Ipecacuanha
- VERMEULEN Frans
Ip.
I'm extraordinarily patient provided I get my own way in the end.
[Margaret Thatcher]
Signs
Cephaelis ipecacuanha. [Psychotria ipecacuanha]. Ipecac Root. 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 Str. ignatii.
DISTRIBUTION The family Rubiaceae 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. Genera such as Cinchona and Cephaelis [Ipecacuanha] are important medicinally. 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, napthalene derivatives, polyphenols, cyanogenic compounds, tannins. The family has been reviewed as a source of emetine type alkaloids, active principles causing violent vomiting. 1
GENUS The genus Cephaelis contains some 180 species of herbs, shrubs and small trees. It is pantropical in distribution. Closely related to Palicourea and Psychotria, some species have been included in these two genera. Some taxonomists do not recognize Cephaelis as a separate genus, and transfer its species to other genera, in most cases Psychotria; hence the name Psychotria ipecacuanha.
SPECIES Cephaelis ipecacuanha is a native of Brazil, flourishing in moist, thick, and shady woods. It is a small, almost herbaceous shrub with a slender rather prostrate stem, growing to 30 cm, and long, straggling roots. It blooms in January and February with very small, white flowers collected to the number of 8, 12, or more into a semiglobular head. Appearing in May, the fruit is an ovate, obtuse berry which is at first purple, but becomes almost black when ripe. The thickened root of this species is of great economic importance as the source of the well-known ipecac. Cultivation has been attempted in South-East Asia, but with limited success.
NAME Cephaelis derives from Gr kephale, a head, in allusion to close arrangement of the flowers of these shrubs and herbs. The specific name comes from the local Brazilian name for the plant, i-pe-kaa-guéne, which literally means 'road-side sick-making plant.' The name ipecac properly belongs to the Brazilian Cephaelis species, but in the United States it has been applied to several species belonging to different plant families, such as Euphorbia ipecacuanha [American ipecac, ipecac spurge], Gillenia trifoliata [Indian physic], Apocynum androsaemifolium [dogbane], and Triosteum perfoliatum [fever root].
CONSTITUENTS The major active constituents of Ipecac root are the isoquinoline alkaloids emetine and cephaeline, which exert their effects through activation of the vomiting centre, but also through local irritation in the stomach. Emetine is excreted unchanged in the urine. It appears within 20-40 minutes of an ingested dose and has a long half-life with as much as 35% of the drug being retained after 35 days. Studies have shown that ipecac removes between 30-50 % of the stomach contents depending on the interval between ingestion and emesis. A delay in 30 minutes significantly decreases the effectiveness of ipecac induced emesis to decrease absorption 8 and a delay of greater than 90 minutes renders it essentially ineffective. 2 Emetine and cephaeline belong to the same class of alkaloids as protoberberines [Berberis, Hydrastis], morphine alkaloids [Poppy family] and mescaline [Lophophora].
TOXICITY The roots are most toxic and contain the alkaloid emetine, which weakens the heart. Vomiting occurs within 30 minutes after ingestion but may not be fatal until 24 hours to a week later. Ipecac can be cardiotoxic if not vomited and allowed to be absorbed. The commercially available ipecac syrup comes from the dried roots of the plant. Ipecac syrup may cause persistent vomiting, diarrhoea, lethargy and drowsiness. "Cardiac and skeletal muscle myopathy are the most common manifestations of chronic ipecac use. Myocardial damage may be manifest in a number of ways including tachycardia, hypotension, dyspnoea, precordial chest pain and EKG abnormalities. In addition to cardiac toxicity, there are neuromuscular effects that consist of weakness, aching, tenderness and stiffness of skeletal muscles, especially those of the neck and extremities. Weakness and muscular pain tend to persist until ipecac usage is discontinued; they usually present before the cardiovascular symptoms appear. Mild sensory disturbance and tremor occur rarely."3 The dust of the root produces inflammation of the air-passages and conjunctivitis; applied to the skin in the form of an ointment, it excites a pustular eruption similar to that caused by tartar emetic. Emetine has produced redness, papules, vesicles, pustules and urticaria on the forearms and arms of pharmacists. "In some individuals, the inhalation of the powdered drug provokes decided paroxysms, closely resembling spasmodic asthmatic attacks - the chief symptoms being great dyspnoea, with marked anxiety and prostration, and wheezing respiration and cough. This is often accompanied with violent and prolonged sneezing and spitting of blood. Such attacks are usually followed by a free expectoration of mucus."4
MUNCHAUSEN The abuse of ipecac syrup by anorectics and bulimics, to induce vomiting, has been associated with severe cardiomyopathies and death. Ipecac misuse is also encountered in "children who are victims of the Munchausen by proxy syndrome where ipecac is administered surreptitiously for the purpose of inducing symptoms such as intractable vomiting, intestinal pseudo-obstruction, haemorrhagic colitis, muscle weakness and cardio-myopathy."5 The Munchausen syndrome - also termed Pathologic Malingering, Chronic Factitious Illness, or Hospital Hobos - is characterised by repeated fabrication of illness, usually acute, dramatic, and convincing, by a person who wanders from hospital to hospital for treatment. In a bizarre variant of the syndrome, a child may be used as a surrogate patient. [This has been referred to as 'Munchausen by proxy.'] The parent falsifies history and may injure the child with drugs, add blood or bacterial contaminants to urine specimens, etc. - all in order to simulate disease. 6
MEDICINE "The Portuguese learned of this Indian remedy for bowel problems when they settled Brazil, and the root was introduced to Europe around 1672 as a remedy for dysentery. Originally sold in Paris as a secret remedy, the plant showed such value in bowel affections that no less a personage than Louis XIV eventually heaped a large sum of money and public honours on the physician who popularized its use, on the condition that he make it public. Like many other similar drugs, ipecac is emetic only in large doses; in intermediate doses it is nauseant, diaphoretic, and expectorant; in small doses it is a mild stomach stimulant, increasing the appetite and aiding digestion. Very small doses have also been used to treat the vomiting of pregnancy. When used as a nauseant, ipeca was also observed to exert a sedative effect on the vascular system; hence it came to be employed for haemorrhages, particularly of the uterus."7 Combined with opium and potassium sulphate, under the name of Dover's powder, ipecac was in the 19th century considered one of the best diaphoretics in rheumatism and slight febrile affections. Due to its astringent properties, Dover's powder was also much employed for the treatment of diarrhoea and dysentery. Although often replaced by activated charcoal, ipecac syrup is still used in some hospital casualty departments for the treatment of cases of poisoning in children and sometimes adults. It is also commonly found in many patent cough medicines for the treatment of bronchitis and whooping cough.
PROVINGS •• [1] Hahnemann - 4 provers; method: unknown.
•• [2] Bock - self-experimentation, 1829; method: repeated doses of 1/2 to 15 grains.
•• [3] Lembke - self-experimentation; method: two doses of 1/2 grain of Ipeca-root, effects recorded for 2 days.
[1] Schultes and Raffauf, The Healing Forest. [2-3] Perry, Ipecac; Clinical Toxicology Review, Oct. 1995; Massachusetts Poison Control System. [4] King's American Dispensatory. [5] Perry, ibid. [6] Merck Manual. [7] Weiner, Weiner's Herbal.
Affinity
MUCOUS MEMBRANES [DIGESTIVE TRACT; stomach; RESPIRATORY; lungs]. Nerves [pneumogastric; spinal; cutaneous]. Umbilicus. * Right side. Left side.
Modalities
Worse: WARMTH; damp warmth; warm room; warm moist, south winds. Overeating [ice cream; pork; veal; mixed or rich foods; fruits; salad; fats]. Periodically. Quinine. Heat and cold. Recession of eruptions. Slightest motion. Winter and dry weather. Autumn. Cold nights after hot days. Stooping [vomiting].
Better: Open air.
Main symptoms
M Discontented - hard to please.
• "His disposition is full of wishes and longing he knows not for what."
• "He has pleasure in nothing, nothing is agreeable to him."
• "Everything is repugnant to him." [Hahnemann]
• "The Ipecacuanha subject manifests extreme impatience, and is described as being full of desires which are vague and ill-defined. This leads to discontent and a tendency to be scornful of anything and everything. Children wail and scream continuously; adults are sulky and ill-humoured all day long. Everything is repugnant - a psychological nausea and disgust." [Gibson]
c Ailments from vexation and reserved displeasure. [Hering]
M Contempt.
• "Sullen unsociable moroseness, that makes him disdain everything."
• "Sulky humour, that despises everything, and he desires that others also should not esteem or care for anything." [Hahnemann]
M Thinks himself unfortunate.
[Hahnemann comes up with exactly the same symptom in his proving of China.]
G Ailments, PAINS and CONSTANT NAUSEA and vomiting.
Nausea not > by vomiting.
• "Adapted to cases where the gastric symptoms predominate." [Allen]
• "One of the best guides to the use of this remedy, is a constant but unavailable desire to vomit; or immediately after vomiting they wish to do so again." [Guernsey]
• "Pallor predominates, and a typical facies nauseatica may be present with down-turned corners of mouth and well-defined nasolabial furrow. This is especially likely to be observed in children and will call to mind two other remedies, Aethusa and Antimonium tartaricum." [Gibson]
G Great CHILLINESS.
• "There is no warmth in the body at all; the slightest cold is unbearable." [Gibson]
c Becomes hot and sweaty [and nauseous] during spasms of pain.
G NO THIRST.
G < FAT food, pork, pastry, candy, etc.. G < Cold and heat. < Cold dry weather. G < HEAT. < Warm south wind. Faintness from summer heat; faintness in warm room. G < Eating FAST. G Haemorrhages of bright red colour and sudden. [epistaxis, haemorrhoids, menstruation, haematemesis] • "Uterine haemorrhages, with bright red flow, usually with vomiting and dyspnoea is definitely Ipec." [Morrison] • "Quite a number of adolescent girls have violent dysmenorrhoea. Characteristically they are rather warm-blooded people, and with the spasms of pain - they very often describe it as cutting pain in the lower abdomen - they become hot and perspiring, with acute nausea. They cannot stand up and any movement makes them worse. They have a perfectly clean tongue and a normal temperature. Very often Ipecac. will stop the attack as well as the tendency to dysmenorrhoea. It is one of the very useful remedies for colic, and tends to be overlooked." [Borland] c Characteristic for the dysmenorrhoea, according to Guernsey, is a pain about the umbilicus running to the uterus. G Respiratory ailments and NAUSEA and CLEAN TONGUE. • "Constant nausea with a clean tongue is the watchword." [Dewey] G Gastric ailments [NAUSEA] and constant SALIVATION. G Weakness AFTER MENSES. P COLDS [in children]. Starting with obstruction of the nose at night. Followed by hoarseness and suffocative, spasmodic cough. And Retching and vomiting. P VOMITING < STOOPING. P Bronchiolitis, bronchitis or asthma with spasmodic, suffocative cough. And Retching and VOMITING. RATTLING, great accumulation of mucus in chest, but NO EXPECTORATION. Child stiffens and becomes pale or blue; gasps for breath. P DRY, SPASMODIC COUGH, ENDING IN CHOKING AND GAGGING. Rubrics Mind Ailments from, suppressed anger [2], being scorned [1]. Anger, at noise [1]. Aversion to everything [1]. Capriciousness, rejects the things for which he has been longing [2]. Contemptuous [2], of everything [1]. Delusions, he is unfortunate [1]. Silent grief [1]. Industrious, before menses [1]. Jealousy, desires that others shall not appreciate anything [2/1]. Passionate [2]. Disposition to slander [1]. Head Pain, from fat food [1], from laughing [1], extending to roots of teeth [1/1], extending to root of tongue [2/1]. Eye Lachrymation, when looking steadily [1]. Pain, pressing outward, during headache [1*]. Nose Sneezing, before coughing [2]. Face Coldness, during headache [1]. Throat Choking, when clearing the throat [2]. Stomach Nausea, constant [2], deathly [3], faintlike [2], after eating fats [1], from smell of food [2], from rich food [2], after fruit [2], with haemorrhage [3/1], after ice cream [2], when looking at moving objects [1], after pork [2], after smoking [3], from sweets [2]. Vomiting, during attacks of asthma [1/1], after mother's milk [1]. Rectum Diarrhoea, after sour fruit [2], after the slightest indiscretion in eating [2], after pastry [2]. Female Menses, copious, < cold air [1]. Cough Paroxysmal, attacks follow one another quickly [2]. Sleep Sleepiness, after vomiting [3]. Chill With disordered stomach [2]. Uncovering, undressing > [2].
Perspiration
Cold, with nausea [2], with vomiting [2].
Skin
Itching, not > until he vomits [2/1].
Generals
Faintness,, from odour of cooking food [1], from summer heat [2]. Weakness, during menses, disproportionate to loss of blood [2].
* Repertory addition [Hughes].
Food
Aversion: [3]: Food, smell of. [2]: Fat.
Desire: [3]: Delicacies. [2]: Sweets. [1]: Cold drinks.
Worse: [3]: Veal. [2]: Coffee; fat; food, smell of; fruit; fruit, sour; pork; rich food; tobacco. [1]: Buckwheat; butter; dry food; fried food; frozen food; ice; milk, mother's; pancakes; pastry; raisins; salad; sour; sweets.
 |
| Ipecacuanha |
I'm extraordinarily patient provided I get my own way in the end.
[Margaret Thatcher]
Signs
Cephaelis ipecacuanha. [Psychotria ipecacuanha]. Ipecac Root. 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 Str. ignatii.
DISTRIBUTION The family Rubiaceae 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. Genera such as Cinchona and Cephaelis [Ipecacuanha] are important medicinally. 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, napthalene derivatives, polyphenols, cyanogenic compounds, tannins. The family has been reviewed as a source of emetine type alkaloids, active principles causing violent vomiting. 1
GENUS The genus Cephaelis contains some 180 species of herbs, shrubs and small trees. It is pantropical in distribution. Closely related to Palicourea and Psychotria, some species have been included in these two genera. Some taxonomists do not recognize Cephaelis as a separate genus, and transfer its species to other genera, in most cases Psychotria; hence the name Psychotria ipecacuanha.
SPECIES Cephaelis ipecacuanha is a native of Brazil, flourishing in moist, thick, and shady woods. It is a small, almost herbaceous shrub with a slender rather prostrate stem, growing to 30 cm, and long, straggling roots. It blooms in January and February with very small, white flowers collected to the number of 8, 12, or more into a semiglobular head. Appearing in May, the fruit is an ovate, obtuse berry which is at first purple, but becomes almost black when ripe. The thickened root of this species is of great economic importance as the source of the well-known ipecac. Cultivation has been attempted in South-East Asia, but with limited success.
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| Ipecacuanha |
CONSTITUENTS The major active constituents of Ipecac root are the isoquinoline alkaloids emetine and cephaeline, which exert their effects through activation of the vomiting centre, but also through local irritation in the stomach. Emetine is excreted unchanged in the urine. It appears within 20-40 minutes of an ingested dose and has a long half-life with as much as 35% of the drug being retained after 35 days. Studies have shown that ipecac removes between 30-50 % of the stomach contents depending on the interval between ingestion and emesis. A delay in 30 minutes significantly decreases the effectiveness of ipecac induced emesis to decrease absorption 8 and a delay of greater than 90 minutes renders it essentially ineffective. 2 Emetine and cephaeline belong to the same class of alkaloids as protoberberines [Berberis, Hydrastis], morphine alkaloids [Poppy family] and mescaline [Lophophora].
TOXICITY The roots are most toxic and contain the alkaloid emetine, which weakens the heart. Vomiting occurs within 30 minutes after ingestion but may not be fatal until 24 hours to a week later. Ipecac can be cardiotoxic if not vomited and allowed to be absorbed. The commercially available ipecac syrup comes from the dried roots of the plant. Ipecac syrup may cause persistent vomiting, diarrhoea, lethargy and drowsiness. "Cardiac and skeletal muscle myopathy are the most common manifestations of chronic ipecac use. Myocardial damage may be manifest in a number of ways including tachycardia, hypotension, dyspnoea, precordial chest pain and EKG abnormalities. In addition to cardiac toxicity, there are neuromuscular effects that consist of weakness, aching, tenderness and stiffness of skeletal muscles, especially those of the neck and extremities. Weakness and muscular pain tend to persist until ipecac usage is discontinued; they usually present before the cardiovascular symptoms appear. Mild sensory disturbance and tremor occur rarely."3 The dust of the root produces inflammation of the air-passages and conjunctivitis; applied to the skin in the form of an ointment, it excites a pustular eruption similar to that caused by tartar emetic. Emetine has produced redness, papules, vesicles, pustules and urticaria on the forearms and arms of pharmacists. "In some individuals, the inhalation of the powdered drug provokes decided paroxysms, closely resembling spasmodic asthmatic attacks - the chief symptoms being great dyspnoea, with marked anxiety and prostration, and wheezing respiration and cough. This is often accompanied with violent and prolonged sneezing and spitting of blood. Such attacks are usually followed by a free expectoration of mucus."4
MUNCHAUSEN The abuse of ipecac syrup by anorectics and bulimics, to induce vomiting, has been associated with severe cardiomyopathies and death. Ipecac misuse is also encountered in "children who are victims of the Munchausen by proxy syndrome where ipecac is administered surreptitiously for the purpose of inducing symptoms such as intractable vomiting, intestinal pseudo-obstruction, haemorrhagic colitis, muscle weakness and cardio-myopathy."5 The Munchausen syndrome - also termed Pathologic Malingering, Chronic Factitious Illness, or Hospital Hobos - is characterised by repeated fabrication of illness, usually acute, dramatic, and convincing, by a person who wanders from hospital to hospital for treatment. In a bizarre variant of the syndrome, a child may be used as a surrogate patient. [This has been referred to as 'Munchausen by proxy.'] The parent falsifies history and may injure the child with drugs, add blood or bacterial contaminants to urine specimens, etc. - all in order to simulate disease. 6
MEDICINE "The Portuguese learned of this Indian remedy for bowel problems when they settled Brazil, and the root was introduced to Europe around 1672 as a remedy for dysentery. Originally sold in Paris as a secret remedy, the plant showed such value in bowel affections that no less a personage than Louis XIV eventually heaped a large sum of money and public honours on the physician who popularized its use, on the condition that he make it public. Like many other similar drugs, ipecac is emetic only in large doses; in intermediate doses it is nauseant, diaphoretic, and expectorant; in small doses it is a mild stomach stimulant, increasing the appetite and aiding digestion. Very small doses have also been used to treat the vomiting of pregnancy. When used as a nauseant, ipeca was also observed to exert a sedative effect on the vascular system; hence it came to be employed for haemorrhages, particularly of the uterus."7 Combined with opium and potassium sulphate, under the name of Dover's powder, ipecac was in the 19th century considered one of the best diaphoretics in rheumatism and slight febrile affections. Due to its astringent properties, Dover's powder was also much employed for the treatment of diarrhoea and dysentery. Although often replaced by activated charcoal, ipecac syrup is still used in some hospital casualty departments for the treatment of cases of poisoning in children and sometimes adults. It is also commonly found in many patent cough medicines for the treatment of bronchitis and whooping cough.
PROVINGS •• [1] Hahnemann - 4 provers; method: unknown.
•• [2] Bock - self-experimentation, 1829; method: repeated doses of 1/2 to 15 grains.
•• [3] Lembke - self-experimentation; method: two doses of 1/2 grain of Ipeca-root, effects recorded for 2 days.
[1] Schultes and Raffauf, The Healing Forest. [2-3] Perry, Ipecac; Clinical Toxicology Review, Oct. 1995; Massachusetts Poison Control System. [4] King's American Dispensatory. [5] Perry, ibid. [6] Merck Manual. [7] Weiner, Weiner's Herbal.
Affinity
MUCOUS MEMBRANES [DIGESTIVE TRACT; stomach; RESPIRATORY; lungs]. Nerves [pneumogastric; spinal; cutaneous]. Umbilicus. * Right side. Left side.
Modalities
Worse: WARMTH; damp warmth; warm room; warm moist, south winds. Overeating [ice cream; pork; veal; mixed or rich foods; fruits; salad; fats]. Periodically. Quinine. Heat and cold. Recession of eruptions. Slightest motion. Winter and dry weather. Autumn. Cold nights after hot days. Stooping [vomiting].
Better: Open air.
Main symptoms
M Discontented - hard to please.
• "His disposition is full of wishes and longing he knows not for what."
• "He has pleasure in nothing, nothing is agreeable to him."
• "Everything is repugnant to him." [Hahnemann]
• "The Ipecacuanha subject manifests extreme impatience, and is described as being full of desires which are vague and ill-defined. This leads to discontent and a tendency to be scornful of anything and everything. Children wail and scream continuously; adults are sulky and ill-humoured all day long. Everything is repugnant - a psychological nausea and disgust." [Gibson]
c Ailments from vexation and reserved displeasure. [Hering]
M Contempt.
• "Sullen unsociable moroseness, that makes him disdain everything."
• "Sulky humour, that despises everything, and he desires that others also should not esteem or care for anything." [Hahnemann]
M Thinks himself unfortunate.
[Hahnemann comes up with exactly the same symptom in his proving of China.]
G Ailments, PAINS and CONSTANT NAUSEA and vomiting.
Nausea not > by vomiting.
• "Adapted to cases where the gastric symptoms predominate." [Allen]
• "One of the best guides to the use of this remedy, is a constant but unavailable desire to vomit; or immediately after vomiting they wish to do so again." [Guernsey]
• "Pallor predominates, and a typical facies nauseatica may be present with down-turned corners of mouth and well-defined nasolabial furrow. This is especially likely to be observed in children and will call to mind two other remedies, Aethusa and Antimonium tartaricum." [Gibson]
G Great CHILLINESS.
• "There is no warmth in the body at all; the slightest cold is unbearable." [Gibson]
c Becomes hot and sweaty [and nauseous] during spasms of pain.
G NO THIRST.
G < FAT food, pork, pastry, candy, etc.. G < Cold and heat. < Cold dry weather. G < HEAT. < Warm south wind. Faintness from summer heat; faintness in warm room. G < Eating FAST. G Haemorrhages of bright red colour and sudden. [epistaxis, haemorrhoids, menstruation, haematemesis] • "Uterine haemorrhages, with bright red flow, usually with vomiting and dyspnoea is definitely Ipec." [Morrison] • "Quite a number of adolescent girls have violent dysmenorrhoea. Characteristically they are rather warm-blooded people, and with the spasms of pain - they very often describe it as cutting pain in the lower abdomen - they become hot and perspiring, with acute nausea. They cannot stand up and any movement makes them worse. They have a perfectly clean tongue and a normal temperature. Very often Ipecac. will stop the attack as well as the tendency to dysmenorrhoea. It is one of the very useful remedies for colic, and tends to be overlooked." [Borland] c Characteristic for the dysmenorrhoea, according to Guernsey, is a pain about the umbilicus running to the uterus. G Respiratory ailments and NAUSEA and CLEAN TONGUE. • "Constant nausea with a clean tongue is the watchword." [Dewey] G Gastric ailments [NAUSEA] and constant SALIVATION. G Weakness AFTER MENSES. P COLDS [in children]. Starting with obstruction of the nose at night. Followed by hoarseness and suffocative, spasmodic cough. And Retching and vomiting. P VOMITING < STOOPING. P Bronchiolitis, bronchitis or asthma with spasmodic, suffocative cough. And Retching and VOMITING. RATTLING, great accumulation of mucus in chest, but NO EXPECTORATION. Child stiffens and becomes pale or blue; gasps for breath. P DRY, SPASMODIC COUGH, ENDING IN CHOKING AND GAGGING. Rubrics Mind Ailments from, suppressed anger [2], being scorned [1]. Anger, at noise [1]. Aversion to everything [1]. Capriciousness, rejects the things for which he has been longing [2]. Contemptuous [2], of everything [1]. Delusions, he is unfortunate [1]. Silent grief [1]. Industrious, before menses [1]. Jealousy, desires that others shall not appreciate anything [2/1]. Passionate [2]. Disposition to slander [1]. Head Pain, from fat food [1], from laughing [1], extending to roots of teeth [1/1], extending to root of tongue [2/1]. Eye Lachrymation, when looking steadily [1]. Pain, pressing outward, during headache [1*]. Nose Sneezing, before coughing [2]. Face Coldness, during headache [1]. Throat Choking, when clearing the throat [2]. Stomach Nausea, constant [2], deathly [3], faintlike [2], after eating fats [1], from smell of food [2], from rich food [2], after fruit [2], with haemorrhage [3/1], after ice cream [2], when looking at moving objects [1], after pork [2], after smoking [3], from sweets [2]. Vomiting, during attacks of asthma [1/1], after mother's milk [1]. Rectum Diarrhoea, after sour fruit [2], after the slightest indiscretion in eating [2], after pastry [2]. Female Menses, copious, < cold air [1]. Cough Paroxysmal, attacks follow one another quickly [2]. Sleep Sleepiness, after vomiting [3]. Chill With disordered stomach [2]. Uncovering, undressing > [2].
Perspiration
Cold, with nausea [2], with vomiting [2].
Skin
Itching, not > until he vomits [2/1].
Generals
Faintness,, from odour of cooking food [1], from summer heat [2]. Weakness, during menses, disproportionate to loss of blood [2].
* Repertory addition [Hughes].
Food
Aversion: [3]: Food, smell of. [2]: Fat.
Desire: [3]: Delicacies. [2]: Sweets. [1]: Cold drinks.
Worse: [3]: Veal. [2]: Coffee; fat; food, smell of; fruit; fruit, sour; pork; rich food; tobacco. [1]: Buckwheat; butter; dry food; fried food; frozen food; ice; milk, mother's; pancakes; pastry; raisins; salad; sour; sweets.
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