(See also Amenorrhoea, Dysmenorrhoea, Leucorrhoea, etc.).
Pulsatilla is one of the first remedies thought of in affection peculiar to women. Its essentially feminine disposition of gentleness timidity, mildness, docility – “excellent thing in woman” – is most characteristic of the drug; even tearfulness, another feminine attribute, strongly points to Pulsatilla. Then, too, we have fickleness, indecision and changeableness, which are certainly characteristic of Pulsatilla and of some women. On the female organs Pulsatilla exerts a decide action; first let us note its effect on menstruation. It has a scanty menstrual flow with severe griping pains which are very severe at times, so severe that the patient can hardly bear the pain, it doubles her up. Thus, Pulsatilla, becomes a useful remedy in dysmenorrhoea. Dark menses which are delayed and accompanied with this severe menstrual colic and the characteristic temperament will be the indications; Chamomilla has dark menses and intolerance of pain, but temperament will distinguish. Aconite is also a useful remedy in dysmenorrhoea, but the discharge is bright red, the patient is plethoric and the whole picture indicates the congestive form which may have a distinct cause back of it, such as getting the feet wet; while Pulsatilla at the same time is rather a lymphatic remedy. The menses of Pulsatilla, besides being scanty, are quite apt to appear too late. There are few combination which might be mentioned here with profit. Thus we have menses as follows:
Late scanty : Pulsatilla, Conium, Dulcamara, Phosphorous and Sulphur.
Late and profuse : Causticum and Iodine.
Early and scanty : Conium, Natrum muriaticum, Phosphorous and Silicea.
Early and profuse: Ammonium carbonicum, Belladonna Calcarea carbonica and Platinum.
This scantiness of the menses as well as the delay in their appearance suggest at once the use of Pulsatilla in amenorrhoea, and it is a very useful remedy, but it must be closely indicated, Where the menses flow by fits and starts, and when due to wetting of the feet, it is indicated, as also in delayed first menses in chlorotic girls. It must be distinguished from Dulcamara, which has menstrual suppression from getting the feet wet, but the temperament is not that of Pulsatilla. Then, too, Dulcamara has characteristically an eruption on the face which precedes menstruation; The leucorrhoea of Pulsatilla is chlorotic in nature and is apt to accompany the delayed and scanty menstruation; it is usually thick, creamy or milky, but it may be thin, acrid and associated with swelling of the uvula. A general distinction between Pulsatilla and Sepia is that Pulsatilla is worse during menstruation and Sepia before menstruation.
Sepia is a remedy acting especially on the female organs and is a most valuable one; it produces in its provings venous congestion, which accounts for many of its symptoms. The general symptoms in a case calling for Sepia are of the utmost importance. Thus we have characteristically the weakness and want of tone, in the whole system, the yellow complexion, the yellow saddle over the nose, the sunken dark-ringed eyes, the relief fro violent motion, due probably to the toning up of the venous system by such, and the amelioration in the middle of the day. These are all ground characteristics of the remedy; when they are present the other symptoms will be found to correspond with the drug most beautifully. The menstruation of Sepia may be of almost any combination, late and scanty being the most frequent. They may be early and scanty or early and profuse – discolorations of the skin attending menstruation are characteristic; the flow is apt to be dark, the menses are preceded by aching in the abdomen and by colicky pains. Amenorrhoea in those of distinct Sepia temperament where there is extreme sensitiveness to all impression. The leucorrhoea of Sepia is yellow – green in color and somewhat offensive. It may be milky; it is worse before the menses and is accompanied by bearing down. On the uterus itself Sepia exerts a decided action; the uterus is found to be enlarged and the cervix is indurated. Thus Sepia becomes a useful remedy in displacements, especially prolapsus or retroversions. There is irritability of the bladder and leucorrhoea. Dunham praised it highly here. There is often present a sensation as if the womb were clutched and suddenly released. Bearing down pains are grandly characteristic of Sepia; the patient feels as if everything would protrude from the vulva and this sensation is relieved by sitting with the limbs crossed. There is also with this a severe lumbo-sacral backache. It has great dryness of the vulva and vagina; painful to touch. Lilium tigrinum resembles Sepia closely in bearing down and dragging in the uterine region; with Lilium the patient has to support the vulva with the hand; the two drugs are easily differentiated. Though Dr. Dunham designated Sepia as the remedy par excellence for prolapsus, it should not be prescribed in a routine way. The symptoms are clear and on e should always bear in mind (if I may be allowed to borrow from Du Maurier) the irrepressible Sepianess of the remedy, that is its characteristics of weakness, sallowness epigastric goneness and heaviness. On the ovaries Sepia produces some action; it is useful for chronic ovaritis, with dull, heavy pains and the general characteristic of the remedy.