Citrullus colocynthis. Cucumis colocynthis. Bitter apple, N.O. Cucurbitaceae. Tincture of the pulp of the fruit.
PATHOGENESIS.
The colocynth fruit contains a glucoside called colocynthin, which produces profuse watery stools, with much pain and frequently tenesmus.
In cases of poisoning the bowel is acutely inflamed and blood is passed in the stool with shreds of epithelium. The stomach is also irritated and nausea and vomiting occur. The rectum is inflamed, and in one case the intestines were glued together by recent lymph, showing the power of colocynth to inflame the peritoneum. When injected subcutaneously it still causes purging, owing to its excretion by the bowel, and when so administered it also causes inflammation of the kidneys. In moderate doses it accelerates the movements of both the small and large intestines, and causes diarrhoea of liquid stools accompanied by colic.
Colocynth acts through the nervous system and affects not only the solar plexus and the tissue to which it distributes branches, but also the trigeminal, lumbar, crural and other nerves, producing irritation and neuralgia which at times goes on to inflammation.
Digestive System.-Coming to the more minute symptomatology of the provers, we find that colocynth causes burning and a sensation as if scalded on the tip and dorsum of the tongue, with persistent, disgusting, bitter taste, roughness and scraping of the throat, violent thirst and empty eructations with cutting, tearing pains which, from different parts of the chest and abdomen, concentrate in the pit of the stomach. There are griping pains in the epigastrium after each meal and cramps in the stomach, relieved by eructations, which are sometimes described as “sobbing.” The gastric pains are often accompanied by pain in the face and teeth. The abdomen is distended with flatus and is painful. Severe cutting pains are felt, mostly in the neighbourhood of the umbilicus; the patient has to bend double, as he is worse in any other position, and he likes to press the abdomen against something hard, such as the back of a chair or the end of the bed; he is restless, turns and twists about and screams with the pain, which comes on worse at intervals of five or ten minutes and is relieved by discharge of flatus or stool. The pain is cutting, cramping, or “as if the intestines were being squeezed between stones.” There are also isolated, deep, stitching pains felt in either flank and in the ovarian regions and constant rumbling and croaking occur in all parts of the abdomen. Coffee and tobacco smoking relieve the pains in the bowels, but any other drink or food aggravates. Urging to stool is frequent and excessive; the stools are copious, faecal, thin, frothy, saffron-yellow and pappy, with great discharge of wind (aloes), and they are renewed after the least food or drink (aloes, ferr).
Urinary.-There is increased flow of cloudy, reddish urine, or it is brown, like beer, and deposits a flocculent sediment. There may be sudden, violent pressure to urinate, which passes off at once after emission of flatus.
Sexual.-Sexual desire in increased and there are drawing pains in the testicles and spermatic cords. The menses are more profuse and too early. Cramp-like pains are felt in the left ovarian region, relieved by flexing the thigh strongly on the abdomen.
Mind.-The patient’s mood is irritable and morose, he is impatient, disinclined to talk, and easily angered and offended.
Head.-A painful tearing and digging is felt in the head, which is aggravated by moving the eyelids and eyes. The head is confused, and a heavy pressure pain occurs in the forehead and occiput; it is worse from stooping and lying on the back. Boring and throbbing are felt in the temples. Vertigo on turning the head, especially to the left.
Eyes.-The orbits are sore, with aching and pressive pains. In one prover the ball of the right eye felt harder than usual, and the sight was obscured by a circle with rays before the field of vision. These symptoms suggest an incipient glaucoma. Pressure and sharp pains occur in the eyeballs, twitching of the right upper eyelid, and stitching pains in both lids.
Face.-The face is dark red or pale. Cramp-like constrictive pains, coming in waves or paroxysms, are felt in the cheek bones and extend to the left eye, and there are left-sided, burning, stinging pains which extend to the ear and head.
Back and Limbs.-The muscles of the nape are stiff; drawing pains are felt in the cervical and dorsal muscles; acute aching pain occurs at the inner margin of the right scapula and a painful lassitude in the small of the back. Rheumatico-gouty pains are felt in all the limbs, but chiefly in the right shoulder and in the palms, which feel contracted : the muscles of the ball of the right thumb, the hips, where the pain is cramping as though the parts are screwed in a vice, and the patient prefers to lie on the affected side with the knees drawn up; in the right thigh, which feels when walking as though the psoas muscle is shortened; and in the left hip and down the posterior aspect of the left thigh to the popliteal space. The knees and feet “go to sleep.” The pains in the limbs are worse from movement and better from warmth. The patient has all sorts of rheumatic pains in various parts, which are often attended with formication and numbness; he is sensitive to damp weather and open air, feels weak with the pains, has heats and chills, which latter usually come on between 4 and 5 p.m., with thirst and prostration, and last about half an hour.
Sleep.-He wakes from vivid dreams in a perspiration that smells like urine.
THERAPEUTICS.
Neuralgias.-Colocynth has found its therapeutic applications, in accordance with the above pathogenesis, in neuralgia and colic. It is useful in neuralgia of any part when the pain is sharp and cutting, or as if clamped with iron bands, and when it is relieved by hard pressure. It is valuable in intermittent headache in persons of rheumatic, gouty, or nervous diathesis. It is especially useful for facial neuralgia, usually on the left side; the pain comes in waves, is relieved by heat and pressure, is aggravated by rest, and is often brought on by excitement or vexation, and frequently accompanied by toothache. The modality, “aggravation by rest,” in the case of facial pain, is in contrast with that of the limbs, which is “aggravated by movement,” to which sciatica is another exception. The eye usually sciatica is another exception. The eye usually shares in the facial neuralgia, but colocynth is also useful in rheumatic iritis when the pain is worse in the evening and at night; it has been used in the first stage of glaucoma. Colocynth is one of the medicines most frequently employed for sciatica, in which the pains is of the “clamping” character, is relieved by heat and hard pressure, and is worse during repose: it may be so severe as to drive the patient to despair.
“Ovarian neuralgia,” or pain in the ovarian region, which may be due to localized peritonitis, and is cramp-like, or as if the parts are squeezed in a vice, is indicative of colocynth. Small ovarian or broad ligament cystic tumours have been reported cured by it. The left ovary is more frequently affected. Neuralgic pains in the spermatic cords and testicles are amenable to its influence, especially if coincident with diarrhoea and colic. The rheumatic, neuralgic pains occurring in the limbs, for which colocynth is suitable, are worse from motion 9except sciatica) cold and damp, and warmth generally relieves. Pressure also relieves at first, but if the pain has lasted a long time the part becomes too sensitive to bear it.
Colic.-Even more than for neuralgias, colocynth has been used for colic. This, too, is really a neuralgia of the spinal nerves reflected from the alimentary tract through the nerves of the solar plexus. The colic and diarrhoea requiring treatment with colocynth arise from exposure to cold, especially at the changes of the seasons when there is a hot sun but cold winds, from drinking cold drinks when overheated, from indigestible food, high living, eating fruit, potatoes, and starchy food, and most characteristically from emotions such as anger (bry.), indignation (staph.) and grief (ign.). The colic is very severe and accompanied by much movement of flatus which, when it passes, gives relief. It is worse in paroxysms, during which the patient screams with the pain, cannot keep still, wriggles and twists himself, and must bend double and press the abdomen against something hard. Diarrhoea follows, of fluid or pappy stools, associated with emission of much flatus, which gives decided relief. Besides abdominal colic, neuralgic pains may shoot down to the testicles, ovaries, or down the thighs; these too are relieved by the passage of flatus and stool.
Colocynth is equally the medicine for dysentery with bloody stools when the characteristic pains are present. The same abdominal symptoms, as also cramp-like pain in the ovarian region, as if the part were being squeezed in a vice, may occur from suppression of the menses or lochia, or may complicate menstruation and are amenable to colocynth. In menstrual colic of this description the pain is relieved by flexing the thighs strongly on the pelvis, a mode of exerting firm pressure.
Edwin Awdas Neatby founded the Missionary School of Homeopathy and the London Homeopathic Hospital in 1903, and run by the British Homeopathic Association. He died in East Grinstead, Sussex, on the 1st December 1933. Edwin Awdas Neatby wrote The place of operation in the treatment of uterine fibroids, Modern developments in medicine, Pleural effusions in children, Manual of Homoeo Therapeutics,