicated in diarrhoea, especially if watery or liquid stools are mixed with hard particles and are discharged together with noisy flatus. 'Frequent diarrhoea; stools like water, with many eructations, and copious passage of urine'. Watery diarrhoea, intermingled with undigested food.
The attacks of weakness after stool are very characteristic, too. After every stool, tremulous weakness, that ceases in the open air. And: after stool, palpitation of the heart, with intermission of heart beats.
Stools coated with blood.
Involuntary discharge of stool during sleep.
Stitches in the anus when not at stool.

Urinary Organs

The best-known symptom in this region has been quoted above:
'The discharge of urine suddenly stops during urination and only continues after a while'.
Frequently there is also cutting in urethra during urination with it; also burning during or after micturition.
The problems with urination may have their cause in a weakness of the bladder but also in hypertrophy of the prostate gland.
Frequent urging to urinate and strangury; with burning in urethra and feeling of heat during micturition.
Frequent urination at night. 'Has to get up at 2 o'clock to urinate, several nights successively'.
Dribbling of urine in old men.
Turbid, whitish and viscous urine.
Urine is more easily discharged while standing, but in the beginning almost nothing is discharged even when standing; later on, however, the urine flows freely.

Male Genitalia

The ill effects of sudden loss of a sexual partner in both sexes are discussed extensively above.
Sexual weakness: impotence; erections absent, incomplete or of too short duration. Depression and weariness after coition.
But sexual desire is indeed present. Intense sexual desire with lack of sexual potency is characteristic. 'Vivid sexual desire, without erection'.
Frequent discharge of prostatic fluid, on every emotion, on straining for stool, etc.; also with itching of prepuce.
Nocturnal ejaculations without erotic dreams. Spermatorrhoea; with intermittent discharge of urine.
Swelling and induration of the testicles, especially after contusion; cancer of testicles. Cancer of the prostate.
Cutting pain in the urethra at the moment of ejaculation.
Violent pain of testes. 'Pain as though a knife was cutting through the middle of the scrotum, between the testes upward as far as the root of the penis; with frequent short repetitions'. In his Dictionary, Clarke reports a case of contusion of the testes with very similar pains; Conium C200 relieved in 5 minutes! There is also pressive, pinching and tearing pain in the testicles.

Female Genitalia

In this region, Conium has particularly caused and cured indurations and hard tumours with stinging, shooting pains. It has been frequently used in mammary and uterine cancer, and in induration and enlargement of the ovaries as well. Some proving symptoms: 'Hardness of the right breast, with painfulness to touch and nightly stitches with it'. 'Stitches, as with needles, in the left mammary gland'. Conium proved especially useful, in hard tumours after a blow or beating against the mamma.
Moreover, Conium is indicated in many complaints in connection with menstruation. Some symptoms caused and cured by Conium that occurred before the menses: aching in limbs, tearful mood, restlessness and anxious worry about every trifle; anxious dreams; pains in mammae, especially on every jar; dry heat in whole body, but without thirst; stinging pains in the liver region, more at night while lying down and especially on inspiration; flatulence; pain inside in the root of nose.
Dysmenorrhoea with violent uterine cramps. Some descriptions: 'Grinding pain is felt above pudendum; the abdomen becomes inflated, the pain affects the chest and stitches are felt in left side'. Pressure downward and drawing in the thigh or stitching pain in the vagina. Contractive pain in the hypogastrium disappearing on walking in the open air. Concomitant symptoms: great fear when alone, but dread of strangers or company; stitches in mammae; headache; eruption all over body, consisting of small red nodules that burn violently after scratching and disappear with the end of the menstrual bleeding.
Moreover, Conium has effected a cessation or suppression of the menses, and so it has acted curatively in amenorrhoea and complaints from amenorrhoea, and in too scanty menses as well. If the 'premenstrual' symptoms mentioned above occur every four weeks but the bleeding is totally absent, there is a good chance that Conium is indicated. 'Menses stopped by putting hands in cold water'.
In a recent case, this symptom permitted the cure of a patient whose menses stopped after the first day. She had prepared beans in cold water before. Now she suffered with pain and congestion in abdomen, back and mammae (which was not the case otherwise). The cause made the therapist think of Conium, and the remedy brought the menses back and made the pain disappear (Sharma, Klassische Homoopathie 6/92).
Leucorrhoea which is preceded by much abdominal pain and a weak and lame feeling in the small of the back; afterwards lassitude and exhaustion. 'Leucorrhoea of a white acrid mucus, which caused burning'. 'Thick, milky leucorrhoea, with contractive labour-like colic coming from both sides'. A discharge of bloody mucus is also reported. Conium may also be indicated in vomiting of pregnancy; in complete insomnia and extreme exhaustion for days after childbirth, with excessive photophobia; in oozing of milk from the breasts long after weaning of the child, but also in dwindling of the mammae. 'The female milk glands shrivel from Conium so that the most beautiful bosom looks like an empty fold of the skin' (from Heraclides). Severe itching deep in the vagina.
Violent stitches at the female parts.
Vulva very sore to the touch.

Neck and Back

Conium is an important remedy in indurated swelling of cervical lymph nodes.
'Crawling in the spine, as from falling asleep'. Permanent sensation of numbness in the region of the shoulder blades.
Tensive pains in back, especially in the muscles below the scapulae, aggravated by raising the arms.
Pains as if sprained in the left side of back, also in the neck.
Stitches in small of back, with a drawing pain through the lumbar vertebrae, when standing.
Pain in small of back, especially drawing or dragging downward, in connection with the menses, prolapsus of the uterus or something like that.
Bad effects from spinal injury. There is a case report about a young man who had fallen from the second storey onto the stone pavement of the street. More than a year later he still suffered from very annoying pain in the lumbar region (on which he had fallen), especially when laughing, sneezing or taking a quick breath. Conium brought about a great, rapid and permanent amelioration of the pain.

Extremities

Weakness, powerlessness, prostration, lame feelings and paralysis of the extremities are symptoms of Conium.
'Loss of power on awaking from siesta, arms and legs as if separated from the body'. The limbs are stiff, heavy, almost useless, moving them provokes a 'disagreeable feeling', can hardly walk.
Paralysis first of the lower, then of the upper extremities.
Trembling of all limbs.
Sensations of numbness and coldness, especially in fingers and toes, sometimes spreading from there towards the body.
Bruised feeling in all the joints, especially during rest; much better or disappearing during motion.
Shoulders feel sore, as if pressed on. The clothes seem to lie on them like a load.
Swelling and induration of the axillar lymph nodes, also when there are tumours of the mammae.
Cramp-like pain in the muscles of the forearms, especially when leaning on arms.
Cracking in the wrist, especially in the evening.
Perspiration of the palms.
Yellow spots on fingers; yellow finger nails.
Gait is faltering, vacillating, staggering as if drunk, dragging his legs after him.
When he closes his eyes, he is able to walk straight and steady, but when they are open he begins to stagger.
Pain going from hypogastric region down legs, in dysmenorrhoea.
Feeling of weakness, even to trembling, in the right thigh, while walking.
Or else: on walking in the open air, cramp-like pain in the anterior muscles of the right thigh.
Tiredness and 'fatigue pain' in knees.
Cracking of the knees on becoming erect.
Cramps in calves; tensive, stiff pains in the calves.
'Painful reddish spots on the calves, later turning yellow or green like from contusions, and preventing the mobility of the foot which is bent like from shortening of the tendons'.
Coldness of one foot, with distension of abdomen.
Sensation as if the bone pierced the skin at the heel.
Numbness and insensibility of the feet; they tend to become cold, with liability to catch a cold.

Sleep

Insomnia and late falling asleep, only after midnight.
Restless sleep, nightmares, anxious dreams and frightful dreams, interrupting the sleep.
Dreams of dead people and corpses; of people who are alive in reality but dead in the dream.
Or else: sleep too deep, like stupefied, unrefreshing; headache aggravated after sleep. Especially after waking from siesta symptoms like 'insensibility', confusion, powerlessness etc. will occur.
Irresistible sleepiness during the day. 'He could not refrain from sleep with all his will power; had to lie down and sleep'.

Fever

Great internal and external heat, with great nervousness. Burning heat through the whole body. Sensation of internal and external heat after sleep. A fever symptom from the Chronic Diseases; 'Sensation of heat in whole body, also increased warmth of skin which can be felt externally, with dry and sticky lips, without thirst, even with aversion to drinks, and with an insipid saliva in the mouth; noise and shining objects affect him, as well as any motion; he wants to sit lonesome with closed eyes'. Chilliness, shivering and coldness, especially early in the morning and in the afternoon; at 5 am; from 3 to 5 pm.
'Chill with trembling in all limbs, so he always has to stay in the warmth of the sun'.
The Conium perspiration has one striking and very important modality: 'Sweat as soon as she closes the eyes, only in the beginning of the sleep; even by day, when sleeping in sitting position'.

Skin

Itching of the skin, especially of the backs of the fingers. 'Itching stitches, as from fleas, one directly after the other, here and there on the body, but always single stitches, never two at the same time'.
Yellow discolouration of the skin, also of the finger nails and the whites of eyes.
Brown spots on the body.
Urticaria after violent bodily exercise.
Obstinate herpetic eruptions in different places, e.g. around the neck, behind the ears, in the crook of the knee, on hands and forearms; usually moist and burning, worse by warmth.

An example by Hartlaub: 'Sudden herpetic eruption on forearm, beginning as a small spot and gradually spreading over arm; skin became porous, very red and raw, with furrows and depressions. Sore, broken places formed here and there in the skin, viscid lymph or blood oozing from them, lymph drying and forming white crusts under which the exudation still continues; intense itching in affected parts, with irresistible desire to scratch, particularly in evening; surrounding lymphatics swollen and involved...' Burning nodules on the skin during the menses, disappearing with the end of the bleeding. Petechia, especially in old people. Tendency to necrotic ulcers.

CLINICAL
Asthma. Bladder, inflammation of. Breast, affections of. Bronchitis. Bruises. Cancer. Cataract. Chorea. Cough. Cysts, sebaceous. Depression. Diphtheritic paralysis. Dysmenia. Erisipelas. Eyes, affections of. Galactorrhoea. Herpes. Hypochondriasis. Jaundice. Liver, enlarged. Melancholia. Menstruation, disordered. Numbness. Ovaries, affections of. Paralysis. Peritonitis. Phthisis. Pregnancy, breasts painful in. Prostatitis. Ptoses. Scrofula. Spermatorrhoea. Sterility. Stomach, affections of. Testicles, affections of. Trismus. Tumours. Ulcers. Vertigo. Vision, disordered.

RELATIONS
Antidoted by: Coffea, Dulcamera, Nitricum acidum, Nitri spiritus dulcis
It antidotes: Mercurius, Nitricum acidum, Sulphur.
Compatible: Arnica, Arsenicum, Belladonna, Calcarea phosphorica, Lycopodium, Nux vomica, Phosphorus, Pulsatilla, Rhus tox., Stramonium.
Incompatible: Psorinum

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Palladium

The essential features
Palladium patients are having tremendous emotional insecurity with strong emotions that cannot be expressed, and in this way creating a blockade, a deep inner conflict that needs constant support on the part of those around and especially those whom they are intemately connected, all this is coupled wiyth a tremeddous unexpressed egoism.

They actually think all the time that they are worth more than the others think about them, and it does not matter how much praise thay may others use for them it is neverr enough. An insatiable hunger for flattery, not only praise but really flatter. It is impressive how much they crave it and how little they openly admit and ask for it.

They will sit in the company of many people and if nobody pays attention to them for sometimes they have a strong sense that they are neglected. On the contrary if they feel that they are appreciated they keep very alive and excitable during the contact with the others, and they spend so much emotional energy that when they go back home and are alone again they feel exhausted. Actually this feeling for the need for support and the good opinion from others follows them all the time as always there is cause in a family with children for such a situation.

This can become a source of real everyday suffering You can praise them to the limit and will be very happy they thrive on praise, even if what you say about them is an outright lie or an exaggerated statement. They need to be loved and admired to a pathological degree. The opinion of others is so important that their balance and equianimity depends on this.

If they do not have such treatment they feel that their pride has been wounded, they feel that they are ignored that they are neglected, they may even have delusions of been neglected. If somebody instead of praising them eyen slightly criticises them, they go to pieces. They are insulted tremendously their inner pride is shattered and their paranoia about it can go as far as having real delusions that they every body wants to insult them.

This remedy is similar to Platina in the fact that have an exagerated sense of greatness, which will never be openly admitted that is why we see delusions that have grown larger that they are taller than they actually are. Here again there is a difference from Platina who feels that is taller than others. The Palladium exhibits no open confrontation with others on the contrary he avoids it like anything, will not show his inner, almost subconscious self-importance to the outsiders, they will be rather quite, timid with actually a strong lack of self-confidence and may be passed unoticed in a social gathering but still they want praise they want flattery.

A child will do well at school if praised every day by the parents and the teachers but will do very bad if he is criticised at all. Many times if the parents donot realise what they must do the child goes in to a state of total inadequay, they become lazy they are not interested in making any effort.

Children with less than average intelligence believe that are very good and intelligent in their class even when the marks they get are mediocre of even worse.

It is this state of false greatness that is preparing for them to feel wounded with the least provocation

There is hautiness, but this exaggerated sense of self importance stays inside, will never be expressed, stays as a feeling that is not confessed in any way, and this is different from Platina who will declare, will show in many ways how important she is, how great she is.

This general idea of being "bigger" "greater" than they really are which is felt internally but not expressed to the outside world will lead the organism to produce huge tumors especially on the sexual organs and more especially the ovaries. These areas are the diseased areas that are producing disease according to the idea symbolised by the medicine

Here it must be said that in order to recognise or to discover the symbolic ideas expressed by the medicines one should be very carefull in pronouncing them as such a task requires a lot of experience, analytical and at the same time synthetic mind that can take the facts, can analyse them and then synthesise them in to a coherent idea.

I hear a lot latetly about the "essence" of the remedy and one student was asking me in the interval of a course " please give me the essence" of the carbons in one word! These are dangeous things to play with as they give false ideas to the uninitited students and also mak it sound as if the finding of a remedy could be an oversimplified process.

Palladium is one of the main remedies that we must think when we see huge tumors developing in the sexual organs of the female especially. Huge tumors in ovaries. The frustration is usually there in this area, as sexual drive is usually high and sex is connected very much with the need to be accepted. Palladium has an excessive sexual appetite, they will be ecxited with obsene words during sexual intercourse and in general even the child likes slung words that have a rude sexual connotetion.

If they get offended or irritated they can become violent in their reactions and expressions and then they use offensive language. Palladium due to its internal conflict, internal need for affection and yet there is a pride that does not allow them to ask for it eventually brings about a convulsed state, which can produce convulsive movements first of the face and eventually of the whole body. It is a wonderfull remedy for Gilles de la Turret's syndrom when the child appears practically normal while he is in the school, or in a social function, where the opinion of others matters very much, but when he goes back home the nervous system lets loose and the patient goes in to spasms, twitches and makes all kinds of grimaces making short frightening sounds and the whole organism seems to be in a turmoil yet the next day at school they keep perfect control of their nervous system and nobody can imagine what they are suffering from, but there is this anomalous energy that amasses and adds up all the time and needs to be detonated soon.

When the nervous system of Paladium is affected then it seems to be in a constant state of stress and turmoil. This remedy together with Cuprum, Stramonium and Hyoscyamus are the principal remedies in this syndrom. Chorea and all kinds of spasmodic conditions are covered by the pathogenesis of this remedy

Keynotes
Headache across the head from ear to ear.

Huge tumpors of the right ovary

Glairy mucus discharges

Pain relieved by pressure

As if the uterus would prolapse

As if something is hanging from the throat

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Belladonna

Atropa Belladonna
Deadly Nightshade
N.O.Solanaceae
Tincture of whole plant when beginning to flower

THE ESSENTIAL FEATURES
When one 'clearly perceives what it is in medicines which heals,' as Hahnemann enjoins, then one no longer thinks of a medicine in narrow terms. That is to say, when one understands the essence of a remedy, one can envision the possible applications of that remedy in their broadest context.

Many of our medicines are spoken of as 'acute remedies' or 'constitutional remedies', but no such artificial boundaries exist in homeopathy. In the course of my personal experience I have observed that Belladonna, a medicine generally considered as an acute remedy, is among the most frequently used polychrests for chronic conditions as well.

Belladonna is a remedy characterised by great intensity and vividness. Both Belladonna patients and Belladonna disease processes are impressive because of the great energy they manifest. Thus, Belladonna pathology can be among the most extravagant produced by any remedy in our entire materia medica. Great forcefulness seems to characterise the pathological processes of Belladonna. Similarly, the constitutional Belladonna individual generally appears vital and intense. He seems to possess a great amount of well-balanced energy.

One rarely finds a use for this remedy in depleted, apathetic individuals. Rather, Belladonna people look healthy and robust. They seem to be people without deep miasmatic illness, without many layers of sickness. Consequently, there is frequently a paucity of mental and emotional symptoms in the first stages of pathology of these patients. Furthermore, they almost invariably have clear aggravations after taking the remedy and generally require little long-term management.

In most homeopathic materia medica great emphasis is placed on the 'suddenness' of Belladonna conditions. This 'sudden' quality certainly pertains to acute conditions and also to some of the individual crises of chronic conditions, but in the typical chronic cases one very frequently sees a slow steady intensification of symptomatology over the years. Thus, it is usual to find a history where the symptoms began rather innocuously but have been progressing steadily, such that within the last year or so the condition has become unbearable, driving the patient to seek treatment.

The pathology of the constitutional Belladonna patient generally confines itself to the physical level; this contrasts with the usual patient course seen in other remedies. Typically, a patient will initially manifest only physical symptoms, but, with added stress or suppressive medical therapies, the disease penetrates to involve deeper levels of the organism, i.e., the mental-emotional sphere. Consequently, in most cases, one sees a mixture of both psychological and physical symptoms.

Belladonna constitutions, however, seem to 'quarantine' the pathology to but some specific physical disorder, perhaps because of their relatively higher vitality. In these patients one usually encounters a history of a progressive intensification of the physical disorder and little evidence of mental or emotional affect. For example, one often hears a patient relate a history of migraine headaches which originally were infrequent and rather mild but which have in the past two years increased in frequency to several times a week and which consist of an almost maddening pain.

As a consequence of the above observations, one can say that the diagnosis and prescription of Belladonna is generally made on the basis of physical disorders. However, a characteristic Belladonna personality does exist.

External Appearance
The Belladonna external appearance is one of vitality. These people are full of life and may appear plethoric. Their faces are often red and flushed, and their eyes seem to glisten. As mentioned below, they are not easily ignored or passed by, but tend to stand out in the crowd.

The Mental and Emotional Picture
Belladonna individuals are vivid; they have a type of presence which is not easily ignored. They are the kind of people who stand out in a group; they may even tend to find themselves the centre of attention at parties as a result of their bright eyes and great vitality. However, they are not people who seek out company. The Belladonna personality possesses substance and richness. They are intellectuals of obvious intelligence and a great number of vividly expressed ideas. They have strong, vivid emotions and sentiments, vivid thoughts and imaginations. More than anything they are excitable.

Although they do not avoid company, it appears that their thoughts and imaginations are so vivid that they do not need extra stimulation from outside sources. In fact, they seem to avoid strong stimuli and have an aversion to noisy, bright places. Furthermore, their strong characters do not need support from others. They do not like to reveal their suffering (although in a crisis they are usually unable to hide it). They do not require consolation, and they tend to keep their problems to themselves.

Irritability and Anger
In our materia medica the Belladonna pathology is presented in such a manner as to make you think that unless somebody is totally psychotic, convulsed or in a delirium you cannot prescribe this remedy. My experience with the chronic patients of Belladonna, with those I call the constitutional type, is quite different. I have seen a lot of Belladonna cases that had no mental pathology at all. As stated, the pathology in constitutional Belladonna is generally confined to the physical plane. But, of course, when the patients' defenses are extensively harassed, there can be deterioration to deeper levels and then we see a sudden appearance of mental pathology.

We do not see a progressive psychopathological state. The mental-emotional pathology that does finally appear in Belladonna can be seen as an accentuation of the described personality type. The same 'intensity' that characterises the Belladonna physical pathology applies to the mental-emotional pathology; they both come on like a storm.

Irritability, anger, and finally violent impulses and violent mania can be witnessed. Irritability is the one symptom which is consistently present even in the early stages of pathology. One very often finds a history of impatience and sudden flares of temper. These patients may literally explode with anger. There are paroxysms of anger and shouting, and a patient may say that when he is angry, "The whole building hears me shout!". The anger is such that it can bring about coughing while the face becomes extremely red. The patient becomes angry even at his own mistakes and then wants to break things. Sometimes the anger alternates with weeping in a state beyond his control.

The anger is, however, equally rapidly forgotten, like a storm that rages and quickly subsides. But beware, should anyone try to give advice to a Belladonna patient while in this temper, however kindly one may try, the result will be to make him furious and explode in an even worse manner.

Anxieties and Fears
Because the Belladonna individual is generally strong in character, he is not prone to suffer fears and anxieties. One does find anxiety about health in some cases, especially fear of cancer, but this fear is easily overcome by the reassurance of a physician and soon forgotten. Anxiety is not generally marked in Belladonna cases, though it may appear sometimes alternating with rage, or in a crowd, or during menses. There can also infrequently occur fear of death or fear of the dark. Of course, the most famous fear of Belladonna is the fear of dogs and fear of animals in general. As Belladonna is a remedy with a vivid imagination it is natural that there should be a fear of imaginary things.

Destructiveness
There is also an element of violence running throughout Belladonna. When the patient does begin to show signs of mental-emotional pathology, he may mention a desire to perform violent acts. In the earlier stages the patient may struggle to control various compulsions to violence; e.g., a temptation to bite or to pull someone's hair. He may even feel compelled to grab the hair of an unknown bystander, but he restrains himself. In a state of rage or delirium he may lose control however, and actually strike those around him, biting people or objects, such as a spoon.

Belladonna can become very destructive in its psychosis or delirium. There is a desire to tear one's clothes, to kill people, or to be killed.

A Belladonna patient can become very destructive under the influence of alcohol. The Belladonna mental pathology is very much aggravated by drinking hard spirits.

Rage and Mania
Finally, when all control is lost, one sees the occurrence of one of the most violent manias produced by any remedy. As stated, the Belladonna constitution is generally resistant to psychological impairments, but it may suddenly deteriorate into advanced mental pathology. The Belladonna rage can appear during headaches, or, alternatively, during the excited state a fit can be brought on by simply touching the patient. The Belladonna patient can become frighteningly destructive and wildly violent, wanting to strike people or bite them as previously described.

There is a wildness in him, a wild look on his face, and his strength may be greatly increased. He may turn to barking and growling like a dog in his delirium. During an interval from the enraged state he may want to die, and may try to commit suicide. Belladonna is indicated in cases of manic depression where the state of mania that we have just described is succeeded by long periods of depression with a desire for death, where the patient wishes to commit suicide by hanging or stabbing himself, or in any other kind of violent way.

These violent episodes may also occur during febrile deliriums. One may see such a case in utter delirium, groping around the room and literally trying to climb the walls or trying to gather objects off the wall. In this state the patient sees black animals on the walls and furniture, he spits around and makes grimaces while his strength is tremendously increased. It is truly frightening to observe such a case. At other times the patient hallucinates and sees all manner of phantoms, evil spectres and faces with vicious fangs. He may talk about devils, saying that he will be taken away by the devil. In the midst of these vicious hallucinations the patient may laugh in a sardonic and almost evil manner.

Further symptoms that may be found during a Belladonna state of mania include bouts of knocking the head against a wall, attempts to strike out at imaginary objects, or at people imagined to be on their abdomen or face. Sometimes there are convulsions during the mania state and the fury. In epileptics we see the fury and rage with the full intensity of the remedy and frightful distortions of the face.

Psychosis
In a Belladonna case a state of psychosis may arise due to a number of factors in which the natural outlets for the emotions are suppressed. For example, an individual may suffer from excessive anger, whatever the cause, and be unable to find a proper outlet for this anger. Alternatively, a person may be unable to fulfil his ambitions, or may have to suppress them. Other factors include an eruption of feelings which may have been suppressed, or a terrible fright, grief or mortification suffered by the patient. These situations may all lead to a psychotic state. The form of the psychosis may be different, depending mostly on the cause, but the common characteristics are the glistening of the eyes, the heat of the face, the inner excitability, the senseless restlessness and the increased strength. Belladonna should also be thought of in conditions like pyromania and kleptomania.

In a case where the ambitions have been affected the resulting psychosis will show excessive pomposity. The person for instance may say that he has made a great discovery from which he stands to gain a lot of money. He signs cheques for vast amounts to overpay people for buying things that he cannot afford or does not need. He brags a lot and talks in an excited and intense manner. He sleeps only a few hours at night and roams about in an aimless way all day. Should anybody try to contradict him he flies off in a temper and becomes very aggressive, with an impulse to kill.

If the reason for madness is a love disappointment the form of the psychosis may take a on very different aspect. Here you will have a patient who may strip down to only his shirt and run out into the street in broad daylight, gesticulating and uttering many absurd things. He may start a sort of wild dancing, with shrieking, singing, clapping of the hands. The dancing may alternate with sighing. He jumps over chairs and tables, tears his own hair, indulges in obscene talk and cursing. He may spit and bite at those around him.

The madness may alternatively result from grief, and here you may see a different picture again, though the basic characteristics should be present as already mentioned. This patient has a tendency to sit and break pins or sticks, making gestures as if he were drinking. He may go to hide with fear in his eyes. He has a feeling of being possessed by the devil or pursued by the police, or he may feel that he is divided into two parts. He may have the illusion that he is a dog and start growling and barking. He is impelled to touch everything, and aimlessly walks around and around in a circle.

Delusions, Hallucinations and Visions
During the Belladonna psychosis and febrile states the patient experiences vivid delusions, hallucinations and visions. The vivid imagination of Belladonna and its excitability have been mentioned. In certain circumstances this imagination may suddenly burst forth giving rise to hallucinations or visions. Most often this occurs in febrile states, but it also arises in mental disorders. These visions may occur with the eyes wide open; furthermore, the hallucinations are not of pale ghostly images but rather sharp, vivid pictures. If the patient mentions that he has a tendency to be delirious and to see visions as soon as he suffers a fever, this can be a strong confirmation of the diagnosis for Belladonna.

The delusions of Belladonna can be triggered by fever, by injuries to the head, by suppressed menstruation and by hysteria, and they are almost always accompanied by dilated pupils and a red face.

A typical Belladonna delirium is described here by Kent: In the evening he was seized with such violent delirium that it required three men to confine him; his face was livid; his eyes injected and protruding, pupils strongly dilated; carotid arteries pulsating most violently; a full, hard pulse, with loss of power to swallow. Violent delirium; broke into fits of laughter, then gnashed teeth disposed to bite and strike those around.'

The following examples may serve to illustrate the almost unlimited delusions of the Belladonna delirium:
The patient throws his arms about, moves his lips as if talking, urinates outside the pot.
He has delusions of fire on distant home; of someone trying to take away the bed clothes; of body sinking down between the thighs; of cockroaches swarming about the room.
He believes that he sees cucumbers on the bed, or dead persons, or black dogs.
He imagines himself dreaming when awake; sees giants, a friend's head sticking out of a bottle, a transparent and speckled head.
He thinks himself a juggler, thinks that he has a transparent nose.
He sees brilliantly coloured, glittering objects.
He thinks that a physician is a policeman, that he is riding on an ox.
He misrepresents his sensations.
He sees spectres, ghosts, spirits in fire.
His head and nose seemed to be transparent; trees seem to be people in fantastic costume.
He sees large turtles in room.

Kent summarises the whole picture beautifully:
'The mental symptoms of Belladonna are delightful to study, but dreadful to look upon. The mental symptoms are such as come on in intense fevers, such as are observed in maniacal excitement, in delirium. Excitement runs all through. Violence runs all through the mental symptoms. It is a wild state. He is wild; striking, biting, tearing things, doing unusual things; doing strange things; doing unexpected things. He is in a state of excitability. These mental symptoms that come on during fevers, the delirium and excitement, are very commonly ameliorated by eating a little light food.'

Sleep
The intensity that characterises the mental-emotional pathology of Belladonna is mirrored by the intensity of the sleep, which in this remedy is of exceptional interest. Patients may talk loudly during sleep, even in a quarrelsome manner. They confess things they have done during the day in a very vivid manner. They sing or croak during sleep. They turn around restlessly in bed in a kind of fury and stretch and kick the sleeping partner. They grind their teeth and in general those who sleep with them will tell you of the intense activity that characterises their sleep. They may be prone to somnambulism, or may suffer from insomnia the whole night, with starting at the least noise, burning skin, constipation and headache.

The Belladonna Child
The Belladonna vitality and vividness are nowhere more apparent than in the child, who is full of energy and restlessness. His appearance is characterised by red cheeks, hot skin and glistening eyes. He jumps around all over the room, from the chair to the table to the bed. In the consultation room he will not stay in one place. This is a lively child, full of imagination and very impressionable. Whatever the child experiences during the day seems to be re-lived during sleep. The mother will tell you about his sleep and the intensity with which this child sleeps, the restlessness, talking or screaming during sleep, even getting up and walking around. The child is difficult to wake and has nightly enuresis, particularly after sugar or sweet things. He is aggressive and fights with other children, but is not malicious like the Stramonium child.

While studying the child's history you will learn that the child is prone to convulsions with high fever. When suffering from abdominal pain there is vomiting of all food, and a violent thirst develops, coupled with great prostration. Lying flat on the abdomen ameliorates the pain. The convulsions are brought on from light, from a draft of cold air, from the infant becoming cooled. They are more likely to occur in nervous, brainy children, with a good sized head.

In the case of an inflammation of the meninges the child becomes wild and beside himself. The aggression increases tremendously, he strikes those around him, makes terrible grimaces, has contortion of the limbs and becomes tremendously restless. In delirium the child talks a great deal, and this is followed by laughing; he does not recognise his parents. The convulsions can be so strong that the child may fly off the bed to the floor from the sudden convulsion.

While the child is unconscious and convulsed, he bores in to the nose with his forefinger, so hard and with such force that he bores a hole there. If the nurse tries to prevent the child's hand from doing such damage to himself a severe convulsion supervenes. Special attention should be placed here on this strange symptom for Belladonna: boring with the finger in the nose and cheek ameliorates the general condition of the child.

Kent writes:
'In Belladona the infant also commonly remains in a profound stupor, the profound stupor that goes with congestion of the brain; pupils dilated; skin hot and dry; face red, throbbing carotid arteries. Finally the child becomes pale as the stupor increases and the neck is drawn back, because as it progresses the base of the brain and spine become involved, and the muscles of the neck contract, drawing the head backwards, and he rolls the head; eyes staring, pupils dilated. This mental state is associated with scarlet fever and with cerebrospinal meningitis.'

Belladonna is one of the remedies that fits most closely the symptomatology of the terrible disease that hits the young: Gilles de la Tourette's syndrome. The child makes terrible tics and grimaces, and is so restless that he cannot be restrained to sit quietly for five seconds. He spits, repeats obscenities, makes terrible sounds with his nose and larynx, groans, coughs, barks, looks retarded, sometimes is destructive and at other times tender. He seems impulsive, doing everything and anything that comes to his mind.

Crying seems to ameliorate the Belladonna symptoms, even in adults. A tearful mood in children and even babies is characteristic, but they do not want consolation, which only aggravates their condition. They cry for the sake of crying and this seems to do them good. Eating ameliorates most of the conditions in Belladonna. It has been observed in hydrocephalic children that they cry until they get something to eat.

Restlessness during stool is another characteristic in Belladonna children. When children are sick in bed with congestion of the brain, they have an intensely hot head while throbbing is apparent. The temporal arteries and the carotid arteries pulsate, with great violence.

During fever, Belladonna children can also behave like Chamomilla or Cina. They are capricious, cannot stand being talked to in a nice pacifying voice, fly into a temper on being given good advice for anything, complain that everything tastes bitter, desire things which when offered are refused, and cry with the least provocation. Lastly, Belladonna should be considered in cases of worms in children.

Sexuality
The sexuality of Belladonna is usually well balanced, but when this sphere is affected the result can be a tremendous increase in desire leading to excessive practices such as nymphomania and frequent masturbation. This heightened sexual excitement cannot be satisfied easily. Thus we find cases of Belladonna who are shameless in their sexual conduct and sometimes practice exhibitionism. The excitement is so great that interrupted coition can cause a general upset of the organism leading to the appearance of a headache or even a fever. In women the increase in desire can lead to an obsession with the idea of marriage.

Speech
The Belladonna speech is characterised by a number of difficulties and impediments. There seems to be a weakness of the organ of speech, leading to stammering like one who is intoxicated. Speech may be confused, hasty, incoherent, even unintelligible. Temporary speechlessness may occur, where the patient cannot utter a sound.

Causative Factors
The symptomatology in this remedy may be brought on by a number of different factors, the main one of which concerns the circulation which, when affected by a stress factor, especially heat or cold or excitement, may cause symptoms to appear. Unfulfilled ambition is another factor, when one expects that he will become rich or famous from a project and this does not come true. Injuries to the head, disappointed love, reverses of fortune, grief, anger and fright are further factors to be considered in a Belladonna case.

General remarks
The Belladonna pathology tends to be carried to extremes. For example, when irritability appears, it tends to be extreme irritability. Similarly one may note the greatly heightened intensity of the physical complaints; for example, the headaches are rarely mild and nagging but severe, throbbing and bursting, indeed they are among the most violent in all of our materia medica. Again, when the fever rises, it rises fast and is very high.

It seems that the expression of the symptomatology cannot be restrained by the organism; it breaks out, rages wildly and then passes suddenly leaving the patient exhausted. As stated, the individual crises may occur with suddenness, but the chronic conditions tend to slowly mount in intensity, gradually approaching the extremes described.

As previously stated, the vast majority of Belladonna cases involve predominantly physical pathology. The pathological processes of Belladonna tend to be concentrated on the vascular system. Flushing and vascular congestion are the hallmarks of this remedy, with engorgement of blood vessels and throbbing, pulsating pains. In acute conditions the congestion may be truly violent, characteristically involving intense heat and a sensation as if the part were burning. The patient is compelled to use cold compresses, even ice, to find relief. This heat can be so intense that one can literally see steam emanating from the compress.

In the chronic conditions, however, milder conditions can be seen. Flushing of the face is a well-known characteristic of Belladonna, but one may also see flushing in other regions such as the back or the extremities. For example, episodic congestion of the legs can occur where the feet become hot and have to be uncovered for several days until the congestion subsides. Belladonna also has marked dryness of the skin and of all the mucous membranes, yet when this dryness involves the mouth, there is generally little thirst.

Anything that markedly alters the circulation can provoke or aggravate the Belladonna state. Generally, overheating and abrupt exposure to cold can provoke or aggravate the symptoms, not just in the immediate sense but also chronically. One often hears a history of chronic headaches or vertigo, etc., which began after a patient washed his hair and immediately went out into the cold air. Belladonna patients can be either warm-blooded or chilly or sensitive to both heat and cold. Rarely does one find in the constitutional Belladonna extreme chilliness or warm-bloodedness.

The consistent theme is that abrupt temperature changes provoke symptoms by altering the circulation. Belladonna can be adversely affected by exposure to the sun, to overheating from sitting in the sun. It is curious that such apparently vital patients can be so easily discomfited by so mild a stress as entering the cold when overheated. It is as if the intense energetic state of Belladonna is but precariously held in balance, vulnerable to the slightest bit of extra stimulation.

Also, hormonal disturbances may bring about these circulatory changes; consequently, many of the complaints of Belladonna occur around the time of menstruation: before, during, or after. Symptoms may also follow childbirth or hysterectomy.

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Digitalis Purpurea

Digitalis purpurea. The foxglove.
N.O. Scrophulariaceae.
Tincture of the second year leaves.

THE ESSENTIAL FEATURES
Digitalis is primarily a heart remedy. It should be considered when the pulse is abnormally slow and later in the pathology, fast or irregular, intermittent; where there is heart disease, with great weakness, and the patient can hardly talk, and is losing strength to the point that he feels faint. Cold skin and irregular respiration will often point to such cardiac pathology. All this can be accompanied by deathly nausea and emptiness in the stomach; weakness and dilation of the myocardium; and prostration from the slightest exertion.

Digitalis will be indicated if you have been told by the patient that when the problem started (whether acute or chronic), the pulse was very slow, even down to 40 beats per minute. Hahnemann says that Digitalis 'greatly slows down the pulse in its primary action', and this initial slowing down of the pulse rate is a guiding symptom of Digitalis in almost all cases, no matter what the pathology.

It must be understood that here the heart is in a precarious state, is really very weak, and therefore it can be expected that later in the evolution of the case (under stress or exertion) the heart rate will suddenly increase, to the extent of extreme tachycardia, arrhythmia and auricular fibrillation. For example, the pulse may be very slow when lying down, but on sudden motion, even the slightest, it can become quick, dicrotic and irregular. If the patient sits up, raises his hand or turns his head, the pulse races.

This is a 8 minute-long video from one of Prof Vithoulkas' live courses at Alonissos, where he describes some elements of the Digitalis essense of materia medica and clinical uses.
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You can find more videos by prof G. Vithoulkas on our Homeopathy Video Courses page.

The greatest indication for Digitalis is in failure of compensation, cardiac muscular failure and when atrial fibrillation has set in, especially when it comes after rheumatic fever. There is arrhythmia of several kinds: irregular and unequal pulse; 'Distension of the arteries, sometimes more and sometimes less'; extrasystoles, in irregular distribution or after every normal beat of the heart; intermissions of irregular kind and length of time; 'the slow and small pulse frequently intermits for a shorter or longer time'.

An interesting symptom is a feeling as though the heart had stood still, with great anxiety and a feeling of a need to hold the breath. This usually follows after careless, violent motion, especially moving the arms upward. If a patient expresses a feeling that his heart will stand still as soon as he moves even slightly, and when this still occurs even if he holds his breath in an attempt to prevent it, then this is a strong indication for Digitalis. (Gelsemium, on the contrary, has a feeling that his heart will stand still as soon as he stops moving.)

Baehr describes such an attack, which often very much resembles angina pectoris: 'The patient feels his heart stand still for a moment, with inexpressible anxiety and sudden fainting; this is followed by some violent and quick beats. One patient described them like this: as though the heart had torn itself loose, and were freely swaying to and fro like a pendulum, hanging from a thin thread'.

Digitalis will be also indicated when the liver is affected, again either from an acute or a chronic condition; for example jaundice with induration or hypertrophy of the liver, if the heart is also involved with bradycardia, or jaundice complicated with any heart dysfunction. Typically the patient has to walk about in agony, with precordial anxiety, and with urging to urinate. He has a bluish appearance of the face.

The patient can eat very little, but in one or two hours he has an empty, 'gone' feeling in the stomach, with fainting and trembling, and has to eat immediately. There is hypoglycaemia due to a dysfunction of the liver, and also hypotension. There is great weakness and the desire to be alone. Digitalis is also indicated in urinogenital problems when there is swelling of the prostate gland, especially after gonorrhea. There is suppression of urine; frequent urging to urinate, with much effort, but only a few drops are evacuated.

The genitalia are often in a state of 'great irritability accompanied with great weakness', meaning that male patients tend to have arousal and ejaculation against their will. They have frequent, painful erections disturbing their sleep (compare Staphysagria). There is an 'exaltation of lascivious fancy', especially in older men suffering with enlarged prostate. Sexual imagination is greatly stimulated, with lascivious mental images around the clock, and semen discharged at night, often followed by pain in the penis or urethra, and especially by a feeling of weakness and lassitude.

In the broader sexual sphere, Digitalis seems to raise the desire for sex but takes away the potency; Digitalis people can resort to masturbation. Arousal is easy, yet the patient feels tired and unable to find a partner. 'Several times at night a feeling as though a pollution [ejaculation] should occur but none came; great sexual desire but no ability to perform coition'. In women this state of easy arousal, but without deep satisfaction, can lead to compulsive sexuality, 'nymphomania'. After intercourse or ejaculation, Digitalis can have reactions ranging from unconsciousness to irritability.

Digitalis will be indicated in deathly nausea, for any reason.

Anxiety and Fear
The Digitalis anxiety can be so intense as to be agonising. It is somewhat vague in character, but very intense in degree, and it comes on in paroxysms. It may be connected with a depressed state of mind, fear of death, or fear of psychosis. A characteristic symptom is an anxiety of conscience, coupled with massive self-reproach (compare Cyclamen). 'Internal anxiefy, like pangs of conscience, as though he had committed a crime or as though he were about to be reproved'. 'Anxiety as though he had committed something evil'.

Alternatively, the anxiety is directed towards the future rather than to the past, with evil foreboding and apprehensions. 'Anxiety, with great dread of the future, worst every evening with sadness and weeping, which brings relief. 'Fearful apprehension of a sad character, with great depression, extremely aggravated by music'.

The severe feelings of anxiety are often coupled with great restlessness, also with nervous insomnia and a feeling 'as if he should fly to pieces', as Kent says. The anxieties are referred to the epigastrium, the region of stomach and heart, where they are din lost physically felt as a fear of death. 'Apprehensiveness that seems to come from the epigastrium'. 'Every shock, like bad news, strikes in the epigastrium'.

A characteristic symptom from the proving is: 'Weakness at stomach, like a sinking, as though life should become extinct'. Also: 'Nausea with inclination to vomit, as if she would die... with extreme depression of mind and apprehensiveness'. Another form of manifestation is during the sleep, as frightening dreams of falling. 'Frequent waking at night in fright, by dreams of falling from a height or into water'.

The patient fears death, evil, psychosis and misfortune; he wants to be alone when tired, and feels despondent that his senses are dull. Fear of death while walking has been reported. This leads to melancholia, dull lethargy with a slow pulse; and particularly anxiety at twilight.

Depression
Digitalis patients have a disposition to depressed moods. They do not like company, and they have no desire to talk or to do anything; they sigh constantly, which seems to relieve a little. 'Tearful sadness about several things in which he didn't succeed'. Digitalis is sensitive, not only to moral impressions, but to music and sensual impressions. On the other hand, the sadness of these people is often coupled with a considerable excitability, as could be observed in severe anxiety.

The gloomy mood is attended by peevishness and inclination to quarrel. 'Great irritability; everything affects him very much, especially sad things, and the merest trifle may excite an inconsolable despair in him'. This 'sad irritability' is sometimes felt physically too, in the form of a 'sensation of sickness' that mostly affects vision. 'He is sad and has a feeling as though he were very sick; all objects look to him as if he had a fever, he seems to have the altered sense of vision as in fever'.

This 'sad excitement' may result in trivial symptoms, such as stammering when talking in public or to strangers, but can also lead to very acute pathological states, including delirium, hallucinations, manic episodes, psychotic states of confusion, even attempts to commit suicide. 'Raving excitement alternating with melancholy' (Bonninghausen). Baehr relates a case that was cured with Digitalis; the patient suffered with 'delirious mania' and complete insomnia, and could only with difficulty be prevented from jumping out of the window. 'Anxiety and sadness, with sleeplessness at night, owing to pains at heart, from unhappy love'.

The intellectual capacities are markedly impaired in Digitalis. Memory becomes weak; the patient forgets everything immediately, with internal and external heat of the head. Digitalis patients often feel a strange dullness in the head that somewhat resembles intoxication. The ability to think is restricted, but this does not correspond to the patient's subjective experience; he rather feels that his brain is more active than before. Imagination may be extraordinarily vivid. These states of mental weakness also correspond with a severe physical exhaustion, especially with a tendency to faint. 'General weakness as if all the parts of the body were fatigued'.

Generalities
A remarkable sensation is an internal jerking as if a current of electricity passed through the body.

Digitalis is worse in the warm air of a room, but coldness may also provoke a number of symptoms. But most remarkable is an aggravation of all complaints by motion, especially by sudden and violent movement, whereas rest ameliorates, especially lying flat on the back. Lying on the left side aggravates, especially the heart symptoms.

Digitalis patients are inclined to lose their appetites completely, and if they eat anyway this will rather aggravate their symptoms. But most marked is a very violent disgust to odours of food which provokes a deadly nausea (compare Cocculus, Colchicum). Digitalis is one of the remedies with loss of appetite and disgust of food, but much thirst. But it should be noted that feelings of canine hunger have also been observed in the pathogenesis. During a proving of Digitalis on himself, Baehr woke in the morning with a violent sensation of hunger. After a while it was replaced by complete loss of appetite, 'as though the stomach was extremely full and its contents were standing up in the throat'. The sequence, hungry on waking, soon afterwards complete loss of appetite, even disgust from smell of food, has also been used as a keynote of Digitalis.

Vertigo and Head

Vertigo with fainting and weakness. 'Vertigo, with an anxious feeling as though faintness would occur'. Vertigo with trembling, especially when going upstairs; with weakness of the lower limbs. Vertigo with a slow pulse, especially on rising from sitting or lying. Dizziness with constant ringing in ears.

A dull feeling in the whole head, with restriction of the ability of thinking; sometimes also with an ecstatic or intoxicated feeling as if the brain activity were rather expanded than restricted.
Strange sensations inside the head: 'Feeling as though the brain were beating like water against both sides of the skull and were about to burst it, a pulse-like sensation'. An 'undulating headache' with the same sensation, ameliorated while lying down or stooping, worse when standing or bending backward. Sensation as though something fell forward inside the head on stooping. But particularly: 'A sudden cracking noise in the head, during the midday nap, with frightened starting up'. This 'cracking sensation' has also been described as 'metallic', or 'as if brain were made of fine glass and shattered at a blow', or 'a report like from firing of a pistol'. Sometimes it occurs during sleep, sometimes after retiring, preventing sleep.
An 'uneasy tensive sensation in the sinciput' may occur when the eyes are turned to one side without moving the head.
Rush of blood to the head but often with pale face; a heavy pressive headache as from congestion and fullness.
Throbbing headache in the forehead or at the bottom of the orbitae. 'The Digitalis headache... has the character of megrim; it occurs all of a sudden, in violent paroxysms, seems to be caused by a sudden rush of blood into the head, is usually half-sided and seated in the forehead'.
Half-sided headache 'like an internal itching'.
Pressive headache in forehead and temples which is aggravated by exerting the mind and thinking.
'A pressive pain by jerks, now in the temples, now in the whole head'. A peculiar symptom was elicited in a case of Ballard, quoted in Clarke's Dictionary: the patient had headache and dizziness, and after drinking he complained about a 'bad feeling about the head'. After drinking cold water the pain would seat itself in the forehead and extend down the nose. Pain externally at the head, especially pressive-stitching or tearing-stitching pain at the side of the forehead and at the temples.
'The head constantly falls backward, while sitting and walking, as if the anterior cervical muscles were paralysed and had no support'.

Eyes
Digitalis has a great number of disturbances of vision:
Vision of colours is altered. Green or yellow vision; faces look pale like corpses; in the morning all objects look as though they were covered with snow. Sees flashing gleams in brilliant colours, red, green or yellow; during the twilight. Or else: rainbow colours surround a candle flame like a halo.
Flickering scotoma.
Dark bodies like flies seem to float before the eyes, especially if one tries to observe distant objects.
On covering or closing eyes, brilliant bodies seem to jump before them.
A darkness like a cloud or fog, passing by before the eyes, impairs the vision; sometimes only in upper part of visual field. 'In the evening when walking, it seems as though the upper part of the visual field were shaded by a dark cloud'.
Dimness of vision like a veil before the eyes; with burning pain in the bow of the right eyebrow.
Double vision, even triple vision.
The movements of the eyes may be affected in a peculiar way: 'Inclination of both eyes to turn to the left; if he forcibly turned them to the right, they hurt, and then he saw on this side all the near objects twice or thrice'.
An interesting symptom is also an 'altered sense of vision', which is not identical with the visual disturbances quoted above. Two observations from the provings: 'The external objects presented themselves in a false gleam; he didn 't see them actually twice, but still they were not seen in their true light'. 'All the objects look as if he had a fever, as though he had the altered sense of vision as in fever'.
The pupils may either be dilated or contracted, often their reaction to light is reduced.
Inflammation of the Meibomian glands, hordeolum internum: pale red swelling of margins of lids; if the lid is everted, yellowish-reddish strings extending downward are seen; burning of margins of lids and photophobia. Agglutinated eyes in the morning.
Ophthalmia following after coryza that suddenly ceases. Inflammatory redness of conjunctiva and lids; sensation as from sand or coarse dust in the corners of the eyes; pressive pain or piercing stitches in the eyes; photophobia; constant lachrymation, aggravated by bright light and cold air; profuse suppuration in the canthi.
Violent stitches darting through the eyes, in the afternoon while lying down. Blue discolouration of the eyelids and other peripheral parts (as the lips, the nails); cyanosis.

Ears
Hissing before both ears, as from boiling water. If this symptom occurred in the context of partial deafness, Digitalis 'not seldom' effected a cure, as Hahnemann writes in a footnote.
Cracking in the head, on falling asleep, or else during sleep and waking from it. Single stitches behind the ear, externally.
Glands at and behind ear painfully swollen.

Nose
Epistaxis of bright red blood; also in connection with cyanosis.
Headache extending down the nose, after drinking cold water.
Very sensitive to odours of food which provoke extreme nausea.
Coryza 'in a high degree', with cough; can hardly speak, loses sense of smell. A striking symptom in coryza is violent and frequent sneezing.

Face
Pale, even bluish face, bluish hue under the pallor; eyelids, lips and tongue blue. The face may remain unusually pale even with congestion to the head.
Bloated face, pale or livid, also with distension of veins around the eyes, at the ears and lips and upon the tongue.
Black, inflamed, suppurating comedones in face.
Dry, even parched lips.
Convulsions on one (left) side of face.
Drawing and stinging pain in face, worse by external warmth; among other conditions, Digitalis cured a prosopalgia following herpes Zoster in face.

Mouth
Profuse salivation. The saliva may taste sweet, and/or it may smell very badly. Or else: bitter taste, especially bread tastes bitter.
Accumulation of saliva in the mouth, with spitting and violent nausea when swallowing it.
Salivation with soreness in the whole buccal cavity, also of tongue and gums. A sensation in the mouth as if softly roughed up, as though the buccal cavity were covered with velvet inside; with insipid and slimy taste. Tongue pale, coated white, or else coloured bluish; also with swollen veins upon it. With the Digitalis vomiting, the tongue is often totally clean. Swelling of lips and tongue, with foetid salivation and anuria.

Respiration
Hoarseness, mostly in the morning on waking; after nocturnal perspiration sometimes so great that speaking is impossible. Painless hoarseness. Tenacious mucus in the throat which is loosened by coughing. Or else: 'In the morning, mucus in the throat, easily detached but usually coming into the pharynx when trying to hawk it up, so that he has to swallow it'. Respiration is often irregular and performed by a series of deep sighs. Dyspnoea or oppression of chest compelling to breathe deeply, but even that does not seem to supply enough oxygen. Some descriptions of this very characteristic symptom: 'Distressing tightness of breathing, for many days, he frequently had to take a deep breath, yet it seemed to him that he had not enough air, especially on sitting' (Hahnemann). 'Very annoying shortness of breathing, while sitting as well as while walking, worst toward evening and in the evening. Constant desire to take a very deep breath, but on attempting to do so it seems as though the chest could be only half filled. In addition, there is a cough, especially when breathing deeply, which only seldom produces sputa consisting of lumpy, hardened mucus. All clothes seem to be too tight, but loosening them does not ameliorate' (Baehr).
Digitalis may be indicated both in quick and short and in deep and slow respiration; the characteristic feature is the feeling of air hunger which cannot be appeased. In the Chronic Diseases we find: 'Respiration difficult, slow and deep', but also: 'Breath short, wanting; unable to hold it long enough, is quickly compelled to inspire anew'.
An important sensation in the context of this lack of air is a feeling as though the internal parts of the chest had grown together; cannot get enough air, has to sit up. This symptom has been confirmed several times. Because of these and some other symptoms, Digitalis is frequently indicated in asthma. A cured case of Baehr, the symptoms of which have a been introduced into the materia medica and repertories: 'A 20-year-old sculptor had asthmatic attacks. Tightness of breathing came on all of a sudden, usually in the forenoon between 10 and 12 and in the afternoon between 4 and 6, with a sensation as if the thorax were constricted, with anxiety allowing no rest, but without heat. When the dyspnoea is at its height, sometimes a sensation as though the sternum were torn. Lying quietly in a horizontal position relieves after a while'. There are also Digitalis cases (as quoted above) where sitting up ameliorates; but an amelioration in horizontal position, especially when lying on the back, is more characteristic of the remedy. The feeling as though something had grown together in the chest may also indicate Digitalis in other complaints, for instance in neuralgic pain of the thorax in consequence of exposure to cold. In a recent case (see Miiller, Archiv fur Homoopathik 1993/2) this sensation was described: '...as if something were glued together in the chest and were torn apart on rising; or as though a steel spring pressed itself through the cover of a mattress'.
The dyspnoea of Digitalis may be accompanied by a painful feeling of weakness and lassitude in the chest; such a 'weak sensation' usually has its origin in the epigastrium, ascending from there into the chest. Another characteristic symptom of Digitalis is a gasping respiration, especially on falling asleep. As in Lachesis, the breathing may be arrested in the moment of falling asleep, returning suddenly with a gasp that wakes the patient. 'Gasping respiration, each breath seems as though it would be the last'. The Digitalis cough is best characterised by a quotation from Bonninghausen's book about whooping-cough: 'Hollow, deep spasmodic cough, excited by roughness and scraping at the palate and in the trachea; dry in the morning, in the evening with scanty, difficult expectoration of yellow, gelatinous slime of a sweetish taste, sometimes also with a little dark blood. Aggravation: midnight and morning. Being heated. Eating. Cold drinking. Speaking. Walking. Open air. (Warm air in a room.) On waking. Bending body forward'. After eating, the cough may be so violent that food is vomited. Dry cough, with infrequent expectoration consisting of hard balls of mucus. Pain in the thorax, especially in the region of the heart, resembling rheumatic pain, may also be cured by Digitalis. They may begin at the left margin of the sternum, changing from there to the right side and back again.

Heart
In the 'Essential Features' some important heart symptoms of Digitalis are already discussed, especially the bradycardia, the intermissions and extrasystoles, the aggravation from motion and the sensation as though the heart would stand still as soon as one moved, often followed by a fluttering sensation at the heart. There are, however, a great number of heart symptoms in Digitalis, because there is a close affinity of this remedy to the heart.
Irregular pulse, both in respect of the power of the expansion of the arteries and in respect of the frequency. For example: 'Slow pulse of 50 beats, which are absolutely irregular, between 3 to 4 soft beats a full and hard one'. 'With a frequency of 78, beating strong from twelve to twenty times, and then very weak for four or five times'. 'Great slowness and irregularity of the pulse'. The slow and small pulse often intermits for a shorter or longer time. Slowness of pulse, especially in the beginning of a diseased condition, is typical for a Digitalis case, and this slow pulse is often unusually hard and strong. 'Single violent and slow beats of the heart, with sudden strong heat in the occiput and transient fainting, all of this lasting only a moment'. (The strengthening of heart contraction with decrease of pulse frequency is the desired action in allopathic use of Digitalis.) But Digitalis may also have a slow pulse that is small and even thread-like, and the remedy may also be indicated in racing, flaying, hardly perceptible pulse. In any case, there is very often some kind of arrhythmia, especially pulsus bigeminus. Absolute arrhythmia; heart beat and radial pulse may not be synchronous.
A description by Baehr: 'Some quick beats are followed by a series of fuller and slower ones, of indefinite number. The intermissions... seldom fill a time of two pulsations; usually only one pulsation is missing after 3, 5 or 7, even 15, 16 or 18 beats - as if the heart wanted to have a break'. A characteristic observation from a proving: 'Pulse 60 when sitting, 72 when standing, the slightest motion made it immediately more rapid; noting the pulse while leaning backward in a reclining chair and then raising myself to slowly sitting upright, the pulse became in a moment jerky and very much smaller and weaker'. Or else: 'The least muscular exertion renders the heart's action laboured and intermittent'. Anxiety at heart is also an important symptom of the foxglove. 'Pressing constrictive heartbeats, with anxiety and spasmodic pain in sternum and beneath ribs, increased on bending head and upper part of body forward'. Or else: 'Stronger and almost audible pulsations of heart, with anxiety and constrictive pains behind the sternum'.
Sometimes there is also a feeling as if the heart were grasped by a hand which presses it slowly together (compare Cactus), especially on each intermission of the pulse.
There are also less violent manifestations of precordial anxiety, e.g. a 'dull and disagreeable feeling' or an 'uneasiness' in the region of the heart (Possart). Sudden attacks of violent and irregular palpitation, with a feeling of impending death and fearful anguish; aggravated by the slightest motion. Also: sensation of uneasiness and palpitations of the heart when climbing even a little; before the proving, these ascents had not had any action upon the organism.
Palpitation of the heart originating in grief, with pain in left side of chest and down left arm; also with numbness of the fingers.
Attacks of palpitation with great mental depression, self-reproaches, anxiety and fear of loss of reason.
Heart murmurs: blowing, 'bruit de souffle' (whistling noise); dull rushing and rumbling.

Stomach
Complete loss of appetite, with disgust of odours of food, with a clean tongue; also with an indescribable sensation of emptiness in the stomach. Sometimes there is a desire for bitter food. Or else: violent sensation of hunger on waking, soon followed by complete loss of appetite with a sensation as though the food stood up in the throat.
Violent thirst, especially for cold and sour drinks.
Extreme nausea: deathly, 'as if he should die'; in recurrent attacks; especially in the morning on waking; with inclination to vomit and actual vomiting.
'Sensation of fullness and nausea, with a clean tongue'.
The nausea is usually coupled with a tremendous sensation of weakness in the stomach, 'like a sinking, as if life were becoming extinct'.
This 'deathly' feeling is very characteristic, and a footnote in Hahnemann's Materia Medica Pura says: 'All patients used the same expressions for this complaint'. Great mental depression and sensations of apprehension in the epigastric region may also accompany the nausea.
A characteristic of Digitalis is also nausea remaining after vomiting. Vomiting of mucus and food, the things eaten are wrapped in white mucus; with amelioration of the bellyache. 'Vomiting, first of food, then of bile'.
A sharp burning, extending from the stomach into the oesophagus and lasting the whole day.
Indigestion with nausea in the morning, frequent vomiting, bitter taste, loss of appetite, thirst, diarrhoea, vertigo and frontal headache.
Great sensitivity in epigastric region, producing frequent deep sighs. Stitching pain, beginning in the pit of the stomach and extending to the sides and to the back.

Abdomen
In this region, Digitalis especially affects the liver. Sensitivity, pressing pain, swelling and induration in the liver region are frequent symptoms, but especially icterus. Jaundice with spasms and with grey, ashen stools. Icterus with slow pulse. Unaccustomed sensation of fullness in the abdomen, with loss of appetite but also if a there is a good appetite.
In the left side of the abdomen a feeling as if something pressed itself through the muscle wall. Sensation of soreness in the abdominal ring, left side, as though a hernia were protruding. Digitalis has been prescribed in incarcerated hernia.
Abdominal pain constrictive, or as though the bowel were twisted, with tremendous, death-like weakness and sinking feeling at the stomach. 'Increased movings in the intestinal canal, passing over into a slight cutting pain. This cutting pain later extends to the lowest part of the abdomen, to the pubic bone, and there changed to a pressing and dragging that was felt down through the pelvic cavity as far as the testicles' (Hartlaub and Trinks, Materia Medica Pura). Or else: cutting pain in the abdomen, with urging for stool.

Rectum and Stool
Bright, clay-like, grey or even white stools, usually soft and pasty, are a characteristic of Digitalis.
Diarrhoea, also violent, of an ashen or chalky colour; pappy, watery or 'faeces mixed with mucus'.
Before a diarrhoeic stool, pressive or cutting abdominal pain that disappears with the stool.
Diarrhoea, immediately followed by renewed urging in the rectum. Constipation; stools sluggish, completely lacking for days; difficult and scanty; grey, clay-like.
Frequent urging for stool, also with urging to urinate; very small and soft stools, hardly relieving the urging.

Urinary Organs
Digitalis has often been given successfully in oedema and hydropsia, especially if the dropsical condition had something to do with heart problems. As Hahnemann points out in a footnote, difficult urination is an important feature of the remedy, also in oedematous conditions.
Frequent urging to urinate, also with much effort, but fruitless, or evacuation of only some drops. In these cases, the urine is usually high-coloured, reddish or dark brown, and burning on urination.
Incessant urging to urinate, especially during the night, compelling to stand up; with dizziness as soon as one rises.
Difficult discharge of urine, as from a narrowed place in the urethra; '...a pressive burning sensation in the middle of the urethra as though it were too narrow there'. Or else: a contractile pain in the bladder which makes urination difficult. Or: urination difficult, as if there were no urine in the bladder, but all the same much urging.
A characteristic throbbing or cutting pain at the neck of the bladder when urinating, as though a straw were being thrust back and forth; especially at night.
Retention of urine because of enlarged prostate gland, with constant urging.
Another action of Digitalis in the urinary system is that the urging does not disappear after urination, even if it was profuse. 'Constant urging to urinate, remaining after urination'. 'Urging toward the bladder, soon causing a sensation as if it was overfull, but this did by no means disappear, although she frequently discharged urine'. Or else: increased desire to urinate after a few drops have passed, compelling patient to walk the floor in distress, although motion increases desire. (Compare: nausea remaining after vomiting; urging for stool that returns immediately after diarrhoeic stool.) Urine with a sediment like brick-dust.
Less frequently, Digitalis has a profuse secretion of urine, sometimes accompa-nied by cutting-drawing pain in the bladder. 'Incessant urging to urinate, and every time a scanty discharge; but notwithstanding this, on the whole the amount discharged was very profuse, for 24 hours'. 'Frequent and profuse discharge of pale yellow, watery urine'. After such a diuresis, retention of urine may again prevail, accompanied by nausea and vomiting.

Male Genitalia
Complaints from enlargement of the prostate; difficult urination, with burning, cutting, or throbbing pain; residuary urine remaining in the bladder. Because of this enlargement the genitalia are often in a state of '/b>great irritability with great weakness', i.e. the patients tend to have erections and ejaculations against their will, but also great relaxation of the parts with impotence.
'Incessant irritation of the genitals; frequent, almost painful erections were disturbing sleep at night'. Sexual imagination is stimulated a lot, the prover has 'lascivious images' in his head all day and night, and semen is discharged at night. 'Several times at night a feeling as though a pollution [ejaculation] should occur but none came; in the morning, a glutinous moisture at the orifice of the urethra'.
Great sexual desire but no ability to perform intercourse.
An itching irritation in the glans penis, especially if connected with frequent urging to urinate.
Digitalis has also been given successfully in hydrocele, even when the swelling was excessive. Jahr relates: 'The scrotum looks like a bladder filled with water'.
The ejaculations are often followed by pain in the penis or urethra, and especially by a feeling of weakness and lassitude.

Female Genitalia
Digitalis has been used when the menses failed to appear, also when the first menstruation was much retarded, especially if vicarious bleeding from the lungs was present; in menorrhagia where the bleeding sometimes lasted without interruption for weeks; in painful menses with severe pain in the abdomen and small of the back; in hydrometra; in oedema of the labia pudendi, making urination very difficult.
It is especially indicated if the following concomitant symptoms are present: very slow pulse, also with intermissions; bright-coloured stools; sexual fantasies day and night.
Sudden flushes of heat, irregular pulse, palpitation of heart from least motion; during climacteric period.

Extremities
Cold limbs.
Pain in all joints as if broken, especially after siesta.
Relaxation, paralytic weakness and prostration of all limbs, but especially in the lower extremities, as after a long journey.
Taut and painful swelling, first of the legs, afterwards of the hands and forearms.
Heaviness and paralytic weakness in whole left arm; can hardly raise it, can not even make a fist because it hurts so.
Sharp pain in the left arm, with tingling in the fingers, especially in connection with heart complaints.
A 'thrilling' sensation in the elbow joint as though the arm were growing numb and the nerve were pressed upon.
Violent tearing at the right forearm, more external, during rest and motion.
Annoying feeling of prostration and weakness in the carpus and the forearm.
Swelling of one hand with its fingers, especially at night. Trembling of the hands.
The fingers grow numb frequently and easily. 'Numbness and anaesthesia of the last three fingers and half of the ball of the right hand'.
Coldness of one hand, with warmth of the other.
Powerlessness and paralytic weakness of the lower limbs, especially in the knees.
Tendency to stagger when walking, especially if there is small, weak, slow and intermittent pulse.
Oedematous swelling of feet and legs, also painful; especially during the day, disappearing again at night; in context of loss of menstrual bleeding.
Sensation in the legs as though a red hot wire suddenly darted through them.
Lassitude of the legs, has to extend them constantly.

Sleep
Restless and unrefreshing sleep, with frequent waking as from a fright. Frequent starting from sleep, especially from dreams 'of falling from a height or into water'. 'Frequent waking, as from anxiety and as if it were time to rise'. 'Sleep disturbed by disagreeable dreams full of failed plans'.
Nightmares immediately in the first sleep; he wakes bathed in sweat and with palpitation of the heart. This proving symptom induced Oehme to give the remedy in several cases of nightmares, with great success.
Tossing about during sleep, unable to keep lying on any spot; always lies in a horizontal position on his back.
Unable to fall sleep if he lies on the left side; as soon as he turns around he falls asleep.
Insomnia with violent palpitation of the heart and pulsation in the left ear.
'Frequently great sleepiness', even 'somnolence', lethargy.

Fever, Chill and Perspiration
Coldness of the skin, especially of the extremities. Internal and external coldness everywhere, with clammy sweat and great sensitivity to cold.
But also: general aggravation from 'warm air in a room'. Coldness beginning in the remote extremities and spreading from there over the whole body.
Coldness in the whole body which is also felt externally; with a warm face, subjectively as well as objectively. 'Chill over the whole body, with heat and redness of face'. However, the face may also remain pale or bluish in spite of the feeling of warmth.
Internal coldness. Internal chill in the whole body, and at the same time unusual warmth externally, which can be felt on touch. Shivering and chill over the whole back.
Warmth over the whole body, with cold sweat on the forehead; sudden sensation of warmth over the whole body, followed by weakness of all parts of the organism.
Night sweat; profuse, cold perspiration.
Flushes of heat during the climacteric period, with palpitation of the heart and irregular pulse.

Skin
General pallor of the skin, also with a bluish hue.
Cyanosis, because of heart problems; icterus.
A peculiar corrosive itching of the skin on several parts of the body, provoking scratching. Scratching relieves the itching but it soon returns. If the desire to scratch is resisted, however, the itching increases more and more and finally changes to an 'intolerable burning stitching pain, as from needles'.

CLINICAL
Amaurosis. Angina pectoris. Asthma. Bright's disease. Cyanosis. Delirium tremens. Fever. Gonorrhoea. Headache. Heart, affections of. Hydrocele. Hydrocephalus. Impotence. Jaundice. Lungs, congestion of. Memory, lost. Meningitis. Noises in head. Paraphimosis. Prostate, enlarged. Ptyalism. Spermatorrhoea. Toothache. Urinary disorders. Vision, disorders of. Water retention.

RELATIONS
Antidoted by: vegetable acids, vinegar, infusion of galls, ether, camphor, Serp.
It antidotes: wine, Myric. (jaundice).
Compatible: Bell, Bry., Cham., Chi., Lye, Nux-v., Op., Phos., Puis., Sep., Sul., Verat.
Incompatible: Chin, (increases the anxiety); Nit-s-d.
Compare: Apocy., Ars., Bell., Bry., Camph., Con., Kalm., Lycps., Zinc, Verat.
Acon, (anxiety),
Ant-t. (deathly nausea),
Lach. (sleep),
Crataegus (weak heart),
Nat-m. (frequent and intermittent pulse),
Phos. (genital symptoms),
Spi., Sul., Tab. (deathly nausea),
Gonorrhoea, Sul. (prepuce indurated; Dig., puffed, infiltrated with serum)
Paraphimosis, Coloc.
Palpitation with diarrhoea, Ant.
Act on base of brain, Lob., Tab.
One hand cold, the other hot, Chi., Pul., Ip., Mosch.
Fainting before stool, Sul. fafter stool, Nux-v., Crot-t.).
Food eaten comes up by mouthfuls, Ferr., Phos.
Every shock strikes in pit of stomach, Phos., Mez., Kali-c, Calc.
Cracking in head, Aloe.
Headache extending into nose, Dios.

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