Moderator: prof. B. Ramaswamy
Family: Rubiaceae (Ip, Coff)
Species: officinalis, ledgeriana, succirubra, calisaya
Synonyms: Quinaquina officinalis, Quinaquina lancifolia, Quinaquina coccinea
Common names: Quinine bark, quina, quinine, kinakina, China bark, cinchona bark, yellow cinchona, red cinchona, Peruvian bark, Jesuit's bark, quina-quina, calisaya bark, fever tree
preparation: tincture of dried bark
Dr. Cullen was an authority on the subject of the Materia Medica of his day, an experienced lecturer, a talented chemist, and a brilliant and popular teacher in Edinburgh. Cullen published the first edition of his book (A Treatise on Materia Medica), in London, in 1773. Another edition was issued in 1789 in two volumes, and it was this edition that Hahnemann used in translation. In this book, Volume II, Cullen devotes about twenty pages to Cortex Peruvianis (Peruvian Bark), giving its therapeutical uses in the treatment of intermittent and remittent fevers, advises its use to prevent the chill, and gives minute directions for the safest period of the disease in which to use it. (Cullen died in 1790).
The result of experiment with Peruvian bark will be given in Hahnemann's own words. In the translation of William Cullen's “Materia Medica," Leipsic, Schweikert, 1790, page 108 of Volume II, appears the following footnote by Hahnemann. "Substances which excite a kind of fever, as very strong coffee, pepper, Aconite, Ignatia, Arsenic, extinguish the types of the fever. I took by way of experiment, twice a day, four drachms of good China. My feet, finger ends, etc., at first became cold ; I grew languid and drowsy ; then my heart began to palpitate, and my pulse grew hard and small ; intolerable anxiety, trembling (but without cold rigor), prostration throughout all my limbs then pulsation in my head, redness of my cheeks, thirst, and, in short, all these symptoms, which are ordinarily characteristic of intermittent fever, made their appearance, one after the other, yet without the peculiar chilly, shivering rigor." " Briefly, even those symptoms which are of regular occurrence and especially characteristic - as the stupidity of mind, the kind of rigidity in all the limbs, but, above all the numb, disagreeable sensation, which seems to have its seat in the periosteum, over every bone in the body - all these make their appearance.
This paroxysm lasted two or three hours each time, and recurred if I repeated this dose, not otherwise; I discontinued it, and was in good health." (Brit. Jour. of Hom., Vol. 24, p. 207. Ameke, p. 103.)
Cinchona derives its name from countess of Cinchon, wife of viceroy of Peru, who was the means of introducing the Peruvian bark in Europe, in 1640, for the cure of intermittent fever. Cinchona contains five alkaloids, two simple acids, two tannic acids and a resinoid. The alkaloid quinia which is found most abundant in the yellow or calisaya bark is the one most frequently used by the old school. It insoluble in saliva and soluble in combination with gastric juice, but most active form is combination of quinia and sulphuric acid, the ordinary quinine.
The genus Cinchona contains about forty species of trees. They grow 15-20 meters in height and produce white, pink, or yellow flowers. All cinchonas are indigenous to the eastern slopes of the Amazonian area of the Andes, where they grow from 1,500-3,000 meters in elevation on either side of the equator (from Colombia to Bolivia). They can also be found in the northern part of the Andes (on the eastern slopes of the central and western ranges). They are now widely cultivated in many tropical countries for their commercial value, although they are not indigenous to those areas.
Cinchona, or quinine bark, is one of the rainforest's most famous plants and most important discoveries. Legend has it that the name cinchona came from the countess of Chinchon, the wife of a Peruvian viceroy, who was cured of a malarial type of fever by using the bark of the cinchona tree in 1638. It was supposedly introduced to European medicine in 1640 by the countess of Chinchon, even before botanists had identified and named the species of tree. Quinine bark was first advertised for sale in England in 1658, and was made official in the British Pharmacopoeia in 1677. Physicians gave credit to the drug and, because of its effectiveness with malaria; it was recognized officially even while the identity of the tree species remained unknown. Several years after the "Countess's powder" arrived in England, it arrived in Spain. There, quinine bark was used by the Jesuits very early in its history and due to the influence of the Company of Jesus, the newly named "Jesuit's powder" became known all over Europe. When the plant was finally botanically classified almost one hundred years later in 1737, botanists still named it after the countess for her contribution. Throughout the mid-1600s to mid-1800s quinine bark was the primary treatment for malaria and it evidenced remarkable results. It was also used for fever, indigestion, mouth and throat diseases, and cancer.
Natural quinine bark is still employed in herbal medicine systems around the world today. In Brazilian herbal medicine quinine bark is considered a tonic, a digestive stimulant, and fever-reducer. It is used for anemia, indigestion, gastrointestinal disorders, general fatigue, fevers, malaria and as an appetite stimulant. Other folk remedies in South America cite quinine bark as a natural remedy for cancer (breast, glands, liver, mesentery, and spleen), amebic infections, heart problems, colds, diarrhea, dysentery, dyspepsia, fevers, flu, hangover, lumbago, malaria, neuralgia, pneumonia, sciatica, typhoid, and varicose veins. In European herbal medicine the bark is considered antiprotozoal, antispasmodic, antimalarial, a bitter tonic, and a fever-reducer. There it is used as an appetite stimulant, for hair loss, alcoholism, liver, spleen, and gallbladder disorders; and to treat irregular heart beat, anemia, leg cramps, and fevers of all kinds. In the U.S., quinine bark is used as a tonic and digestive aid; to reduce heart palpitations and normalize heart functions; to stimulate digestion and appetite; for hemorrhoids, varicose veins, headaches, leg cramps, colds, flu, and indigestion; and for its astringent, bactericidal, and anesthetic actions in various other conditions.
In 1820 two scientists, Pelletier and Caventou, isolated an alkaloid chemical in the bark which provided the highest antimalarial effect and named it quinine. Once discovered, methods were developed to extract only the quinine alkaloid from the natural bark to sell as an antimalarial drug.
The South American rainforests benefited from the income generated by harvesting cinchona bark for the extraction of this alkaloid from the bark for the manufacture of quinine drugs. In the middle of the 19th century, though, seeds of Cinchona calisaya and Cinchona pubescens were smuggled out of South America by the British and the Dutch. The calisaya species was planted and cultivated in Java by the Dutch and the pubescens species was cultivated in India and Ceylon by the British. However, the quinine content of these species was too low for high-grade, cost effective, commercial production of quinine. The Dutch then smuggled seeds of Cinchona ledgeriana out of Bolivia, paying $20 for a pound of seeds, and soon established extensive plantations of quinine-rich cinchona trees in Java. They quickly dominated the world production of quinine and, by 1918; the majority of the world's supply of quinine was under the total control of the Dutch "kina burea" in Amsterdam. Huge profits were reaped - but Bolivia and Peru, from whence the resource originated, saw none of it.
The upheavals of the Second World War led to changes in the market which still remain in effect today. When Java was occupied by the Japanese in 1942, the Allies' supply of quinine was cut off. South American sources of cinchona trees and quinine bark were once again in demand, but new plantations were planted by the Allies in Africa as well. This dire shortage of quinine fueled research for developing and producing a synthetic version of the quinine alkaloid rather than relying on the natural bark. In 1944 scientists were able to synthesize the quinine alkaloid in the laboratory. This led to various synthesized and patented quinine drugs which were manufactured by several pharmaceutical companies and which were of course, highly profitable. Today, Indonesia and India still cultivate cinchona trees; however Africa, with their expansions of the old WWII plantations, has emerged as the leading supplier of quinine bark. Much lower on the list of producers are the South American countries of Peru, Bolivia, and Ecuador, still struggling to compete. Although all cinchona species are good sources of quinine, C. succirubra and C. ledgeriana are the species containing the highest amount of quinine alkaloids - which is why they are the species of choice for cultivation today.
The cardiac effects of cinchona bark were noted in academic medicine at the end of the 17th century. Quinine was used sporadically through the first half of the 18th century for cardiac problems and arrhythmia and it became a standard of cardiac therapy in the second half of the 19th century. Another alkaloid chemical called quinidine was discovered to be responsible for this beneficial cardiac effect. Quinidine, a compound produced from quinine, is still used in cardiology today, sold as a prescription drug for arrhythmia. The sales demand for this drug still generates the need for harvesting natural quinine bark today because scientists have been unsuccessful in synthesizing this chemical without utilizing the natural quinine found in cinchona bark.
The most import of the cinchona alkoloids are –
Quinine – C20H24O2
Quinidine -- C20H24O2
Cinchonine – C20H24N2O
Cinchonidine – C20H24N2O
Quinamine – C20H24N2O2
Quinic Acid – C7H12O6
Cincho tannic acid
Quinovic acid – C24H38O4
The main plant chemicals found in quinine bark include: aricine, caffeic acid, cinchofulvic acid, cincholic acid, cinchonain, cinchonidine, cinchonine, cinchophyllamine, cinchotannic acid, cinchotine, conquinamine, cuscamidine, cuscamine, cusconidine, cusconine, epicatechin, javanine, paricine, proanthocyanidins, quinacimine, quinamine, quinic acid, quinicine, quinine, quininidine, quinovic acid, quinovin, and sucirubine.
Table: Alkaloid Content Comparison by Cinchona species
Species Total Alkaloids (%) Quinine Content (%)
C. calisaya 3 - 7 0 - 4
C. pubescens 4.5 - 8.5 1 - 3
C. officinalis 5 - 8 2 - 7.5
C. ledgeriana 5 -14 3 - 13
C. succirubra 6 - 16 4 - 14
REGION: BLOOD, CIRCULATION, SECRETIONS – digestive organs, liver, spleen, nerves.
Centre of action of cinchona and its alkaloid sulphate of quinine is ganglionic nervous centres that control the function of organic life, and the base of the brain. Its great action is to cause the debility of ganglionic nutritive fibres. Debility is to nervous system what anemia is to blood, and that is the great field for the action of quinine. Its medical effect is to build up and prevent the destruction of nervous tissue may be called as great conservator and builder of ganglionic nervous system. The action on the brain is powerful and specific, especially centers upon the base of brain affection those lobes that control the organic function of the system and parts that controls emotional and intellectual functions are only affected sympathetically. This is why it seldom produces mental excitement, delirium and come. But its specific action upon the base of the brain is constantly shown as disturbance of hearing, loss of sight and reflex muscular movements of circulation and respiration. The ganglia in which produces such debility and prostration at the base of brain are corpora, striata optic thalami and corpora quadrigemina. From debility and prostration of these organs arises congestion of brain, but congestion hardly ever produces inflammation.
Debility from exhausting discharges, from loss of vital fluids (loss of blood, diarrhoea, profuse and exhausting sweat, prolonged lactation, sexual excess etc.), together with a nervous erethism, calls for this remedy. Continuous and chronic loss of fluids. Loss of fluids may have happened long before the occurrence of the symptoms.
Persons who have suffered much from neuralgias due to malarial influences, who have become anaemic and sickly from repeated haemorrhages, are likely to develop symptoms calling for China.
Periodicity is most marked. Severe acute diseases like influenza, lack of sleep by night watching, prolonged mental exertion. Seldom indicated in the earlier stages of acute disease.
China produces a gradually increasing anaemia, with great pallor and weakness. It is sometimes indicated in plethoric individuals, but this is the exception, and even in this class we find that the symptoms are tending towards the cachectic state.
Throughout the body there is a gradually increasing sensitivity, a gradually increasing irritability of the nerves. Nervous erethism, extremely sensitive to all external influences. Increasingly sensitive to touch, to motion, to cold air, so that he is chilled from exposure. The pains are brought on by exposure to the wind, by cold air, and are increased by motion and touch.
Old malarial conditions that have been suppressed with quinine; gradually increasing pallor, bloodlessness, cachexia, until the patient is always catching cold, has liver troubles, bowel troubles, disordered stomach, is made miserable and sick by nearly everything he does. cannot eat fruit without having indigestion; cannot eat sour things.
This patient bleeds easily; bleeds from any orifice of the body from the nose, from the throat, from the uterus. And after hemorrhage complaints come on. Tendency to congestion and often inflammation, in connection with hemorrhages. Inflammation of the part that bleeds or of distant parts. For instance, a woman aborts, has a haemorrhage, but with apparently no provocation, inflammation of the uterus or of the lungs sets in. With these inflammations there is also great irritability of the tissues, tearing pains, cramping in the muscles and actual convulsions (Secale). Another feature about this inflammation is its rapid progress and intensity, quickly going into gangrene. Inflammation after haemorrhage and the parts rapidly turn black. China has a fullness of the veins. Not exactly a varicose condition, but a sort of paralysis of the coatings of the veins. The veins become full during fever.
Sensitive to the odors of flowers, of cooking, of tobacco. Weak, relaxed, emaciated, pale, with feeble heart, feeble circulation and tendency to dropsy. Dropsy that comes after hemorrhage.
Periodicity, Pains come on with regularity at a given time each day. Intermittent fevers appear with regularity and run a regular course. A part of this periodicity is an aggravation at night, and sometimes sharply at midnight. In colic that comes on regularly every night at 12 o'clock. Haemorrhage from the nose coming on with regularity. Diarrhoea at night. Several gushing, black, watery stool; during the night; in the daytime, only after eating.
China is indicated in conditions following the loss of blood and other animal fluids; as, for instance, in those who are suffering from sexual excesses, from secret vice. They have become feeble, sleepless and irritable.
Mind: Weakness of mind. Inability to think or remember. He is unable to control the mind, to make it do what he wants it to do. Intolerance of superficial gesture of support or consolation. Peevish, angry, and easily flies into a temper. Discontented and sensitive mood, inclined to quarrelling. Most violent anger, he’d like to stab someone. Irritable, anything can irritate them, provoking fits of passion or very hurtful, sarcastic comments.(Nux.v). Sudden changes of mod occur. The ill humor is increased by petting and caressing, he prefers to be alone. Introvert. (Nat.m, Ign). Self sufficient in their emotions. They do not seek and do not need the approval of others. Excessive vividness of mind and fancy make the individuals to feel very intensely, make the people endowed with great imaginative powers and gravitate to artistic pursuits, especially poetry. (Ign – tends more to be musician). He is apathetic, indifferent, low spirited, silent, disinclined to think. Closed, reticent, withdrawn into themselves. (Nat.m). Lies awake at night making plans, theorizing, building air castles, thinking of the wonderful things he is going to do some day. He makes a lot of big plans for the future. In the morning he wonders how he could have thought such foolish things. [Nat.m – dwells on the occurrences of the day when they are in bed, but dwells on past unpleasant events (pessimistic), Staph – romantic. Sexual, erotic compelled to masturbate]. Aversion to physical and mental exertion. Very difficult to communicate and deal with other people. Direct communication of gratitude and appreciation is very difficult. Full of fear at night. Fear of animals, dogs, of creeping things. Wants to commit suicide, but lacks courage. Gradually the mind grows weaker; he uses wrong expressions or misplaces words. Slow flow of ideas. Periodic stand still of thinking. This state of mind comes on after haemorrhage. Insomnia after haemorrhage. Uneasy sleep at night, with dreams that cause anxiety and starting up, on waking from which he cannot collect his senses or about which he continues to be anxious. Vivid dreams. A woman, after having suffered great loss of blood, will be sleepless night after night. The woman after severe haemorrhage does not make blood. There is mal-assimilation, and the vertigo persists for days and weeks
Head: Congestive headaches in broken down constitutions. Pressing and throbbing, as soon as the air strikes the head. Headache better in a warm room; worse from touch; worse from motion; worse from cold. Hard pressure ameliorates the China pains, as light pressure aggravates. The jar and motion of walking hurt the head. Even turning over in bed aggravates. Cannot ride in a carriage or anything that jolts. Profuse sweating of the scalp. Headaches aggravated at night. Headaches from sexual excesses; loss of animal fluids.
Eyes: Photophobia. Yellowness of the sclera, Exposure to cold wind will bring on neuralgia; ameliorated from keeping quiet and from keeping warm. Nocturnal blindness, dimness of vision. Feeling as if sand were in the eyes. Pains worse from light. Better in the dark.
Ears: Every little noise is painful. Ringing; roaring, buzzing, and singing, chirping like crickets in the ears. Dry catarrh of the middle ear. It gradually increases until there is total deafness, and the noises in the ear continue long after the patient has lost the ability to distinguish articulate sounds. Haemorrhage from the ear. Offensive, bloody, purulent discharges.
Nose: Frequent nosebleed in anemic patients. Odors nauseate. Sensitiveness to the odors of flowers, cooking, tobacco. Influenza with debility. Coryza, sneezing, watery discharge. Violent dry sneezing. Cold sweat about nose.
Face: The face is withered, shrunken, sallow, anaemic, sickly. Red when the fever is on and sometimes when the chill is on, but in the apyrexia pale, sickly and sallow. Neuralgia of the face; tearing, rending, knifelike pains with the usual modalities. The veins of the face are distended. This is frequently observed during the fever and sweat of the China intermittents.
Teeth: The teeth get loose, the gums swell. The teeth are painful while chewing; they feel too long. Toothache with every little cold. Rending as if teeth were being pulled out, every time the child nurses at the breast. Exudations about the teeth and gums. Black, and foetid great putridity in the lower forms of fever.
Taste: The taste is extremely acute. Exaggerated so that nothing tastes natural. Bitter taste in the mouth. Food tastes bitter or too salty. Burning as from pepper on tip of the tongue. Dryness in the mouth and throat. Difficult swallowing. Sometimes there is canine hunger, but one of the most common features is loathing of everything; aversion to all food. Loathing and violent hunger. Hunger and yet want of appetite. Indifference to eating and drinking. Only while eating some appetite and natural taste for food return.
Loss of appetite. Aversion to all food. Aversion to bread. Ill effects of tea. Milk disagrees. Thirst is peculiar. The patient will say: "I know my chill is coming on now because I have thirst."
Thirst: before the chill, but as soon as the chill comes on there is no thirst. But when he begins to warm up he begins to get thirsty; that is during the period in which the two overlap he is thirsty, but when the chill has fairly subsided and the heat is upon him his thirst subsides also and he only wants to wet his mouth. But as the hot spell begins to subside he increases the amount taken, and all through the sweat he can hardly get water enough. Thirst before and after the chill and thirst during the sweat. No thirst during the chill. No thirst during the hot spell. You will cure more cases of intermittent fever with Ipecac and Nux vomica, than with China. China has well-defined chill, fever and sweat.
Stomach: Gastric symptoms from eating fish, fruit, and from drinking wine. Flatulent distension almost to bursting. There are constant eructations, loud and strong, and yet no relief. In Carb. veg. after belching a little, there is relief. Lyc. has both. Tympanitic distension of the abdomen and stomach in low forms of fever. Vomiting of blood. Sometimes followed by dropsy of the extremities. Hiccough.
Nausea. Vomiting. Eructations, tasting of food, or they are bitter, sour. Frequent vomiting. Vomiting of sour mucus, bile, blood. Likely to occur at night. Pulsation in the stomach and rumbling. Cold feeling in the stomach. Fermentation after eating fruit. Acidity. Disorders of the stomach after milk.
Diarrhoea: Copious, watery black discharges from the bowels. Undigested, froathy, yellow, painless worse at night, immediately after eating, fruit, during hot weather. Gurgling and rumbling in the abdomen. Great quantities of flatus expelled from the bowels. Diarrhea comes on gradually. Stools more and more watery. Chronic diarrhoea, with emaciation and aggravation at night. Petroleum has a chronic diarrhoea, but only in the daytime.
Genitals: Of the male genital organs the most striking feature is weakness. Hemorrhage from the uterus. Prolapse. Menses, too early and too profuse; black, clotted blood; menstrual colic; metrorrhagia. Pains and convulsions; convulsions come on in the midst of the haemorrhage; cramps in the uterus along with haemorrhage; labor-like pains; ringing in the ears; loss of sight; sliding down in bed. In confinement the lochia is profuse and lasts too long. Deterioration of health from prolonged lactation; toothache; neuralgia of the face.
Respiration: Difficult respiration, rattling and filling up of the chest with mucus asthma.
Pressure in the chest, as from violent rush of blood; violent palpitation, bloody sputa, sudden prostration. Dry, suffocative cough at night; profuse night sweats. Pains in the chest, increasing sensitiveness to cold, heat and redness of the face with cold hands.
Fever: intermittent, paroxysms anticipate from two to three hours each attack, return every week or fortnight, never at night. All stages well marked. Chill in forenoon, commencing in breast, thirst before chill and little and often. Debilitating night sweats all over on being covered, or during sleep. Free perspiration esp. on single parts. On icy cold and other is warm.
Along the spine there are sore spots.
"Knees weak, especially when walking."
China cures low, forms of fever, remittent or intermittent, typhoid or malarial.
Worse: vital loses, touch, jar, noise, periodically – alternate days (Nat.m, Ars), cold draft; wind, open air, eating fruit, milk, mental exertion
Better: hard pressure, loose clothing (Lach)
Compare. - (Cinchona or China)
Arn., Ars., Bell., Calc. c., Ced., Coff., Ferr., Graph., Lyc., Merc., Natr. mur., Nux v., Phos., Phos. ac., Puls., Sulph., Tarant.
Complememtary: Ferr, Calc.p
Antidotes. - (Cinchona or China)
Aran., Arn., Ars., Bell., Calc. c., Carb. v., Eupat. perf., Ferr., Ipec., Lach., Merc., Natr. mur., Nux v., Puls., Sep., Sulph., Verat. alb.
Ars., Ipec., Ferr., Cupr.