Encyclopaedia Homeopathica

BORLAND D. M., Some Emergencies of General Practice (bl8)

BORLAND Douglas M.

Some emergencies of general practice *

It would seem that for most of us life comes in phases. For our generation there was the period before the First World War, then the phase of the war, followed by the period between the wars, and then the phase of the Second World War. These are common to all, but there are also phases peculiar to each of us. I am now looking back over the period when I was actively engaged in the work of the Hospital and the teaching carried on there. Thinking of my early days and the difficulties then confronting me I wondered if in any way I could help those starting out on the same road. As a result, I am tempted to offer you this paper on some of the emergencies confronting the beginner in homoeopathic general practice. I think emergencies are one of one's greatest difficulties when beginning to practice Homoeopathy. In an acute emergency one has to do something immediately; we cannot spend time hunting for a drug. All these emergency cases fall roughly into two main groups - the patient who is dying, and the patient who is in great pain. You sometimes get the two combined. There is a third problem - Is the case medical or surgical? - and that is always at the back of one's mind. Here it is your general medical skill that comes in; in the other two types it is a question of homoeopathic knowledge. So it is the dangerous case and the case of acute pain that I want to consider here. In the first instance you will find that the matching of acute pain is much the more difficult; the cases of acute danger are much easier to tackle. The dangerous cases usually resolve themselves into a question of cardiac failure in one form or another, I think from the homoeopathic standpoint one can tackle these cases of incipient cardiac failure very satisfactorily. The simplest way to group the dangerous cases from a drug point of view is to look on them under three headings : 1, the cases with acute cardiac failure ; 2, the case in which there is a gradual cardiac failure with a tendency to dilatation; and 3, the case of acute cardiac attack of the anginous type.

Acute cardiac failure

For the acute cardiac failures I think you will find that most of your cases require one of four drugs; Arsenic, Antimony tart., Carbo veg., and Oxalic acid. There are various points about these individual drugs which help you in your selection, and you will find that very soon you begin to select your drug almost as quickly as you spot your pathological condition, and by the time you have overhauled your patient you know what to give. In the Arsenic case you have the typical Arsenic mental distress, with extreme fear, extreme anxiety, mental and physical restlessness, and with a constant thirst, a desire for small sips of ice-cold water. So far as the actual local symptoms are concerned the main complaint is of a feeling of extreme cardiac pressure, a sensation of great weight on, or constriction of, the chest, as if the patient cannot get enough breath in, and a fear that he is just going to die. The patients as a rule are cold, they feel cold, but they may complain of some burning pain in the chest. In appearance they always look extremely anxious and are grey, their lips rather pale, may be a little cyanotic, and they give you the impression of being very dangerously ill. They often have a peculiar pinched, wrinkled, grey appearance. As a rule in these cases you will get the history that the attack has developed quite suddenly, and the response to Arsenic should be equally quick. If you do not get a response to Arsenic within a quarter of an hour the patient is not an Arsenic one. The first response that you ought to get is a diminution of the patient's mental anxiety and extreme fear; the restlessness beginning to subside, and he begins to feel a little warmer. In these cases my experience has been that you are wise to administer the highest potency of Arsenic you have with you, Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica and as I now carry all remedies up to the cm. I always give cms. of Arsenic. But whatever potency you have with you, use the highest, because this is the kind of case that will die very rapidly and you gain more by giving whatever potency you have than by wasting time going home to get a higher one. The Arsenic seems to act very much like a temporary cardiac stimulant, and I find that in the majority of these cases you have to repeat the dose, certainly to begin with, about every 15 minutes. The next thing is that very often one sees a case of that sort which responds perfectly well, the patient is better, everyone feels he is getting over it, and then in three, or four, or six hours the symptoms begin to come back, the patient no longer responds to Arsenic, collapses and dies. That was my experience at one time. Then it began to dawn on me that I had given another drug during the reactive period I could have carried these cases on. I found that when this was done the patients did not get the secondary collapse and were thus saved. To achieve this result you have to give your secondary drug within four to six hours of the primary collapse while the patient is still responding to the Arsenic, otherwise you are in great danger of having a secondary collapse which you cannot combat. So remember that this is one of the very few instances in which one appears to ride right across the dictum that so long as the patient is improving one carries on with the same drug. In these acute cases if you have set up a reaction at all you have got to take advantage of it, otherwise the patient will sink again. The drugs which as a rule I have found these Arsenic cases go on to in the reactive stage are Phosphorus or Sulphur, but that is by no means constant. You can quite see that grey, pinched, anxious Arsenic patient responding, getting a little warmer, less pinched and drawn, not so anxious or restless, with a little more colour, and becoming a typical Phosphorous type. Equally you can see them going to the other extreme, where they are too hot, with irregular waves of heat and cold, rather tending to push the blankets off, still with air hunger and going on to Sulphur.

These are the two commonest drugs you will need, but whatever the response is you ought to be able to follow up immediately you get the action well under way. The Antimony tart. patients have very much the same sort of condition, but mentally they are quite different. In Antimony tart. there is a more definite tendency towards cyanosis than in Arsenic, you never see a patient needing Antimony tart., without very definite cyanosis signs in the finger nails, often extending over the whole of the hands, and the feet may be involved as well. We do not get the same degree of mental anxiety in Antimony tart. as in Arsenic. The patients are more down and out, much more hopeless and depressed. They are never quite so restless nor so pale. Again, there is none of the thirst you meet with in Arsenic, in fact anything to drink seems to increase the feeling of distress. Another contrast is that the Antimony tart. patient is very much aggravated by heat, and especially by any stuffiness in the atmosphere. But there is one point to remember here as a contrast between Antimony tart. and Carbo veg. : the Antimony tart. patients do not like a stream of air circulating round them; they want the room fresh, but they like it still. In most Antimony tart. patients there is a very early tendency to oedema of the lower extremities. Another point which helps in your Antimony tart. diagnosis is that practically all these patients have a very thickly coated tongue --it is a thick white coat - and a rather sticky, uncomfortable mouth. They have a feeling of fullness in the chest much more than the sensation of acute pressure found in Arsenic. An you are likely to find pretty generalised, diffuse rales in the lower parts of the chest on both sides. In contrast to Arsenic. the collapse is similar to that after a pneumonic crisis, and if the patient responds to Antimony tart. it will carry him through. You do not have to be on your guard to find the follow-up drug as you have to be in an Arsenic case. The Carbo veg. case gives the classical picture of the patient with all the symptoms of collapse. They have the cold sweaty skin, are mentally dull, rather foggy in their outlook with not a very clear idea of where they are or what is going to happen to them. There is intense air hunger, and, in spite of their cold, clammy extremities, they want the air blowing on them; they cannot bear the bedclothes around the neck and they do definitely benefit from the exhibition of oxygen. They are very much paler than the Antimony tart. patients, the lips tend to be pale rather than cyanotic, and there is none of the underlying blueness one associates with Antimony tart. The next point is that they always have a feeling of great distension, not so much in the chest as in the upper abdomen, and the cardiac distress is always associated with a good deal of flatulence. Like the Antimony tart. patients, any attempt to eat or drink tends to increase the distress, and they have none of the Arsenic thirst. Another apparent contradiction you come across in Carbo veg. is that, in spite of the desire to be uncovered and the intolerance of the blankets around the upper part of the neck or chest, these patients complain of icy-cold extremities, Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica as if the legs were just lumps of lead, and they cannot get them warm at all.

I think in Carbo veg. you have to be careful as to how long you are going to keep up your drug administration when you get the patient responding --sweating less, the surface becoming warmer, and the distress less acute. You are wise then to be thinking of a second drug, because some Carbo veg. patients do relapse although many of them make quite a straight recovery on that remedy. You do have to be careful. If you find the patient has responded up to a point on Carbo veg. do not imagine that a higher potency of Carbo veg. is necessarily going to carry on the improvement. As a rule it does not, and it is much better to look round for a fresh drug to keep up the reaction. In the majority of these cases the drug that follows best has been Sulphur, although Kali carb. should always be considered. The last of the drugs which I commonly think of for these collapsed conditions is Oxalic acid. Oxalic acid has one or two very outstanding symptoms which are a great help in the selection of that drug. The first is that the patients always complain of a feeling of the most intense exhaustion, very often associated with a sensation of numbness. They frequently state that their legs and feet numb and paralysed, as if they had no legs at all. The skin surface is just about as cold and clammy as it is in Carbo veg., but there is a peculiar mottled cyanosis in Oxalic acid which you do not get in the other drugs. The finger tips and finger nails and toe nails will be definitely cyanotic, but in addition there is a peculiar mottled appearance of the hands and feet which is quite distinctive of Oxalic acid. There is a somewhat similar mottled, cyanotic appearance in the face, especially over the malar bones. These patients, in contrast to the Arsenic type, want to keep absolutely still, and movement of any kind greatly increases their distress. In addition to the general distress, most of these Oxalic acid patients complain of very definite sharp praecordial pains. These pains are not like the typical anginous stab, but more of sharp pricking sort of pain which usually comes through from the back and may run up the left side of the sternum towards the clavicle, or down the left side of sternum into the epigastrium. The most starting cases giving this picture that I have seen have been in the critical stage of an influenzial pneumonia where the patient was just fading out, having lost all strength, and the heart failing rapidly. I think all the patients of that type that I have seen have been left basal pneumonias. I remember seeing two or three patients who apparently were doing quite well on Natrum sulph.. react beautifully to oxalic acid. But one does get indications for its use in chronic cardiac cases as well.

Gradual cardiac failure with tendency to dilation

In these cases the heart is just gradually giving out, beginning to dilate a little, becoming slightly irregular, while the patients are going down hill. If the condition is not so acute as to call for one of the four drugs we have been discussing there are another three or four which you may find very helpful. That is quite apart from your ordinary prescribing. You find that in many of these cases in which there is a tendency to cardiac failure, the heart picks up and the tendency to dilation disappears on your ordinary prescribing, and you do not need to prescribe on the cardiac symptoms particularly, that is to say, the patient responds to the drug for their general symptoms. For instance, quite frequently in pneumonia, a bad case, with the patient pretty worn out with indications for Lycopodium there is a tendency to a failing heart, with dilation, but after the administration of Lycopodium the heart picks up, the pulse steadies, and the tendency to dilation disappears. You find the same in all acute illness where the patient is responding to the particular drug indicated. But you also get cases in which the patient is doing quite well but there is a tendency to cardiac failure which is not responding to the apparently indicated remedy, then you have to consider the drugs for cardiac failure in addition. For these cases the most common drugs are the Snake Poisons, especially Lachesis and Naja. And less commonly Lycopus and Laurocerasus. It is very difficult to distinguish one Snake Poison from another in such conditions. In appearance they are all very similar, but much the most common remedies for these conditions are Lachesis and Naja. The Lachesis picture I think is pretty typical of all, and there are just a few indications which make one choose Naja in preference to Lachesis. In all these cases indicating the Snake Poison you get a rather purplish, bloated appearance. They suffer from a feeling of tightness or constriction in the chest, more commonly in the upper part of the chest, and they are intolerant of any weight or pressure of the bedclothes, or any tight clothing round the upper part of the chest, or neck. All are sensitive Copyright 2000, Archibel S.A.

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to heat; they feel hot and they dislike a hot stuffy room. They have a marked aggravation after sleep; they get acute suffocative attacks when they all fall asleep and they wake up in increased distress. All these Snake Poison patients in their cardiac distress have a marked aggravation from being turned over on to the left side. They have a very marked tremor, and their hands are shaky. And most of them as they tend to get worse become mentally fogged, confused, and very often become difficult and suspicious. If there were nothing more than that, one would give Lachesis. But in a certain number of these cases you get rather acute stitching pains which go right through the chest from the precordium to the region of the scapula, associated with very marked numbness, particularly in the left arm and hand. Where the numbness is pronounced one would give Naja in preference to Lachesis. If the pain - stitching in character - is more marked one tends to give Naja, but if the feeling of constriction is predominant then Lachesis is the remedy. But the general symptoms are identical. I think possibly Naja is a little less red, less bloated looking, a little paler than Lachesis, but that is not very striking. Apart from the Snake Poison there are two other drugs which you will find very useful in these conditions. The first of these is Lycopus. You get indications for Lycopus in a case in which the heart is just starting to fail; it is beginning to dilate a little, and the pulse is tending to become a little irregular. The patients are pale rather than cyanotic, and are always restless. The outstanding symptom of the Lycopus case is that the patients complain of a horrible tumultuous sensation in the cardiac region. They very often tell you it feels as if their heart had suddenly run away and was just going mad. This is accompanied by a feeling of intense throbbing extending up into the neck and right into the head. The other Lycopus symptom which helps is that accompanying his tumult in the chest there is a very marked tendency to cough. It feels as if the heart just tuns away, it sets up an acute irritation, and they cough. Another Lycopus distinguishing symptom is that the distress is vastly increased by turning over on the right side - a contrast with the Snake Poisons which are worse turning over on the left side. Lastly, these Lycopus patients have an intense dislike of any food, and particularly of the smell of food. The last of these drugs I want to touch on is Laurocerasus. The Laurocerasus picture is very definite, and I think the easiest way to remember it is to picture for yourself the appearance presented by a congenital heart in a patient 16 to 18 years of age. You know the peculiar bluish-red appearance of the congenital heart, somewhat clubbed fingers, which again are rather congested, and the bluish appearance - almost like ripe grapes - of the lips. That is the underlying colour you get in Laurocerasus. These patients always suffer from extreme dyspnoea, very nearly Cheyne-Stokes in character. They take a sudden gasp for breath, followed by two or three long breaths, then the breathing gets gradually shallower, next a pause, then two or three gasps, and so it goes on. Another feature is that the respiratory dyspnoea gets very much worse when the patient sits up; they are better in a semi-prone position. A point which is an apparent contradiction is that with this extreme cyanosis you get a very early tendency to the development of hypo-static pneumonia at the bases, and when it has developed the cough is very much more troublesome unless they are reasonably propped up. When lying down the cough is worse, yet if they sit up the feeling of constriction is increased, so they have to get a position midway between. These patients are always chilly. They want to be kept warm, and they feel cold to touch. And of course, as you would expect in a condition of that sort, any movement or exertion aggravates them acutely.

Anginous attacks
Let us look now at the cases with definite anginous attacks. For these cases you must give the patient relief very speedily. It is a little difficult to pick out of the Materia Medica the most commonly indicated drug for it, but I think one can limit the choice to about one of half a dozen - Aconite, Cactus, Arsenic, Iodine, Spongia, Spigelia and Lilium tig. The outstanding characteristic of the majority of these cases in their first attack is an absolutely overwhelming fear. The patient is certain he is going to die, and that very speedily, and he is terrified. He is quite unable to keep still, and yet any movement seems to aggravate his distress. Here a dose of Aconite in high potency will give relief almost instantaneously. I have seen a case of that sort and put a dose of Aconite on the tongue and almost before the remedy Copyright 2000, Archibel S.A.

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could be swallowed that patient was feeling better. I usually carried 10m as my highest potency in general practice and I gave Aconite 10m. The man had a similar attack at a later date, and the anxiety, the distress, and the fear were nothing like so marked because he had come through one attack before, and Aconite had no effect at all. That has been my experience. Where you are dealing with the first attack and the patient is quite certain he is going to die, Aconite does relieve him right away, but does not act in a second or later attack. So if you get a man with his first attack, give a dose of Aconite and you will probably find in no time he is feeling more comfortable. But if he has had a previous attack Aconite will not be helpful. For the patient who is having a subsequent attack much the most likely drug to help is Cactus. Cactus has a good deal of anxiety and fear, but it is quite different from that of Aconite. It is not a fear that the immediate attack will be fatal, it is more a conviction that he has an absolutely incurable condition which will eventually kill him. That is one point about the Cactus indications. Another is the type of the actual distress of which the patient complains. He feels as if he had a tight band around the chest which was gradually becoming tighter and tighter and that if this constriction did not let up soon the heart would be unable to function. It is that feeling of increasing tension which gives you the Cactus indication. In addition you may get stabbing; radiating pains from the precordium, but they are not so characteristic of Cactus as the intense constricting feeling, which is, of course, just exactly how the majority of your anginous patients describe it. In these acute conditions I always give the drug in high potency because it acts much more quickly and one wants instant relief. Then you will get an occasional patient having an anginous attack with very similar constricting feelings, not quite so intense but a definite feeling of constriction. The patient has been ailing for some time, is rather anxious and worried, very chilly, and accompanying this feeling of constriction there is an acute, distressing, burning sensation in the chest. These anginous patients respond very well to a dose of Arsenic. I have never seen Arsenic do anything in an anginous attack except in the rather broken down, ill-looking, very definitely anxious, fearful, with that sense of constriction accompanied by the burning discomfort in the chest. And Arsenic does relieve these cases quickly. There is another type of case which is very similar to that; with very much the same sensation, but the feeling of constriction, the feeling of tension, is described as being actually in the heart itself rather than involving the whole of the side of the chest. The patients are just about as anxious as the Arsenicum patients - in fact all these anginous patients are anxious - but instead of the intense chilliness of the Arsenic they are uncomfortable in heat and in a stuffy atmosphere. They are just about as restless, but instead of the pale, drawn appearance which you get in Arsenic, they tend to be rather flushed, and as a rule they are dark-haired, dark-complexioned people. They are rather underweight, in spite of the fact that they have always been pretty good livers and very often have an appetite above the average although they have not been putting on weight. These cases respond exceedingly well to Iodine. Then there is yet another type of case in which instead of the complaint being of constriction it is of a progressive sensation of swelling in the heart region. It feels as if the heart gets bigger and bigger until it would finally burst, and this sensation of fullness spreads up into the neck. This sensation of fullness and swelling is very much aggravated by lying down, when the patient feels as if he would nearly choke and it is accompanied by very acute pain. The patients themselves are chilly and any draught of air increases their distress. In addition to the feeling of distension, they usually complain of more or less marked numbness, particularly of the left arm and hand, though very frequently there is numbness of the hand only without any involvement of the arm, and not infrequently they complain of numbness of the lower extremities too. As a rule the face and neck give you the impression of being some what congested; they do not have the pale, drawn, wrinkled Arsenicum appearance. And these cases respond well to Spongia. Another drug which you will find useful in a condition which is somewhat similar, though not an angina at all, but which you meet with in hysterical women. You will fail to find any cardiac lesion, but they will produce a symptom picture difficult to distinguish from a true anginous attack. They have the very marked stabbing, radiating pains, and often an intense hyperaesthesia of the chest wall. They are very depressed, frightened, and intensely irritable. They are sensitive to heat, and their distress is aggravated by any movement. Copyright 2000, Archibel S.A.

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In addition to the stabbing pains they have the anginous sense of constriction, tightness, of the chest wall. These cases are usually associated with some kind of pelvic lesion, or a history of having had some gynaecological illness. I have seen quite a number of these cases now in which an electro-cardiogram shows no lesion at all. And all the symptoms have cleared up entirely with Lilium tig. So you seen when you are confronted with one of these very distressing conditions where you have to make a quick decision, it is fairly easy to individualize and get something which will give almost instantaneous relief.

Pain killers
The next problem I want to touch on is the patient suffering from acute pain. Pain killers are a little difficult to systematize, and I thought probably the most helpful way would be to consider the cases of acute pain which one meets with in general practice, and these I think one can classify to a certain extent. One gets acute neuralgias, acute inflammation of one of the serous membranes, and acute colic. I think that more or less covers the ordinary conditions one meets with in general practice. To tackle these from the homoeopathic standpoint is not very difficult. If one considers the acute neuralgias from the prescribing point of view one takes the character of the pain and the circumstances which make it better or worse, and to a lesser extent it s situation. It is on these that one mainly prescribes : in other words, on the character of the pain and the modalities. It is exactly the same as regards serous inflammations; again it is partly on the situation but much more on the character of the pain and the circumstances which modify it that one prescribes. With colic equally; and it does not matter whether it be gallstone, intestinal or renal colic, one pays a little attention to the situation but very much more to the character of the pain and what modifies it. Working on these lines it is possible to take up the three groups and give the indications for the leading drugs which you must have at your finger ends. But before taking these up in detail I should like to touch on another very painful condition commonly met with in general practice, namely ACUTE EARACHE.

Acute earache
If you go to a patient who is suffering from violent earache, acute stabbing pains in the the ear, and tenderness over the mastoid region, when you first look t it from the homoeopathic standpoint you are completely lost. After a little experience you find that these cases are very satisfactory, you get your relief astonishingly quickly, and often a case which you expect would require incision of the membrane within the next few hours quickly subsides ad the patient is comfortable when you go back in the evening. That is the sort of thing you should be able to do in these acute conditions. In cases of acute otitis with violent pains all round the the mastoid region there are three or four drugs I want to consider. Supposing you take the the case which has come on very suddenly, with a history of the patient having been out in a very cold north-east wind, he is intensely restless, the pains are very violent, usually burning in character. He is irritable, a bit scared, with all the signs of a rising temperature, and extreme tenderness to touch. With that history after a few doses of Aconite the acute inflammatory process which is just starting will have entirely disappeared. That is the type that one hopes for, and which one sees very often in winter. You will get another case - usually in children - where there is not the same definite history of chill, although that may be present, but where the pain is even more intense and where the patient is practically beside himself with pain, will not stay still, is as cross and as irritable as can be, again with extreme tenderness, and you get the impression that nothing that the friends do satisfies him. You give him a few doses of Chamomilla and again the whole inflammatory process will rapidly subside. The next case has gone a little further; there is much more tenderness over the mastoid region, possibly a little bulging, and the ear begins to look a little more prominent on the affected side. The external ear is very red, often much redder than on the opposite side. There are very acute stabbing pains running into the ear, the condition is a little comforted by hot applications, and the patient is extremely sorry for himself, miserable, wanting to be comforted, probably a little tearful, but without the irritability of Chamomilla, and Capsicum almost always clears it up. In addition to the three drugs which I have considered, one always has in mind the possibility of a Pulsatilla child requiring a Copyright 2000, Archibel S.A.

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dose of Pulsatilla for the condition. And also one not infrequently sees a case giving indications for Mercury or Hepar sulph., but these I have no time to do more than mention. Then to go on to typical acute neuralgias, facial neuralgias, or acute sciaticas, or things of that sort where, you want to get immediate relief. Again you can use pretty well routine methods for relieving these cases. Let is consider the acute facial neuralgias, for instance acute trigeminal neuralgia; there are two outstanding drugs for these conditions. It does not really matter which branch of the nerve is involved, you take a case like that, with violent pain coming in sharp stabs, or twinges of pain running up the course of the nerve, coming on from any movement of the muscles of the face, very much aggravated by any draught of air, with extreme superficial tenderness over the affected nerve, which is much more comfortable from warmth, applied warmth, and also from firm supporting pressure. That case, particularly when it involves the right side, almost always responds to Mag. Phos. - nine out of ten will so respond. Incidentally this does not apply to dental neuralgia, these are much more different and they run to quite a number of different drugs. If you have the same condition, with practically the same symptoms, the same modalities, affecting the left side, it generally responds to Colocynth. The side usually determines the choice, but occasionally either drug may relieve neuralgias involving the opposite side. Where you get an orbital neuralgia, with much more sharp stinging pains, "as if a red hot needle were stuck into it" is a very common description in these cases, and the pains tending to radiate out over the course of the nerve, in the majority of cases you get relief from Spigelia. There is one very useful point about Spigelia; and that is that you sometimes get the statement that, in spite of the burning character of the pain, after it has been touched there is a strange cold sensation in the affected area. That is Spigelia and Spigelia alone. These are the three drugs which I find much the most useful in a routine way for facial neuralgias. As a rule I use high potencies, but I do not like to go too high because sometimes in these very painful conditions the very high potency aggravates the pain for the time being, for ten minutes or so, and thus causes unnecessary suffering, so in th these cases with acute pain I seldom go higher than a 30 potency.

Post-herpetic neuralgias
There is another group of conditions of the same type, the post-herpetic neuralgias, which are sometimes very troublesome. You know the ordinary shingles neuralgia where the patient comes with acute burning pain along the course of the intercostal nerve and gives a history that he has had a small crop of shingles, very often so light that he paid little or no attention to it. Well, if you can get the same modalities as you got in the facial neuralgias under Mag. Phos., that remedy will often relieve. Much more commonly you find that these post-herpetic cases respond to Ranunculus. The particular features for this drug are the history of herpes, the very sharp shooting pains extending along the course of the intercostal nerve, that the painful area is very sensitive to touch, that the pain is induced or aggravated by it, and you may get the statement that the patient is extremely conscious of any weather change because it will cause a return of the neuralgia again. Well, that type of case responds in almost every instance to Ranunculus. You will get a few of these cases which have not responded to Ranunculus, with much the same distribution of pain, and the same modalities, but without the marked aggravation in wet weather, where the affected area is extremely sensitive to any cold draught, particularly sensitive to any bathing with cold water, and where the pains are likely to be very troublesome at night, and with a marked hyperaesthesia over the affected area. And these cases usually respond to Mezereum.

Sciatica
Then you get another type of neuralgia - the sciaticas. And there again you can get helpful leads. In cases of sciatica, in which I can get no indications at all but the ordinary classical symptoms of sciatica, that is to say, acute pain down the sciatic nerve, which is aggravated by any movement, is very sensitive to cold, more comfortable if kept quiet and warm, then it depends which leg is involved what drug I give. If it is a right sided sciatica I give Mag. Phos., but if it is a left sided I give Colocynth. And you would be astonished how often one gets almost immediate relief from either Mag. Phos. or Colocynth. Copyright 2000, Archibel S.A.

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Some sciatica patients are frightfully uncomfortable the longer they keep still, they have got to start moving, and there are two drugs which seem to cover the majority of these cases. If the patient is warm-blooded, and the sciatic pains tend to be more troublesome when warm, particularly warmth of bed, and rather better when moving about, in the majority of instances one gets relief from Kali Iod. If, on the other hand, you have very much the same modalities with a chilly patient, particularly if he is sensitive to damp as well as cold, and again more comfortable when moving about, Rhus will clear the majority of such cases. Then there are one or two odd indications which sometimes help you in a sciatica where you can get no other distinguishing symptoms. For instance, if you get a sciatica which has, associated with the acute sciatic pain, marked numbness, there are two drugs which cover most of your cases. One is Gnaphalium, which has this sensation of numbness associated with pain and tenderness over the sciatic nerve more marked than any other drug in the Materia Medica. The second drug which has this numbness associated with pain and tenderness of the sciatic nerve is Plumbum, and the main indication which suggests this remedy is that. I have never seen a sciatica giving indications for Plumbum which was not associated with extreme constipation as well as the pain and numbness.

Acute colic
In case of acute colic, renal, hepatic, or intestinal one can give quick relief by fairly snapshot prescribing. When you go to such a case and know that morphia and atropine will relieve the spasm, it is very tempting to use them. If you cannot get your homoeopathic drug in a snapshot way I think you are bound to give the patient relief with your hypodermic. To my mind the disadvantages of this procedure are twofold. First, there is the disadvantage that after such relief it is necessary to begin to treat the case now masked, if not actually complicated, by the action of the morphia. Secondly, there is always the danger that in an acute case of this kind the morphia may conceal the development of a surgical emergency which in consequence may be missed. Suppose you have a hepatic colic, it is quite likely to be use to a stone pressing down into the bile ducts, which may perforate. If morphia has been used it is quite possible - one has seen it happen - that owing to the sedative, indications of the perforation are not detected for hours afterwards. The clinical picture is masked, and you are exposing the patient to a very grave risk. So if there is a method of dealing with these colics apart from morphia I think it is wise to use it. But, as I say, you are only justified in using it if you are getting relief; the patient need not suffer merely because you would prefer using a homoeopathic drug to a sedative. Fortunately the indications in these colics are usually pretty definite. If you have a case of a first attack of colic, whether it be hepatic or renal it is a very devastating experience for the patient and he is usually terrified. The pains are usually extreme and nearly drive the patient crazy, and if, in addition, the patient feels frightfully cold, very anxious, faint whenever he sits up or sands up, and yet cannot bear the room being hot, Aconite will usually give relief within a couple of minutes. You will seldom get indication for Aconite in repeated attacks. The patients somehow begin to realise that although the condition is frightfully painful it is not moral, so the mental anxiety necessary for the administration of Aconite is not present, and without that mental anxiety Aconite does not seem to act. Another case having repeated attacks, each short in duration, developing quite suddenly, stopping as suddenly, associated with a feeling of fullness in the epigastrium, and where the attacks are induced, or very much aggravated, by any fluids, and accompanied by flushing of the face dilated pupils and a full bounding pulse, Belladonna relieves them almost immediately. Consider another patient who has had liver symptoms for some time, just vague discomfort, slight fullness in the right hypochondrium, a good deal of flatulence, intolerance of fats, and who is losing condition becoming sallow and slightly yellow. He develops an acute hepatic colic, with violent shoots of pain going right through to the back, particularly to the angle of the right scapula, which subside and leave a constant ache in the hepatic region, and then he gets another violent colicky attack. These attacks are relieved by very hot applications, or the drinking of water as hot as it can be swallowed. Chelidonium relieves these attacks in the most astonishing way. In these cases, X-rays usually reveal a number of gallstones. And, in contrast with what happens with morphia and atropine treatment, subsequent X-rays after Chelidonium has been given frequently show that one or more of these gallstones have passed almost painlessly. So with Chelidonium you are well under way with your treatment of the gallstones, whereas with morphia and atropine you merely relieve the acute attack of pain. In other words, you have already taken a long step in the treatment of that patient towards clearing the condition altogether. That is one point to be said in favour of your Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica homoeopathic treatment rather than the merely sedative relief.

There are quite a number of other drugs for these colics, some of them hepatic, some renal, and some intestinal, and they all have their own individual points which are very easy to pick up at the bedside. If one memorizes them in this way it is astonishing the ease of your work in acute cases. You see I am not giving you the full description of these drugs, I am picking out only the points which apply too this type of case. That is how you have to do it in practice, but you must remember that these drugs I am giving you for these conditions are the common ones, and that every now and then you meet a case which appears to call for one of these drugs and yet the patient does not respond. There are certain homoeopathic physicians who sometimes call me out in consultation for acute cases and I know perfectly well before I leave my room that it is no use my thinking of these drugs as they will already have been given; and what I have to get is something that is not common but out of the way. I remember seeing a case of gallstones colic with one of our very good physicians. It was an elderly woman, and she had that typical Chelidonium picture. Of course she had had Chelidonium already, but without benefit. The doctor said, "I don't understand this case at all; I think she must have a malignant lever." I asked why, and he said, "Because she has all the Chelidonium indications and she does not respond." This is the sort of old case you will meet with, so if that should happen to be your first one do not think therefore that Homoeopathy does not work; you will find that as time goes on you get more and more cases that do work and the exceptions are fewer and fewer. As a matter of fact that particular case responded to a dose of one of the Snake Poisons, but I have never seen another case that had a Snake Poison for that condition, and one gave it purely because she had already had her Chelidonium; had I seen the case in the first instance I should certainly have given Chelidonium. In spite of the old cases it is worth while getting these ordinary drugs at your finger ends so that when cases crop up you can prescribe easily on the few indications of the acute condition as presented to you. There are one or two other drugs that I can touch on which you will find very helpful in these colics. For instance, Berberis, which is extremely useful in colics whether renal or gallstone. The outstanding point about the Berberis colic, no matter its situation, is that from one centre the pain radiates in all directions. Suppose you have a renal colic - and when Berberis is indicated I think it is more commonly on the left side than the right - you will find that where you get indications for Berberis the colicky pain starting in the renal region, or in the course of the ureter, there is one centre of acute pain, and from that centre the pain radiates in all directions. If you have a hepatic colic you get the centre of acute intensity in the gall-bladder, and from there that pain radiates in all directions, it goes through to the back, into the chest, into the abdomen. That is the outstanding point about these Berberis colics. In addition to that, where you are dealing with a renal colic you almost always get an acute urging to urinate, and a good deal of pain on urination. Where you are dealing with a biliary colic, it is usually accompanied by a very marked aggravation from any movement; this is present to a slight extent in the renal colics, but it is not so marked; and in both the patient is very distressed, and has a pale, earthy looking complexion. The pallor, I think, is more marked in the renal cases, and where there has been a previous gallstone colic you may get a jaundiced tinge in the hepatic cases. It is a very useful drug, and I do not know any other which has the extent of radiation of pain that you get in Berberis. It is surprising how widespread the area of tenderness can be which is associated with a Berberis colic, so much so that in gallstone attacks you get so much tenderness and resistance that you are very afraid of a perforated gall-bladder you get such a resistant right upper rectus, and you may be very suspicious of a peri-renal abscess in the renal cases, again because of the extreme resistance of the muscles on the side of the abdomen. In a Berberis renal case the urine is as rule rather suggestive. More commonly it is not bloodstained, but contains a quantity of greyish-white deposit which may be pure pus, but mostly contains pus and a quantity of amorphous material usually phosphates, sometimes urates. Although it is a very dirty looking urine it is surprisingly inoffensive. There are two drugs which one always thinks of for colics of any kind, and they are Colocynth. and Mag. Phos. It does not matter where the colic is; when you have an acute abdominal colic of any kind one always thinks of the possibility of either Colocynth. or Mag. Phos. Both remedies are often useful for colic in any area, uterine, intestinal, bile ducts, or renal - it does not matter which it is. The point about these drugs is that they are almost identical, that always in their colics the pain is very extreme, and the patients are doubled up with pain. In both cases the pains are relieved by external pressure, and by heat. In Mag. Phos. there is rather more relief from rubbing than there is in Colocynth., which prefers steady, hard pressure. The next thing about them is that their colics are intermitting. The patients get spasms of pain which come up to head and then subside. Copyright 2000, Archibel S.A.

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There are one or two distinguishing points which help you to choose between Colocynth. and Mag. Phos. With Colocynth. in the attacks of colic you always find the patient intensely irritable. He is frightfully impatient, wants something done at once, wants immediate relief, and is liable to be violently angry if the relief is not forthcoming. In Mag. Phos. there is not the same degree of irritability, and the patient is distraught because of the intensity of the pain rather than violently angry. Another point that sometimes helps in your selection is that Colocynth. tends to have a slightly coated tongue, particularly if it is the digestive tract that is upset, whereas when Mag. Phos. is indicated it usually is clean. Both these drugs have a marked aggravation from cold, a little more marked in Mag. Phos. than in Colocynth. For instance, Mag. Phos. is exceedingly sensitive to a draught on the area, whereas Colocynth, though it likes hot applications, is not so extremely sensitive to cold air in its neighbourhood. Another distinguishing point between the two is that in Colocynth. there is apt to be a tendency to giddiness, particularly on turning more especially to the left, but this is not present in Mag. Phos. Where you have a report that the colic - and I think this applies much more commonly to uterine than to intestinal colic has followed on an attack of anger it is almost of anger it is almost certainly Colocynth. you require. If the colic is the result of over-indulgence in cheese it is Colocynth. that is indicated, not Mag. Phos. If the pain is the result of exposure to cold, either a dysmenorrhoea or an abdominal colic, it is much more likely to be Mag. Phos. than Colocynth. These are two of the most useful drugs in the Materia Medica for colics, and it is surprising the relief you can get, even in cases of intestinal obstruction, from the administration of Colocynth. or Mag. Phos. I have seen cases of intestinal carcinoma with partial obstruction in which the patients were suffering from intense recurring colicky pains coming to a head and then subsiding. Mag. Phos. has given the most astonishing relief. Less commonly in such cases where there has been marked irritability in addition to the local symptoms, Colocynth. has also done wonders. Very often one or other of these drugs has kept a patient in a surprising degree of comfort till death supervened. In these malignant colics I never th go high; a 30 potency is sufficient. In an ordinary acute colic, say dysmenorrhoea, I give a 10M and the relief is almost immediate, and the same applies to intestinal colics. There is another drug which is very useful as a contrast to these two, and it has very much the same sort of pain, a very violent, spasmodic colic coming on quite suddenly, rising up to head, then subsiding, and that is Dioscorea. Dioscorea has the same relief from applied heat, and it is sometimes more comfortable for him pressure, but, in contradistinction to the other two drugs, instead of the patients being doubled up with pain they are hyper-extended; you find them bending back as far as possible. And the only drug I know which has that violent abdominal colic which does get relief from extreme extension is Dioscorea. I have seen it useful in gall-bladder attacks, in a few intestinal colics, and in a case of violent dysmenorrhoea. I have never tried it in renal case. Where you get that extreme extension of the spine you can give Dioscorea every time without asking any further questions. There is one other drug I want to mention because one tends to forget it as a colic medicine, and that is Ipecacuanha. Ipecac. is one of the most useful colic drugs we haven and the indications for it are very clear and definite. The character of the pain described in Ipecac. is much more cutting than the acute spasmodic pain occurring in most other drugs. But the outstanding feature of Ipecac. is the feeling of intense nausea which develops with each spasm of pain. Accompanying that nausea is the other Ipecac. characteristic that in spite of that feeling of deathly sickness the patient has a clean tongue. You will see quite a number of adolescent girls who get most violent dysmenorrhoea, they are rather warm-blood people, and with the spasm of pain - they very often describe is as cutting pain in the lower abdomen they get hot and sweaty and deadly sick so that they cannot stand up and any movement makes them worse. They have a perfectly clean tongue and a normal temperature, and very often Ipecac. will stop the attack, and even the tendency to dysmenorrhoea altogether. It is one of the very useful drugs and, as I say, one of the ones one tends to overlook. I have seen several cases of renal colic, associated with the same intense nausea, which have responded to Ipecac., but I think that is more rare; it is more commonly in uterine cases that you get indications for it. There are three drugs I always tend to associate in my own mind for colics : Lycopodium, Raphanus and Opium, the reason being that in all three the colic is accompanied by violent abdominal flatulence. It Is always an intestinal colic in which I expect to find indications for one or other of these drugs. It may be associated with a gall-bladder disturbance, and if so it is much more likely to be Lycopodium than either of the other two. In all three there is a tendency for the flatulence to be stuck in various pockets in the abdomen, that is to say, you get Copyright 2000, Archibel S.A.

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irregular areas of distension. In all three you are likely to get indications in post-operative abdominal distensions, semi-paralytic conditions of the bowel. Where you have definite paralytic conditions like a paralytic ileus following abdominal section you are more likely to get indications for Raphanus and Opium than for Lycopodium, but if the paralytic condition happens to be more in the region of the caecum the indications are probably for Lycopodium rather than for the other two. That is the general picture, and there are one or two distinguishing points which help you. For instance, in Lycopodium the colicky pain is likely to start on the right side of the abdomen, down towards the right iliac fossa, and spread over to the left side, whereas in the other two it remains more or less localised in the one definite area. In Lycopodium you are very liable to get a late afternoon period of extreme distress, the ordinary 4 to 8 p.m. aggravation of Lycopodium. There is likely to be very much more rumbling and gurgling in the abdomen in Lycopodium, and there is more tendency to eructation, whereas in the other two the patient does not seem to get the wind up to the same extent. Where there is eructation the patients usually complain of a very sour taste in Lycopodium cases. In Lycopodium you usually have a somewhat emaciated patient with a rather sallow, pale complexion. There are one or two points that lead you to Opium instead of the other two. In Opium, as I said, there is apt to be a definite area of distension, and the patient may say that he gets a feeling as if everything simply churned up to one point and could not get past it, or as if something were trying to squeeze the intestinal contents past some obstructing band, or as if something were being forced through a very narrow opening. Another point that leads to the selection of Opium is that which these attacks of colic the Opium patient tends to become very flushed and hot, feels the bed abominably hot, wants to push the blankets off, and after the spasm has subsided tends to become very pale, limp, and often stuporose. The area of distension in Opium is likely to be in the centre of the abdomen rather than in the right iliac fossa, and it is one of the most commonly indicated drugs in a paralytic ileus. Another point that sometimes puts you on to Opium is that when the pains are developing and coming up to a head the Opium patients develop an extreme hyperaesthesia to noise. I remember one patient who had a paralytic ileus after an abdominal section and as he was working up to another attack of vomiting he had that hyperaesthesia to noise more marked than I have ever seen it. If the nurse in the room happened to jangle the basin into which he was going to be sick he nearly went off his head and he turned and fairly cursed her. That hyperaesthesia to noise made me think of Opium, and it completely controlled his attack and the whole condition subsided. This hyperaesthesia is worth remembering as it is so different from the sluggish condition induced by the administration of Opium in material doses. The Raphanus type of post-operative colic is again slightly different. Instead of getting the right side of the abdomen distended as in Lycopodium, or the swelling up in the middle as in Opium, in Raphanus you get pockets of wind, a small area coming up in one place, getting quite hard, and then subsiding, followed by fresh areas doing exactly the same. These pockets of wind may be in any part of the abdomen. In acute attacks of pain the patients tend to get a little flushed, but not so flushed as the Opium patients, and they do not have the tendency to eructation that one associates with Lycopodium, in fact they do not seem to be able to get rid of their wind at all either upwards or downwards. But it is these small isolated pockets coming up in irregular areas throughout the abdomen which give you your main lead in Raphanus cases, and I have seen quite a number of them now, post-operative cases, and it is astonishing how quickly after a dose of this remedy the disturbance subsides and the patient begins to pass flatulence quite comfortably. th In post-operative cases I usually give Lycopodium in 200 potency. In Raphanus I always use the 200 s; having found this potency worked I have stuck to it. In Opium, I usually give a higher potency because these cases are pretty extreme. There are, of course, endless other drugs which have colic, but I am trying to pick out those most useful in emergencies. There is one other which you ought to know Podophyllum. Podophyllum you will find useful in hepatic colics mainly. It is helpful in intestinal colics associated with diarrhoea, I mean with acute diarrhoea, but then you prescribe it much more on the diarrhoea symptoms than on those of the colic. But you do get indications for it in hepatic colics purely on the local symptoms. I think in these cases where you have Podophyllum indicated in hepatic colic you always have a degree of infection of the gall-bladder, and one of the first things that makes you think of the possibility of Podophyllum is the fact that the maximum temperature is in the morning and not in the evening. It has a 7 o'clock in the morning peak temperature. In addition to that, the Podophyllum patients are very miserable and depressed, almost disgusted with life. There is always a degree of jaundice in the gall-bladder cases, and it may be pretty marked. Copyright 2000, Archibel S.A.

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In the majority of these cases the pain is not definitely localized in the gall-bladder area, it is more in the epigastrium as a whole, and tends to spread across from the middle of the epigastrium towards the liver region. The pains are twisting in character, and they are much aggravated by taking food. In these Podophyllum cases when the acute pain has subsided there is a horrible feeling of soreness in the liver region, and you find these patients lying stroking the liver, which gives a great sense of comfort. When I see an infected gall-bladder with a morning temperature instead of an evening one I immediately think of Podophyllum. It is astonishing how often one gets this indication, and then you generally see the patient lying in bed stroking the liver region. In every case where the morning temperature and that relief from stroking have put me on to Podophyllum I have found that the other symptoms fitted in.

Discussion
Dr. mcCrae thought the paper was a masterpiece. There was nothing in it to criticize, there were details of valuable help to everybody which were like the artist sharpening his pencil to produce some line of particular splendour which would make the picture complete. Most had pencils but they were blunt, and the homoeopath would always be grateful for these amazingly useful hints. He hoped Dr. Borland would soon return so that the members could thank him personally. He also thanked the President for the way in which he had read the paper. Dr. John Paterson said that they had listened to a real clinical paper. There was not much which one could criticize, but one might add a little. With regard to the cardiac cases, Arsenic and Sulphur his experience was that Arsenic was often the acute of Sulphur and on the mental side they were the exact opposite. One found that a Sulphur patient swung in an acute condition to Arsenic and Dr. Borland had brought out that point. He was interested in the question of Aconite acting in the first attack but not in the second. There had been many discussions about covering the totality of the symptoms and here was evidence that the homoeopathic remedy could be prescribed on the mental symptoms which worked in the first instance but it did not cover the whole of the case. It was possible to prescribe homoeopathically without covering the whole of the case, only covering a phase because obviously on the next occasion the pain was present but not the fear, the Aconite had removed one phase of the case - mental fear. Aconite came out very strongly in the air raids. Another remedy was Natrum Mur. He wondered if any orthodox practitioners were surprised that there was no mention of Digitalis but Digitalis was quite useful in these slightly relaxing hearts in homoeopathic doses, not in the massive doses given in allopathic medicine. With regard to renal colic, in examining the stools of patients the Bacillus Morgan came out very frequently and he associated Lycopodium with it. Lycopodium had always been considered to be a right-sided remedy but the peculiar point about a case in which it had proved successful was that the pain had been left-sided and when the case had been X-rayed it had been found that the right kidney was more involved than the left, so that it looked as if the actual renal colic condition started in the left kidney but gave no trouble. It was only when the right kidney was involved that the first symptom developed, so that even with a left-sided renal colic Lycopodium should not be excluded. Dr. Stonham said that the paper was excellent and the sort of paper which would appeal to the general practitioner, who was always coming up against acute cases. To have such cases so plainly stated with the drug indications for them was very valuable. There were one or two points he would like to mention with regard to Aconite which, as Dr. Borland had said, was very useful in many cases. The case which he did not mention was the acute pulmonary oedema. He had given Aconite 30 in such cases and it quickly calmed the patient in that distressing and somewhat dangerous condition and he had found it valuable not only in the first case but also in cases when the attack has been repeated. Dr. Borland said he gave Laurocerasus in acute heart complaints. He had had an acute case with Cheyne-Stokes respiration, it looked as if the patient would die, he gave Hydrocyanic Acid and he recovered very nicely. Many people would substantiate the value of Dr. Borland's paper. Dr. G. R. Mitchell said that a clinical paper was most useful. He wanted to criticize something Dr. Paterson said when he took the Aconite example as not prescribing on the totality. He would have thought it was an example of prescribing on that procedure because in the first case, on all the manifestations, Aconite was the drug, and it worked and on the second occasion there was a different totality, and the Aconite did not work. That was the way he would regarded the matter. Dr. hardy added her grateful thanks to Dr. Borland for his paper. With regard to medicines for heart complaints she agreed with Dr. Paterson that Digitalis 200, one dose, was very effective in the semi-chronic or chronic case of the right sided congestion, blue face and blue nails, but not in the acute patient. She also used mother tincture Crataegus for heart patients because it was specific for the cardiac muscle. Another drug which was used in Russia was Adonis mother Copyright 2000, Archibel S.A.

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tincture, five drops to a dose. There was a remark which she did not like about Chelidonium - that the patient did not respond and that it must therefore be cancer. The case was Lachesis to start with and that did not exclude the possibility of cancer. She had a very bad case of cancer which was cured by Lachesis, a liver case with constant pain. In her personal experience Raphanus was indicated in the hepatic lesions, and Momordica in splenic lesions. Dr. Le Hunte Cooper did not think too much could be said about the work which had been put into this paper and the wonderful collection of details on which indications had been given and which were of the greatest possible value. The paper would require a great deal of study, so that these indications could be taken for future use. He was rather in favour of trying to keep the remedies which were very definitely specific for particular conditions because in cases where there was an emergency, there was no time to seek for all the exact indications which might help, but he was rather surprised that Dr. Borland did not make more use of the Snake Poisons in heart cases because he must admit he would not be without Lachesis. If there was any suggestion of heart failure he would give Lachesis and would be surprised if it did not answer. There was one rather interesting point from the homoeopathic point of view with regard to Snake Poisons and that was to think of the first thing which an individual felt when he was bitten by a snake, which was death, and when death threatened the patient the prescriber should think of the Snake Poisons. He mentioned this in a paper he read on Snake Poisons in Berlin just before the war and it attracted the attention of reporters who were present. In the Berliner Tageblatte there appeared in headlines, "When death threatens, think of the Snake Poisons." Another point was that he thought a little more might have been made of Pulsatilla for the ear. His experience was that a pain in the ear was met by Pulsatilla irrespective of the indications of the Pulsatilla patient. One liked to have something at the back of one's mind which could help immediately without having to think too completely of other remedies. If one had too many remedies they came in afterwards, but at first one might fall between two stools. Dr. Alva Benjamin said that with regard to the collapse cases one would have thought that Dr. Borland would have mentioned Veratrum Album for cases of great coldness and excessive sweating. With regard to heart cases he had had a lot of help from Chamomilla, particularly when the pain was very severe. With regard to ear cases he was surprised Dr. Borland did not mention Bryonia for inflammatory conditions; he had found It admirable. In one case the child was developing mastoid. He asked Dr. Cunningham to come to see the case, meantime giving the child Bryonia 10M, and almost immediately there was no need for him to attend. He had had other cases in which he found Bryonia 10M extremely valuable. Dr. Hardy added that Bryonia was very useful. In one case she gave a dose of Bryonia where the patient was lying on the painful side and did not want to move, which cleared up in ten minutes. Dr. Fraser Kerr said that the Aconite cases had interested him; he thought that the mental aspects were not so much mental as characteristic of the whole case. In one of his own cases of a child of 11 or 12 with asthma who was in a dreadful state he gave Aconite and within a few moments she was relatively easy. The mental aspects characterized the whole case. Dr. Ghai said that during the last four or five years he could not remember a case where he had used morphia in a very large panel and private practice. He could recall three or four cases of children with earache, flushed, dilated pupils with the pain coming and going constantly, for which he gave Belladonna 30 and the next day the child was better. Pulsatilla was very useful but usually in the Pulsatilla patient the pain did not come and go constantly. Dr. C. E. Wheeler thought that as all the members felt the same about Dr. Borland's paper a special message should be sent to him from the meeting. Dr. Borland would be gratified to know that his paper had been enjoyed so much. From the earlier years that he knew Dr. Borland he had always realized that he had the gift of classifying his experience to himself and getting the maximum value of it and that was why he could express himself clearly. He had managed to get what he wanted to say into a succinct space, although the paper was long there was no over-elaboration of detail. His principal feeling as he listened was certainly one of enjoyment but also of regret that he had not been able to sit under Dr. Borland. He must have made it easier for beginners by his ability to get into the other person's mind the essentials of a very wide experience. It was not merely one or two cases, he had watched these things and had been able to classify them. It was not that the drugs Dr. Borland had mentioned were unfamiliar, although the speaker would admit that he had never given Oxalic Acid in heart emergencies, and would like to see the next case which came along; in this way they were classified. There were one or two points which he would mention. The first was the relation drawn between Mag. Phos. and Colocynth. He personally had never been able to decide whether Colocynth. was a left sided drug; he had given it for left-side neuralgia. The most prominent ingredient in tincture of Colocynth. was Mag. Phos. so that in prescribing Colocynth. one Copyright 2000, Archibel S.A.

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was giving Mag. Phos., which raised an interesting point, and he made it because it was the general observation which enabled one to see whether the point had substance and one which should be studied. It had been in his mind since he realized that tinctures were mixtures; Lycopodium contained a lot of Silica and so on, so did Belladonna and the balsam compounds. He did not think atropine was a pain reliever, it was a relaxer. That was the point in his mind, whether the drug which presumably was responsible for the relief of a group of symptoms would be just as effective if it were given alone. The Colocynth. was chosen on the whole symptomatology which was all in Mag. Phos. - the pain, etc. Did Mag. Phos. indicate Colocynth.? Was it not probable that the vehicle was important and that it would not be so effective if the Mag. Phos. had not been given? I there was to be research he would suggest that this was a suitable subject. A far more detailed knowledge of the proportions of mineral ingredients in the vegetable tinctures was needed. Such research might throw a great deal of light on some symptoms when they would be associated in that way. There were potassium salts in Pulsatilla and it was the potassium salt which stood out in a particular tincture. With regard to dysmenorrhoeal pain where there was excessive periods and nausea, he would have thought of Ipecac. and Verat. Alb. In Podophyllum the one outstanding symptom was that there was normally a gastro-colic reflex-taking food into the stomach stimulated the movement of the colon and there had to be a motion after every meal; that would be a strong indication to him. He would suggest that a definite expression of pleasure for his paper should be sent to Dr. Borland. Dr. W. lees Templeton said that most of them felt that they had been back at school and he felt not only humbled but humiliated, for the must admit that he did not get such good results, possibly because one did not always get the symptoms. Most of the emergencies he saw were unable to give symptoms and one had to judge on appearances. He was glad, therefore, that Dr. Borland had elaborated on the appearance of the patient, because that was important. With regard to drugs, he did not find Ant. Tart. was useful in heart cases because he believed the pathology was different. He thought Ant. Tart. had a pulmonary pathology, not cardiac. Carbo veg. had a great and justifiable reputation as the "corpse reviver" and it did work when the appropriate symptoms were present. Cold sweat he looked upon as a guiding symptom for Verat. Alb. and he had verified its value in collapse. He was sorry that Dr. Borland was not more specific in his diagnoses, e.g. if pain was due to coronary thrombosis he doubted if the high potency alone should ease this particular pain in a matter of minutes. The wait with the patient for four or five hours for the second presentation was a serious matter when one was called out in the middle of the night, and like confinements many of these emergencies did occur at night. Why was this, he wondered. With regard to otitis media he felt that the success obtained depended on the stage at which the doctor was called in. If he got in early and there were good indications the result could be very good, but how rarely one did get to it early! Beyond that stage it was not so easy, and people talked as if a mastoid arose suddenly; it did not, it was not a question of an earache today and a mastoid tomorrow. He had seen Capsicum successful where there was tenderness and swelling of the mastoid, but with otitis media and a purulent discharge he would not delay in seeking the advice of the aurist. Pulsatilla and Silica were the great polychrests in otitis media with discharge. Belladonna and Chamomilla to abort and avoid discharge. Again with fifth nerve neuralgia it was question of stage at which the doctor saw the patient. If it was a chronic case the treatment was not easy. Supra-orbital neuralgia after sinus trouble was interesting, and frequently he found that China Sulph. was indicated and proved efficacious. Post-herpetic pain was another difficult condition to influence. If there was scar tissue present in the posterior root it would take more than one dose of Ranunculus to remove it. Many of these cases had already received Ranunculus in the acute condition. The drug he found most useful in the acute condition was Arsenic where the eruption was widespread, and Arsenic covered the pathology of the condition as well. Sciatica was rarely easy. The typical Colocynth. case where the pain was better for lying on the painful side was often quoted, but how often did one get it? Kali Iod. was the drug where the patient would not SIT DOWN in the consulting room; Rhus had to be considered in the fibrositic conditions. This was not a true sciatica, as shown by the improvement from exercise; a true sciatica rarely was. With reference to the colics he was glad Dr. Borland mentioned the symptoms of Dioscorea where the patient rolled about and did not know what to do - a very useful indication. Here the amelioration of Dioscorea was rarely obtained, but Clarke stresses the symptom "moves all over the place to get relief". As well as giving the homoeopathic remedy in these colic cases he confessed he often left something more palliative, but he was frequently surprised how rarely this was required. One useful indication for Lycopodium in renal colic was pain in the back better on passing urine. Some might say Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica that it was a mechanical relief, but he doubted if this was so.

15

He would like to stress again the importance of the objective description of the symptoms in these emergencies - the appearance of the patient, his colour, position and movements were usually all one had to prescribe on. In painful conditions so much depended on circumstances. If of short duration and there was little pathological change, speedy results could be obtained; but if the condition was chronic he feared that to claim too much would only lead to disappointment. No that results could not be obtained, but only as a result of a serious study of the whole case. In his clinic he advised that if local modalities were good, to prescribe in the first instance one these alone, and only when this failed to take the whole case, but he emphasized this method only where the local symptoms were good. Dr. A. Moncrieff added her thanks to Dr. Borland whom she considered our most brilliant prescriber in acute conditions, and what success she had in acute prescribing she felt was due to his teaching. In her children's clinic she had a great number of cases of otitis media and most of them came not necessarily in the very acute stage when probably Belladonna might be indicated, but with a history of acute earache for one or two nights. On examination of the drums there would be redness and possibly bulging, and she had found Pulsatilla so often indicated if the condition affected the right ear that she almost tended to use it as a routine remedy. If the left ear was affected she often found Silica useful, and Hepar Sulph. if the child was so hypersensitive to pain that he or she cried before being touched. Most of her ear cases either cleared up or discharged, the exception being the very tough drums which she occasionally had to refer to Dr. Cunningham. With regard to colics, she agreed with Dr. Wheeler that Verat. Alb. was very useful in dysmenorrhoea accompanied with vomiting, and had found Dr. Tyler's experiences of Tuberculinum also most effective in this condition. The President said that a message would be sent to Dr. Borland. He had found great pleasure in reading the paper. He would not say very much about the drugs, but Arnica for a tired heart was useful. Very often there were no indications on which o prescribe at all. He did not agree with Dr. Cooper. He saw two boys, brothers, the other day : John sat on the chair, Kit sat on his mother's knee but John would not do so, although he would do anything for his mother. He was typical Bryonia case and the other child was a typical Pulsatilla. With regard to Dr. Ghai's remarks on Belladonna in earaches, there was no drug for any one complaint, it often depended on the season of the year. There were remedies suitable for summer, autumn, winter and spring; just then with the high cold winds it was Belladonna. With regard to dysmenorrhoea very often Mag. Phos. would help in the acute attack, and the remedy which had helped him the most was Tuberculinum 6, and it very often eliminated the need for Mag. Phos. They all knew that Carbo veg. was a "corpse reviver"; with regard to Veratrum Alb. he had a very severe diarrhoea one day, with a cold clammy sweat. He took a dose of Veratrum Alb. and in twenty minutes was relieved. A patient came to him with neuralgia in the face, he got her X-rayed and found a black speck in one of her teeth. For two years she had amalgam in that tooth and she had to have it removed. One had to be careful that there was not some such cause for pain in the face.

BORLAND D. M., The Treatment of Certain Heart Conditions (bl2)

BORLAND Douglas M.

Acute heart failure

Arsenicum album
-There will be the typical Arsenic mental distress, with extreme fear, extreme anxiety, mental and physical restlessness, with constant thirst and desire for small sips of ice-cold waster. -So far as the actual local symptoms are concerned, the main complaint is of a feeling of extreme cardiac pressure, a feeling Copyright 2000, Archibel S.A.

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of great weight or constriction of the chest. Associated with this the patients feel as if they cannot get enough air into the lungs, and feel that they are just going to die. -The patients as a rule are cold, they feel cold, though they may complain of some burning pain in the chest. -In appearance, they always look extremely anxious. They are grey, their lips are rather pale, may be a little cyanotic, and they give you the impression of being very dangerously ill. They very often have a peculiar pinched, wrinkled, grey appearance. -As a rule in these cases one gets a history that the attack has developed quite suddenly, and the response to Arsenic should be equally quick. In a case of that sort, if one does not get a response to Arsenic within a quarter of an hour the patient is not an Arsenic patient. The first response that one ought to get is a diminution of the patient's mental anxiety and extreme fear, the restlessness beginning to subside, and the patient beginning to feel a little warmer. -In a case of that sort my experience has been that one is wise to administer the highest potency of Arsenic available, because this is the kind of case that will die very rapidly and no time should be wasted on low potencies. The Arsenic seems to act very much like a temporary cardiac stimulant, and I find that in the majority of these cases one has to repeat the dose, certainly to begin with, about every 15 minutes. -There is a very important practical point in connection with these cases, namely, that one very often sees a case of this sort which responds perfectly well, the patient is better, everyone feels he is getting over it, and then in 3, or 4, or 6 hours the symptoms begin to come back, the patient no longer responds to Arsenic and collapses and dies. That was my experience at one time. -Then it began to dawn on me that had I cut in with another drug during the reactive period I could have carried these patients on. -I found that when I did this they did not get the secondary collapse, and one saved them. But to that one has to get in the secondary drug within 4 to 6 hours of the primary collapse while the patient is responding to the Arsenic, otherwise there is great danger of a secondary collapse which one cannot combat. -This seems to be one of the very few instances in which one appears to ride right across the dictum that so long as the patient is improving one carries on with the same drug. In these acute Arsenic cases if one has set up a reaction at all one has to take advantage of the reaction, and if one does not do so the patient will sink. -The drugs which, as a rule, I have found these Arsenic cases go on to in the reactive stage are Phosphorus or Sulphur, but that is by no means constant, I am merely throwing it out as a help. -One can easily picture that grey, pinched, anxious Arsenic patient responding, getting a little warmer, a little less grey, a little less pinched, a little less drawn, a little less anxious, a little more color, and going on to a typical Phosphorous. Equally one can see them going to the other extreme where they are too hot, with irregular waves of heat and cold, rather tending to push the blankets off, still with air- hunger, and going on to Sulphur. -These are the two commonest drugs, but whatever the response is one ought to be able to follow it up immediately the reaction is well under way.

Antimonium tartaricum
-The Antimony tart. patients present a somewhat similar picture, but there are clear points of difference. -In Antimony tart. there is more a definite tendency towards cyanosis than in Arsenic, one never sees an Antimony tart. patient without very definite signs of cyanosis. This may involve the whole extremities or may be confined to the finger and toe nails. -One never sees the same kind of mental anxiety in Antimony tart. The patients are more down and out, much more hopeless, more depressed. They are never quite so restless and never quite so pale. -Again, there is none of the thirst one meets with in Arsenic, in fact anything to drink seems to increase the patient's distress. -Another contrast is that the Antimony tart. patient is very much aggravated by heat, and especially by any stuffiness in the atmosphere. There is one point worth nothing here as a contrast between Antimony tart. and Carbo veg., Antimony tart. patients do not like a stream of air circulating round them, they want the room fresh, but they like it still. -In most of these Antimony tart. patients there is a very early tendency to oedema of the lower extremities. -Another point which helps you in your Antimony tart. selection is that practically all these patients have a very thickly coated tongue a white coat with a rather sticky, uncomfortable mouth. -They have a feeling of fullness in the chest rather than the feeling of acute pressure found in Arsenic. And one usually finds pretty generalized, diffuse rales in the lower parts of the chest on both sides. -In contrast to Arsenic, if one has a case of this type it is the kind of collapse one meets with after a pneumonic crisis if Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica the patient responds to Antimony tart. it will carry him through. -One does not have to be on the jump to find the follow-up drug as one has to be in the Arsenic case.

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Carbo vegetabilis
-presents the classical picture of patients with all the symptoms of collapse. They have the cold sweaty skin, they are mentally dull, rather foggy in their outlook, have not a very clear idea of where they are or what is going to happen to them. They have the most intense air hunger, an, in spite of their cold clammy extremities, they want the air blowing on them, they cannot bear to have the bedclothes round their necks, and they do definitely benefit from the administration of oxygen. -They are very much paler than the Antimony tart. patients, the lips tend to be pale rather than cyanotic, and there is none of the underlying blueness one associates with Antimony tart. -The next point is that they always have a feeling of horrible distension. It is very often complained of not so much in the chest as in the upper abdomen, and their cardiac distress is always associated with a good deal of flatulence. -Like the Antimony tart. patients, any attempt to eat or drink tends very much to increase their distress, and they have none of the Arsenic thirst. Another apparent contradiction you come across in Carbo veg. is that, in spite of their desire to be uncovered, and the intolerance of the blankets round the upper part of the neck or chest, these Carbo veg. patients complain of ice-cold extremities, they feel as if the legs are just lumps of lead, and they cannot get them warm at all. -I think in Carbo veg. one has to be careful as to how long one is to keep up the administration once the patient is responding, sweating less, the surface becoming warmer, and the distress less acute. It is wise then to hunt round for a second drug in case of need, because some Carbo veg. patients do relapse, although many of them make quite a straight recovery on Carbo veg. One does have to be careful. If one finds a patient who has responded up to a point on Carbo veg. it does not follow that a higher potency of Carbo veg. is going to carry on the good work. As a rule it does not, and it is much better to hunt round for a fresh drug to keep up the reaction. Often when the patient has responded only up to a point to the administration of Carbo veg. the follow-up drug will be found to be Sulphur, but Kali carb. should always be considered.

Oxalicum acidum
-has one or two very outstanding symptoms which are often met with in cases of collapse, and which are a great help in the selection of the drug. -First, the patients always complain of a feeling of the most intense exhaustion. Associated with that exhaustion there is usually a sense of numbness. The patients very often they say they don't feel as if they had any legs at all. -The skin surface is just about as cold and clammy as it is in Carbo veg., but there is a peculiar mottled cyanosis in Oxalic acid which one does not get in the other drugs. The finger tips and finger nails and toe nails will be definitely cyanotic, but in addition to that there is a peculiar mottled appearance of the hands and feet which is quite distinctive of Oxalic acid. There is a somewhat similar mottled, cyanotic appearance in the face, very often over the malar bones. -The patients, in contrast to the Arsenic patients, want to keep absolutely dead still, movement of any kind vastly increases their distress. -In addition to their general distress, most of these Oxalic acid patients complain of peculiar, very definite, sharp, precordial pains. -The pain is not like the typical angina's pain, it is a sharp pricking sort of pain which usually comes through from the back and may run up the left side of the sternum towards the clavicle, or down the left side of the sternum into the epigastrium. -The most startling cases giving this picture that I have seen have been in the critical stage of an influenzal pneumonia where the patient was just petering out, seemed to have lost all strength, was dead beat, and the heart was just giving out. All the patients of that type that I have seen have had left basal pneumonias. I remember seeing two or three cases which apparently were doing quite well on Natrum sulph. and collapsed, and they reacted beautifully to Oxalic acid. But one does get indications for it in chronic cardiac cases as well.

Chronic heart failure

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Lachesis mutus
-In all these cases indicating the Snake Poisons there is a rather purplish bloated appearance. They all suffer from a feeling of tightness or constriction in the chest, more commonly in the upper part of the chest, and they are all intolerant of any weight or pressure of the bedclothes, or any tight clothing round the upper part of the chest or the neck. All are sensitive to heat; they feel hot, and they dislike a hot stuffy room. They all have a marked aggravation after sleep. They get acute suffocative attacks when they fall asleep, and they wake up in increased distress. -All these Snake Poison patients in their cardiac distresses have a marked aggravation from being turned over on the left side. -All of them have a very marked tremor, their hands are shaky. -And most of them, as they tend to get worse, become difficult and suspicious. If there were nothing more than that one would give them Lachesis. But in a certain number of these cases there are rather acute stitching pains which go right through the the chest from the precordium to the region of the scapula, associated with very marked numbness, particularly in the left arm and hand. And where that numbness is pronounced one tends to give Naja in preference to Lachesis. -If the the pain, stitching pain, is more marked, one tends to give Naja. If the feeling of constriction is more marked, one tends to give Lachesis. But their general symptoms are identical. I think possibly Naja is a little less red, less bloated looking, a little paler than Lachesis, but that is not very striking. -To my mind the the choice of one of the other Shake Poisons as distinct from Lachesis and Naja in such cases is always governed by the general symptom picture rather than by the purely cardiac picture. For example, one may require Crotalus horridus in a case of failing heart associated with acute sepsis, but one would be guided to the choice by the septic state rather than by the cardiac symptoms per se.

Lycopodium clavatum
-One gets indications for Lycopus in a case in which the heart is just beginning to fail; it is beginning to dilate a little, and the pulse is tending to become a little irregular. -The patients tend to be pale rather than cyanotic, and they are always restless. The outstanding symptom of the Lycopus case is that the patients complain of a horrible tumultuous sensation in the cardiac region. They very often tell one it feels as if their heart had suddenly run away and was just going mad. This is accompanied by a feeling of intense throbbing extending up into the neck and right into the head. -The other Lycopus symptom which helps one is that accompanying thus tumult taking place in the chest there is a very marked tendency to cough. It feels as if the heart just runs away, it sets up an acute irritation, and they cough. Another Lycopus distinguishing symptom is that their distress is vastly increased by turning over on the right side a contrast with the Snake Poisons which are worse turning over on the left side. -Lastly, these Lycopus patients have an intense dislike of any food, particularly the smell of food.

Laurocerasus
-The Laurocerasus picture is very definite, and I find the easiest way to remember it is to picture to oneself the appearance presented by a congenital heart of about 16 to 18 years of age. You know the peculiar bluish red appearance of the congenital heart, somewhat clubbed fingers, which, again, are rather congested, and the peculiar bluish appearance almost like ripe grapes of the lips. That is the sort of underlying color one associates with Laurocerasus. -These patients always suffer from extreme dyspnoea, and the type of dyspnoea is very nearly Cheyne Stokes in character. They take a sudden gust for breath, then two or three long breaths, then the breathing gets gradually shallower, then a pause, then two or three gasps, and so it goes on. -Another feature is that the respiratory dyspnoea gets very much worse if they are sat up; they are better in a semi-prone position. -There is a marked tendency to the early development of hypostatic pneumonia in such cases, and once this has appeared the patient's cough is more troublesome unless they are reasonably propped up. When lying the cough is worse. Sitting bolt upright produces a feeling of extreme constriction of the chest. Semi-prone is the position of choice.

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Angina and pseudoangina

Aconitum napellus
-If one thinks for a moment of any cases of the kind one has seen one finds, I think, that the outstanding characteristic of the majority of these cases in their first attack is an absolutely overwhelming fear. The patient is certain he is going to die, and that he is going to die very speedily, and he is terrified. He is quite unable to keep still, and yet any movement seems to aggravate his distress. In a case of that sort a dose of Aconite high will give relief almost instantaneously. I have seen such a case and put a dose of Aconite on the patient's tongue, and before the medicine could be swallowed the patient was feeling better. It is almost instantaneous. I usually carried 10 m. as my highest potency in general practice, and I gave Aconite 10 m. -That man had a similar attack at a later date, and the anxiety, the distress, and the fear were nothing like so marked because he had come through one attack before, and Aconite had no effect at all. That has been my experience. Where one is dealing with the first attack and the patient is quite certain he is going to die, Aconite does relieve him right away, but it does not act in a second or later attack. So if one gets a man in his first attack a dose of Aconite will probably help and in no time he will be feeling more comfortable. If he has had a previous attack, however, Aconite is unlikely to help him.

Cactus grandiflorus
-If you have a patient who is having a later attack much the most likely drug to help is Cactus. Cactus has a good deal of anxiety and fear, but it is quite different from that of Aconite. It is not a fear that the immediate attack will kill him, it is more a conviction that he has an absolutely incurable condition which will eventually wipe him out. -That is one point about the Cactus indications. Another point is the type of the actual distress of which the patient complains. -He feels as if he had a tight band round the chest which was gradually becoming tighter and tighter and that if this tightness does not let up soon the heart will be unable to function. -It is that feeling of increasing tension which gives the Cactus indication. -In addition to the constriction there may be stabbing radiating pains from the precordium, but they are not so characteristic of Cactus as the intense constricting feeling, which is, of course, just exactly how the majority of angina's patients describe their feeling. -In these acute conditions I always give my drug high, because it acts much more quickly, and one must get relief as quickly as possible.

Arsenicum album
-Occasionally one comes across a patient having an anginous attack with very similar constricting feelings, not quite so intense as in Cactus where it seems to dominate the whole picture, but still a definite feeling of constriction. The patient has been ailing for some time, is rather anxious and worried, very chilly, and accompanying the feeling of constriction there is a pretty acute, distressing, burning sensation in the chest. These anginous patients respond very well to a dose of Arsenic. I have never seen Arsenic do anything in an anginous attack except in the rather broken down, ill-looking patient, who is a bit pale, rather withered looking, very definitely anxious, fearful, with that sense of constriction accompanied by the burning discomfort in the chest, and Arsenic does relieve these quite quickly.

Iodium
-There is another type of case which is very similar to that, with very much the same sensation, but the feeling of constriction, the feeling of tension, is described as being actually in the heart itself rather than involving the whole of the side of the chest. The patients are just about as anxious as the Arsenicum patients in fact all these anginous patients are anxious but instead of the intense chilliness of the Arsenic they are uncomfortable in heat and in a stuffy atmosphere. They are just about as restless, but, instead of the pale, drawn appearances which you get in Arsenic they Copyright 2000, Archibel S.A.

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tend to be rather more flushed, and, as a rule, they are dark-haired, dark complexioned people. They are usually rather underweight, in spite of the fact that one gets a report that they have always been pretty good livers, and they very often have an appetite above the average, although they have not been putting on weight. These cases respond exceedingly well to Iodine.

Spongia tosta
-There is yet another type of case in which instead of the complaint being of constriction it is of a sensation of progressive swelling in the heart region. It feels as if the heart gets bigger and bigger until it would finally burst, and this sensation of fullness spreads up into the neck. -This sensation of fullness and swelling is very much aggravated by lying down, when the patient feels as if he would nearly choke, and it is accompanied by pretty acute pain. The patients themselves are chilly, and any draught of air increases their distress. -In addition to their feeling of distension, they usually complain of more or less marked numbness, particularly of the left arm and hand, though very frequently there is numbness of the hand without any involvement of the arm, and not infrequently they complain of numbness of the lower extremities, too. -As a rule, the face and neck give you the impression of being somewhat congested, they do not have the pale, drawn, wrinkled Arsenicum appearance. -These cases respond well to Spongia.

Spigelia anthelmia
-There is another drug which is useful in the case which has not got the typical anginous constriction, but has much more the pseudoanginous stabbing, radiating pains charp, stabbing pains starting in the precordium, spreading up into the neck, may be across into the right side, or may be more or less numbness involving the whole affected area, and as a rule the pain that they stress is a little eased by turning over on the right side. -Accompanying the stabbing pains there is always more or less marked hyperesthesia over the precordium. If you attempt to percuss out the area of cardiac dullness the patient resents it extremely. Any movement aggravates the pain, or brings on a violent attack. These cases respond very well indeed to doses of Spigelia.

Lilium tigrinum
-There is a condition which is not an angina at all, but which one meets with in hysterical women. One fails to find any cardiac lesion, but the patients will produce a symptom- picture which one finds difficult to distinguish from a true anginous attack. That is to say, they have very marked stabbing, radiating pains, and they very often have an intense hyperaesthesia of the chest wall. They are very depressed, they are very frightened, and they are intensely irritable. They are sensitive to heat, and they distress is aggravated by any movement. -In addition to their stabbing pains they have the anginous sense of constriction, tightness, of the chest wall. -These cases are usually associated with some kind of pelvic lesion, or a history of having had some gynecological illness. -I have seen quite a number of these cases now in which I have had an electrocardiogram done which showed no lesion at all. -And all the symptoms have cleared up entirely on doses of Lilium tig. -They are two other medicines which are of great value in treating heart conditions, namely, Cratoegus Oxyacantha and Lactrodectus mactans.

Heart conditions in general

Crataegus oxyacantha
-The condition in which I have found Crataegus of the greatest value is the myocardial degeneration with a steadily failing heart. -In such a condition there will be the usual accompanying symptoms, steadily increasing pulse rate, signs of pulmonary congestion, a certain amount of oedema, slight cyanosis, and aggravation from any exertion. Copyright 2000, Archibel S.A.

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-In such a condition Crataegus in low potency has in my experience produced the most dramatic effects and an astonishing amount of recovery in the apparently irreparably demaged heart. -I am in the habit of giving Crataegus 3x every 3 to 4 hours for several weeks.

Latrodectus mactans
-The indications for Lactodectus are again in cases of cardiac failure. The type of case in which Y have found it most useful is in a case of heart failure accompanied by, or dependent on, a definite valvular lesion. -As in Cactus, there are the usual physical signs of a failing heart, but, in addition, in Lactrodectus there is always very marked irritability, and the patients always complain of numbness of the left hand and arm, and they usually have precordial pain, which may be of any degree of severity. -In such a case I have found great help from the administration of Lactrodectus 12 or 30 , given at short intervals, say 2 to 4 hours, for a matter of 24 hours, and then repeated only when necessary.

BOUKO LEVY M., Homeopathic and Drainage Repertory (bkl1)

BOUKO LEVY

Preface
FOREWORD This family book can be used everyday by mothers, therapists, and doctors. With this book, the most effective and least toxic medication can be found to treat diseases occurring in the family. Of course, there is no replacement for a doctor trained in homeopathic medicine. However, this book can be of great assistance when there is an emergency or if a doctor is not available. Once a physician is consulted, the information obtained by using this book to analyze a critical situation will be of great help. This book can also be used at the beginning of the homeopathic medical student's training to obtain good results. These successes will allow the student to gain self confidence and appreciate how homeopathic reasoning takes into account the individual reactions of a patient. By using the information in this book on drainage techniques, practitioners who are already familiar with homeopathic prescribing will add tremendously to their successes. In the past one hundred years, environmental, nutritional, and chemical stresses have changed and the sensitivity of the patient has increased while the strength of their immune system has declined. Therefore, it is essential that the practitioner help the patient regain and maintain their health as quickly as possible by draining or detoxifying the organs and balancing their functions through biotherapeutics. Many homeopaths combine the new biotherapeutics of phytotherapy, phytogemmotherapy, organotherapy, trace elements, and satellite drainage remedies, with classical homeopathic prescribing. These biotherapeutics, which have their roots in the old healing philosophies, will help a patient reach and maintain their optimum health. Most of the chemicals physicians have on their therapeutic palette can bring on very unpleasant side effects and sometimes these side effects are very dangerous. Allopathic drugs may also stop certain symptoms of a chronic disease, but this does not mean they can cure the patient. Homeopathy, however, is a family medicine. It acts well on acute diseases such as infections, colds, headaches, athletic injuries, cystitis, etc., as well as on chronic diseases such as allergies, arthritis, asthma, eczema, colitis, mastitis, etc.. Overall, it is a complete system of medicine related to the other branches of the Healing Arts. Many patients will derive a great benefit from combining homeopathic techniques with diet, acupuncture, chiropractic and osteopathy.

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Homeopathic medicine and cybernetics

"We shall never gain complete control of nature; our organism, which is itself an element of nature, will always be perishable and limited in its power to adapt, just as in the amplitude of its functions. But noticing this must not paralyze us; on the contrary, it indicates to our being the direction to follow." - Sigmund Freud -

Discomfort in the Civilization - 1929.

Our solar system is known as a cybernetic system in which the planet earth and other planets interact and function as a whole system. Our [body's systems also obey the same general laws as the rest of the universe: each organ, cell, hormone, vitamin, etc., all interact and react with each other in order for the body to function within its own organization. The planetary system contains all the elements necessary to maintain life. Homeopathic medicines are elements taken from this system, either from the plant, animal, or mineral kingdom. When they are prepared according to homeopathic procedures, these medications become powerful natural remedies, without dangerous side effects. Homeopathy is a natural system of medicine based on the experimental scientific method. It is also a cybernetic system in which the totality of the organization is interdependent on the dynamics of communications between subunits, i.e. cell to cell, organ to organ, hormone to hormone, etc. The ecosystem is a loop or feedback system, defining a group in equilibrium by its entries and exits. A homeopathic remedy acts with the very precise coded information that it gets more precise with increasing potencies. Most of the natural elements circulating in our body such as hormones, vitamins, trace elements, D.N. A., etc., are found in very small quantities and are naturally succussed or shaken about 80 times a minute by the force of the heart beat. Homeopathic remedies which are prepared by dilution and dynamization contain the same type of coded information that exists in these naturally occurring diluted and dynamized bodily elements. Also, the information contained in a homeopathic remedy comes from the three kingdoms of nature and is more accessible and penetrating to the systems of the body than any synthetic drug. This natural analogy is the basis of homeopathic reasoning and explains why homeopathic remedies are more effective than synthetic drugs at correcting disorders in the body's systems. In other words, homeopathic medicine helps the individual to adapt to the general laws of the planetary system where they live and follow its evolution.

The new biotherapeutic remedies Drainage

The disorders that the patient presents to the homeopath are superficial expressions reflected from their deep reactive mode. Each person is made of various layers and the homeopath must take them off carefully, one by one, to penetrate deep into the mechanisms of the patient. As the homeopath removes each layer, the body needs assistance in detoxifying and tonifying the affected organs. It needs drainage of the essential emunctories. It usually takes many years to become a good homeopath. The materia medica evolves all the time and the repertories are very large. So, how can we quickly get good results in chronic diseases? An easy way to penetrate the homeopathic world, is to use the techniques of drainage. This is the perfect field of action for the new biotherapeutics which have been prepared from the three everpresent kingdoms of nature, i.e. the plant, animal, and mineral kingdoms. These new biotherapeutics are excellent for all ages. They are particularly effective for all chronic diseases such as allergies, ear, nose, and throat pathologies, woman's health, rheumatisms, digestive disorders, overabundance diseases, stress management, and general ageing functions. In most cases, the patient needs to stimulate the organs affected by a chronic disease. The body's cleaning and fortifying abilities are naturally maintained by the wheel of emunctories. Copyright 2000, Archibel S.A.

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Two courses of emunctories treat and eliminate the stream of toxins along this wheel. The first course goes from the skin to the digestive system and then to the respiratory system. The second course evolves from the urinary system, then goes to the osteo-articular system and finally to the cardio-vascular system. All of the emunctories are govemed by the endocrine and nervous system and must be considered at each stage of treatment. Our individual wheel of emunctories turns according to our own constitution, reactive mode, and line of life. In the evolution of a chronic disease, the order in which the different organs are affected shows the exact treatment strategy to follow and the type of drainage the patient needs. The key to chronic disease treatment is good detoxification. Drainage regulates the activity of the blocked or deficient organs and improves the quality of the essential emunctories. This is the first condition necessary for a quick and complete healing. Drainage and hygiene of the body are always necessary to correct and maintain health.

Techniques of drainage
phytotherapy: plant extracts, in mother tincture (M.T. ) and phytogemmotherapy: bud extracts, in first decimal ( lX) Plants are the basic elements to use for the drainage of all chronic diseases. They must be used for prolonged courses of treatment, usually for a minimum of 2 months each. It is important to alternate the different plants according to the rhythm of seasons: vascular plants should be given in the Summer and rheumatic plants in the Winter, liver detoxifying plants in the Spring and kidney detoxifying plants in the Fall.

Organotherapy
Organotherapeutic remedies are healthy organ extracts or organ secretions prepared according to the general rules of homeopathic remedies. The most commonly used potency is the 4C.

Action of the remedy according to its potency

4C stimulates the organ 7C regulates the function 9C suppresses the activity All diseases evolve to a cellular destruction of the system. Organotherapy will help to slow down the natural and pathological deterioration of the organ and its function. Organs must work in harmony with the body so that each organ can assimilate the proper nutrition from the body as well as help to maintain the health of the body. Organotherapy represents a vital support for over stressed organs and must be started in all lesional pathologies. Along with, or after, prolonged allopathic treatments, organotherapy will support the organs and help them to recover their natural functioning.

Trace elements
Trace elements are metals and metalloids present inside the human body, in minute quantities, necessary for normal metabolic functioning. As biotherapeutic remedies they can be used in either liquid or pill form and are known as oligotherapeutic remedies. They should be used when the patient has a functional pathology. A functional pathology means that the patient does not have any deep organ lesions, rather, the disorders are due to the difficulty of the person to adapt to stressful conditions. There are many cases where oligotherapy is an essential part of the treatment. For example, in arthritis it is a major complementary therapeutic; during viral infections it stimulates the immune system and facilitates a quick and complete healing.

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Satellite remedies
Satellite remedies facilitate the action of polychrests by improving the function of the affected emunctories. In acute and chronic pathologies they aid in the drainage of the patient. Some have a very sharp action such as lemna minor, the satellite of thuya and calcarea carbonica, acting on the nose mucosa. Others have a wide emunctorial field of action such as chelidonium, the satellite of several polychrests, acting on many emunctories. They should be used before the polychrest or nosode and during the entire chronic treatment, in 4C to 7C potencies, 1 to 6 times a day or less, or as needed. They will help to prevent the aggravations that are produced by a deep acting remedy and permit the stabilization of a chronic disease. Drainage is the easiest and most natural way to safely practice preventive medicine.

The four constitutions and four reactive modes

The four constitutions describe the patient's framework, they determine the predisposition and sensitivity to develop specific pathologies. The four reactive modes direct the evolution of the chronic diseases, they show the development of the body and it's functions. The human edifice is a mosaic made of the four constitutions and four reactive modes. However, each person is characterized by 1 or 2 constitutions and reactive modes which evolve naturally throughout their life. Some patients present one constitution that is very closely related to one reactive mode. For example, carbonic can be very closely related to psoric, phosphoric to tuberculinic.

The four constitutions

The carbonic constitutional type develops broadly. The skeleton is thick and resistant, the hands and teeth are strong and square, the joints are stiff. They are punctual, obstinate, like discipline and respect the law. They have a tendency to congestions, obesity and sclerosis. The phosphoric constitutional type grows thin. The skeleton is long, fragile, and very flexible. Their teeth make the dentist's day. They are creative, artistic, and suffer from being oversensitive with wide mood swings. They have a tendency to decalcification, a sluggish lymphatic system, chronic suppurations and organ degeneration. The natrum constitutional type grows in a vague diamond shape. All of the tissues are bloated by water retention. The walk is slow and disturbed by an ineffective anxious restlessness and all kinds of tics. They are suspicious, introverted, secretive and obsessional. Their tendency is to develop chronic infections, and in particular warts and tumours in the genital system. The fluoric constitutional type has a twisted growth. The skeleton presents with varied malformations and asymmetries with marked flexibility and hyperlaxity of the joints. They walk as though they are on a tight-rope. Intuitive or insensible, fast or slow, genius or retarded, their nervous system is always involved. They will develop vascular disorders and ulcerative processes.

The four reactive modes

The psoric (earth) reactive mode has centrifugal reactions. They are improved by eliminations, which reestablishes their balance. The pathologies alternate periodically with arthritis, parasitosis, allergies, increased IgE, urticaria and hay-fever, eczema and asthma, psoriasis and piles, skin and intestinal diseases, etc.. Copyright 2000, Archibel S.A.

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The eliminations, natural and pathological, are ill-smelling and cause itching. Between the periods of elimination they feel well, but with functional ageing they develop temperature regulation disorders, fatigue, and abnormal hunger. Sedentary life, overabundance, lack of physical exercise and allopathic suppression of their attempt to eliminate will progressively break down the psoric. Their reactive mode is to balance. The tuberculinic (air) reactive mode evolves by sudden paroxysmal attacks according to their extreme sensitivity. Some tuberculinics present with allergies while others present with anergy. Some present with no specific defenses and others present with increased IgG. The Lymphatic, venous, hepatic, and respiratory systems are predominantly affected with a general exhaustion syndrome and nervous hypersensitivity. Their endocrine disorders are dominated by a hyperexcitability of the thyroid gland. They have a mineralization defect that is particularly aggravated during the growth periods of childhood and adolescence, and in old age it is associated with the luetic reactive mode. Mentally and physically, this person is bounced up and down by cyclothymic rhythms (alternating moods of elation and mild depression); The eliminations exhaust the patient. The chronic disease state evolves quickly into a condition of cellular degeneration and necrosis, such as hepatitis or pneumonia. Their reactive mode is to over-react. The sycotic (water) reactive mode drags into conditions of progressive degeneration. Toxins, germs, vaccinations, and prolonged allopathic treatments aggravate the deceleration of their metabolic functions and the intoxication of their reticuloendothelial tissue by water retention. All of the symptoms are aggravated by dampness. They are like a garbage can that is maladjusted to their environment and cannot get rid of the toxic wastes that they accumulate. They usually develop persistent chronic infections, especially E.N. T. and genito-urinary infections, obsessive ideas, and tumours that are the result of a failure of their normal immune system function. The body is progressively invaded by overabundance diseases. The patient repeats the same action, the same behaviors and physical tics, over and over. Their reactive mode is no reaction. The luetic (fire) reactive mode presents with a physical and mental disharmony that leads the patient to ulcerative and sclerotic processes. The target organs are the vascular walls, elastic tissue, bones, skin, mucous membranes, throat, and neuroendocrine system. They manifests entire system imbalances and as a result of being dominated by the speed of life, pathologies related to environment stress. They also develop cyclothymic instabilities, spasmodic disorders with insecurity syndromes, and growth disorders that in the extreme result in being either a midget or a giant. Restlessness and fears are aggravated during the night. These paradoxical behaviors and cellular mutations drive their life of anarchy. They evolve with infection and necrosis, induration and sclerosis, exostosis, decalcification spots and ptosis. Their reactive mode is to live in unbalance.

Treatment of the reactive modes

Treatment of the chronic patient consists of aiding the affected organs in regaining their strength and reestablishing a balance between the function of the body and the affected organs. Drainage of each reactive mode is essential to slow down the natural ageing process. The psoric is always overloading themselves with food, drink and activity. They need prolonged digestive drainage and a good diet with daily physical exercise. The tuberculinic must always receive mineral salts and intense periodical drainage to activate the venous, Lymphatic, hepatic and pancreatic systems. Drainage of their nervous system is essential. The sycotic must unblock their emunctories and stimulate their immune system, especially with organotherapeutics. They need prolonged digestive and urinary drainage. The luetic needs drainage of the arteries, veins, and capillaries, as well as, regulation of the nervous system. They might need mineral salts and endocrine drainage during periods of growth and in old age. Copyright 2000, Archibel S.A.

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The line of life

In order to correctly analyze the patient's case, the practitioner must be able to perfectly draw the patient's individual line of life. It's course shows the evolution of the reactive modes and the logic in the appearance of the different diseases that occurred during their life. From birth, all individuals will evolve by 7 cycles, just as they contain 7 lives in the planetary system. Each organ and function corresponds to a particular planet: the brain to the Moon, the liver to Jupiter, the kidneys to Venus, the lungs to Mercury, the gallbladder to Mars, the spleen to Saturn, and the heart to the Sun. The 4 reactive modes also follow a natural evolution during our life, just as our growth and our maturity follow natural cycles until death. The first cycle corresponds to intra-uterine life. From birth, the line of life can be divided into 6 essential cycles: birth until 7 years, 7 to 14 years, 14 to 21 years, 21 years until the menopausal or andropausal period begins, the period of menopause or andropause, and finally old age.

The first cycle intra-uterine life

O1 corresponds to the first moment of birth, when the two germinal cells meet and combine producing the first embryonic cell ,which develops into a fetus in total darkness for 9 months. This is the first program that encodes hereditary information about the immune functions. O2 corresponds to the second birth, the discovery of oxygen and light. O1 to O2 contains the essential mystery of creation. Embryonic and foetal studies give very precious information to the doctor about the human body; for example, the same type of cells produce the skin and nervous systems, another type of cell produces both the genital and urinary systems. All of the changes that take place in the mother during the pregnancy are extremely important for understanding the future health of the mother and her child.

The second cycle the first seven years

The second program is encoded from O to 7 years and will determine many of the disease patterns for the rest of a person's life. During the first cycle of 7 years, there is a natural evolution of the four reactive modes along the line of life which marks the development of any healthy child. The infant is a psoric, they remove stresses by skin eruptions and digestive disorders. When these two emunctories are surpassed, respiratory system pathologies appear. The depth of the hereditary psora can be precisely evaluated from these first moments of the child's life. When the child starts walking and talking, they express their luetic reactive mode. They experiment with their center of gravity and the power of language, eventually becoming self-sufficient. This is the time for night fears and restlessness. When the child discovers cleanliness, between the ages of 18 and 36 months, they become sycotic. They can repeat the same nose or ear infections over and over, never becoming completely healthy. Their behaviors are obsessional, not only mentally but also physically, with a lack of immune system response. During growth accelerations, they are tuberculinic. They have sudden and violent pathologies, such as fevers, bronchitis, parasitosis, arthritis, colics, etc., with or superimposed on chronic fatigue and decalcification. At this period the child must always recieve mineral salts, such as Schuessler salts. During the first seven years of life, this natural movement of the reactive modes can be disturbed by many factors such as infectious diseases, epidemics, vaccinations, pollutions, stresses, etc. The line of life often shows the patient's individual sensitivity with one or two reactive modes dominating their history. The evolution of this second cycle corresponds to the visible maturation of their immune system and will express itself through similar pathologies all the rest life of their life.

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The other cycles

Seven years of age corresponds to the beginning of the Oedipus cycle. This period of time is dominated by the luetic reactive mode, just as when the child learned to walk they needed the same luetic energy. During the third cycle, from ages 7 to 14 years, the child develops into puberty. The endocrine glands are stimulated and develop beginning with suprarenal, then the thyroid. When the genital glands mature puberty is established. In the fourth cycle, from ages l4 to 21 years, these natural endocrine changes will orient the reactions of the person to the tuberculino-sycotic mode which can remain with them their entire life and provoke tumoral pathologies when their fertility declines. After 21 years of age, during the fifth cycle of mature age, the different methods of adaptation turn around and show which of the 4 reactive modes the patient is operating in for that particular period of time. Usually the pathologies of the first two cycles return. The sixth cycle, the period of menopause or andropause, is a particularly luetic period. The seventh cycle is dominated by elderly emunctories which are worn out with deep lesions of the vascular and osseous systems. This patient should be given a prolonged drainage of their emunctorial system. Respect the hierarchy of the the natural wheel. The individual line of life indicates the dominant reactive modes of the patient and shows the correct order to follow with the homeopathic therapy. The treatment strategy of chronic diseases lies in the precise analysis of the two first cycles, which point out the dominant general modalities of the patient. The natural evolution of the second and third cycle of the line of life

Symptoms and remedies Symptoms

The value of a symptom is proportional to: ( I ) the importance the patient gives to it, (2) its precision, described by sensations and modalities, (3) its peculiarity, symptoms which are unusual from the norm. In this repertory, the symptoms are described in two degrees; Ist degree symptoms are capitalized and 2nd degree symptoms are in lower case. However, all of the remedies are important inside each rubric. Etiological symptoms, when they are the real cause, are first in the hierarchy. General and mental symptoms are next and local symptoms have the least value. Above this hierarchy, the general reactive mode which can be recognized as accidents on the line of life, take a strong etiological and general value. One must be careful with the so called "etiological" symptoms. Most of the time they are a general modality and not the real beginning of the pathology. When the disease is not neuro-psychiatric any mental symptoms will have the most importance. In acute cases, mental symptoms that stand out will lead directly to the remedy. In neuro-psychiatric cases, the easiest and most useful symptoms are the general symptoms, i.e. , the general reactive mode, general modality, periodicity, side, temperature, climate, pain, sensory organs, sensations, appetite, aversions, desires, thirst, sweat, sleep, dreams, and sexuality. The local symptoms are at the bottom of the hierarchy. They can take a general value when they are recurring during the line of life or present in at least 3 organs as a particular reactive mode of the patient. Acute cases need only 2 or 3 marked symptoms consisting of a localization, a sensation and a modality, to find the correct homeopathic remedy. A specific behaviour, a general modality, and a precise cause, has the strengh of 2 marked symptoms and accelerates the Copyright 2000, Archibel S.A.

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diagnosis of the proper remedy. In chronic diseases, local symptoms are the most dangerous elements for a homeopathic diagnosis, except when they have very marked modalities, or better yet, when they become a general reactive mode of the patient.

Remedies
It takes time to understand the individual's evolution and reactive mode associations. Only after the reactions of the patient to the medication have been observed can the precise choices be made in successive consultations. Acute diseases must be treated with satellite remedies and polychrests. In most of the cases the correct potency to use is 5C. The remedy must only be repeated if the symptoms persist. Some remedies have a fast but short action, such as aconitum. They don't need to be used for a long time, but they must be repeated frequently. Other remedies act slowly and deeply, such as mercurius, and they must not be repeated often. In most chronic treatments, the remedies should be chosen according to this order: First, use drainage techniques on the affected organs with phytotherapy, phytogemmotherapy, organotherapy, and trace elements. Second, use satellite remedies that act on precise organs and functions. They will treat the acute attacks, facilitate the action of the polychrests, and help to prevent aggravations. Third, use polychrests or general remedies which contain the totality of the patient's physical, emotional, and mental symptoms. Fourth, use nosodes and blockage remedies promptly, to unblock a pathological evolution when the previous treatments do not lead to the patient's improvement. Remedies also have a time of day during which they act more effectively. Generally, it is better to give plant remedies in the morning and the mineral remedies in the evening. The usual potency for satellite remedies is 4C. This general rule is based on the depth of action of the 3 natural kingdoms, plants are for the day and minerals are for the night, however, there are many exceptions. Animal remedies obey individual rules. Mental or general symptoms call for high potencies from 9C to 10 M and over. In most of the acute cases, a high potency must not be repeated frequently. In some chronic pathologies, the homeopathic remedy has to be repeated several times a day. This is especially the case when the disease is neuro-psychiatric, the patient is in a deadlock and has to be pushed out with force and energy. In all cases, the homeopathic treatment must also clear out all allopathic drugs and accelerate a healthy detoxification and clearing. The first cure must always include the active and prolonged drainage of the affected organs and functions.

How to use this book

This dictionary of symptoms, diseases and pathologies gives several techniques of treatment according to the needs of the patient, i.e. the acute treatment and the chronic treatment with their strategies. The index of rubrics should be consulted first and is sufficient in most cases. The index of pathologies allows the practitioner to refer to all the rubrics concerning a particular symptom, disease, drainage system, or organ. These two indexes contain physical, mental, and emotional symptoms, all the essential emunctories, many anatomical systems such as the eye, knee, nails, etc, and modalities. The end of each rubric is cross-referenced to the main rubrics that are related to that rubric. This opens the field of research by bringing into the picture new concomitant pathologies and modalities, allowing remedies to be picked with more precision. Local, general, and drainage remedies are in italics and will often be sufficient as a first treatment in many simple cases.

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The treatment strategy of chronic diseases follows 4 main stages

( I )Start with drainage, using the new biotherapeutics and satellite remedies. The potency used must be low, from mother tincture (M.T. ) to 5C. Plant remedies are always first. Facilitate the drainage by using the similimum of the symptoms of the acute disease, and remedies of time aggravation or a particular modality. Insist on trace elements for pathologies of adaptation and viral diseases, organotherapeutics when the organs have suffered, and phytogemmotherapy for all prolonged drainage treatments. (2)When the acute symptoms are cleared out, start the blockage remedies, either for physical blockages such as pertusinum in allergy, or for emotional blockages such as ambra grisea in fibrositis, or for mental blockages such as staphysagria in reactional depression. Use high potencies, starting with 9C and go higher if necessary. Repeat one dose every week or more often, such as 1 to 4 times a day if needed. Avoid deep acting remedies such as the main nosodes or heavy metals, except when the patient corresponds to a heavy metal. These remedies must be introduced slowly. Some difficult blockages may need a prolonged treatment of at least 9 months with a urine isotherapeutic remedy. (3)Next regulate the reactive mode of the chronic disease. Use the polychrests corresponding to the reactive mode of the chronic disease, such as natrum muriaticum in asthma, lycopodium in gout, arsenicum album in coronaritis, etc. (4)Finally, regulate the reactive mode of the patient by introducing the heavy metals of the patient, their successive blockage remedies, and the nosodes of the 4 reactive modes. The order of these remedies will be governed by the chronology of each person's individual line of life. At any stage of a treatment, the correct remedies might fail. It is important at this stage to clear out all of the allopathic blockages, as well as, any of life's traumas to develop the true picture of the evolution of the patient's pathology.

Homeopathic and drainage repertory

Abdominal pain
There are many causes of abdominal pain. It is a very frequent problem during childhood that is certainly in direct relationship to the emotional life. When you ask the child where their pain is, they always give the same answer : "around the belly button". To control a spasmodic state of the abdomen, use the neurovegetative regulators (See : nervousness, tetany), of which one of the leaders is : 1 dose, 1 to 3 times a day : MAGNESIUM TRACE ELEMENT See : anger, anorexia, anxiety, appetite, aversion, bulimia, capricious, colitis, constipation, cramps, delivery, desire, diarrhea, dyspepsia, emotional, eructations, excitement, faintness, fears, flatulence, gallbladder, gastric ulcer, gastroenteritis, hepatic, jealousy, nervousness, pains, pancreatitis, parasitism, pregnancy, restlessness, sadness, sensations, since, teething, tetany, trauma, vomiting.

Abscess
Homeopathic remedies are useful in all 3 stage of suppuration (inflammation, pus collection, and drainage), as well as in recurring abscesses. A culture of the pus must always be done, in case antibiotics are necessary to clear out the acute state.

Acute
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First stage, inflammation Local treatment

20 drops on warm wet compresses : CALENDULA / ECHINACEA / a.a. p.M. T. -- the swelling : red, hot, throbbing, paroxystic pains, agg. by least jar : 3 granules, as needed : BELLADONNA 4C rose colour, itching, stinging pains amel. by cold applications : 3 granules, as needed : APIS 4C - the suppuration : the key remedy is : HEPAR SULFUR careful ! HEPAR SULFUR's action obeys to the general laws of homeopathic remedies. HEPAR SULFUR 5C activates the suppuration (use only on open abscess). It must never be used on a closed cavity (breast, ear, sinus,etc), unless there is a good natural or surgical way out for the pus. HEPAR SULFUR 15C reduces the suppuration. When the abscess starts, use high potencies to concentrate the suppuration, this centripetal movement will sterilize the pus center. - in most of the cases : 3 granules : PYROGENIUM 5C one dose, 1 hour later : HEPAR SULFUR 15C - to accelerate the pus collection : Some difficult or advanced cases a resistant to the fast and complete action of HEPAR SULFUR 15C : alternate every hour, 3 granules, according to symptom evolution : PYROGENIUM 5C, or LACHESIS 5C

Second stage, pus collection Usual treatment

The abscess is so hard and sensitive that the slightest touch makes the patient scream. Two dangers must be controlled : closed cavity : The diffusion of the suppuration needs an active centripetal sterilization (high potencies), HEPAR SULFUR's action is intensified by the repetition of increasing doses of the remedy, one dose every hour in severe cases. 1st HEPAR SULFUR 9C 2nd HEPAR SULFUR 15C 3rd HEPAR SULFUR 30C open cavity : The surgical drainage (when necessary) must be helped by a centrifugal sterilization (low potencies). 3 granules, 1 to 4 times a day, as needed : HEPAR SULFUR 4C - to avoid complications, give anti-infectious agents : 1/2 hr before each dose of HEPAR SULFUR, 3 granules : MYRISTICA 4C / PYROGENIUM 5C / a.a. p. - when the following occurs : redness which darkens, a black spot appears, repeated boils, all kind of abscess with tendency to gangrene, suppuration from bites, earth contamination and wounds : 1 dose, every hour : Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica ANTHRACINUM 9C, then 12C, then 15C, then 30C - in case of spreading boils, generalized infection, septicemia evolution : 10 drops, every hour, as needed : ECHINACEA M.T.

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Third stage, drainage

To heal an abscess, the medications must perform these 3 functions : sterilize, reconstitute the tissues, prevent a recurrence. - drainage of open abscess, severe cases with hot persistent abscesses that are near bursting : repeat 20 drops every hour, as needed : ECHINACEA 1X / HEPAR SULFUR 4C / SILICEA 15C / a.a. p.

Recurrent boils
(See :furuncles, infections, vaccination) Each disease needs a strategy built around the reactive modes that dominate the individual's line of life . The detoxification of emunctories needs specific drainage to restore their normal functions and balance the immune system.

Background treatment
alternate every other week, one dose : - psoro-luetic : HEPAR SULFUR 9C, or MERCURIUS SOLUBILIS 9C - tuberculino-sycotic : SILICEA 9C, or THUYA 9C

Chronic suppuration
-- make an isotherapeutic with the patient's pus : daily, 3 granules : ISOTHERAPEUTIC 5C weekly, one dose, increasing the potency in the following order : ISOTHERAPEUTIC 7C, then ISOTHERAPEUTIC 9C, then 12C, then 15C, then 24C, then 30C. Repeat the same sequence of 6 doses, at least 4 times (6 months) - in case of a recurrence : always keep a few doses of : ISOTHERAPEUTIC 30C See : acne, adenitis, bite, breast, bronchitis, colitis, fever, fistula, genital exterior, impetigo, infections, itching, lymphangitis, mumps, mycosis, nodes, otitis, pains, sensations, since, sinusitis, skin, sweat, thirst, tonsillitis, trauma, vaccination.

Acne
Inflammation and infection of the sebaceous glands is under the control of the endocrine system. Most of the cases start around puberty and cure spontaneously, with mature age. The adolescent's self-image is reduced as blackheads appear on their face. The treatment is aimed at preventing scarring. On the line of life, acne points out the dominating reactive modes : psora : auto poisoning, pollutions, hyper-reactive immune system. sycosis : repeated and prolonged infections, non-reactive immune system. luesa : necrotic destruction, deforming scars. tuberculinism : fatty degeneration, lasting infection, hyper reactive immune system. The immune system will retain scars which can not be easily removed.

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Teenager Local treatment

several times a day, apply the following preparation on the new blackheads : PRECIPITATE SULPHUR ( 2gr ) / 60% CAMPHORATED ALCOHOL ( 60gr ) / a.a. p.

Usual treatment
every day : 20 to 50 drops : RIBES NIGRUM BUDS 1X one dose : morning : COPPER GOLD SILVER TRACE ELEMENT evening : MANGANESE COPPER TRACE ELEMENT 3 granules : morning : ARNICA 5C evening : KALIUM BROMATUM 5C alternate every other week, one dose : GRAPHITES 9C, or THUYA 9C every month, one dose : on the 1st of the month : TUBERCULINUM RESIDUUM 9C on the 15th of the month : ENTEROCOCCINUM 15C

Thin subject Usual treatment

alternate every other day, 3 granules : CALCAREA SILICATA 6X, or NATRUM PHOSPHORICUM 6X one dose, every week, in the following order : 1st NATRUM MURIATICUM 15C 2nd CALCAREA PHOSPHORICA 9C 3rd SULFUR IODATUM 9C 4th CALCAREA PHOSPHORICA 15C - in case of old looking greasy face and balding (See :falling hair) : one dose, every 10 days : SELENIUM 7C - in case of warts; staphylococcus; menstrual disorders; genital or urinary infections; chronic purulence (intestines, lung, sinus) : one dose, every 10 days : THUYA 9C - thick itching scars, amel. by warm applications, agg. by shaving : one dose, every 10 days : RADIUM BROMATUM 7C - in case of indurated acne, with hard nodes : 3 granules, daily : ARSENICUM BROMATUM 5C

Heavy subject Usual treatment

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Encyclopaedia Homeopathica 3 granules, every day : morning : ANTIMONIUM CRUDUM 5C evening : GRAPHITES 5C one dose, every week, in the following order : 1st THUYA 9C 2nd BROMUM 7C 3rd THUYA 9C 4th TUBERCULINUM RESIDUUM 9C - in case of digestive disorders : 3 granules, 1 to 3 times a day : CHELIDONIUM / HYDRASTIS / JUGLANS REGIA / RAPHANUS / a.a. p. 6X

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Modalities
-- agg. by menses : 20 drops, 1 to 3 times a day : EUGENIA JAMBOLANA 3X - itching; impetigo; infected vesicles : during the acute attacks (See : herpes) : 3 granules, 3 times a day : RHUS TOXICODENDRON 4C for chronic conditions, alternate every other month, as needed : 20 drops, 3 times a day : 1st month : JUGLANS CINEREA 3X, 2nd month : ECHINACEA 1X, etc.

Location Forehead
- thin subject; very fearful; easy weeping; restlessness, agg. twilight : 3 granules, in the evening : CAUSTICUM 9C - very meticulous; anxiety, agg. after midnight, between 1 and 3 A.M. : one dose, weekly : ARSENICUM ALBUM 9C - recurring abscesses; very irritable; quarrelsome; plays with fire : one dose, weekly : HEPAR SULFUR 15C - oily forehead; eczema at margins of hair; extremely secretive and introverted : one dose, monthly : NATRUM MURIATICUM 15C - extremely tired; puberty; depression and melancholy; sexual desire : one dose, weekly : PHOSPHORIC ACID 15C - does not like washing; dirty; greedy; craves sweets; sociable : one dose, twice a month : SULFUR FLAVUM 9C - big head upon thin body; ill-smelling foot sweat; chronic purulence : one dose, twice a month : SILICEA 9C - constipated; hepatic congestion; craves vinegar; aversion for milk; sad; indifferent, angers at trifles : one dose, twice a month : SEPIA 9C

Nose
- thin subject : 3 granules, daily : CALCAREA PHOSPHORICA 6X - heavy subject : one dose, weekly : CAPSICUM 9C - with warts : Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica 3 granules, daily : CAUSTICUM 5C

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Chin
- always : 20 drops, 1 to 3 times a day : VIOLA TRICOLOR 3X -- constipated; lasting boils : 3 granules, daily : HYDRASTIS 4C

Back
- fat; constipated; chilly; chronic eczema (folds, face, feet, genital); sties : 3 granules, daily : GRAPHITES 5C - boils on the neck : alternate every other day, 3 granules : KALIUM IODATUM 5C or LACHESIS 5C - bleeding and extremely painful boils (See : pains, biting) ; cracks of orifices; craves fat foods : 3 granules, daily : NITRIC ACID 5C - recurring and lasting infections during life; polyps; warts; cysts : 3 granules, daily : THUYA 5C See : abscess, anorexia, bulimia, cysts, decalcification, eczema, face, hair falling, hepatic, infections, menses, prementrual, scars, since, skin, vaccination, warts.

Acrocyanosis
This vasomotor disorder is seen essentially on the upper limbs, however it can involve just one ear, the nose, or any extremity of the body. The cold provokes a sudden arterial constriction, the affected part becomes blue then white, with pins and needles, numbness and acute pains. When pressed, the white teguments redden.

Lymphatic subject
20 drops, 3 times a day : HAMAMELIS / PULSATILLA / a.a. p. 3X one dose, every new moon : PULSATILLA 15C

Vascular subject
- frostbite; agg. by heat; arteritis; diabetes; old age : 3 granules, 3 times a day : SECALE CORNUTUM 5C -- constricting blue; amel. by cold; related to menstruations; agg. by blocked elimination (nose, menses, speech, etc) : 3 granules, daily : LACHESIS 5C

Cramps
- frostbite especially in face, ice cold; hot needles, burning and itching chilblains : 3 granules, 3 times a day : AGARICUS 5C - arteritis; diabetes; eldery : 3 granules, at night : CUPRUM ARSENICOSUM 7C See : air, arteritis, cold, heart, heat, mountain, pains, sensations, since, tetany, veins, wind.

Adenitis
Copyright 2000, Archibel S.A.

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Inflammation of the lymph nodes is a frequent and natural reaction to viral and bacterial invasions. Monocytosis syndromes that include all pathologies with increased monocytes, as well as mononucleosis, are characteristic of the patient's reactive mode. Mononucleosis covers the hyposthenic, dystonic and anergic states (See : nodes) and is the result of a lymphatico-hepatic regression. If the patient is mainly a tuberculinic, the delay in healing and the repeated infections also belong also to the sycotic. The patient might repeat these anergic symptoms every year at the same period, just like a birthday celebration.

Usual treatment
one dose, daily : morning : COPPER GOLD SILVER TRACE ELEMENT noon : MANGANESE COPPER TRACE ELEMENT evening : MAGNESIUM TRACE ELEMENT

Acute
- agg. by damp cold; repeated E.N. T. and lung infections; eczema, diarrheas : 3 granules, 3 times a day : DULCAMARA 5C - with stiff neck, pains radiate to ears; acute or chronic tonsillitis : 3 granules, 3 times a day : PHYTOLACCA 5C - very severe pharyngitis; high fever; prostration; scarlet fever; measles : 3 granules, every hour : AILANTHUS GLANDULOSA 4C

Chronic
- for drainage : 3 granules, 3 times a day : CISTUS CANADENSIS 3X - for suppuration : thin subject : 3 granules, at night : MERCURIUS SOLUBILIS 5C fat subject : 3 granules, daily : GRAPHITES 5C chilly subject : 3 granules, at night : SILICEA 6X See : abscess, adenoids, air, allergy, cold, coryza, cough, fever, german measles, hayfever, heat, infections, measles, mumps, nodes, otitis, pains, rhinopharyngitis, seaside, since, tonsillitis, vaccination, whooping cough, wind.

Adenoids
Many children present with repeated E.N. T. and lung pathologies because of a chronic inflammation of the posterior nasal lymphatics. These children can avoid surgery and the complications of infection if homeopathic treatment is given early. The results are always excellent when the reactive mode remedies are used in the proper order.

Usual treatment
- very sensitive to cold : 1 or 2 homeopathic spoons of the trituration daily : AGRAPHIS NUTANS / CALCAREA CARBONICA / LEMNA MINOR / a.a. p. 3X - nose and anus itching; oxyuriasis (See parasitism); hiccough : 1 or 2 homeopathic spoons of trituration daily : CALCAREA CARBONICA / CINA / TEUCRIUM MARUM / a.a. p. 4C - chronic infections; greenish discharges; polyps : 3 granules, 1 to 3 times a day : KALIUM BICHROMICUM / TEUCRIUM MARUM / THUYA / a.a. p. 4C Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica - chronic adenoid inflammation, Eustachian tube obstruction : 3 granules, 1 to 3 times a day : HYDRASTIS / KALIUM BICHROMICUM / MEZEREUM / a.a. p. 4C - suffocation : sudden, with cyanosis, when sucking, during rest, wakes up suddenly before midnight; laryngitis, asthma, chronic nose obstruction in newborn : 10 drops, in the evening : SAMBUCCUS NIGRA 1X violent, spasmodic cough with mucus vomiting, agg. when waking : 3 granules, daily : CORALLIUM RUBRUM 4C

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Plump child
- timidity; slow in comprehending; chronic enlarged tonsils : 3 granules, 3 times a day : BARYTA CARBONICA 5C and one dose, weekly : BARYTA CARBONICA 30C - fair hair; intolerant to milk (milk allergy); whooping cough; hoarseness : one dose, every full and new moon : BROMUM 9C

Thin child
- diarrhea; rhinopharyngitis by least damp cold, during teething : 3 granules, daily : CALCAREA PHOSPHORICA 6X one dose, weekly : CALCAREA PHOSPHORICA 15C - no appetite exept for sweets but intense thirst, chronic cervical nodes : one dose, every 2 weeks : SULFUR IODATUM 9C See : abscess, adenitis, air, allergy, asthma, cold, coryza, decalcification, german measles, hayfever, heat, measles, nodes, nose obstruction, otitis, parasitism, polyps, rhinopharyngitis, since, sinusitis, teething, vaccination, whooping cough, wind

Ageing
Homeopathic medicines are not to be looked at as a panacea for the Fountain of Youth. Homeopathic remedies, with good individualized drainage, prevents disorders from developing in the entire system and prolongs an active life.

Trace elements
Alternate one month courses of treatment, one dose, daily : 1st month : morning : MANGANESE COBALT evening : ZINC COPPER 2nd month : morning : COPPER GOLD SILVER evening : ZINC NICKEL COBALT

Phytogemmotherapy General tonic treatment

alternate one month courses of treatment : 1st month of treatment : morning, 20 to 40 drops : CRATAEGUS / ELEUTHEROCOCCUS 1X / LEONURUS CARDIACA 3X / a.a. p. 1X. evening, 50 drops : PANAX GINSENG M.T. Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica 2nd month of treatment : 50 to 100 drops, daily : morning : CHRYSANTHELLUM AMERICANUM M.T. evening : VISCUM ALBUM 3X - in case of arthritis : 50 to 100 drops, daily : morning : BETULA PUBESCENS BUDS 1X evening : SEQUOIA GIGANTEA YOUNG SHOOTS 1X

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Organotherapy General drainage

20 to 40 drops, 1 to 3 times a day : HEPATINE / NEPHRINE / a.a. p. 4C - osteoarticular diseases : 20 to 40 drops, 1 to 3 times a day : CARTILAGO/ MEDULOSS / OSSEINUM / PARATHYROIDINUMINUMINUM / a.a. p. 4C - nervous system tonification : alternate 40 drops, every other evening : even days : BULBINUM / CEREBRINUM / MEDULLINE / a.a. p. 4C odd days : hypothalamus / SURRENINE / THYROIDINUM / a.a. p. 4C - in case of insomnia : 20 to 100 drops, in the evening : ESCHSCHOLTZIA CALIFORNIA M.T. - to improve the immune system : one dose, every 2 weeks : THYMULINE 7C

Background Essentially nervous

- frequent, nervous, spasmodic coughs; extreme timidity; agg. by music : one dose, as needed : AMBRA GRISEA 9C - terrible anger; depressed; vascular sclerosis; high blood pressure : one dose, as needed : AURUM METAL 9C - changing moods; fear of diseases; does not want to be alone : one dose, as needed : KALIUM CARBONICUM 9C - annoyed by little things; fussy; fear of breaking down by stress : one dose, as needed : LYCOPODIUM 9C

Essentially apathetic
- brain arteriosclerosis; weak and slow memory; aversion to strangers : one dose, as needed : BARYTA CARBONICA 30C - sad; melancholic; exhausted; pulsations in all vessels; agg. in Summer : one dose, as needed : SELENIUM 9C - high blood pressure; arteritis; aversion and agg. by heat; amel. by uncovering : 3 granules, 1 to 3 times a day, as needed : SECALE CORNUTUM 5C - feels heavy, painless, lack of vital reactions; agg. by heat; amel. by cold drinks : one dose, as needed : OPIUM 9C See : anxiety, arteritis, arteriosclerosis, arthritis, brain softening, cholesterol, eczema, face, fatigue, hair falling, heart, insomnia, itching, memory, nervousness, sadness, since, skin, trembling, veins. Copyright 2000, Archibel S.A.

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Air
Certain atmosphere conditions, such as cold, hot, or damp, etc, can affect the well-being of the patient. Often the prescription for a change of environment, will help the patient more than any heavy medicinal treatment. For example, in certain tuberculinic patients mountain air can relieve the symptoms of bronchitis.

Sensitivity Mountain
- aggravated by being in the mountains : one dose, monthly : LUESINUM 15C - improved by being in the mountains : one dose, monthly : TUBERCULINUM 15C

Seashore
- aggravated by seashore : with loss of appetite and loss of weight, eczema, asthma, insomnia : one dose, monthly : ARSENICUM ALBUM 15C sadness, mental fatigue, constipation, amel. violent physical exercise : one dose, weekly : SEPIA 9C - improved by seashore; restlessness agg. in the evening; goes out all the night; eczema; asthma; craves sweets, salt, and alcoholic drinks : one dose, monthly : MEDORRHINUM 15C

Needs open air

- phobia (elevator, bridge, crowds); anticipation; fears; obesssions; hurried : one dose, every 2 weeks : ARGENTUM NITRICUM 15C - faints if he cannot breathe open air, agg. by heat in general, amel. cold applications : one dose, every full moon : PULSATILLA 15C

agg. by least draft of air

- on head; since haircut or washing head; throbbing headache : 3 granules, every hour : BELLADONNA 5C - cold air on feet stops flow of menses : one dose, every 2 weeks : CALCAREA CARBONICA 9C - agg. all mental features (anxiety, restlessness); extremely fearful of catching infectious diseases : one dose, weekly : KALIUM CARBONICUM 9C

Sensations
- of continuous lack of air, needs to be fanned, old people : 3 granules, 1 to 4 times a day : CARBO VEGETABILIS 4C - cold air inside the whole body, burning in arteries, old people : one dose, weekly : ARSENICUM ALBUM 7C - hot air in the head, palpitations, high blood pressure, anger : one dose, monthly : AURUM METAL 9C See : anxiety, asthma, aversion, cold, cough, desire, heat, mountains, seaside, sensations, sighing, since, tetany, wind, Copyright 2000, Archibel S.A.

Encyclopaedia Homeopathica whooping cough.

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Albumin
When proteins are found in the urine, a complete and careful investigation needs to be done to determine the cause. There are many causes, from a very severe acute disease such as nephritis, to a transient condition like orthostatic proteinuria during growth periods. Obviously, this symptom is more frequent during pregnancy and the first stage of treatment is to recommend a proper diet that excludes most of the salted foods.

Orthostatic proteinuria Thin subject Usual treatment

every other 2 weeks, alternate one dose : PHOSPHORIC ACID 15C, or STANNUM IODATUM 15C every month, one dose : NATRUM MURIATICUM 15C - adolescent with important acne and lung weakness, chronic eczema : 3 granules 1 to 3 times a day : ARSENICUM IODATUM 5C -- adolescent growing quickly, depression, fatigue, anorexia, sexual excitability : 3 granules, every morning : PHOSPHORIC ACID 4C 3 granules, 3 times a day : CALCAREA PHOSPHORICA 6X

Healthy looking with localized redness

- intolerant to heat; amel. by coolness (air, water); hepatic, venous disorders : 3 granules, 1 to 3 times a day : PULSATILLA 5C - very sensitive to cold; lung weakness; anemia; flushes of heat : 3 granules, 1 to 3 times a day : FERRUM METAL 5C See : anorexia, blood pressure, cystitis, decalcification, depression, edema, fatigue, heart, lithiasis, nephritis, pregnancy, urination.

Alcoholism
Alcohol abuse cannot be healed by homeopathy alone, special psychological care is also essential. However, the practitioner can help these difficult patients find a physical and mental balance. The drainage techniques, especially organotherapy and satellite remedies, are always necessary to support the injured organs (brain, liver, nerves, pancreas, and stomach).

General remedies
one dose, every week, in the following order : - young subject : 1st NUX VOMICA 9C

Copyright 2000, Archibel S.A.