The Witch Hazel. Hamamelis virginica. N.O. Hamamelidaceae.
HAMAMELIS. Preparations of witch hazel have long been used in America for the results of traumatism, especially for bruising causing venous haemorrhages. In the middle of last century hamamelis was “proved” and the effects obtained were epistaxis, with flushing of the face and fulness of the vessels of the head, and severe testicular pain. Its use clinically was soon extended to passive bleeding from almost any site, when the blood is dark and does not readily coagulate; the flow is steady and occurs from any orifice or into almost any cavity of the body.
Apart from injury it appears to be in cases where the haemorrhage is due rather to some fault in the vessels than to changes in the blood that hamamelis is useful. In consequence its use has been extended to varices and phlebitis.
The various haemorrhages need not be referred to in full detail, but it is mostly for those due to injury, especially to bruising, that this remedy is required, and for bleeding from congested or ulcerated surfaces having mildly septic causes. It is useful both internally and as a local application for burns of the first degree. It seems to moderate oozing, even the ulcerating malignant growths; for active bright bleeding due to erosion of arterial twigs it is not indicated. The following special areas may be mentioned: The eye, for subconjunctival or intra-ocular haemorrhage, brought on by a blow or by severe coughing; the nose, for epistaxis due to a blow, or occurring vicariously in epistaxis due to a blow, or occurring vicariously in girls and young women, and giving relief to headache or menstrual pain; the uterus, for menorrhagia with blood of the type described, with dysmenorrhoea, pain in the (right) ovarian region of a sore bruised character-pain due to a blow or to riding over rough ground or hard climbing, especially at high altitudes; the lungs, for haemoptysis, dark and effortless or with slight tickling cough.
Haemorrhoids, though not more important, deserve mention apart because much more common and because the original reputation of the drug depends so largely on its success in this affection. The piles are blue, with burning, soreness and heaviness, accompanied by severe backache and by repeated haemorrhages of dark blood, which give relief. The piles protrude and are liable to become excoriated or inflamed from pressure or gripping by the sphincter ani; they may be very irritable.
Varicose veins of the lower extremities, especially where the smaller veins or capillaries are also full and dilated, and the legs feel heavy and bruised and are swollen (not oedematous) and tender to the touch-these are quickly relieved by hamamelis internally and locally, aided by support in the daytime by a crepe bandage.
The aching and dragging of varicocele, or labial varices in pregnancy, may be relieved though the varicosis may not be removed.
Phlebitis, whether of an inflamed pile or of a vein in the extremities due to chafing, to a blow, or to mild sepsis after an abdominal or other operation, will require hamamelis. If the site is accessible its local use should not be omitted. The aching along a varicose vein and the full sore feeling of the musculo- cutaneous areas drained by it will be removed and recovery hastened. The prostration following the bleeding requiring hamamelis is out of proportion to the amount of blood lost, except in the case of vicarious haemorrhage, where the occurrences may go on for long periods without affecting the health.
The chief prover experienced neuralgic pain in the testicles of a dull, aching character, but becoming so “excruciating” as to compel him to stop the experiment. The pain was accompanied by constant backache and frequent micturition, in some instances suddenly leaving the testes and going to the abdomen, producing great faintness and nausea.
In the daytime he felt very sad and gloomy and at night and sexual dreams. Other provers experienced similar testicular pain, with pain in the spermatic cord and perspiration of scrotum. Erections with or without emissions were experienced. In several provers urinary symptoms appeared, such as frequent micturition with constant desire to pass water, only a small quantity being usually passed at one time, the urine being pale, and with or without a deposit looking like urates.
Throughout the provings pains were also felt in various joints; they were described as “rheumatic”, or simply as aching, weary, dull, sticking, or shooting, accompanied by stiffness (fingers), and heat and dryness of hands and elbow (right). Walking and running made the pains worse in feet and knees and movement aggravated that in the neck (right side). The following areas were involved, in the upper extremities- shoulders, upper arm, humerus, arm (flexors), elbow-joints, hands, wrist (right), finger-joints (especially first joint of index), palms; neck (right); lumbar region, back (severe backache), and sacrum; in the lower extremities-hips (worse left), sciatic nerve, popliteal space, knee (left), patella, legs, feet, right and left great toe.
The complex of these four sets of symptoms-urinary, testicular, muscular and joint pains-a genuine association in the same individual, has led to its successful prescription in orchitis, in orchitis, in epididymitis of gonorrhoeal origin and in “rheumatism” due to the same case.
Hamamelis would be useful in any of these sets of symptoms separately and without the gonorrhoeal cause if the leading indications of the drug were present. It has also been proposed for some cases of gout, and its resemblance in some spheres to pulsatilla would also favour its use in that malady.
Analogy of function led to the use of hamamelis in ovaritis and supposed ovarian cases, with sharp pains and sickening faintness. The pains in the loins, sciatic nerves, &c., would support the prescription of this remedy.
The kind of clinical case for which in the pelvic sphere it may be strikingly useful is found in some coli intoxications, either ascending infections or direct infections from the bowel through adhesions. Influenzal infections may have similar symptoms. There are hypogastric pains, either side, with general tenderness across the belly, slight rises of temperature, 99degree to 100degree F., some vesical pain and burning smarting on micturition, tenderness on vaginal examination, especially in one or other fornix, and some thickening of the Fallopian tubes. Loss of appetite, coated tongue, tendency to constipation, headache, quickened pulse and disturbed sleep complete the picture.
Gonorrhoeal affections in the acute stage in women would probably require other remedies.
Other symptoms have led to its use in dysmenorrhoea, with pain in the ovarian region and flow such as has already been described; and for vaginismus, followed by burning and pruritus vulvae, to which it is clearly homoeopathic.
Headache commonly accompanies other features in a hamamelis case. Many varieties have been experienced. The most common is frontal headache, with a feeling of fulness just above the nose; or pain in temples, or over right eye.
Modalities of headache are that it is worse from sitting or lying, worse at 9a.m. or on rising, bending forwards, and from taking cold. It is better from walking in the open air, reading, thinking or talking, in the evening out of doors, when busy, from epistaxis. Vertigo is not unusual.
Mind.- The mental condition may be either low spirited and gloomy, the sufferer desiring to be spoken to (with headache and rheumatic pains), or he may be cross, irritable, restless with difficulty in going to sleep on account of mental activity. In some cases ideas suggestive of the grandiose ideas of general paralysis of the insane may be present, such as “a feeling that she ought to be reverenced by all around her, and have great respect paid to her opinions,” or ” a desire to hear lofty, sublime conversation” without desire to talk.
Feverishness may be present, with dry throat, thirst, which drinking water does not allay, chilliness, followed by heat, with a tendency to a “low” type, with oozing of dark, non-coagulable blood.
Decided throat symptoms manifest themselves, the appearance of fauces and pharynx being that of congestion, the venules being markedly dilated and the tonsils swollen; the subjective sensations are described as dryness and soreness with thirst for large quantities of water which, however, do not bring relief, and constant desire to drink persists, or a feeling as if a lump were lodged in the throat. Rawness and roughness are localized in the fauces. There may also be constant desire to swallow, which causes pain. The dryness may last all night. Hawking of mucus, sometimes blood-stained, is reported. The injected vessels on a reddened base are often seen in gouty and alcoholic, and when associated with the subjective symptoms, local and general, of hamamelis, will be indications for that remedy. It has, indeed, been used with success in such throats.
The reputation of hamamelis extends to haematuria, and the drug may be of utility pending discovery of the cause of the symptom. It need hardly be said that there is no evidence that hamamelis will produce (say) urinary calculus (renal or vesical), and it will therefore act, at the best, merely as a palliative in bleeding due to their presence. The same is true of other symptomatic haemorrhages, such as haemoptysis, melaen or haematemesis, though in some of these cases (e.g., gastrostaxis) the remedy might also be curative. The kind of haemorrhage in the case must resemble that produced by the drug and the other symptoms should also correspond.
(1) Mind.-Mental symptoms are not common in hamamelis patients, except in genito-urinary cases. When present they may be either (a) depression with desire to be alone and not to be talked to, or (b) irritability, restlessness and mental activity preventing sleep, or less commonly (c) grandiose ideas.
(2) The heat modality of hamamelis though not very marked is aggravation from warm damp air.
(3) Sensitiveness to exposure, taking cold easily.
(4) Bruised, sore feeling of affected parts-from injury or “rheumatism” of muscles and joints.
(5) Varicosis and phlebitis.
(6) Passive haemorrhages, dark, non-coagulable, traumatic or vicarious, from many sites.
(7) Bruises and wounds-lacerated or contused.
(8) Haemorrhoids, bleeding or thrombosed, with local soreness and burning or tenderness, and characteristic bleeding. Anus feels raw.
(9) Subacute ovaritis and metritis, with or without haemorrhage.
(10) Dysmenorrhoea and uterine haemorrhage.
(11) Urethritis and epididymitis, not acute stage.
(12) Haemoptysis, with tickling cough; haematuria; haematemesis or melaen; menorrhagia (passive); epistaxis which relieves headache.
Warm damp air, pressure, motion, touch, 9 a.m. (headache).
Epistaxis (headache), open air (headache), reading (head), thinking or talking (head).