CINCHONA CALISAYA-YELLOW PERUVIAN BARK.
Cinchona derives its name from the Countess of Cinchon, wife of the 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 substance” (Bartholow) and we take them all in a dose of China. (China is old continental medical Latin for bark.)
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 is insoluble in the saliva and soluble in combination with the gastric juice, but the most active form is a combination of quinia and sulphuric acid, the ordinary quinine.
Hahnemann, perhaps, was the first to call attention to the fact that quinine was harmful when indulged in as a habit, for, he says: “Excepting opium, I know no medicine that has been more and oftener misused in disease, and employed to the injury of mankind, than cinchona bark” (Mat. Medorrhinum Pura).
Everyone knows it now, and Ringer says: “The salts of Quinia are protoplasmic poisons, arresting amoeboid and the allied movements of the white corpuscles” and destroying large numbers of them.
Bartholow says: “Quinia also affects the function of the red blood corpuscles as carriers of active oxygen (ozone) and diminishes the oxidizing power of the blood.”
While some old school authors question as to whether quinine lessens the excretion of urea, as it certainly does lessen the excretion of urea, as it certainly does lessen the excretion of uric acid, Allen claims that it does, saying that “it particularly retards the elimination of nitrogenous waste (urea and uric acid) and causes the retention and accumulation of effete products in the system.” It is especially because of the waste material being retained instead of being thrown off by the system, that Allen considers the increased weight and sense of “tone” that may be found when one first begins to take quinine, but, as he says, “the ultimate result is deplorable.”
I do not feel that I am the one to speak to you in detail against the use of quinine. You have had it from others, and if you had not, I would not consider that I was competent to talk to you against it, for, although I have administered it on numerous occasions, it was given in ignorance and before I had begun the study of medicine. I would advise you, however, to read carefully the article on quinine as found in any old school materia medica, not only that you may be enabled to advise your patients against its use, but also that you may decide each one for himself, if there are not sufficient arguments, all unconsciously presented, to deter a scientific physician from using quinine on other than the homoeopathic indications.
One of the prominent symptoms calling for China is weakness; a mental and physical exhaustion (155); a disinclination to make any mental effort; a general apathetic condition and indifference to what goes on about him, either low-spirited or irritable, but extremely weak. This debility, anaemia (15) or leucocythemia, is due especially to loss of fluids, and ranges all the way from prostration due to prolonged nursing (146), to excessive weakness from profuse night-sweats (185).
Sensitiveness of all nerves (166) and acuteness of the senses, touch (166), hearing and smell, and associated with weakness, is another important condition calling for this remedy.
Periodicity is marked in China, the troubles recurring on certain hours, days or seasons.
Mentally it is useful says Talcott, for “melancholia and subacute mania when there are general anaemia, profound debility, and tendency to periodical aggravation of all the symptoms.”
Talcott also says: “Patients are sometimes sent to insane asylums because they have been made insane, in my opinion, not alone by the diseases from which they suffered, but also by a blind, reckless and unwarrantable use of Cinchona, of its alkaloids, given in overpowering and disastrous doses, “Cinchona, if unwisely used, may become as dangerous in its effects as the excessive use of alcoholic stimulants.”
One of the first symptoms noticed from taking quinine is severe headache and roaring in the ears.
In the roaring for which we prescribe China there is a throbbing (102), bursting pain(104), noticed especially in the temples and associated with great sensitiveness of the scalp to touch (91), with pain when the hair is moved. Sometimes we have a sensation as if the brain beat in waves against the skull (106), or as if it were moving back and forth and hitting against the sides of the skull. It is useful for violent anaemic headache (93) due to sexual excesses or after loss of blood, a hammering headache (102), better from hard pressure (92), worse from slightest touch, and associated with vertigo and flickering before the eyes (77).
Large doses of quinine often dim the vision and sometimes cause total temporary blindness, and China is useful in retinal asthenopia, with flickering before the eyes (77), for transient blindness, especially after sexual excesses or loss of other vital fluids, and for night-blindness (76). It is to be thought of for ciliary neuralgia (75) and supraorbital neuralgia, the pains worse from the slightest touch and with periodical aggravations, frequently associated with (104) or following malaria.
Tinnitus aurium is one of the usual symptoms of cinchonism and China is of value for ringing and roaring in the ears (65), with loss of hearing, especially when associated with anaemia. We also have intolerance to loud noises and sensitiveness of the external ear to touch, as well as neuralgic pains in the ears (63), worse from the least pressure.
Remember China in nosebleed in anaemic people, with ringing in the ears and for nosebleed relieving a severe throbbing headache (102).
The toothache calling for China is neuralgic, with the pains worse from slightly touching the teeth and better from clenching them tightly (187).
China is a remedy to be thought of for chronic salivation (163), due to mercurial poisoning (139).
“Quinine,” says Bartholow, “on account of its bitter principles, two tannic acids, acts as a stomachic tonic; that is, it promotes the appetite, the flow of gastric juice and the digestive power. Long continued, as is the case with all bitters, it sets up a gastric catarrh and digestion becomes painful and labored.”
Ringer, in speaking on the same subject, says: “These alkaloids, if too long employed, disorder the stomach, producing heat and weight at the epigastrium, loss of appetite, nausea, sickness and even diarrhoea.”
These will do for the gross symptoms; to our provings we must look for the finer and differential symptoms and taking them altogether, we find China useful for the generic term, “dyspepsia.” There is loss of appetite and indifference to eating and drinking; there is a full feeling before they begin to eat (177), a feeling of constant satiety, but on eating there is a natural taste to food.
There is a feeling of coldness in the stomach (178) and if they eat at all they desire plenty of condiments (9), sour things (9) and stimulants (9) to warm the stomach up and start digestion. Digestion is very slow (178), they feel an increased fulness even when eating only a little (177), which fulness lasts for a long time after a meal, and is associated with distention of the abdomen, bitter eructations (178) of food and often loud belchings without relief (181).
It is useful in acid dyspepsia (178), with distention of the whole abdomen, much fermentation and rumbling (11) and pains of various sorts. There is fermentation after eating fruit and heartburn (114) after drinking milk (6), with a constant full feeling and no relief from belching gas.
In wasting diseases we may have voracious appetite (119) but with non-assimilation of food, undigested stools, rapid emaciation and copious night-sweats (185). It is useful for catarrh of the stomach (178) and for gastro-duodenal catarrh, with yellow coated tongue, a loathing of food yet canine hunger (119). In haemorrhage from the stomach, we would have extreme sensitiveness of the stomach to touch (12) and great prostration, resulting from the loss of blood.
The spleen is enlarged (173), especially in chronic malarial poisoning and in jaundice (122) of nursing children, the abdomen is swollen, with enlarged liver and spleen.
A great deal has been written concerning the use of China in gall-stone colic (82). If the pain is severe you may meet with success by giving the indicated remedy or you may be obliged to resort to the use of adjuvants, but the especial interest that attaches to China is that by its regular use, and the 6th potency is mentioned, one may permanently cure the tendency to gallstone formation.
The diarrhoea calling for China is usually painless and associated with great weakness and exhaustion (58), which may be noticed simply after the stool, or constantly as the result of the many movements. The abdomen is distended (13), with a great deal of fermentation and rumbling in the bowels (11) and there is a desire for acids and condiments.
The stools contain undigested food (60), are sometimes involuntary when passing gas (59) and often of a cadaverous odor (59). There is aggravation directly after eating (57) and an aggravation at night, and frequently the movements are only at night, and after meals.
It is of value for diarrhoea from fruit (57), with fermentation and emissions of much fetid flatus, in the diarrhoea of phthisis (60) and in that occurring during or after debilitating diseases or from prolonged nursing. It is often advantageous in beginning the treatment for the cure of chronic diarrhoea, to give China for a day or two so as to relieve the condition of prostration. Remember that the diarrhoea of China is not only exhausting but is usually painless.
In the male sexual sphere it is of value for weakness following nocturnal emissions (167) or other sexual excesses (167), amounting even to impotency (168).
In the female the menses are too early and too profuse (135), usually dark and clotted (136), and followed by great exhaustion (138). We may find leucorrhoea that comes on instead of the menses (126), the leucorrhoea being bloody, fetid (126) and purulent and associated with great weakness. It is of great value for post-partum haemorrhage (152), due to atony of the uterus, with fainting, cold skin and other evidence of collapse (34) from the loss of blood.
We find ovaritis resulting from sexual excesses or following haemorrhages with, extreme sensitiveness of the parts to touch (148). We also have a condition of general anaemia (15) due to prolonged nursing, in which this remedy is frequently indicated, as well as in haemorrhage from the lungs (27) while nursing, or when nursing causes great weakness or prostration.
China is of value for bronchorrhoea (26), with great prostration, simulating the last stage of phthisis, with loud rales throughout the chest (45), with extreme sensitiveness of the chest (30) and intolerance of any pressure over it (29). It must be thought of when you fear that phthisis will develop after exhausted vitality or loss of fluids, and associated with profuse night-sweats (185).
We may have cough after eating (41), and cough caused by laughing is mentioned prominently (41); in both conditions with more or less suffocation as, if the larynx were full of mucus. There is also a dry, hacking, nervous cough (46), worse, perhaps, in the morning, caused by irritation as from sulphur fumes (43), with dyspepsia, pain in the spleen, palpitation and intolerance of tight clothing over the chest (29).
Full dose of China, used in the proving, produced pain and tenderness in the vertebrae, especially in the dorsal region, and it is useful in spinal irritability (171), with extreme sensitiveness, the pain shooting up to the head when the spine is touched.
It has been used in locomotor ataxia (127), with numbness (146), but especially with a sensation as if cords were tied about the leg (165), or as if the garters were too tight and the legs were going to sleep (71).
It is useful in hip-joint disease (117) where there is great prostration, due to prolonged suppuration, with diarrhoea and night-sweats, and for dropsy of the lower extremities, in anaemic conditions, with general sensitiveness of the surface of the body to the slightest touch (166).
China presents an additional interest to us, quite apart from its remedial action in disease, for it was the first drug proved by Hahnemann.
“In 1790, while engaged upon a translation of Cullen’s Materia Medica, Hahnemann was struck by the contradictory properties ascribed to Peruvian bark and the various explanations that were given of its operation in intermittent fever. Dissatisfied with the latter, he resolved to try upon himself the effects of the medicine, and after several powerful doses, discovered symptoms analogous to those of intermittent fever.
“The fact that a drug had produced upon a man in health the very symptoms which it was required to cure in a stick man immediately suggested to him the great law Similia Similibus Curantur’ (T. F. Allen in Appleton’s Cyclop.).
It is well for us to remember that the detractors of Hahnemann who asserts that he was not the discover of this law can find in the Organon this sentence: “Indeed there have been physicians from time to time who had presentiments that medicines, by their power of producing analogous morbid symptoms, would cure analogous morbid conditions” (Wesselhoeft Translation, p. 45).
Hahnemann cites seven authors, from Hippocrates, or from one of the books attributed to him, to Stahl, a Danish physician, all of whom theorized more or less on the law.
Hippocrates, after having explained the rules of healing by contraries, says: “Another proceeding; the disease is produced by similars, and by similars which the patient is made to take, he is restored from the disease to health (Teste’s Mat. Medorrhinum).
Stahl says: “The rule, which is admitted in medicine, of treating diseases by contraries or by remedies which are opposed to the effects of these maladies, is composed false and absurd. I am persuaded, on the contrary, that diseases yield to agents which determine a similar affection (similia similibus)” (Teste’s Mat. Medorrhinum).
Hahnemann in a foot-note, says: “In citing the following passages of writers who have had some presentiment of homoeopathy, I do not mean to prove the excellence of the method (which establishes itself without further proof), but I wish to free myself from a reproach of having passed them over in silence to arrogate to myself the merit of the discovery.” (Organon, translated by C. H. Devrient, Esq., 1833).
No, Hahnemann did not discover the law of cure and never claimed that he did, but by his proving of drugs on the healthy he succeeded in organizing a materia medica and made fruitful a law, “which had remained until then, an empty and unmeaning formula” (Teste).
Quinine, the chief reliance of the old school for all malarial conditions, will cure intermittent fever, and when it does, I believe it is because the case was one similar to that which quinine produces. In the great majority of cases, however, where it is given it simply suppresses the paroxysms for the time being.
The intermittent fever for which we give China is one in which the paroxysm is fully developed, the three stages, chill, fever and sweat, being pronounced and there is an interval of time between the chill and fever, and between the fever and sweat. There is no special time that is characteristic for the paroxysm, as it may begin at any hour of the day.
There are frequently severe headache (104) and pronounced thirst (121) preceding the chill; no thirst during the fever or chill but thirst during the sweat. The chill and fever are strongly marked and the sweats is profuse and debilitating.
During the apyrexia there is great debility, soreness over the liver and spleen and ringing in the ears.
Arsenicum, Carbo vegetabilis, Ipecac., Pulsatilla, Veratruma. are a few of the remedies that act as antidotes to China.
I use China 1st.