China officinalis:CINCHONISM A single dose of 2 to 8 grams orally of pure quinine may be fatal to an adult.
-VERMEULEN Frans,
Chin.
Adversity is the state in which a man most easily becomes acquainted with himself, being especially free from admirers then.
[Samuel Johnson]
Art imitates nature in this: not to dare is to dwindle.
[John Updike]
Signs
Cinchona officinalis. Quinine Tree. Peruvian Bark. N.O. Rubiaceae.
CLASSIFICATION Dependent on the taxonomic system, the number of genera placed in the Rubiaceae or Coffee family varies from 500 to 600; some botanists recognize about 7,000 species as belonging to this family, while others include about 10,000 species. It is a large family of trees, shrubs, lianas and herbs, sometimes ant-inhabited, epiphytic or aquatic. Older systems recognize two subfamilies, but recently three completely different subfamilies have been supposed, as follows: Rubioideae [comprising 11 tribes], Cinchonoideae [17 tribes], and Guettardoideae [1 tribe]. The Rubiaceae resembles members of the Gentianales, in particular the Loganiaceae, which includes Gelsemium, Spigelia, Strychnos nux-vomica, and Strychnos ignatii.
DISTRIBUTION The family is concentrated in the tropics and subtropics with some species represented in temperate regions and even the Arctic and Antarctic. Most tropical species are trees or shrubs while temperate ones are herbaceous. The most economically important genus of the family is Coffea, the source of coffee; other members, such as Cinchona and Cephaelis [Ipecacuanha], are important medicinally, or are cultivated as ornamentals, e.g. Gardenia and Bouvardia. Well-known European herbaceous members include Rubia, Asperula and Galium.
PHARMACOLOGY The family is rich in chemical constituents of potential biodynamic activity. These include iridoids, several types of alkaloids, triterpenes and their glycosides, sterols, anthraquinones, naphthalene derivatives, polyphenols, tannins, cyanogenic compounds. The family has been reviewed as a source of emetine type alkaloids, active principles causing violent vomiting. 1
ANTS "Interesting examples of association with ants are found in the genera Myrmecodia and Hydnophytum, native to tropical Asia and Australia. All members of these genera are epiphytes which cling to branches of trees with their roots. Large swellings, containing a network of cavities, develop on the roots, and are inhabited by ants. Although it has been supposed that the plant and insects have developed a symbiosis of mutual benefit - the ant guarding the plant and providing it with extra nutrients, receiving shelter in return - it has not been proved that they are in fact interdependent."2
CINCHONA The genus Cinchona comprises about 40 species of trees reaching 15 to 20 m in height and producing white, pink or yellow flowers. There are numerous varieties, sub-varieties, and hybrids. All Cinchonas are indigenous to the eastern slopes of the Amazonian area of the Andes where they grow between 1,500 to 3,000 metres in elevation on either side of the equator [from Columbia to Bolivia]. Cinchonas are now widely cultivated in many tropical countries for their commercial value. Although they are not native to those areas, planters in the East Indies have succeeded in increasing the amount of quinine in certain Cinchona species. The commercial production of quinine is now centred in Africa [Zaire, Burundi, Cameroon, Kenya]; lower on the list of producers are Indonesia [Java] and India, with South American countries as Peru, Bolivia and Ecuador bringing up the rear.
ALONE ON A HILL Cinchona trees grow in inhospitable, inaccessible regions. "In 1735 a group of explorer-naturalists were sent on an expedition by the French Académie des Sciences to search for the fever-bark tree in South America. One of these, Joseph de Jussieu, in 1736, after undergoing appalling hardships, was at last rewarded by the sight of the quinaquina tree, a tall, upright evergreen, its leaves shining in the sun and its white, pink, lavender or red flowers faintly transparent. He was shocked to find that the Indians either chopped the trees down or stripped the bark so ruthlessly that few trees survived. For there were no endless quinaquina forests. The trees never grew in clumps, but always stood alone on hillsides, sometimes quite close to the Andean frost line, 10,000 feet up. The leaves on the older trees, perhaps eighty feet high with trunk diameter of fourteen to sixteen feet, were fiery red."3
NOMENCLATURE Cinchona bark is the dried bark of stem or root of various species of Cinchona. Different species bear the name officinalis. The C. officinalis cultivated mostly in Java is Cinchona ledgeriana, while the C. officinalis from Bolivia is termed Cinchona calisaya. Ecuador provides C. pubescens [also named C. succirubra]; Cinchona micrantha and another C. officinalis come from Peru. The specific name ledgeriana derives from the British trader Charles Ledger who sold seeds of a Peruvian Cinchona species to the Dutch.
NAME The common name of the tree comes from a local word, quinaquina, meaning 'the bark of barks.' Legend has it that the name cinchona comes from the Countess of Chinchon, the wife of the viceroy of Peru, who was cured of a malarial fever in about 1638 by a tribal witch doctor [who the viceroy subsequently appointed as the royal physician]. The Countess reportedly returned to Spain in 1640, bringing the bark with her, but historians doubt whether the Countess ever returned to Europe - the Countess died in Cartagena, Colombia, in 1641 - and claim that the Jesuits were the first to bring the bark to Europe and to spread its use through Spain and the rest of the continent.
HISTORY Although cinchona bark had a definite place in folk medicine of the Andes as 'Palo de calenturas' [fever-tree], a royal person was 'needed' to make it famous. The Jesuits used quinine bark very early in its history, first advertised for sale in England in 1658. It was made official in the London Pharmacopoeia in 1677 under the name Cortex peruvianis. Several years after the 'cinchona bark' arrived in Spain, the virtues of the bark were rapidly recognized. Due to the influence of the Jesuits the 'tree of fever of the region of Loja' then became known all over Europe, under the name 'Jesuits' powder.' Because of its specificity of its action on malaria, Cinchona was officially recognized even while the identity of the producing species remained unknown until 1742 [when Linnaeus in his Genera Plantarum named the species Cinchona]. Throughout the 1600s to mid 1800 Quinine Bark was the most used treatment for malaria, as well as for fever, indigestion, mouth and throat diseases, and cancer. In the second half of the 19th century purified quinine became a standard component of cardiac therapy. In 1820, two scientists, Pelletier and Caventou, had isolated a quinoline alkaloid in the bark which provided the highest anti-malarial effect and named it quinine. Methods were then developed to extract the quinine from the natural bark. Until the end of the 19th century the South American rainforests benefited from the income generated by harvesting the natural bark in their territory. In the middle of the 19th century, however, the British and the Dutch broke this monopoly by smuggling out seeds of Cinchona calisaya and Cinchona pubescens. The calisaya species was planted and cultivated in Java by the Dutch and the pubescens species in India and Ceylon by the British. Because the quinine content was too low for high grade and effective quinine production, the Dutch smuggled seeds of Cinchona ledgeriana out of Bolivia and established extensive plantations of high grade Cinchona trees in Java. The widespread use of cinchona came about because of the colonizing efforts of Europeans, and the drug, in turn, aided Europe in expanding its colonization even further. By 1918, the production of quinine was under the total control of the Dutch 'kina bureau' in Amsterdam. The upheavals of World War II severely disrupted the Dutch domination, leading to changes in the market which still remain in effect today. During World War II it was an important part of Japanese strategy to cut the world off from supplies of quinine, resulting in the planting of new African plantations and in research for developing and producing synthetic antimalarials. 4
RELIGION The German naturalist and explorer Alexander von Humboldt [1769-1859] placed the [non-]acceptance of cinchona bark in 17th-century European medicine against a background of religious wars. "It almost goes without saying that among Protestant physicians hatred of the Jesuits and religious intolerance lie at the bottom of the long conflict over the good or harm effected by Peruvian Bark." The drug appeared in England in a period that malaria was the scourge of the land. The English Protestants rejected it out of fear that the drug, so closely associated with Catholicism, was some sort of 'popish plot' against them. The bark was an insidious poison which the Jesuits had brought to Europe for the purpose of exterminating all those who had thrown off their allegiance to Rome, as one Protestant author put it boldly. Their leader Oliver Cromwell [1599-1658] died from malaria after refusing, as legend has it, "the powder of the devil." The 17th century medical establishment was a bit reluctant too, but things changed after Sir Robert Talbor cured King Charles II and the son of France's King Louis XIV of 'swamp fever'. Talbor openly denounced the Jesuits' powder, but secretly had used it to cure the royals - he mixed Jesuits' powder with opium and various wines to disguise it from detection. It acquired Talbor - who described himself as a feverologist - a great reputation for the cure of swamp fevers, as well as a great fortune. In 1682 Louis XIV bought a 'secret remedy' from Talbor. After Talbor's death, the king made public that the ingredient was Peruvian bark, which was then called the 'English remedy'. This contributed to its popularity in England, although, initially, it was mainly the wealthy who could afford the high costs of the bark. The English physician Sydenham [1624-1689] helped popularize cinchona bark in treating malaria. "Of all simples," he said, "Peruvian bark is best; for a few grains morning and evening strengthen and enliven the blood."
PARANOIA Talbor was considered a quack by the College of Physicians. But after he had cured King Charles II, the king not only made him a knight but also appointed Sir Robert to the College of Physicians. The college's members disapproved of Talbot for two reasons: he discarded the necessity of bleeding and purging, and he refused to reveal his secret cure for malaria. Talbor's secretiveness was understandable. He was giving Jesuits' powder to Charles II at the very time that a Titus Oates testified that there was a vast Jesuit conspiracy to murder the king and to place his Roman Catholic brother James on the throne. The paranoia turned London into a place of hysterical bigotry. Vast anti-Catholic parades wound their way through the city, bearing with them the Peruvian bark, or the facsimile of it, with great signs telling the gruesome story of how the Jesuits were using it to exterminate the non-Jesuit population. The fever of religious hatred and intolerance raged as did that of malaria. The word 'Jesuitical' even made its way into the dictionary as a synonym for crafty and intriguing. 5
CONSTITUENTS Cinchona contains about 35 alkaloids, as well as cinchotannic, quinic and quinovic acids, volatile oils, and cinchona red. The alkaloid content varies according to the source of the bark. The cultivated bark contains 7-10% total alkaloids of which about 70% is quinine. Cinchona succirubra [C. pubescens] and Cinchona ledgeriana are the species with the highest amount of quinine alkaloids. The standardized method for the assay of cinchona is named 'Brussels 1949. ' The bark emits a characteristic purple vapour when heated in a test tube. 6 Quinine is incompatible with iodides and salicylates.
QUININE Quinine is the primary alkaloid of Cinchona. Quinine compounds consist of very bitter crystals or crystalline powder which effloresce on exposure to air and darken on exposure to light. One gram of quinine dissolves in 1900 ml water, 760 ml boiling water, and 0.8 ml alcohol. The blue fluorescence is especially strong in diluted sulphuric acid. Compounds derived from Cinchona have to be protected from light. The same is true for the natural alkaloids. The alkaloid content of the bark increases if the bark is protected from light and air by layers of damp moss, a process called 'mossing'.
USES Nearly half of the cinchona harvest is directed to the food industry for the production of quinine water, tonic water, and as a bitter additive [e.g. in 'bitter lemon']. Quinine extract is also used as a local anaesthetic in hair tonics and sunscreen preparations. It serves as a flavouring agent in numerous over-the-counter cold and headache remedies. Perhaps 30 to 50% of the quinine is converted to quinidine, a prescription antiarrhythmic drug.
CINCHONISM A single dose of 2 to 8 grams orally of pure quinine may be fatal to an adult. Small amounts may cause quinine-sensitive people to suffer a hypersensitivity reaction, consisting of nausea, vomiting, visual disturbances, ringing in the ears, nerve deafness, itching, flushing of skin, and skin rashes. Most marked are the effects on the special senses, in particular hearing and vision. Quinine poisoning may result in deafness, often temporarily, rarely permanent, as well as in dimness of vision, especially for colours, or temporary blindness or colour blindness. The effects are opposite to those of coffee - botanically closely related to cinchona - which tends to increase sensory acuity. Excessive plasma levels of quinine can result in hypotension, cardiac dysrhythmias and severe CNS disturbances such as delirium and coma. Other rarer side-effects are hypoglycaemia, blood dyscrasias [esp. thrombocytopenia] and hypersensitivity reactions. Quinine can stimulate insulin release. Quinine passes through the placenta and into breast milk. Quinine and its synthetic substitutes are particularly toxic to the organ of Corti, but they affect as well both the auditory and vestibular portions of the inner ear. The highest frequencies are usually affected first, and high-pitched tinnitus or vertigo may develop. In severe cases a permanent loss of hearing can be produced.
TOXICOLOGY Quinine has an established place in today's pharmacopoeia. The availability of the drug allows its ingestion in excessive doses for intended abortion and intended suicide, as in the past. "It is now clear that there are two dosage levels at which quinine [and its congeners] may be toxic. The first is a very low level caused by a single dose of as little as 12 mg. The symptoms are those of thrombocytopenic purpura. The cause is an immune reaction in which the drug acts as a haptene. The visual system is affected as much or as little as it would be in purpura caused by any other haptene. Its blood vessels are subject to haemorrhage secondary to thrombocytopenia as any set of vessels would be, but there is no specific selectivity for the eye. The usual therapeutic regime for malaria is 1.3 g per day in four divided doses for seven days. Experiments on human volunteers have shown that eye effects of blurring, a decrease of visual acuity, and loss of the peripheral field occur with single doses of 2.5 to 4.0 mg. A single dose of 8 mg can be fatal. It is doses of 2.5 g and above that have specific eye effects."7
MALARIA Although today malaria [ague; intermittent fever; swamp fever] is commonly considered a disease of tropical lands, in the 17th century it affected vast parts of Europe, including Rome, Versailles and London. Early 17th-century malaria patients had one principal cure available to them - bleeding. If bleeding was ineffective, the physician might try purging or the use of emetics. "Malaria is mosquito-borne and is one of the major killer diseases of the world, causing up to 2.7 million deaths annually and a staggering amount of chronic ill health. In some parts of Africa, 10% of the deaths of children under 5 years are due to the direct effects of malaria, and its contribution to the mortality from other diseases cannot be computed. About 50 years, the World Health Organization attempted to eradicate malaria using the powerful 'residual' insecticides and the highly effective antimalarial drugs which had become available. By the end of the 1950s the incidence of malaria had dropped dramatically. However, during the 1970s it became clear that the attempt at eradication had failed - largely owing to the increasing resistance of the mosquito to the insecticides and of the parasite to the drugs - and currently malaria causes over 300 million new infections annually, many being the 'malignant' form of the infection caused by the most dangerous of the parasites, Plasmodium falciparum. At present about 46% of mankind lives in malarious areas. Sporadic cases - the result of air travel - are quite common in Western Europe and the USA, where the risk of transmission is negligible, and the incidence of this travellers' malaria is rising year by year. ... Immunity to malaria occurs and can protect many individuals living in malarious areas. The immunity is lost if the individual is absent from the area for more than 6 months."8
MEDICINAL USES Cinchona bark has a worldwide use. Its key actions are fever-reducing, antimalarial, tonic, appetite-stimulating, antispasmodic, astringent, and antibacterial. In Brazil the bark is used for anaemia, debility, dyspepsia, fatigue, gastrointestinal disorders, and malaria. In European herbal medicine it is considered to be effective for alcoholism, anaemia, cramps, sepsis, arrhythmias, diarrhoea, enlarged spleen, gall-bladder disorders, loss of hair, and liver disorders. In the USA, natural cinchona bark is used as a tonic and digestive aid, to reduce heart palpitations, for haemorrhoids, varicose veins, headaches, leg cramps, colds and flu, dyspepsia, and for its bactericidal and anaesthetic effects.
TONIC The first idea of the doctrine of homoeopathy seems to have entered Hahnemann's mind in the year 1790, while he was engaged in translating Cullen's Materia Medica into German. Cullen defended the old opinion that the efficacy of cinchona bark depended upon its 'tonic effect on the stomach.' The idea of quinine having a general strengthening effect has survived until today, as is shown by the Encyclopaedia Britannica: "Administration of quinine dramatically improves the condition of a person suffering from malaria; the parasites promptly disappear from the blood, and the symptoms of the disease are quickly alleviated." The effect is strengthening but not curative! "When quinine treatment is terminated, however, many recovered patients suffer another attack of malaria several weeks later." Hahnemann's reply still applies, too: "How can they ever imagine that they can strengthen a sick person whilst he is still suffering from his disease, the source of his weakness? Have they ever seen a patient rapidly cured of his disease by appropriate remedies who failed to recover his strength in the very process of the removal of his disease? ... If cinchona bark is to make all sick persons strong, active and cheerful, it must needs be the universal panacea which shall at once deliver all patients from all their maladies. ... It is no doubt true that by the first doses of bark the strength of the patient, be he ever so ill, is increased for a few hours; he is able to raise himself up in bed all alone, as if by a miracle; he wants to get out of bed and put on his clothes; all at once he speaks in a stronger more resolute manner, venturing to walk alone, and grows animated, eagerly desires to eat this or that, - but a careful accurate observer easily sees that this excitation is only an unnatural tension. A few hours pass and the patient sinks back, sinks deeper into his disease, and the fatal result is often accelerated. ... Strength cannot be materially poured into the organism by a decoction of china [or by wine]."
Research during World War II has produced a number of synthetic antimalarial drugs, such as chloroquine and chloroguanide, that suppress more effectively the growth of the blood forms of the malarial parasite. Their total laboratory synthesis in 1944 is perceived as "one of the classical achievements of synthetic organic chemistry."
FIRST EXPERIMENT Quinine bark is famous as the first substance that Hahnemann tested on himself, leading to the formulation of the Law of Similars. Yet it seems likely that Hahnemann has conducted self-experimentations in the years prior to the 'China-experiment'. In a footnote to the translation of Cullen's Materia Medica, Hahnemann describes his course of action: "I took, by way of experiment, for several days four drams of good bark twice a day. My feet, finger-ends, etc., first became cold, and I felt tired and sleepy, then my heart began to beat, and my pulse became hard and quick; I got an insufferable feeling of uneasiness, a trembling [but without rigor], a weariness in all my limbs; then a beating in my head, redness of the cheeks, thirst, - in short, all the old symptoms with which I was familiar in ague appeared one after another, yet without any actual chill or rigor. In brief, even those particularly characteristic symptoms which I was wont to observe in agues - obtuseness of the senses, kind of rigidity in limbs, but especially that numb disagreeable feeling which seems to have its seat in the periosteum of all the bones of the body - all put in an appearance. This paroxysm lasted each time 2 or 3 hours, and came on afresh whenever I repeated the dose, but not otherwise. I left off, and was quite well."
NEW EXPERIMENT In an attempt to retrace Hahnemann's experiment, Shupis took the official tincture of China off. in doses of 4 drams three times daily for a total of three ounces over a period of three days. Contrary to Hahnemann, Shupis was not quite well when he left off; he recorded symptoms for a period of 42 days and experienced on the 21st day intolerable influenza-like symptoms [which coincided with a small, local influenza-epidemic], which could not be antidoted. 9 Part of the 85 symptoms he recorded is included below.
PROVINGS •• [1] Hahnemann - 22 provers; method: unknown.
•• [2] Jörg - 7 provers, 1823; method: a few doses of tincture, in doses from 18 to 140 drops, or of powder; symptoms recorded for 2-14 days.
•• [3] Shupis - self-experimentation, 1963; method: 'the official tincture of China officinalis was employed in doses of 4 drams three times daily for a total of three ounces over a period of three days; symptoms were recorded for 42 days.'
•• [4] Gnaiger - 21 provers, 1992; method: 19 provers took one daily dose of 30c for one week, one prover took 6x twice daily and another took a single dose of 200c.
The participants in Gnaiger's experiment knew which substance they were proving. Hahnemann, too, never concealed from his provers the names of the drugs that were proved.
[1] Schultes and Raffauf, The Healing Forest. [2] Heywood, Flowering Plants of the World. [3] Homoeopathy, Oct. 1969. [4] Rain-tree. com [website]. [5] Fr. Gene Nevins, SJ. [6] Merck Index. [7] Klaassen, Casarett and Doull's Toxicology. [8] Rang et al, Pharmacology. [9] Shupis, Cinchona officinalis; Journal of the American Institute of Homeopathy, Nov.-Dec. 1963.
Affinity
BLOOD. CIRCULATION. SECRETIONS [digestive; organs; liver]. Spleen. Nerves. Mucous membranes. * Left side. Right side.
Modalities
Worse: LOSS OF FLUIDS. TOUCH. Jar. Noise. PERIODICALLY [alternate days]. Cold; drafts; wind. Open air. Eating. Fruit. Milk. Mental exertion. Night. Motion. Walking.
Better: Hard pressure. Evening. Loosening clothes. Bending double. Lying down. Fasting.
Main symptoms
M DELICACY.
• Artistic persons - like beautiful colours, "feel the colours"; make verses, painters; strong SENSE of BEAUTY. Reserved disposition; express themselves in writing poems, painting; find it difficult or impossible to express their feelings in ordinary words; only talk about themselves with confident persons, good friends. Strong imaginative power, evening in bed [compare Nat-m.], or daydreaming. Chin. thinks about all kinds of positive and wonderful things, like being able to fly, relaxing on a warm day at the seaside, being the richest person of the world, etc., after which they feel happy and satisfied and fall asleep. They usually think of nice stories in which they play the hero. The same pattern can occur during the day, when they are disturbed or embarrassed. Nat-m., on the other hand, dwells on past disagreeable occurrences, i.e. thinks about all kinds of negative things. [Ghegas]
• "China is one of the most sensitive of all types. She has the emotional and the aesthetic sensitivity of Ignatia, but in addition there is usually a psychic sensitivity, and often an extreme physical/sensory sensitivity as well. One's first impression of a China individual is often one of sensitivity. She will approach you rather warily, and may remain wary until she knows you well, and even then, she will only reveal her true sensitivity if she is convinced that you are both understanding and sensitive. ... There are two types of China individuals; the worldly and the other-worldly. Both are very sensitive, but whilst the former is principally sensitive to any form of aggression, the latter is also sensitive in a psychic sense. These ethereal Chinas are the most psychic of all constitutional types. These are generally fascinating people who are principally interested in spiritual matters, and they are all the more interesting because their spiritual interests are based on direct experience, rather than intellectual attraction. They are generally quiet, modest people who possess a great deal of wisdom, which they will not 'cast before swine'. [Bailey]
M OVERSENSITIVITY.
[1] Least touch < while hard pressure >.
[2] Extreme susceptibility to cold air and wind.
[3] Least noise is experienced as painful. Tinnitus aureum.
[4] Oversensitivity to odours: cooking odours and tobacco.
[5] Acute sense of taste.
• "This is rather interesting because, in spite of their extremely acute sense of taste, quite a number of China patients develop a craving for all sorts of highly tasting food - pungent, spicy things - in order to tickle their appetites." [Borland]
c Shupis noticed:
• Sensitive to slightest offence. Temper short, sensitive to least offence.
• Rooms appears brighter.
• All intricate objects appear clear, e.g. smallest visible tree branches.
• More conscious of background sounds and noises.
• Difficulty sleeping, oversensitive to bed creaking which I never before noticed.
• Senses overly acute, hearing, sight, contradiction, mild offences.
• Sensitive to everything, disgusted, want to throw in sponge. Desire to drink yet no craving. Want to get drunk and let the world go to hell. 1
M CONTACT.
• Aversion to superficial contacts [< 'slight touch'], only wants deep contacts and friendships [> 'hard, deep pressure'].
• "It's difficult to make contact with Chin. patients because they don't like superficial contacts and can be abusive, impolite and inconsequential in answering questions. They will only open up when they feel real interest and sympathy. [Ghegas]
M Collision.
• Every external impression leaves deep traces. The intensity of China's inner life can lead to exhaustion ["loss of mental fluids"], with the result that they become irritable and even violent, insulting and abusive. In this stage the world becomes hostile; they feel unfortunate, do not want to live any more but lack the courage to commit suicide. [Ghegas]
• "China individuals want to think about everything at once; their mind is teeming with ideas, and they are inclined to collide with others' beliefs ... which eventually exhausts them." [Grandgeorge]
• "The fire which inspires the more spiritual China person with meditative ecstasy and philosophical passion tends to be expressed as irritability in the more worldly China individual. The latter is still very sensitive, in the sense of fearful and suspicious, and also sensitive aesthetically and physically, but she is of this world. She is generally an analytical person, with a fine intellect, but lacks the self-confidence to make full use of it. She is also a rather wilful person. ... Although she may lack confidence with strangers, and is generally on her guard in company, she can make her family's life hell with her moodiness and her tendency to criticise and blame. ... The China individual exhibits traits from both ends of the China spectrum, being highly psychic and spiritually orientated, and also critical and socially skilful." [Bailey]
M Quality.
Desire to have the BEST THINGS.
Objects seem unworthy.
Things seem unattractive.
• "What formerly appeared to him in a bright genial light, seems now to be lustreless, unworthy, and shallow." [Hahnemann]
• "China is ambitious and plans step by step. He achieves his ambition by building castles in the air. He feels what he possesses is not good enough and that he would have possessed better things if he had not been obstructed and hindered. Therefore he fantasises and imagines that he possesses finer and more expensive things than he actually does. He never really puts his plans into action." [Sankaran]
M Full of PLANS and IDEAS [esp. in evening and at night].
• "He makes a number of grand plans for the future."
• "He makes many plans, and thinks over their accomplishment; many ideas force themselves upon him at once."
• He has many ideas, undertakes to carry out all sorts of things, builds castles in the air [after some hours]."
• He has a number of plans in his head which he greatly desires to carry into execution, in the evening." [Hahnemann]
[observed by four different provers!]
CLARITY of MIND evening and night.
Sleeplessness from activity of mind.
• "For in China's inner world you see
A hero lives in fantasy
He dreams of deeds extremely grand
But actually he's just a man." [Chatroux]
M Delusion he is UNFORTUNATE; the world is HOSTILE.
[delusion he is being constantly harassed by enemies]
• "Discontented; he thinks himself unfortunate, and fancies he is opposed and tormented by everybody [after 5 hours]." [Hahnemann]
• "The feeling in China is: 'I am weak and so people attack, trouble and torture me', a feeling of being persecuted. The patient feels he is weak, not good enough, that he is persecuted and hindered at his work by other people, that he is obstructed from achieving his ambition. So he fantasises and in these fantasies he makes himself worthy and achieves his ambitions, and in this way uses fantasies to cover up the inherent feeling of not being good enough." [Sankaran]
M Apathy, indifference and sadness following severe diseases.
M Animals.
• "While they sometimes behave aggressively towards people, they can be very afraid of animals, particularly of most harmless animals such as cows, horses, sheep, a little dog, a chicken, a cat or a mouse. In children, this strong fear of animals is very characteristic of China. E.g. , a 10-year old child who makes a large detour in order not to pass the cows."2
Gibson mentions a fear of crawling insects.
M Threat - violent impulses.
• "Awakened at 2:00 A.M. by a dream of a vicious strangler who stealthily approached from the rear and suddenly killed. I tried to lure him."3
• "I awoke at 3:30 A.M. with a peculiar feeling: I suddenly had the completely irrational thought, a compulsion almost, to jump up and throw myself on my sleeping partner in order to strangle him. I told myself that this was ridiculous, but the compulsive thought became stronger and stronger. I controlled myself with all my strength and got violent palpitations of the heart [no tachycardia] shaking my body. Then I got the idea to run out in the cool, dark night and to scream out loud - again this irresistible urge. Deeply distressed I lay in the darkness and felt one more compulsion, though far less than the first, to strangle my partner. Now I can imagine what a 'compulsion' is. I lay awake until dawn, and then fell asleep with difficulty."4
G Ailments after LOSS OF FLUIDS.
[profuse, exhausting discharges, haemorrhages, excessive or prolonged lactation, diarrhoea, suppurations, perspiration, vomiting, excessive masturbation]
G Periodical and intermittent complaints.
G Circulatory disturbances: haemorrhages, anaemia, oedematous swelling and fluid retention.
G CHILLY.
< COLD in general. • "All China patients are intensely chilly, very sensitive to cold draughts and want to be warmly covered up all the time. To this symptom of general chilliness you can add a China peculiarity: the patients complain of intense coldness in the stomach." [Borland] G Perspiration day and night, during sleep [on being covered] or even when closing the eyes [Con.]. G > Hard PRESSURE.
< TOUCH, slight touch. G CANINE HUNGER, esp. AT NIGHT. During daytime, feeling of satiety after a few mouthfuls. Or the reverse: Increased appetite when one begins to eat. G Aversion to butter and greasy things. • "Not infrequently you meet a patient who complains of a horrible, slimy feeling in the mouth and, when that is present, they usually develop an intense antipathy to butter or greasy food of any kind." [Borland] Intolerance of sour things, fish, flatulent food, fruit, wine, milk [esp. in infants]. • "All China patients give a history of absolute intolerance to any acid - sour food or sour drink. These immediately produce a feeling of acute, abdominal discomfort, increased abdominal distension, general gurgling in the abdomen and an attack of diarrhoea." [Borland] G Thirst variable. At times great thirst for water. Usually no thirst during chills and fever. G Bad effects from ABUSE of TEA. P HEADACHE, bursting pain. And Red face; throbbing of head and carotids. And Great sensitiveness of scalp and even of the hair. Extending from occiput to whole head. < Sitting or lying; must stand erect or walk. < Motion, jar, touch. < Cold draughts. > Warm room, hard pressure.
Long lasting congestive headaches and deafness and noises in the ears.
P Excessive DISTENSION of abdomen due to ACCUMULATION of GAS.
And Frequent ERUCTATIONS which do not >.
Colicky pains, vomiting and diarrhoea can accompany meteorism.
P Gallstone colics, every day at the SAME HOUR.
< At night and after eating; > Bending double.
[1] Shupis, Cinchona officinalis; Journal of the Am. Inst. of Hom., Nov.-Dec. 1963. [2] Ghegas, Children's Remedies; HL 1/93. [3] Shupis, ibid. [4] Gnaiger, China - eine Arzneimittelprüfung; Doc. Hom., 1992.
Rubrics
Mind
Admonition, even kindly < [1]. Anger, alternating with indifference [1], from caressing [1/1], so angry that he could have stabbed anyone [1], inclined to vex others [3]. Aversion to all persons [1]. Full of cares about trifles [2]. Confusion, at night on waking [1], from beer [1], > excitement [1]. Contemptuous of everything [2]. Delusions, he is hindered by everyone [2], he is tormented [2], he is unfortunate [2], is hindered at work [2], he has suffered wrong [1G]. Full of indefinite desires [1]. Excitement, after hearing horrible things [3]. Fear of killing [2], of being pitied [1], to fly into a rage [1], of suffocation, at night [2]. Insanity, with desire to travel [1]. Desire to kill, beloved ones [1]. Malicious, hurting other people's feelings [1/1]. Reading, desires to be read to [1]. Desire for writing [1].
Head
Pain, > coffee [1], > after epistaxis [1], > motion of head [2], while doing some disagreeable work [1/1]; forehead, above eyes, alternating sides [1G].
Eye
Lachrymation, with photophobia [1G].
Vision
Hemiopia, left half lost [1G]. Loss of vision, from exerting eyes [1].
Ear
Noises, during headache [3], during menses [1].
Nose
Odours, imaginary, like a corpse [1]. Smell, acute, to odour of cooking food [1], to flowers [1], to tobacco [1].
Face
Perspiration, cold, around mouth [3], on side lain on [1].
Mouth
Numbness, tip of tongue [1S]. Tip of tongue sensitive as if cracked [1S]. Taste, saltish, of food [3]; slimy, after drinking [1/1]; sour, of sweets [1]; sweetish, when smoking [1].
Teeth
Pain, > biting teeth together [2], while nursing the infant [2/1].
Throat
Constant disposition to swallow from bitter taste in mouth [1/1].
Stomach
Pain, from lactation [1; Carb-v.], > motion [3; Kali-c.]; pressing, > lying on back [1], while lying on side [1/1].
Abdomen
Flatulence, after operation [2/1].
Rectum
Diarrhoea, after loss of fluids [2], after weaning [3].
Stool
Undigested, at night [3], after fruit [3].
Female
Metrorrhagia, from chamomile tea [2; Ign.].
Back
Sensation of a lump, dorsal region, between scapulae [1].
Limbs
Coldness, of one hand, other hand hot [2].
Sleep
Disturbed, by hunger [1], by vertigo [1]. Position, arms under the head [1], with head bent backward [1], with lower limbs drawn up [1] or stretched out [1].
Dreams
Long forgotten events [1]. Frightful, alternating with headache [1/1]. High places [1]. Quarrels about money [1/1]. Being stabbed [1].
Perspiration
At night, when covering ever so little [2/1]. When exercising in open air [2]. On covered parts [3]. Odour, sickly [2].
Generals
After abuse of iron [2]. Oversensitive to allopathic medicine [2].
* Repertory additions: [G] = Gnaiger, [S] = Shupis.
Food
Aversion: [3]: Beer; bread; butter; fats and rich food; hot food; fruit; meat. [2]: Coffee; food, warm; melons; milk. [1]: Cheese; cold water; drinks; farinaceous; salt; soup; sour; strawberries; water.
Desire: [3]: Cold drinks; delicacies; spicy; sweets. [2]: Coffee; refreshing; salty; tea. [1]: Alcohol; beer; bitter [*]; brandy; chamomile tea; cherries; chocolate; coffee, burnt; fruit; fruit, acid; gruel; pastry; pungent; sour; whisky; wine.
Worse: [3]: Fruit; milk; wine. [2]: Bread and butter; cabbage; farinaceous; flatulent food; fruit, acid; pepper; sauerkraut; tea. [1]: Apples; beans and peas; beer; bread; butter; cherries; coffee; corn; dry food; fat; fish, spoiled; grapes; gruel; hot food; meat, spoiled; milk, sour; soup; sour; veal; warm food.
* Observed by two provers in Gnaiger's proving.
Chin.
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| China officinalis |
[Samuel Johnson]
Art imitates nature in this: not to dare is to dwindle.
[John Updike]
Signs
Cinchona officinalis. Quinine Tree. Peruvian Bark. N.O. Rubiaceae.
CLASSIFICATION Dependent on the taxonomic system, the number of genera placed in the Rubiaceae or Coffee family varies from 500 to 600; some botanists recognize about 7,000 species as belonging to this family, while others include about 10,000 species. It is a large family of trees, shrubs, lianas and herbs, sometimes ant-inhabited, epiphytic or aquatic. Older systems recognize two subfamilies, but recently three completely different subfamilies have been supposed, as follows: Rubioideae [comprising 11 tribes], Cinchonoideae [17 tribes], and Guettardoideae [1 tribe]. The Rubiaceae resembles members of the Gentianales, in particular the Loganiaceae, which includes Gelsemium, Spigelia, Strychnos nux-vomica, and Strychnos ignatii.
DISTRIBUTION The family is concentrated in the tropics and subtropics with some species represented in temperate regions and even the Arctic and Antarctic. Most tropical species are trees or shrubs while temperate ones are herbaceous. The most economically important genus of the family is Coffea, the source of coffee; other members, such as Cinchona and Cephaelis [Ipecacuanha], are important medicinally, or are cultivated as ornamentals, e.g. Gardenia and Bouvardia. Well-known European herbaceous members include Rubia, Asperula and Galium.
PHARMACOLOGY The family is rich in chemical constituents of potential biodynamic activity. These include iridoids, several types of alkaloids, triterpenes and their glycosides, sterols, anthraquinones, naphthalene derivatives, polyphenols, tannins, cyanogenic compounds. The family has been reviewed as a source of emetine type alkaloids, active principles causing violent vomiting. 1
ANTS "Interesting examples of association with ants are found in the genera Myrmecodia and Hydnophytum, native to tropical Asia and Australia. All members of these genera are epiphytes which cling to branches of trees with their roots. Large swellings, containing a network of cavities, develop on the roots, and are inhabited by ants. Although it has been supposed that the plant and insects have developed a symbiosis of mutual benefit - the ant guarding the plant and providing it with extra nutrients, receiving shelter in return - it has not been proved that they are in fact interdependent."2
CINCHONA The genus Cinchona comprises about 40 species of trees reaching 15 to 20 m in height and producing white, pink or yellow flowers. There are numerous varieties, sub-varieties, and hybrids. All Cinchonas are indigenous to the eastern slopes of the Amazonian area of the Andes where they grow between 1,500 to 3,000 metres in elevation on either side of the equator [from Columbia to Bolivia]. Cinchonas are now widely cultivated in many tropical countries for their commercial value. Although they are not native to those areas, planters in the East Indies have succeeded in increasing the amount of quinine in certain Cinchona species. The commercial production of quinine is now centred in Africa [Zaire, Burundi, Cameroon, Kenya]; lower on the list of producers are Indonesia [Java] and India, with South American countries as Peru, Bolivia and Ecuador bringing up the rear.
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| China officinalis leaves |
NOMENCLATURE Cinchona bark is the dried bark of stem or root of various species of Cinchona. Different species bear the name officinalis. The C. officinalis cultivated mostly in Java is Cinchona ledgeriana, while the C. officinalis from Bolivia is termed Cinchona calisaya. Ecuador provides C. pubescens [also named C. succirubra]; Cinchona micrantha and another C. officinalis come from Peru. The specific name ledgeriana derives from the British trader Charles Ledger who sold seeds of a Peruvian Cinchona species to the Dutch.
NAME The common name of the tree comes from a local word, quinaquina, meaning 'the bark of barks.' Legend has it that the name cinchona comes from the Countess of Chinchon, the wife of the viceroy of Peru, who was cured of a malarial fever in about 1638 by a tribal witch doctor [who the viceroy subsequently appointed as the royal physician]. The Countess reportedly returned to Spain in 1640, bringing the bark with her, but historians doubt whether the Countess ever returned to Europe - the Countess died in Cartagena, Colombia, in 1641 - and claim that the Jesuits were the first to bring the bark to Europe and to spread its use through Spain and the rest of the continent.
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| Cinchona leaves |
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| Cinchona bark |
PARANOIA Talbor was considered a quack by the College of Physicians. But after he had cured King Charles II, the king not only made him a knight but also appointed Sir Robert to the College of Physicians. The college's members disapproved of Talbot for two reasons: he discarded the necessity of bleeding and purging, and he refused to reveal his secret cure for malaria. Talbor's secretiveness was understandable. He was giving Jesuits' powder to Charles II at the very time that a Titus Oates testified that there was a vast Jesuit conspiracy to murder the king and to place his Roman Catholic brother James on the throne. The paranoia turned London into a place of hysterical bigotry. Vast anti-Catholic parades wound their way through the city, bearing with them the Peruvian bark, or the facsimile of it, with great signs telling the gruesome story of how the Jesuits were using it to exterminate the non-Jesuit population. The fever of religious hatred and intolerance raged as did that of malaria. The word 'Jesuitical' even made its way into the dictionary as a synonym for crafty and intriguing. 5
CONSTITUENTS Cinchona contains about 35 alkaloids, as well as cinchotannic, quinic and quinovic acids, volatile oils, and cinchona red. The alkaloid content varies according to the source of the bark. The cultivated bark contains 7-10% total alkaloids of which about 70% is quinine. Cinchona succirubra [C. pubescens] and Cinchona ledgeriana are the species with the highest amount of quinine alkaloids. The standardized method for the assay of cinchona is named 'Brussels 1949. ' The bark emits a characteristic purple vapour when heated in a test tube. 6 Quinine is incompatible with iodides and salicylates.
QUININE Quinine is the primary alkaloid of Cinchona. Quinine compounds consist of very bitter crystals or crystalline powder which effloresce on exposure to air and darken on exposure to light. One gram of quinine dissolves in 1900 ml water, 760 ml boiling water, and 0.8 ml alcohol. The blue fluorescence is especially strong in diluted sulphuric acid. Compounds derived from Cinchona have to be protected from light. The same is true for the natural alkaloids. The alkaloid content of the bark increases if the bark is protected from light and air by layers of damp moss, a process called 'mossing'.
USES Nearly half of the cinchona harvest is directed to the food industry for the production of quinine water, tonic water, and as a bitter additive [e.g. in 'bitter lemon']. Quinine extract is also used as a local anaesthetic in hair tonics and sunscreen preparations. It serves as a flavouring agent in numerous over-the-counter cold and headache remedies. Perhaps 30 to 50% of the quinine is converted to quinidine, a prescription antiarrhythmic drug.
CINCHONISM A single dose of 2 to 8 grams orally of pure quinine may be fatal to an adult. Small amounts may cause quinine-sensitive people to suffer a hypersensitivity reaction, consisting of nausea, vomiting, visual disturbances, ringing in the ears, nerve deafness, itching, flushing of skin, and skin rashes. Most marked are the effects on the special senses, in particular hearing and vision. Quinine poisoning may result in deafness, often temporarily, rarely permanent, as well as in dimness of vision, especially for colours, or temporary blindness or colour blindness. The effects are opposite to those of coffee - botanically closely related to cinchona - which tends to increase sensory acuity. Excessive plasma levels of quinine can result in hypotension, cardiac dysrhythmias and severe CNS disturbances such as delirium and coma. Other rarer side-effects are hypoglycaemia, blood dyscrasias [esp. thrombocytopenia] and hypersensitivity reactions. Quinine can stimulate insulin release. Quinine passes through the placenta and into breast milk. Quinine and its synthetic substitutes are particularly toxic to the organ of Corti, but they affect as well both the auditory and vestibular portions of the inner ear. The highest frequencies are usually affected first, and high-pitched tinnitus or vertigo may develop. In severe cases a permanent loss of hearing can be produced.
TOXICOLOGY Quinine has an established place in today's pharmacopoeia. The availability of the drug allows its ingestion in excessive doses for intended abortion and intended suicide, as in the past. "It is now clear that there are two dosage levels at which quinine [and its congeners] may be toxic. The first is a very low level caused by a single dose of as little as 12 mg. The symptoms are those of thrombocytopenic purpura. The cause is an immune reaction in which the drug acts as a haptene. The visual system is affected as much or as little as it would be in purpura caused by any other haptene. Its blood vessels are subject to haemorrhage secondary to thrombocytopenia as any set of vessels would be, but there is no specific selectivity for the eye. The usual therapeutic regime for malaria is 1.3 g per day in four divided doses for seven days. Experiments on human volunteers have shown that eye effects of blurring, a decrease of visual acuity, and loss of the peripheral field occur with single doses of 2.5 to 4.0 mg. A single dose of 8 mg can be fatal. It is doses of 2.5 g and above that have specific eye effects."7
MALARIA Although today malaria [ague; intermittent fever; swamp fever] is commonly considered a disease of tropical lands, in the 17th century it affected vast parts of Europe, including Rome, Versailles and London. Early 17th-century malaria patients had one principal cure available to them - bleeding. If bleeding was ineffective, the physician might try purging or the use of emetics. "Malaria is mosquito-borne and is one of the major killer diseases of the world, causing up to 2.7 million deaths annually and a staggering amount of chronic ill health. In some parts of Africa, 10% of the deaths of children under 5 years are due to the direct effects of malaria, and its contribution to the mortality from other diseases cannot be computed. About 50 years, the World Health Organization attempted to eradicate malaria using the powerful 'residual' insecticides and the highly effective antimalarial drugs which had become available. By the end of the 1950s the incidence of malaria had dropped dramatically. However, during the 1970s it became clear that the attempt at eradication had failed - largely owing to the increasing resistance of the mosquito to the insecticides and of the parasite to the drugs - and currently malaria causes over 300 million new infections annually, many being the 'malignant' form of the infection caused by the most dangerous of the parasites, Plasmodium falciparum. At present about 46% of mankind lives in malarious areas. Sporadic cases - the result of air travel - are quite common in Western Europe and the USA, where the risk of transmission is negligible, and the incidence of this travellers' malaria is rising year by year. ... Immunity to malaria occurs and can protect many individuals living in malarious areas. The immunity is lost if the individual is absent from the area for more than 6 months."8
MEDICINAL USES Cinchona bark has a worldwide use. Its key actions are fever-reducing, antimalarial, tonic, appetite-stimulating, antispasmodic, astringent, and antibacterial. In Brazil the bark is used for anaemia, debility, dyspepsia, fatigue, gastrointestinal disorders, and malaria. In European herbal medicine it is considered to be effective for alcoholism, anaemia, cramps, sepsis, arrhythmias, diarrhoea, enlarged spleen, gall-bladder disorders, loss of hair, and liver disorders. In the USA, natural cinchona bark is used as a tonic and digestive aid, to reduce heart palpitations, for haemorrhoids, varicose veins, headaches, leg cramps, colds and flu, dyspepsia, and for its bactericidal and anaesthetic effects.
TONIC The first idea of the doctrine of homoeopathy seems to have entered Hahnemann's mind in the year 1790, while he was engaged in translating Cullen's Materia Medica into German. Cullen defended the old opinion that the efficacy of cinchona bark depended upon its 'tonic effect on the stomach.' The idea of quinine having a general strengthening effect has survived until today, as is shown by the Encyclopaedia Britannica: "Administration of quinine dramatically improves the condition of a person suffering from malaria; the parasites promptly disappear from the blood, and the symptoms of the disease are quickly alleviated." The effect is strengthening but not curative! "When quinine treatment is terminated, however, many recovered patients suffer another attack of malaria several weeks later." Hahnemann's reply still applies, too: "How can they ever imagine that they can strengthen a sick person whilst he is still suffering from his disease, the source of his weakness? Have they ever seen a patient rapidly cured of his disease by appropriate remedies who failed to recover his strength in the very process of the removal of his disease? ... If cinchona bark is to make all sick persons strong, active and cheerful, it must needs be the universal panacea which shall at once deliver all patients from all their maladies. ... It is no doubt true that by the first doses of bark the strength of the patient, be he ever so ill, is increased for a few hours; he is able to raise himself up in bed all alone, as if by a miracle; he wants to get out of bed and put on his clothes; all at once he speaks in a stronger more resolute manner, venturing to walk alone, and grows animated, eagerly desires to eat this or that, - but a careful accurate observer easily sees that this excitation is only an unnatural tension. A few hours pass and the patient sinks back, sinks deeper into his disease, and the fatal result is often accelerated. ... Strength cannot be materially poured into the organism by a decoction of china [or by wine]."
Research during World War II has produced a number of synthetic antimalarial drugs, such as chloroquine and chloroguanide, that suppress more effectively the growth of the blood forms of the malarial parasite. Their total laboratory synthesis in 1944 is perceived as "one of the classical achievements of synthetic organic chemistry."
FIRST EXPERIMENT Quinine bark is famous as the first substance that Hahnemann tested on himself, leading to the formulation of the Law of Similars. Yet it seems likely that Hahnemann has conducted self-experimentations in the years prior to the 'China-experiment'. In a footnote to the translation of Cullen's Materia Medica, Hahnemann describes his course of action: "I took, by way of experiment, for several days four drams of good bark twice a day. My feet, finger-ends, etc., first became cold, and I felt tired and sleepy, then my heart began to beat, and my pulse became hard and quick; I got an insufferable feeling of uneasiness, a trembling [but without rigor], a weariness in all my limbs; then a beating in my head, redness of the cheeks, thirst, - in short, all the old symptoms with which I was familiar in ague appeared one after another, yet without any actual chill or rigor. In brief, even those particularly characteristic symptoms which I was wont to observe in agues - obtuseness of the senses, kind of rigidity in limbs, but especially that numb disagreeable feeling which seems to have its seat in the periosteum of all the bones of the body - all put in an appearance. This paroxysm lasted each time 2 or 3 hours, and came on afresh whenever I repeated the dose, but not otherwise. I left off, and was quite well."
NEW EXPERIMENT In an attempt to retrace Hahnemann's experiment, Shupis took the official tincture of China off. in doses of 4 drams three times daily for a total of three ounces over a period of three days. Contrary to Hahnemann, Shupis was not quite well when he left off; he recorded symptoms for a period of 42 days and experienced on the 21st day intolerable influenza-like symptoms [which coincided with a small, local influenza-epidemic], which could not be antidoted. 9 Part of the 85 symptoms he recorded is included below.
PROVINGS •• [1] Hahnemann - 22 provers; method: unknown.
•• [2] Jörg - 7 provers, 1823; method: a few doses of tincture, in doses from 18 to 140 drops, or of powder; symptoms recorded for 2-14 days.
•• [3] Shupis - self-experimentation, 1963; method: 'the official tincture of China officinalis was employed in doses of 4 drams three times daily for a total of three ounces over a period of three days; symptoms were recorded for 42 days.'
•• [4] Gnaiger - 21 provers, 1992; method: 19 provers took one daily dose of 30c for one week, one prover took 6x twice daily and another took a single dose of 200c.
The participants in Gnaiger's experiment knew which substance they were proving. Hahnemann, too, never concealed from his provers the names of the drugs that were proved.
[1] Schultes and Raffauf, The Healing Forest. [2] Heywood, Flowering Plants of the World. [3] Homoeopathy, Oct. 1969. [4] Rain-tree. com [website]. [5] Fr. Gene Nevins, SJ. [6] Merck Index. [7] Klaassen, Casarett and Doull's Toxicology. [8] Rang et al, Pharmacology. [9] Shupis, Cinchona officinalis; Journal of the American Institute of Homeopathy, Nov.-Dec. 1963.
Affinity
BLOOD. CIRCULATION. SECRETIONS [digestive; organs; liver]. Spleen. Nerves. Mucous membranes. * Left side. Right side.
Modalities
Worse: LOSS OF FLUIDS. TOUCH. Jar. Noise. PERIODICALLY [alternate days]. Cold; drafts; wind. Open air. Eating. Fruit. Milk. Mental exertion. Night. Motion. Walking.
Better: Hard pressure. Evening. Loosening clothes. Bending double. Lying down. Fasting.
Main symptoms
M DELICACY.
• Artistic persons - like beautiful colours, "feel the colours"; make verses, painters; strong SENSE of BEAUTY. Reserved disposition; express themselves in writing poems, painting; find it difficult or impossible to express their feelings in ordinary words; only talk about themselves with confident persons, good friends. Strong imaginative power, evening in bed [compare Nat-m.], or daydreaming. Chin. thinks about all kinds of positive and wonderful things, like being able to fly, relaxing on a warm day at the seaside, being the richest person of the world, etc., after which they feel happy and satisfied and fall asleep. They usually think of nice stories in which they play the hero. The same pattern can occur during the day, when they are disturbed or embarrassed. Nat-m., on the other hand, dwells on past disagreeable occurrences, i.e. thinks about all kinds of negative things. [Ghegas]
• "China is one of the most sensitive of all types. She has the emotional and the aesthetic sensitivity of Ignatia, but in addition there is usually a psychic sensitivity, and often an extreme physical/sensory sensitivity as well. One's first impression of a China individual is often one of sensitivity. She will approach you rather warily, and may remain wary until she knows you well, and even then, she will only reveal her true sensitivity if she is convinced that you are both understanding and sensitive. ... There are two types of China individuals; the worldly and the other-worldly. Both are very sensitive, but whilst the former is principally sensitive to any form of aggression, the latter is also sensitive in a psychic sense. These ethereal Chinas are the most psychic of all constitutional types. These are generally fascinating people who are principally interested in spiritual matters, and they are all the more interesting because their spiritual interests are based on direct experience, rather than intellectual attraction. They are generally quiet, modest people who possess a great deal of wisdom, which they will not 'cast before swine'. [Bailey]
M OVERSENSITIVITY.
[1] Least touch < while hard pressure >.
[2] Extreme susceptibility to cold air and wind.
[3] Least noise is experienced as painful. Tinnitus aureum.
[4] Oversensitivity to odours: cooking odours and tobacco.
[5] Acute sense of taste.
• "This is rather interesting because, in spite of their extremely acute sense of taste, quite a number of China patients develop a craving for all sorts of highly tasting food - pungent, spicy things - in order to tickle their appetites." [Borland]
c Shupis noticed:
• Sensitive to slightest offence. Temper short, sensitive to least offence.
• Rooms appears brighter.
• All intricate objects appear clear, e.g. smallest visible tree branches.
• More conscious of background sounds and noises.
• Difficulty sleeping, oversensitive to bed creaking which I never before noticed.
• Senses overly acute, hearing, sight, contradiction, mild offences.
• Sensitive to everything, disgusted, want to throw in sponge. Desire to drink yet no craving. Want to get drunk and let the world go to hell. 1
M CONTACT.
• Aversion to superficial contacts [< 'slight touch'], only wants deep contacts and friendships [> 'hard, deep pressure'].
• "It's difficult to make contact with Chin. patients because they don't like superficial contacts and can be abusive, impolite and inconsequential in answering questions. They will only open up when they feel real interest and sympathy. [Ghegas]
M Collision.
• Every external impression leaves deep traces. The intensity of China's inner life can lead to exhaustion ["loss of mental fluids"], with the result that they become irritable and even violent, insulting and abusive. In this stage the world becomes hostile; they feel unfortunate, do not want to live any more but lack the courage to commit suicide. [Ghegas]
• "China individuals want to think about everything at once; their mind is teeming with ideas, and they are inclined to collide with others' beliefs ... which eventually exhausts them." [Grandgeorge]
• "The fire which inspires the more spiritual China person with meditative ecstasy and philosophical passion tends to be expressed as irritability in the more worldly China individual. The latter is still very sensitive, in the sense of fearful and suspicious, and also sensitive aesthetically and physically, but she is of this world. She is generally an analytical person, with a fine intellect, but lacks the self-confidence to make full use of it. She is also a rather wilful person. ... Although she may lack confidence with strangers, and is generally on her guard in company, she can make her family's life hell with her moodiness and her tendency to criticise and blame. ... The China individual exhibits traits from both ends of the China spectrum, being highly psychic and spiritually orientated, and also critical and socially skilful." [Bailey]
M Quality.
Desire to have the BEST THINGS.
Objects seem unworthy.
Things seem unattractive.
• "What formerly appeared to him in a bright genial light, seems now to be lustreless, unworthy, and shallow." [Hahnemann]
• "China is ambitious and plans step by step. He achieves his ambition by building castles in the air. He feels what he possesses is not good enough and that he would have possessed better things if he had not been obstructed and hindered. Therefore he fantasises and imagines that he possesses finer and more expensive things than he actually does. He never really puts his plans into action." [Sankaran]
M Full of PLANS and IDEAS [esp. in evening and at night].
• "He makes a number of grand plans for the future."
• "He makes many plans, and thinks over their accomplishment; many ideas force themselves upon him at once."
• He has many ideas, undertakes to carry out all sorts of things, builds castles in the air [after some hours]."
• He has a number of plans in his head which he greatly desires to carry into execution, in the evening." [Hahnemann]
[observed by four different provers!]
CLARITY of MIND evening and night.
Sleeplessness from activity of mind.
• "For in China's inner world you see
A hero lives in fantasy
He dreams of deeds extremely grand
But actually he's just a man." [Chatroux]
M Delusion he is UNFORTUNATE; the world is HOSTILE.
[delusion he is being constantly harassed by enemies]
• "Discontented; he thinks himself unfortunate, and fancies he is opposed and tormented by everybody [after 5 hours]." [Hahnemann]
• "The feeling in China is: 'I am weak and so people attack, trouble and torture me', a feeling of being persecuted. The patient feels he is weak, not good enough, that he is persecuted and hindered at his work by other people, that he is obstructed from achieving his ambition. So he fantasises and in these fantasies he makes himself worthy and achieves his ambitions, and in this way uses fantasies to cover up the inherent feeling of not being good enough." [Sankaran]
M Apathy, indifference and sadness following severe diseases.
M Animals.
• "While they sometimes behave aggressively towards people, they can be very afraid of animals, particularly of most harmless animals such as cows, horses, sheep, a little dog, a chicken, a cat or a mouse. In children, this strong fear of animals is very characteristic of China. E.g. , a 10-year old child who makes a large detour in order not to pass the cows."2
Gibson mentions a fear of crawling insects.
M Threat - violent impulses.
• "Awakened at 2:00 A.M. by a dream of a vicious strangler who stealthily approached from the rear and suddenly killed. I tried to lure him."3
• "I awoke at 3:30 A.M. with a peculiar feeling: I suddenly had the completely irrational thought, a compulsion almost, to jump up and throw myself on my sleeping partner in order to strangle him. I told myself that this was ridiculous, but the compulsive thought became stronger and stronger. I controlled myself with all my strength and got violent palpitations of the heart [no tachycardia] shaking my body. Then I got the idea to run out in the cool, dark night and to scream out loud - again this irresistible urge. Deeply distressed I lay in the darkness and felt one more compulsion, though far less than the first, to strangle my partner. Now I can imagine what a 'compulsion' is. I lay awake until dawn, and then fell asleep with difficulty."4
G Ailments after LOSS OF FLUIDS.
[profuse, exhausting discharges, haemorrhages, excessive or prolonged lactation, diarrhoea, suppurations, perspiration, vomiting, excessive masturbation]
G Periodical and intermittent complaints.
G Circulatory disturbances: haemorrhages, anaemia, oedematous swelling and fluid retention.
G CHILLY.
< COLD in general. • "All China patients are intensely chilly, very sensitive to cold draughts and want to be warmly covered up all the time. To this symptom of general chilliness you can add a China peculiarity: the patients complain of intense coldness in the stomach." [Borland] G Perspiration day and night, during sleep [on being covered] or even when closing the eyes [Con.]. G > Hard PRESSURE.
< TOUCH, slight touch. G CANINE HUNGER, esp. AT NIGHT. During daytime, feeling of satiety after a few mouthfuls. Or the reverse: Increased appetite when one begins to eat. G Aversion to butter and greasy things. • "Not infrequently you meet a patient who complains of a horrible, slimy feeling in the mouth and, when that is present, they usually develop an intense antipathy to butter or greasy food of any kind." [Borland] Intolerance of sour things, fish, flatulent food, fruit, wine, milk [esp. in infants]. • "All China patients give a history of absolute intolerance to any acid - sour food or sour drink. These immediately produce a feeling of acute, abdominal discomfort, increased abdominal distension, general gurgling in the abdomen and an attack of diarrhoea." [Borland] G Thirst variable. At times great thirst for water. Usually no thirst during chills and fever. G Bad effects from ABUSE of TEA. P HEADACHE, bursting pain. And Red face; throbbing of head and carotids. And Great sensitiveness of scalp and even of the hair. Extending from occiput to whole head. < Sitting or lying; must stand erect or walk. < Motion, jar, touch. < Cold draughts. > Warm room, hard pressure.
Long lasting congestive headaches and deafness and noises in the ears.
P Excessive DISTENSION of abdomen due to ACCUMULATION of GAS.
And Frequent ERUCTATIONS which do not >.
Colicky pains, vomiting and diarrhoea can accompany meteorism.
P Gallstone colics, every day at the SAME HOUR.
< At night and after eating; > Bending double.
[1] Shupis, Cinchona officinalis; Journal of the Am. Inst. of Hom., Nov.-Dec. 1963. [2] Ghegas, Children's Remedies; HL 1/93. [3] Shupis, ibid. [4] Gnaiger, China - eine Arzneimittelprüfung; Doc. Hom., 1992.
Rubrics
Mind
Admonition, even kindly < [1]. Anger, alternating with indifference [1], from caressing [1/1], so angry that he could have stabbed anyone [1], inclined to vex others [3]. Aversion to all persons [1]. Full of cares about trifles [2]. Confusion, at night on waking [1], from beer [1], > excitement [1]. Contemptuous of everything [2]. Delusions, he is hindered by everyone [2], he is tormented [2], he is unfortunate [2], is hindered at work [2], he has suffered wrong [1G]. Full of indefinite desires [1]. Excitement, after hearing horrible things [3]. Fear of killing [2], of being pitied [1], to fly into a rage [1], of suffocation, at night [2]. Insanity, with desire to travel [1]. Desire to kill, beloved ones [1]. Malicious, hurting other people's feelings [1/1]. Reading, desires to be read to [1]. Desire for writing [1].
Head
Pain, > coffee [1], > after epistaxis [1], > motion of head [2], while doing some disagreeable work [1/1]; forehead, above eyes, alternating sides [1G].
Eye
Lachrymation, with photophobia [1G].
Vision
Hemiopia, left half lost [1G]. Loss of vision, from exerting eyes [1].
Ear
Noises, during headache [3], during menses [1].
Nose
Odours, imaginary, like a corpse [1]. Smell, acute, to odour of cooking food [1], to flowers [1], to tobacco [1].
Face
Perspiration, cold, around mouth [3], on side lain on [1].
Mouth
Numbness, tip of tongue [1S]. Tip of tongue sensitive as if cracked [1S]. Taste, saltish, of food [3]; slimy, after drinking [1/1]; sour, of sweets [1]; sweetish, when smoking [1].
Teeth
Pain, > biting teeth together [2], while nursing the infant [2/1].
Throat
Constant disposition to swallow from bitter taste in mouth [1/1].
Stomach
Pain, from lactation [1; Carb-v.], > motion [3; Kali-c.]; pressing, > lying on back [1], while lying on side [1/1].
Abdomen
Flatulence, after operation [2/1].
Rectum
Diarrhoea, after loss of fluids [2], after weaning [3].
Stool
Undigested, at night [3], after fruit [3].
Female
Metrorrhagia, from chamomile tea [2; Ign.].
Back
Sensation of a lump, dorsal region, between scapulae [1].
Limbs
Coldness, of one hand, other hand hot [2].
Sleep
Disturbed, by hunger [1], by vertigo [1]. Position, arms under the head [1], with head bent backward [1], with lower limbs drawn up [1] or stretched out [1].
Dreams
Long forgotten events [1]. Frightful, alternating with headache [1/1]. High places [1]. Quarrels about money [1/1]. Being stabbed [1].
Perspiration
At night, when covering ever so little [2/1]. When exercising in open air [2]. On covered parts [3]. Odour, sickly [2].
Generals
After abuse of iron [2]. Oversensitive to allopathic medicine [2].
* Repertory additions: [G] = Gnaiger, [S] = Shupis.
Food
Aversion: [3]: Beer; bread; butter; fats and rich food; hot food; fruit; meat. [2]: Coffee; food, warm; melons; milk. [1]: Cheese; cold water; drinks; farinaceous; salt; soup; sour; strawberries; water.
Desire: [3]: Cold drinks; delicacies; spicy; sweets. [2]: Coffee; refreshing; salty; tea. [1]: Alcohol; beer; bitter [*]; brandy; chamomile tea; cherries; chocolate; coffee, burnt; fruit; fruit, acid; gruel; pastry; pungent; sour; whisky; wine.
Worse: [3]: Fruit; milk; wine. [2]: Bread and butter; cabbage; farinaceous; flatulent food; fruit, acid; pepper; sauerkraut; tea. [1]: Apples; beans and peas; beer; bread; butter; cherries; coffee; corn; dry food; fat; fish, spoiled; grapes; gruel; hot food; meat, spoiled; milk, sour; soup; sour; veal; warm food.
* Observed by two provers in Gnaiger's proving.
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