Aesculus hippocastanum. Horse chestnut. N.O. Sapindaceae.
The horse chestnut is only used as a remedy on the homoeopathic principle and there are no laboratory tests or poisonings on which to base a pathogenesis. Provings supplemented by clinical records supply the information we possess as to its powers. A tincture is made from the ripe decorticated nut.
The chief effect of aesculus falls upon the upper and lower ends of the alimentary canal (pharynx and rectum), on the venous system generally, on the back the nasal cavities and the joints.
The Drug Irritates the Nasal Mucous Membrane.- Acute coryza, with thin watery discharge sneezing, a feeling of fulness or stuffiness, mucus in the posterior nares passing into the pharynx these are early effects. Or the nose may be dry raw, sensitive to cold air.
Throat.- Irritation of the fauces and pharynx is shown by dark red colour of the mucous membrane, soreness or pain on swallowing, frequent swallowing a burning, raw feeling; a sense of constriction and of stiffness may be present. The appearance is that of follicular pharyngitis and, after the acute stage is over, the veins of the throat are left in a dilated varicose condition.
The eyes suffer in a similar manner heat redness lachrymation may be associated with the coryza, leaving dilated vessels.
Rectum and Anus.- Passing over the intermediate portions of the alimentary tract (which are less markedly affected), the lower end of the rectum and the anus are strikingly irritated. The following expressions are used, singly or in combination to describe the conditions and sensations produced, some on one prover and some on others; Dryness, heat, sensation of fulness and of foreign bodies in the anus, e.g., small sticks or splinters, itching burning after stool and pain shooting up the rectum. In some cases piles were produced. Along with the feeling of fulness or as an advanced stage of the same an actual swelling of the mucosa and an incipient prolapse may come on. After stool the wall of the bowel may remain down for some time.
The usual condition of the bowel is one of constipation; the stool is large and hard; it is dry and difficult to pass; ineffectual urging may be present. Or diarrhoea the lining were thickened and obstructed the passage of the faeces.
Back.- Associated with these rectal symptoms there is usually a more or less pronounced backache-a lumbosacral pain or pain extending from the back to the hip and in the sacro-iliac joints. At the worst it is very severe, impeding movement and compelling rest which relieves. Walking and especially stooping, increase the pain. In getting up from sitting the back is very stiff and painful.
Digestive system.- Though less conspicuous than the symptoms narrated there is evidence of a general disturbance of digestion, indicative probably of catarrh and of portal congestion. Indeed, the hepatic symptoms have not received enough attention and have not been sufficiently utilized.
Mouth.- The tongue is coated white or yellow and may feel “scalded” or sore, a bitter or metallic taste may be complained of and salivation is a frequent symptom, often associated with or consequent upon nausea, which is a frequent effect. This may go on to retching or vomiting. The face looks pale and sickly. Eructations occur, often tasting of the food or causing the food to “repeat” or there may be sour bitter or merely tasteless “wind” One of the gastric and the sensation of a stone there or between the shoulders. From the epigastrium a pain may shoot to the region of the liver which area maybe decidedly tender to the touch as indeed, the whole abdomen may be. Distension, rumbling and the passing of foul flatus add to the patient’s sufferings.
Head.-Again in association with the digestive symptoms and the piles there is usually headache of no very pronounced type; it is frequently frontal with a feeling of something (commonly interpreted as “the brain”) pressing outwards. Flushes of heat over occiput neck and shoulders occur. With the headache is a confused, heavy feeling; and a heavy feeling of the eyelids, amounting to drowsiness. Yawning and vertigo are frequent features. The pains shoot laterally, left to right and right to left not more one way then the other; frontal and parietal pains.
The mental state varies but it is mainly a not unusual combination of dulness or gloom, absent-mindedness and lack of power to concentrate the thoughts with irritability if crossed or in any way opposed, or obliged to do things he dislikes doing. The patient or prover easily loses his temper.
There may be a dazed feeling on walking the prover not recognizing the place in which he is or the people surrounding him. This is a temporary feature quickly passing off, but not uncommon with indigestion. It resembles the distress on waking found under lachesis. Or sadness, loss of memory and disinclination and inability for work, may be present.
Respiration is not much affected. There may be temporarily a very tickling cough with raw feeling in the chest as after taking cold, with expectoration of sweetish stringy phlegm. A sharp pain, worse in the right chest and aggravated by taking a deep breath, has been observed.
Generalities.- A somewhat vague feeling attributed to the drug by provers and patients. It is described as a fulness in different parts of the body-limbs, head, abdomen-as if the parts contained too much blood. This causes a feeling of heaviness, weakness, or loss of power (paralysed feeling) in limbs. The patient can hardly walk and may feel faint.
Associated with the liver symptoms there very commonly occur itching and tickling of the skin in any part of the body. Pulsation felt in the cardiac region (palpitation) and extending to or felt in the limbs, is experienced by the aesculus patient, usually in association with headache and hepatic symptoms.
Fever.- General chilliness and shivering like ague have been described.
Muscular and joint symptoms are met with but they are chiefly clinical, and will be mentioned under the head of therapeutics.
The foregoing account if successful, presents a picture of a fairly wide, but sufficiently defined symptom-complex which in the past has been held to be explained by assuming a certain amount of irritation of mucous surfaces associated with a generalized venous stasis especially in the portal circulation. Whether this explanation be physiologically and pathologically correct, time will show. Clinically the complex is found to exist, whatever its interpretation, and it is met by aesculus as a remedy whether occurring in whole or in Part.
It is unnecessary to go over the whole field again the elements of the “complex” (or picture) being partly derived from provings and partly from cured symptoms.
Here and there precisionizing features may be added.
The patient requiring aesculus may resemble one calling for pulsatilla in some of the features of his case. That drug also effects the venous system, and some of the symptoms of the two drugs correspond, with fine differences. The general symptoms of both drugs (and of their corresponding patients) are improved by bodily exercise (e.g. head and digestion), but the aesculus case requires vigorous exercise to improve the circulation and general metabolism, whereas the pulsatilla case requires gentle movement. Both are better for cool fresh air, but the aesculus case is more frequently benefited by local heat, e.g., painful joints or stinging neuralgic pains.
Another feature resembling a pulsatilla is that the superficial pains of aesculus-sharp, shooting or tearing pains- frequently change their seat and more rapidly from one area to another. These changes do not affect so many sites and functions as is the case with pulsatilla.
In the provings the test is not always carried so far as to induce piles where none existed (though that did actually happen), yet the counterpart clinically (i.e., the cure of piles) is a very constant feature. The piles are large purple protrusions, which feel full to bursting, but they do not often burst (i.e., bleed), they are called blind. They may took “almost as if they would slough” (Kent, loc, cit). To ensure the success of the prescription, the backache described, the headache and the mental condition (dulness plus irritability) should be present. Constipation is not so constantly present in haemorrhoids requiring aesculus as in those needing nux vom., sulphur or collinsonia. Other varicosities may be helped by our drug, e.g., varicose ulcers of legs, when the skin round the ulcer is dusky or purplish and the other feature of the patient correspond. When the veins become inflamed then puls, or hamamelis will (probably) replace aesculus.
The backache, too, suggests other remedies-sepia, lycopodium or antim. tart. It may exist without piles being obvious, but the general digestive and without piles being obvious, but the general digestive and mental features should then be prominent to justify the selection of aesculus. In pelvic congestion in women with the same backache., with marked aggravation from walking bearing down, and leucorrhoea (thick and yellow), aesculus should be considered. It is found in cases of pregnancy and uterine prolapse.
Sore throat need not be further considered, having already been sufficiently described.
One other sphere, chiefly brought out clinically, is joint and muscle pains-so called gout and rheumatism. There is general muscular soreness or aching. Pains in the joints-chiefly of the upper extremities-may move rapidly from place to place, and be relieved by local heat. Clinically, tenderness on pressure over the sacro-iliac joints and pain there, which may extend down the leg like sciatica, furnish useful indications for aesculus.
Apart from the general symptoms of aesculus it will hardly be called for in respiratory diseases, but if these complicate the aesculus case they will be covered by the drug-tickling cough, stitches in the chest wall, &c, as described.
(1) Piles with or without constipation but with backache- with modalities mentioned.
(2) Sore throat.
(3) Hepatic pains with indigestion and abdominal distension. Pain after defecation.
(4) Varicose veins and ulcers, with bluish margins.
(5) Depression and irritability, combined or alternating.
Motion and walking (especially the back); stooping or rising (back); inspiration of cold air (coryza or cough), heat (general) with exception in case of muscular (rheumatic) local pains. On waking.
Fresh air (head and general)m warmth (local pains), Rest (back); vigorous exercise relieves headache and hepatic symptoms.