NUX VOMICA


Homeopathic remedy Nux Vomica from A Manual of Homeopathic Therapeutics by Edwin A. Neatby, comprising the characteristic symptoms of homeopathic remedies from clinical indications, published in 1927….


      Strychnos nux vomica. Poison nut, Vomit nut. N.O. Loganiaceae. Tincture and trituration of the dried ripe seeds.

PATHOGENESIS.

      NUX VOMICA seeds contain strychnine and the nearly allied alkaloid brucine, the more active principle being strychnine, C21H22N2O2.

Strychnine has a powerful stimulant action on the central nervous system, especially on the spinal cord, throughout the whole vertebrate kingdom. In small doses strychnine improves the appetite, makes the patient feel stronger and more buoyant and renders the special senses more acute. In large doses the same effects are present but are overshadowed by more prominent symptoms. First, there is a feeling of stiffness in the muscles of the neck and face, then reflex action is so much increased that a slight touch or even a current of air evokes a sudden start or violent movement. The increased reflex movement is accompanied by restlessness; tremor or involuntary twitches are seen in the limbs and then a sudden convulsion occurs in which all the muscles of the body are involved, but in which the stronger muscles, the extensors, prevail. The head is drawn back and the trunk arched backwards (opisthotonos) and the facial muscles contract into a grin, the risus sardonicus. Contraction of the respiratory muscles fixes the chest, rendering breathing impossible, and the patient becomes cyanosed. At the beginning of the convulsion the muscles are tonically contracted, hard and firm, but soon tremor ensues and after a few intermittent contractions the convulsion is over and there is complete muscular relaxation. Immediately after a convulsion reflex irritability is low, but it soon becomes exaggerated again, till a second convulsion occurs exactly resembling the first. As a rule, after a few convulsions, death takes place from asphyxia due to respiration failing to be re-established when the spasm passes off. Sometimes reflex irritability and convulsions gradually diminish and the patient dies of asphyxia from gradual paralysis of respiration. The mind remains clear during both convulsion and interval. After very large doses no convulsions occur, but the patient dies almost immediately from asphyxia due to paralysis of the central nervous system.

The action of strychnine is principally on the spinal cord, and the convulsions are of purely spinal origin; the peripheral nerves and the muscles are unaffected. The portion of the reflex are affected appears to be the synapses of the neurons, intercalated between the posterior roots and the anterior cornua. The response to external stimuli is first a reflex action which, like the normal reflex action, is co-ordinated and purposive, though exaggerated, and varies in strength with the strength of the stimulus, but when the latter is responded to by a convulsion the normal co-ordinated movement gives place to a universal uncoordinated movement in which contraction is always maximal; a stronger stimulus produces no greater effect. The action of strychnine is to remove resistances to the passage of impulses through the spinal cord and thereby to extend the area over which an impulse acts, and at the same time to abolish co-ordination, for which the presence of resisting influences is necessary.

An exception to the greater sensitiveness of the special senses from small doses of strychnine being due to its action on the nervous system occurs in the case of sight, where probably the increase in the field of vision and increased sensitiveness to light are at all events partly attributable to its acting on the cells of the retina and not to cerebral changes.

Stimulation of the spinal cord by strychnine is followed by depression and paralysis. The medulla oblongata, including the respiratory center, is first slightly stimulated and then paralysed. The heart is not directly affected, but may be slightly slowed by stimulation of the inhibitory centre. During the convulsions the blood-pressure is greatly raised, but falls again afterwards.

Strychnine causes a flow of saliva and increased appetite. It is absorbed from the intestines and increases the movements of the bowel, perhaps from an action on the ganglionic pleura the bowel wall. It is absorbed rapidly, from 10 to 20 per cent. is excreted in the urine and the rest is oxidized in the liver. Only a very slight degree of tolerance is developed, however long may be the period during which it is administered. Cases of poisoning by the seeds or tincture of nux vomica display the same symptoms as those related above as produced by strychnine, but some of the autopsies showed, in addition congestion or inflammation of the mucous membrane of the stomach, duodenum and first part of the jejunum, the duodenum being the part most affected.

PROVINGS

      Of nux vomica show the early stage of its action on the nervous system, the stage of increased reflex excitability and of hypersensitiveness of the special senses. They also show the marked influence nux has on the digestive system, not so much from causing inflammation as from producing irregular and spasmodic action, an irregular, perverted peristalsis. This same character of irregular and spasmodic action is witnessed also in the genito-urinary and respiratory systems. Co-incidently with disorders of these functions are symptoms referable to the mind and head.

Digestion.-As the symptom of the digestive system are those which give to nux its most frequent application in therapeutics it will be well to commence with them. The mouth is dry, without much thirst, but saliva accumulates in the fauces and causes hawking and retching. The tongue is coated a thick white, and sometimes there are blisters on it. Small aphthous ulcers are frequent on the inside of the lips and cheeks, the gums are ulcerated and a decayed tooth, or a whole row of teeth, may have stinging pains in them, especially after eating, or on exposure to cold air, or from taking cold food. Food and drink taste natural but there is a foul, sour odour from the mouth, worse in the morning and after food. The throat feels raw as if scraped, there may be spasmodic, constrictive pain from the mouth to the stomach, and stitches run up into ears on swallowing. The patient is thirsty for milk, but has an aversion from meat, from his usual food and drink, tobacco coffee and water. There are bitter, sour eructations, or waterbrash, with heartburn. The patient is usually hungry, but has nausea, especially in the morning, after eating and drinking, and from smoking; it is frequently accompanied by retching and vomiting of the food last eaten, or of sour mucus, which sometimes is intermixed with blood. He may feel faint with nausea. The epigastrium is bloated and tender, a sensation of pressure, as of a stone in the stomach, comes on an hour or two after a meal, or there may be violent pain of a cramping character. There is tightness about the waist, and the patient wants to loosen his clothing. The stomach region is sensitive to pressure. Pains extend to the scapulae, up the chest, or drown the back to the anus, with urging to stool. The stomach pains are due to irregular peristalsis of the stomach wall, and are set up by indigestible food, spices, alcohol, and the abuse of drugs, especially in persons of sedentary habits, and in those addicted to too luxurious and profuse a diet or to debauchery.

Irregular peristalsis produces in the abdomen griping and pinching pains, flatulence is incarcerated under the short ribs, and the abdomen becomes distended, especially after eating; loud rumbling and gurgling occur. The pains may come on periodically in the morning, after eating, or in the evening after lying down, and make the patient bend double. They cause a sensation as if diarrhoea would come. There is a feeling of weakness in the abdominal rings, especially the left. Stitching pains or throbbing are felt in the region of the liver, which is painful from contact or motion, and jaundice may be present. Jerking and twitching occur in the abdominal muscles. The characteristics action of nux on the rectum is to cause constipation with frequent, but ineffectual desire for stool (anac., sil., sulph.). This is a result of the irregular peristalsis caused by the drug, whereby one portion of the bowel will urge on the contents while another constricts and prevents their passage. Constipation and diarrhoea may alternate. After a stool has passed there is a sensation as if more remained behind but could not be evacuated. Sometimes the excessive urging to pass something results in the discharge of mucus and bright red blood, with faeces or without them, but with a feeling of constriction or contraction in the rectum. Urging may be so violent as to cause prolapse of the rectal mucous membrane, but it ceases after passage of stool, with great relief to the patient. Sometimes a diarrhoea stool is passed suddenly and unconsciously from a spasm being reflexly caused by taking food into the stomach.

Urine.-With disturbed digestion or liver function the urine is scanty and high-coloured, with reddish or brickdust sediments, its passage is made painful by spasms of the sphincter vesicae, so that it can be passed only in drops, with burning and tearing in the neck of the bladder, thus there may be painful, ineffectual urging to urinate. Sexual desire is too easily excited, erections occur on the slightest provocation, emission occurs too readily during coitus, and nocturnal emissions are frequent.

Edwin Awdas Neatby
Edwin Awdas Neatby 1858 – 1933 MD was an orthodox physician who converted to homeopathy to become a physician at the London Homeopathic Hospital, Consulting Physician at the Buchanan Homeopathic Hospital St. Leonard’s on Sea, Consulting Surgeon at the Leaf Hospital Eastbourne, President of the British Homeopathic Society.

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,