Nux vomica. [Nux-v]
Perhaps no remedy in the Materia Medica is oftener prescribed for anything than is **Nux vomica for constipation. **Nux vomica has peculiar and characteristic indications for constipation, and when prescribed upon these indications it will cure every time. Nothing is surer than this. But **Nux vomica is often prescribed when these indications are not present, and often does much good; in this class of cases there will almost invariably be present one of the great clinical indications of the remedy, and that is, its value in ***antidoting purgative medicines. In many cases of inveterate constipation calling for this, that, and the other remedy, it will be noticed that expected results are not obtained and will not be obtained until **Nux vomica has been given to antidote the effects of drastic medicines. Then the case can be prescribed for, the indications followed, and success result. Another thing about **Nux is the fact that while prescribed low, as in the tincture, it will frequently relieve constipation, but to cure it the drug must be given in a much higher potency.
**Hydrastis is another remedy that is sometimes useful after the abuse of purgatives, laxatives, cathartics and their like. In all these cases, however, the symptoms calling for the respective drug should be present. Hughes claims it to be superior to **Nux as usually prescribed. He recommends a drop or two of the tincture in water once daily before breakfast. **Hydrastis has a symptom, however, which is quite characteristic, that is a ***sinking, gone feeling at the epigastrium, which **Nux vomica does not have to any extent. The constipation of **Nux vomica is usually of the kind induced by lazy habits, inattention to Nature’s calls in the first place, want of exercise, sedentary habits, and a sluggish condition of the whole system. It is due not only to inactivity of the whole system. It is due not only to inactivity of the intestines, but to an irregularity of the peristaltic actions, giving rise to the great characteristic, ***constant ineffectual urging to stool, and when the stool does occur it is incomplete and unsatisfactory, as if a part remained behind. Absence of desire for defecation contra- indicates **Nux. Inflammatory symptoms or pain generally contra- indicates. Carbo vegetabilis has urging, but it is due to wind, while **Opium and Bryonia have no urging at all. According to d’Espiney, the physical signs of this inharmonious intestinal action can be felt by palpating the abdominal walls.
**Anacardium resembles **Nux vomica in many ways. It has a sensation of a plug in the rectum which cannot be expelled. There is a fitful intestinal activity, but withal a powerlessness of the rectum. Even soft stools are expelled with difficulty. Small quantities may be expelled with each attempt. The mental symptoms of **Nux are important in treating constipation, for the effect that constipation has upon the minds of some people is well known. In cases indicating **Nux vomica there will be a great crossness, irascibility and objection to all opposition. The **Nux stool is also apt to be large, and haemorrhoids are a frequent accompaniment. We may sum up **Nux vomica by calling again the attention to the mental characteristics, the sedentary temperament, the fitful intestinal action and its antidotal relation to purgative drugs.
Dr. Cartier, of Paris, well says: **”Nux vomica should never be given in constipation according to the law of similars in the low attenuations, or in the mother tincture. An opposite effect will be produced thereby, an augmentation of the spasmodic state of the intestines; the higher the dilution the better the chance success. Nor should it be too often repeated.”.
Many of the older homoeopaths used to give Sulphur and **Nux vomica in alteration for constipation. They complement each other, follow each other well, but better results will be obtained if each be given singly when indicated; for, surely, both cannot be indicated at once. With **Sulphur there is an ineffectual urging to stool, with a sensation of heat and discomfort in the rectum, and there is a general uneasy feeling all through the intestinal tract, due to abdominal plethora or passive portal congestion. It is very useful remedy with which to commence the treatment of constipation, though, unless the symptoms call for it, it should not be given. A bad constitution and frequent ill health are good indications to start with, a tendency to piles is another. The stools are hard, dark, dry, and expelled with great straining, the first effort to stool being extremely painful. There is apt to be much twitching and burning of the anus, the evacuation are often unsatisfactory, and, as in **Nux vomica, there is often a sensation as if a part remained behind. Another characteristic symptom of Sulphur is constipation alternating with diarrhoea. The general temperament of the drug has much to do with its choice; in fact, almost all of the indications for its use will be the general ones. The general venous system is usually at fault in true **Sulphur cases, and anything that stimulates this system into action, such as exercise and cold, always benefits the Sulphur patient. **Sulphur needs to be given high and n continued for any length of time.
While the constipation of **Nux is due to irregularity of intestinal action, that of **Opium is due to absolute inaction of the intestines, a regular paralysis of the peristaltic movement. There is an absence of desire, absolutely no urging to stool whatever, and so the faeces become impacted in the bowels; and when passed at all come in little, hard, dry, black balls, here resembling the stool of **Plumbum, but with Plumbum there is some activity. Another drug which has no urging to stool is Bryonia, but here the lack of urging is rather due to dryness of the mucous membrane than to intestinal inactivity; with **Opium there is a want of sensibility throughout the intestinal tract, and consequently the constipation is not apt to inconvenience the patient, hence it is apt to go on getting worse until the attention is called to it by the flatus accumulating in the upper part of the intestines. Where the faeces require artificial means for their removal, this remedy should be thought of, though **Selenium, Alumina, Plumbum or Bryonia may be used in this condition. Diminished secretions are also characteristic of **Opium, so that dryness intestinal inactivity, is one of the causes of constipation of old people; the patient is drowsy and dizzy.
As we have already seen, with **Plumbum there is some intestinal action; in fact, at times there is considerable. Lead colic is one of the effects of the drug. So we have urging to stool, and accompanying this urging is a colic with a marked retraction of the abdominal walls. The stool is passed with the greatest difficulty and consists of little round balls, which are black, dry and hard, and there is accompanying, a marked spasm of the sphincter ani which is apt to be painful. The anus feels as if drawn upward. With this drug there is loss of muscular activity and diminished secretion of intestinal glands. Thus we see that the indications for **Plumbum in constipation are concise and precise.
Chief among remedies for constipation due to dryness of the intestinal tract stands **Alumina. There is diminished peristaltic movement and complete inertia of the rectum, so that we have the symptom, soft stool expelled with difficulty, explained. There is little or no urging to stool. The stools may be hard and knotty like sheep dung, or may be soft. It is one of our most useful remedies in constipation of children where the rectum is dry, inflamed and bleeding about the orifice. **Alumina differs from **Bryonia chiefly in the state of rectal inactivity. A dry mouth and an irritated looking tongue may lead to the selection of **Alumina. There is much straining with the remedy and the stool is passed in very small quantities, piecemeal, so to speak. If the characteristics of Alumina are prominent in a given case, they may be due to the use of aluminum ware in cooking. Even Spring water boiled in an aluminum pot will deposit a white sediment on cooling.
The large-hard-dry-stool-as-if-burnt of **Bryonia is familiar to all of our Medical School. The constipation of the drug is due to dryness and there is no urging. **Alumina is similar; its constipation is also due to dryness, but it has such complete inactivity of the rectum that even a soft stool is expelled with difficulty. With **Bryonia the stools are passed with a great deal of difficulty, owing to an atony of the intestines similar to **Veratrum album and **Opium. **Nux vomica, as we have seen, produces and cures constipation due to fitful, irregular, peristaltic action. **Bryonia cures constipation where not only the intestinal secretions are diminished, but the muscular action as well. Constipation in young children, according to Hughes, is frequently cured by Bryonia 30th. It is said to act better in rheumatic subjects and in summer. The mental condition of irritability and ill-humor will often be present as a concomitant of the **Bryonia constipation. Older writers alternated **Bryonia and **Nux vomica with success in very obstinate cases.
Natrum muriaticum. [Nat-m]
All the muriates have crumbly stools, and so we find that the characteristic constipated stool of **Natrum muriaticum is a hard and crumbly one; the rectum is dry, the stool is hard to expel and causes bleeding, smarting and soreness in the rectum. There is ineffectual urging to stool, with stitches in the rectum. It sometimes comes in the most obstinate cases, which are accompanied by hypochondriasis. **Magnesia muriatica, another of the muriates, has characteristically a constipation in which the stools are passed with great difficulty, being composed of hard lumps like sheep dung, which are so dry that they crumble as they pass the anus. **Ammonium muriaticum has this same symptom of dry and crumbly stools, they may also be coated externally with mucus. In constipation of young people who are subjected to acne and comedons, **Natrum muriaticum should be thought of.
Like **Nux vomica, Lycopodium has a sensation after stool as if something remained behind. Constipation, due to constriction of the rectum, calls for this remedy, and here it reminds one of **Silicea. The constipation, too, is apt to be associated with the haemorrhoids The rectum contracts & protrudes with the stool. The stools are dry and hard, or the first part hard, the last soft. In the constipation of children and pregnant women it often finds a place, and it is here praised by Hartmann. A great deal of rumbling in the abdomen following the stool is an additional indication. **Nux and Lycopodium may be easily distinguished, though each has ineffectual urging to stool. In **Nux vomica, as, we have seen, this is due to irregular peristaltic action, while with **Lycopodium it is due to a constriction of the rectum. The mental symptoms here, too, are of the utmost importance; the depression, the melancholy and the apprehension are characteristic.
Graphites is one of our best remedies in constipation, if Homoeopathy can be said to have “best remedies”. With this drug there is no urging. The patient sometimes goes days without a stool, and when it does come it is composed of little round balls, knotted together with shreds of mucus and accompanied with great pain when passing, owing to the fissure. These fissures, as well as the haemorrhoids which accompany them, burn, smart and itch intolerably. Excessive soreness of the anus in making the post defecation toilet is an indication for its use. Three or four remedies are usually to be thought of in this condition of fissure of the anus; they are: **Silicea, Nitric acid, Paeonia and Ratanhia; these, with **Graphites, will remove in most cases the underlying disease leading to the fissure. Aching of the anus after stool is also characteristic of **Graphites, and sometimes we have with the drug ineffectual urging. The mucus-coated stool, the extreme soreness of the anus, the general **Graphites temperament of sadness and obesity, will easily decide for the remedy. **Graphites suits especially women who suffer from a neglect to attend promptly to nature’s call.
With Platina, there is torpor of the whole intestinal tract, unsuccessful urging to stool and great dryness of the rectum. The stools seem to adhere to the rectum like glue or putty. There is great weakness in the abdomen and a sensation as if there were a load in the rectum which could not be expelled. It is considered a remedy for the constipation of emigrants and travellers, so it would seem to find an additional indication where the trouble was brought on by change in manner of living. It is also a remedy for the constipation due to lead poisoning. There is frequent urging, scanty, dry stool and great abdominal weakness. As under **Ignatia, there are sharp stitches in the rectum.
When constipation is due to inefficient expulsive force of the rectum and a spasmodic condition of the sphincter then Silicea is our remedy. With this condition we have a condition where the sphincter suddenly contracts and the partially expelled stool recedes. **Causticum has constipation due to powerlessness of the rectum, so that the patient almost stands in order to enable him to get sufficient power to expel the stool, but the spasmodic condition of Silicea is absent. As with **Graphites, Silicea has a great deal of soreness about the anus, also an oozing of moisture. There is urging to stool and a sensation as if faeces remained in the rectum.
Veratrum album. [Verat]
Though this remedy is;one of our greatest diarrhoea remedies, it has a marked effect in the treatment of constipation. The symptoms calling for its use are as follows: There is complete atony of the intestines, as under **Bryonia and Opium. The faeces accumulate in large masses in into a sweat; but finally has to give it up, and the faeces have to be removed by artificial means. There are extreme cases where the patient is able to force a passage for himself; the stools are large, hard and black. As with the diarrhoea there may be faintness after the stool.
Dunham speaks of the constipation of **Veratrum as one characterized by a disposition to stool in the upper part of the intestinal canal and an indisposition to stool in the lower part. Dr. Bryce claims that it will bring stool quickest of any medicine I ever tried.” He used 3x. It comes in very well after **Nux vomica, especially in constipation of children.
**Podophyllum 12th has proved of use in constipation of children. Of course, the above remedies will not cure every case of constipation, but they will, if studied closely, be found to correspond with the majority of cases.
**Phosphorus has a constipation of long slender stools voided with much straining.